The Study Boards 2018 Binder

16 aug exam.
docx
_fruitpunchDay 2.docx
1000 MCQS _ PROSTHODONTICS Plus March_September MCQs.docx
20180222RQS.docx
A song and dance of dentin.docx
AL-rqs.pdf
andres gomez.docx
ARROZ CON MANGO.pdf
August 17-18, 2018.docx
CACTUS FILE.pdf
Challenge 123.docx
COMPLETE-FINAL-part-2-rev.pdf
DAY-2.docx
Dr. S Js final file Part 2 .pdf
fruitpuch.docx
Golden corrected!!!.pdf
Important Questions_1.pdf
Important rqs RITA.docx
Jada Joseph RQ June 29 _ 30.docx
June 4-5 rqs.docx
kiwi.pdf
LEAH_S File.pdf
MAY 3 2018 RQ.pdf
Mia Jones - RQ.docx
Misi-file-all-subj-rev.pdf
Mony Rqs-Feb.2018.docx
NBDE buster.docx
NBDE PART2 RQs 10-11 MAY.docx
NEWMASTERBOARDS2.pdf
Patient Management Important.docx
pt mgmt oues.docx
remebered questions.pdf
REMEMBER QUESTIONS FROM MAY.docx
REZA-NEW-YORK-2016.pdf
RQ_s June 2018.pdf
RQJuly26-Aug1st.docx
RQS MAY 9-10.docx
RQs May 15 16.docx
RQS NBDE II.docx
Rqs.docx
rqs2018.docx
Sairaja solved May Rqs.docx
Sara RQs Aug 2018 .docx
smart notes.docx
Solved all april 2018.pdf
Solved all May 2018.docx
August RQs ,lets discuss
Entire andres entire rita
Like the WHOLE file
Every single q was there
1.Laryngospasm: stridor, treatment is succinyl choline administration..
2.midozolam or methohecxital for prolonged sedation midozolam
3.implant distane from structure s, another implant , mental nerve

implant to implant- 3mm
Implant to anterior loop is 2mm

Implant to mental foramen is 5mm
Implant to natural tooth is 1.5mm
4.modelling demonstration by elder sibling to the kid
5.Shaping modification of habit
6.pt management " so you are worried about this red spot" q
7.candidiasis does not cause ulcerative patch
8 .angels malocc is based on molar relationship
9.working non working contacts qs from rita
10. Erosive lichen planus -CF

C/f- red ulcers
H/f- loss of rete pegs

Treatment- corticosteroid
11.thiazides indications Hypertension
12.patient needs an interpreter q

13.pt says appointment is taking too long q
14.paraphrasing q repeat what pt said in summarized way
15.composite in posterior should match

1.original outline
2.be flat
3.should mimic opposite tooth
1.. bcz if its 3 it will not occlude
16.is retromolar pad a landmark for placing implant F Landmark for mandible denture
16.identity tip of nose in radio graph
17.fibrous dysplasia in radiograph Ground glass
18.first q from rita
19.rests vertical support
20.moisture contamination in amalgam Failure
20.trecher colins syndrome malformed ear, Symptoms include downward-slanting eyes, a very small
jaw and chin, hearing loss, and vision loss. Some babies may be born with a hole in the roof of their
mouth (cleft palate).
22.suprabasilar split in phemphigus T
23.neurofibromatosis Cafe au lait, lisch nodules, freckles, Brown pigmentation
23.lichen planus most common reticular lichen planus, common in buccal mucosa
24.inc vdo = clicking

26.inc intraocc space = decrease vdo
These three q n a are long confusing but if you know the VDO and it's effects jus make a note and
go for the answer
27.polymerisation shrinking is higher in cavities witha high c factor as class 1
28.inadeq frame work= repeated # w

Inadeq framework=Repeated # q
29.bullos phemphiod q bullous pempnigoid ( bmmp ) antibodies directed for the basal layer so there
are no achantolisis here and the bullae is subepithelial between basal layer and epithelium
30.fibrous dysp in radiograph ground Glass appearance
31.sodium hypochlor - like some six seven qs on that Does not chelate/antibacterial/dissolves
organic tissue/irrigant
32.apex locater q cannot locate minor perforation
33.LA in antidepressant rx effects yes u cannot give la with epinefrine and tca antidepreseeants bcz
exist a sensitization to epinefrine in la due to the animuscarinic effects of tca antidepressants
34.phenytoin= grand mal rx T
35.veeners staing
36.micro etch etch silane q
37.thyroglossal cyst midline in neck
38.ameloblaastoma= local invasion T
39.cirrhosis tests Bilirubin test, Ift, PT, test
40.sedation in DM
41.Gardner's syndrome intestinal polyps

42.cleidocranial dysostosis Supernumerary teeth/ no clavicle
43, TMj= MRI T
44.INR levels 1 healthy/2-3 cardiac patient. Extrinsic pathway/PT
45.mandibular molar extraction where does the root dissaper into Submandibular
46.ludwigs angina submental, sub mandibular, sublingual
47.HLA antigens and RAS
48.oligodontia defect in initiation stage, ectodermal dysplasia, more than 6 teeth are missing
49.salivary igA
50.DM 1 = blindness
51.taurodontism large pulp chamber square shaped towards apical
52.Oligodontia
53.least and most in every single thing lol
54.eruption sch is very imp 4-5 qs in this
Calcification too
55.PFM reductions functional= 2mm, nonfunctional= 1.5mm
56.interferences three qs
57.no LA qs
56.Banthine for salivary reduction Pro- banthine is the drug to treat peptic ulcer and helps in
reduction of saliva
57.Moa finestradine Inhibits 5 alpha reductase, given in benign prostate hyperplasia
58.moa asprin irreversible inhibition of cox-1 enzyme
59.doxy advantages = ext half life more water soluble
59.biotransformation biotransformation is when theliver makes some precess in the drug so the drug
can convert in a more polar water soluble form and that way can be excreted
60.all the qs on p value din mango
61.null hypothesis qs two of them

62.first 7 straight in same order from andres gomez
63.subgingival margins and issues with it subgingival margin u can disrupt the clinical width and then
the tooth will be periodontally compromise
64. Most common gingival disease in school kids lol option anug and marginal gingivtis
65.anug organisms spirocheta and fusobacteria
67.no antobiotics in Chr Periodontitis T
68. Veneers and staining less than 1 month= amines, 1 month= microleakage
69.perineural invasion q ACC
70.OKC recurrence q T
71.carbenicillin = indole positive proteus q T
72.hepatitis vaccination q Total 3 doses of hepatitis b vaccine.. ist dose then 4 weeks later 2nd dose
then 8 weeks later 3rd dose I think .... no booster doses are required
73.test for autoclave =bio moniters q
74.Veneer reduction
Incisal .0.7
Middle- 0.5
Cervical- 0.3
76.new attachment in perio
new attachment - perio
SRP- long junctional
Flap- reattachment
79.diff between gingivitis and periodontitis Clinical attachment loss
80.MWF
81.tori= All the qs we have ever seen on tori

82.RPD, I-bar
83.antiobiotics made from= bacteria fungi q T
84.HSV Acyclovir
85.bells palsy due to facial nerve paralysis
86.candidiasis alllllll the qs in alll the files lol
87. reciprocal anchorage Force applied equal and opposite direction not parallel but collinear
88.hypotensive eff of oxycodone due to release of histamine
89.leukemia- spontaneous haemorrhage
90.disadvantage of oral sedation slow absorotion by GIT
91.disadvantage of fillers in composite less polishable, more polymerization shrinkage
92.migraine -triptans . serotonin uptake agonists
93.indicatuons for RMGIC subgingival caries
94. dry socket irrigation then sedative dressing

95-placebo drugs Hypothetical drug.. to make pt ensure he is taking medication.. can be multivitamin
or normal saline... Used for pts who need medications even if they are good.. used in 50% of cases
97.silmulates salivary flow unsimulated salivary flow both qs like 3 times stimulated 1ml/min,
unstimulated 0.1ml/min
98. TMI- with reduction wand without 3 qs i thnk' tmj with reduction clicking. Without reduction limited
opening is seen
99.cohirt study-incidence
100. macroglossia seen in down syndrome, acromegaly
101.Defiant kid q voice control
101. modellin g and voice control
103.pulp testing in a tooth with crown cold test
104.2 yr old kid-fear of seperation
105 6 year old kid =fear of unknown q
106. Andes case

Day 2
1. Old man who was a wheat farmer, smoked 40 packs per year for 40 yrs. Had Lisinopril,
aspirin 81 mg, had a white patch on lower lip
q- why is the white patch on the lip- actinic chelitis or leukoplakia

q- histopathology of the white lesion- more keratin
q- he had max 3rd molars on both sides they asked which rpd classification
q- lower molars had mods and various pocket depths, lower anteriors had mobility,
furcation- they asked to classify the type of perio disease
q – prognosis affected by- (a) mobility
(b) furcation (c) contour of restorations (d) replacement of
missing teeth
q- one tooth had fractured amalgam mod- which is best method of restoration- pins,
pfm, onlays
q- if it was to be extracted what would be the complication it was a max rc treated
molar with big amalgam with pins
q – pointed to fordyces granules in pic
q. had posterior crossbite and collapsed occlusion- reason was asked
few more q regarding type of clasp and occlusal rest
2. Pt with history of bipolar and depression, has history of lithium toxicity which reduced
renal function to 40%, needs dialysis often, takes meds for depression amitrytilline and
some other new drugs, declared as disabled and doesn’t work , history of smokeless
tobacco. His full mouth radiographs were given and had poor oral health
q. which meds can result in nephrotoxicity except- ibuprofen, aspirin, erythromycin, another
drug
q. if pt required extraction what precaution to be taken
q. had attrition on incisal and occlusal tips, what did he have?- bruxism
q. dose modification of antidepressants in bruxers before dental tt
q. his crowns were in poor shape – what to replace with
q. what to replace the edentulous areas with- implant or rpd
q. rpd base should move with functional forces t/f
a few other q related to pharma
3. Young girl with asthma, posterior cross bite on left side , narrow maxilla, left max
posterior had a band and loop space maintainer
Q – estimate age of pt , whether earlier or late for chronological age
q. mobility of deciduous canine present , permanent tooth bud was way up still, what to
do?
q. asked whether all teeth were present or not which was missing- had a missing mand
2nd pm
q- type of resorption in deciduous 2 molar
q- the 1st pm was at same level as deciduous molar- why
q- caries risk assessment
q- reason to retain 2molar- complicated options
q- ankylosed deciduous doesn’t prevent what?- supra eruption of opposing tooth, since
it itself was in infraocclusion
q- had to identify hyoid bone on her ceph
another q in DAY 1 related to ceph was which structure appears as a single in lat ceph-
orbit, ramus, pterygomaxillary fissure, sella
4. Middle aged lady released from alchohol rehabilitation after 18 months, wanted
extraction of posterior teeth which hurt. Type 2 diabetes. She was also taking another
drug other than metformin whose name I didn’t know
q- which drugs can be given to her as painkiller- oxy, Percocet, Vicodin, ibuprofen and
another drug
q-. had moderate oral hygiene. Not too bad- was asked which replacement best for her
level of oral hygiene
q- what might be the cause of implant failure in her case- perio, diabetes, smoking and
another option
5. Young guy with adhd, asthma, juvenile diabetes and lots of allergies primarily penicillin,
had tonsils removed couple of years back
q- which type of facial angle.
q- if deep bite and mand molar extruded what happens to the bite, and mand angle
q- what should be precaution in dental operatory
q. does he need prophylaxis
q- how to correct cross bite in his case- only rt max premolars and molars in crossbite
q- he had lesion on palate – erythematous lump- biopsy showed keratinized mucosa,
vital cortical and cancellous bone- ossifying fibroma, exostosis, osteoblastoma,
had 2-3 tough q about ortho
6. Old man had lesion on tongue which had mixed redand white areas, hiv positive, poor
perio health, Hispanic, without insurance, lots of root stumps
q- asked about lesion- only mentioned white lesions nothing so I picked best possible
scenario
q- blue patch below the tongue- seemed normal to me
q- weird q about a tooth with post in rf – width of post too thick, thin, enough gp or less
gp
q- few more prostho q
q- they gave viral load and said which one was suitable for dental tt
that’s all I can remember folks- I know I wasn’t being too specific but hope this helps
1000 MCQS – PROSTHODONTICS
Plus March & September 2014 MCQs in Prosthodontics
84. What is the purpose of making a record of protrusive relation and what function
does it serve after it is made
A. To register the condylar path and to adjust the inclination of the incisal guidance.
B. To aid in determining the freeway space and to adjust the inclination of the incisal
guidance.
C. To register the condylar path and to adjust the condylar guides of the articulator so that
they are equivalent to the condylar paths of the patient.
D. To aid in establishing the occlusal vertical dimension and to adjust the condylar guides of
the articulator so that they are equivalent to the condylar paths of the patient.
86. The main factor controlling a decision to increase the occlusal height of teeth for
extensive oral reconstruction is whether
A. The inter occlusal distance will be physiologically acceptable after treatment
B. There will be sufficient tooth bulk in the abutment teeth for proper retention of the crowns
C. At least two third of the original alveolar process will remain for adequate periodontal
support
D. The aesthetic appearance of the patient will improve sufficiently to warrant the planned
reconstruction
87. In planning and construction of a cast metal partial denture the study cast
A. facilitate the construction of custom/special trays
B. minimize the need for articulating
C. provide only limited information about inter ridge distance, which is
best assessed clinically
D. can be used as a working cast when duplicating facilities are not available
88. Periodontal damage to abutment teeth of partial denture with distal extension can
best be avoided by
A. Applying Stressbreakers
B. Employing bar clasps on all abutment teeth
C. Maintaining tissue support of the distal extension
D. Clasping at least two teeth for each edentulous area
E. Maintaining the clasp arms on all abutment teeth at the ideal degree of tension
89. Which of these muscles may affect the borders of mandibular complete denture
A. Mentalis
B. Lateral pterygoid
C. Orbicularis oris
D. Levator angulioris
E. Temporal
90. Jaw relation of an edentulous patient has been established. The maxillary cast has
been mounted on an articulator without a face bow. You decide to increase the occlusal
vertical dimension by 4mm this will necessitate
A. Opening the articulator 4mm
B. A new centric relation to be recorded
C. A change in the condylar guide settings
D. An increase in the rest vertical dimension
91. Following extraction of the molar teeth**

A. The ridge height is lost more from the maxilla than from the mandible
B. The maxillary ridge will get more bone lost from the palatal aspect than the buccal
C. The mandibular arch is relatively narrower than the maxillary arch
D. Compared with the pre-resorption state, the mandibular ridge will lose more bone from the
lingual aspect than the buccal one.
92. Which of the following is a major disadvantage to immediate complete denture

therapy
A. Trauma to extraction site
B. Increased the potential of infection
C. Impossibility for anterior try in
D. Excessive resorption of residual ridge
100. What is the main purpose of using Stress breakers

A. To distribute the load between teeth and ridges
B. To distribute the load between the clasps and the face end of the saddle
C. It relieves the abutment tooth of occlusal loads that may exceed their physiologic strength
103. Which is more retentive form for anterior bridge

A. ¾ partial veneer crown
B. Class V inlay
C. Pinlay Veneer
D. Class III inlay with pins
125. Patient with class II division II; the lateral incisor is missing. You want to make a
fixed bridge which of the following is suitable:
A. Rocket bridge using central incisor as abutment
B. Cantilever using central incisor
C. Fixed bridge using the central incisor and bicuspid

126. When repairing a fracture of lower complete denture. Which statement is correct:
A. Self curing will distort the denture
B. Cold curing will not be strong enough because of small area of attachment
C. There is a possibility of occlusal disharmony
141. The setting expansion of casting investment is approximately
A. 0 to 0.1%
B. 0.1 to 0.5%
C. 0.5 to 1%
D. 1.1 to 1.6%
142. The contraction of gold alloys on solidifying is approximately:
A. 0.5%
B. 2.5%
C. 1.40%
D. 3%
143. The un-polymerized monomer in Self-cured resin is approximately:**
A. 0.5%
B. 2.5%
C. 5%
D. 10%
144. A volume shrinkage of methyl meta cyrelate monomer when is polymerized:**
A. 12%
B. 15%
C. 18%
D. 21%
147. Oil or water on impression for treatment casts causes

A. An increase of the quality
B. No alteration
C. A decrease of the quality
D. Bubbles on the cast
E. None of the above
148. What is Path of Insertion

A. The movement of the appliance from the points of initial contacts to path of final rest
position
B. The movement of the appliance from the points of rest position until it is not in contact
with teeth
149. What is Path of Removal

A. The appliances movement from the rest position to the last contacts of its rigid parts with
the supporting teeth
B. The movement of the appliance from the points of initial contacts to path of final rest
position
150. When correction preparation for re contouring of occlusal surface is to be applied.

Grinding only of the adjusted surface
A. Should not be felt flat
B. Require a flat crown
C. Require no contact with adjacent teeth
D. Should be felt flat
151. To obtain a desired projection of occlusal loads, the floor of the occlusal rest should
A. Be convex
B. Slope from the marginal ridge towards Contact?? of abutment
C. Slope from Contact?? of abutment towards the marginal ridge
D. Be concave
E. Does not slope from the marginal ridge towards Contact?? of abutment
F. None of the above
152. The transfer of stress by Tensile Action employs T. reaction;a process that within
limit
A. Fails to promote bone growth
B. Promote bone growth and maintenance
C. Fails to promote maintenance
D. None of the above
153. Which of the following arrears CAN NOT be determined by survey analysis of
partially edentulous cast
A. Areas to be revealed as blocked out to properly loca?? Rigid parts of a frame work
B. Areas to be shaped to properly loc?? Rigid parts of framework
C. Areas used for guideline planes
D. Areas used for retention
E. Areas used for support
F. Depth of rest seats
154. In partial dentures the guidelines “Guiding Planes” serve to

A. Aids in balancing occlusion
B. Assure predictable clasp retention
C. Form right angle with the occlusal plane
D. Eliminate the necessity for precision attachment
E. Eliminate the necessity for a posterior clasp
155. Rough surface of porcelain /Porosity/ is a result of

A. Lack of compression
B. Sudden high temperature
156. The most common failure in constructing porcelain to metal is

A. Improper metal framework
B. Rapid heating
158. The maxillary canine is missing. The best way for making Cantilever bridge
A. Both premolars
B. Incisors and premolars
159. Ante’s Law: Dr. Ante in 1926 stated that

A. “The combined pericemental area of the abutment teeth should be
equal to or greater in pericemental area than tooth or teeth to be
replaced”
160. Why would you decide to replace the anterior missing teeth for partial denture
using bridge
A. Aesthetic
B. Overjet
C. Overbite
161. In regards to Gold casting alloys which one is available for bridge
A. Hard alloy “Type III”
B. Type II
C. Type I
163. The first thing to check when patient comes complaining of pain under denture is:
A. Occlusion
B. Soft tissues changes
164. Fovea Palatini, is a landmark to determine the posterior

bonds of upper denture
A. Post dam
B. Flanges
166. Modulus of elasticity is defined as

A. The stress at the proportional limit
B. The stress-strain ratio within the proportional limit
167. Tissue conditioning material : (Silicon lining material)
A. Are more resilient than plastic acrylic
B. Can minimise any bacterial colonies
169. The position of cusps of maxillary first premolar during setting of teeth and on
occlusal view is positioned**
A. Distally
B. Mesially
C. Central buccolingually
179. Kine-matic face bow is used for recording (to locate)

A. Hinge movement (position) axis
180. Why do you polish the teeth before seating of partial dentures
A. To smooth the rough surface
B. To minimize the retention of plaque
C. To increase the adoptability of occlusal rests
181. The contact between artificial and natural teeth in partial dentures
A. Slight touch in the balancing side
B. Should not be in touch at all
182. Polyvinyl impression material are

A. The most stable
B. The most resistant to heat
184. Wax patterns ARE NOT to be left on the bench for long time because of
A. Distortion
B. Lost of elasticity
185. The undercut for Cobalt Chrome’s retentive arm clasp is

A. 0.75mm
B. 0.50mm
C. 0.25mm
186. When surveying

A. Tilt the cast
187. What statement is false

A. Not to survey when making the crown
188. Gold clasp is more elastic than Cobalt Chrome, but Co-Chrome has high modulus
of elasticity
A. The first statement is false the second is true
B. Both are true
C. The first is true the second is false
D. Both are false
189. Overdentures are best used for

A. Canines and premolars
B. Posterior teeth
190. What is main reason of ordering another Periapical radiograph of the same tooth
A. To disclose the other roots
B. To observe tooth from different angle
191. The ideal length of RCT is

A. At the apex
B. As far as you can obturate
C. 0.5 t0 1.5 mm before the apex
192. Retentive part of clasp position is

A. Below the survey line
B. Above survey line
C. As close as possible to the gingival margins
193. To minimize the load on free end saddle partial denture

A. Use teeth with narrow Buccal-Lingual dimension
B. Use mucco-compressive impression
194. Retentive Clasps

A. Alloy with high modulus of elasticity
B. Clasp arm is gingivally located
205. In melting gold, which part of flame we will use
A. Reduced zone
B. Oxidizing zone
206. To increase the stability of the lower denture

A. The occlusal plane should be below the tongue
B. The occlusal plane should be above the tongue
C. The lingual flanges should be concave
207. If the investment is burnout rapidly, what will happen

A. Back pressure porosity
B. Cracking of the investment
208. What is the DISADVANTAGE of gypsum dies**

A. Weak edge strength and lack of surface details
B. Dimensional inaccuracy
209. Overdenture advantage is**

A. Proprioceptors
212. The best way of getting good retention in full veneer crown is by
A. Tapering
B. Long path of insertion
213. Wrought metal is to be

A. Marble
B. Quenched
C. Subjected /undergone/ to cold treatment during processing
(annealed)
237. Patient with lower denture and complaining of paresthesia of the lower lip; the
most common cause is,
A. Pressure on mental foramen
B. Pressure on the genioglossi Mylohyoid muscles

255. Impression without elastomer in custom tray has been taken for crown
preparation; it will be two days before impression gets to the laboratory for
construction of the crown. Which impression material is preferred?
A. Polyether
B. Thiokol or meraptan rubber
C. Condensation silicone
D. Vinyl polysiloxane
273. The most common cause of porosity in porcelain jacket crown is

A. Moisture contamination
B. Excessive firing temperature
C. Failure to anneal the platinum matrix
D. Excessive condensation of the porcelain
E. Inadequate condensation of the porcelain
274. The main factor controlling a decision to increase the occlusal height of teeth for
extensive oral reconstruction is whether
A. the inter occlusal distance will be physiologically acceptable after treatment
B. there will be sufficient tooth bulk in the abutment teeth for proper retention of the crowns
C. at least two third of the original alveolar process will remain for adequate periodontal
support
D. the aesthetic appearance of the patient will improve sufficiently to warrant the planned
reconstruction
275. An advantage of metal-ceramic crowns, compared with full ceramic crowns for
restoring anterior teeth is
A. Palatal reduction may be of minimal thickness
B. Overall conservative for tooth structure
C. Ability to watch the appearance of adjacent natural teeth
D. Less laboratory time
276. In cementing Maryland or Roche bridges, the effect is generally to

A. Lighten the colour of the teeth by the opacity of the cement
B. Darken the colour of the abutment by the presence of metal on the lingual
C. Have no detrimental colour effect
D. Darken the abutment teeth by incisal metal coverage
277. The minimal labial tooth reduction for satisfactory aesthetics with porcelain fused
to metal crown is
A. 1mm
B. The full thickness of enamel
C. 1.5 mm
D. 2.5mm
E. One third of the dentine thickness
278. The gingival portion of natural tooth differs in colour from

the incisal portion because the
A. Lighting angle is different
B. Gingival and incisal portions have different fluorescent qualities
C. Gingival area has a dentine background
D. Incident light is different
279. In bridge work, which of the followings terms is NOT CORRECT

A. A retainer could be a crown to which a bridge is attached to
B. A connector connects a pontic to a retainer or two retainers to each other
C. The saddle is the area of the edentulous ridge over which the pontic will lie and comes in
contact with pontic
D. A pontic is an artificial tooth as part of a bridge
280. A crown casting with a chamfer margin fits the die; but in the
mouth the casting is open approximately 0.3mm. A satisfactory
fit and accurate physiological close of the gingival area of the
crown can BEST be achieved by
A. Hand burnishing
B. Mechanical burnishing
C. Using finishing burs and points to remove the enamel margins on the tooth
D. Making a new impression and remaking the crown
E. Relieving the inside of the occlusal surface of the casting to allow for further seating
281. When describing a removable partial denture, the minor connector refers to**
A. Rigid components anterior to the premolar teeth
B. Flexible components, in contrast to rigid major connectors
C. Smaller connectors which connect denture components to the major connector
D. The components of the denture base which provides reciprocation
282. The means by which one part of a partial denture framework opposes the action of
the retainer in faction is**
A. Tripoding
B. Reciprocation
C. Stress breaking
D. Indirect retention
283. In removable partial denture, the principle of an indirect retainer is that

A. Stabilise against lateral movement
B. Prevent settling of major connectors
C. Restrict tissue movement at the distal extension base of the partial denture
D. Minimise movement of the base away from the supporting tissue
284. Distortion or change in shape of a cast partial denture clasp during its clinical use
probably indicates that the
A. Ductility was too low
B. Hardness was too great
C. Ultimate tensile strength was too low
D. Tension temperature was too high
E. Elastic limit was exceeded
285. Which of the following is true regarding preparation of custom tray for elastomeric
impression
A. Adhesive is preferred over perforation
B. Perforation provides adequate retention
C. Adhesive is applied immediately before procedure
D. Perforations are not made in the area over the prepared tooth
286. When a removable partial denture is terminally seated ; the retentive clasps tips
should
A. Apply retentive force into the body of the teeth
B. Exert no force
C. Be invisible
D. Resist torque through the long axis of the teeth
287. Why do you construct a lower removable partial denture with lingual bar
A. It is used when the space between raised floor, mouth and gingival margin is minimal
B. Plaque accumulation is less than lingual plate
C. Should be make thicker when short
288. The Fovea Palatinae are

A. Foramina covering the lesser palatine nerves and vessels
B. Morphologically related to the formation of the premaxilla
C. Located on either sides of the midline close to the junction of the hard and soft palate
D. Closely related to the rugae of the palate
289. Which of following restoration material its strength is not effected by pins
A. Amalgam
B. Composite resin
290. Which one of following statement about Overdenture is not correct

A. Greater occlusal loads can be applied by the patient
B. Retention and stability are generally better than with conventional complete denture
C. Alveolar bone resorption is reduced
D. The retained roots are covered by the denture thus protecting them from caries and
periodontal diseases
291. Which of the following is a major disadvantage to immediate complete denture

therapy
A. Trauma to extraction site
B. Increased the potential of infection
C. Impossibility for anterior try in
D. Excessive resorption of residual ridge
299. Rank the following impressions materials according to their flexibility
A. Alginate> Polysulphide> Silicone> Zinc Oxide Eugenol
B. Silicone> Alginate> Polysulphide> Zinc Oxide Eugenol
C. Alginate> Polysulphide> Zinc Oxide Eugenol>Silicone
D. Alginate> Silicone> Polysulfide> Zinc Oxide Eugenol
E. Alginate> Zinc Oxide Eugenol> Silicone> Polysulphide
300. Denture resin are usually available as powder and liquid that are mixed to form
a plastic dough; the powder is referred to as,**
A. Initiator
B. Polymer
C. Inhibitor
D. Monomer
E. Dimer
301. Which one of the following is the major disadvantage of stone dies used for
crown fabrication,
A. They lack accurate reproduction of surface details
B. Their overall dimensions are slightly smaller than the original impression
C. The strength of the stone
D. The hazard of aspiration of toxic materials during trimming of the dies

304. When all other removable partial denture consideration remains unchanged;
clasps constructed of which material can be engage the deepest under cut
A. Chrome cobalt casts
B. Nickel chrome casts
C. Wrought stainless steel
D. Wrought gold
305. Which one of the following types of pain is most likely to be associated with cranio
mandibular disorders
A. Exacerbated pain by hot or cold food
B. Keeps patient awake at night
C. Associated with muscle tenderness
D. Associated with trigger spots related to the trigeminal nerve
306. The incisal guidance on the articulator is the**

A. Mechanical equivalent of horizontal and vertical overlap of upper and lower incisors
B. Mechanical equivalent at the compensating curve
C. Same as condylar guidance
D. Estimated by the equation: Incisal guidance = 1/8 of condylar Guidance
315. What controls the occlusion:**?? Check Boucher C.D.
A. Teeth
B. Receptors in periodontal membrane
C. Proprioceptors
D. Neuromuscular receptors
E. TMJ
F. All of the above
319. Where do Maryland bridges lose retention often:
A. Resin-metal
B. Resin enamel
C. Resin layer
320. What is the function of gypsum-binder in the investment:**
A. Setting and hydroscopic

B. Strength and rigidity
321. Where is the retentive position on tooth according to the survey line:
A. Below the height of contour
B. Next to gingival margins
322. In regards to distal free end saddle; what is TRUE:
A. Will require relining more often than a denture supported with teeth
323. What are the most common errors when constructing partial denture:
A. Improper survey
B. Bad positioning of the occlusal rests
C. Incorrect design
335. The major cause of jacket crown breakage is,
A. Inclusion of platinum foil
B. Use of weak cementum
C. Voids of porcelain
D. Porcelain is thinner than 1mm
336. Pontic replaces upper first molars in a bridge should be:
A. Slightly compress soft tissues
B. Be clear of soft tissues
C. Just in contact with soft tissues
337. Labially displaced anterior tooth is restored with a gold core porcelain jacket
crown so that it is in line with the arch; the crown will appears:
A. Short
B. Long
C. Narrow
D. Wide
352. Why Class IV gold can not be used in cavity as a filling material:
A. Can not be polished “burnished”
B. The corrosive properties
353. The type of gold that used for dental bridges is,
A. Hard 18%
B. Type IV 75%
354. In regards to Partial dentures, how do you establish reliable vertical dimension,
A. Wax if the remaining teeth occlude
355. In regards to indirect compare to direct wax technique:**
A. Low temperature solidifying point
B. Hard in room temperature
C. Higher flow in room temperature
468. Which impression material should NOT be kept in water within on hour: “in
another paper was: 30 mins before pouring”
A. Polyether
B. Condensation silicone
C. Polyvinyl silicone
469. High copper amalgam lasts longer than low copper amalgam because of**
A. Increased compressive strength
B. Increased corrosion resistance
C. High creep
D. Increased tensile strength
E. Decreased setting expansion
470. Porosity in acrylic dentures is caused by

A. Contraction porosity in thickest point of the denture
B. Insufficient pressure during flasking causes it
471. The shortest facial height is when

A. Teeth are overlapped
B. There is maximum cuspal interdigitation
472. What is TRUE about vertical dimension

A. Does not change for the whole life
B. Decreases when head is tilted back
C. Increases when a lower denture is placed in mouth
474. Why would you cast gold in hot mould**

A. To compensate for the expansion of investment.
475. If temporary cementation is required, which cement will you use

A. ZOE
B. Zinc Polycarboxylate
C. GIC
476. In the construction of an RPD, guiding planes are created by

A. Perpendicular to the occlusal plane
B. Parallel side towards the path of placement.
477. When should pour polyether impression materials

A. Within 24 hours after taking impression
B. Within 30 minutes after taking impression
C. Should be stored dry and then poured
D. Should be stored in humid place
478. Which of the following is a frequent cause of opaqueness in a porcelain jacket

crown
A. Porcelain layer is too thin over the opaque layer.
B. Porcelain layer is too thick
481. A gingivally extended chrome cobalt cast clasp

A. Can extend 0.5 under the surveyor line
B. Can extend 0.25 under the surveyor line
C. Will resist deforming forces better compared to cast gold
482. The first molars are extracted in both arches
A. The bone resorption will be the same for both arches
B. Resorption is more on the palatal side of maxillary molars
C. Resorption is more on lingual side of mandibular molars
D. The ridge height resorbs more in maxilla than mandible
483. The use of nickel chromium in base plate should be judiciously considered because
A. A significant number of females are allergic to nickel
B. A significant number of female are allergic to chromium
C. A significant number of males are allergic to nickel
485. During mouth preparation for RPD on tooth adjacent to edentulous area. There is
dentine exposure
A. Restoration is required
B. Proceed with rest seat preparation and fabrication if involved area is
not more than 2mm
486.After making an impression to reline an RPD the dentist notes that the indirect
retainers are not resting on the tooth. To avoid this what process should have
undertaken initially
A. Ask patient to bite firmly while impression is setting
B. Hold the metal base frame against the abutment tooth while setting
C. Fabricate new denture
D. Add impression material and close the gap
496. The area of the posterior palatal seal includes which of the following:
A. [left][right]
B. Hamular notch
542. What is the ideal length for a post in post-core in an endodontically treated
tooth:
A. 2/3 of the tooth length
B. ½ of the tooth length
C. 1.5 times that of the crown
D. Same as the anticipated crown
543. Which is correct in regard to shade selection of crowns:

A. It should be selected before starting preparation
B. Chroma is the lightness/darkness of colours
C. Value is the colour itself
D. Hue is the concentration of colours
545. Strain is defined as :**

A. An external force
B. An internal force to oppose external load
C. Deformity opposed the applied load
547. Self polymerising acrylic resins differ from heat cured resins because they
exhibit:
A. Higher molecules weight
B. Higher content of residual monomers
548. The advantage of firing porcelain in vacuum:**

A. Reduces size of air-bubbles incorporated thus decreasing porosity
B. Removes water before firing, increasing the hardness of porcelain
C. Significantly lowers firing temperature
549. The contraction (Gaseous) porosity in inlays is related to:**
A. Overheating of the alloy
B. Molten gases
C. Diameter of the sprue
D. Overheating of investment
550. Where would you expect to find the Mylohyoid in relation to periphery of
complete denture:
A. Mandibular buccal in the midline
B. Mandibular lingual in the midline
C. Mandibular disto buccal area
554. Splinting the adjacent teeth in fixed bridge is primarily done to:
A. Distribute the occlusal load
B. Achieve better retention
555. Porcelain must not be contaminated by handling between which two stages:
A. Pre-soldering and heat treatment
B. Heat treatment and opaque /bake/ stages
C. Opaque and bisque stages
D. Bisque and glazing stages
E. First opaque bake and second opaque bake
556. What is the relationship of the retentive portion of the partial dentures retainers
to the survey line of abutment:
A. Gingival /Below/
B. Occlusal /Above/
C. No relation
557. Which of the following liquids is not suitable for prolonged immersion of cobalt
chrome partial dentures:
A. Alkaline peroxidase
B. Hypochlorite solutions
C. Soap solutions
D. Water
558. Dentures hyperplasia is generally attributed to:
A. Poor oral hygiene
B. Denture movement
559. In complete dentures, cheek biting is most likely a result of:
A. Reduced Overjet of posterior
B. Increased vertical dimension
C. Teeth have large cusp inclines
560. Resting face height in edentulous patients:
A. Decreases when head is tilted back
B. Increases when lower denture is inserted
C. Does not change over time
561. Ala-Tragal line is:**
A. The line running from the tragus of the nose to ala of the ear
B. A guide used to orient the occlusal plane
C. Parallel to Frankfurt horizontal plane
D. A guide to the occluding face height in complete denture.
562. Decision to employ cusped or without cusps teeth is influenced by:**
A. Reverse Overjet
B. TMJ problems
C. Cranio mandibular skeletal relationship
568. It is desirable to major connectors of upper partial dentures to:**
A. At least 5 mm away from the gingival margin

B. Cover the anterior palate
570. When you tries to seat a crown on tooth you find a discrepancy of 0.3mm at the
margin; you will:
A. Reduce inner surface of crown
B. Remake a new crown
C. Smooth the enamel at the margin
D. Hand burnish crown margins
578. In surveying; calibration of examiners data is important because:
A. It reduces the errors in gathered data.
678. In full dentures porosity in the most thickest area is due to:**
A. Gaseous porosity
B. Shrinkage porosity
699. What is TRUE about Chrome-Cobalt partial denture:
A. No immersion of dentures in hypochlorite
725. Terminal Hinge Axis can be obtained by:
A. Face bow
B. Kinematic face bow
C. Articulator
738. Compared to dental plaster all die stones:

A. Require less gauging water
B. Require more gauging water
C. Require the same quantity of gauging water
D. Are beta-hemihydrate
739. The MOST effective manner to produce a hard surface on a cast is by:
A. Employ as much water as possible on mixing
B. Employ as little water as possible on mixing
C. Adding 2% of borax to the mix
D. Adding calcium tetraborate
740. When dry cast is immersed in water saturated with calcium sulphate:**
A. There is contraction
B. There is negligible expansion
C. There is definite expansion
D. There is no change
741. Fusion temperature of impression compound should occur:

A. Below mouth temperature
B. Above mouth temperature
C. As of the skin temperature
D. At the room temperature
742. The flow of the following percentage is allowable for impression compound
(type I) at the oral temp of 37º
A. 6%
B. 10%
C. 2%
D. 20%
743. The disadvantage of heating the impression compound in a water bath is:
A. It may become brittle
B. It may become grainy
C. Lower moles with constituents are leached out
D. The plasticity of the compound may be altered
E. All of the above
744. Generally there is ???? zinc oxide eugenol impression pastes between flow are:
A. Working time
B. Accelerator
C. Setting time
D. Composition
745. Dental impression materials are hydrocolloids of:

A. The emulsoid type
B. The suspension type
C. The sol type
D. The gel type
746. Elastomers are:**

A. Hydrophilic
B. Hydrophobic
C. Water-loving impression material
D. Potassium alginates
747. The polysulfide rubber impression materials are:
A. Not sensitive to temperature when curing
B. Quite sensitive to temperature when curing
C. Less sensitive to temperature than silicone rubber
D. The same sensitivity to temperature as silicone rubber
748. The elastic properties of rubber impression materials:

A. Improves with time
B. Deteriorates with time
C. Deteriorates when exposed to temperature
D. Improves when exposed to temperature
749. The effect of the temperature rising above 100ºC on heat-cured denture-base
acrylic resins is:
A. Produces porosity on the external portion of the resin.
B. Produces porosity on the internal portion of the resin.
C. Produces porosity on the surface of the resin.
D. Prevents porosity on the interior of the resin
774. When adhesive is used with polysulphide impression material:
A. Should be thin and dry
776. Reversible hydrocolloids impression material in comparison to alginate are:
A. Better for undercuts areas
777. You can increase the retention of Maryland bridge by:
A. Incorporate mesh work in wax pattern
B. Perforation techniques in the metal cast
778. Maryland bridges are made of:
A. Nickel chrome
779. Initiation of curing process in self cure acrylic resin is achieved by:**
A. Benzyl peroxide
791. Which of the following Gold casting alloys are available:

A. Medium alloy “Type II”
B. Hard alloy “Type III”
C. Extra Hard alloy
814. The outcome of rapid wax burn out is:

A. Cracking of the investment
B. Back pressure porosity
818. The MOST common cause for midline fracture is:

A. Impact
B. Fatigue
819. The function of face bow is:
A. Orient maxilla to TMJ
824. An Obturator in cleft palate plate is maintained by:

A. Cohesion
B. Atmospheric pressure
C. Retention in the defect
D. Patient support it with the tongue
825. In a fixed moveable bridge where should the moveable (non rigid) connectors be
placed:
A. Distal to anterior retainers
B. Mesial to posterior retainers
828. What is the minimal labial reduction for porcelain metal crowns:
A. 1mm
B. 1.5mm
C. 0.5mm
829. What is the function of flux:
A. To protect alloy from oxidation, and distribute metallic oxides as they are formed
830. What is TRUE:
A. Boiling point of acrylic > boiling point of water
B. Boiling point of acrylic is similar to that of water
C. Boiling point of acrylic < boiling point of water

831. Porcelain bonded to metal is strongest:
A. In compression
B. In tension
862. What is TRUE in regard to the preparation of occlusal rests:

A. Use an inverted cone bur
B. Use a flat fissure bur
C. Parallel to occlusal plane
D. At right angle to the long axis of tooth
864. The cervical finish line of a full veneer crown preparation should be placed:
A. Just supragingival whenever is possible
B. According to the depth of gingival crevice
C. Subgingival to reduce ability of recurrent caries
D. At the junction of tooth and amalgam core
867. Which of the following will NOT be used in determination of vertical dimension:
A. Aesthetic
B. Phonetics
C. Gothic arch tracing
D. Swallowing
868. Zinc oxide impression material:
A. May cause irritation to mucosa
B. Is a thermoplastic material
872. A lateral incisor labial to the arch needs to be restored in normal alignment with
PFM retraction. How will the tooth appear:
A. Too wide
B. Too short
C. To narrow
D. To long
873. Which of the following cusps is more prone to crack:

A. Buccal of lower molars
B. Lingual of lower molars
C. Lingual of upper molars
D. Buccal of upper molars
874. Flexibility of the retentive clasp arm depends on:

A. Length
B. Cross section
C. Material
D. Degree of taper
E. All of the above
877. Why are three tripods marked on a cast being surveyed:

A. To orient cast to articulator
B. To orient cast to surveyor
C. To provide guide planes
878. An irregular shaped void on surface of a gold cast would indicate that:
A. A fragment of investment had been carried into the mould
B. Air carried into mould
C. Burning out of wax was inadequate
D. The powder/water ratio for the investment was too high
881. In regards to connectors on dentures; which of the following is correct:
A. Major connector should be rigid as possible
B. Minor connector should engage undercuts
883. What is CORRECT in regard to the periodontal surface area in mandibular

teeth:
A. First molar> first premolar> second premolar
B. Canine> first premolar> second premolar
C. Canine> lateral incisor> central incisor
884. A cast crown fits on the die but not on the tooth, the discrepancy is about 0.3mm,
what would you do:
A. Relieve cast from the inside
B. Take a new impression and make new crown
C. Burnish margins
D. Use thick mix of cement
887. What interferes with maxillary denture in posterior vestibular fold:
A. Coronoid process
B. Condyle
C. Masseter muscle
888. In regard to shade, chroma is:

A. Brightness
B. Saturation of hue
C. Value
889. How long should acrylic self-cure special trays been made prior to taking
impression:
A. 12 hrs
B. Immediately after fabricating it
C. After been left in water for an hour
D. Wait for an hour before pouring
890. The MAIN CAUSE of gingivitis in partial-denture patients is:

A. Placement of dentures
B. Plaque accumulation
891. What of the following is TRUE regarding the placement of the movable
component of the non-rigid connector in a fixed bridge:
A. Should be placed on the longer retainer
B. Mesial drift causes unseating of the distally placed connector
892. When lateral incisor is lost a patient has Class II Division II type with deep bite.
Which of the following is contra indicated:
A. Fixed bridge with canine and central incisor as abutment
B. Non-rigid connector with central incisor as abutment
893. What is the neutral zone:

A. The zone where displacing forces are neutral
B. The zone where buccal and lingual forces are balanced
894. What is the Bilaminar Zone:**

A. Formed of, or having, two laminae, or thin plates. Which is the distal
attachment of superior hard lateral plate
B. A vascular, innervated tissue that plays an important role in allowing the
condyle to move foreward
925. Flexibility of the retentive clasp arm Does not relate to:
A. Length
B. Cross section
C. Material
D. Degree of taper
E. Under cut area
926. Protrusive movement in wax:
A. Can not be perforated

930. The OPTIMUM crown to root ratio for abutment tooth is:**
A. 2:3
B. 1:1
931. What does contraindicate bridge works:

A. Long edentulous span which will lead to damage of abutments
932. Elasticity of impression material will lead to ideally:

A. Prevent distortion when impression is removed out of the mouth
933. A patient has been coming to your clinic for several times complaining about
soreness under the denture, what would you do:
A. Check occlusion of lower buccal cusps
934. What is the difference between arcon and non arcon articulator:
A. In arcon the condylar element is in the lower compartment
947. The auxiliary occlusal rest on teeth for partial denture should be placed:
A. Away from edentulous space
B. Adjacent to edentulous space
C. Near fulcrum line
D. Away from fulcrum line
948. A vital tooth has a crown cemented to a pin-retained amalgam core; where does
a failure occur:
A. Between crown and cement
B. Between core and cement
C. In the crown and the root
D. In the core and the margin preparation
958. The advantage of using the lingual plate on lingual bar is:
A. It acts as indirect retention
959. Retention in precision attachment is achieved by:
A. Frictional resistance
960. How much under cut area a clasp arm should engage:**
A. As much under the undercut as possible
B. Anywhere beyond the survey line
C. A predetermined amount of undercut

963. Why don’t we use porcelain in long span bridge works:
A. Because of the high casting shrinkage of porcelain
964. You have patient with Class II division 2; which of the following is
contraindicated:
A. Cantilever bridge
B. Maryland bridge
965. How will you cover a lower premolar when making a metallic porcelain crown:
A. Cover the occlusal and buccal cusp by porcelain
B. Cover just buccal cusp by porcelain
967. What sort of alloys do you use for bridges:

A. Ductile
B. Hard
C. High sensitivity
968. What sort of material do you use for the fabrication of Maryland bridges:
A. Single phase materials
B. Multi phase materials
C. Extra hard
D. The same as bonding material
987. In a posterior vital molar with a core the best material to restore is:
A. Amalgam
B. Composite resin
C. GIC
988. The function of the incisor pin of an articulator:

A. Horizontal and vertical overlap
989. Which of the following is an important consideration when deciding whether to

design an upper partial denture without anterior flange:
A. The amount of labial alveolar bone resorption
990. Zincoxide-eugenol impression paste:

A. Can not be used in areas with undercuts
991. When restoring with composite resins, why do we do the cavo surface bevelling:
A. Aesthetic
992. In regard to denture stomatitis:

A. Due to overgrowth of some normal commensal of oral cavity
1000. Well constructed complete denture:
A. Needs little maintenance

B. Less than a week for adjustment and total success
C. Adverse effects and decrease taste sensations
1002. Which muscle acts on the disto lingual contour of lower denture:
A. Mentalis
B. Masseter
C. Mylohyoid
D. Buccinator
1010. When should not contaminate metallic framework during fabrication of

porcelain fused to metal crown:
A. Between bisque stage and glazing stage
B. Between preheat and opaque stages
C. Between opaque and bisque stages
D. Between one opaque and two opaque stages
1011. “Pop off” of a porcelain veneer from under the lying gold crown is due to:**
A. Too thick application of pure gold surface conditioner
B. Contamination at the porcelain metal interface
C. Under firing the opaque layer
D. All of the above
1012. Attrition in elderly, why do teeth maintain contact:
A. Building bone around the fundus of alveolar bone and deposition of cementum
B. Increased interocclusal distance
C. Formation of dentine
1014. Initial condylar guidance of 25 degree was wrong is changed to 45 degree. What
changes will you make to achieve balanced occlusion:
A. Decrease incisal guidance
B. Reduce cusps height
C. Increase compensate curve
1017. What is the shape of occlusal rest:
A. Spoon shape with rounded margin
1048. The placement of metal stops at a location remote to direct retainers to increase
retention is termed:
A. Indirect retainers
1049. The hamular notch is important in full dentures construction because it aids in
the setting position of the artificial teeth
A. First statement is true, but the reason given is false
1050. When setting up teeth for complete dentures having bilateral balanced occlusion,
separation of posterior teeth during protrusion is done by:
A. Increasing the anterior posterior occlusal curve
B. Decreasing the angle orientation of the occlusal plane
1051. When patient bites in protrusion you notice that posterior teeth do not meet, what
would you do to solve this:
A. Increase the compensatory curve
B. Decrease the angle of the occlusal plane
1052. The MOST common reason for full denture failure:
A. Inadequate interocclusal clearance

1057. What does “SYNERESIS” in prosthodontics mean:
A. Loss of water and contraction
1058. Why would you invest the wax pattern as soon as possible in an indirect inlay
fabrication:
A. Minimise distortion
B. Avoid contraction
C. Avoid expansion
March 2014
What is TRUE in regard to the preparation of occlusal rests:
A. Use an inverted cone bur
B. Use a flat fissure bur
C. Parallel to occlusal plane
D. At right angle to the long axis of tooth
E. None of the above E
The auxiliary occlusal rest on teeth for partial denture should be placed:
A. Away from edentulous space
B. Adjacent to edentulous space
C. Near fulcrum line
D. Away from fulcrum line
Impression material for making final impression for implant prosthesis is:-
A. Additional silicone
B. condensation silicones
C. Polyether
D. Polysulphides
What is TRUE:
A. Boiling point of acrylic acid > boiling point of water
B. Boiling point of acrylic acid is similar to that of water
C. Boiling point of acrylic acid < boiling point of water
How will cover lower premolar when making a mettalic porcelain crown
a. cover the occlusal and buccal surfaces by porcelain
b. cover just buccal surface by porcelain
For a porcelain fused to metal restoration, the metal surface
A. requires some degree of mechanical retention.
B. should not be heat treated.
C. requires a well polished surface.
D. must develop an oxide for chemical bonding.
September 2014
1. Tripod marking in surveyor is used to:
A. Remount the cast on d articulator
B. Re orient the cast on surveyor..
C.
D.
2. Maximum support in distal extension RPD gained through
1- indirect retainers
2- Proper tissue support by denture base
3- occlusal rests
4- clasps
5- use stress breakers
3. Free way space. What is Correct
A. Can be meassured accurately only in dentulous patients
B.It is set 2-4 mm in edentulous patient
C It is VDO minus VDR.
4. Contraindication of (enamel shell) restorations:
A. Deep bite
B. Class 2 div 1
C. Class 2 div 2
D. Edge to edge bite
E. Class 3
5. What is the advantage of acrylic resin over Cr-Co
1- cost
2- plaque control
3- ease of adding teeth
4- better thermal conductivity
5-
6. Taking impression with elastomers for maxillary fixed bridge using custom tray,
the special tray should be
1- perforated
2- having space of 3mm
3- having space of 5mm
4- tray can be flexed
5- adhesive not required
7. What is the clinical symptoms of mental nerve compression by the denture
borders?
a. lower lip & chin numbness
b. Lower lip pain
8. In determining the replacement of missing anteriors with ridge lap design or
with incorporation of labial flange, what factor is most important
A.High lip line
B.Patient wishes
C. Need for anterior retention
D.Degree of ridge resorption
9. What determines the limits of the inferior border of the lingual component of an
RPD ..... plz exact phrase
1- Elevation of anterior floor of the mouth
2- Space of the tongue
3- Sub Mandibular duct opening
4- anterior crowding
5- whether lingual plate or lingual bar is used
10. Attrition in elderly ppl doesnt cause loss of contact.reason is

A.deposition of bone around a fundus
B.deposition of cementum at apical area
C.both a n b
D.
11. What is advantage of PFM than all ceramic restoration
A. Minimal lingual reduction
B. Overall conservative
C.
D.
E.
12. Pt. Had new resin-bonded bridge, it fell off 3 months after cementation but
occlusion and design are not a problem...ttt
A. Just do pumice enamel and re etch metal and cement
B. Slightly reduce lingual enamel and retch and bond metal
C. Remake metal create resin tags
D. Remake the bridge
13. Distortion or change in shape of cast partial denture during its clinical use
probably indicates that
a) ductility was too low
b) hardness was too great
c) ultimate tensile strength was too low
d) tension temp was too high
e) elastic limit was exceeded
14. Fixed-fixed partial denture is most preferred as
A. Most conservative
B. Can be given in long spans
C. Can be given for non parallel abutments
D.Diverged abutments
E.Over tapered abutments
15. In the exam there was a question about the advantage of “Kroll” RPI Clasp :
-best esthetics
-minimal tissue contact
-better retention
-minimizes the need for indirect retention
16. Implant not favourable in the 14 15 region for a 45 yr old pt.
A.Maxillary sinus expansion
B.Poor bone quality
C.Inadequate space for two adjacent implants
D. Need bone augmentation
17. Muscles required to close the mouth till centric occlusion:

1. lateral pterygoid
2. medial pterygoid
3. masseter
4. temporalis
A.1 2 3
B. 2 3 4
C. 3 & 4
D. All of the above
18. RPD Framework doesn't fit the patient’s mouth but seated on cast
1- distortion of impression
2- inadequate expansion of investment
3-
4-
5-
19. Circumferential clasp, What is incorrect

1- Rigid 2/3 above survey line & flexible 1/3 below
2- Flexible 2/3 above survey line & rigid 1/3 below
3- Should always engage deepest undercut
4- Cross section is circle
5- Should engage a predetermined undercut
SBQ: A lady in 70s had new denture few months back.its ok when denture at rest or
when she is talking but gets loose during chewing.(function)
She is in early stage of parkinson
Marked resorption of mand post region with super erupted ant teeth.
Maxillary ridge has deep undercut
Q.1 the red lump on ant max site?
A. Incisive papilla
Q.2 reason for denture to become loose
A. Involuntary muscles due to parkinson
B. Canine interference during lateral movements
C . Increase VDO
D . Improper palatal anatomy
E. Due to Decrease saliva
Q3- what is the difficulty during construction of lower RPD:
A. High occlusal level of lower ant teeth
B. Inadequate space for the tongue (a bit large)
C. Adjust occlusal plane according to retromolar.area and new…
D.. Problematic buccal frenums
E. Resorbed upper anterior ridge
OTHER MCQS
Fixed Prostho
1. What is Ante’s Law about?
a. The relation between the span of the bridge and the pontics
b. The periodontal area of the abutment teeth
c. The relation between the length of the root and the abutment.
2. The ideal length of core in the fabrication of crown and core of endodontically treated
tooth is:
a. 1.5 of crown length
b. The length of the crown
c. 2/3 tooth/root length
3. In the construction of a full veneer gold crown, future recession of gingival tissue can
be prevented or at least minimised by:
a. Extension of the crown 1 mm under the gingival crevice
b. Reproduction of normal tooth inclines in the gingival one third of the crown
c. Slight over contouring of the tooth in the gingival one fifth of the crown
d. Slight under contouring of the tooth in the gingival one fifth of the crown
4. In cementing Maryland or Roche bridges, the effect is generally to:
a. Lighten the colour of the teeth by the opacity of the cement
b. Darken the colour of the abutment by the presence of metal on the lingual
c. Have no detrimental colour effect
d. Darken the abutment teeth by incisal metal coverage
5. Crown fits on the die, but on the tooth there is a discrepancy of about 0.3mm, what
will you do?
a. Remake the crown
b. Grind the interior of the crown
c. Prepare the tooth further
6. Patient with class I malocclusion, he has canine guard occlusion, where will you face
difficulties in crown preparation?
a. You will not face difficulties
b. Mandibular canine
c. Maxillary canine
7. In short clinical crowns, what is true in regards to crown preparation?

a. The shorter the crown the more parallel the walls should be
b. Short clinical crowns are not good candidates
c. The shorter the crown the more tapered the walls should be
8. In comparing porcelain to metal-crown with full porcelain crown in anterior teeth:

a. Porcelain to metal crown is more conservative (minimal reduction) on the palatal
surface
b. Metal-crowns are more aesthetic than full porcelain
c. Preparation of the tooth is more simple when doing full porcelain crowns
9. In a class II/2 malocclusion, which bridge design would be contraindicated for a

missing
lateral upper incisor?
a. Cantilever bridge
b. Maryland bridge
c. Metal bridgework
10. Which is the best cantilever bridge design for missing maxillary canine? Abutment
on
a. Both premolars
b. Lateral and central incisor
c. Lateral incisor
d. First premolar
11. What is the best way to cement a Maryland bridge?
a. GIC
b. Resin
c. High compression restorative resin
Removable Partial Prosthodontics

1. What is true about partial dentures?
a. They cause immediate changes in the oral plaque behaviour
b. Night wearing of dentures reduces plaque accumulation
c. Relieving the gingival area reduces gingival enlargement
2. The biting load of denture base to tissues compared to teeth is:

a. Ten times more
b. Ten times less
c. Equal
3. An occlusal approaching clasp TIP:

a. Should occupy a predetermined undercut
b. Contact the tooth under the survey line
c. Rigid
4. In the construction of partial dentures the surveyor is not used to:

a. Contour the wax as part of the fabrication of the working cast
b. Locate the guide planes
c. Determine the location of indirect retainers
d. Identify any undesirable undercuts
5. Which of the following does not affect the elasticity of retentive clasp?
a. Length of the arm
b. The cross section shape
c. The material used
d. The undercut area
6. A partial denture that seats on the master cast but fails to seat correctly in the mouth
is a result of:
a. Contraction of the metal framework during casting
b. Insufficient expansion of the investment material
c. Distortion of impression
d. Failure to block out unwanted undercuts
7. In removable partial dentures, the principle of an indirect retainer is that it:

a. Stabilises against lateral movement
b. Prevents setting of major connectors
c. Restricts tissue movement at the distal extension base of the partial denture
d. Minimises movement of the base away from the supporting tissue
8. Surveyor is not indicated for which one of the following?

a. To determine the place of the indirect retainer
b. To determine direct retention
c. To establish the line of maximum contour
9. Regarding the tip of the retention arm of the retainer in partial denture, what is true?
a. It should engage the predetermined undercut
b. It should engage the maximum undercut available
c. It should not engage any undercuts
Complete Prosthodontics
1. If aesthetic is not a concern, what is the first thing to do to treat soreness under
dentures?
a. Take the denture off for a week
b. Rinse the denture in nystatin
c. Apply tissue conditioner
2. Frankfort plane extends from:

a. Horizontally from sella to nasion
b. Ala of the nose to tragus
c. Horizontally from point on superior aspect of
external auditory meatus to orbitale
3. Which of the following muscles may affect the borders of a mandibular complete
denture?
a. Mentalis
b. Lateral pterygoid
c. Orbicularis oris
d. Levator oris
4. Jaw relations for edentulous patient have been established. The maxillary cast has
been mounted on the articulator without face-bow and you decide to increase the
occlusal vertical dimension by 4 mm. This will need:
a. Opening the articulator 4 mm
b. A new centric relation record
c. Changes in the condylar guide settings
d. Increase in the vertical dimension
5. Which of the following will NOT be used in determination of vertical dimension?
a. Aesthetics
b. Phonetics
c. Gothic arch tracing
d. Swallowing
6. Shape and irregularity of ridge edge in a patient who needs full denture, what is your
treatment?
a. Do not proceed with treatment
b. Minimal surgical intervention
c. Implant surgery
7. What is important in determining the terminal hinge axis?

a. Kinematic face bow
b. Wax bite registry
c. Working casts in dye stone
8. What is the advantage of overdenture in comparison to full denture?

a. Proprioceptors
b. Simplicity of elaboration
c. Aesthetics
9. Failure of denture is commonly due to:

a. Increased occlusal plane
b. Decreased vertical dimension
c. Insufficient denture bearing area
d. Wrong freeway space
10. Diffuse pain under a complete mandibular denture is most likely caused by:
a. Overextension of the denture flange
b. Occlusal plane too high
c. Occlusal face height too great
d. Mental foramen near crest of ridge
1. The reaction of adrenergic alpha on blood vessels
2. What is epinephrine reversal
3. What is flumazenil for
4. What is phystiogistimatic for
5. H1 reaction pathway
6. What drug is used for angina
7. Does myocardial infarction use morphine or epinephrine
8. antiretraction valve is for
9. what dose of crtisol will cause adrenal depression
10. something about Neurofibrosis
11. Melkersson–Rosenthal syndrome ( in the choice )
12. lip swelling after impression due to
(A) hypertension, (B) anaphylaxis, (C) angioedema, (D) hematoma
13. cells most abundant in the periapical abscess
14. which is/is not local factor of periodontitis : smoking, DM, malnutrition
15. Characteristics of Down syndrome : macroglossia?
16. Pregnant woman drink alcohol will cause baby? Encephalopathy
17. What drugs pregnant woman can’t use
18. Topical fungal drug: ketoconazole
amphotericin B : IV; fluconazole: IV and oral;
19. Amantadine : antiviral and anti-parkinson
20. best choice local anesthesia without epinephrine
21. differential diagnosis: lateral tongue nodule : pyogenic, central giant cell granuloma
22. adrenal depression corridor dose
23. causing dry mouth : Albuterol? ( in the choice )
24. Plavix( in the choice )
25. Cause of green orange stain on tooth: Congenital ? Food?
I took my test on March 1st and 2nd. Thank you to everyone in the group who helped along the
way especially Ndbe motherofthree, Mony, and Adela Rodriquez. Day 1 was hard, I had about
50 questions from the Mango file. I was happy to see a question I knew. There were questions I
was asked that I had never heard of while in school. I marked very few questions (10 or less). If I
didn’t know something I picked a best guess and moved on. Of the ones I did mark, they were
mostly working or non-working questions. Use Golden for the different studies and patient
management. Day 2 was better but I think that’s because there were less questions. Sorry I
couldn’t remember more, I was tired. Good luck everyone.
What instrument is used to test the blood flow in the pulp of a tooth?
a) Ultrasound
b) Electronic pulp tester
c) Some other ones I can’t remember
Where is the best placement for a pin? (I had no idea what this question was asking)
a) Barely into dentin

b) Cementum
c) Enamel
d) Alveolar bone
What effects the retention of the post palatal seal of a denture
a) over extension
b) under extension
Band and loop does all except: does not stop supra-eruption of opposing tooth (old RQ).
Study working and non-working movements. (at least 6q’s on this)
Asked to identify pano landmarks (incisive foramen, Hyoid, Zygomatic process of the maxilla)
Distance of cbct from patient
a) 6 feet
b) 5 feet
c) 15cm
d) 60cm
Combination (Kelly) Syndrome is which of the following?

a) Maxillary class IV RPD
b) Will be more stable with implants in the mandibular posterior region
c) Loss of alveolar bone in the maxillary posterior region
d) Causes increased angle of occlusion
When do we remove surgically maxillary tori? It extends postiriorly to posterior seal area.
Tx of ANUG
Hydrogen peroxide oral rinse: 3% or less for 1-2 minutes
Acetaminophen max dose: 4000 mg daily
Aggressive periodontitis- due to AA (Aggregatibacter Actinomycetemcomitans) and use

tetracycline to cure it.
Hemophilia- check PTT (partial thromboplastin time) before oral surgery
Warfarin ( Coumarin) user- check INR before Os. Stop taking Warfarin 5days prior to OS
you can giv
Vitamin K. You can do OS if pt's INR is less then 2.5.
Alcoholic pt needed to check- PT (prothrombin time) before OS
Bleeding time- only related to platelet count

Aspirin has no affect on PT, PTT, INR but affect on bleeding time (platelet counts)
45 Gy doesn't cause osteoradionecrosis: more than 65 Gy (6500 Rads) is associated with

ORN.
ORN need hyperbaric oxygen therapy.
ORN most associated w/ mandible.
Ionizing radiation: damage to living tissues through large molecules excitation(ionized)
IRM is zinc oxide eugenol + what? Methylmethacrylate
the least accurate impression material for crown? I chose irriversible hydrocolloid
Maximum lidocaine for 16 kg kid? 16x4.4
side effect of nitrous: nausea
Best mouth rinse for disabled child. I chose sodium fluoride, not sure
the least caries risk: in kid who is drinking water from bottle during the night
Ludwigs angina
stridor: laryngospasm
recurrent ulcer on mucolabial fold, heals without scaring: aphthous ulcer
15 year old boy, fever, lymphadenopathy, some vesicles and ulcers in mouth. I chose primary
herpetic gingivostomatitis
Day 2
Black middle aged female patient that wanted a diastema closure between #8 and 9. Which
would make this a difficult procedure?
a) Medications would inhibit bone remolding

b) Diastema is too far apart
c) Patient expectations
d) Radio opacity between 8 and 9
Same lady asking a question on her pano, what is the error? Lead collar causing mandibular
anterior teeth to be whited out.
Same question from Mango 1172. Female patient comes into your office wanting all her
teeth out because they are causing her problems. She has her max and mand anterior teeth
only. They don’t look bad. Had question ethical questions like should you extraction all her
teeth and if so what patient ethic could you be violating? Different treatment options like
RPD designs.
Case question about a recovering drug and alcoholic. What medication not to give alcoholic?
Asks what are the radiolucent outlines on the anterior PA: mandibular tori. Asked about
which should not be included as part as he prophylaxis treatement? What bacteria is in LAP?
Since he is no longer using drug is he considered a treat to relapse? True or False..He has
impacted third molars, should you tell the patient he has them? T. Should you extract them as
part of your treatment plan? F.
Same case as mango 1230 and 1231
Healthy 23-year-old female comes in for initial exam because she finally has dental
insurance. She is only taking birth control and has missing #20 and old PFM crown on #5.
Several questions on implants and ortho molar uprighting of #19. Pt doesn’t like the metal
colar showing on #5 due to recession (about 1mm) treatment options to fix it like GTR, new
crown and polish margin.
AL ( RQS- AUG 3rd_ 4TH )

1) sequence of using retraction cord in double cord tech.

2) when is first mand perm molar crown calcification
complete?
a) At birth b) 3-4yrs c) 6yrs d) –

3) Neurofibromatosis

4) aspirin- hypoprothombinemia, decrease platelet
aggregation, increase bleeding time

5) when can an older patients kid make treatment decision?

6) When do we do biopsy for lesion
a) Immediately b) when the lesion does not resolve with
local treatment for 10-14 days c) after 6months d)-

7) Green discoloration in the cervical third of a pfm crown
a) Copper b) silver c) palladium d) gold

8) Radiation to the body is measured by
a) Exposed dose b) absorbed dose c) radiated dose d)
emitted dose

9) Safe drug for patient with renal failure/

10) what cells are found in herpes infection
a) lipshutz cells b) tzanck cells c) langerhan cells

11) hepatisis A spreads by
a) blood b) food and baverages c) serum d) iv

12) after giving IANB block patient returns back with pain?

13) presence of bacteria is not tested by?
a) interlukin test b) endotoxins
c) enzymes d) cell wall components

14) I got x-rays of
a) nutrient canals
b) AOT
c) ameloblastoma
d) condensing ostitis
e) pagets disease
f) zygomatic process of maxilla
g) traumatic bone cyst
h) light xray due to less exposure time
i) fusion

15) In charge of dental materials and devices –FDA
16) important characteristic at age 11
a) eruption of canines b) eruption of canines and premolars
c) eruption of all premolars d) eruption of 2nd premolars
17) x-ray question using SLOB rule

18) when is the lingual flange recorded
a) full tongue movements b) functional tongue movements
c) constricting the massater c) pulling the cheek

19) each of the following effect the thickness of the base except
a) remaining depth of dentin b) closeness to pulp
c) size of the tooth d) type of base used

20) hairy tongue – which papilla?

22) how do you identify multiple myeloma
a) pano b) pano and pa c) bitewing d) pano and occlusal

23) please read the sounds during wax tryin, about the incisal
guide pin during protrusive movements, and condylar guidance.

24) epithelium for the new graft comes from?

25) which tooth has a single root canal?
a) mand central root b) max incisor root ( did not mention
which incisor) c) mand canine root d) max canine root

26) internal structure of implant is designed to
a) fit the abutment in b) to prevent rotation of abutment
c) to mount the analogue d) …………

27) n2o contraindicated in ?
28) 15 year old boy gets hurt while playing soccer to his right
TMJ, no evidence of # or injury on x-rays but patient complains
of pain during normal functions. What is the immediate initial
treatment?
a) analgesics with soft diet b) IMF c) antibiotics
d) analgesics with correction of occlusion

29) how to calculate pocket depth
30) battery
40) arcon and non arcon articulators
41) trephination
42) appearance of papilloma ( pedunculated, rough, pale…)
43) periimplantitis
44) temporal arthritis leads to – blindness
45) type-2 diabetes most common in which race
46) advantages of porcelain veneers over composite veneers
47) inter appointment root canal medication in endo
a) ca(oh)2 b) MTA c) 5%chlorhexidine d) …….
48)veracity, do no harm
49) torches
50) cracked tooth syndrome- clinical symptoms
51) why is important to rule out okc
a) due to potential for malignancy b) asso with nevoid basal
cell carcinoma c) recurrence rate d) infection

52) spaces involved in ludwigs angina
53) best analgesic for alcoholics
a) hydroxycodeine+ acetaminophen b) acetaminophen
c) cocaine d) ibuprofen ( no oxycodeine in options)
54) Q about wheel chair transfer- I choose ask the patient
55) margins and contraindications in MWF
56) q about recession next to healthy keratinized gingiva –
laterally positioned graft
57) which AB is seen in high concentrations in gingival sulcus
58) during a osseous surgery the interdental bone height is
reduced below the labiolingual bone height
a) reverse architecture b) normal architecture ……….
59) most common type of periodontal disease seen in high
school children
a) marginal gingivitis b) anug c) herpetic gingivitis
d) herpangina

60) dry socket treatment
61) VDR – VDO = 3-5mm which is equal to
a) normal space of speaking b) increase in interocclusal space
c) …don’t remember the options

62) myasthenia gravis best antibiotic
63) cells abundant in an abcess
64) most common crown root ratio
65) most common fracture seen in kids- condylar
66) lip paresthesia seen in
a) malignancy b) okc c) nerve damage d) cerebrovascular
damage
67) epi with propranolol act on which receptors
68) pictures of ---- hemangioma on tongue, anug, melanotic
macule, draining sinus of a carious tooth
69) most radio resistant tissue
70) when there is arch length discrepancy which tooth moves
out of the arch
71) periapical abscess vs periodontal abscess – EPT
72) GTR – indications and contraindications
73) clindamycin – MOA and side effects
74) smokeless tobacco asso with
75) Desensitization, active listening
76) 17cc carpule of 2% lido, how much 1:50000 epi somrthing…
77) combination syndrome includes all except
78) pharma I had all straight forward questions
79) best way to clean a grade2 furcation
a) tooth pick b) water pick c) interdental brush d) scaler…
80) orange green stain on the tooth?

1. The decision to replace an existing amalgam restoration should be made as soon as the
restoration exhibits
A- Creep
B- Recurrent caries
C- Corrosion and tarnish
D- Ditching around occlusal margins
2. A child’s behavior problem can be managed by desensitization if the basis of the problem is
A- Pain
B- Fear
C- Emotional
D- The parents
3. A 9 year old presents with acute gingival pain of four days duration. There are small, round
ulcers on the interproximal gingival and buccal mucosa. Which of the following is the most likely
diagnosis?
A- Primary herpetic gingivostomatitis
B- Necrotizing ulcerative gingivitis
C- Aphthous stomatitis
D- Gingival abscess
4. Which of the following has been most strongly implicated in the cause of aphthous stomatitis?
A- Cytomegalovirus
B- Allergy to tomatoes
C- Herpes simplex virus
D- Staphylococcal organisms
E- Human leukocyte antigens
5. Which of the following premolars is most likely to have three canals?

A- Maxillary first
B- Maxillary second
C- Mandibular first
D- Mandibular second
6. One advantage of using a fiber-reinforced post for restoring an endodontically treated tooth is
that it
A- Has a modulus of elasticity similar to stainless steel
B- Has a modulus of elasticity similar to dentin
C- Is highly radiopaque and easy to visualize on a radiograph
D- Is stronger and more resistant to fracture than a cast metal post
7. A patient with Stage I medication related osteonecrosis of the jaw (MRONJ) with exposed bone
in the maxilla is best treated with
A- Radiation therapy
B- Hyperbaric oxygen
C- Debridement of the area
D- Chlorhexidine rinses
8. If a particular test is to correctly identify 95 out of 100 existing disease cases, then that test
would have a
A- Specificity of 95%
B- Sensitivity of 95%
C- Positive predictive value of 95%
D- Validity of 95%
9. What percent of hydrogen peroxide should be used for debriding and intraoral wound?
A- 3 percent
B- 10 percent
C- 20 percent
D- 37 percent
10. Disadvantages of oral sedation include which of the following?

A- Multiple drugs needed for proper sedation
B- High incidence and severity of adverse reactions
C- Unpredictable absorption of drugs from the GI tract
D- Short duration of action
11. Auxiliary resistance from features in fixed dental prostheses such as boxes and grooves should
ideally be located?
A- Facially
B- Lingually
C- Occlusally
D- Proximally
12. Which of the following factors does NOT impact the development of xerostomia in an aging
population?
A- Chronological age
B- Medications
C- Radiation therapy to the head and neck
D- Systemic disease
13. Informed consent reflects which of the following ethical principles?

A- Justice
B- Autonomy
C- Beneficence
D- Nonmaleficense
14. Which of the following type(s) of amalgam alloy provide the best clinical durability?
A- High copper spherical only
B- Conventional spherical only
C- High cooper admixture and high cooper spherical
D- High cooper admixture and conventional spherical
15. Drug-induced hypnosis can be produced by depressing which of the following?

A- Cerebellum
B- Hypothalamus
C- limbic system
D- Reticular activating system
16. Mandibular hypoplasia, coloboma of the lower eyelid, and malformations of the prinna of the ear
are fracture of which of the following diseases?
A- Apert Syndrome
B- Cleidocranial dysplasia
C- Mandibulofacial dysostosis (Treacher Collins Syndrome)
D- Crouzon syndrome (craniofacial dysostosis)
17. Which permanent teeth are least often congenitally missing?

A- Lateral incisors
B- Canines
C- Premolars
D- Third molars
18. The water supply of a community has 0.28 ppm fluoride. Which of the following procedures is
appropiate for a 4-year-old child exhibiting moderate caries risk?
A- Prescribing a fluoride mouthrinse
B- Prescribing a systemic fluoride supplement
C- Applying fluoride topically at each visit
D- Additional fluoride is unnecessary
19. Phenytoin is most often recommended for controlling which of the following seizures?
A- Status epilepticus
B- Tonic-clonic (grand mal)
C- Absence epilepsy (petit mal)
D- Myoclonic seizure in childhood
20. Which of the following is a interference during working movements for a posterior complete
crown restoration?
A- The lingual inclines of mandibular teeth contact the buccal inclines of maxillary teeth
B- The lingual inclines of mandibular teeth contact the lingual inclines of maxillary teeth
C- The buccal inclines of mandibular teeth contact the buccal inclines of maxillary teeth
D- The buccal inclines of mandibular teeth contact the lingual inclines of maxillary teeth
21. The purpose of scaling is to remove acquired deposits on the teeth.
Scaling can be performed on both enamel and root surfaces
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
22. Which of the following would be LEAST likely to lead to the development of root surface
caries on facial surfaces?
A- Low salivary flow
B- Elevated levels of sucrose consumption
C- Streptococcus sanguis dominating adjacent plaque
D- History of head/neck radiation therapy
23. A patient’s mandibular canal is positioned lingually to her mandibular third molar. In what
direction would the canal appear to move on a radiograph, if the X-ray tube were moved inferiorly
(i.e., if the x-ray beam were pointing superiorly)?
A- Apically
B- Mesially
C- Distally
D- Occusally
24. Dental phobia is classified as a personality disorder

Dental anxiety can result from the pairing of previously innocuous stimuli with an unpleasant
experience
25. What is the easiest method for examining a 12-month-old child?

A- Child in the dental chair and parent at chairside
B- Parent in the dental chair and the child sitting on parent’s lap
C- Dentist and parent in a knee-to-knee position whit the child’s head on dentist’s lap
D- Dentist and parent in a knee-to-knee position with the child’s head on parent’s lap
26. Each of the following is a common cause of denture gagging EXCEPT one. Which is the
EXCEPTION?
E- Inadequate posterior palatal seal
F- Excessive vertical dimension
G- Bulkiness of denture
A- Excessive anterior guidance
27. Which of the following will allow transillumination of the light throughout the crown?
A- Crack extending into denting
B- Crown-to-root fracture
C- Craze line
D- Split tooth
28. Plaque microorganisms produce extra-cellular substances that separate one bacterial cell from
another and that form a matrix for further plaque accumulation. This “matrix” is made up of
dextrans and
A- Levans
B- Mucoproteins
C- Disaccharides
D- Monosaccharides
29. What is the most common side effect when administering nitrous oxide and oxygen?
A- Allergic reaction
B- Respiratory depression
C- Tachycardia
D- Nausea
30. A displaced fracture of the mandible courses from the angle to the third molar. This fracture
is potencially difficult to treat with a closed reduction because of
A- Injury to the neurovascular bundle
B- Malocclusion secondary to the injury
C- Compromise of the blood supply to the mandible
D- Distraction of the fracture segments by muscle pull
31. Each of the following is a common cause of denture gagging EXCEPT one. Which is the
EXCEPTION?
A- Inadequate posterior palatal seal
B- Excessive vertical dimension
C- Bulkiness of denture
D- Excessive anterior guidance
32. What is the minimum amount of bone needed between 2 adjacent implants?
A- 1mm
B- 2mm
C- 3mm
D- 4mm
33. Which of the following statements is true about setting expansion of plaster, stone, and
improved stone (Type IV)?
A- The setting expansion of improved stone is the highest
B- Increasing the spatulation decreases expansion
C- Increasing the water/power ratio decreases the setting expansion
D- Adding water to surface during setting decreases expansion
34. Which of the following represents the best way to increase a patient’s pain tolerance?
A- Stress that pain does not signify damage
B- Tell the patient that the procedure will be completed soon
C- Tell the patient that he/she should be able to tolerate the pain
D- Increase the patient’s sense of control over the denture of the pain
35. Which of the following explains why the fovea palatini are not used as landmarks for
determining the precise posterior border of maxillary denture base?
A- They have no relation to the vibrating line area
B- They are inconsistent in their relationship to the vibrating line
C- They are opening of mucous glands that should not be covered y the denture border
D- They are located on the horizontal hard palate
36. Which of the following is the most reliable method for determining the pulp responsiveness of
a tooth with a full coverage crown?
A- Radiographic examination
B- Electric pulp test
C- Thermal test
D- Palpation
37. Which of the following is an indication for removal of a maxillary torus to fabrication of a
maxillary denture?
A- Inadequate inter-arch space exists
B- Tissue covering torus is thin
C- It interferes with posterior palatal seal
D- Denture is to be placed immediately
38. A new patient presents with severe chronic periodontitis and has a history of two heart
attacks. The patient is not sure when the heart attacks occurred or the severity. The dentist’s
next step in treatment should be to
A- Complete gross scaling to decrease the bacterial load
B- Have the patient rinse with chlorhexidine gluconate (Peridex)
C- Request a consult from the patient’s physician prior to any treatment
D- Confine the treatment to simple restorative procedures
39. Which hematologic disorder represents a malignancy of plasma cell origin?
A- Burkitt lymphoma
B- Hemophilia
C- Thalassemia
D- Multiple myeloma
40. Which of the following might precipitate an asthma attack?

A- Narcotic analgesics
B- Nonsteroidal antiinflamatory drugs
C- Corticosteroids
D- Sympathomimetic amines
41. Which of the following most closely resembles normal parotid gland histologically?
A- Pleomorphic adenoma
B- Monomorphic adenoma
C- Acinic cell carcinoma
D- Adenoid cystic carcinoma
42. The most dominant emotional factor in management of 4-to-6-year-old children is fear of
A- Pain
B- The unknown
C- The dentist
D- Being separated from parents
43. Gingivectomy is NOT indicated when the base of the pocket is located
A- Apical to the alveolar crest
B- Below the free gingival groove
C- Coronal to the cementoenamel junction
D- Apical to the cervical convexity of the tooth crown
44. Which of the following neuralgias is correctly associated with its cranial nerve?
A- Tic douloureux – XII
B- Bell palsy – VII
C- Auriculotemporal syndrome – VI
D- Eagle syndrome – X
45. A furcation radiolucency in a 5-year-old child’s primary molar is most due to

A- Trauma
B- Pulpal necrosis
C- Normal anatomy
D- Eruption of a premolar
46. In which of the following mandibular fracture cases should the intermaxillary fixation be
released earliest?
A- A high condylar fracture
B- A fracture through the site of an impacted third molar
C- An angle fracture and contralateral parasymphyseal fracture
D- A jaw in which the treatment has been delayed by the management of other injuries
47. A dental office employee wishes to verify that instruments have been sterilized. Which of the
following methods is most accurate?
A- Place indicator tape on the instruments
B- Use biological monitors
C- Examine the sterilizer packages for color changes
D- Observe the temperature gauge on the sterilizing unit
48. A normal unstimulated salivary flow rate for an adult dentate patient should be
A- 0.01 mL per minute
B- 0.1 mL per minute
C- 1.0 mL per minute
D- 10.0 mL per minute
49. Which of the following represents a common side effect of the alkylating-type anticancer
drugs such as mechlorethamine (Mustargen)?
A- Ototoxicity
B- Nephrotoxicity
C- Bone marrow depression
D- Accumulation of uric acid
50. Which of the following directly image the TMJ disc?

A- TMJ tomography
B- TMJ arthrography
C- Panoramic radiography
D- Transcranial radiography
E- Magnetic resonance imaging
51. Excessive trituration of amalgam should be avoided because it will

A- Cause excessive expansion
B- Cause the amalgam to set prematurely
C- Remain soft for too long
D- Cause the amalgam to lose its anatomy in 24 hours
52. Which of the following is most likely the major consideration prior to performing a
gingivectomy?
A- Amount of attachment loss
B- Measurement probe depth
C- Level of the alveolar crest
D- Width of the attached gingiva
53. Regeneration of the periodontal attachment apparatus include

A- Cementum, bone, and periodontal ligament
B- Dentin, cementum, and periodontal ligament
C- Cementum, junctional epitelium, and bone
D- Junctional epithelium, gingival fibers, and periodontal ligament
54. A dentist will make impressions for a patient who has an excessive salivary flow. To decrease
the flow, this dentist might appropriately prescribe which of the following drugs?
A- Propantheline (Pro-Banthine)
B- Salsalate (Disalcid)
C- Pilocarpine (Salagen)
D- Neostigmine (Prostigmin)
55. At 90 kVp and 15mA at a BID distance of inches, the exposure time for a film is 0.5 seconds.
In the same situation, which of the following should represent the exposure time at 16 inches?
A- 0.25 seconds
B- 1.0 second
C- 2.0 seconds
D- 4.0 seconds
56. Which of the following study designs is the best suited to control for both known and unknown
confounders?
A- Case-control study
B- Cross-sectional study
C- Cohort study
D- Randomized clinical trial
57. A dentist has planned in-office-bleaching and porcelain laminate veneers for a patient’s
maxillary anterior teeth. What would be the best sequence of treatment?
A- Bleaching, 2 week delay, tooth preparation, bonding procedures
B- Bleaching and tooth preparation, 2-5 day delay, bonding procedures
C- Tooth preparation, 2 week delay, bleaching, and bonding procedures
D- Tooth preparation, 2 week delay, bonding, and then bleaching procedures
58. A 14-year-old female has gingival tissues that bleed easily on gentle probing. The color of the
gingiva ranges from light red to magenta. Probing depths range from 1 - 3mm. Some of the
interdental papillae are swollen. Which of the following represents the most likely diagnosis?
A- Gingivitis
B- Localized aggressive periodontitis
C- Herpetic gingivostomatitis
D- Necrotizing ulcerative gingivitis
59. A 65-year-old white male smokes 2 packs of cigarretes per day. He had a heart attack six
weeks ago and continues to have chest pains even while at rest. He is transported to the office by
wheelchair because be becomes extremely short of breath with even mild exertion. The physical
status that best describes the above patients is
A- P.S.I
B- P.S.II
C- P.S.III
D- P.S.IV
60. Which of the following substances is contraindicated for a patient taking ginseng?
A- Penicillin
B- Digitalis
C- Aspirin
D- Alcohol
61. What is the indicated treatment for a primary molar with a carious pulp exposure and a
furcation radiolucency?
A- Formocresol pulpotomy
B- Indirect pulp cap
C- Extraction
D- Direct pulp cap
62. The pathogenic microorganisms of chronic periodontitis includes each of the following EXCEPT
one. Which one is the EXCEPTION?
A- Porphyromonas gingivalis
B- Prevotella intermedia
C- Tannerella forsythensis
D- Actinomyces viscosus
63. Compared with high noble alloys for metal-ceramic restorations, base metal alloys are best
used for which of the following?
A- Optimum esthetics
B- Single crowns
C- Long-span bridges
D- Patients with allergies to metals
64. Adolescents undergoing orthodontic treatment often have problems with home oral hygiene
regimens. The MOST effective management plan is to
A- Educate the patient about the importance of oral hygiene when wearing braces
B- Develop a plan of contingent reinforcement for brushing and flossing
C- Refuse to continue treatment unless oral hygiene improves
D- Have parents remind adolescents to brush
E- Provide limited praise for small progress made at each visit
65. In attempting to correct a single tooth anterior crossbite with a removable appliance, Which of
the following is the most important for the dentist to consider?
A- Making periodic adjustments
B- Incorporating maximum retention
C- Patient’s overbite
D- Making sure there is adequate space
66. Patients with low health literacy are

A- Less likely to ask questions during their dental visits
B- More likely to fail to show for dental appointments
C- Likely to look over written materials and say they don’t understand
D- High school graduates
67. Which of the following represents the most significant finding regarding ectodermal dysplasia?
A- Multiple osteomas
B- Supernumerary teeth
C- Multiple impacted teeth
D- Sparse hair
68. Surgical flap access therapy is indicated and most beneficial when used
A- For those early to moderate defects not resolved with initial therapy
B- As the initial treatment for patients having extremely heavy subgingival calculus
C- To eliminate pocketing more rapidly so the patient can proceed with treatment
D- To improve plaque control effectiveness in patients having difficult achieving good plaque
control
69. Which of the following is NOT true regarding paraphrasing?

A- Paraphrasing is restating the patient’s views in one’s own words
B- Paraphrasing is agreeing with and accepting the other person’s position
C- The secret to good paraphrasing is voicing patient values
D- Paraphrasing is attempt to understand and acknowledge another’s perspective
70. The mother of an 8-year-old patient insists on staying in the room during treatment. In the
past, she seemed to be very overprotective of her child with her body language and comments.
Which were disruptive to treatment. How could the dentist best address this patient’s mother?
A- “You seem really concerned, perhaps you need to be talking with someone about this”
B- I know you care, however you are causing your child to be more upset, no less”
C- “I’m sorry, but I need you to stay in the waiting room so we can get his work done”
D- “I know you are concerned. Please stay in the room, and try to be as positive and quiet as
possible”
71. A ‘W” in front of the rubber dam clamp number indicates that the rubber dam clamp
A- Is made from work-hardened metal
B- Has a non-reflective surface
C- Has a wing
D- Is wingless
72. Subgingival margin of crown is indicated when

A- Surrounding soft tissue is thick bio-type
B- Porcelain laminate veneer is planned
C- An all-ceramic crown is planned
D- Cemental hypersensitive is suspected
73. Most dens invaginatus defects are found in which of the following types of teeth?
A- Maxillary central incisor
B- Maxillary lateral incisor
C- Mandibular first premolar
D- Maxillary first premolar
74. A panoramic radiograph of a 55-year-old female reveals generalized widening of the

periodontal ligament space and bilateral resorption of the mandibular angles. What is the most
likely diagnosis?
A- Fibrous dysplasia
B- Progressive systemic sclerosis
C- Osteosarcoma
D- Marfan syndrome
75. Which of the following is NOT a characteristic of a modified Widman Flap procedure?
A- Submarginal incision
B- Replaced flap
C- Inverse bevel incision
D- Flap margin placement at the osseous crest
76. A developmentally-disabled patient should be treated with
A- Flattery
B- Deference
C- Consistency
D- Permissiveness
77. Which of the following is the best choice to avoid the effect of metamerism?
A- Select a porcelain shade using light only
B- Select the shade that looks optimal under multiple light sources
C- Avoid fluorescent lighting when selecting a porcelain shade
D- Add additional layer of opaque porcelain prior to placing body porcelain
78. A 55-year-old male patient, who is currently prescribed warfarin (Coumadin) 5 mg daily,
requires surgical therapy. What is the most appropiate pre-surgical laboratory test?
A- Fibrinogen time
B- Partial thromboplastin time
C- International normalized ratio
D- Bleeding time
79. Which term refers to a physician or dentist performing an operation for which there was no
consent?
A- Assault
B- Nonmaleficence
C- Disclosure
D- Battery
80. Blocking the synthesis of prostaglandins does NOT produce which of the following conditions?
A- Antipyresis
B- Increased gastric mucous production
C- Decreased platelet aggregation
D- Decreased renal blood flow
81. Leukemia is suspected when a patient demonstrates which of the following sighs or symptoms?
A- Red sclera
B- Pale conjuntiva
C- Splinter hemorrhage under the finger nails
D- Spontaneous gingival bleeding
82. During clinical evaluation of a complete crown on a mandibular right first molar, a premature
contact causes the mandible to deviate to the patient’s left. One would expect to see the
interfering contact marked on which surfaces of the crown?
A- Mesial marginal ridge
B- Buccal inclines
C- Mesial inclines
D- Lingual inclines
83. The best time perform oral surgery on a patient receiving dialysis 3 times per week is
A- Day of dialysis
B- 1 day before dialysis
C- 1 day after dialysis
D- 2 days after dialysis
84. Infections arising from the periapical region of the mandibular first premolars perforate
through the lingual cortex to the
A- Pterygomaxillary space
B- Submental space
C- Sublingual space
D- Submandibular space
85. Which of the following represents the 3 essential factors for the initiation of the carious
lesion?
A- Bacteria, polysaccharides, and enamel
B- Bacteria, suitable carbohydrate, and susceptible tooth
C- Lactobacilli, easily fermentable carbohydrate, and susceptible tooth
D- Lactobacilli, suitable substrate, and enamel
86. Causality (cause and effect) may NOT be inferred from which of the following studies?
A- Cross-sectional
B- Cohort
C- Case-control
D- Clinical trial
87. Which teeth are the most susceptible to recurrence of periodontal disease after active
periodontal treatment is completed?
A- Maxillary premolars because of lateral occlusal forces
B- Mandibular premolars because of non-working interferences
C- Maxillary molars becauses of anatomy of their furcations
D- Mandibular molars because of increased number of cervical enamel projections
88. What is the LEAST likely reason for postoperative sensitivity after a Class I occlusal
composite restoration is placed?
A- Gap formation which allows bacterial penetration into the dentin tubules
B- Gap formation which allows an outward flow of fluid from through the dentin tubules
C- Direct toxic effects of a 15 second acid etc on the pulp
D- Cuspal deformation due to contraction forces of polymerization shrinkage
89. Which area of the mouth has the LEAST amount of keratinized tissue on the buccal aspect?
A- Maxillary incisors
B- Maxillary premolars
C- Mandibular incisors
D- Mandibular premolars
90. Pain referred to the ear derives most often from which teeth?
A- Maxillary molars
C- Mandibular molars
91. During a routing examination, the dentist sees a large radiolucency at the apex of the maxillary
right first premolar. The tooth is not painful, does not respond to pulp testing, and has no evidence
of a sinus tract. The most probable diagnosis is
A- Asymptomatic apical periodontitis
B- Symptomatic apical periodontitis
C- Symptomatic irreversible pulpitis
D- Chronic apical abscess
92. A 32-year-old male patient reports a history of having been hospitalized for psychiatric
evaluation, and is currently taking taking lithium carbonate on a daily basis. Which of the following
diseases does this patient most likely have?
A- Parkinsonism
B- Schizophrenia
C- Bipolar disorder
D- Psychotic depression
E- Paranoia with delusions
93. To achieve ideal overjet and overbite in an adult patient with a 16 mm pretreatment overjet,
orthodontic treatment would most likely require
A- Orthodontic tooth movement only
B- Orthognatic surgical treatment only
C- Combined orthodontic/surgical treatment
D- Premolar extraction therapy only
94. A patient has only the mandibular anterior teeth remaining. The treatment plan calls for a
maxillary complete denture and mandibular removable partial denture. Which of the following is
desirable in the occlusal scheme?
A- Bilateral simultaneous contact of anterior and posterior teeth in centric relation position
B- Canine guidance with posterior disclusion during excursive movements
C- Bilateral balanced contact during excursive movements
D- Unilateral group function during excursive movements
95. An edentulous patient is to be treated using maxillary and mandibular complete dentures. The
patient is healthy and the ridges are well healed. A maxillary torus is present and extends beyond
the area of the proposed posterior palatal seal. Which of the following represents the treatment
of choice?
A- Removal of torus, followed by fabrication of maxillary and mandibular complete dentures
B- Extension of maxillary denture base onto the moveable soft palate to achieve adequate seal
C- Fabrication of a maxillary denture with an open/horshoe palate which avoids the torus
D- The use of relief over the area of the torus during maxillary and mandibular denture fabrication
96. The patient should sign the informed consent for surgery
A- At the time of filling out history and insurance forms
B- After medical history and physical examination
C- After formulation by dentist of a surgical treatment plan
D- After a full discussuion of the surgical treatment plan
97. Which of the following is the single most important factor affecting pulpal response to tooth
preparation?
A- Heat
B- Remaining dentin thickness
C- Desiccation
D- Invasion of bacteria
98. Metastatic disease to the oral region is most likely to occur in Which of the following
locations?
A- Tongue
B- Posterior maxilla
C- Posterior mandible
D- Floor of the mouth
99. Glossitis and angular cheilitis are oral manifestations of what type of nutrient deficiency?
A- Calcium
B- Vitamin D
C- Iron
D- Zinc
100. Distinctly blue color of the sclera is a feature of Which of the following conditions?
A- Gardner syndrome
B- Osteogenesis imperfecta
C- Hypohydrotic ectodermal dysplasia
D- Stuge-weber angiomatosis
101. A 16-year-old patient has a long history of mild pain in the area of the mandibular left first
molar. Radiographs reveal deep caries in the tooth with an irregular radiopaque lesion apical to the
mesial root. Which of the following represents the most likely diagnosis?
A- Periradicular granuloma
B- Condensing osteitis
C- Asymptomatic apical periodontitis
D- Periapical cyst
102. Diagnostic radiology is based on which of the following interactions of X-radiation with
matter?
A- Thompson effect
B- Pair production
C- Photoelectric effect
D- Photonuclear disintegration
103. Each of the following would be included in a differential diagnosis of the palatal pigmentation
EXCEPT one. Which is the EXCEPTION?
A- Lentigo
B- Melanotic macula
C- Melanocytic nevus
D- Melanotic neuroectodermal tumor
104. Paresthesia of the inferior alveolar nerve is most often seen after the fracture of which area
of the mandible?
A- Angle
B- Condyle
C- Symphysis
D- Coronoid process
105. A patient says, “I have been avoiding coming to see you because there is an ugly, red sor spot
on the roof of my mouth”. Which of the following responses by the dentist best exemplifies a
reflective response?
A- “Has you diet changed lately”
B- “You really shouldn’t worry about it”
C- “Don’t be afraid, I’ll take a careful look”
D- “You should have had something like that looked at right away”
E- ‘It sounds as if you’re quite concerned about this condition”
106. Which of the following is related to reciprocal anchorage in orthodontic therapy?

A- Tipping a tooth
B- Extraoral force
C- Equal and opposite forces
D- Bodily movement of a tooth
107. Diazepam-mediated effects include

A- Peripherally-acting muscle relaxation
B- Lowering seizure Threshold
C- Anterograde amnesia
D- Analgesia
108. What is the maximum recommended dose of acetaminophen that can be prescribed in a 24
hour time period?
A- 2.5 grams
B- 3 grams
C- 3.5 grams
D- 4 grams
109. Although the results of a diagnosis test are NOT necessarily accurate, they are consistent.
This test has high
A- Generalizability
B- Specificity
C- Reliability
D- Validity
110. Nitrous oxide/oxygen is contraindicated for patients

A- With anxiety
B- With special health care needs
C- With profound local anesthesia
D- In the first trimester of pregnancy
1- The patient
A- Is at increased risk for bleeding
B- Is at increased risk for hepatocellular carcinoma
C- Is a potential carrier for hepatitis A
D- Had a disease that does not involve a bloodborne pathogen
2- Which side-effect of sertraline (Zoloft) has implications for the patient’s oral health?
A- Gingival inflammation
B- Salivary hypofunction
C- Tissue hyperplasia
D- Aphthous ulcers
3- The patient states that “all of my teeth are sensitive to hot and cold, and my gums bleed
whenever I brush my teeth”. The initial treatment should involve each of the following EXCEPT one.
Which one is the EXCEPTION?
A- Full-mouth scalling and root planning
B- Prescription for a desensitizing toothpaste
C- 4 quadrants of periodontal surgery
D- Home care instruction, then follow up visit
4- The most likely cause of the V-shaped radiolucency between the roots of the teeth 2 and 4
would be
A- An idiopathic bone cavity
B- A maxillary sinus pseudocyst
C- Maxillary sinus
D- A radicular cyst
5- Which would NOT be included in a differential diagnosis of the right mandibular radiolucency?
A- Keratocystic odontogenic tumor
B- Ameloblastoma
C- Periapical (radicular) cyst
D- Lateral periodontal cyst
D- Aphthous ulcers
7- The best initial management for the mandibular radiolucency would be

A- Radiographic follow-up in 6 months
B- Endodontic therapy on tooth 31
C- Incisional biopsy
D- Block resection
8- The technique to image the lingual opacity was

A- An occlusal radiograph
B- A modified panoramic image
C- An axial plane cone beam CT
D- A modified periapical radiograph
9- What is the Angle Classification of the molar relationships?

A- Left Class I, Right Class II
B- Left Class I, Right Class III
C- Left Class II, Right Class I
D- Left Class II, Right Class III
E- Left Class III, Right Class I
10- An exaggerated curve of the occlusal plane and loss of the image clarity of the roots of the
anterior teeth is indicative of a
A- Normal finding
B- Panoramic positioning error
C- Film processing error
D- Developmental disorder
11- Preventive oral health behavior is influenced by each of the following factors EXCEPT one.
A- Public policy
B- Social context
C- Psychological factors
D- Access to preventive measures
12- What is the most likely cause of the chalky-white appearance of the enamel of this patient’s
teeth?
A- Fluorosis
B- Ectodermal dysplasia
C- Amelogenesis imperfecta
D- Dentinogenesis imperfecta
13- Which is true about the position of tooth 27?

A- Missing premolar on the mandibular left has allowed more space for the left canine
B- Mandibular incisors have shifted to the right blocking out the right canine
C- Posterior teeth have drifted mesially more on the mandibular right than the left
D- Right canine has ankylosed whereas the left canine has undergone normal eruption
14- The lesion between teeth 30 and 31 is treated by enucleation and curettage. Each of the
following are risks with this procedure EXCEPT one. Which is the EXCEPTION?
A- Devitalization of teeth 30 and 31
B- Damage to the lingual nerve
C- Post-operative infection
D- Damage to the inferior alveolar nerve
E- Lesion recurrence
ARROZ CON MANGO
Dear friends, these are remembered/repeated questions (RQs) and answers I COPIED
and PASTED from different discussions on Facebook. I feel sorry because I couldn’t
organize the file the way I wanted but I hope it helps. Probably you’ll find some wrong
answers in this file, but PLEASE … DO NOT CRITICIZE! Find out the right answer, learn it,
share it, PASS your test and BE HAPPY J
I wish you all the best
GOD BLESS YOU!
PAITO
1. All of the following are adverse effects of opioids except? diarrhea and somnolence
2. Advantage of osteogenesis distraction is? less relapse, large movements
3. An investigation that is not accurate but consistent is: reliability
4. Remineralized enamel is rough and cavitation? Dark hard and opaque
5. Characteristics of a child with autism - repetitive action, sensitive to light and noise
6. S,z,che sounds : Teeth barely touching – True
7. Something about bio-transformation, more polar and less lipid soluble? - True
8. How much of he population has herpes? 80% - (65-90% worldwide; 80-85% USA) More
than 3.7 billion people under the age of 50 – or 67% of the population – are infected
with herpes simplex virus type 1 (HSV-1), according to WHO's first global estimates of
HSV-1 infection published today in the journal PLOS ONE.
9. Steps of plaque formation: pellicle, biofilm, materia alba, plaque
10. Dose of hydrocortisone taken per year that will indicate have adrenal insufficiency
and need supplement dose for surgery - 20 mg 2 weeks for 2 years
11. Rpd clasp breakage due to what? Work hardening
12. Most impacted tooth? Third molar not in options - Maxillary canine
13. Least common survival of lip cancer – white female
14. Aspirin mode of action - inhibit irreversible platelet aggregation thromboxane a2
15. Myasthenia gravis, what is contraindicated? erythromycin and aminoglycosides
16. Treatment for ANUG - Debridement and mouth rinse with h2O2 and if systemic
involvement then antibiotics
17. Which type of periodontitis needs antibiotics – LAP
18. Antibiotic used for periodontitis - Tetra and Pen V, also metro
19. Asthma physiology definition - Wheezing on expiration
20. Ranitidine definition - Selective H2 (Histamine) receptor antagonist, these receptors
are present in Gastric mucosa lining. Thereby blocking the receptors and prevents
release of Gastric acid.
21. Which is prevalent: 1 wall defect, 2 wall defect, 3 wall defect
22. Penumbra definition - Penumbra is lack of sharpness of the film.
23. Which is more hydrophillic pvs or polyether (this question was asked to me twice
during day1) - Polyether (but also hydrocolloids)
24. Many questions on study model all leading to a common answer that was cross
sectional study model (they tend to repeat the questions in different formations during
day 1).
25. Face division vertically and horizontally - vertical 3 and horizontal 5
26. Disease more common in men (hemophilia)
27. One q on relation between incisal guidace is equal and condylar guidance - When
adjusting the condylar guidance for protrusive relationship, the incisal guide pin on
the articulator should be raised out of contact with the incisal guided table.
28. Many qs on study model leading to a common answer that was clinical trail (mostly
they were on effectively of practices, drugs, etc).
29. Which has poorest prognosis and the answer was PLGA salivary gland tumor. They
had confused it with adenoid cystic and mucoepi - False - Pleomorphous Low Grade
Adenocarcinoma (PLGA) has good prognosis after surgical excision (Mosby) – I think
answer is Adenoid Cystic Carcinoma
30. A lot of questions on anti cancer drugs so study it carefully… really sorry that i don’t
remember them as I was poor in that topic - Dihydrofolate reductase by
methotrexate, amoxicillin inhibits renal tubular secretion of methotrexate.
31. What comes before plaque or pellicle or biofilm
32. Deepest part of occlusal rest for rpd - marginal ridge
33. Simple questions in oral patho about cleidocranial as to what it affects (clavicles)
34. Many many many questions in endo with positive or negative findings in relation to
percussion, palpation, night pain and then diagnosis of the combinations were asked.
35. Simple questions in relation to pulpectomy and pulpotomy: pulpotomy - vital /
pulpectomy - non vital
36. Questions on modellling technique in pt mngmt (pt made to observe his cousins or
friends behaviour to improve his own)
37. Disto buccal extension of mandi cd lateral limit influenced by masseter or ramus
38. Key feature of the custom tray during final impression is its under extension? - The
custom tray for a final mandibular or maxillary complete denture impression should
have a spacer w/ stops to ensure the tray will be seated in proper relationship to the
arch, and to ensure adequate room for the impression material. Other features:
trimmed 2 mm short of the mucosal reflection and frenae. The primary indicator of the
accuracy of border molding is the stability and lack is displacement of the tray in the
mouth.
39. Class ii and iii drug:
S II: amphetamines, morphine, cocaine, pentobarbital, oxycodone, methadone,
codeine, and Percocet (acetaminophen + oxycodone). (Must have a written
prescription and cannot be refilled)
S III: Tylenol 3, Vicodin - must have a written prescription, refills do not need new
prescription and may be called into the pharmacy.
40. Absolute contra of papoose straps emergency situation or a co-operative patient

41. Hemorrhage common complication of maxi extractions and to my surprise the same
question with mandi extractions was asked but without the option of dry socket,
infection was the only sane option so i went for it.
42. A lot of questions on 3/4th and 7/8 crowns but they were basic ones and i could
derive the answer by using the facts given in dental decks.
43. A lot of questions on ethical principals of a dentist (guys for these questions please ref
to the ethical principal details mentioned on the ada website…. If you do it from there
you will be able to nail each and every one of:
http://www.ada.org/~/media/ADA/Member%20Center/FIles/2016_ADA_Code_Of_Ethics.
pdf?la=en
44. What sound is affected if incisors are placed too far superiorly and ant: f and v
45. Best (conservative) method to close a 1 mm non patho diastema in a young adult is:
composite
46. If a patient doesn’t have 3rd molars how many furcations will he have in mxi arch (to
make the calculation simple there are three furcations for maxi teeth mesial distal and
Buccal rest is simple calculation) - 16 - maxillary molars have 3 furcations (4 molars * 3
furcations = 12), 1st pm is bifurcated, that means it has 2 furcations (2*2=4). We have
16 furcations. 2nd premolars, central incisors, lateral incisors and canines do not have
furcations.
47. Most common site for graft iliac – true
48. Most common site for mandi fracture – condyle
49. Complication with distraction osteogenesis - nerve damage
50. Implant analogue used to replicate the position of implant on the implant platform
(confusing options were if its used for impressions? Nope that’s impression copings –
An implant analogue is an implant replica and is inserted into the set impression
material before the cast is poured. Impression coping is attached directly to the
implant fixture head. Impression copings facilitate transfer of the intraoral location of
the implant to the same position on the laboratory cast. Impression copings can be
either screwed into the implant body or screwed or snapped onto an implant
abutment.
51. Simple questions on implants like distance from adjacent tooth and the implant
1.5mm
52. Distance from the ant loop and the implant which is 5mm
53. During IANB bleeding is caused due to puncture into which artery – inferior alveolar
artery
54. Two questions on ideal resto material for a class v lesion but this patient was young
and had an active caries condition (I was shocked to see this question repeat twice
with minor formation changes) - According to DD: glass ionomer is indicated in high
caries risk and CLASS V where esthetics is a concern, so I would go with GIC.
55. Two questions on the incision for int bevel in which direction is it directed - the internal
bevel incision (reverse bevel) starts at a distance from the gingival margin and is
aimed at the bone crest.
56. Which of the following cements should not be used with all ceramic restorations due
to reports of ceramic fractures? 1. Gic 2. Resin luting cement 3. Zinc phosphate
cement 4. Resin modified GIC
57. Same went for gingivectomy (same q on where is the incision directed) - above
mucogingival junction .
58. Why do we remove bone during modified widman flap - to achieve a good tissue
adaptation to the neck of the teeth.
59. Which type of comp are used for two cases posterior comp and for repairing small
occlusal defects (micro, mid, macro, etc ) - Microhybrids - they have particular size
small enough to polish to a shine similar to microfills but large enough to be highly
filled, thus achieving higher strength. Particle size small enough to polish and high
strength. Retain good properties of hybrids (strength), with improved handling.
Polishability almost equal to microfills. Universal use—anterior and posterior
restorations.
- Microfills: high polishability but low fracture toughness (esthetic areas, anterior
restorations), lower elastic modulus—better in class V situations.
- Hybrids: not high polish but improved physical properties compared to microfills.,
Universal use—anterior and posterior restorations.
- Macro filled composites: First-generation” restorative composites. Poor physical and
mechanical properties. Poor esthetics.
60. Why don’t we do posterior comp - because of its low wear resistance we don’t do
posterior composite in cases of bruxism.
61. Dentist does a comp but shade is too light what is the most conservative mngmt
which acc to my opnion was apply tint and not redo the entire restoration – tint
62. Simple q like chisel cuts - used mainly to cut enamel
63. A lot of questions on mngmt of hypertension like wha drug for mild cases, what drug
for sever cases or htn emergency:
- Mild hypertension: CHLOROTHIAZIDE (thiazides), diuretics, beta-blockers such as
PROPRANOLOL, alpha1 blockers such as ATENOLOL, centrally acting adrenergic drugs
such as METHYLDOPA or CLONIDINE, angiotensin converting enzyme inhibitors such as
CAPTOPRIL, LISINOPRIL.
- Severe hypertension: GUANETHIDINE and ganglionic blocking agents.
64. What not to give in COPD emergency mnmgt which acc to my opinion was only
oxygen (other options had a potent bronchodilator along whith o2 which is the way
to go) – True, inhalation of 100% oxygen is contraindicated in a patient w/ COPD
65. Montelukast and zakirlucast what type of drugs in relation to their effect on
leukotriene - Block leukotriene (cys-LT1) receptors
66. Simple calculations in LA (based upon normal values and how much to give i the give
case, how much epi is present in x carpule ).
67. Effect of age on biotransformation of the drug (this was a bouncer for me)- W/ age ->
slower rate of biotransformation and reduced rates of elimination - Children will
inactivate and eliminate medications faster than adults. In the elderly there may be a
diminished dose requirement for many medications because of age-related
decreases in liver mass, hepatic enzyme activity, and hepatic blood flow.
68. If one increases the h2o to powder ratio what does it do with relation to hardness and
expansion (this is for gypsum) - decreased setting expansion and decreased strength
(increased setting time)
69. What property of a cement is not affected by water to powder ratio options were
solubility, consistency, thickness, etc
70. What would one prefer distal rest or mesial rest…. always go for mesial rest - mesial to
edentulous area.
71. Sulcular depth req for lingual bar - depth = 7-8 mm minimum
At least 4 mm below the gingival margins
72. Most rigid type of maxi major connector - anterior-posterior palatal strap
73. Question on migrane with how the TRIPTANS work - Triptans are agonists at serotonin 5-
HT(1b/1d) receptors - serotonin 5-HT agonist antimigraine drugs (Mosby)
74. Pt with symptoms of headache fatigue fever and vision loss… the only sane option
was temporal arteritis – True: weight loss, polymyalgia, rheumatic, fever, decreased
vision, jaw claudication. (Mosby)
75. Supernumerary teeth with intestinal polps and osteomas (Gardners syndrome) - True
76. Unstimulated flow from submandibular salivary gland - 0.1ml/minute
77. Ant flabby tissue under maxi cd and mandi ant natural teeth combination syndrome
or kellys syndrome – True
78. Pka with rate of onset, lipid solubility with bioavailability of a drug (two questions on
that)
79. Sign of kidney failure which will levels will shoot the earliest blood: uric acid, creatinine,
creatinine phosphokinase, urea, etc - creatinine
80. Q on when to treat patient with respect to dialysis: one day after his dialysis.
81. Commonly used nsaid in kids is: ibuprofen
82. Acetaminophen acts on temp centre in hypothalamus thus causing its anti pyretic
effect, options were supposed to confuse us to choose prostaglandins. Hypothalamus
-> temperature regulation center.
83. Then the same old same old question was asked as to if a patient has basal cel
carcinoma and you are about to break the news to him and he says that just tell me
straight do i have cancer or not, first response should be should i cal someone to be
with you, the other option which made sense was that prognosis of basal cell is good
but this shoudnt be the anser in my opnio as the patient is in a grumpy mood and you
need to calm him down first before going on to discuss the details with him).
84. Advantage of led light cure with respect to haolge - energy efficient, lightweight,
lifetime bulb.
85. What is the first stage of HIV infection, i went for asymptomatic phase as that’s the first
stage followed by acute infection, aids related complex which as hairy tongue,
leukoplakia, and other stuff and lastly full blown AIDS.
86. Dementia early sign short term loss or long term loss… i went with short term as one of
my family member suffered from it so i remembered it crystal clear.
87. Autism patient will have problem with listening and speaking there was a q on that
too - Delay in several skill areas as talking, listening, plating with peers, and attention
span.
88. Denture considerations in patients with diabetes like use porcelain teeth, arch shape
should be narrow, imp with non pressure tech rest of the points are given in decks…
the question was on arch shape
89. One opg with a radio lucency extending from post mand to ant, the sane option was
OKC and the confusing options were ameloblastoma, but since ameloblastoma
spreads labiolingually rather than ant post - OKC - antero-posterior direction without
bony expansion and often associated with impacted tooth.
90. One more pano with radiolucency seen with unerrupted tooth and the only sane
option was dentigerous cyst - It contains a crown of an unerupted tooth (DD)
91. Cause of ORN which had two conf options like bisphos and 42 gy , i went with bisphos
as 42 gy is susceptible and more than 60 gy means he has high chances but bisphos is
like the principal cause that’s y it was called BRONJ but now they have changed it to
MRONJ which is medically induced orn – FALSE: osteoradionecrosis (ORN) is related to
head and neck radiation and BRONJ is bisphosphonate-related osteonecrosis of the
jaw - related to intravenous and oral bisphosphonates therapy. If the case is about
ORN the answer is not bisphosphonates. If the question is about BRONJ or MRONJ the
answer should be bisphosphonates.
92. Base value for good patient relation is: communication should be good
93. Same follow up on this question was active listening is done by active eye contact.
94. Never judge a patient …this was the q and a never what …. (and the only sane
option was) judge
95. Plz do all the interferences and wht cusps occlude with what during maximum
intcusptn… there is a nice video on youtube called fence diagram video which i had
done during part one that helped me a lot.
96. Very little qs on ortho mostly with cephalometrics angles like sna snb and stuff bc they
were kept in store for day two
97. Dist between casette/grid and the collimator for a lateral ceph 15cm, 60 cm, 5 inch, 6
inch (as per i remember these were the options, but i just randomly gussed this one ).
98. One pano of a kid and dental age was asked
99. Supernumerary teeth occurs due to problem in what stage of tooth development ans
was: initiation
100. Basic questions on space maintainers like loss of uni first primary molar what does
one give – Band and loop
101. Class v cavity punch the hole on rubber dam more bucally - True
102. Same for gold restoration use 212 ivory clamp - clamp #212 for CLASS V facial
preparation
103. Same for teeth who bear clamps the hole should be bigger than the rest - hole
punched larger than usual and slightly to the facial of the other holes in the arch. - BB
104. Intrusion of primary maxi central 5mm inside what to do splint it or leave and
follow up and allow to re-erupt.
105. Most common cause of amalgam failure imp prep or moisture contamination
106. Bur to polish porcelain is diamond
107. Question on what type of dentin shouldn’t be removed during prep which is
eburnated dentin - True - we don’t remove sclerotic = eburnated dentin
108. One question which i don’t remember very clearly but it was on the fact that
never do pulpo on closed apex – True, pulpotomy is indicated on undeveloped
primary roots.
109. One thing we cant see clearly on 2d image is missed canal or extra canal which
requires CBCT - Dental cone beam computed tomography (CT) … but the way this
was put was confusing but once i read it carefully i could break it down .
110. Le forte 1 was with max sinus
111. Plz do all the elevators carefully, i got a question saying which of these can’t be
used for mandi pm and the only sane option was 151 – False: #151 is for mandibular
pm, we can’t use #23 because it is for mandibular molars.
112. You need to adjust the denture near bucca frenum as the denture keeps on
falling when the patient smiles… this is due to which muscle – Because it’s maxillary it
should be orbicularis. Buccal frenum -> triangularis (mandibular), Labial frenum ->
orbicularis (mandibular and maxillary).
113. For implant the instrument specification is: low speed and high torque
114. One question on bundling with the same scenario as dentist charging a
procedure as one whe and the insurance company charging it as two different
procedures - I think it’s unbundling -> separating of a dental procedure into
component parts.
115. Stippling is seen on: Attached gingiva
116. You did a prep with high speed and diamond bur, tooth is sensitive, what is it
about bur and handpiece that it caused sensitivity? A) Desiccation b) traumatized
dentin c) Heat
117. What is lithium used for? Psychotic stage of bipolar
118. 8yrs old girl with ant crossbite, max laterals have not erupted yet. When and how
do you treat crossbite? I put immediate tx and some appliance with springs
119. Same girl, supposedly there’s a supernumerary not erupted next to 6, what can
happen when u extract it? A-necrosis of 6 B- necrosis of 7 C-necrosis of 8 D-7 won’t
erupt
120. Benzo overdose? Flumazanil
121. Flumazenil what for? Reverse benzodiazepines
122. Tooth most with dry socket. – mandibular 3rd molar
123. Pvs and latex interaction - sulfur in the latex retards the setting of addition silicone
materials.
124. What does major connector does? Rigidity and Stability
125. Width of palatal strap - I put 8mm not sure, (single palatal strap its width is more
than 8mm)
126. How do u compensate protrusion in articulator something like that. I put slide
forward 5-8mm
127. Lesion hard and painful near lower pm. Options fibroma, neurofibroma, traumatic
neuroma. They didn’t say that pt had denture. (Traumatic neuroma = painful /
Neurofibroma = asymptomatic)
128. Lesion on tongue: Pyogenic granuloma, Ectopic thyroid gland, Giant ossifying
fibroma (Pyogenic granuloma = 75% on gingiva / Giant ossifying fibroma = exclusive
to gingiva / Ectopic thyroid gland = base of tongue) - it's provably pyogenic
granuloma because pyogenic granulomas are also found on the tongue, BUT! Keep
in mind that neurilemoma (schwannoma) is an encapsulated mass that presents as
an asymptomatic lump and the tongue is the most common location.
129. Hemangioma on tongue – hamartoma
130. Pt with aids what do u ask? Cd4 or viral count – T-cell counts are most important
for staging the disease and guiding dental treatment. (Kaplan Cases)
131. New pt upset, crossing arms, looking at floor. What do u ask after introduction
-What brings u here today?
132. Pointer in facebow, what for – designed to mark anterior reference point
(infraorbital notch) and can be locked in position with a clamp. It is present in the
arbitrary facebow.
133. Saturation -Chroma –hue –value
134. What albuterol causes -risk of caries -dry mouth (chronic use of albuterol is known
to cause xerostomia).
135. What not to give in asthmatic attack? We give: 1st oxygen w/ beta2-adrenergic
agonist (albuterol, terbutaline). If resistant to beta agonists => Theophylline. We can
also give corticosteroids. Epi is only for severe asthmatic attack.
136. Heart rate in child - 110
137. Max dose of Tylenol – 4g (4000 mg per 24 hours)
138. Tylenol kids: 10-15 mg/Kg dose every 4-6h
139. Kid is 65 pounds, how many carpules of lido? 1-3
140. ANB of 5.1 what skeletal class is - Class II (ANB >4 = Class II)
141. SNA of 87 and SNB of 81 what it means - Skeletal class II – prognathic maxilla
142. Pt wants dentures. For tx, pt had 2 and 3, 22, 24, 24, 25, 27, 32. 18 What is
unnaceptable do for tx plan option. There were different types of options with
implants, fpd, etc. I put extraction of all teeth
143. Tylenol which schedule - Sch 3 if with codeine (Tylenol 3)
144. Need of sinus lift for ext of ant upper teeth? False!
145. What pain med for patient with apnea - Nevertheless, patients with OSA who
undergo surgical procedures should receive regional analgesia and non-opioid
agents (e.g., NSAIDs) if there are no contraindications for their use.
146. Disadvantage of NO2 - It is not a complete pain reliever (a local anesthetic is still
required), nausea is the most common patient complaint, and diffusion hypoxia can
occur.
147. What could cause unilateral class II molar? Early extraction of A (max 2nd molar)
Early unilateral loss of a deciduous second molar is likely to cause the developing
dentition to be crowded as the first permanent molar will drift or tip mesially.
148. 0.1% chlorhexidine gel. Where do u use it?
Interproximal caries
Root Erosion
Occlusal amalgam with minor open margin
149. Goal of GTR? - Coronal movement of PDL - regenerate the periodontum,
promoting growth of endothelial cells, osteblasts and cementoblasts (NOT EPITHELIAL
CELLS)
150. What no to do on D of 3rd molar is there’s not enough keratinized tissue? I put
Distal wedge
151. What anxiolytic for pregnant and breastfeeding – Promethazine
152. DMFT for what study? Community trials (epidemiological)
153. Who has more diabetes? Black males
154. Perio doesn’t depend on nutritional - T
155. In class III kennedy where do u get support and retention from? Entirely tooth
supported (abutments) – Rests and bases for support
156. Pt with porcelain and amalgams, what fluoride to give? Neutral NaF
157. Most common anomaly? DI (after cleft palate)
158. First pass metabolism – Liver (enteral – oral)
159. Teeth joined by dentin and cementum? Fusion
160. What pain med for liver toxicity? Oxycodone
161. What pain for pt with bleeding problems? Acetaminophen
162. Ginseng not with? Aspirin
163. Advantage of IV – Titration
164. Reverse epinephrine by – Phentolamine (selective alpha blocker phentalomine,
phenoxybenzamine, prazosin)
165. Epi works on which receptor: all alpha and beta
166. First side effect of beta blocker - weakness or drowsiness (The most common
adverse side effects of beta blockers are WEAKNESS & DROWSINESS) - BB
167. Which Anesthesia without epi – Mepivacaine
168. Allergic to both ester and amide what to give – Diphenhydramine (Benadril)
169. EMLA composed of which two type of anesthesia - Lido 2.5 % and 2.5% prilocaine
170. Which Anesthesia not with anemia – prilocaine
171. Anesthesia not vasodilator – Cocaine
172. Why anesthesia not work in inflammation - Less free base
173. First nerve affect by LA - Small unmyelinated (pain and temperature)
174. Which trimester contraindicate the No2 -1st
175. Most Caries where? Max 1st molar (according to Kaplan)
176. Overdose of LA what to give – diazepam (for toxicity)
177. Antagonist of diazepam – flumazenil
178. Problem in liver which benzo to give - LOT- lorazepam, oxazepam n temazepam
179. Buspirone which receptor works in – Serotonin - BUSPIRONE (BUSPAR) - a minor
tranquilizer orally administered anxiolytic (anti-anxiety agent) whose mechanism works
by DIMINISHING SEROTONERGIC ACTIVITY. - BB
180. Best anti epileptic for absence seizure – Ethosuxemide
181. LA contra with which drug: MOA - LA with epi contra with MAO inhibitors, also
with TCA – Epi contraindicated w/ Levodopa.
182. Omeprazol used for (GERD or zollinger)? – GERD
183. Remember all the antibiotics effect on protein synthesis - Clinda, macrolides,
tetracyclines, aminoglycosides, chloramphenicol
184. Most common side effect of clindamycine is - Psudomembranous colitis
185. Mech of action of nystatin - inhibit ergosterol
186. Which drug increase the effect of amoxicillin – Probenecid
187. Drug not with milk – Tetracycline
188. All of these are antipsychotic exept (lorazepam) - T
189. Drug not with cimetidine – Terfenadine (Seldane) (dangerous drug interaction) –
Cimetidine: a potent inhibitor of hepatic drug-metabolizing enzymes.
190. Drugs known to interact with SELDANE are ketoconazole (NIZORAL), erythromycin
(E-MYCIN), nefazodone (SERZONE), itraconazole (SPORANOX), clarithromycin
(BIAXIN), mibefradil (POSICOR) as well as grapefruit juice.
191. Eps (Extrapyramidal syndrome) with which drug except: clozapine - Effectively
treats Schizophrenia and more effective & less toxic than the older drugs. - BB
192. Aspirin cuz all except (hyperpnea / tacypenia / hyperkalemia / hyperthermia) – It
causes hypokalemia, not hyperkalemia.
193. Tx of motion sickness – scopolamine
194. Tx of myasthenia gravis – pyridostigmine (edrophonium just for diagnosis) -
Neostigmine or Pyridostigmine - are cholinesterase inhibitors used to reverse the NMJ
blockade (paralysis) caused by NMJ blockers. - BB
195. Edrophonuim all true except (cause dry mouth) – Edrophonium is an indirect-
acting cholinergic agonist (cholinomimetic). Drug of choice to "diagnose" myasthenia
gravis because of its rapid onset of action and reversibility.
196. Which drug is safe in Myesthenia Gravis (a) Penicillin (b) Erythromycin (c)
Clarithromycin (d) IIDR
197. Tx of xerostomia due to radiation – Pilocarpine
198. Overdose of organophosphate cholinesterase inhibitor – Pralidoxime
199. Dont use cortisone in (all the answer were contraindicate so I picked all)
200. Mech of action of diltiazem - Calcium channel blockers useful as anti-anginal
agents to treat chronic stable angina pectoris by blocking calcium entry through the
membranous calcium ion channels of cardiac and vascular smooth muscle. -
Calcium channel blockers that prevent angina attacks by dilating coronary blood
vessels to improve blood flow to the heart muscle. - Calcium channel blockers
decrease oxygen demand by reducing afterload by reducing peripheral resistance
via vasodilation.
201. Contra for use digoxin – Diuretics (will inc digitalis toxicity), also contraindicated in
ventricular fibrillation & ventricular tachycardia.
202. Mech of action of heparin - potentiation of Antithrombin III, thus inactivating
thrombin. This prevents the formation of fibrin. – BB
203. The most important anticoagulant effect of heparin is to interfere with the
convertion of: 1. PTA t PTC 2. PTC to factor VII 3. Fibrinogen to fibrin – (ASDA) 4.
Prothrombin to thrombin 5. Proaccelerin to accelerin.
204. Aldosterone antagonist – Spironolactone – Spironolactone a pharmacologic
antagonist of aldosterone in the collecting tubule. Spironolactone competes with
aldosterone receptor sites in the renal tubules causing increased secretion of Na+, CI,
and H20, while conserving K+. - BB
205. Cyp34A u should know how drug effect on it, from dd only - Inhibitors are
antifungals, increase triazolam serum concentration. Cytochrome P450 3A4
(abbreviated CYP3A4, is an important enzyme in the body, mainly found in the liver
and in the intestine. It oxidizes small foreign organic molecules (xenobiotics), such as
toxins or drugs, so that they can be removed from the body. – Wiki
206. Which drugs affect cytochrome P450 metabolism of other drugs? erythromycin
lowers cytochrome P450 metabolism of other drugs, Macrolid ABs, antifungual,
cimetidine
207. Tx of glaucoma by: betaxolol – Pilocarpine, Betaxolol, Latanoprost, Bimatoprost
208. Overdose of lead tx by - EDTA by chelation (Mosby)
209. Modafinil decreases GABA to improve what – glutamate (Modafinil decreases
GABA and increases glutamate, dopamine, and orexin)
210. Overdose of morphine tx by – Naloxone (Opioid adverse effects are reversed &
recovery hastened by administration of Naloxone (Narcan) an opioid antagonist.)
211. Only opioid transmucosal is – Fentanyl
212. Side effects of opioid - sedation, dizziness, nausea, vomiting, constipation,
physical dependence, tolerance, and respiratory depression.
213. Common Side Effects OF OPIOIDS: sedation and drowsiness (by depressing the
conscious centers of the brain), dizziness, & nausea. The MOST common side effect of
the narcotic (opiate) analgesics is NAUSEA. Narcotic analgesics DO NOT cause peptic
ulcers (steroids) or insomnia. - BB
214. Light pass through to through? (craze line / crack)
215. Not in the first line of tx of periodontists? (antibiotic/surgery)
216. Not feature of modify Widman flap? (displace/no reduce of osseous defect)
217. Most common cause of amalgam failure is? contamination
218. Doing FMX and u charged the patient for each one is: unbundling
219. If u reject null hypothesis and p = 0.08 (type 1 error)
220. Wheelchair (I picked something with sliding) - Important points: 1. Two people
required for shifting patient. 2. Do not pull patient from behind chair. 3. Lock chair
wheels before shifting. - Sliding board is the best
221. Child with furcation involve in tooth number E best treatment is (extraction)? –
According to Mosby à if it is a restorable 2nd primary molar and there is no root
resorption, tx of choice is pulpectomy. We need to know the child’s age too. If it is a
1st molar w/ furcation involvement then we talk about extraction.
222. Best test to test tooth with crown (cold test)
223. Worst media to save avulsion tooth (water)
224. Union between two teeth by the mean of cementum is (concrescense)
225. Stimulated salivary flow (1ml/min)-1L in 24h
226. Unstimulated (0.1ml/min) no 0.2 or 0.3
227. Trapezoidal mouth and shovel incisor? Apert - Oral manifestations of Apert
syndrome includes trapezoidal shaped mouth, shovel shaped incisors, Byzantine arch
shaped palate, severely delayed eruption, severe crowding and ectopic eruption. -
BB
228. Baby bottle decay affect mostly (max ant)
229. Most common cause of sealant failure - Contamination with saliva
230. Most beneficiated tooth with sealants? Maxillary 1st molar
231. NaF for how many minutes should be applied – 4 minutes
232. Most common congenital missing primary tooth – primary maxillary lateral
incisors
233. Missing permanent - Most common congenitally missing tooth is the mandibular
second premolar (excluding 3rd molars), followed by the lateral incisor, followed by
the maxillary second premolar (Mosby)
234. Most common primary ankylosed tooth? Primary 2nd mandibular molar – now
you know why J
235. The smallest primary tooth is - Primary mandibular lateral incisor
236. Mesial cusp ridge is longer than distal one in - Maxillary 1st pm, also in primary
max canine.
237. Which stage abnormality may cause peg shape lateral – bell stage
(morphodifferentiation)
238. Two canals mostly in which pm - maxillary 1st pm
239. EDTA I picked can remove THIN calcification not any calcification (Thin layer of
calcification)
240. Question about pulp diagnosis (pain on percussion) not respond to thermal (I
picked d) A: abscess with irreversible pulpitis B:reverible pulpitis C:periodontitis D: non
of above
241. No generation after endo for: dentin
242. Remineralized enamel is harder and darker – T
243. 245 longer than 330 – T
244. Change amalgam to composite (I picked veracity) - T
245. Class 2 caries triangle and the apex to the pulp – T
246. Cusp reduction resistance form – T
247. Most lab complain from: under prepared – T
248. Composite and bleaching wait 1 week before composite – T
249. Ameloblastoma from okc (light microscope)
250. Which of these will not cause SICKLE CELL anemia crisis – NO2
251. Stridor (larangyospasm)
252. Seizure due to (hypo-Na) - hypoNAtremia
253. Initiator of light cure?? 1/Camphoroquinone 2/ benzyl peroxide
254. Albuterol side effect? tremor, anxiety, headache, muscle cramp, DRY MOUTH,
tachycardia.
255. Albuterol side effects except? a. excess salivation b. tachycardia c. diarrhea. d.
CNS stimulation.
256. Ledronate use in treat which disease - Pagets, osteoporosis
257. N2o side effect: Nausea and vomiting
258. Pt on Biophosphonate what to do? endo
259. With the increase in age, keratinization of the gingiva: decreases
260. Width of attached gingiva with age – increases
261. 40 years male how to correct cross bite ? Surgery
262. Not feature of modify Widman flap (displace/no reduce of osseous defect) – bony
defects can be curetted (Oxford)
263. Most common respiratory problem in dental clinic (hyperventilation / no asthma
in the choices)
264. Target in x Ray? anode and tungsten
265. Dementia? Short term memory loss
266. Amantadine: antiviral (influenza A) and antiparkinsonian drug.
267. ADHD? Which drug – Amphetamine (Adderall) and methylphenidate (Ritalin)
268. Large composit and acceptable appearance what to do? Tint
269. More affect perio? Smoking
270. Distobuccal complete denture? Masseter
271. 0.01? Type 1 error
272. Least Ab use? Chronic perio
273. Lisinopril moa? Inhibition of the Angiotensin-Converting Enzyme. Angiotensin-
Converting Enzyme (ACE) Inhibitor: interfere with the conversion of Angiotensin I
(weak vasoconstrictor) into Angiotensin II (highly effective vasoconstrictor that
simulates the release of Aldosterone) by inhibiting the Angiotensin-Converting
Enzyme. - BB
274. What will not set off an event in a child with sickle disease: Trauma, Cold,
Infection, Nitrous oxide
275. Will have wavelength ? HUE
276. Pt mouth breather? Open bite
277. Most tooth affect perio? Max molar (Max 1st molar – most difficult)
278. Distance btw Implants? 3mm
279. Down syndrom = Macroglossia
280. ANUG treatment – debridement, hydrogen peroxide (or warm saline) rinses, and
antibiotic therapy (penicillin V) ONLY if there is systemic involvement (i.e. fever,
malaise, lymphadenopathy). Patients with HIV-associated ANUG require gentle
debridement and antimicrobial rinses.
281. Max sinus x Ray? Waters, Ct, Both in op
282. Lefort 1? Max sinus involvement
283. Atenolol which receptor? Atenolol (Tenormin) - competitive b1 cardioselective
antagonist that blocks b1 receptors to treat hypertension, chronic angina pectoris, or
after a heart attack (MI recovery).
284. Flouride which ion? OH- ion (hydroxil ion)
285. The color of gingiva is due to: A. Capillaries B. Thickness of epithelium C.
Thickness of keratinization and pigmentation D. All of the above
286. While u taking pano u patient move? Horizontal overlap
287. Junctional epithelium: Is permeable
288. Least test for recent Truma ? EPT
289. Most common cause of xerostomia? Medication
290. Dentogingival unit comprises of: Gingival fibers and junctional epithelium
291. Free gingival groove represents: Histologic depth of gingival sulcus
292. Which type of cells are most numerous in gingiva? Keratinocytes
293. Gingiva is supplied by: Supraperiosteal vessels
294. The junctional epithelium is attached to the tooth by: Basal lamina
295. Gingiva is attached by: Junctional epithelium
296. The length of junctional epithelium is: 0.25-1.35 mm
297. Least width of attached gingiva is found on the facial aspect of: First premolar
298. Normal consistency of gingiva is: A. Soft B. Hard C. Firm D. Firm and leathery
299. Gingiva in children: Less keratinized, less stippled
300. Eulanin fibers are found in: A. Gingiva B. Cementum C. Alveolar D. Periodontal
ligament
301. The function of Langerhan's cells is: Antigen presentation to lymphocytes
302. Langerhan's cells are absent in: Junctional epithelium
303. Which periodontal fibers are consistent and are reconstructed even after the
destruction of the alveolar bone? Transeptal
304. In periodontal ligament, there is: type I collagen
305. Periodontal ligament is: narrower on mesial surface
306. The periodontal ligament: contains epithelial cells of Malassez
307. PDL is thinnest at: Middle
308. What type of fibers are principal fibers of PDL? Collagenous
309. Periodontal fibers which are most resistant to forces along the long axis are:
Oblique
310. The thixotropic theory claims that: The periodontal ligament has the rheologic
behavior of a thixotropic gel
311. Alveolar bone is: Compact bone
312. Anatomic form of roots of teeth is determined by:
Hertwig's root sheath
313. “Indifferent fibers" are: Collagen fibers
314. With aging, changes in periodontal ligament are:
A. Decrease in number of cells and increase in collagen fibers
B. Increase in number of cells and decrease in collagen fibers
C. Increase in number of elastic fibers
D. Hyalinization changes
315. Feature of aging periodontium is: Scalloping of
cementum and alveolar bone surface
316. Unattached gingiva: A. is interdental gingiva B. is below
mucogingival fold C. cannot be separated by probe
D. is marginal gingiva
317. A black line on the gingiva which follows the contour of the margin is due to:
A. lead B. Argyria C. Iron D. Mercury
318. Basal lamina consists of: Type IV collagen fibers
319. Cementum found on the cervical third of the root is: Acellular extrinsic fiber
cementum
320. The cell that is present in stratum spinosum and stratum basale is: Melanocytes
321. What make penicillin allergic - Beta lactame ring
322. Space loss after loss of which primary tooth - Mand 2nd molar
323. Composite discolored but intact what to do - Redo or polish (go w/ Tint if in
options)
324. What happen if temp of developing solution is too high - Dark
325. When you put occlusal rest set of direct reatiner mesial or distal to edentulous
area? mesial
326. Inc water powder ratio in gypsum does what: Decreased setting expansion,
Decreased strength, increase working/setting time (retards the time)
327. Which bur is not good for porcelain – Carbide
328. Advantage of implant over fix partial denture
329. Best way to dec fear of child – TSD
330. Best way to dec fear of child ..I said sit down to child's level
331. Dentist ask a child u want me to help you to sit on the chair ...how to define this
situation: one option was perceived helplessness
332. Tooth most involved in VRF - Mand 1st molar
333. Advantage of stainless steel over ni titanium – strength
334. Ledge what to do - bypass it and continue
335. Collagenase and elastase by which bacteria - Porphyromonas gingivalis
336. LOW WEAR RESISTANCE is the property of filled resins that is primarily to blame for
the failure of Class II composite restorations – T
337. Common reason for failure of composite in posterior - Saliva contamination or
occlussal wear (recurrent caries according to other books)
338. Anterior teeth heavily damaged what do you do - PFM or all ceramic crown
339. What can't be used as retainers in FPD: inlay
340. Primary tooth with shortest occlusal table - Upper primary first molar
341. Pt came back after a month with discolored margins what could be the reason –
microleakage
342. Pt came back after 3 day with discolored margins on veneer what could be the
reason - Amine or micro-leakage or bacteria
343. Function of post - Retain core
344. Why you record protusive relationship - to adjust condylar guidance
A protrusive record registers the anterior-inferior condyle path at one particular point in
the translatory movement of the condyles. - Mosby
345. A dentist is preparing all maxillary anterior teeth for metal-ceramic crowns. Which
of the following procedures is necessary to preserve and restore anterior guidance?
A. Protrusive record B. Template for provisional restorations C. Custom incisal guide
table D. Interocclusal record in centric relation - Anterior guidance must be preserved
by means of construction of a custom incisal guide table, especially when restorative
procedures change the surfaces of anterior teeth that guide the mandible in excursive
(lateral, protrusive) movements. - Mosby
346. Where to place retentive arm - Retentive terminal alone below ht of contour at
junction of middle and gingival third (FB group discussion) / Gingival one third of
crown in measured undercut (Mosby) - The reciprocal clasp should contact the tooth
on or above the height of contour of the tooth (Middle one third of crown).
347. Reciprocal arm what for – Stabilization (resistance of horizontal forces),
reciprocation, and auxiliary indirect retention (bracing). Placed on Suprabulge area.
348. Reciprocal anchorage? - Elastics to close diastema? No
- Reciprocal tooth movement—two equal anchorage value teeth or groups of teeth
(units) are moved against each other and move the same amount toward or away
from each other.
- Reinforced anchorage—adding additional teeth to a unit to distribute the force over a
greater area and slowing the movement of the anchor unit. Another method for
reinforcing anchorage would be extraoral force, such as with headgear, with
interarch elastics, or by using an implant.
349. Behaviour modifiaction definition? Behavior modification is a treatment
approach, based on the principles of operant conditioning, that replaces undesirable
behaviors with more desirable ones through positive or negative reinforcement.
350. Child lives in fluoridated area he had a lot of plaque what do you suggest - More
systemic fluoride or topical fluoride or fissure sealants.
351. Topical antifungal options fluconazole clotrimazole miconazole griseofulvin
352. Antifungal that can be topical and systemic. fluconazole clotrimazole
miconazole, griseofulvin - Miconazole Therapeutic Uses: is an azole antifungal drug
available for topical and systemic administration - BB
353. Does premedications required options were cardiac stent murmurs pt had knee
replacement within 2years or congestive heart failure or recent MI
354. Bacteria present in gingiva in ANUG when tissue is not necrosis - Spirochete or
P.interdemdia (P intermedia only, necrosis assoc with spirochete- DD).
355. Pt is having asymptomatic brown macules on buccal mucosa - Increase melanin
or melanocyte proliferation. - “Melanotic macules: These lesions can also occur within
the oral cavity, commonly gingiva, buccal mucosa or palate. The cause increased
melanin production with NO increase in melanocyte number.”
356. Least resistant to fracture - Leiutic or feldspathic
357. How morphine cause nausea - Centrally acting right ? – True
358. Probing depth is 5 and prob pass 2 mm apical from CNJ how much is the
attachment loss – 2 mm
359. Which structure is damaged during free gingival flap surgery taken from palate:
Greater palatine artery or nerve
360. The reason of high pressure in pregnant women – Pre-eclampsia
361. After IAN block patient gets infection of which space – Ptergomandibular
(masticatory) or messeter or lateral pharyngeal or medial ptergoid
362. A lot of translucency on pontics gingival 3rd what is the reason- wrong shade
selection or wrong metal thickness or inadequate preparation
363. Excessive translucency of the gingival 1/3 of an anterior metal ceramic pontic is
caused by: 1. Inadequate framework design 2. Error in shape selection 3. Poor ridge
contour. 4. The palladium content in the gold alloy.
364. On x-ray of max tooth RL between the margin of a crown and tooth on distal
proximal surface. The reason of RL can be all, except: resin, cervical burn, cervical
caries. (Other options I do not remember).
365. Preloading of implant whats the major concern – Torque
366. Pt wit gag needs to take x ray? How to manage that - Systematic desensitization
or graded exposure
367. Folic acid intake in pat for? – no answer options - Folic acid is commonly
prescribed for patients with sickle cell anemia to prevent development of
megaloblastic anemia - Folic acid to prevent neural tube defects.
368. Abscess can be released from perio pocket or not – YES
369. What do you say if patient ask about instrument sterilization - its according to
universal precautions
370. Gtr best for - GTR best for 3 wall defect and also class 2 furcation
371. Does anyone know from Class 1 till 4 furcation the treatment plan?
Class 1 furcation - good prognosis
Class 2 furcation – GTR
Class 3 furcation
....in maxilla - Root amputation
....in mandible - Hemisection
Class 4 furcation – Extract
372. Pain medication for alchoholic - Nsaid or oxycodone
373. Most common emergency in dental clinic - syncope
374. Most common resp emergency in clinic - hyperventilation
375. Function of major connector: Stability or rigidity.
376. Can we give lorazepam in liver disase? - LOT - lorazepam, oxazepam,
Temazepam - good when liver problems.
377. How to determine periodontal success - No bleeding on probing or establish
clinical attachment? - The BEST CRITERION to evaluate the success of SRP is NO
BLEEDING ON PROBING (since BOP indicates active inflammatory periodontal
disease). Amount of attachment loss is the most important factor in the determination
of a prognosis of a tooth with periodontal disease (more accurate than probing
depth, tooth mobility, and presence of furcation involvement). à Long term prognosis
= plaque
- Attachment loss à Prognosis of tooth w/ periodontal disease
- Bleeding on probing à periodontal success
- Plaque à Long term prognosis
378. TWO MOST CRITICAL FACTORS to determine the prognosis of a periodontally
involved tooth are MOBILITY & ATTACHMENT LOSS (the most critical).
379. Who review patient on maintenance after referral with periodontal treatment:
Dentist or hygienist or dental assistance.
380. Drug for neuogenic and manic disoder.. Tegretol (carbamazepine) or lithium
381. Viral load of HIV 10000 do you treat the patient or referral to specialist – refer
382. Abscess can be relieved thru perio pocket.T/F
383. Feeling of been in the doom - Panic attack or anxiety or simple fear
384. Tongue blade appliance is used in? – anterior cross bite
385. Pt recive blow to eye orbital floor less common to fracture t/False
386. Pt who took treatment for hep A before 3 years so he still contagious or NO
387. What drug (pain) you give to pt with renal failure: Tylenol nsaid codien morphine
388. Teeth with necrotic pulp and perio damage. Only RCT or perio treatment too?
Only RCT
389. At least 4mm of gutta-percha MUST remain to preserve the apical seal.
390. Face bow transfers relation of arches? In centric relation, In centric occlusion
391. Most common site(s) for contact stomatitis – Side of tongue, Hard palate, Gingiva,
All
392. Best radiograph for implant? CT scan. PA. MRI
393. How to treat oropharyngeal candidiasis in HIV patient - Topical or systemic,
(fluconazole). Esophageal and pharyngeal candidiasis is related with AIDS. Oral
candidiasis à topical antifungal (clotrimazole or nystatin). – Kaplan Cases
394. You have HIV+ pt you can do all of the followin except
a) treath with metronidozole
b) free gingival graft
c)prophylaxix to treat candidiasis
“Data from prospective controlled trials indicate that fluconazole can reduce the risk
of mucosal disease (i.e., oropharyngeal, esophageal, and vulvovaginal) in patients
with advanced HIV. However, routine primary prophylaxis is not recommended
because mucosal disease is associated with very low attributable morbidity and
mortality and, moreover, acute therapy is highly effective. Primary antifungal
prophylaxis can lead to infections caused by drug-resistant Candida species and
introduce significant drug-drug interactions. In addition long-term oral prophylaxis is
expensive. Therefore, routine primary prophylaxis is not recommended (AIII).”
395. Permanent tooth with largest occlusal table – maxillary first molar.
396. Epithelium comes from the donor site – T
397. Dexterity- Something to do with flossing -> 5 brush and 8 floss. If lack of dexterity
can’t do interproximal floss – T
398. Perio v/s endo abscess- pulp testing, lat percussion
399. Opaque porcelain function mask dark oxidized color – T
400. Methotrexate- anti cancer drug folic acid inhibitor – T
401. What is battery? Treatment without informed consent
402. Autonomy - Let the patient decide.
403. Ectodermal dysplasia oligodontia, sparse hair - anodontia or oligodontia,
depressed bridge of nose, lack of sweat glands, and the child appears much older
than he or she is. (DD)
404. Diabetes commonly found in which ethnicity? Black male
405. Periodontis most Common? Black male
406. What causes cervical discoloration of PFM copper, ag. Plaque
407. Flame shaped radiolucency above an unerupted third molar – pericoronaritis
408. Safe drug in pregnancy acetaminophen
409. Safe drug in breastfeeding promethazine
410. Prolonged use of Aspirin can cause metabolic acidosis
411. Fusion, Gemination - Fusion less number and gemination extra number or one big
crown, Fusion 2 buds fuse together and form one tooth.. from total no of teeth, there is
decrease in number.
412. Failure of which stage of tooth development affect Number of teeth – initiation
413. Size – morphodifferentiation (bell stage)
414. Which disease lead to MI - thrombosis(I pick atherosclerosis,but I think it is
thrombosis, other two wasn’t relate - (MI usually caused by thrombus formation)
415. Acute adrenal insufficiency : a. gingival hyperplasia b. cardiovascular collapse c.
hypotension d. ketoacidosis - ASDA
416. Low contrast- kvp (Long scale, low contrast, hight kvp)
417. Which doesn’t recur- AOT
418. Antibiotic treatment- LAP -> Tetra
419. Seizures grand mal phenytoin (and Carbamazepine – Tegretol)-
420. Petit mal – ethosuximide - Ethosuximide in the treatment of absence (petit mal)
seizures.
421. Overdose cocaine mydriasis
422. Overdose opioids miosis
423. Short clinical crown- what to do- read from prostho decks, proxy grooves if lack
F-L resistance (buccal – retention / proximal – resistance)
424. Pedunculated leision – papilloma
425. Dry socket sedative = dressing
426. Benzoyl peroxide decomposition by tertiary amine in chemically activated resin
self cured - a chemical activator like dimethyl-p-toluidine (a tertiary amine) is added
to the monomer (MMA) to decompose the benzoyl peroxide initiator into free
radicals.
427. Excess bilirubin in blood? kernicterus
428. Epi reversal? Phentolamine – Phentolamine (OraVerse) is used in dentistry to
reverse soft tissue anesthesia more quickly after procedures involving a local
anesthetic with a vasoconstrictor. Alpha adrenoceptor blockers, such as
phentolamine, inhibit the vasoconstrictor effect of epinephrine but not the vasodilator
effect of epinephrine. The administration of alpha blockers results in epinephrine
reversal. (Mosby)
429. Pt shows reaction to the LA vasoconstrictor so to recover the reactions u will
administer: Alpha 1 antagonist - the ZOSINSSSS
430. Which of the following drugs is most effective as an antidepressant?
a. Diazepam b. Reserpine c. Amitriptyline
431. Tricyclic antidepressants have a prominent side effect that most nearly resembles
the usual pharmacological action of a. Codeine b. Atropine ans c. Ephedrine
432. If you have two distribution that are asymmetrical that’s means a) normal
B) skewed is the ans c) bimodal
433. Meds not given to a pt who has epinephrine - MOA and Tricyclic antidepressant
(Also Levodopa)
434. Complication of temporal arteritis - blindness
435. Gtr best for – 3 narrow wall defect
436. If the patient has maxillary protrusion and we need to pull the maxillary backward
which we will use
a) straight pull gear b) cervical pull gear c) face bow d) reverse bull gear
Cervical-pull headgear à consists of a cervical neck strap (as anchorage) and a
standard facebow inserting into the headgear tube of the maxillary first molar
attachments. The objectives of treatment with these types of headgear are to restrict
anterior growth of the maxilla and to distalize and erupt maxillary molars. A MAJOR
DISADVANTAGE OF TREATMENT USING CERVICAL HEADGEAR IS POSSIBLE EXTRUSION OF
THE MAXILLARY MOLARS.
437. What make the reaction on the one that has monomer and activator that was
using it for prepaing the secondary impression on the study cast on the lap . its
activated by A) exothermic reaction b) MMA with the monomer
438. Gtr-- involves coronal movement of pdl
439. Antidepressants serotonin / SSRI-fluoxitene zoloft,both- SNRI TCA-->Amitryptilline
440. Pain medication for alchoholic – OXYCODONE
441. Fetal alcohol syndrome - Mid face deficiencies, cleft lip (Individuals with fetal
alcohol syndrome may have cleft lip with or without cleft palate)
442. Antibioticis of maythenia gravis – penicillin safe (erythro increases weakness)
443. If no enough space what tooth pop out of arch maxi and mand. – First premolars
444. B blockers - Glucagon
445. Acetamenophen - N Acetyl
446. Xylitol is best used anticariogenic when it's a: mouthwash, tablet, chewing gum,
varnish
447. Xylitol gum used for :- - DECREDSED SALIVATION (xerostomy) - PREVENT CARIES
448. FDA. determines which drugs are to be sold by prescription only: Schedulle 2 and
3 must have a written prescription. (The only difference is that class 2 cannot be
refilled whereas class 3 can be refilled even over the phone.)
449. Contraindication of RCT - vertical root fracture (also Uncontrolled DM, Recent MI,
Leukemia)
450. Resistance for short crown proximal grooves
451. Laser in periodontal diseases use for sulcular debridment
452. Meperidine? sintetic opioid, narcotic, less potent than morphine, more than
codiene, shorter duration of action, interaction with MOA can cause convulsions.
453. Which study can show incidence – descriptive (cross sectional shows prevalence
Cohort is for incidence)
454. Theory of stress and how affect immunity – Stress induce cortisol and reduce
immunity
455. Objective fear after previous painful stimulus (own experience)
Objective fear is one that you experience directly. If, for example, you had a painful
dental visit while having a tooth extracted; the next time you needed a tooth
extracted you would be fearful because of this prior experience. If you told your
friend about the bad experience and he needed a tooth extracted, and he had fear,
this would be subjective fear.
456. Thyroid crisis symptoms hyperT HR increased (High Bp, high body temperature,
persistant sweating tachycardia, high fever)
457. Hypoxia sign – cyanosis (Cyanosis and increase in pulse rate too - DD)
458. Signs of oxygen want 1. Cyanosis 2. Pulse rate decrease 3. Tachycardia
459. Antibiotic in gingiva tetracyclines
460. Wheelchair Q – sliding
461. How base metal prevent corrosion – chromium
462. What is the most common psych disorder? Depression
463. Leakage in amalgam decrease with age
464. Systemic desensitization - hierarchy of slowly increasing anxiety stimulus
465. 16 kg anasthesia calculation 70,4 mg
466. Most common emergency in dental clinic - asthma or syncope
467. Most common respiratory emergency it is hyperventilation (no asthma in options)
468. Most common respiratory emergency it is Asthma...I was so happy no
hyperventilation in the options
469. Primary stress bearing areas in dentures - max - primary ridge ...secondary rugae
mand - primary buccal shelf - and also primary if good ridge
470. Primary areas of support in max and mandibular. Thought we’re maxillary ridge
and buccal shelf for mand but options were not together: For mandibular complete
denture, the residual ridges if large and broad, are also considered primary support
areas.
471. In USA most dental pay is - out of pocket self pay
472. Which is more important? Chroma, value (value is VIP and choosing process is
HUE first then VALUE then CHROMA)
473. Which show saturation of color? – chroma
474. Radiation water lysis - Hydrolysis of water
475. Facebow transfer - hinge axis
476. Arcon vs non-acron - Arcon resembles tmj
477. Dental lamina appears at which week 6 th week
478. Distolingual extension of mand, denture which muscle sup constrictor
479. Incisal edge of anterior teeth touch where? vermilion border
480. Bur for burnishing porcelain = diamond
481. Sodium hypochloride does all except (Chelation)
482. Impresion material moisture tolerant – Polysulfides (because they are
hydrophobic).
483. Polyvinyl siloxanes - excellent DIMENSIONAL STABILITY and very low permanent
deformation.
484. Behcet's syndrome associated with aphthous ulcers

485. High school children have marginal gingivitis
486. Ginseng contraindicated with salicyclic acid
487. Erosion – GERD
488. Initiation: supernumerary/missing teeth
489. Bell - 2 types : morphodifferentiation: shape!!! histodifferetioation: d.imperfecta
a.imperfecta
490. Apposition: enamel hypoPLASIASSS
491. Moisture contamination in amalgam
a) Increases delayed expansion
b) Something related to amalgam strength
DELAYED EXPANSION of amalgam restorations is associated with insufficient trituration &
condensation, and amalgam contamination by moisture during trituration and
condensation (MAIN cause of failures). - BB
492. Central giant cell granuloma is seen with pts with condition of /?
Hyperparathyroidism - Brown tumor of hyperparathyroidism masquerading as central
giant cell granuloma in a renal transplant recipient.
493. Which cement causes irritation to pulp – zinc phosphate
494. Sialilitithiasis is found whew = warton duct (submandibular duct was as an oprtion)
- calcified mass or sialolith forms within a salivary gland, usually in the duct of the
submandibular gland (also termed "Wharton's duct").
495. Kid came to clinic touched everything and last he came to dentist and allowed
to keep probe in the mouth what the behavior? – Desensitization
496. Digoxin – it is used for congestive heart disease, atrial fibrillation and when you
drink in conjunction with diurectic can increase the toxicity of digoxin
497. Contraindication for nitrous oxide (nasal congestion)
498. Best place for implant ant mand
499. Solution to keep an avulsed tooth hanks worst -> water
500. Aplastic anemia -> chloramphenicol
501. Pseudomembranous colitis (clindamycin)
502. Therapeutic effect (safety)
503. No to do w asthm - Give Oxygen?? – We can give oxygen in asthma (acute
attack - give oxygen and albuterol / severe asthma ONLY – epinephrine) 0.3mg OF
1:1000 EPINEPHRINE SHOULD BE ADMINISTERED SUBCUTANEOUSLY
504. No contraindication w asthma - Nitrious oxide
505. Gingival graft contraindications (pocket below alveolar crest) – A FGG is used to
increase the zone of attached gingiva and possibility of gaining root coverage. NOT
used with DEEP WIDE RECESSIONS.
506. Gingival graft contraindicated when: a) pocket is below the alveolar crest b)
pocket is below free gingival groove c) excessive keratinized tissue
507. Which LA is good without vasoconstrictor? Mepi
508. Bipolar disorder lithium (LITHIUM - current drug of choice to treat the MANIC
PHASE of bipolar disorder)
509. On which receptors Epi works a1 a2 b1 b2. I choose a1 but not sure – We know it is
all but it affects beta receptors predominantly.
510. Morphine overdose = naloxone
511. Porcelain porosity = Inadequate condensation
512. Unbundling - when doctor describes the whole treatment in different parts,
separate charge code instead combine.
513. Most commonly used TCA Amitryptyline – AMITRIPTYLINE (ELAVlL) - the most widely
used TRICYCLIC ANTI-DEPRESSANT to treat unipolar disorder (depression).
514. Cocaine produces vomiting by = activating CTZ in brain
515. Ques about H1 and H2 receptor --> H1 smooth muscle, H2 gastrointestinal
516. Down Syndrome – macroglossia
517. Ectodermal dysplasia= scarce hair
518. Patient smokes pipe and has red bumps on palate= Nicotine stomatitis (hard
palate)
519. Arch discrepancy after loss of which tooth = Mand 2 nd molar - The premature
loss of the mandibular primary canine reflects insufficient arch size in the anterior
region.
520. Which is NOT used to inhibit salivary secretion = Pilocarpine
521. Osteogenesis imperfecta with = DI
522. Rapport active listening
523. Caries not depend on quantity of carbs
524. Radiograph id tip of the nose, external auditory meatus
525. Cavernous thrombosis infection via anterior triangle
526. Tooth mostly involved in perio relapse Max 2nd molar – Furcation involvement of
maxillary 2nd molar has the poorest prognosis following therapy / Trifurcation on
maxillary 1st molar are the most difficult of all to root plane (DD)
527. Warfarin test – INR/PT
528. Why you do not use fovea as indicator - it blocks minor salivary glands
529. Sausage like appearance on radiograph sialolithiasis or sialodenitis (I pick the first
one, not sure) – SIALODOCHITIS: within the gland sausage-link appearance.
Sialodochitis (also termed ductal sialadenitis), is inflammation of the duct system of a
salivary gland.
530. Antiretraction valves prevent cross contamination (between patients)
531. Hepatitis A positive can checked by
a) HBcg b) HBSg group c) no treatment d) alkaline triphostate - (Hep A infection is
identified by HAV-specific antibodies (IgM if acute, IgG if past disease)
532. Composite and bleaching wait 1 week before composite
533. Which is a characteristic of a gold inlay? A: Axial walls converge toward the
pulpal floor
534. Ortho treatment before veneer placement
535. By having excess amount of monomer in acrylic can create excessive amounts of
what: shrinkage
536. Dementia pt, which one the most challenging? 1-ext 2-denture is the ans
3-srp 4-amalgam
537. If you have 2 proximal cavities
a) you will fill smaller, prepare larger first ans
b) you will fill larger and prepare the smaller first
C) you will fill smaller and prepare the smaller first
d) you will fill the larger and prepare the larger first
538. Pin retained - Which statement is not correct? increasing in number of pin
strengthen amalgam
539. Best biopsy for small bean sized white lesion? a) Incisional b) excisional is the ans
c) brush
540. Steroid dose need medical consultant 20 mg for 2 weeks 2 year
541. Osteosarcoma = PDL widening
542. Patient presents with blow to face and horizontal fracture of a previously
endodontically treated molar. The fracture is 2mm from the anatomical crown. What
should the dentist do?
a. Treat root canal with Calcium Hydroxide
b. Place temporary crown and revisit in 3 months
c. Immobilize
d. Ext ans
543. Pt with MOD done 1 month ago, complained it hurt when he bits
A) polymerization shrinkage B) leakage c ) cracked tooth is the ans
544. Most common Impacted tooth - Mandi 3m , maxi 3m, max canine
545. Ludwig angina spaces – Submand, Sublingual, Submental
546. Xerostomia due to medications
547. Most common cyst = periapical - RADICULAR CYST (APICAL PERIODONTAL CYST
OR PERIAPICAL CYST) - MOST COMMON ODONTOGENIC CYST - BB
548. Warthin tumor which gland affects – parotid
549. Sulfur granules and lumpy jaw = actinomycosis
550. Most common infectious stage in syphilis – secondary
551. Hand and foot lesion which virus – coxsackievirus
552. REGIONAL ODONTODYSPLASIA: involves the hard tissues that are derived from
both epithelia (enamel) and mesenchymal (dentin and cementum). The teeth in a
region or quadrant of the maxilla or mandible are affected to the extent that they
exhibit short roots, open apical foramina, and enlarged pulp chambers – ghost teeth.
The cause is unknown and because of the poor quality of the affected teeth, their
removal is usually indicated.
553. Which of these has pain same to tooth pain (hsv/VZV/max sinusitis) - Shingles (vzv)
can mimic tooth ache.
554. How to differentiate ANUG from primary herpetic gingivostomatits - Intact
interdental papillae in herpes
555. Question about lesion in eye has a name subnour something like this i picked
phemphigus but it is mmp - The most common and feared diagnosis associated with
symblepharon is Mucous Membrane Pemphigoid (MMP)
556. Cobblestone appearance – Papillary hyperplasia
557. Which taste bud affected in geographic tongue - Filliform
558. Multiple myeloma starts = bone pain
559. Not vasodilaltor = cocaine
560. Not a(alpha) blocker = metoprolol
561. No nitrious oxide = in 1 st trimester
562. Cooling while implant placement - The bone is prepared with special metallic
burs driven at slow speeds with copious water- cooling
563. In implant preparation, which of the following can be used? A) hydroxyapatite
irrigation b) High Speed Hand Piece c) Low torque d)Air Coolant
564. Crevicular fluid cells PMNs
565. Opioid= mu receptors
566. Full dentures clicking = increased VDO
567. Carcinoma vs carcinoma in situ = no invasion
568. Fungal infection = nystatin
569. Systemic fungal = fluconazole
570. Erythroplakia= carcinoma in situ – Like "leukoplakia", ERYTHROPLAKIA has no
histologic connotation, but most erythroplakias are histologically diagnosed as severe
epithelial dysplasia, carcinoma in situ, or invasive squamous cell carcinoma. - DD
571. Open bite= LeFort 1
572. Most allergic metal = nickel
573. FRANKFORT-HORIZONTAL PLANE - constructed by drawing a line connecting
PORION & ORBITALE.
574. Labiodental sounds and what do they determine? Labiodental sound (fricative)-
f,v,ph, formed by maxillary incisor contacting the wet/dry line of mandibular lip. This
sounds help determining the position of incisal edge of maxillary anterior teeth.
575. Open apex tx: Vital apexogenesis / Non vital apexification
576. Mouthguard= MPDS
577. Polyether= sticks to teeth
578. RPD connector fracture = do soldering
579. Traumatic neuroma= mental nerve region
580. Primary mand 2 nd resembles - permanent mandibular first molar
581. Access opening for mand molar – Trapezoid
582. MWF = reduce pocket LINING
583. No gingivoectomy = with thin gingiva (An adequate amount of attached gingiva
must be present before a gingivectomy is done, otherwise the result will be an area
with minimal or no attached gingiva.) - DD
584. Drug testing = clinical trials
585. Where you give GA? 2 year old kid needs lot of restoration
586. Fearful patient how you respond? intoduce tools or TSD
587. Introduce instruments and tools = Desensitization
588. Smokeless tobacco - verrucous carcinoma – verrucous carcinoma (Associated
with smokeless tobacco habit).- DD
589. Fracture w paresthesia= angle of mandible
590. Minimum amount gutta percha left in canal after placement of post? 2 or 3 or 5
mm (IT’S 4mm).
591. Buccal-lingual bone width necessary for 4 mm implant. NO 6mm in options! I took
7mm.
592. Battery - Treatment without consent form
593. Pt with dialysis, when to do treatment? 1 day after dialysis
594. Harder area to floss - Mesial maxillary 1 pm
595. If open bite 8 mm, which kind of treatment do you do? Surgery, LeFort 1
596. Amalgam failure - THE CONTAMINATION OF THE AMALGAM BY MOISTURE DURING
TRITURATION AND CONDENSATION IS UNQUEATIONABLE THE PRINCIPAL CAUSE OF
FAILURES (DD).
597. Question about pigmentation in options was Neurofibromatosis and Preuz-
Jeghers. Pay attention to cafe-au-late spots! Both have pigmentation, but only
Neurof. has cafe-au late! – Café-au-lait found in VON RECKLINGHAUSEN'S DISEASE
(NEUROFIBROMATOSIS) and Albright's Syndrome (McCune-Albright Syndrome)
598. Osteoradionecrosis? More in mandible/ more in maxilla/ 42 gy? According to dd
its more than 40 gry and more in mandible (controversial)
599. How treat root caries? Composite, amalgam, GIC
600. Best filling for class 5 – GIC
601. Mucocele where most common? Upper lip, lower lip, side of tongue
602. Ginco Biloba contraindication? all anticoagulants
603. Cleft lip which embryo week? It was 6-9 the only reasonable option I took
cleft lip 6 weeks - 7 weeks
cleft palate 8-12 weeks - decks
604. Bleeding few days after extraction? fibrinolysis.
605. Transillumination: craze - full tooth illuminate / crack - light stopped - not full tooth
/ sialolith - in children
606. When do you use Laser or Electrocoagulation surgery intraorally? Only logical
option was capillary bleeding!
607. Motion sickness. Treatment: scopolamine
608. When is gingiva inflammation least expected? I was torn between Xerostomia
and Lack of keratinized gingiva. I chose lack of keratinized gingiva, although in
Dental School we learned, that when keratinized gingiva is missing, gingivitis is
programmed! But, Xerostomia sounded worse, so I took lack of keratinized gingiva!
609. Forceps for upper PM - 150 and 150A
610. What is not true about Xerostomia? Few very obvious true options, I chose it is
extremely difficult to treat it with Saliva substitutes and inducers.
611. Q. about V-form caries, tip towards the DEJ (interproximal/smooth surface)
612. Burn mouth syndrome due to: candida
613. Warthin tumor – 2nd most benign salivary gland tumor more in PAROTID GLAND
and more common reason is smoking.
614. Q. about Pemphigoid - I think, there was an option with basement membrane
and hemidesmosomes
615. All are advantages of per oral sedatives in the dental clinic except? There was an
option about GI absorption, and well controlled effect, that I chose.
616. Best topical Antibiotic agent? Options were H2O2, CHX, Ethanol and something
else. I chose CHX
617. 3 Qs about TAD (=Temporary Anchorage Device). Where it gets its stability from?
stability from cortical bone and increase stability if placed perpendicular. – The
primary stability of miniscrews is a result of mechanical interlocking of the threads with
cortical bone. Placement of miniscrews perpendicular to cortical bone to take
advantage of biological and biomechanical stability when applying heavy
orthopedic forces.
618. Tx for Status Epilepticus. NO Diazepam in options!!! There was Midazolam in the
options, and I chose that! Phenytoin could be an option too.
619. 2 y.o. uncooperative child. What to do to examine? GA, Papoose board, Restrict
by dental assistant, Restrict by parent.
620. Fluoride function on Enamel - reduces solubility
621. Most secure indicator for future caries? Bacteria, something else, salivary flow (the
more the better)
622. How to avoid cheek bites? increase the horizontal overlap in post teeth
623. Xerostomia causing drugs work on which receptor: Parasympathetic cholinergic
624. Drug conjugation. Add molecule to drug (to make it ionized so less fat soluble and
more water soluble)
625. Wrought wire can “do something” around 0,2 mm to the abutment tooth if
minimal wire length is 4, 6 or 8 mm? I took 4mm! I don’t have any idea what they were
talking about
626. Whats the most favorable taper of abutment to make RPD in part of inch: 0.02-
0.01 - 0.03 - 0.039
627. Most common to see in a teenage girl with buccal erupted canine? Anterior
deep bite, recession, 2 others – “…The former displayed significantly higher
frequencies at adolescence of ectopic eruption (mostly maxillary canines), anterior
cross-bite, extreme maxillary overjet, deep bite, and crowding.”
628. Abutment height in implant restorations selected according to? Only logical
option was according to implant lenght! I immediately thought about the abutment-
implant ratio!
629. Cocain effect? contraction of dilator pupillae, contraction of sphincter pupillae, 2
other stupid options.
630. Used as topical LA? Cocain, Benzo, Lido, Bupivacaine - Lidocaine is a local
anesthetic drug used topically in dentistry - BB.
631. Face rash, defect on heart, kidney and blood vessels? Lupus
632. Cause for Hairy Leukoplakia? HIV, EBV, HSV, Candida (don’t confuse w/ hairy
tongue)
633. Dry socket tx. - sedative, dressing no antibiotic, no curettage
634. Most difficult to maintain space? In a 9 y.o missing permanent MX M1 - 5 y.o
missing primary MD M1 - 6 y.o missing primary MD M2, one more I don't remember.
635. After RCT on a tooth with sinus tract, what is the tx for the sinus tract itself. Funny
options! We all know, that NO therapy is needed, right?! ;)
636. Disease with excessive bone production, but less bone resorption? Paget disease
was the only logic option
637. Mouth breather have? Open bite, long face, deep bite etc. Open bite and long
face
638. Typical face feature for muscle weakness? Same like mouth breather. They could
be the best couple - long face, open bite
639. Kid with ADHD what tx.? Methylphenidate , Amphetamines
640. Incision for palate tori. Y incision – a double “Y” incision should be made over the
midline of the torus. (DD)
641. Pain drug for the night? naproxen - 8 hour relief
642. Pt had tooth extraction want to sleep at night whst u give ? naproxen
643. Side effect of opioids, all except question. Side effects of opioids are sedation,
dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and
respiratory depression. NO gastric ulcers, NO insomnia, NO somnolence, NO diarrhea.
644. Lateral positioned flap - the option I chose was to maintain or improve keratinized
gingiva
645. Most common cause of amalgam failure à unquestionable moisture (DD)
646. Q. about rejecting null hypothesis. Type 1 error
647. What is the strongest point of statistics?
648. Selectivity / Sensitivity in clinical trials
649. Q. on clediocranial dysplasia – clavicle, supernumerary
650. In USA most dental payment – cash out of pocket
651. Restauration in anterior teeth done weeks ago, filling too light. What is the most
conservative tx. Keyword here is conservative!!! - Tint
652. Which shows saturation of color? chroma
653. Chronic periodontitis most seen in? male african american
654. Face-bow – hinge
655. In English the s/ch/sh sounds, how is anterior teeth position - very little distance
betw. anterior teeth.
656. Major connector function - stability rigidity
657. Why do we do apexification? - non vital tooth, apical barrier for rct after 3 months
if calcified (“induce root development” is apexogenesis for vital tooth, apexification
for non vital for apical barrier!)
658. Most common seizure in children - febrile
659. Tx. for atypicaly erupting permanent tooth, with gingival margin above CEJ.
Gingivectomy, Apical positioned flap, others (Apical positioned flap, to not waste
keratinized gingiva)
660. Best graft material - autograft
661. Where do you get the most amount of graft material from? illiac
662. Pka has effect on - onset
663. All can be Dif. Diagnosis of Leukoplakia except. - I think I chose Verrucous
leukoplakia, just because they look so different – White sponge nevus is often
mistaken for leukoplakia BUT appears early in life. Focal (frictional) keratosis: common
white lesion caused by chronic friction on the mucosa. Differentiated from idiopathic
leukoplakia because cause is known. Leukoedema disappears with stretching. (DD)
664. Collimation purpose - Reduce size of beam
665. Calculation of incidence index - Out of 1000 patients —-> 200 diseased patients
last year, 300 this year. 300-200=100, 100/1000= 0,1
666. Kid with bad OH what ortho tx? Fixed, removable, no tx
667. Veneer facial reduction – 0.5mm
668. If a Porcelain to metal fused anterior crown too opaque, what”s the reason? less
2nd plane reduction
669. Perio-Endo lesion tx. – first endo
670. MRI how does that work?- Clinical magnetic resonance imaging (clinical MRI) is
an imaging technique used in radiology to form pictures of the anatomy and the
physiological processes of the body in both health and disease. MRI scanners use
strong magnetic fields, radio waves, and field gradients to generate images of the
organs in the body. MRI does not involve x-rays, which distinguishes it from computed
tomography (CT or CAT).
671. Drug against kidney failure, what's the best to analyze and prove its action?
Creatinine test
672. If lower complete denture overextended buccodistaly what structure impaired?
masseter
673. In upper complete denture overextended buccodistaly what structure impaired?
coronoid
674. Pseudomembranous colitis - Clindamycin
675. Patient has a palatal torus that extends beyond posterior palatal seal into the soft
palatal area, and in need of complete denture. What to do? Remove it
676. Ignoring the pt bad behavior – extinguishing
677. Which tooth more prone to caries? Maxillary 1st molar (Kaplan)
678. High kV? Long wave lenght low energy; Short wave length high energy; 2 more
combinations
679. Dexterity – floss (5 brush 8 floss)
680. Q. about a kid with Autism. Repetitive and Sensitive to light and high volume
681. Q. about ACE-blockers - It actually directly blocks the Angiotensin-Converting-
Enzyme, not the Angiotensin - blocks the enzyme which converts angiotensin I to
angiotensin II.
682. Actinomycosis – sulfur granules
683. Vertical root fracture most commonly seen? Mandibular molars
684. Crown to root fracture most commonly seen? Maxillary anterior
685. Perforation of anterior maxillary incisors during RCT access in general most
common on which surface? Mesial - Maxillary Anterior teeth: Mesial perforation due
to distal axial inclination. Mand. Ant: LABIAL perforation due to lingual inclination
686. Cast impression least acurate? Reversible Hydrocolloids, Irreversible
Hydrocolloids, Polyether, one more
687. Q on Chronic Heart Failure.
PHARMACOLOGIC THERAPY: DIURETICS (used to control fluid retention), ACE INHIBITORS
(interfere w/ the renin-angiotensin system, are required of all patients w/ cardiac
failure unless contraindicated), VASODILATORS (including hydralazine and nitrates,
are used when the use of ACE inhibitors is not possible), BETA BLOCKERS (should be
used in patients w/left ventricular dysfunction, unless contraindicated), DIGITALIS can
improve symptoms and exercise tolerance by increasing cardiac contractility, other
medications include oxygen and morphine. ASPIRIN, NSAIDs, and CALCIUM CHANNEL
BLOCKERS SHOULD BE AVOIDED. Patient treatment and dental management
considerations: prolonged rest, administration of oxygen, digitalis (patients are prone
to nausea and vomiting), diuretics/vasodilators (patients are prone to orthostatic
hypotention; avoid excessive epinephrine), dicumarol (patients may have bleeding
problem). The beneficial effects of digitalis in congestive heart failure results in part
from the fact that digitalis causes a decrease in end-diastolic volume, an increase in
stroke volume and cardiac output, a decrease in central venous pressure, and a
decrease in rate of the heart where tachycardia exists. Digitalis glycosides generally
decrease edema, decrease heart size, decrease heart rate, and decrease residual
diastolic volume.
688. Neuropraxia - I chose the option about damaged axon, but intact epineurium –
FALSE -> Neuropraxia is the mildest form of neural injury. Local axon demylineation
occurs at the site of injury. However, the axon, the endoneurium, the perineurium, and
the epineurium are INTACT.
689. If a patient has had a car accident and an assumption of broken cervical spine,
which xray is contraindicated? Waters, SMV, Pano, CT
690. Q. about Sterilization.
691. Pat. With xerostomia. All is true for the indications to manufacture a complete
denture with METAL basis except? More acuracity, More wetability, Low cost, More
durability
692. Pat. comes back after two weeks with discolored margins. Cause? amine
693. Qs about preparation before grafting. I chose the option to remove all granular
tissue completely.
694. Carbamacepin used in? They give you very confusing options, that look similar!!! I
chose nerve pain.
695. Which postion is patient related? VDO, CR, VPR, ICP
696. What will most likely cause the odontoblastic processe to retract in the dentinal
tubules? Desiccation? (or Depth to which dentinal tubules are cut?)
697. All is correct about sclerotic dentin except? I was torn between extremely low
permeability or better bond with restorative materials compared to normal dentin..
698. Which study doesn’t show cause and effect. - cross sectional
699. Two questions on Incisal guidance.
700. What is true about remineralized enamel. - more resistant to future acid
701. Sialolithiasis. – submandibular gland
702. Patient complains of pain due to oral mucositis after radiotherapy. The pain is
best treated with? a) Nystatin b) Benzyl hydrochloride (BENZYDAMINE
HYDROCHLORIDE) c) Topical corticosteroid d) Morphine
703. Characteristic feature of AML? Auer rods
704. Pindborg tumor or CEOT - Liesegang rings / rx: snow appearance
705. Elective RCT contraindication. – recent MI
706. Gagging patient, what's the tx in a long term. Desensitization
707. Exhaling wheezing. - Asthma
708. Adverse effect of codiene. Miosis, nausea
709. Culture sensitivity test. - It was also about an infection that couldn’t be treated with
particular AB
710. Not easy Qs. about pontic design.
711. Action of beta blocker on smooth muscle? vasoconstriction
712. What is true about if a general dentist decides to perform a treatment which is
normally done by specialist.- No maleficiency in options! There was something like,
“He has to perform as good as a specialist, if he does the tx”
713. Q. about orthostatic hypotension. - Patients taking diuretics/vasodilators are
prone to orthostatic hypotension, also avoid excessive EPI. - A fainting spell that
occurs due to a rapid fall in BP when moving from the supine to the upright position
when getting out of the dental chair. The symptoms are similar to simple fainting, but
the condition is related to positioning. Amyl Nitrite (Nitrites): Adverse Effects à
orthostatic hypotension & headache.
714. Pain killer in pt who has just withdrawn alcohol? Hydrocodone (opioid)
715. Alcoholic pt pain med? Put naproxen. (if not in option hydrocodone)
716. Side effect of erythromycin? Gastrointestinal disturbances – GI tract upset is the
most common side effect of the erythromycins (take with food).
717. Risk of extraction of upper Molar? Palatal root goes to sinus
718. Risk of extraction of #32? Damage to L nerve (IAN before Lingual)
719. What’s unethical? Charge more to difficult pts, Raise fees to particular group of
insurance.
720. Radiopacity in lower molar area, no teeth. I put idiopathic schlerosis
721. Pt with bleeding gums and skin lesions? What condition – Leukemia
722. 2 yrs old intrudes incisor all the way in but doesn’t touch perm. Vital. What to do?
Ortho extrusion then splint? Leave it
723. 14 is intruded in middle age pt, has distal caries, how to level plane of occlusion?
Extract, Intrusion, Crown
724. Mode: The most frequent measurement in a set of data.
725. What type of study is if they look for prevalence? Cross Sectional
726. Socioeconomic influences the risk of developing perio and caries T
727. Due to this there’s risk of perio disease at ALL ages? F
728. What is that a drug has the strongest effect? Potency – Efficacy
729. Treatment of LAP - Put SRP and abx
730. Tx of perio with calculus on smoker. Put: debridement, oh, tobacco cessation
advice.
731. When referring a mesialized 32 with irreversible pulpitis with curved roots for RCT,
what’s the least important: curve roots, Canal calcification, Difficulty with anesthesia,
Inclination of tooth (chose this)
732. U see nasty white lesion on floor of mouth, suspect of except: Scc, Verrucous
carcinoma, Leukoplakia, Nicotinic stomatitis (chose this)
733. Same lesion what do u do first to dx? Cytology Excision Biopsy Nothing Wait a
month.
734. Glass fiber post compared to custom made post: Aesthetic. Tooth conservation.
Less chances of fracture.
735. Patient has tissue on palate due to denture, how to treat? Laser Excision Nothing
Not wear denture for a while
736. Funtion of the internal part of an implant? they didn’t mention hex i chose
antirotation
737. Short molar how to get extra retention? Groove on buccal
738. When doing protrusive on articulator, do you raise the pin? YES
739. What resto gives more retention for a short crown? Mod onlay, Veneer with
grooves, 3/4 with proximal grooves (chose this, not sure)
740. Non-nitrate vasodilator for angina? Dipyridemole, nitroglycerin, lisinopril,
isoflorophtate
741. What are filters for? Filtration reduces patient dose, contrast, & film density.
Absorbs not useful xray (long length), reducing the patient dosage.
742. IAN anesthesia not well, what accessory nerve might be causing pain?
Mylohyoideo nerve
743. U did resto, patient comes back after 6 months with pain to sweet and bitting?
Reversible pulpitis
744. Lower molar, no pain. Has radiolucency on all apex of roots, why? Spontaneous
necrosis, Vertical fracture, horizontal fracture
745. Target = tungsten? T
746. What happens if you increase more liquid to ZOE? more soluble?
747. Area most susceptible of caries: pits and fissure, above the contact, cervical of
contact
748. ANGINA: NITROGLYCERIN, sometimes propranolol, calcium channel blockers,
such as verapamil. Angina is primarily treated with nitroglycerin. Drugs that can be
used in the prevention and treatment of angina pectoris: propranolol, nitroglycerin,
isosorbide dinitrate, pentaerythritol tetranitrate - DD
749. Selective serotonin re-uptake inhibitor drug with the longest half-life (SSRI) –
Fluoxetine (Prozac)
750. Advantage of glass fiber posts - Similar modulus of elasticity as dentin
751. What is the indication for an apicoectomy? a. Failed root canal that cannot be
reinstrumented b. Root canal that is difficult to perform
752. Example of someone who comes into the office and has a belligerent attitude
and says that every dentist she has seen has been incompetent and then 30 minutes
into the appointment she starts praising you and saying that you are the best dentist
she has had, this person’s personality is best described as: a. Narcissistic b. Borderline
c. Schizoid
753. Halogen light and LED light which is true:
a. LED light does not polymerize unless has champhoroquinone initiator
b. LED light cannot be battery operated
c. LED light bulb has a short life span
d. LED light emits wavelength 350-370
754. Amantadine (Symmetrel)- anti-viral agent that enters the CNS to treat Parkinson's
disease by potentiating dopaminergic responses.
755. Osteoporosis: Thin traveculae
756. Which of the following describes growth after menarche: a. Increases b. Stays
constant c. Stops (Mosby: general body tissues including muscles and bone
accelerate growth at the same time reproductive tissues proliferate.)
757. Implant is successful? a. 1mm bone loss in year one, 0.2 every year after b. 1 mm
bone loss year one, 0.02mm every year after – Mosby and DD say 0.02 mm, no
misprints!
758. When analyzing the arch distance which space do they analyze? 1- mesial of
canine to canine 2- mesial of first premolar to first premolar 3- mesial of first molar to
first molar ( I think the answer is 3) – Mosby: distal from second primary molar to distal
of second primary molar on other side
759. Which one of the tooth is most prone to cracked tooth o syndrome? 1-Maxillary
premolar 2- mandibular premolar 3-maxillar first molar 4-mandibular second molar -
(mandibular first molars followed by 2nd mandibular molar and maxillary premolars)
760. Pt comes to you with complete denture that is loose, she wants a new one, and
there is redness under the upper denture with papillary hyperplasia? What is your
immediate management ? Excision of lesion, Tissue conditioner on the same denture.
Make impression and fabrication a new.
761. The roubela causing mental retardation is caused by? 1- genetically 2- acquired
3- chromosal
762. Permanent max lat inc calcification starts when - 10-12 months (max centrals 3-4
months)
763. Primary principle of behavior modification a) stimulus cause behavior b) behavior
has consequences
764. If pt was addicted to alcohol and had a treatment for his addiction, and for 18
months successfully is not drinking. He is considered to be completely recovered from
addiction. T/F
765. Which tooth has most common crown-to-root fracture: max anterior incisors,
mand ant incisors, max molars, mand molars
766. Most common with chronic periodontitis: Hispanic male, Hispanic female, Black
male, Black female
767. Prevalence of cells in gingival sulcus: neutrophils, macrophages, plasma cells
768. Mild facets on occlusal surfaces in primary dentition indicate: normal function,
indicate early malocclusion, parafunction habits, occlusal interferences
769. NUG clinically resembles: primary herpetic gingivitis
770. Actinomycosis of Jaw commonly leads to: diffuse sclerosing osteomyelitis, or
ruptures through facial neck soft tissues via multiple drain sinuses
771. Disadvantage of partial thickness flap is: unable to increase zone keratinised
gingiva, or dissection from vascular supply source - A or missed option, i have
disadvantage in my notes lack of surgical flexibility (limited visibilty and access) from
old rq
772. Class II drugs: Percocet, Vicodin, Tylenol 3
773. Studies proved that caries can be arrested by placement of: Ca hydroxide, GIC,
or sealing well the margins of restorations – On the basis of the studies cited in this
review, one can state that there is substantial evidence that the removal of all
infected dentin in deep carious lesions is not required for successful caries treatment—
provided that the restoration can seal the lesion from the oral environment effectively.
774. RCT was done one year ago, periapical RL became larger since then, all can
explain this, except: Apical scar, proximity to incisive canal, different angulation of x-
ray...
775. As for ectodermal dysplasia is the lack of development of zygoma, for
cleidocranial dysplasia it is: clavicle
776. Cleidocranial à supernumerary
777. Ranula develops because of: stone, or trauma to the duct – Mucocele = trauma
778. Min count of granulocytes for elective surgery: 1,000mm3, 15,000, 100,000, 10,000...
779. In children and adolescents most common cause of xerostomia? 1) sjron,
2)salivary gland obstruction 3) nocturnal mouth breathing
780. Varicosity under tongue: because of untreated HTN (there was not age in options)
781. Pt has vasovagal syncope, you do all, except: A. Administer oxygen B. Place in
Tredenburg position C. Give epinephrine D. Apply spirits of ammonia E. Maintain
airflow
782. Minimum of hydrocortisone for the Pt to be considered suppressed if taken daily:
20 mg before 2 weeks for 2 years, 10 mg before 2 weeks for 2 years, 100 mg same..
783. In modified Widman flap it is: full-thickness flap, or partial flap Modified Widman
Flap - The modified Widman procedure is a replaced mucoperiosteal (full thickness)
flap procedure.
784. Inferior alveolar artery is a branch from: external carotid artery, or internal
785. Mandibular tori are to be removed before constructing the denture. T/F if interfere
786. You need to put in surgery consent about the risk of damaging lingual nerve. T/F
787. Side effects of albumin are all, except: tachycardia, stimulation of CNS, insomnia,
increased salivation, diarrhea. (people say it is “atropine” written wrong, so answer
here is salivation).
788. The Q about relation of consistency and frequency of maintenance perio visits
and patient compliance and long-term warranty
789. A patient's compliance with schedule maintenance visits has no effect on the
long-term retention of periodontally treated. Frequency of maintenance visits has no
correlation with the development of periodontal pockets and gingivitis.
1. Both statements are false. (ANS)
2. Both statements are true.
3. The fist sta. is true, the second is false.
4. The first sta. us false, the second is true.
790. With the damage of oculomotor nerve where eye will move: (there were 2
directions in every option, like upward and medial, or downward and lateral...)
downward and outward, ptosis – Oculomotor controls superior rectus (elevation and
adduction), medial rectus (adduction), inferior rectus (depression and adduction) and
inferior oblique (elevation and abduction) – FA
791. With the trauma of CN VI nerve in which direction difficult to stare: (one option),
downward, upward, lateral, medial
792. MOA of sulfanilamide (sulfonamide): bacteriostatic, inhibit protein synthesis,
COMPETE with PABA to inhibit PABAs actions, which prevents bacterial folic acid
synthesis to inhibit cellular growth.
793. Pt on sulfonamides, what will be the most likely side effect that being a dentist
you can say? ERYTHEMA MULTIFORME? – EM is a type of allergic hypersensitivity
reaction in response to medications, infections, or illness. Medications associated with
erythema multiforme include sulfonamides, penicillins, barbiturates , & phenytoin.
794. It is the preferred to quite smoking on the day when full extractions series
scheduled. T/F
795. To be able to burnish a margin of a gold restoration which one should be
exceed? a) Modulus of elasticity b) Yield strength
796. What impression material has a natural affinity to water? (no hydrochloride in
options) Polyether (hydrophilic)
797. Initiate Chantix week before planning on quitting smoking. T/F - Varenicline (trade
name Chantix and Champix), is a prescription medication used to treat nicotine
addiction. Begin CHANTIX dosing one week before this date.
798. In anterior mandibular teeth there is some crowding. The gingival recession can
develop because of all, except: frenum pull, asthma inhaler use, plaque, not enough
overbite...
799. Know immunosupressive drugs: (will give you 4 of them, you rule out one) Also
know their side effects more than candida. – I answered Candida but I did not know
what was this drug about...Guys, memorize this mycophenolate drug is
immunosuppressant!
800. Mycophenolate (CellCept) is used with other medications to help prevent
transplant organ rejection (attack of the transplanted organ by the immune system of
the person receiving the organ) in people who have received kidney, heart, and liver
transplants.
801. Q just before this one asking all are immunosuppressive except one?
Methylphenidate – (treatment of attention deficit hyperactivity disorder (ADHD) and
narcolepsy), among the more serious adverse reactions are nervousness, insomnia ,
and anorexia.
802. What can decrease the effect of Warfarin: liver insufficiency, stimulation of
hepatic microsomal metabolism - an increased response to warfarin would be
expected in patients with liver impairment.
803. Pt with bizarre behavior and confusion, you administer: insulin, epinephrine,
glucose
804. The reason to mounting study models is to observe: vertical dimension of
occlusion, vertical dimension of rest, interdental occlusion, size and location of
anterior teeth.
805. After polishing which appears first on teeth: material alba, biofilm, pellicle
806. Deepest part of occlusal rest is in: central fossa, marginal ridge – The deepest part
of an occlusal rest preparation should be inside the lowered marginal ridge. The
marginal ridge is lowered to provide bulk and to accommodate the origin of the
occlusal rest with the least occlusal interference. – McCracken
807. Which agency initiated Hazzard communication program: CDC, OSHA, EPA
808. Hazzard communication program is about: protecting from and managing
blood-born and infectious exposure, protecting from chemical exposures
809. Primary teeth shed prematurely in: cyclic neutropenia? - Yes, true. Perio disease
may result in loosening of teeth and early tooth loss in young children.
810. There was x-ray with upper canine with still forming apex, looked basically normal
in my opinion, but had in canal some obliterated oval structures...asked it is due to: AI,
DI, DD, regional odontogenic dysplasia. Had permanent max canine still forming
apex, yes with some premolars and 2nd molars still forming apex too. Those
obliterated structures I noticed in both upper canines, but Q asked only about left
one. It was regular width canal with pulpal stones. Tooth also was showing half out
and the rest under gingiva still. I googled, found some research article where it saying
if pulpal stones are seen in several teeth in young permanent teeth the condition is
systemic and characteristic to DD – Dentin dysplasia TYPE II (coronal dysplasia): color
of primary teeth is opalescent (amber-colored) color of permanent teeth is normal,
coronal pulps of permanent teeth are usually enlarged (”thistle tube”) and may
contain pulp stones (DD)
811. If there is narrow attached gingiva next to maxillary second molar what you
cannot do: apically displaced flap, gingivectomy, distal wedge – Distal wedge
procedures, frequently performed after wisdom teeth are extracted, because the
bone fill is usually poor, leaving a periodontal defect. Only if sufficient space exists
distal to the last molar, a band of attached gingiva may be present. In such a case, a
distal wedge operation can be performed. (DD).
812. 14 yo has a good oral hygiene, lives in community fluoridated area. For
prevention of future caries what should be instructed: better oral hygiene, placing
sealants in all 4 1st molars, fluoride gel placement by pt daily, fluoride rinse daily after
brushing.
813. Also she has a little brown discoloration in her mand 1st molar occlusal pit and
fissure, with an explorer catching on it, you should: place sealant over, preventive
resin resto, amalgam, no treatment at this time.
814. Biological width: junctional epi and connective tissue attachment within sulcus,
junctional and connective tissue attachment
815. Side effects of nitroglycerin: (know more, can be an except Q) – hypotension w/
reflex tachycardia, syncope, headache, flushed skin, dizziness, paradoxical
bradycardia (google books) – MOSBY: Headache, syncope, tachycardia, tolerance,
methemoglobinemia.
816. Side effect of nitroglycerine a. nausea, headache b. lightheadness, respiratory
depression
817. Most common post-extraction complication is (did not mention any jaw): dry
socket, infection, hemorrhage, fracture
818. Least reoccurrence after removal: ameloblastoma, adenomatoid odontogenic
tumor
819. Only microscopy can determine the diagnosis: ameloblastic fibroma, fibro-
odontoma, KOT, radicular cyst - ODONTOGENIC KERATOCYST - follicular & dentigerous
cysts that contain keratinizing material, and differs from other odontogenic cysts due
to their microscopic appearance & clinical behavior.
820. Pt with chipped veneer but would like to keep it, for fixing chipped part with
composite you do: micro-etch, etch, silane, bonding
821. Most common location of intraoral melanoma: palate and gingiva, palate and
lip...
822. In osteoporosis you expect to see: brown tumors, thin trabecular, decreased
calcification of cortical bone
823. What is not an advantage of LED cure in comparison to halogen: lifetime bulb,
energy efficient, weight, curing depth
824. First sign of HIV: asymptomatic, hairy tongue, opportunistic manifestations
825. What change in white blood cells you see in cellulitis: neutropenia, neutrophilia,
lymphocytosis...
826. Type of external resorption in pulpal necrosis: inflammatory, replacement
827. Nitrous oxide is contraindicated in asthma pts. T/F NO can be used in anxious pts.
T/F
828. Which is safe in all trimesters of pregnancy: ibuprofen, aspirin, some opioid,
acetaminophen+codeine (Tylenol 3)
829. How to differentiate incipient white caries on smooth surface with remineralized
caries: transillumination, enamel illumination, with using explorer on surface, with better
lighting and air drying
830. Studies showed the the effect of leukotriens in: asthma, stomach ulcers
831. Implant analog is what for: to take an impression with it, to pour impression with it
832. All influence duration of anesthesia, Except one: (I think ASDA q)
833. Which muscle to take considerations in shaping the lingual border of denture:
mylohyoid, genioglossus, geniohyoid
834. If posterior palatal seal is too deep it causes: unseating of denture, gagging
835. Soccer player wakes up with sore temporal muscle and stiffness of the jaw:
myofacial syndrome, osteoarthritis
836. Helix built in uprighting molar serves for: increase force, increase range, increase
body translation - in dd ortho card 14 mention helices are incorporated to increase
the action range and flexibility , so its b
837. Posture has an influence on: (different intraoral findings in options) - If I remember
it correctly , the options were vdo, vertical dimension at rest...
838. Veneer with discolored margin after 3 weeks, reason: amines, insufficient resin
839. FDA is conducting a clinical trial about a new drug on animals and human. What
is the phase 3 of this study?
a. to see if the drug is cancerous on animal or not
b. to find the effective dose of the drug
c. to find the MOA of drug
d. …..--> there was another option which I think it was the correct answer but I don’t
remember it
phase 1 - Safety and dosage
phase 2 - Evaluate/find effectiveness
phase 3 - to CONFIRM the effectiveness, to find common side effects
phase 4 - to find the RARE side effects
840. Which one in wax try in for complete denture? a. Facebow record b. Esthetic
841. Early primary teeth lost a. papillon-lefevre syndrome - T (autosomal recessive,
deficiency in cathepsin C, primary teeth lost by 4 years old, permanent teeth lost by
14 years old).
842. Most common in mandibule premolar region a. CCOT b. OKC c. OM d. fibrous
dysplasia e. lateral periodontal cyst
843. Submandibular space drainage through which muscle a. platysma b. masseter c.
median pterygoid
844. When draining purulent exudate from an abscess of the pterygomandibular
space using an intraoral approach, the buccinator muscle is most likely to be incised.
- DD
845. Which oral pigmented lesion resolve spontaneously? a. varix b. freckle c.
melanotic macule
846. Which is correct about conjugation? a. adding a molecule to the drug b. making
the drug more lipid soluble c. increase in the effect of drug
847. Which of these cognitive behavior decrease in a normal process of aging: a.
learning b. attention c. reaction
848. Which one does NOT show the dispersing of date a. variance b. median c.
standard error
849. DMF shows? a. caries b.oral hygiene
850. Dmf index = measures how permanent dentition is affect by caries
851. Fail-safe mechanism part of NO machine does not let the increase of NO flew by
what percent a.20 b.50 c.70 d.90
852. Pappoos board isn’t used in which situation: Treatment of a 14 years old
cooperative patient
853. Where do progenitor cells for new attachment come from? a) alveolar ridge b)
PDL c) cementum d) connective tissue of gingiva
854. What does bimaxillary protrusion mean? A protrusive dentoalveolar position of
maxillary and mandibular arches that produces a convex facial profile.
855. Pt doesn’t have upper 3rd molars. How many furcations do we have in upper
jaw? a. 12 b. 14 c. 8 is the ans now if 6 is in there is 6?? The answer should be 16! first
maxillary premolars are BIFURCATED! Maxillary molars are TRIFURCATED! That means
we have (4 maxillary molars * 3 furcations) + (2 first maxillary premolars * 2 furcations)
= 16 FURCATIONS!!!
856. Retentive clasp fracture? a. Work hardening b. Crystal formation in clasp c. Low
modulus of elasticity d. High elongation
857. Mild wear facet in primary dentition? a. No treatment needed b. It is bcs of
parafunction
858. Which one has least effect on DURATION of local anesthesia a. Systemic
absorption of drug b. Bind to protein in tissue (Absorption = bioavailability, Duration =
protein binding)
859. Missing more than two teeth but not all them – Oligodontia
860. What impression material has a natural affinity to water? a) Polyether
b) Additional silicon c) Condensing silicon d) Poly sulfide
861. What do you see in pathology of osteoporosis - Thin trabecula
862. Not a symptom for dentin dysplasia (enamel loss)
863. Most common supernumerary tooth – Mesiodens
864. Most common variable tooth is - Max Lat
865. Most common tooth affected by dens in dente – Max lateral
866. Most common type of tooth loss in bulimic pt - erosion, lingual aspect
867. Another question about tooth loss was unclear it was about tooth loss due to
tooth influx – Abfraction
868. Patient who has medical history but is not debilitating but will require medical
management and dental modifications – 1-ASA 3 2- ASA2
869. Failure in morphodifferentiation results in . a.size and shape abnormality ,b. peg
lateral ,c. macrodontia d. All is the ans
870. Bald tongue and dysphagia is in a risk of developing which cancer - Plummer
vinson syndrome expressing as SCC (Oral Symptoms: angular stomatitis, smooth, red,
painful tongue with atrophy of the papillae).
871. Problem in CL channel which disease - Cystic fibrosis
872. Crowe’s sign - Neurofibromatosis type 1 (von Recklinghausen disease of skin) à
autosomal dominant disease, due to a mutation of the tumor suppressor gene NF1, six
or more café-au-lait macules greater than 1.5 cm – these are usually smooth-
surfaced (“Coast of California”), two or more neurofibromas OR one plexiform
neurofibroma (pathognomonic for the condition), axillary freckling (called Crowe’s
sign), iris hamartomas (called Lish nodules).
873. Uniform widen in pdl and bilateral resorb of angel what is the disease: No
scleroderma in options but “SYSTEMIC SCLEROSIS” (its is also known as SCLERODERMA)
874. Pt has PDL space widening with radiolucency at the angle of the mandible
(a) multiple sclerosis (b) osteosarcoma (c) fibrous dysplasia (d) other options – Now you
know the missing option.
875. Oral sign with achondroplasia - Normal tooth, crowding and class 3 – DD à The
teeth are of normal size but there is limited space within the maxillary and mandibular
arches for them to erupt into, which causes overcrowding and subsequent
malocclusion.
876. Dental problem with decreased Alk pho – Hypophosphatasia = Enlarged pulp
and incomplete roots. DD à CHILDHOOD: THE MOST COMMON FEAUTRE IS PREMATURE
LOSS OF PRIMARY TEETH WITHOUT INFLAMMATORY RESPONSE. The premature loss of
teeth in children and adults is usually characteristic. Radiographically, the teeth
display enlarged pulp chambers and pulp canals, deficient root development as well
as alveolar bone loss. Patients w/ Paget disease have high levels of serum alkaline
phosphatase.
877. X linked associated with thin hair and hypodontia - Ectodermal dysplasia
878. What does the hyperbaric chamber help with I put angiogenesis
879. Time for surgical hand washing is 3 min
880. Which drug gives tardive dyskansia is phenothiazines - Tardive dyskinesia-a serious,
irreversible neurological disorder that can appear at any age. It is a side effect of
antipsychotic/neuroleptic drugs (i.e. phenothiazine).
881. What condition of the tongue involves the foliate papilla is - lingual tonsil
hyperplasia
882. Supernumerary teeth with cranial bossing which syndrome - Cleidocranial
dysplasia – CD: the most distinctive features include delayed tooth eruption and
supernumerary teeth, hypoplastic or aplastic clavicles, cranial bossing, and
hypertelorism. (Mosby)
883. Warm bone sign of which disease – Paget (Paget's bone is also hypervascular and
may feel warm to palpation.)
884. Early shedding of primary teeth and delay of perm teeth – Cherubism
885. Dry and rough hair and enlarge tongue and max over grow associated with –
Hypothyroidism
886. Bells palsy which nerve – Facial (VII)
887. Delay healing associated with all except (Cushing /Addison/-DM/vit c increase)
888. IgM heterohybridomas diagnosis for - Infectious mononucleosis by EBV
889. Punch out appearance and M spike - Multiple myeloma
890. Medicines in MM - Cyclophosphamide (alkylating agent, immunosuppressant) is
used in DD, bisphosphonates
891. Wide pdl and paresthesia and tooth loss with – Osteosarcoma
892. Sharp pain in throat increase with chewing (Unilateral pain in throat worsen by
chewing) – Glossopharyngeal neuralgia
893. Meds not given to pt on anti cholinergic tx - opioids
894. Most common non odonto cyst is – Nasopalatine Duct Cyst (Incisive Canal Cyst)-
a "heart-shaped" radiolucency in the midline of the hard palate. It is the most
common non-odontogenic/developmental fissural cyst.
895. Pear shape cyst is – Globulomaxillary - Globulomaxillary Cyst-an inverted "pear-
shaped" radiolucency in bone between the roots of the maxillary lateral & canine
(often causes the roots of the involved teeth to diverge). - Tear shape its lateral
periodontal cyst.
896. Calcified flax cerbi with which syndrome - Nevoid basal cell syndr / Gorlin syndr
897. Most common cyst – Radicular
898. Only way to differentiate bw granuloma and radicular cyst – Histology
899. Tennis racket and honeycomb appearance which cancer - Odontogenic
myxoma
900. Periapical cemental dysp more in – middle age black women/mandible anterior
901. Complex odontoma more in – posterior mandible
902. Most common burn in mouth due to – aspirin
903. Geographic necrosis with kidney problem what is the diagnosis – Wegener’s
granulomatosis (Oral lesions present as strawberry gingivitis.)
904. Most common gland affected by salivary gland tumor is –parotid
905. Question about necrotizing silometaplasia – NECROTIZING SIALOMETAPLASIA:
deep-seated palatal ulcer with clinical and histologic features mimicking those of a
malignant neoplasm. Recognized lesion of the minor salivary glands, characterized
by necrosis of the glandular parenchyma w/ associated squamous metaplasia and
hyperplasia of the ductal epithelium. The initiating event of necrotizing
sialometaplasia is believed to be related to ischemia, secondary to alteration of local
blood supply. Both, clinically and histologically, the lesion may simulate a malignancy
and, in the past, the condition has been misdiagnosed as a squamous cell carcinoma
or mucoepidermoid carcinoma. FOLLOWING BIOPSY AND THE ESTABLISHMENT OF THE
DIAGNOSIS, FURTHER TREATMENT GENERALLY IS NOT RECOMMENDED SINCE HEALING
USUALLY OCCURS WITHING 6-10 WEEKS.
906. Porcelain has tooth matching color by – glaze firing
907. Dentist choice by metamerism - Different colors under different light sources
908. Lab adds stains in the inside of the porcelain – to decrease value
909. Lab glazes and polishes the porcelain in the end of the design - More compatible
to the gingiva; In dd card 135, said the glaze firing is the last firing and it produce
smooth and translucent surface. During glazing: Surface layers of porcelain melt
slightly, coalescing the particles and filling in surface defects (Mosby page 361)
910. Meds not given to one on BDZ – antifungal agents
911. Meds contraindicated in pt on barbiturates – phenothiazines, alcohol,
antihypertensive agents, and antihistamines (Kaplan)
912. Chlorothiazide – electrolyte test because it causes hypokalemia
913. Except sweat changes, pt will also show what changes in cystic fibrosis: lung,
saliva, urine and some other options - CF results in several symptoms (the most
important symptom affects the digestive tract and lungs).
914. Medicines contraindicated in a cystic fibrosis pt – beta 2 antagonists, NO2
(General anesthesia is avoided too in DD, they will have COPD, like chronic bronchitis
, sinusitis , so beta 2 agonist will help)
915. COPD pt, what is contraindicated - 100% o2 therapy, nitrous oxide, If patient with
copd is taking theophylline should not prescribed erythromycin, it will lead to toxicity,
card 75 surgery, General anesthesia is contraindicated and avoid certain antibiotic
barbiturate, narcotic, antihistamin and anticolinergic. (USC pt management manual
book).
916. Max amount of N2O that can you flow into the tube at a time - 70% adult / 50%
kids
917. Tetraycline works by: no 30s or protein synthesis in option, but there was options of
interference with collagenase, 50s unit, plasma proteins and dna gyrase
918. Pt on your chair, presents with insulin shock, what will you do next? Orange juice,
glucose, epinephrine, O2, etc - The treatment of choice for hypoglycemia in an
unconscious diabetic patient: EMS should be contacted. Then 1mg of glucagon can
be injected IM, or 50 ml of 50% glucose (dextrose) solution can be given by rapid IV
infusion. If conscious, oral glucose (orange juice). - DD
919. Pt on hep B meds, what will you do? Call physician, order regular CBC etc. blood
reports, were some fancy names of tests later.
920. Mandi tori removal, most frequent complication? Options were loss of cortical
border bone, injury to mental n, lingual n, or IAN injury
921. During maxillary tori removal, you accidentally perforate a part of the palate with
the tori, what structure will you see? Nasal cavity, inferior concha, pharynx and one
more irrelevant option
922. During 3M removal, which mand part is most likely to get fractured? Lingual plate
923. Closed mandi fracture, which is most likely to interfere with the closed reduction?
Pull of muscle, 3 different combinations of muscles in 3 options, one option was
improper access
924. Intermaxillary fixation indicated in all the following except? Know all the situations
when it is needed: Typical indications for its use are minimally displaced fractures,
deep bite cases, stabilization of fracture during open reduction and internal fixation,
orthognathic surgeries and in tumor resection surgeries
925. Intermaxillary fixation is released earlieast in which of the following? Options with
different mandibular feacture sites – The IMF wires are usually removed in 3 weeks and
jaw exercises encouraged. Immobilization beyond 3 weeks in condylar fractures can
result in ankylosis of temporomandibular joints. The intermaxillary wires may be
reapplied for another week if occlusion is not good. Also, a simple, nondisplaced,
greenstick (incomplete fracture) mandibular fracture in a healthy child would
certainly require less intermaxillar fixation time than multiple, grossly comminuted,
compound mandibular fractures in an older unhealthy patient.
926. Best radiograph to view zygoma? No submentovertex option, waters, PA, CT, MRI
927. Pt with a nodule on the middle of the neck, what is most likely dx? Thyroglossal
duct cyst probably, don’t rmbr other options
928. Bluish lesion on lateral surface of tongue for 5yr painless what is it varicosities or
hemangioma –
929. Warty lesion—papilloma
930. Maxillary incisor 4 teeth rpd, what should we achieve? --- Mac anterior teeth
contacting on protrusion only, at CR, balanced occlusion, canine guided occlusion
931. Benzoyl peroxide decomposition by tertiary amine in chemically activated resin –
T
932. Abx in cellulitis with draining fistula yes or no
933. Antibiotic for sinusitis – Augmentin
934. Complication of temporal artritis – Blindness
935. Where do we use 10% chx varnish? P&f caries prevention, white smooth surface
caries prevention, secondary caries prevention
936. Parkinson's disease, except --- is progressive, always require medication,
associated with intentional tremor, associated with dementia
937. Amount of epithelial regeneration everyday is 0.5-1 mm – T
938. Chronic periodontitis, class 2 diabetes mellitus-- black males
939. Gtr best for: horizontal augmentation, class 2 furcation, one wall defect, class 3
furcation
940. Gtr-- involves coronal movement of pdl – T
941. Reattachment concept – Reunion of tissue to the rooth
942. Radiographic appearance of pericornitis – flame shape
943. Ameloblastoma, Benign, Localy aggressive, Reverse polarization, Rl post mn,
Extreme facial deformity, teeth vital, painless, honey comb or soap bubble
appearance
944. Basal cell carcinoma Most common skin cancer - Upper lip or lateral nose, Best
prognosis, Sun exp area
945. Value negative calculation - Positive predictive value is the probability that
subjects with a positive screening test truly have the disease. Negative predictive
value is the probability that subjects with a negative screening test truly don't have
the disease.
Predict value positive: TP/(TP+FN)*100
Predict value negative: TN/(TN+FP)*100
946. Which of the following drugs is associated with the reaction of hepatitis? A.
Valproic acid B. Quinidine C. Isoniazid D. Ethosuximide
947. Which of the following drugs is associated with the reaction of Stevens-Johnson
syndrome? A. Valproic acid B. Quinidine C. Isoniazid D. Ethosuximide
948. Which of the following drugs is associated with the reaction of Tendon
dyfunction? A. Digitalis B. Niacin C. Tetracycline D. Fluoroquinolones
949. Which of the following is considered a class IA Sodium Channel blocker? A.
Propafenone B. Disopyramide C. Aminodarone D. Quinidine (Supraventricular
tachyarrhythmias)
950. When part of body is thick which of the following applies? a. X rays penetrate
more and the object appears more radiopaque b. X rays penetrate more and the
object appears more radioluscent c. Change of developing cancer in that body part
is less d. Chance of cancerous change is more – (if “penetrate” hear means
“absorption”, because if the substance is thicker, it will absorb more photons and the
resultant imaging will be white.
951. Rate of implant success after 10 years? a. 90 b. 95 c. 80 d. 85
952. Which results in necrotic pulp a. Inflammatory resorption b. Replacement
resorption c. External resorption
953. Over the counter bleaching is with 25 % carbamide peroxide and the most
common side effect is tooth sensitivity
a. Both statements are true
b. First statement is true, second is false
c. First statement is false, second is true
d. Both statements are false
954. While performing a tooth preparation, removal of one of the cusps and
replacement with restorative material corresponds to the idea of: a. Resistance form
b. Retention form c. Outline form d. Convenience form
955. A patient who had a deep MOD composite placed in one of the lower molars
complains about pain and sensitivity, dentist replaces the occlusal of the restoration
with a new composite and pain is gone what is an explanation of why the pain
occurred? a. Voids in the previous restoration b. Leakage c. Fracture of the tooth –
The reason for post operative sensitivity is polymerization shrinkage causing gaps,
which could result in rapid movement of dentinal fluid and this sensitivity. - BB
956. Recurrent caries incidence for a class II composite is highest where? a. Gingival
floor
957. DO composite does NOT contain which of the following? A. Axiopulpal line angle
b. Axio gingival line angle c. Mesiofacial line angle d. Axio distal line angle
958. Which one of the following has the highest difference of coefficient of thermal
expansion with the actual tooth? 1- ceramics 2- porcelain 3-polymers 4-polemr
associated with resin. – Wax (250-400)
959. When there is minimum attached gingival, what happens? 1- most likely you get
gingival recession
960. When you have a horizontal rot fracture how do u take and x-ray?
1-one xray from angulated vertical angle
2-one x-ray from horizontal angulated angle
3-3-multiple x-rays from different horizontal angles
4-multiple x-rays from different vertical angle (One at 0 degrees, then one at + and – 15
degrees – Mosby)
961. When do u remove alveolar proper? 1-ostectomy 2- osteotomy 3-alevoplasty etc
962. A pedunculated white lesion on the palate that is rough, what is it? 1- fibrome 2-
papiloma 3-pleomorphic adenoma
963. Porcelain has tooth matching color by? a. Dentist choice by metamerism b. Lab
adds stains in the inside of the porcelain c. Lab glazes and polishes the porcelain in
the end of the design
964. All of these could be considered as differential diagnosis of aneurysmal bone cyst
except? osteomas, fibrous dysplasia, central giant cell granuloma, hemangioma
965. For routine tooth extraction ,all is true except?
2 major forces are luxation and rotation
teeth are extracted by luxation forces
teeth are extracted by rotation forces (Rotation only for single rooted teeth. Not all)
class 2 lever is used in tooth extraction
966. Compared to a full thickness flap, a partial thickness(split-thickness) flap will
A. increase the loss of marginal bone.
B. reduce infraosseous defects.
C. provide improved surgical access.
D. increase the amount of attached gingiva.
E. reduce healing time
967. Which of the following is not an action of epinephrine when given in high doses?
increases liver glycogenolysis
causes bronchoconstriction
produces rise in bp
evokes extrasystoles in the heart
produces restlessness and anxiety
968. What will you see in a diabetic patient? general gingival recession, gingival
abcess, necrotizing gingiva, periodontal abcess
969. At high concentration of fluoride in drinking water (4ppm) the caries incidence:
a) remains the same b) decrease c) increases
970. Moderately developmentally disabled 5-year-old child is crying excessively and
resisting physically during an emergency dental visit. Which of the following methods
of patient management should the dentist use in this situation? Voice control, Home,
Physical restrain – Master app
971. What will prohibit mesial drift of tooth toward edentulous area? Proper axio-
occlusal contact (opposing and adjacent tooth) – T
972. Proximal resistance form of amalgam restoration comes from what? a.
convergence of buccal / lingual wall b. retention grooves in axiobuccal / axiolingual
walls c. Dovetail – DD: dovetail provides resistance to proximal displacement.
973. Oral granulomas, apthous ulcer, rectal bleeding is seen in. Wegeners
granulomatosis, ulcerative colitis, crohns disease
974. Which treatment has the least successful long term prognosis on a deep carious
lesion on #3? 1. Direct pulp capping, 2. Indirect pulp capping, 3. Pulpotomy, 4.
Pulpectomy and RCT - Direct pulp capping is for noncarious exposure only. (Mosby)
975. What would be the most reasonable cause for a tooth’s symptoms to change
from reversible to irreversible pulpitis? a) Accumulation of traumatic injuries b)
Bacterial involvement inside pulp chamber c) Increased intra-pulpal pressure
976. Excess interocclusal space causes: a) decrease VDO b) increase VDO c) same
VDO
977. Biotransformation of drug causes – lipid soluble, protein binding, therapeutic
active - makes it water soluble (less lipid soluble, more ionized)
978. Fear causes – inc pain tolerance, intensify pain - Fear often increases the person's
perception of pain, and pain then increases feelings of fear and anxiety.
979. Which part of curette tip is adapted to the toot (a) distal 3rd (b) middle 3rd (c)
proximal 3rd end – Lower third (1/3)
980. Diagnose Chronic apical abscess vs Chronic periodontal abscess
(a) EPT (b) Radiograph (c) Thermal test – I think answer is “c” but EVERYBODY say “a”
981. Which drug is effective against Herpetic simplex, Herpes Zoster and Varicella
Zoster
(a) Amantadine (b) Valiclovir (c) other IDK – According to Mosby PG 335 – Table 8-39:
VALACYCLOVIR is effective against HSV and VZV- FOSCARNET is the only drug
effective against HSV, VZV, and CMV.
982. Radiograph showing radiopacity in lower right mandibular area spreading from
2nd molar to 1st premolar
(a) Perifying ossifying fibroma (b) CGCG (c) Fibrous dysplasia (d) IDK
Fibrous dyplasia is radiopaque, not well circumscribed and ground glass appearance.
983. Pt avoiding dentist becoz of ugly ulcer on palate and also shows concern while
sitting on chair, what do you say?
(a) Don't worry I will look at it in detail (b) It seems you are concerned with that condition
in your mouth (I picked this one as we don't give false assurance to any pt)
984. A dentist conductes a study about satisfaction of patients treated in 1 month
period of time which study is this? ( basically a cause effect relationship result)
(a) Case control (b) Cohort (c) Cross sectional (d) Clinical trial (my ans I just picked
because it is interventional study I might be wrong)
985. Informed consent can have all of the following EXCEPT: A) Informed consent must
be presented in advance of the treatment. B) Informed consent must contain
treatment options. C) Informed consent must be in written form. D) Informed consent
must contain risks and benefits of the treatment…..
986. One ques was on paraphrasing: they gave 4 totally confusing statement...I was
supposed to pick which was NOT paraphrasing pt words.....
987. Patient complains, “Why do I have to stay here for so long for you to do this, why
can’t you finish it already?” A) Because that’s how treatment works you idiot. B) That’s
how long it takes to provide quality care. C) It seems like you’re upset, may be we
can reschedule you for another day for longer appointment. D) It seems you are
upset, what are your concerns about the procedure we’re doing today?
988. Question about what do you need for caries: Bacteria, supporting carbs and a
susceptible tooth
989. Primary tooth requires additional reduction on which surface
(a) Mesial and distal (b) lingual (c) buccal (d) other option
DD à In the case of first primary molars, the buccal bulges often are very prominent. It is
sometimes necessary to remove them to get the preformed crown to fit over the
buccal prominence.
990. Incisal guide table is for (a) for anterior teeth arrangement (b) condylar guidance
991. PID ques about changing from 8 to 16 inch all other parameter remain only
change in exposure time from 0.5 to which one (0.5*4=2)
992. In X-ray tube , Electrons are produced by ?
A- molybdenum cup
B- leaded glass
C- tungsten filament
D- copper filament
993. X-rays are produced when
(1)protons strike the anode.
(2)electrons strike the anode.
(3)the anode is heated above 3,000 degrees C.
994. x ray effect is called: thompson effect or photoelectric effect
995. Epinephrin given along with erectile dysfunction medication what effect is
produced: epinephrine is a vasoconstrictor!! so epinephrine will reduce the effect of
the drug
996. Removal of subgingival calculus is termed as
(a) scaling- (b) root planing – removal of infected cementum (c) curettage – removal of
infected pocket lining
997. Ques asking which procedure is most conservative when width of caries is more
than 1/3 of intercuspal space a) amalgum b) inlay c) onlay d) cronw
998. Epi reversal is due to – alpha 1 blocker
999. Force put on crown, where is center of translation or rotation? Halfway down root
(axis of rotation located in the apical 1/3 of the root – tipping)
1000. Best to debride infected oral wound? 3% hydrogen peroxide
1001. Pt with Alzheimer dz, what do you do? Continue to monitor
1002. Lidocaine – mepivacaine (Cross allergy, both are amide)
1003. Cocaine produces vomiting by – activating CTZ in brain
1004. Actinic cheilitis occurs with - SCC
1005. Amnesia related ques of which ans was Alprazolam – T - anterograde Amnesia
1006. Sertraline (Zoloft) adverse effect or something – frankly speaking I forgot what it
was in my test I randomly picket xerostomia hope it is right - Yes zoloft or sertraline...
cause xerostomia
1007. Zoloft what does it act on? Serotonin – it’s an SSRI (selective serotonin reuptake
inhibitor)
1008. Complement activated by – a) T cells b) B cells c) lymphokines d)
immunecomplex
1009. What do we write the consult for: A) To gain certain information B) To gain
clearance C) To have a better relationship with patient’s physician, of course.
1010. Wheel chair transfer ques with option – sliding method still is best technique to
transfer pt
1011. Disabled kid, best measure: Consistency
1012. Articular disk has 25 mm opening with click then on closure there is again a click,
when is there is another click what is it due to – disk rest on condyle on opening and
moves forward on closure (indirectly disk displacement with reduction)
1013. Best Amalgam: High copper spherical amalgam
1014. Mandibular 3rd molar root lost: submandibular space
1015. Which of the following is clinical sign of Leukemia: Bleeding from gums, pale
conjunctiva, fever
1016. Acromegaly causes: Excessive growth of mandible
1017. Radiograph of zygomatic arch – CT scan, NO submentovertex in options
1018. Patient does not have tooth #11 and has all the premolars, which one has the
Worst Prognosis: A) fixed bridge from #10-12. B) RPD with pontic for #11 – C) Implants
with canine guidance
1019. Pt with medullary carcinoma of thyroid
a-hyperparatyrodisum
b-MEN (Pheochromocytoma and MEN cause thyroid cancer)
c-interstinal polyps
1020. Kid-8 year old- 3mm crowding. TX
a-primary canine extract
b-primary canine disking
c-molar extract
d- molar disking
1021. blood flow test in pulp? ts Doppler ( for blood flow) or like this thing , was before rq
with options
1022. IRM added in 1990, what was that?
a-ZnPo4
b-titanium
c-silver
d-PMMA
1023. Discolouration with ant tooth, endo treated portion of carious teeth, need to be
restore? TX
a-porcelin veneer
b-FCC – Full Ceramic Crown
c-metal crown
d-composite
1024. After injection-pt feels tachycardia, weak, wheezing, lethargy. Reason?
Anaphylaxis, hyperglycemia, anxiety attach
1025. Edge to Edge ant bite seen in photograph what is not recommended?
a. PFM Crown
b. All ceramic crown
1026. Patient has lithium overdoes its effects is greater on ? KIDNEY and TYROID.
Nausea, diarrhea, convulsion, coma, cardiac arrhythmias, polydipsia, polyuria, inhibits
the effect of antiodiuretic hormone on the kidney. TYROID ENLARGEMENT: increases
stimulating hormone (TSH) secretion; may cause hypothyroidism.
1027. Most type of bacteria in ANUG ? A. Provetella b. Spirochete
1028. What type of fracture associated with exposed impacted tooth? A. Comminuted.
B. Compound c. Simple - Compound. Bone would be exposed through the mucosa
near teeth.
1029. Least likely virus to be found in the oral cavity infections – HIV
1030. Which lesion resolves by itself? Hematoma and hamartoma both in option, others
were obvious tx needed.
1031. Bone marrow depression by what drug? – Chloromphenicol
1032. Tx of osteromyelitis? Was surgical options, no meds - Sequestrectomy,
saucerization, curettage
1033. Tooth prep ques on anterior teeth, reduction on middle and incisal third for PFM:
gingival 0.3, middle 0.5, incisal 0.7
1034. Finishing line in PFM (CHAMFER 1.0mm - LABIAL SHOULDER 1.5mm) and veneer
(CHAMFER) – Butt joint (SHOULDER) for porcelain jacket crowns
1035. Pt came in for a 3 month recall, initial therapy doesn’t show any changes, pocket
depths not exceeding 3-4 mm, what tx step will u do? srp and wait for 3 more months,
surgery only if pockets greater than 4 mm
1036. Pt comes in for a 6 month maintenance appt, little improvement in pdl status and
plaque control is efficient, though u can see infra gingival calculus, what was the
reason? You didn’t do SRP properly, pt has no goof access to the deep pockets, pt
only concerns about looks, etc
1037. Angry child, shows this behavior on the second but was cooperative on the first
appt, what is the best method to control this behavior? N2O tx, GA, papoose board,
voice control
1038. Validity – is the extent to which it actually tests what it claims to test. The validity of
a test is determined by its ability to show which individuals have the disease in
question and which do not.
1039. Sensitivity – percent of persons with the disease
1040. Specificity – percent of persons without the disease
1041. Reliability – equal to the repeatability and reproductibility of a test (level of
agreement between repeated measurements of the same variable).
1042. Macroglossia is not seen in which of the following conditions, chose
hyperparathyroidism,
1043. Pt with mid face ill developed, no ear pinna, which syndrome? Eagle’s, tracher
Collin’s, apert, crouzon - Malformed ear= Trache Collin's
1044. Cause of angular chelitis: immune, speech therapy, poor home care
Predisposing Factors: intra-oral Candida albicans infection, loss of inter-maxillary distance
(decreased vertical dimension), trauma to the labial commissure induced by
prolonged dental treatment. Also linked to Candida albicans. Treatment: NYSTATIN
will eliminate the fungal infection. - BB
1045. Ethical principles and legal rules? Both are same, totally different, ethics exceed
legal rules, rules exceed ethics.
1046. AED - automated external defibrillator (AED) is not used in? children, old patients,
etc - ts not given to trauma pts, kids under 1 year old and ppl with high pulse
A defibrillator must not be used on an individual who is conscious or has a pulse even if it
is erratic but not life-threatening. 1. Responsive 2. Unresponsive WITH pulse 3. People
under 55 LBS 4. People who are soaking wet (dry off chest)
1047. Aspirin patch is histologically? Necrosis, hyperkeratosis, etc
1048. Folic acid inhibited in? methotrexate, fluorouracil – people say both, BUT! -
Methotrexate is a Folic Acid Analog and 5-Fluorouracil (5FU) is a Pyrimidine Analog.
1049. Bisphosphanates are not given in? metastasis of breast ca to bone, metastasis of
prostate to bone, osteomyelitis, multiple myeloma
1050. Which is the most common oral site for metastatic cancer? Posterior mandible
1051. Which is the most common site for primary oral cancer? Tongue
1052. Worst prognosis? Floor of tongue
1053. Best prognosis? Lower lip
1054. Supra basilar split and pemphigus
1055. Bone Grafting, which one shows worst prognosis? Max ant, mand ant, max post,
mand post
1056. Trephination – Apical trephination is accomplished by aggressively placing a No.
15 to 25 k-file beyond the confines of the apex. Surgical trephination is a perforation of
the alveolar cortical bone to release accumulated tissue exudates. A small (5-mm)
horizontal incision is made with a No. 15 scapel blade at the level slightly apical to the
root apex. A No. 6 or 8 round bur is used on a straight handpiece to penetrate the
cortical plate above the root apex. If there is diffuse swelling (cellulitis), antibiotics are
usually indicated. – DD
A. Incision and drainage and trephination.
1. Objectives are to evacuate exudates and purulence and toxic irritants. Removal
speeds healing and reduces discomfort from irritants and pressure. The best treatment
for swelling from acute apical abscess is to establish drainage and to clean and
shape the canal.
Indications for trephination of hard tissues:
a. If a pathway is needed from hard tissue to obtain necessary drainage.
b. When pain is caused by accumulation of exudate within the alveolar bone.
c. To obtain samples for bacteriologic analysis.
Procedure.
a. Incision and drainage is a surgical opening created in soft tissue for the purpose of
releasing exudates or decompressing an area of swelling. Trephination refers to
surgical perforation of the alveolar cortical bone to release accumulated tissue
exudates. Profound anesthesia is difficult to achieve in the presence of infection
because of the acidic pH of the abscess and hyperalgesia. The incision should be
made firmly through periosteum to bone. Vertical incisions are parallel with major
blood vessels and nerves and leave very little scarring. These procedures may include
the placement and subsequent timely removal of a drain. Antibiotics may be
indicated in patients with diffuse swelling (cellulitis), patients with systemic symptoms,
or patients who are immunocompromised.
1057. Purpose of Hex in implants - antirotation
1058. Most common type of caries seen in kids
1059. Non working side interference
1060. Beclomethasone uses – Beclomethasone, Budesonide, & Flunisolide: special
glucocorticoids (INHALERS) developed to treat chronic asthma and bronchial disease
by readily penetrating the airway mucosa, but have very short half-lives after they
enter the blood so systemic effects and toxicity are greatly reduced. - is inhalational
steriod used as inhaler in asthma prevention.
1061. What is advantage of Beclomethasone – corticoid (topical and inhaler)
1062. Combination of tricyclic antidepressants (there was diferent combination but the
correct was) A) imipramine + amitriptyline
1063. Doxycyline read its uses – Doxycycline (Vibramycin)- treats syphilis, rickettsia
infections, Chlamydia, & mycoplasma infections, and is an alternative to mefloquine
for malaria prophylaxis. - Prevents further breakdown of periodontal tissues by
blocking collagenase.
1064. Picture - Hyoid bone (both sides)
1065. Pano- inferior border of mandible
1066. Cocaine - vasoconstrictor
1067. Opioid side effects – Common Side Effects: sedation and drowsiness (by
depressing the conscious centers of the brain), dizziness, & nausea. The MOST
common side effect of the narcotic (opiate) analgesics is NAUSEA. Narcotic
analgesics DO NOT cause peptic ulcers or insomnia.
1068. Fracture at root apex: splinting for how many days? 7-10 days, 2-3 weeks, 4-6
weeks – Horizontal fracture - rigid splinting for 3 - 4 months
1069. Avulsed tooth - flexible splint for 7-10 days (1-2 weeks)
1070. How long after extraction can you insert the complete denture???? 4 weeks, 1
week, 6 weeks, 8 weeks (8-16 WEEKS)
1071. Pt takes too much opioid, what do you see? A. insomnia b. irritability c. headache
d. pt feels cold – because of hypothermia / hypothension
1072. Mepivacaine indication – mepivacaine has less of a vasodilator effect compared
with the others and is the drug usually chosen when a vasoconstrictor is not used with
the local anesthetic.
1073. Question on upcoding – reporting a more complex and/or higher cost procedure
than was actually performed.
1074. Down coding: a practice of third party payers in which the benefit code has
been changed to a less complex and /or lower cost procedure than was reported
where delineated in contract agreements.
1075. Bundling: systematic combining of distinct dental procedures by a third party
payer that result in reduced benefit for the patient/beneficiares.
1076. Unbundling: separating of dental procedure into component parts with each part
having a charge so that the cumulative charge of the component is greater than the
total charge to patients who are not beneficiaries of a dental plan for the same
procedure.
1077. Bacteria seen in chronic periodontitis – P. gingivalis (P. gingivalis, T. forsythia, P.
intemedia, C. rectus)
1078. Chronic periodontitis most common in – black males
1079. Percussion used for- symptomatic apical periodontitis
1080. Ept indications – usually elicits a response at a HIGHER current than normal if the
tooth being tested has CHRONIC PULPITIS. Acute pulpitis - indicated by a lower than
normal current, as acute inflammation mediators lower the pain threshold. Chronic
pulpitis - indicated by a response at a HIGHER current than normal. Hyperemia -
indicated by a LOWER than normal current, but a higher current than with an acute
pulpitis. Pulp necrosis/Abscess - indicated by no response at any current level. - BB
1081. Benzoyl peroxide initiator- self cure
1082. Caoh indications - Calcium hydroxide may be used to induce apical hard tissue
formation. Use calcium hydroxide for reparative dentin. Typical liner used with direct
restorations. - Mosby
1083. Q on galvanic shock patient had electric pain after restoration
1084. Q on reversible pulpitis irreversible pulpitis
1085. Recession - apical positioning flap? I thinks it is contraindicated - Free Gingival
Graft Indications: Prevent further recession and successfully widen (increase the
width) of attached gingiva, used therapeutically to widen attached gingiva after
recession occurs and prophylactically (to prevent), corrects localized narrow
recessions or clefts, but NOT DEEP WIDE RECESSIONS. Pedicle Flap (Laterally Positioned
Flap) - areas where narrow gingival recession. Used to correct or prevent recession by
providing root coverage, creating a wider band of gingiva, and in the absence of
recession to widen the zone of gingiva. Coronally Positioned Flap - a full -thickness
mucoperiosteal flap almost exclusively used to restore gingival height and the zone of
attached gingiva over isolated areas of gingival recession.
1086. Most prevelant - type two diabetes? Type 2 diabetes is the most common form of
diabetes.
1087. Interaction between nitroglycerin and epinephrine is what type of antagonism?
Allosteric, Physiologic, Biochemical, Competitive
1088. Color stability in light cure - Tegdma
1089. Composite class 2 restoration maintained by - extent till caries, retention n
resistance form, rest i forgot options
1090. Rubber dam leakage - holes placed too close
1091. Rest thickness at margin - 0.5/1.5 or 1mm? – Occlusal rest 1.5 mm (Mosby)
1092. Treatment of nug what antibiotics n mouthwashes. - The treatment of NUG or NUP
includes debridement, hydrogen peroxide (or chlorhexidine) rinses, and antibiotic
therapy (Pen. V) if there is systemic involvement (manifested by fever, malaise, and
lymphadenopathy). Patients with HIV-asssociated NUG require gentle debridement
and antimicrobial rinses. (DD)
1093. What distunguish myocardial infarction from angina – thrombosis
1094. Indirect sympathomimetic drug? Diphenyl - Amphetamine is the ans
1095. Occlusal adjustments after composite restoration or amalgam: green stone,
diamond bur, steel bur or carbide bur? - Remaining excess composite = finishing
diamond burs, discs, strips, and the margins finely polished. Aluminum oxide disks
provide the most desirable finished surface for a composite resin. - BB / Green stone is
used to remove a relatively large bulk of amalgam.
1096. Sodium hypochlorite doesn't - chelates
1097. Sodium hypo - dissolves necrotic tissues
1098. If a patient is taking chantix what else need to be included in his smoking quitting
regimen 1)use nicotin patches 2)zyban 3)behavioural counsellingis the ans
1099. Community fluoride: 0.2% / week in underprivileged areas . true is the ans
1100. Case q's about side effect of drug that cause altered taste sensation?
Cyclobenzaprine ans , calcium carbonate
1101. Loosening and premature loss of deciduous teeth seen in early stage of -
hyperphosphatasia - hypophosphatasia IS THE ANS - psuodophosphatasia
vit d resistant rickets - vit d deficient rickets
1102. Patient complains of pain due to oral mucositis after radiotherapy, the pain is best
treated with:
a. Nystatin b. Benzyl hydrochloride IS THE ANS c. Topical conticosteroid d. Morphine
1103. Large filler particles in composite increase the strength of hardness? False - Small
size filler particles in composite resins results in better finishing and greater resistance to
occlusal wear. - BB
1104. Large filler particles in composite increase polishibility & finishing? False
Smaller filler particles are used to produce a resin with a relatively smooth finished surface
- BB
1105. Pt. wd radiation therapy effects- carcinogenisis? Osteoradionecrosis?
Oral mucous membrane: (1) Near the end of the second week of therapy, the mucous
membrane begins to show areas of redness (mucositis), (desquamated epithelial
layer, secondary yeast infection by C. albicans is a common complication and may
require treatment.
1106. Pt. has white spot on cervical area of tooth, what is the treatment- fluoride varnish
or no treatment
1107. Reverse smile - pt chin upward
1108. In class V amalgam preparation for an incipient lesion, the ideal internal form of
the preparation has which of the following features?
a. Axial wall is flat b. Mesial and distal walls converge c. Occlusal and gingival walls
converge d. Axial wall is uniformly deep into dentin
1109. Lithium – bipolar
1110. In preparing a class I cavity for dental amalgam, the dentist will diverge the
mesial and distal walls toward the occlusal surface. This divergence serve to
a. Prevent undermining of marginal ridges b. Provide convenience form
c. Resist the forces of mastication d. Extend the preparation into areas more readily
cleansed.
1111. Which bur is used to converge axial wall of the crown, ????/No. 173
1112. Elongation of which papillae - hairy tongue (HYPERTROPHY of the FILIFORM
PAPILLAE)
1113. Facebow – The facebow transfer is NOT a maxillo-mandibular record. Rather, it is
a record used to orient the maxillary cast to the hinge axis on the articulator. The
facebow transfers the maxilla/hinge axis relationship to the articulator during
mounting of the maxillary cast.
1114. TCA antagonist – Physostigmine - Physostigmine's primary therapeutic role aims to
ameliorate delirium as a result of the anticholinergic (more accurately,
antimuscarinic) toxidrome resultant from the blockade of muscarinic receptors by
agents such as atropine, antihistamines, tricyclic antidepressant (TCA), amongst other
xenobiotics.
1115. Class V glass ionomer prep should : not bevel at all – Not for Gic, bevel only for
composite.
1116. What kind of bur cuts more efficiently? Diamond
1117. 12 year girl had AML and bone marrow replacement most likely to find
intraorally? Candidiasis – children w/ leukemia are very susceptible to candida fungal
infections, thus, nystatin rinses are effective tx.
1118. Which drugs cause cleft lip and palate = anticonvulsants , valium, vitamin
deficiency or excess
1119. Place a FPD and it has occlusal deflection, what it the immediate result? A.
fracture B. pain on biting C. sensitivity to cold. – The most common complaint after
cementation of a fixed bridge is sensitivity to hot/cold and is an indication of a
deflective occlusal contact. Inmediate correction of the occlusion must be made.
1120. Which of the following has decreased ALP and early loss of teeth –
hypophosphatasia.
1121. Retention maxillary complete denture = peripheral seal
1122. Retention mandibular complete denture = denture stability in covering as much
basal bone possible without impinging on muscle attachment
1123. PT fractured many FPDs you made her, why? Bad metal frame work design –
Repeated fracture of a porcelain fused to metal (PFM) is due primarily to an
Inadequately Designed Framework.
1124. Why is there a cross-linking agent to dimethacrylate? So you can layer acrylic
without getting craze/fracture lines. STRENGTH-for proper adhesion between
incremental curing.
1125. When will Amelog. Imp. Have the most effect on the maxillary centrals? A. 1-6
months – calcification of maxillary centrals 3-4 months. (Laterals 10-12 months)
1126. What type of drug is PROZAC? Prototype SSRI (selective serotonin reuptake
inhibitor)
1127. Max strength of porcelain? CONDENSATION - Max condensation, less porosity =
stronger porcelain!
1128. Most caries in primary teeth seen where? distal to mandibular 1st
1129. In young patients, stains are more prominent on which area of the teeth? cervical
1130. Which of the following does a .02 taper indicate for a K-file?
(1)0.02mm increase in diameter per 1mm of file length
1131. Picture of traumatic granuloma (pyogenic granuloma) in buccal vestibule, what
is the Tx? Excision, If pregnant, lesion may regress after birth – BB
1132. NSAIDs works on? Platelet reversibly – except aspirin
1133. What causes gingival hyperplasia? Calcium Channel Blockers: Verapamil
1134. Which thyroid drug adds iodine to thyroxine decreasing its level – prothiouracil.
1135. Which antiretroviral causes pancreatitis and peripheral neuralgia – Stavudine
1136. Forcepts – elevation, luxation, compression, reflection? – Luxation – Elevation and
reflection is periosteal, compression is fingers.
1137. THE BUCCINADOR MUSCLE IS PIERCED BY THE NEEDLE WHEN PERFORMING AN
INFERIOR ALVEOLAR NERVE BLOCK. – DD
1138. Intraoral lesion of TB seen as – tonsillitis and ulceration (ulcer in the mid-dorsum or
tip of the tongue)
1139. Hyperventilating : tachypnea and tachycardia
1140. Most caries susceptible tooth – maxillary 1st molar – upper 1st molar are most
commonly affected (Kaplan)
1141. Must difficult to change – HUE, easiest – CHROMA
1142. Which of the following should NOT be prescribed for a patient receiving warfarin?
A. Acetaminophen.
B. Metronidazole.
C. Penicillin.
d. Codeine
1143. In pediatric patients 1. asthma has a decreasing prevalence. 2. asthma is an
acute inflammatory disorder. 3. asthma leads to increased caries. 4. asthmatic
attacks can be triggered by anxiety
1144. Positive Nikolsky: Pemphigus Vulgarys, Pemphigoid, Epydermolysis Bullosa
1145. Radiologic damage is less with:
A. more oxygen
B. decreased are of exposure (or less oxygen)
1146. Congestive heart failure: pedal edema, dyspnea and orthopnea
1147. Least sedative drug: Chlorpheniramine, Fexofenadine (second generation)
1148. A patient has a crown on tooth #30. On trying to close the jaw, the jaw deviates
to the left. What is the reason? Interference on buccal inclines
1149. Which of the following is the most important factor affecting pulpal response?
(1)Heat
(2)Depth to which dentinal tubules are cut (remaining dentin thickness) - ASDA
(3)Desiccation
MANNA BHATT RQs
1. K sparing drug: Amiloride, triamterene, Spironolactone

Spironolactone
Thiazides
Na and Cl cotransport
Dec resorption of Na and Cl
Hydrocholrothiazide - prototype
Loop diuretic
Na/K/2cl cotransport
Inhibits resorption of Na and Cl
Furosemide -prototype
Bumetanide
Ethacrynic acid
Torsemide
K sparing
Na channel block: spironolactone
Eplerenone
- aldosterone antagonist: Amiloride
Triamterene
Carbonic anhydrase:
Acetazolamide
Weak diuretic
Used in altitude sickness
Osmotic diuretics
Mannitol
Glycerin
Urea
Used in edema after neurosurgery or trauma to CNS
2. Virax in oral cavity? Virax (Acyclovir) used for Rx of Herpes infection
3. What procedures you cant do in AIDS patient? Antifungal prophylaxis
4. Opiods effects. The short-term effects of opiate use can include: Feelings of
euphoria, pain relief, drowsiness, sedation. Long-Term Effects of Opiates: Nausea and
vomiting, abdominal distention and bloating, constipation, liver damage (especially
prevalent in abuse of drugs that combine opiates with acetaminophen), brain
damage due to hypoxia, resulting from respiratory depression, development of
tolerance, dependence.
5. Papoose contraindication: Mentally compromised pt
6. Battery
7. Lot of prostho occlusal interference questions
8. Which study doesn’t show cause and effect: Cross sectional, and also examine two
variables at the same moment.
9. Drugs those blocks prostaglandins has increased effect on gastric mucosa?
No it decrease gastric mucosa and increase gastric acid (peptic ulcer). Aspirin and
other cox inhibitors.
10. Patient with squeletal prognatic maxilla and lower class 3 molar relationship. What
do u do per surgical ortho treatment? a.Labial movement of both upper and lower
incisors b.Lingual movement of upper and lower incisors c.Labial movement for upper
incisors and lingual for lower d.Lingual movement for upper incisors and labial for
lower
We do pre surgical with brackets bring lower lingually, and for upper surgically we do
lefort 1.
11. Combination syndrome
12. Chs of band and loop
13. Least fracture resitant ; lithium, feldpathic, zirconia
14. Pka ( ph when drug is 50% ionized and 50% non ionized ) has effect on what?
onset
15. 16 kg of 3 year old how many mgs LA to give? 16 x 4.4 : 70.4 mg
16. What meds you give in osteomyelitis? Clindamicin

17. Pt with bizarre behavior and disorientation you give what? ; insulin, glucose
18. Initial stages of sedation what pt feels?
19. Condensing osteitis? Excessive bone mineralization around the apex of an
asymptomatic vital tooth. Radiopacity may be caused by low-grade pulp irritation.
This process is asymptomatic and bening. It does not require endodontic therapy.
20. 2 questions on Periapical Cemental ossifying
21. What cyst in roots of mandibular premolar? lateral periodontal (also is the least
common gral. cyst)
22. What lesions are not radiopaque? ; Adenomatoid Odontogenic Tumor (AOT),
ameloblastic fibroma, odontoma
23. Least likely to occur, AOT, odontogenic myxoma

Adenomatoid Odontogenic Tumor (AOT): Teens, females; anterior jaws; in association
with the crowns of impacted teeth. Well – circumscribed unilocular RL lesion, may
have small opaque foci. Enucleation, totally bening, encapsulated lesion that does
not regres.
24. Which anticancer drugs effect on folic acid? Methotrexate
25. RG pictures Rg ameloblastic fibro odontoma

26. 9 year old kid swollen gingiva, recureent skin infections
27. what is complication of maxillary molar extractions
28. what is easily curable, macule, hematoma, or something?
29. 2 questions on Incisal guidance
30. RPD I bar fractured what you do? Soldiering
31. What does conjugation do to a drug? Make IT more water soluble
143. Problem with manual dexterity, what will he have problem with?
Flossing
Brushing
144. Dexterity comes by what age?

A.3-4 years
B.1-2 years
C.5-6 years
D.7-8 years
143. What surface of a tooth benefits the most from systemic fluoride
Roots
Pits and fissures
Smooth surfaces
144. Which surface part of the tooth gets the least benefit of flouride?
1-Occlusal,
2-Proximal,
3-Root,
4-Facial
The use of fluorides is the best approach to preventing caries. Fluoride, however, is
believed to be least effective on the occlusal or chewing tooth surfaces.
145. Characteristic feature of Achondroplasia?

-open bite
-midface deficiency
145. Patient with achondroplasia, what will you most probably see
a) class 2
b) open bite
c) class 3
146. Which is more prone to injury in mand molar extraction :

1) IAN
2) Lingual nerve
3) None
Trauma to inferior alveolar nerve may occur in the area of the roots of the mandibular
third molars. Lingial nerve travels very close to the lingual cortex of the mandible in this
area.
147. For a population, the researcher divides the number of disease cases by the number
of people. By so doing, the investigator will have calculated which of the following
rates:
a- incidence
b- odds ratio
c- prevalence
d- specificity
148. Orange stain is added to porcelain in order to? Decrease value, increase the
chroma of a basically yellow shade. Staining a porcelain restoration will reduce the
value (as will using a complementary color). It’s almost impossible to increase the
vale. Master app: orange stain is commonly used to change the hue of porcelain.
149. A 50yr old male patient has been advised for multiple extractions in relation to tooth
#4, #6, #15, #20, #22, #25. Which of the following is the correct extraction sequence?
A) # 4, #6, #15, #25, #22, #20
B )#4, #15, #6, #25, #22, #20
C) #15, #4, #6, #20, #25, #22 - Canines are extracted last
D) #25, #22, #20, #6, #4, #15
E) #15, #6, #4, #25, #20, #22
150. Which of the following would you NOT prescribe for a patient receiving Warfarin
(Coumadin®)?
1. Acetylsalicylic acid.
2. Metronidazole.
3. Erythromycin.
4. Codeine.
A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.
Metronidazole and Erythromycin inhibits warfarin metabolism. Aspirin inhibits platelet
aggregation and causes bleeding.
151. Where would you look in a scientific journal to find the dependent and independent
variables
· Intro
· Materials · Methods ** Moby pg 225
· Conclusion
· Summary
152. Which antibiotic is appropriate for premedication in the penicillin allergic patient?
a. Cephalexin
b. Clindamycin
c. Erythromycin d. Amoxicillin e. Ampiciilin
153. Which one is the most likely to promote proliferation of subgingival, black-pigmented
bacteroides.
A. Oral cont raceptives
B. Propranolol Underal®)
C. Chloroth iazide (Diuril®
154. The drug-of-choice for the treatment of adrenergically induced arrhythmias:
quinidine.
lidocaine.
phenytoin.
propranolol. Propranolol is a non selective B locker so it blocks adrenergically B1 receptor,
B 1 receptor action is heart rate and force
155. Propranolol and epinephrine given together: epinephrine is adrenergic

neurotransmitter causing increase in HR and PB... propranolol would block beta
causing bradycardia instead
156. Which of the following locations would a perforation demonstrate the best
prognosis?
(1)Apical 1/3 of root
(2)Middle 1/3 of root
(3)Coronal 1/3 of root
Perforations located close to the apex have better prognosis than those near the crestal
bone (Google books) - talking bout root surfaces. "Coronal third of the root, the
prognosis is poor." Mosby pg 20.
157. Study among smokers and nonsmoker for 6 years (2010-2016) to develop disease?
1 Cross sectional study
2 Cohort study
3 Case Control study
4 Interventional study
Cohort study: prospective cohort study – a general population is followed through time to
see who develops the disease. The investigators choose or define a sample of
subjects who do not yet have the outcome of interest. Retrospective cohort study:
used to evaluate the effect that a specific exposure has had on population.
Investigators choose or define a sample of subjects who had the outcome of interest.
They measure risk factors in each subject that may have predicted the subsequent
outcome.
158. Case control study based on

A risk
B exposure.
C disease
D incident
Case-control study: people with a condition (cases) are compared with people without it
(controls) but who are similar in other characteristics. Hypothesized causal exposures
are sought in the past medical records. Prevalence.
159. A study which is conducted in different cases to find out the etiology of different
diseases varying in different subjects:
A) case control study
B) clinical trial
C) cross sectional stud
160. Cross-sectional study:

A. Descriptive
B. Analytical
C. Experimental
161. Hyperplastic lingual tonsils may resemble which of the following?

1. Epulis fissuratum
2. Lingual varicosities
3. SCC
4.median rhomboid glossitis. 5. Prominent fungiform papillae.
162. Sarcoidosis resembles?

a,Median Rhomboid glossitis
b,Benign migratory glossitis
c-granuloma
No tuberculosis and histoplasmosis ..choose from above. Sarcoidosis is a disease of
unknown etiology characterized by granuloma formation in a variety of organs.
163. Where does the epithelial for a graft come from? with
a. Donor epithelium
b. Donor connective tissue
c. Recipient epithelium d. Recipient connective tissue
164. Ultrasonic scalers are contraindicated with composite restoration ... T

When scaling porcelain and composites, the use of an ultrasonic scaler is
contraindicated. Porcelain may fracture or lose marginal integrity. Composites have
shown surface alterations, and amalgams have shown a loss of marginal integrity and
surface damage.
165. The longest acting .most potent and most toxic LA

1 lidocaine
2 dibucaine
3 bupivacaine
4 tetracaine
166. Class II amalgam restoration has a overhang at gingival margin. This might have
been caused by which
of the following?
a. poor adaptation of the matrix band
b. poor carving
c. did not wedge the matrix band
Overhang - wedge
Overcontour- matrix
167. Excessive VDo= less freeway space

decreased VDO= more freeway space? T
168. Not reversible index is:

a.perio
b.gingival
c.DMFT
d.OHI-S
168. DMFT index is only used for permanent teeth. T/F
169. DMFT index limitation means? This only shows you the history of decay, missing, and
filled teeth in ones mouth. It doesn't give you anymore info than that. So lets say the
patient has root caries; DMFT will not tell you anything on that, or if the patient has any
sealants, it will not give you any info on that either.
170. DMFT (decayed-missing-filled teeth index) – Best index DMFS (surfaces)
171. What will account for the anterior space for permanent mandibular incisors
1. Flaring max. Incisors
2. Primate space
3. Leeway space
172. Which allows more space for eruption of permanent mandibular incisors?
Leeway space (For late shift) - Leeway is the diff in MD width bet primary C 1st n 2nd
molars and perm C 1st n 2nd premolars.
Primate space
Leeway space - Difference in the size b/w primary posterior teeth and the permanent
canine and premolars. Max- 1.3 mm per quadrant Mandi- 3.1 mm per quadrant
Primate spaces- Naturally occurring space in primary dentition. Max- B/w lat incisor and
canine... Mandible- B/w canine and 1st molar
173. 8 years old Mandibular second primary molar, painful

You did extraction what space maintenance after
A. band and loop
B distal shoe
(at 8 yrs old permanent first molar already erupted)
174. Little girl had ALL, had radiolucency in furcation of primary 2nd molar. What is the
treatment?
• Extraction
• Pulpotomy
• Pulpectomy
Radiolucency in furcation: In primary molars, the initial irreversible pulpitis radiographic

sign is furcation radiolucency. Luglie found that 77% of the primary molars studied had
accessory canals in the furcation area, explaining why the radiolucency appears
there first. In permament molars the radiolucency appears at the apex because it is
where most accessory canals are located. The size of the furcation radiolucency in a
primary molar is nor a contraindication to pulpectomy.
Pulp therapy is contraindicated:

Patients susceptible to bacterial endocarditis
Patients with leukemia
Patient with nephritis
Patients with cancer
Patients with depressed polymorphonuclear leukocyte and granulocyte counts.
Contraindications for pulpectomy:

Nonrestorable tooth
Internal or external root resorption
Teeth without accessible canals (commonly first primary molars)
Significant bone loss.
175. Carbide bur with more cutting blades

A. rough surface at high speed
B. Rough surface at low speed
C. smooth surface at high speed
D. smooth surface at low speed
Therefore, low speeds are generally reserved for excavating decay, using disks, and
polishing, while high and ultra speeds are used for bulk reduction, obtaining outline
form, and removing old restorations. (Kaplan)
176. Antibiotic contraindicated with ALCOHOL are Metronidazole, Tinidazole,

Antimalarial, flurazolione, Griseofulvin
177. Antibiotic contraindicated with ALCOHOL are Metronidazole, Tinidazole,

Antimalarial, flurazolione, Griseofulvin
MARNE NBDE RQ’s ….. y más!
1. Proscar is used to treat? Proscar (Finasteride) is used to treat benign prostatic

hyperplasia (BPH).
2. Motion sickness medication (not include antihistamines): Scopolamine

The most effective single medication for prophylaxis against motion sickness is
SCOPOLAMINE.
3. 3 years old child with 5 mm intruded:

Observe
Extraction
Ortho eruption
4. Most common respiratory emergency

Hyperventilating
Asthma
5. Upper first molar forceps: 150

Maxillary forceps
99 --> Maxi anterior
150--> maxi premolar
18 53 88 (R & L) --> Maxi first and second molar
210--> Maxi 3rd Molar
Mandibular forceps
103--> Mandi anterior
151--> Mandi premolar
13, 15,16,17,23--> Mandi first and second molar
222--> Mandi third
Deciduous forceps
101--> for all teeth
6. 1997 law CHIP: T - For children in families whose income too high to qualify for
Medicaid and private is too costly for them. Offers basic preventive and diagnostic
services. Dental coverage was not a requirement in state (chip) then in 1997 its
included in 49-50 states (mosby 221 page)
7. Dual cured vs light cured, color stability? T - Light cure more stable
8. Image: looked like Geography tongue, (but was not include in option)
In lateral border of tongue, was not there 3 weeks ago
Erytropakia: clinical term to describe any erythematous (red) area on a mucous
membrane, that cannot be attributed to any other pathology.
Lichen planus
Geo. Tongue: inflammatory condition of the mucous membrane of the tongue, usually on
the dorsal surface. It is characterized by areas of smooth, red depapillation (loss of
filliform papillae) which migrate over time. The cause is unknown, but the condition is
entirely benign (importantly, it does not represent oral cancer), and there is no
curative treatment. Uncommonly, geographic tongue may cause a burning sensation
on the tongue, for which various treatments have been described with little formal
evidence of efficacy.
9. Nitroglycerin (antianginal = coronary artery vasodilator) side effects: The two most
common adverse effects caused by nitroglycerin are orthostatic hypotension and
headache DD131. It is sublingually effective within 2-4 minutes – 0.3mg). Antianginal
drug: Nitrate: Nitroglycerin: This drug is the single most effective agent available for
the management of acute angina episodes. Note: It dilates mostly veins. Indications:
angina, acute myocardial infarction, and congestive heart failure. (FA)
10. Patient taking digitalis and diuretics. What's the patient is suffering from? CHF -
Cardiac glycosides or “digitalis”, Digoxin is the most versatile and widely used. They
are used to treat most SUPRAVENTRICULAR ARRHYTMIAS, CARDIOGENIC SHOCK AND
CHRONIC HEART FAILURE. Drug interactions: many drugs affect digoxin levels.
However, digoxin does not affect the levels of other drugs, In addition, when beta–
blockers are added to digoxin in patients with AV conduction abnormalities,
complete heart block can result. Erythromycin, clarithromycin and tetracycline may
increase digitalis absorption and toxicity. Thyroid replacement therapy increases dose
requirements of digoxin. Drugs that lower plasma potassium levels (Thiazide and loop
diuretics) increase digitalis toxicity. Of both digitalis and diuretic given what the pt will
have? It will increase digitalis toxicity and lead to arriyhymia.
11. 22 years old separated lesions in tongue and pharynge, fever, malaise.
Herpetic gingivoestomatitis: Acute herpetic gingivostomatitis (also known as primary
herpetic gingivostomatitis) generally affects children under the age of three and
young adults. There are prodromal symptoms (fever, malaise, irritability, headache,
dysphagia, vomiting, lymphadenopathy) 1 to 2 days prior to local lesions. Then small,
yellowish vesicles form, which rupture quickly, resulting in shallow, round, discrete
ulcers with an erythematous halo - DD
Aphtous ulcer
Herpangina: also called mouth blisters, is a painful mouth infection caused by
coxsackieviruses. Usually, herpangina is produced by one particular strain of
coxsackie virus A (and the term "herpangina virus" refers to coxsackievirus A, but it
can also be caused by coxsackievirus B or echoviruses. Symptoms include sudden
fever with sore throat, headache, loss of appetite, and often neck pain. Within two
days of onset an average of four or five (but sometimes up to twenty) 1 to 2 mm
diameter grayish lumps form and develop into vesicles with red surrounds, and over
24 hours these become shallow ulcers, rarely larger than 5 mm diameter, that heal in
one to seven days. These lesions most often appear on the tonsillar pillars (adjacent to
the tonsils), but also on the soft palate, tonsils, uvula, or tongue.
12. Neurogenic sarcoma associated with what? Neurofibromatosis Neurofibroma may

appear as solitary lesions or as multiple lesions as part of the syndrome called
neurofibromatosis type 1 (von Recklinghausen disease of skin). The solitary
neurofibroma is most commonly found on the skin: in the oral cavity, the tongue and
buccal mucosa are most commonly affected. Derived from Schwann cells and
perineural fibroblasts. Treatment: 1. Solitary: surgical excision – 2. Neurofibromatosis:
removal is impractical due to number of lesions, it is best left untreated because
multiple recurrences may be associated with malignant transformation to neurogenic
sarcoma. The importance of the lesions is the high risk (5% -15%) of malignant
transformation.
13. Axillary freckling, lich nodules. Neurofibromatosis type I (von Recklinghausen's

disease). Clinical features: six or more café-au-lait macules that are greater than 1.5
cm. These are usually smooth-surfaced (Coast of California) / Two or more
neurofibromas OR one plexiform neurofibroma (patognomonic for the condition) /
Axillary freckling (called Crowe’s sign) / Iris hamartomas (called Lisch nodules) / Optic
gliomas and several types of osseous lesions are associated.
14. 4 years old kid is

Fearful
Bossy
Uncooperative
15. In US most dental pay is: private pay? Out of pocket

16. Histology shows parakeratinized epithelial lining and basal paragliding cells
OKC (Keratocystic odontogenic tumor - KOTs): Most common in patients aged 10-40,
multiple lesions found in children may be component of the “nevoid basal cell
carcinoma syndrome” – Gorlin syndrome, the chief site of involvement is the mandible
in the posterior body and ascending ramus, the tendency to grow in an anterior-
posterior direction without bony expansion, carry a recurrence rate of 30%.
Radiographic: well – demarcated area of radiolucency with corticated margins,
unilocular or multilocular, they cannot be distinguished from other cysts
radiographically. Microscopically: the lining epithelium is uniformly thin, (6-8 cell
layers) and has wavy parakeratin, the basal layer is palisaded with intensely staining
(hyperchromatic) nuclei, no rete pegs are present.
17. Researcher has set alpha 0.05. Results showed p value 0.01 and researcher reject null
hypothesis. What type of error is it? / Experiment was done and error 0.05 was the goal
of the experiment. After experiment was completed, the error was 0.01. The question
asks what type of error was it? Type 1 error
If p<0.05, reject the Ho: the observer outcome is judged to be incompatible and the
alternative hypothesis is adopted. In this case, the results are said to be “statistically
significant”.
If p>0.05, accept the Ho.
A type I error occurs when the null hypothesis (H0) is true, but is rejected. It is asserting
something that is absent, a false hit. A type II error occurs when the null hypothesis is
false, but erroneously fails to be rejected. It is failing to assert what is present, a miss.
18. Anterior teeth class 4 big composite done few weeks ago. The filling is acceptable but
too light. What to do?
Re do
Observe
Apply composite tint
19. How to differentiate endodontal and periodontal abscess

Pulp testing .. same with vitality test
Percussion
20. Patient had tooth extraction and wants to sleep at night. What analgesic do you
prescribe? Naproxen (long lasting)
21. Anterior, fractured tooth needs crown lengthening. Which surgery do you do?
Gingivectomy
APF with Osseous contouring
APF without osseous contouring
22. Veneer reduction on facial: 0.5 mm

23. PFM is too opaque on Invisalign 3 rd: insufficient 2 plane reduction
24. Central tendency question:

Mean: adding, dividing
Median: middle measurement in a set of data where half the data are above and half
the data are below the number.
Mode: most frequent
FREQUENNCY DISTRIBUTION
Positively skewed: large number of low scores and small number of very high scores.
Negative skewed: large number of high scores and a relatively small number of low
scores.
25. When is elective RCT? Contraindications

Leukimia, uncontroll DM , recent MI
26. Gingivectomy indications: Gingiva Hyperplasia/Hypertrophy and suprabony pockets!
27. Gingivectomy incision? Above mucogingival junction

28. Remineralized enamel characteristics: Shiny and hard, darker
29. When does enamel start to demineralize (critical ph) 5.5 – T
30. Which is most important: value – T
31. Which show saturation of color: chroma
Hue is color
Chroma is saturation of color
32. Which is not a differential diagnosis of DI?

AI
DD
Ectodermal dysplasia
33. When supernumerary tooth is seen? Cleidocraneal dysplasia T – Gardner too
34. Multiple osteomas seen in: Gardner 's

35. Patient is behaving bad but dentist ignored him and continues treatment. What hi is
doing? Extinction
36. Aspirin side effect (multiple side effect in each option)

Overdosage of salicylates (acute aspirin toxicity) is life threatening and requires
intensive supportive treatment in a hospital. Initial symptoms include RESPIRATORY
ALKALOSIS with HYPERPNEA and TACHYPNEA, NAUSEA, VOMITING, HYPOKALEMIA,
TINNITUS, HEADACHE, DIZZINESS, CONFUSION, DEHYDRATION, HYPERTHERMIA,
HYPERACTIVITY and HEMATOLOGIC ABNORMALITIES, progressing to COMA and
RESPIRATRY COLLAPSE. Chronic aspirin toxicity: SALICYLISM, CNS EFFECTS, BLEEDING
and GI DISTURBANCES. Aspirin is an irreversible platelet inhibitor and can reduce
blood clotting to prolong bleeding. Low doses of aspirin taken regularly can have a
cardio-protective effect. These doses reduce thromboxane production in platelets to
result in the inhibition of platelet aggregation. In this way, aspirin has the ability to
inhibit the formation of life-threatening thrombi (blood cloths).
CONTRAINDICATIONS: bleeding disorders (aspirin will increase bleeding time), do not use
in children (Reye syndrome), pregnancy (specially during the third trimester), peptic
ulcers (aspirin may cause bleeding of the GI tract), ASTHMA, RHINITIS, NASAL POLIPS,
concomitant use of anticoagulants.
37. Dens invaginatus commonly found in? Max Lat
38. Fluoride replaces which group: hydroxyl - What the fluoride treatment does is replace
hydroxyl groups with fluoride.
39. The size of radiolucency in #8 increase after treatment it can't be due to

Apical scar
Change in angulation
Canal leakage
40. Chronic periodontitis most seen in? Black male – T
41. Contraindications of elective RCT? Recent MI, uncontrollable DM
42. Arbitrary articulator
43. Group function: Only possible when Anterior/Canine guidance absent! Otherwise
posterior teeth disoclude! Group function occlusion is characterized by having
working contacts. Sometimes called unilateral balanced occlusion, is an occlusal
relationship in which all posterior teeth on a side contact evenly as the jaw is moved
toward that side (working side). All teeth on the non-working side are free of any
contact. The group function of the teeth on the working side distributes the occlusal
load. The absence of contact on the non-working side prevents those teeth from
being subjected to the destructive, obliquely directed forces found in non-working
interferences. It also saves the centric holding cusps, the mandibular buccal cusps
and the maxillary cusps from excessive wear. THE OBVIOUS ADVANTAGE IS THE
MAINTENANCE OF THE OCCLUSION. Some relationships are not conductive to cuspid
protected occlusion (canine – diclusion of all of the posterior teeth) such as CLASS II or
end-to-end relationships. Some relationships are not amenable to group function such
as CLASS II, deep vertical overlap. When placing a crown on a maxillary canine, if you
change a canine protected occlusion to group function you increase the potential
for a “non-working side” interference.
43. Balanced occlusion: All teeth contact during all excursive movements in complete
dentures -- CR coincides CO - no anterior guidance
44. Orthostatic hypotension ( meds who can cause it): Opiods, anti hypertensives,
nitrates, hypoglycemic
45. Medication interacting with nitroglycerin: EPINEPHRINE (physiologic antagonists)
46. Medication interacting with LA
47. Treatment for cardiovascular disease: Statins
48. Nitroglycerin, propanolol, and something else are all used to treat which of the
following conditon? angina - Nitroglycerin is a vasodilator, dilates the coronary arteries
for proper blood flow
49. Which of the following is not directly related to a drug toxicity of nitroglycerine? a.
Dizziness b.projectile vomiting c.tachycardia d.Headaches
50. Which of the following medications increases the risk of bleeding?

a) Dabigatran - Blood thinner. It can treat and prevent blood clots, reducing the risk of
stroke.
b) Sprinolactone c) Verapamil d) Nitroglycerin e) Losartan
51. A patient who uses nitroglycerine has

A. rheumatic heart disease.
B. asthma.
C. coronary artery disease
D. high blood pressure.
E. cardiac arrhythmia.
Indications: angina, acute myocardial infarction, and congestive heart failure. (FA)
52. Nitroglycerin dilates the coronary arteries in angina pectoris by a.Decreasing the
heart rate reflexly b.Increasing the metabolic work of the myocardium c.Direct action
on smooth muscle in the vessel walls d.Increasing the effective refractory period in
the atrium e.Blocking beta-adrenergic receptor
53. Which antitubercosal drug inhibits the syntesis of arabinogalactan ??

a)isoniazid b)rifampin c)pyrazinamide d)rifabutin e)ethambutol
54. Systemic lupus erythematosus is associated with which medication?

hydralazine, procainamide, isoniazid, all.
55. Which of the following drugs is associated with the reaction of stevens johnson
syndrome? a.quinidine b.valproic acid c.ethosuximide d.isoniazid
56. which of the following agents is used for HIV infections?

a. Amantadine b. Acyclovir c. Zidovudine d. Ribavirin e. Isoniazid
57. The most potent anti tubercular drug is

Isoniazid (often given in a four drug regimen – bacteriostatic and bactericidal)
Rifampicin: most active against bacteria undergoing cell division (bacteriostatic OR
bactericidal)
Pyrazinamide
Ethambutol: active only against mycobacterium
Because the mycobacterium organism tends to develop resistance to any single
antitubercular drug, combination drug therapy is standard in the treatment of
tuberculosis.
58. Which of the following has ototoxic adverse effects?

a. Metronidazole
b. Vancomycin
c. Tetracycline
d. Ceftaroline e. Isoniazid
59. Antibiotic most likely to cause failure of oral contraceptives
Penicillin
Rifampicin
Tetracycline
Cephalosporin Macrolide
60. Locally delivered antimicrobials used to treat infected periodontal pockets include all
of the following EXCEPT
A. Metronidazole B. Chlorhexidine C. Clindamycin D. Doxycycline fibres E. Doxycycline
polymerics
61. What is the best antibiotic to be given in LAP (localized aggressive periodontitis):
Metronidazole or doxycycline – best for perio
62. Which of the following would you NOT prescribe for a patient receiving Warfarin
(Coumadin®)?
1. Acetylsalicylic acid.
2. Metronidazole.
3. Erythromycin.
4. Codeine.
A. (1) (2) (3) B. (1) and (3) C. (2) and (4) D. (4) only E. All of the above.
Metronidazole and Erythromycin inhibits warfarin metabolism. Aspirin inhibits platelet
aggregation and causes
Patient who r taking Warfarin should not take the following Medications :
1- metronidazole & antifungal which ends with zole (ketoconazole)
2- antibiotics (tetracycline, macrolides)
3- antiplatelet (aspirin)
4- NAIDs
63. The most appropriate antibiotic for a periapical dental abscess is A. pen V. B.
cephalosporin. C. erythromycin. D. metronidazole E.ampicillin.
64. Which one mostly use for nausea vominting after surgery
promethazin
diphenhydramine
chloropromasin
65. Which of the following drugs is most likely to dry secretions in the oral cavity?
A. Diazepam B. Promethazine C. Physostigmine D. Propantheline E.Diphenhydramine
66. Each of the following non sedating antihistamines would be contraindicated in an

individual taking cimetidine for heartburn except one. Which one is the exception?
1 astemizole
2 Diphenhydramine
3 fexofenadine - only antihistaminic to be taken with cimetidine
4 hydroxyzine 5 terfenadine
67. When patient has asthmatic attack on dental chair, all of the following can be given
by IV except:
1. Epinephrine
2. corticosteroids
3. Aminophylline
4. Diphenhydramine – avoid antihistamines
68. Each of the following is an advantage of midazolam over diazepam EXCEPT one.
Which one is this EXCEPTION?
A. Less incident of thrombophlebitis
B. Shorter elimination half-life
C. No significant active metabolites
D. Less potential for respiratory depression E. More rapid and predictable onset of action
when given intramuscularly
69. Most BDz sedative used in dentistry ?
midazolam - diazepam
70. What benzo do you give to a 37 yo pt with liver cirrhosis?

a. Diazepam b. Midazolam c. Oxazepam
Follow LOT (Lorazepam, Oxazepam, Temazepam)
MEPERIDINE (Demerol): narcotic that produce SEDATION and RELIEVES PAIN

MIDAZOLAM (Versed): primarily anti-anxiety, short acting, great for short procedures.
Comes as a liquid for pre-operative sedation in children and as injectable for IV
conscious sedation.
Benzodiazepines should never be taken with any form of alcohol. Serious potentiation of
the sedative effect of each will occur leading to unexpected inebriation and
respiratory depression.
Flumazenil (Mazicon): a benzodiazepine antagonist, may be used to reverse the residual
effect of benzodiazepines in the event of an overdose
ADVERSE EFFECTS of NITROUS OXIDE:
- Decreased mental performance, audiovisual ability, and manual dexterity.
- AT high doses and/or high exposures: reduced fertility, spontaneous abortion,
neurological and kidney disease as well as bone marrow suppression (DD#39)
71. Hyperbaric oxygen treatment is used in

A) osteoradio necrosis B) bisphosphonate related osteo necrosis C) both
72. Which is the injectable bisphosphonate that can create complication in dental
treatment ? Palmidronate , Etidronate
73. Bisphosphonate used for treatment of multiple myeloma – T
74. Which of the following represents the most common form of gingival periodontal
disease in school-aged children?
A. Juvenile periodontitis B. Localized acute gingivitis C. Primary herpetic
gingivostomatitis D. Necrotizing ulcerative gingivitis
75. A 20 year old student presents with clinical symptoms of necrotizing ulcerative
gingivitis (NUG). Food intake for the last 24 hours indicates a soft diet lacking in fruits
and vegetables. The patient’s diet is important to investigate further because
A. A deficiency of certain nutrients causes NUG.
B. NUG may be limiting the food choices the patient is making.
C. NUG can be cured through modification of diet.
D. Patients with NUG lose interest in eating.
76. Metronidazole can be used to treat

A. denture stomatitis.
B. recurrent aphthous ulcers.
C. necrotizing ulcerative gingivitis (NUG).
D. primary herpetic gingivostomatitis
77. What is not indicated for management of acute necrotizing ulcerative gingivitis?
Pain medication
Saline rinses
Light debridement
Systemic antibiotics
Topical steroids - because it will further depress immune system
78. Which of the following organisms are pathognomonic of acute necrotic ulcerative
gingivitis
A. Spirochaetes and fusobacterium SP B. Spirochaetes and eikenella corrodes
C. Polymorphs and lymphocytes D. Actinobacillus actinomycetes comitans oral
capnocytophaga E. Porphyromonas gingivalis and prevotella intermedia
79. All of the following should be considered for systemic antibiotic except
A. Extraction of tooth with acute dento alveolar abscess
B. Necrotic ulcerative gingivitis (NUG) unless it is acute.
C. Extraction of 38 or 48 with acute pericoronitis D. Full mouth extraction for a patient
with perio disease
80. Necrotizing ulcerative gingivitis and acute herpetic gingivostomatitis can be

differentiated clinically by
A. location of the lesions: interdental papillae involved in ANUG but not in herpes
B. temperature of the patient.
C. pain.
D. lymphadenopathy.
81. In which of the following situations can topical corticosteroids be used?

A. Angular cheilitis. B. Candidiasis.
C. Herpes labialis. D. Erosive lichen planus. E. Necrotizing ulcerative gingivitis
82. Which of the following periodontal disease causes the most rapid destruction of
alveolar bone
Periodontal abscess.
Chronic periodontitis.
Phenytoin induced gingival hyperplasia
Necrotizing ulcerative gingivitis
83. Localized gingival recession of a permanent mandibular incisor in an 8 year old can
be caused by
A. vitamin C deficiency.
B. ankyloglossia.
C. localized aggressive periodontitis.
D. traumatic occlusion. E. necrotizing ulcerative gingivitis.
NOTES: Diabetes doesn’t directly cause gingival recession but is a risk factor for
periodontal conditions. Occlusal trauma may cause temporary pain and tooth
mobility during occlusal contact but does NOT typically cause gingival recession.
Necrotizing ulcerative gingivitis may cause gingival recession at some point but it is
NOT a common dental condition.
84. What is mainly contraindicated for Orthodontics tooth movement?

a) NSAIDs
b) Corticosteroid
EFFECT: ANTI-INFLAMATORY ACTION, IMMUNOSUPPRESSION, AND AN ANTI-ALLERGENIC
ACTION.
TOXIC EFFECT COCORTICOIDS: GROWTH INHIBITION, HYPERGLYCEMIA, OSTEOPOROSIS,
PSYCHOSIS AND SALT RETENTION. Remember: pharmacologic effects of
mineralocorticoids include an increase in sodium retention and an increase in
potassium depletion, which can lead to edema and hypertension if excessive and
may lead to dehydration and hypotension if insufficient. ADVERSE REACTION: Cushing
syndrome, hyperglycemia, osteoporosis, peptic ulcers, and an increased risk of
infection. (DD#129)
85. GUIDED TISSUE REGENERATION not done in? Shallow infrabony defects, grade 3
furcations, 1,2 wall defects
86. Which of the following tetracycline class drugs should only be taken once daily due to
its long half life?
(1)Demethylchlortetracycline
(2)Doxycycline
(3)Chlortetracycline
86. How do you determine arch length? Primary teeth - distal to to 2 molar to distal to
2molar / Permanent - distal of second primary molar to distal of second primary molar
Arch width ? Inter canine distance
87. Which medicament can be used during pulpotomy procedure? a.calcium hydroxide
b.EDTA c.MTA d.Flowable composite
NOTE: Used in replacement of formocresol, however, because of the high cost, it is not
often used.
88. Connective Tissue Graft is the most predictable treatment modality for root coverage
-T
DD#101, 102, 103

SELECTIVE GRINDING IN WORKING – SIDE RELATION: RULL OF BULL
- Buccal cusp inner inclines of Upper teeth
- Lingual cusp inner inclines of Lower teeth
SELECTIVE GRINDING IN BALANCING SIDE RELATION: LUBL
- Lingual cusp inner inclines Upper teeth (NBDE2)
- Buccal cusp inner inclines Lower teeth
- Never grind the maxillary lingual cusp (primary centric holding cusps)
Working interference – LUBL. Correction- BULL

Non-working Interference: Balancing side (non-working side) interferences generally
occur on the inner aspect of the facial cusps of mandibular molars. Correction- LUBL
Protrusive Interference: occurs between the DISTAL inclines of the facial cusps on
MAXILLARY POSTERIOR teeth and MESIAL inclines of the facial cusps of MANDIBULAR
POSTERIOR teeth – DUML. Correction – MUDL (Grind MESIAL inclines of MAXILLARY
teeth and DISTAL inclines of MANDIBULAR teeth).
CENTRIC: Centric interference (forward slide) can be corrected by grinding mesial

inclines of maxillary teeth and distal inclines of mandibular teeth – MUDL.
Drugs and their antidotes

1. acetaminophen - acetylcycteine
2. benzodiazepine - flumazenil (Mazicon)
3. coumadin - vitamin k
4. curare - tensilon
5. cyanide poisoning - methylene blue
6. digitalis - digibind
7. ethylene poisoning - antizol
8. heparin - protamine sulfate
9. iron - desferal
10. lead - edetate disodium (edta), dimercaprol (bal), succimer (chemet) 11. lovenox -
protamin sulfate
12. magnesium sulfate - calcium gluconate
13. morphine sulfate - naloxone hydrochloride
14. methotrexate - leucovorine
15. mestinon - atropine sulfate
16. neostigmine - pralidoxime chloride (pam)
17. penicillin - epinephrine
18. vincristine (oncovin) - hyaluronidase,also apply moderate heat to disperse drug and
minimize sloughing. (oncovin - iv administration only)
Poison antidotes
arsenic ------------------------------------------------------ dimercaprol, succimer
barbiturates (phenobarbital)------------------------ urine alkalinization, dialysis, activated
charcoal
beta-blockers--------------------------------------------- glucagon
caffeine, metaproterenol, theophylline------------- esmolol
carbon monoxide -------------------------------------- 100% oxygen, hyperbaric o2
cholinesterase inhibitors---------------------------- atropine
cyanide-------------------------------------------------------- nitrite, sodium thiosulfate
ethylene glycol --------------------------------------------ethanol
gold ------------------------------------------------------------dimercaprol
heparin --------------------------------------------------------protamine sulfate
iron salts -----------------------------------------------------deferoxamine
isoniazid------------------------------------------------------- vitamin b6
lead ----------------------------------------------------------- caedta, dimecaprol, succimer
methanol ------------------------------------------------------ ethanol, fomepizole, dialysis
methemoglobin/cyanide poisoning----------------- methylene blue
muscarinic receptor blockers ------------------------ physostigmine
opioids ---------------------------------------------------------- naloxone
organophosphate cholinesterase inhibitors --------- pralidoxime
phencyclidine hydrochloride (pcp) ------------------ ng suction
quinidine, tca's ----------------------------------------------- sodium bicarbonate
salicylates ------------------------------------------------------ urine alkalinization,dialysis, activated
charcoal
snake bites ------------------------------------------------------ antivenin
tissue plasmogen activator (tpa), streptokinase------ aminocaproic acid
warfarin ---------------------------------------------------vitamin k, ffp
alcohol ----------------------- Disulfiram (Antabuse)
INTERACTIONS:
NITROUS OXIDE ------------- VITAMIN B12 synthesis in the human body by interfering with the
enzyme methionine synthase, depleting the body of VITAMIN B12 (brain and nerve
damage).
CONTRAINDICATIONS:
COCORTICOIDS -------------------- Latent TB or fungal infection, AIDS, herpes infections and
patients with peptic ulcer disease (specifically, gastric ulcer) – these drugs themselves
may cause peptic ulcers, congestive heart failure. Orthodontic tooth movement.
(DD125)
NITROUS OXIDE ---------------------- Head injury, bowel obstruction, pneumothorax, middle
ear and sinus infections, COPD (emphysema or bronchitis – NOT ASTHMA, there ARE
NOT contraindications for the use of nitrous oxide sedation in asthmatic patients), first
trimester of pregnancy, with whom communication is difficult (autistic patients),
having a contagious disease since it is difficult to sterilize entire tubes.
NITROGLYCERIN ----------------------- Myocardial infarction with hypotension, hypotension,
and glaucoma. (FA)
DARSHIKA SHAH'S Rq's
1) Three dentist hired a hygienist - patient injured by hygienist, whose liability?

Hygienist
Hygienist and attending dentist
all d 3 dentist
4th dun remember
2) 3mm crowding in Mandibular ant permanent teeth?

No treatment
Extract primary canine
Disk distal of primary canine
And 1 more option
Early treatment: Mixed dentition minor crowding (up to 4 mm) may be corrected by
proper utilization of the leeway space.
3)Class 2 dea prescription?

Hydrocodone + ibuprofen = CLASS III
Hydrocodone + acetaminophen = CLASS II
Codeine + acetaminophen = CLASS III
Oxycodone + acetaminophen = CLASS II
4) Tooth extraction?
On day of dialysis
1 day prior to dialysis
1 day after dialysis
No ext
5) Which requires elective root canal?

Pain in tooth
Exposed pulp
Severely tilted
Dun remember the 4 th option
Sometimes the elective root canal treatment of a tooth with a healthy pulp is indicated
within a broader framework of restorative care. If severely tilted, preparation of the tooth
for a crown is likely to involve hitting the pulp horn, with the possible need for endodontics
on that tooth.
6) Clamp no.212 (or some no. Dun remember exactly) is used for class 5 restoration
Where to punch the hole?
Long sentences asking where to punch the hole - facially, lingually
7) Class 5 - restoration of choice?

Composite
Rmgi = Resin modified glass ionomer
Dun remember other 2 options
8)Most common in man?
Haemophilia
Diabetes
Dun remember other 2 options
9)CaOh success depends on?

Providing 2mm of gic base
10)Which material most stable in moisture

Polysulphide
Polyvinyl siloxane
11)Wat does not aid in restriction and resistance of crown?

Parallel walls
Surface area
Less convergence
1 more option
12)Tooth crown ration fracture most common with?

mandibular first molar (max CI in trauma horizontal fracture, mand molars - vertical
fracture)
13)patient allergic to?

Nickel
Cobalt
Chromium
Berrylium
14)Patient I dun have time to quit smoking?

Precontemplation
Contemplation
Denial
Acceptance
15) Which is trademark name?
Generic
Registered
Patent
Something dun remember the exact question
16) Patient disoriention and something else?

Insulin
Glucose
Epinephrine
Atropine
17) Dementia?
Short term memory loss
Long term memory loss
18) Most common disease in old age? depression
19) Lingual flange recorded by? mylohyoid, genioglossus (lingual frenum), palatoglossus
(retromylohyoid area), superior pharyngeal constrictor (distolingual extension). There
is one option to choose will go with genioglossus it effect the length of lingual flange)
20) Distobuccal by? The distobuccal extension is determined by the position and action
of the masseter muscle
21) Mandibular buccal frenum which muscle? Triangularis

Zygomaticus
Caninus
One muscle from t dunno
4th option dunno
Mandibular labial frenum = orbicularis muscle
Mandibular buccal vestibule = buccinator muscle.
The buccal vestibule: proper extension into this area provides the best support for the
mandibular denture. This area is referred to as the buccal shelf.
The lower buccal labial frenum is: also morphologically similar to the upper buccal labial
frenum but again less developed. It contains muscle fibers from the depressor anguli
oris, or triangularis (another muscle of facial expression)
22)Which sinus involved in fracture ( I dun remember which)?

Maxillary (Mx lefort one)
Frontal
Naso ethmoidal
One more option
23) Which movement of eye restricted in fracture of floor of orbit?

Sup
Inf
Lateral
Medial
Type I orbital floor blow-out fractures FEATURES ' Limitation of ocular movement on up-
gaze.
24) Question asking what is leeway space? Leeway space is the size differential between
the PRIMARY POSTERIOR TEETH (canine, first and second molars), and the PERMANENT
CANINE AND FIRST AND SECOND PREMOLAR - about 3.1 mm per side in the
mandibular arch and 1.3 mm per side in the maxillary arch. (Mn 2.5,Mx 1.5 for each
arch)
25) Scrap amalgam

Sealed (with sulfide)
Metal container
Open
Mercury chloride solution
26) Where is the retentive arm placed? Gingival 1/3 (Between middle and gingival third
below high of contour) - reciprocal is made of base metal alloy and retentive is
wrought wire
27) Metal can be used in denture base for the reasons except? Metal has good
adaptation and abrasion resistance. Otherwise adequate contour is hard, no esthetic
and poor retention. Metal allergy for some patients
28) The retentive arm of clasp features? Retentive arm is rigid ant 1/3 rd, semi rigid middle
third, and flexible terminal 1/3rd. Passive until activated.
29) What does opaquer porcelain help in all except? Opaque porcelain masks the dark
oxide color and will provide porcelain metal bond. Opaque does not make the main
color of the restoration.
30) Y is gold preferred over amalgam? Ideal contour and very biocompatible. Gold
thermal expansion near to tooth, gives ideal contours, better marginal integrity, more
strength, also very biocompatible.
31) Which property is imp for burnishing the restoration? yield strength
32) The inflamed red spots in smokers palate? nicotonic stomatitis
33) Most common site of caries? Pit n fissure
34) Red complex which bacteria? PTT - Porphyromonas gingivitis, Tannerella forsythia and
Treponema denticola.
35)10mA 1sec and .5secs same effect of the film
What is the ma?
10
5
20 (inverse relation)- time is reduced by half so it will double
35) 1 film was given - underdeveloped and options related to it?

Too high temp
Reduced time: Underdeveloped(light film)- developer too cold, developer deplinish,
inadequate time
N more 2
36)16 kg girl max dosage of lidocaine? 16*4.4=70.4

4.4 mg/kg for lidocaine without vasoconstrictor and 7 mg/kg with vasoconstrictor for both
child as well as adults.
37)Buccal root distal to palatal root. Where was d come placed? MESIAL – SLOB (SAME
LINGUAL OPPOSITVE BUCCAL)
38) The bur used to polish porcelain?

Steel
Carbide
Diamond (for cutting)
30-fluted carbide finishing bur is used to plane the porcelain surface and to remove the
striations created by the diamond instruments.
39)The bur with more flutes?

cut efficiently and polish efficiently
Does not cut efficiently and polish efficiently
Cut efficiently and do not polish efficiently
Nor cut nor polish
The greater the number of cutting blades on a bur results in LESS EFFICIENT cutting but a
SMOOTHER SURFACE (polishing burs are of this type). A lesser number of blades on the
bur results on MORE EFFICIENT cutting but a rougher surface (crosscut fissure burs at
high speed or low speed are of this type).
40) The type of speed for implant

site?
High speed high torque
Low speed low torque
High speed low torque
High torque low speed
41) The margin on cementum. Which material to be placed in gingival third? Glass
ionomer cement ( GICs) or RMGIC W/ sandwich technique
42) Repair of porcelain process? micro etch, etch, silane bonding

43) Melanoma location? Palate and
maxillary gingiva/alveolar ridge
44) Cause of mucocele? Mucocele caused

by ruptured salivary duct, usually due to
trauma, seen on the lower lip.
45) Treatment of ranula? complete excision

with gland in new version of DD. Surgical
excision if recurs the excise subling
gland dbm.
46) Pierre robin was - Cleft palate 50%,

retrognathia and glossoptosis.
47) This was related to Gardener. They didnt mention gardener

anywhere just 3 symptoms wat is 4th that u wud check:
Intestinal polyposis, supernumerary teeth, odontomas, dermoid cysts, and colon cancer.
48) Ration of cleft lip in Caucasian? 1:1000

Lip 1:1000
Palate 1:2000
Both 1:700
49) Chronic periodontitis common?

Male Hispanic
Female Hispanic
Male black
Female black
50) Prevelance can be related with which case study? Descriptive
51) Cause and effect which case study? Clinical trail if no effect then cross sectional
study
52)Osteomas, glossptossis wat wud u check for? Gardner syndrome
53) Duct of submandibular gland? Wharton
54) Plastic heat sensitive materials sterilization? Cold (2%glutaradehyde)
55) Does not reoccur ?

Ameloblastoma
Odontogenic myxoma
Aot – Adenomatoid odontogenic tumor (does not recur) dd card 112
Okc
56)12 month rct increase in size of radiolucency all the reason except?
Healing by apical scar - healing by apical scar will not change in size
Insicive canal
Different angulation
Leakage
57) Moa of suphauryl anti diabetic drug? increase insulin production by stimulating b
cells of pancreas
58) Which can be diagnosed only histologically? difference between Radicular cyst vs
Granuloma
59) After 12 months increase in size of lesion in rct treatment teeth except?
Healing by apical scar
Insicive canal
Different angulation
Leakage
60) Pulp necrosis type of wat resorption ?

Inflammatory
Surface
Replacement b
N 1 more option
61) Cellulitis-
Neutrophilia
Neutropenia
Lymphocytosis
One more option
62) OSHA blood borne pathogens - msds sheet:

True - OSHA not related to MSDS sheet
63) Placement of pfm (porcelain fused to

metal) crown margin ant?
Supra
At crest of gingiva
In between crest n epi
Crown-to-root ratio:
Minimum—1/1
Best—1/2
Shoulder margin – when esthetics are imperative (minimum of 1 mm of porcelain can be
stacked at the margin hiding the metal)
64)N d wat makes penicillin allergic? Beta lactame ring
65) Patient has BCC how wud u tell d patient? Good prognosis
do you need to reappointment
this cancer in not as dangerous as others
do you want I called you guardians
the biopsy show that you have a cancer and we do our best to help u out
66) Wat is best X-ray for detecting bone loss? Bitewing
67) Most common finding of cherubism? Bilateral swelling of jaw with premature loss of
prim teeth and delay eruption of perm teeth, soap bubble appearance.
68) Potassium sparing drug? spironolactone
69) Gingivectomy indications contraindications? Indication - supragingival pocket,

enlargement / Contraindication - infrabony pocket, inadequate width of attached
gingiva.
70) facial vertical axis divided? 3 equal thirds – Its 3 plane vertically, 5 planes horizontally
71)cleidocranial wat is absent: clavicle
72)most common salivary gland Tumor: pleomorphic adenoma (mixed tumor)
73) lots n lots of questions related to case study . Which case study tells wat.
74) lot of patient management questions related to desensitisation mostly
75) consent not taken? Which ethic? Violation of Autonomy
76) treatment with out consent? Battery - legal term in which perform a procedure
without consent
77) liquid in gic: Polyacrylic acid
78) statements true reg zinc poly carboxylate:

Good strength not irritating pulp replace zoe
chemical adhesion
high film thickness
Chemical bond to enamel
More More RQs
1. What procedures you cant do in AIDS – Prophylaxis
2. Chs of band and loop - Given early loss of 1st primary molars
3. What cyst in roots of mandibular premolar - Lateral periodontal
4. What lesions are not radiopaque? ; AOT, Ameloblastic fibro odontoma – ameloblastic
fifroma – DD: An opaque focus appears within the ameloblastic fibro-odontoma
owing to the presence of an odontoma. This lesion, therefore, presents as a combined
lucent-opaque lesion, the ameloblastic fibroma is completely lucent.
5. Least likely to occur, AOT, odontogenic myxoma?
6. What is Brown tumors – Hyperparathyroidism
7. Conditions have macroglossia? - Acromegaly, beckwith wieddeman syndrome,
Hypothyroidism,amyloid oasis,down
8. You don’t do RCT with PA radiolucency in which patients? Diabetes (uncontrolled DM)
9. Why you clean tongue? ; esthetic or to prevent odor
10. Treatment of concussion – do nothing
11. Too light x-ray? Why - Developer temp cold,under devolped,exhausted devolper
12. Phelobith location? ; nerve, vein
13. If you take Rg 10 ma with 1 sec exposure and you take another x ray with .5 sec what
MA will you give you want same density rg? 5, 10 or 20 (Inversely proportional)
14. Mouth breather features - open bite constricted maxilla post cross bite, narrow arch
too, short upper lip
15. Mechanism of fluoride? - Hydroxyl group from hydroxyapatite exchange to form
fluorapatite
16. Lefort 1 includes what structure? Maxilla
17. When you make rest on molar you make rest deep enough in marginal ridge, buccal
incline, lingual? 1.5 mm marginal ridge
18. Epinephrine contraindicate in thyroid? T/F - T in In hyperthyroidism
19. Abcess include marginal and interproximal gingiva called? Gingival abscess,
pericornal, periapical
20. Whats the indication of half erupted third molar in 18 years old – extract? but 17 -21 is
when normally 3molars are erupting. In ADA specifications.. Extraction of 3rd molar is
not indicated if it is not causing any problems
21. You can avoid legde if canal is Small, large, short or curved? Short
22. # of granulocyte for sugery – 15000
23. Beta 1 selctive actions - Increase heart rate
24. Papoose contraindication - Mental retarded child, Long procedures, cooperative
child
25. Hemophilia test – PTT
26. Alplrazolam - Anxiety and panic disorder
27. 5 year old child not cooperative, wat to do? conscious sedation? voice control? ga ?
28. Precations for hep patient - why universal precaution? Its changed and expanded to
be renamed as standered precaution card 63 pt
29. Endo perio operative surgery ortho
30. Patient smokes, is implant contraindicated – NO (its risk factor)
31. Primary molar differs from permanent in cervical constriction T
32. Forcep not used for extraction of root
33. Most common organism in implant failure; same as regular dentition – Anerobic
34. Ginseng reacts with which drug – aspirin
35. Ectodermal dysplasia features - Anadontia , conical ant teeth , thin hair , mostly in
male , x link. Anhydrosis.
36. Cleidocranial dysplasia what is missing? clavicle
37. Identify periapical cemental dysplasia - Cemento-osseous dysplasia (COD) is a
benign condition of the jaws that may arise from the fibroblasts of the periodontal
ligaments. It is most common in African-American females. The three types are
periapical cemental dysplasia (common in those of African descent), focal cemento-
osseous dysplasia (Caucasians), and florid cemento-osseous dysplasia (African
descent). Periapical occurs most commonly in the mandibular anterior teeth while
focal appears predominantly in the mandibular posterior teeth and florid in both
maxilla and mandible in multiple quadrants.
38. Dentigerous cyst radigraph
39. Regional odontodysplasia identify - Ghost teeth

40. which week does dental lamina appear? 6 week
41. Piree Robinson syndrome - Cleft palate, retrognathia and glossoptosis
42. Ranula treatment - Marsupilization or excision with remove sub lingual gland
43. Convergence of buccal and lingual wall which tooth? Primary 1st max molar,
44. Distolingual extension of mandibular denture which muscle - Distolingual just superior
constrictor muscle (DD)
45. Which sounds will you look for placing anterior teeth. - Fricative (labiodental) F and V,
formed between the maxillary incisors contacting the wet dry lip line of the
mandibular lip. This sounds help determine the position of the incisal edges of the
maxillary anterior teeth.
46. Incisal edge of max anterior touch were? On the vermilion border
47. Major connector function? Stability and rigidity
48. In distal extension where do you put rest? mesialy
49. Most esthetic pontic design? Ovate
50. Where to place margin of anterior crown - Subgivingival
51. Lot of clinical qs presenting different scenarios and you have to choose appropriate
treatment
52. 3- 4 qs on occlusion. But most of them direct
53. Necrotic pulp with open apex what is treatment of choice? Apexification
54. 1mm exposure what do you do? DPC, pulpotomy,PUlpectomy
55. Patient comes after 1 week of composite says he does not like the color what will you
do? Repeat restoration, add composite and some other options - Redo
56. Which bur do you use for porcelain polishing? Steel, carbide ,diamond
57. Action of beta blocker on smooth muscle? Since B2 adrenergic receptors can cause
vascular smooth muscle dilation beta-blockers may cause some vasoconstriction.
58. Action of beta blocker on cardiac muscle - Beta Blockers are drugs that slow the
heart rate, decrease cardiac output, lessen the force with which the heart muscle
contracts and reduce blood vessel contraction. - Dec cardiac output,dec hr
59. Which patient requires antibiotic prophylaxis? 2 qs about that - Prosthetic valve,
Cyanotic, Previous endocarditis, Valves problems from recently inplanted heart
60. MOA of sufonylurea - Inc insuline by stimulation of beta cell in pancreas
61. All are immunosuppressive except? Some wiered choices – Methotrexate,
Mecaptopurine, Cyclosporine (All are immune suppression )
62. Antimetabolite for cancer which affects folic acid? METHOTREXATE
63. Premolar forcep all except? 150,151 for pm, 99, 203 – EXCEPT 23
64. Bacteria in chronic periodontitis? DD: P. gingivalis, T. forsythia, P. Intermedia, C. rectus,
E. corrodens, F. nucleatum, A. actinomycetemcomitans (Aa). P. micros, and
Treponema and Eubacterium species.
65. Bacteria in NUG? Fuso, Spirochete, Prevotella
66. Gingivectomy where to put incision? A beveled incision is made apical to the pocket
depth.
67. What does biologic width comprise of? JE + CT = 2.04
68. What makes up the periodontium? GIngiva, Alveolar bone, Cementum, PDL
69. Most common complication of extn of max molar? Alveolar fracture - Sinus
perforation
70. Lefort 1 which sinus affected? Maxillary, ethmoid,frontal,mastoid
71. A boxer wearing mouthgused comes with complain of jaw opening in the morning.
What is your diagnosis? MPDS
72. Light radigraph cause? Under developer
73. Lot of qs on patient management. Some straightforward some twisted wording. Moby
is must
74. Cold sterilization which chemical used? Gluteraldihyde
75. Sodium hypochloride does all except? Chelation
76. Common cause of failure of amalgam restoration? Moisture contamination, improper
design, improper trituration. Failure- inadequate design - Fracture- water
contamination
77. There is a fracture line on amalgam restoration what is the treatment of choice? Redo
restoration to check the fracture of tooth, Just remove mesial side and check and
some other options
78. Lot of class 5 what is the material of choice? GIC
79. Which impression material is moisture tolerant? PVS, polyviny, polyether
80. Which material has inherent property of binding with water? PVS, Polyvinyl, polyether
(hydrocolloid was not an option)
81. Modulus of elasticity which property? Siffness (DD)
82. Finger spring applied to move the tooth where will be the most force applied? Tooth
dstal,medial - mesio distal direction
83. Nitrous oxide most common side effect? Just nausea and vomiting (dd)
84. 16kg boy what is the maximum dose of LA - 16*4.4 (dose/kg) = 70.4
85. A defiant child does not want to cooperate which method to use? GA, voice contol,
HIM
86. Gold standard for behaviour modification? Systemic desensitization, modelling,voice
control
87. Lot of clinical qs about indications and contraindications of material use in
restoration?
88. Day 2 practice ASD A PAPERS and treatment options for various ortho and perio
cases.
MORE RQs
1. Which immunoglobulin is concentrated in gingival clevicular fluid: IgG
2. Middle-aged male has a fluctuant mass in the midline of neck: A) Thyroglossal duct
cyst B) Brachial cleft cyst.
3. What else do S. mutans produce along with dextran after breaking down sucrose:
A) mucopolysaccharides B) macros C) levans D) proteins
4. Nerve involved in Bell’s palsy: VII
5. 4mm implant, how much do you need buccolingually: 6mm
6. Mandibular 3rd molar root lost: which space ?
7. IAN block needle infection where: Pharyngeal, Pterygoid, medial pterygoid muscle
8. Veneer facial reduction: 0.5mm
9. PFM buccal margin depth - 1.5mm
10. Patient comes back after 1 year of composite restoration with pain and sensitivity –
microleakage
11. Radiograph to check integrity of Zygomatic arch – CT/ Submentovertex
12. TMJ radiograph - MRI for articular disc
13. Behcet’s syndrome associated with: Aphthous ulcers
14. Bradycardia treatment - Atropine, scopolamine
15. Which is NOT used to inhibit salivary secretion - Pilocarpine or Cevimeline
16. Which is contraindicated in nitrous: nasal congestion – COPD
17. Which of the following confirms the diagnosis of xerostomia: A) location of probing
depths of >4mm. B) location of anterior restorations. (I picked this instead of A
because chemotherapy causes xerostomia which leads to class V lesions) C)
location of partial denture flange
18. Over titration of Amalgam leads to: decrease setting expansion, decrease corrosion,
increase strength
19. Cavernous thrombosis infection via - lymphatic vessels.. as are on the upper lip is
valveless (upper lip infection)
20. Patient does not have tooth #11 and has all the premolars, which one has the Worst
Prognosis: A) fixed bridge from #10-12. B) RPD with pontic for #11 C) Implants
21. Metalloceramic crown which type of bevel - Chamfer 1mm
22. On working interferences and how to correct it - BULL - working side LUBL - non
workin, MUDL - centric and DUML - protrusion
23. Wear facet on the mesio marginal ridge of MB cusp of mandibular molar - Protrusive
interference
24. Macroglossia where is not seen (hypoparathyroidsm)
25. Most prominent cells in crevicular fluid – PMN
26. Ignoring patient behavior - Operant extinction
27. A 5 years old fell and max incisors intrude 3 mm ( tx) – OBSERVE
28. Ectodermal hypoplasia - Affect all structures derived from ectoderm: Anhydrosis,
Spars hair, Anadontia or hypodontia, fine hair, delicate skin, no sweat glands, nails
deformed.
29. Prominent cell in cellulitis - lyphmphocyte , its chronic
30. Most tooth lost in perio treatment - Max 2nd molar
31. Where external bevel incision is made – Giginvectomy - Used in gingivectomy and Its
done apical to pocket (junctional epi) and coronal to mucogingival junction.
32. Disadvantages of modified widman flap - Not eliminate pocket depth, But it removes
pocket lining and then shrinkage and reduction
33. Cleidocraneal dysplasia - No clavicle - Supernumerary teeth delay erruption if teeth.
Frontel boosing
34. Early lost of primary teeth Papillon le fever - Papillon levefe, autosomal recessive,
impaired in T and B lymphocyte, palmer-planter keratosis , advanced periodontitis in
both primary and permenant due to dominant bac (A.A) teeth float in soft tissue,
excessive bone loss and mobility.
35. KOC how to diagnose it - Microscopically , the lining epithelium is thin and
Parakeratinzed , basal layer is palisaded with prominant staining nuclei ,, the lumen
cintain large amount of KERATIN debris and clear fluid similar to serum transudate( dd)
36. Dentigerous cyst (radio and patio) - Impacted / unerupted - radiolucency > 5mm
upto cej - Cyst is lined by epithelial cells derived from reduced enamel epithelium
37. Why to extract bone impacted 3 molar - caries, recurrent pericoronitis, improper
eruption path, resorption of agjacent rooth.
38. Modeling reshaping behavior - successive approximation - Behavior shaping a.k.a.
successive approximation shaping is used when an existing behavior needs to be
changed into a more appropriate or new behavior. The strategy involves use of
reinforcement of successive approximations of a desired behavior.
39. Cross section study - No cause and effect
40. Bundling/unbundling - Bundling pay all procedure together - Unbundling separate
charging.
41. MOA of sulfas - If its sulfanylurra then stimulate insulin from b cell of pancrease
(Stimulate beta cell to inc insulin) - If its sulfonamide then ab compete with gaba and
inhibit folic acid syng
42. Epi should be avoided in excess of: thyroid hormone, Yes because it causes
hypertensive crisis with Grave's disease
43. Max dose of LA for 3 years old with 16 kg – 70.4
44. Changing the exposure time and how will change MA with the others factors
remaining the same – (For example: ma :10 in 1 sec - If exposure time changed to .5
seconds thn MA will be 20 or 5 ??
45. Hardest type of ceramic: Zirconia (From weak to hardest: feldespathic, leucite-
reinforced, lithium disilicate, glass-filled, aluminia, zirconia)
46. Why Zirconia is one of the hardest ceramic? - Due to its sintering technique -- slip cast
technique which increases toughness
47. Diffencial diagnosis of perio endo lesions – vital pulp test (ept)
48. Order of treatment in case of perio – Emergency, Control, Reevaluation, Maintenance
49. The most important factor in choosing color for a crown – Value
50. Finish line of gold crown - in dd ideally its feather edge , but chamfer is used.
51. Finish line of PFM - All CERAMIC shoulder, GOLD chamfer, PFM buccal shoulder and
lingual chamfer.. but if not given.. chamfer considered.
52. # of bur used with gold onlay – 557
53. What not to use for pm (# of forceps) - 23 cowhore
54. Safe analgesic to use in pregnant patient (acetaminophen not an option) Tylenol 3
55. Class 2 narcotics – Percocet
56. Medication use in Parkinson's - Levadopa, carbidopa, Amantidine
57. Alcohol addiction and use of Tylenol - Liver toxicity, so it must be avoided
58. Regional odontodysplasia - Ghost tooth, short roots , open apical foramin, enlarged
pulp chamber, the thinness and poor mineralization quality of enamel give it the gost
shape tooth, affect permenant more than primary, max anterior is more affected
59. Sjogren syndrome - Dry eye(xerohthamia), Dry mouth xerostomia, Rheumatoid arthritis
60. Meds in miastenia gravis – Neostigmine + atropine y pyridostigmine. Endrosphonium
to diagnoses Myastenia Gravis, not for treatmrnt because of short duration
61. Side effect of albuterol - Canidida and xerostomia (Dryness of mouth inc
susceptabilty to candidal infection)
62. Side effect of nitroglycerine: Orthostatic hypotension, Headache, Nausea, Flushing of
face
63. How does the insurance make money-1-pay per case 2-Barter, HMO,
64. There are only mandibular anterior in the mouth and planned was the CD... what do u
look for?1-Balanced occlusion 2-Canine guidance
65. Maxillary molar thin attached gingiva what you do not do on the distal-FGG, Apically
PF, Distal wedge (Apically displaced flap is done in adequate attached gingiva)
66. Nitrous oxide mechanism of action - It works on central nervus system( reticular
activating system ans limbic ) its sympathomimetic, the only inorganic used , weak
anesthetic and strong analgesic , used in conscios sedation ( stage one anesthsia
)(dd)
67. Dens in dente most common involved tooth – LI
68. Most common anomaly-DI, AI DI-1 in 7000
69. Worst possible outcome after splinting the avulsed tooth-Inflammatory resorption ,
Replacement resorption - external root resorption( inflammatry)
70. Down syndrome what do u see-enlargement of maxilla, mandible, Mid-face def
71. Biological width from where to where - Junctional epithelial + C.T = 2.04
72. Menarche- skeletal maturation, cognizant maturation, emotional maturation
73. Characteristic of arrested caries-they did not mention anything about colour but
came up with soft under enlarged gingiva, gingival recession.
74. Epinephrine what it does, Prolong the duration of LA, vasoconstriction
75. Intrinsic and extrinsic pathway of NSIAD - Lipooxygenase and cyclo oxygenase
inhibition pathways - nsaid dont ecffect neither intrinsic nor extrincic pathway of
coagulation,,, it inhibit platalet aggregation by inhibiting thromboxane A2
76. Main disadvantage of GP cones: Does not adapt so requires Zoe
77. Asymptomatic pigmented lesion on the palate 4mmx3mm what you will do for it ? A)
cone beam and excisional biobsy b) cone beam and excisional and antiobiotic
treatment C) no treatment.
78. Whats the heart rate for a child 3 years I believe – 110
79. The most chronic peridontistis will be found on - black males
80. SNA, SNB, ANB- related 82-80-2 - SNA mx to cranium 82 normal More mx protruded
Less mx retruded - Snb mn to cranium 80 normal More mn prot Less mn retr - ANB mx
to mn 2-4 More class 2 Less than 2 three
81. Primary tooth intrusion what u do- Observe
82. Rct contra - Leukemia , uncontroll DM , recent mi
83. Patient stand on the corner looking at the floor and his hand is folded together after
you give him and introducation what you ask him or do next - What bring u here today
84. Xylitol can be most effective in reducing caries by - Increasing salivary flow, inhibiting
formation of bacteria
85. If you have 2 proximal cavities how to manage? Prepare larger first, fill smaller first
86. Epilepsy which drug, grandma and petit – Phenytoin, Peti is exothusmide - grand mal-
phenytoin
87. Germination,fusion ,attrition,erosion what are they know definition
88. Pregnancy safe drug – Promathzine, Tylenol 3 (Amoxylin, Aceta, Tylenol 3,
Promethazin)
89. epi +proponolol what will happen? Hypertensive crisis - Increase BP accompanied by
reflex bradycardia
90. Xray to identify zygomatic arch - Smv and CT
91. Myxoma: honey comb, most common odontogenic mesenchymal tumor, Benign
mesenchymal tumor. Hony comb appearance and tennis racket. May show sun ray
app of osteosarcoms. Cz displacement but not resorption of roots, arise from follicular
connective tissue resembling dental pulp tissue. Odontogenic myxoma (bromyxoma).
1. Uncommon to rare tumor of myxomatous connective tissue (primitive-appearing
connective tissue containing little collagen similar to dental pulp). Either jaw affected.
Radiolucency, often with small loculations (honeycomb pattern). Treated with
surgical excision; moderate recurrence potential owing to lack of encapsulation and
tumor consistency.
92. Ameloblastoma, Benign, Most common epithe tumor, Soap buble with local invasion,
Mn post.
93. Pagets, Max affect more, Hyoercementosis , Cotton wool appearance, Mx, Cotton
wool, Inc alkphosphotase, Osteosarcoma, Cotton wool, Hypercementosis and loss of
lamina dura. Tendency to malignancy osteosarcoma.
94. Gingivectomy incision - External bevel
95. Intracanal medicament – Caoh
96. Crossbitecase,case
97. About ageing of amalgam what happens - Inc marginal seal
98. Difference betn reversible and irreversible
99. Most common in school going - Marginal gingivitis
100. What is diff betn infected and affected - Infected we have to remove and not
remenerilze.
101. Which force for implant - horizontal is worse
102. Some q about sinus lift - Bone graft at the floor of sinus for implant
103. FN plane - Porion orbitale (Porion to orbitale Frankfort plane)
104. Bestxray for mesio dense - Occlusal
105. Porcelian fracture - Porosity in porcelain is result from inadequte condensation
card 29 pros) ,,, porcelain fracture in pfm , is poor design is main coz of fracture (dd)
106. Nitous oxide contra - Nasal congestion, 1st tri, Head injury, Mental retar, COPD
107. .1st primary erupt at 6 to7 MNTHS
108. Most impacted tooth - Lower3rd
109. Paresthesia which fracture? Angle
110. 100% Humidity of alginate – Irrevesible, Synersis
111. About informed consent what it doesnot contain – COST
112. Max anterior common perforation where? - Mesial
113. Drugs for xerostomia - Pilocarpine cevimeline
114. Treatment of xerostomia - stop medication or modify them use of saliva subistitute
or use of hard candy sugar free
115. Atropine - Cause xerostomia, Anticholenrgic
116. Cholinergic - Inc secretion, Miosis, Reduce bp, Inc gastric motility
117. Antichoinergic - Atropine, glycopyrrate, propanthaline, scopalmine
118. Antidepressant – Tca, Moa inhibiters
119. Read about gracy and universal curette, also about specificity ,sensitivity
calculation.
120. Collimination function - Reduce x ray exposure, lead
121. Whitexray pics cause - Not enough developing
122. Chin up pic - Reverse smile – frown
123. Implant q one is temp - 47- less than 1 mint
124. Other was about antirotational element - Hex either external or internal
125. About hue, Color, Index100, Hue selected first
126. What u select 1st hue chorma value? HUE
127. What you cant change hue chorma value
128. h2 blocker ranitidine - TRUE
129. Sulfynoyl urea moa - Stimulate insulin by acting on beta cell
130. Moa of sodium hypochlorite, Irrigation..5.25% ,removes organic debris,
antimicrobial
131. Sodium hypochlorite is not chelating - T
132. Most radioresistance - Muscle and nerve
133. Verrucose leukoplakia-site - Buccal mucosa
134. Terfenadine -- erythro contraindicated (T...Terfenamide (sedane) c.i for
erythromycin)
Ana Karina Perez RQs
1. Patient hip prosthesis with a strok a year ago you give prophylaxis or call to the doctor
- No need to prophylaxy in both situation
2. First symptom of Adrenal gland dysfunction? joint pain and pigmentation
3. Sialolith in which gland? – submandibular
4. Erythroplakia (erythroplasia)1. High-risk, idiopathic red patch of mucosa. 2. Most
represent dysplasia or malignancy. 3. Biopsy mandatory. Much less common than
idiopathic leukoplakia. Cause unknown (idiopathic), some are tobacco related
Usually occurs between 50 and 70 years old. High-risk sites: floor of mouth, tongue,
retromolar area. Microscopy: Mild to moderate dysplasia (10%) Severe
dysplasia/carcinoma in situ (40%) Squamous cell carcinoma (50%)
5. Multiple myel. resemble to? idiopathic histiocytosis, both have punched out
appreance
6. Neuropraxia? Neuropraxia is a type of peripheral nerve injury, and is known as the
mildest form of nerve injury. It is classified as a transient conduction block of motor or
sensory function without nerve degeneration, although loss of motor function is the
most common finding.
7. Advantage of auto cure composite - No light needed
8. What happen when you move when take a pano – Distortion due to patient
movement: a. Movement in the same direction as the beam. There is prolonged
exposure of the same area, with increase in horizontal dimension of the image. b.
Movement in the opposite direction as the beam. The horizontal dimension of the
image in the region is decreased. (In the option was distortion below and too I think is
below)
9. Dif between luz led and halogen - No heat - no fan - so light weight, requires less
power- so battery - so portable. No retinal damage
10. Open coil between two teeth how is the force: Continuous or intermittent - coil give
continius force not decrese like elastic ... coil still active all time
11. Concusion - No treatment. Tooth is neither displaced nor loose but respond to
percussion
12. Best cement for veneer – resin cements (light cure)
13. Men with 54 years old with post cross bite best tto: expansion with appliance, surgery
or do nothing - Surgery its same q in first aid
14. Complex odontoma and compound odontoma - Compound—ant Complex—post
15. I had a question of ginkgo biloa – Anticoagulant, Not given with aspirin and warfarine,
and used as periphral artery vasodialator.
16. Demensia i had 2 q about this - Alzheimer's- short term memory loss – dementia
17. Patient inject local anesthesia iv what happen - Cns excitation, 1st sign of lydo
toxicity: ligtheadedness, dizziness, visual and auditory disturbances, disorientation,
muscle twiching, convulsions. 1st sign from epineprine: elevated pulse rate
(symphatomimetic) followed by CNS depression.
18. Limit amount of exposure more in which? digital imaging
19. Function of conector major: Stability and rigidity
20. Patient white 50 years old have little caries what do you put: flúor, composic, glass
ionome
21. Newly erupted tooth ehat tests for vitality – Cold
22. If the patient had good behavior before what do you do: tell show do or give a gift -
Positive reinforcement
23. What is your name when you attend a nervous patient and compare it with the good
behavior of the patient who are attend it - I think the q meant about modeling
(observational learning )
24. Común tooth with caries - Mand 1 molar
25. Común tooth with fracture - Mand 1 molar
26. Común tooth with periodontist - Max second molar
27. Reduction of porcelain - 2 mm for both metal and porcelain .5 mm for metal and 1 to
1.5 for porcelain
28. Interaction of amoxicilin with methotrexate - Yes, prolong the action of methotrexate
29. Tto of acute manic episode – Lithium
30. Tto for recession - Lateral repositioned flap (pedicle graft) in small recession area, for
large recession area I think we do free gingival graft
31. Phonetic problem associated with f, v - Ant Teeth place too far anteriorly and superior
32. Which test is used to differentiate between endo and perio lesion - Both vitality and
percussion test, ept (dd 2 cards mention that)
33. Which is worse to lose the first molar inf or a second molar in inf - Second molar
34. Most rigid impression material – Polyether
35. Highest chance of pulp necrosis – avulsion
36. Advantage of compound impression - Good detail
37. What can we use for sedation for a pregnant breat feeding woman – Promathazine
38. How Do you do better cleaning with ultrasonic with a thin point or more vibration -
Moooore vibration
39. Tto to ranula – Marsupilization, Excision along with gland as per new dd
40. Which gland ranula – Sublingual
41. Tto to sialolith - Conservative tt is saliva stimulants or for larger surgical
42. Which study doesn't show cause and effect - Crosssectional (case control shows
cause and effect..cross sectional doesn’t)
43. To what space go the tooth of 3 molar inf when yo found extraction - Retro
pharyngeal
44. Pka has effect on what – Onset, onset, with low pka will have faster onset of action
45. Multiple odontoma in which syndrome - Gardner syn
46. Patient with bizarre behavior and disorientation you give what – Glucose
47. Tto to ADHD - amphetamine was in the option (amphetamine was in the option)
48. What do you do in a patient with autism - Use muffler on handpiece to reduce sound,
give instructions one at a time, slowly - patient is Noise sensitive.
49. What cyst in roots of mandibular premolar - Lateral periodontal cyst
50. What is the complication of maxillary molar extractions - Sinus perforation
51. What is easily curable ; hematoma or macule ?
52. Nadal obstruction what sedation you can't give - Nitrous oxide
53. Tto concusion - no need
54. Features of arrested caries – hard, eburnated , black brown
55. Lefort 3 - Separation from cranial base
56. Which surgery for open bite - Lefort 1
57. Serpentile feature - migratory glossitis
58. Which study FDA do to check drugs - Clinical trial
59. Patient said I don't wanna smoking , behavior shaping - Contemplation , when patient
is ready to change negative behavior (smoking) , precontemplation when individual
is not considering in changing this behavior
60. Cleft lip and palate at what month - As average for both, 6-8wks
61. Bucal limitation in mand denture – Masseter (buccal vestibule is buccinator and
distobuccal is masseter)
62. Ideal test for kidney function - Protein creatinine ratio and blood urea nitrogen
63. Reversal acetilcolina – Physostigmine
64. Nerve affected when there is a damage on the uvula - option cnV, VII, IX, X, XII
(vagus)
65. Ancillary freckling seen in – Nurofibromatosis
66. Radiographic is too light why - Underdeveloped, depleted delevoper,temp too cool
67. 3 mm lack of mand arch how you treat - Interdental striping
68. Smokeless tabacco cause what - Verrucous carcinoma
69. Lefort 1 include what structure - Pterygoid maxillary, Palate- greater palatine artery
ecchymosis - guerins sign
70. Lefort 3 include what structure - Complete separation of midface at level Naso-
orbital-ethmoid complex and zygomaticofrontal suture area. Fracture extends
through orbits bilaterally.
71. Anug resemble what - Primary herptic gingivostomatitis
72. When do you do elective rct - Not enough crown structure
73. What % in community water fluoridation: 0,7-1,2 or 0,5 -1
74. Best bone for implant - D1 - mand anterior
75. Fearful patient how you do respond
76. There is a small white stain: amelogesesis imperfecta, for flour , dentinogenesis
imperfect - Enamel hypoplasia
77. A little Pigment on the gingiva if for melanin, smoking a lot of question on day 2 of
pigmentation and xerostomia
78. Patient of class 2 div 2 – picture
79. Picture of osteosarcoma - Sun ray pattern
80. Reversal benzodiazepines – Flumenazil
81. A lot question about flap don't remember the question
82. Hypides in pano
83. Best rx for interproximal caries - Bitewing , and digital is best
84. Q about protein morphogenetic - BMP- present in auto genous grafts - has progenitor
cells -- help in forming new bone
85. Most común seizure: gran mal or febrile - Grand mal, febrile for kids
86. Which antibiotic work on gingiva? azithromycin
87. automated defibrilator, how does it work? a- monophase function b-2 shocks c-
contraindicated below 12 year old d- discharge when needed
88. which bacteria causes elastenase, collagenase? gingivalis
89. 15 year old has fever, malaise, vesicles, lymphadenopathy? acute herpetic
gingivostomatis
90. Necrotisizing sialometaplasia - Most common in palate, Resembles scc, usually occurs
due to anesthesia with adrenaline, Minor salivary gland
91. Porosity in pfm?
92. Cancer of salivary glands and which one has perineurial invasion - adenoid cystic ca-
swiss cheese; perineural invasion - Adenoid cystic carcinoma (ACC) is an uncommon
form of malignant neoplasm that arises within secretory glands, most commonly the
major and minor salivary glands of the head and neck.
93. Fracture also with paresthesia / angle of mandible, BODY
94. Xesrostomia and normal flow rate
95. osteoradionecorosis/hyperbaric oxygen
96. Lateral periodontal abscess is best differentiated from the acute apical abscess by =
pulp test
97. What will not regenerate after rct = dentin formation
98. 3 partner dentist and hygienist hurts patient who involved in a low suit = only dentist
supervising dentist and hygienist
99. How long after extraction you insert the complete denture = 8 weeks
100. Which one is more affect in male = hemophilia
101. Where does the epithelial for a graft come from = donor connective tissue
102. Macroglossia not found in: A)hypothyroidism B)hyperparathiroidism*
103. Radiographic image of (painless lesion, bone expansion) A)fibrous displasia (there
was ground glass appearance to identify)*
104. Most supernumerary located in the: ant max.*
105. Cleidocraniodysplasia - supernumerary*
106. Plasma cell disorders multiple myeloma*
107. Which situation least require insulin A)trauma*
108. Herpangina - enterovirus* (coxsackie A)
109. Material least resistant - high leucite*
110. Which anethetic without vasoconstrictor is best to use - mepivacaine*
111. Do not use in myasthenia gravis A)erythromicine B)peniciline C) imipinem*
112. Broadest spectrum antibiotics - pen g procaine*
113. most common found A)odontoma*
114. Smoothest cutting but not efficient: carbide bur
115. Nitrous oxide side effect: nausea
116. Pt with many sinus fistula: actinomycosis
117. Wheezing during expiration: asthma
118. Where do u prefer GA? Ext of 2 yrs old
119. Pt came with abscess. What u will do first? Incision and drainage
120. Anterior guidance: both horizontal and vertical
121. Wear facet in primary dentition why? Don't remember options (one was habit)
122. Garre osteomyelitis- onion skin
123. Chronic osteomyelitis- moth eaten
124. Scleroderma- purse string mouth + extrusing teeth
125. Von recklinghausen- Cafe au lait spots; lisch spots on iris; crowe sign= axillary
freckles
126. Fibrous dysplasia- ground glass
127. Pagets dis- cotton wool
128. Cherubism- bilateral; soap bubble ; perivascular cuffing
129. Multiple myeloma- punched out
130. How many percent have access to fl community water? 80 is the ans
131. MOA of sulfanamid - inhibit PABA required for folic acid synthesis - inhibit folic acid
synthesis by inhibiting dyhydrofolate reductase by competeting with PABA
132. MAO of sulfonylurea - Stimulates insulin production from beta cells and increase
sensitivity to insulin
133. Which one is class 2? Percocet is the ans
134. INR - extrinsic pathway ans
135. Which is correct about conjugation? adding a molecule to the drug ans
136. Which of these cognitive behavior decrease in a normal process of aging? learning
I think is answ
Today's Rq's
1. What happens when you change from 8’’ to 16’’? 4 times
2. Stages of AIDS and no. of Leukocyte count.
3. Treacher Collin Syndrome - Treacher Collins syndrome, autosomal dominant syndrome

caused by mutation of TCOF1. Coloboma is part of a set of characteristic facies that
features craniofacial malformations, such as downslanting eyes, ear anomalies, or
hypoplasia of zigomatic bone and jaw (micrognathia). Defect in all 1st pharyngeal
pouch derivatives, Malformed ear, mandibular hypoplasia, hypoplasia zygomatic
bone.
4. Ectodermal dysplasia - Lack of sweat glands, oligodontia or anodontia, concave nasal
bridge. X-linked recessive condition that
results in partial or complete anodontia. 2.
Patients also have hypoplasia of other
ectodermal structures, including hair, sweat
glands, and nails.
5. What is the key factor for a denture to be
successful? fabrication design, stability
6. 4 yrs old child – fluoride supplement? 0.25 mg if
water fluoride concentration is 0.3-0.6ppm
and 0.50mg if water fluoride concentration is
less than 0.3ppm
7. Infection stage of syphilis? - Secondary stage
8. Optimum treatment for palatal papillary
hyperplasia? a) Radical dissection
b) Electrosurgery
9. 3 canals- which premolar? 1st PM max
10. Triangular canal central incisor- why? To expose pulp horns
11. Angles Class II- chances of trauma the most - True class II div 1
12. Most broad spectrum antibiotic? Tetracycline and chloramphenicol
13. Angioedema not caused by which drug? Ace inhibitors, angiotensin receptor
blockers, nsaids, penicillins and quinolones CAUSE angioedema. So the answer would
be any other than these classes
14. Dens in dente: Mostly in maxillary laterals
15. SLOB rule - Same lingual, Opposite buccal
16. Most difficult to floss where? Mesial aspect of max PM1
17. Dental clicking- increased VDO, also if porcelain teeth are used in dentures.
18. Function of rest. - provide vertical support for RPD and resist vertical forces for
occlusion
19. Question on function of axial guidance - Axial guidance can be done using guiding
planes in the surveyor used for single path of insertion
20. Horizontal axis of condyle. - rotation movement of mandible
21. As teeth ages, what increases? Hue / chroma - Hue unchanged, chroma increases
and value decreases.
22. Patient wakes up in the morning with sore pain in muscles? Bruxism/Sinusitis
23. Difference between 245 and 330 bur. - Length of them 245=3mm / 330=1.5mm - 245 is
longer
24. Prostaglandin analogue? Lantanoprost, treatment for glaucoma
25. Aspirin and Yinseng? What happens if given together – no, bleeding induces
26. Filtration used in X-ray machines - Lead is used for "collimation". Aluminium for
"filtration"
27. Thompton effect? It must be Compton effect which is increase in wavelength of x rays
or gamma rays.
28. Flouride water level? 0.7-1.2ppm
29. Inner and outer line angles.
30. Angioedema - Acquired angioedema is a specific type of allergic reaction. a.
Precipitated by drugs or food (shell sh, nuts). b. Mediated by mast cell release of
IgE. c. Results in characteristic soft, diffuse swelling of lips, neck, or face. d.Hereditary
angioedema is a rare form that is an autosomal dominant trait. Acquired
angioedema is a rapidly developing allergic reaction that results in characteristic
nonerythematous swelling of lips, face, and neck.
31. Diphenhydramine- anti motion sicknes, Benedryl even given when pt is allergic to
both amide and esters, Anti histamine , anti cholinergic , sedation
32. Difference between snuff dipper and nicotina stomatitis - nicotinic stomatitis lesion
seen on palate due to smoking. Snuf dipper lesion seen on buccal side and it is
mainly due to smokeless tobacco. Snuff--- dysplastic , premalignant Nicotinic --- non
malignant
33. Pt. sitting with folded arms and legs shaking. What do you say to him? What brought
you here
34. Most commom reason for pt. to have a negative attitude for dental treatment.a)
Own dental experience b) Heard from peer/friends
35. Clinical test for Rheumatoid arthritis? Clinical test - watch toes and fingers - they
become crooked --- something like that --- skeletal deformity.
36. Sjogrens syndrome is associated with? Lymphoma? True
37. Reasons for eruption failure. - Ankylosis,primary eruption failure, impaction, down
syndrome etc
38. Critical pH for demineralization of dentin? 5.5 (enamel 5.5- dentin 6.2)
39. Situtaions for temporary restoration. - incomplete root.,,deep caries approaching pulp
40.Reciprocal anchorage. - Elastics to close diastema
41. Diabetes in children can lead to? Blindness
42. B.P. 160/140. Pulse 90. What do you do? Repeat after 15 mins/ call the physician
immediately
43. What happens when you increase water in gypsum. - Decrease strength increase
setting time, decrease expansion increase porosity.
44. LAP t/t: Tetracycline 250mg thrice for 14 days ---- severe cases--- metronidazole and
penicillin, Sc/Rp and antibiotics
45. Area of least attached gingival? Which tooth - Mand 1st pm
46. How to check clinically for the prognosis of PDL attachment. – Probing
47. Pt. with alcohol abuse? What to check in lab report before extraction? Blood alcohol
level – INR
48. Pain on eating sweet- reversible pulpitis
49. Ossifying fibroma - A. Ossifying fibroma. 1. Common fibro-osseous lesion. Can be
considered similar or identical to cementifying broma, although some may reach
considerable size. Clinical features. Radiographically appears as either a well-
circumscribed lucency or a lucency with opaque foci. Seen in adults and young
adults, typically in the body of the mandible. A variant known as juvenile ossifying
fibroma occurs in younger patients and may exhibit an aggressive course.
Microscopically composed of fibroblastic stroma in which new bony islands or
trabeculae are formed. 5. Treatment—curettage or excision; recurrences rare.
50. Pt receive blow to eye orbital floor less common t/f
51. In Facebow transfers relation of arches? - In centric
52. Epinephrine action on which receptor in epinephrine reversal? Epinephrine has effect
on both alpha and beta.....but epinephrine reversal is due to beta receptor
stimulation. - Epinephrine action on Beta receptor in presence of alpha blocker
causes Epinephrine reversa
53. Initiator in heat cured resin – light cured = diketone photoinitiator (camphoroquinone),
self-cure = benzoyl peroxide.
54. Cause of brown discoloration of gingival margin of resin restoration – microleakage
55. Skewed distribution - Negative and positive.. bimodal distribution
56. Cimentidine function - Cimetidine is a drug that blocks the production of acid by
acid-producing cells in the stomach.
57. Topical antibiotic in perio – doxicicline
58. Child with multiple caries - give GA
59. Least congenital missing tooth - Max canine
60. Gingseng contra with aspirin
61. Major connector function: rigidity nd stability
62. incisal position during record – Midline of incisal part of upper incisors
63. First pass metabolism - Enterohepatic circulation (ORAL DRUGS)
64. Other rq Polymerization shrinkage In composite depends upon? Adhesive bond Filler
content Elastic modulus All - DD: Fillers are placed in dental composites to reduce
shrinkage on curing.
65. Pulpitis 5 days after class ll composite is due to - Increase occlusal contact
Microleakage Undercured composite
66. Which sound during wax try in – Sibilant – s and z
67. Least occurrence cyst - Lateral Periodontal Cyst
68. young female pt with vital tooth canine features with AOT
69. Ortho tipping before of veneering before? – before
70. Most imp feature of single implant – Antirotational
71. Drug biotransformation - Excretion of drug..by passing through
72. White rough peduncalted lesion on palate? papilloma or fibroma
73. Primary and secondary stress bearing areas in maxilla - Primary - Residual alveolar
ridge, Secondary – Rugae
74. Primary and secondary stress bearing areas in mandible - Primary Buccal shelf,
Secondary – residual alveolar ridge
75. Best area for successful implant - ant mandible
76. Reason for image distortion
77. Reason for light radiograph - Low Kvp, Ma and exhausted developer and overfixing
78. Pedicle graft - excellent esthetic, less chance of failure, good vascularization and
single recision.
79. Epi of free gingival graft – Donor epith
80. Gingivectomy indication - Gingival hyperplasia.. abnormal growth.. pseudopockets
present, SUPRABONY POCKETS.
81. Gingivectomy contraindication - Infrabony defect
82. Clotrimazole which form torche
83. Topical antifungal - Nystatin and clotrimazole
84. Dentist did wrong treatment and didnt tell pt ... whats that term - violating Verasity
85. Disc movement first it moves 25 mm click is hear than 5 mm. so what side it goes in 5
mm - Ant to normal
86. Tooth size and morphology in which stage of tooth development - Bells stage
87. Mandibular denture position in relation to tongue – Below
88. Unbunding - dentist seperating treatment charges which actually can be counted as
single procedure.
89. Lateral surface of tongue asymptomatic blue lesion in old pt since 5 yrs hemangioma
or varicosities (because of age)
90. Lactating mother sedation drug – Promethazine
91. Fever in children drug of choice – Tylenol, acetaminophen
90. Nephrotoxicity by which drug - Aminoglycoside
91. Reduced insulin dose in what – IV sedation
92. Wheel chair transfer – Sliding
93. Desquamative gingivitis - in pemphigoid , pemphigus, and lichen planus also
94. Antibiotic and surgery is treatment for what lap or anug? Antibiotic-lap, Surgery-
ANUG
95. Herpes peak age - 2-5 years
96. Difference between affected and infected dentin - infected always need to be
removed.
97. Movement for recording buccal frenal area of mandible - Upward and outward
98. Opioid allergy – IRRITATION, Itching, flushing, hives and dec bp
99. Pain killer in renal disease – Oxycodone
100. Cocaine – mydraisis
101. BDZ antagonist – Flumazenil
102. Neurofibromatosis - Cafe au lauts spots, axillary freckling and lisch nodules
103. Direct retainer uses? Retention.
TANYA’s RQs (September 20, 2017)

1. Two questions about mandibular plane angle
2. Mandibular plane angle in class 3- steep or flat (cl3 flat cl2 steep)
3. A steep mandibular plane angle predisponate a person to --- and a flat mandibular
plane angle predisponate a person to ---? long face, short face
4. Class 2 malocclusion A- increase mandibular plane angle B- decrease mandibular
plane angle
5. Which of the following correlate with a steep mandibular plane? Select all that apply
1. Long ant facial vertical dimension
2.greater maxillary- mandibular plane angle
3. Ant open bite 4. All
6. Anterior incisal guide table
7. Reason for Incisive guide table?. Anterior guidance
8. Purpose of incisal guidance, mount casts..? adjust condylar guidance .. begin prep
9. Least strength of ceramic crowns - options - pressed leucite ceramic (strong porcelain
is glass infiltrated alumina.)
10. Most important cause of ceramic crown fracture is due to - options were all lab
procedures like firing, condensation - Inadequate framework/insufficient reduction of
tooth, Yes low temperature in degassing, will affect the bond and more prone to
fracture card 141 pros. Insufficient temperature or insufficient time
11. Floss and brushing dexterity
12. Patient has problem with manual dexterity what will he have problem with?
A) floss B) Brushing C) both - why not both?? because the pt can use an electric
toothbrush
13. Perforation of root canal which is difficult 3mm apical to gingival sulcus (CORONAL
THIRD), 3mm coronal to gingival sulcus, apical 3rd,middle 3rd?
14. Behavior studies by which author? Freud - Freud theory is that the unconscious mind
governs behavior to a greater degree than people suspect. Indeed, the goal of
psychoanalysis is to make the unconscious conscious
15. Few questions about anxiety
16. Pt try to hide fear and anxiety, what we look for to understand it: Micro expression
17. More difficult to handle: Fear - Anxiety
18. Elderly person physically abused whom should u report? Human Health services
19. Kid abuse whom should u report? Social service – In pt management of dental decks,
it says it depends by the state - "Once abuse is suspected against a child, elderly, or
disabled pt, it must be reported to the appropriate agency (of the state)
20. Border molding impression compound and one question was about its thermoplastic
property.
21. What is the primary indicator of accuracy of a border molding on a custom
impression tray? stability, retention - Satbility and lack of displacement in card 1 pros ,
so i think both if in one option
22. Ability of impression compound to be adjusted due to which property? Thermoplastic
23. Polyether imp comp - sticks to teeth
24. Which of the following imp material will distorts the least when it store for 24 hrs before
puring: silicon imp material, polyether imp material - pVS/ Silicon, its most
dimensionaly stable.
25. Cheek biting in complete denture caused by – Absence of buccal horizontal overlap
26. Null hypothesis - Null hypothesis tested in chi test - T
27. P value in null hypothesis above 0.5 means is: statistical insignificant case control study
- If the observed probability is less than or equal to .05 (5%), the null hypothesis is
rejected (i.e., the observed outcome is judged to be incompatible with the notion of
“no difference” or “no effect”), and the alternative hypothesis is adopted. In this case,
the results are said to be “statistically significant.” If the observed probability is greater
than 0.05 (5%), the decision is to accept the null hypothesis, and the results are called
“not statistically significant” or simply NS—the notation o en used in tables.
28. Purpose of statistical tests in clinical trials is: A) to establish validity B) to find alpha
value
C) to reject null hypothesis D) to test specificity of experiment
29. Randomised control trial
30. Which if the following has problem in recall bias:- a. Cohort study b. Cross sectional
study c. Randomised control study d. Case control study
31. WHich case study used in rare(Odd) disease investigation?? Case cOntrOl
32. Apically positioned flap
33. The most predictable for treatment of perio disease?1. Scaling & root planing
2. The modified Widman flap 3. Free gingival flap 4. Apically positioned flap
34. Whats the problem if you wanna perform apically positioned flap surgery in th mand
second and third molar? external obligue bridge
35. Curette angulation
36. If correct angulation is present when working with a universal curette then ...? the
lower shank is parallel to the tooth surface
37. Three q's about perio maintanence therapy steps and prognosis was so confusing
38. Anug
39. Antibiotic for ANUG ? Pencillin V (DD)
40. ANUG mouth rinse? Chlorohexiden, Hydrogen peroxide (DD)
41. Anug is usually accompanied by metallic taste...T or F
42. Squamous cellular carcinoma initial lesion picture
43. Pierre robin syndrome features
44. Patients with pierre-robin syndrome will have? mandibular retrogranthia - cleft palate,
mandiblar retrognathia ,glossoptosis
45. Pierre Robin syndrome is associated with 1. Glossoptosis 2. Cleft palate 3. Respiratory
problems 4.all of the above 5. A and B
46. Which disease does not cause cancer: HIV, HPV, I don’t remember the other options
47. Allergy a lidocaine anesthetic
48. Which pair of anesthetics is most likely to cause cross allergy? 1. Lidocaine and
mepivocaine = T
49. Chroma
50. With age what increase hue value chroma!! - Chroma increases, value dec and hue
unchang
51. Hue
What should be selected first when picking a shade? hue (DD) - First pick HUE and VALUE
is considered THE MOST IMPORT in shade selection.
52. Value
53. Erosion due to acidic foods and drinks is usually found on the cervical ______ portion of
the tooth - facial
54. Facial portions = 3 VER-TI-CAL, 5 HORIZONTAL
55. Free space
56. Free way space? 2 – 3 mm
57. Free way space when at physical rest T/F
58. Open bite or increased free way space = decreased bitting force T/F
59. Phonetics
60. When do you check phonetics for a CD? Wax try in, Tooth try in – DD#20 PROST
61. During try-in of CD, which phonetics is used: Labio-dental, Linguo-dental, Linguo-
alveolar, B m p sounds
62. Radioresistant cells – NERVE, MUSCLE
63. Radiosensitive cells - Bone marrow lymphocytes, basal epithelial, small lymphocyte
64. Which are the most radiosensitive cells in the human body? Basal epithelial cell,
Endothelial cell, Salivary gland acinar cell, Nerve cell, Erythrocyte
65. Radiographic errors
66. Most important characteristic for choosing major connector- Stability & rigidity
67. Histogram shows- Variance – It is an estimate of the probability distribution of a
continuous variable (quantitative variable)
68. Hazard communication standard was prepared by- OSHA
69. Pedal edema, dyspnea, orthopnea are signs of- CHF
70. A dentist cannot do what to correct the small discrepancies- manipulate the cement-
water ratio.
71. Dexterity comes by what age? 6-8, mean 7yrs
72. Dexterity comes by what age? A.3-4 years B.1-2 years C.5-6 years D.7-8 years
73. Most common complication of N2O - bronchospasm was what I marked (nausea,
vomiting and peripheral neuropathy was not in option)
74. Most complication of nitrous oxide: vomiting, behavioral problem, (nausea was not an
option) – DD: the most common complication associated with nitrous oxide sedation is
a behavioral problem (laughing, giddy). Most common adverse effect: nausea and
vomiting. Headache and disorientation can be avoided by administrating 100%
oxygen after nitrous oxide has been discontinued.
75. Best bone for implant- d1, d2, d3, d4
76. Question on sensitivity, specificity, (definition)
77. A diagnostic test that correctly identifies 20% of screened patients as being dx free
has low: Sensitivity, Specificity, Precision – sensitivity is defined as the percent of
persons with the disease who are correctly classified as having the disease (those who
have the disease). Specificity is defined as the percent of persons without the disease
who are correctly classified as not having the disease (those who do not have the
disease).
78. What does identify persons with the disease? Sensitivity, Specificity
79. What causes varices on the tongue? Age
80. Lady presents with blue swelling under tongue? I put ranula
81. Picture said: “erythematous, bleeding swelling” mandibular swelling right next to
premolars on R side? I put pyogenic granuloma - T
82. Patient with diabetes which finding is not consistent? increase collagenase in
crevicular fluid, increase glucose in crevicular fluid, increase gram negative in
crevicular fluid, decrease in thickness of basilar lamina of blood vessels in
periodontium.
83. Most common reason for failure of dental amalgam? moisture contamination,
improper prep design- not enough depth, improper titrutration, improper
condensation - In card 7 operative said most coz failure is moisture, and improper
preparation and not enough depth is reason o fracture, card 120 oprative
84. Crouzons
85. Pt has cranial dysostosis, midface deficiency, hypertelorism and beaten metal
appearnce? a. Crouzons b. Treacher Collins
86. Automatic defibrillator
87. Automated defibrillator expander is used in: cardiac arrest, both kids and adults.
88. Papoose Board
89. 8 years old parent with negative behavior, you use for immobilize extremities: Papoose
board
90. Most convergence in which primary tooth – mandibular 1st molar
91. Least antiplatelet NSAID - celecoxib
92. 4 to 5 questions on implant you should know all implant distance - Distal between 2
implants 3 mm, From IAN 2 mm, From mental 5 mm, Tooth and implants 1.5
93. A lot about endodontics some were very basic questions
94. Plaque ph - so least than 5.5
95. Distolingual what is the best filling material - amalgam (DD)
96. Conical shape what caries?
97. The conical shape of pits and fissures caries shows: A. Two
triangles pointing toward the pulp B. Two triangles pointing
toward the occlusal surface C. Two triangles with their
bases on the DEJ D. Two triangles with their apices on the
DEJ
98. Transillumination
99. Which will show up on transillumination best? Craze line
100. Cracked tooth
101. Patient comes back few months after RCT & Crown
with pain upon biting, what happened...cracked tooth
102. Crack tooth syndrome is most likely found? Mandibular 1st molar
103. Neuropraxia: This type of injury is characterized by a segmental block of the
conduction of the nerve action potential caused by structural damage to the myelin
sheath. The axon and connective tissues including endoneurium, perineurium, and
epineurium are not affected.
104. Neuropraxia: involves both perineurium and epineurium, only perineurium, only
epineurium, none of the above
105. Neuropraxia reversible or irreversible? Reversible
106. Which salivary gland tumors is associated with neuropraxia (nerve damage):
A.Mucoepidemoid carcinoma B. adenoid cystic carcinoma(ACC) C.Acinic cell
carcinoma - adenoid cystic ca has tendency to invade surrounding nerve fibers--
perineural invasion
107. Which of the following glucocorticoids is the strongest? Dexa, Corticoid,
Hydrocortisone
108. Disinfectant for dental chair (min) cavicide?
109. Le fort 1 fracture à Maxillary sinus
110. Maxillary sinus fracture mostly with: Le fort I
111. Collimation does everything except –reduce pt exposure, reduce operator
exposure, film fog, reduce average energy of x-rays
112. The Dentist completes exam and advises x-rays but the pt refuses. What should
the dentist immediately do? When a patient refuses to have dental radiographs, the
dentist must decide whether diagnosis and treatment can take place without the
recommended radiographs. No document can be signed by the patient that
releases the dentist from liability.
113. What is true of osteoradionecrosis.
114. Damage to the blood vessels as oppose to (nerve, muscles) predisposes a
patient to develop osteoradionecrosis. true or false
115. Osteoradionecrosis can be differentiated from osteomyelitis as:
a. Osteoradionecrosis show periosteal reaction
b. Osteoradionecrosis does not show periosteal reaction
c. Cannot be differentiated on basis of periosteal reaction as both show it
d. Cannot be differentiated on basis of periosteal reaction, as both do not show it.
116. X-ray identification: - Median Palatal Suture, Zygomatic process of maxilla, Dorsal
Surface of tongue, Odontoma – RL, RO, RL, RO
117. The severity of response increases with the amount of X-ray exposure. This effect
is called. Deterministic, Stochastic, Genetic
118. Most common recurrent cyst : okc
119. xray for annuerysm cyst - CT or MRI
120. Secondary herpes site - Genitals is HSV 2 for HSV 1 its lips
121. Concentration of apf flouride gel - 1.23% - Since the early 1960s, acidulated
phosphate fluoride (APF) has become the most widely used fluoride compound for
professional application. APF has a pH of about 3.0 and was developed after
experimental work showed that the topical uptake of fluoride by enamel was greater
in an acidic environment. The agent has been tested in several concentrations, the
most common being 1.23% fluoride, usually as NaF, in orthophosphoric acid.
122. Orange stain is important to change chroma or hue? hue
123. Cleft palate prevalence: Palate 1:2000 – The incidence of cleft lip with or without
cleft palate occurs in 1 in 700 – 1000 births (DD), together 1:700 (most prevalence)
124. Retained primary teeth is characteristic for both cleidocranial dysplasia and
ectodermal dysplasia - T/F
125. Multiple supernumerary teeth are most commonly found in A. cherubism. B.
cretinism. C. hypothyroidism. D. cleidocranial dysplasia
126. Cleidocranial dysplasia = supernumeraries
127. Hypothyroidism clinical signs - Cold to touch, thinning of hair, delayed eruption of
permanent
128. Acromegaly clinical signs - Mand prognathism
129. What is called when u do not take patient consent ?? assault ,
nonmaleffi, battery
130. Which bur is used for the crown cutting? 169
131. Which forceps is used for mandibular premolar extraction?? 151
132. Behcets syndrome is associated with ? aphthous ulcers
133. I got three ortho cases, one squamous cell carcinoma
134. Altered cast
135. Altered cast technique? Support
136. Gracey’s curette no. 13 and 14 used for? Distal surface – 1-4 ant, 5-6 ant and
pm, 7-8 post, 11-12 post mesial, 13-14 post dista.
137. After a gingivectomy how does the site heal? a. from the epithelium of the
pockets b. epithelium of the adjacent alveolar mucosa c. endothelium of the blood
vessels
d. primary intention
138. The gingivectomy approach to pocket elimination results in A. healing by
primary intention. B. adequate access to correct irregular osseous contours. C.
retention of all or most of the attached gingiva. D. None of the above.
139. Epulis fissuratum pic
140. 2 questions were on gingivectomy
141. Gingivectomy is used to remove suprabony perio abscess T/F
142. Gingivectomy is used to remove suprabony pocket T/F
143. Pt. have denture, after 5 years he complains of ulcer and inflammation in lower
buccal vestibule. What is the diagnosis: 1/Hypertrophic frenum. 2/ Epulis fissuratum
144. Epulis fissuratum should not be removed before the fabrication of new denture
T/F
145. What is the cause of epulis fissuratum a. unstable denture b. under extention c.
over extention d. traumatic occlusion – DD: The cleft-like kesions of epulis fissuratum
result primarily from overextension of denture flanges. The overextension may result
from long-term neglected or settling subsequent to residual ridge resorption.
Traumatic occlusion of natural teeth opposing an artificial denture may also cause
this condition.
146. Denture stomatitis: localized or generalized chronic inflammation of the denture
bearing mucosa. Clinically, there is redness and a burning sensation. There may be or
may not be discomfort. Trauma and secondary fungal infection appear to be the
most likely cause of denture stomatitis. Treatment: 1. Improved oral hygiene 2. Tissue
rest 3. Antifungal therapy (nystatin) 4. Resilient conditioners 5. New, well-fitting
dentures.
HOW TO DIFFERENTIATE ENDODONTIC AND PERIODONTAL ABSCESS:

DRY SOCKET:
Thought to develop because of increased fibrinolytic activity causing accelerated
lysis of the blood clot. It is most common following extraction of the mandibular
molars. Smoking, premature mouth rinsing, hot liquids, surgical trauma, and oral
contraceptives all have been implicated in the development of a dry socket. Careful
technique and minimal trauma reduce the frequency of patients developing dry
socket. The patient develops severe, dull, throbbing pain 2 to 4 days after a tooth
extraction. The pain is often excruciating, may radiate to the ear, and is not relieved
by oral analgesics.
TREATMENT OF DRY SOCKET:
- Flush out debris with slightly warmed saline solution – gently
- Place a sedative dressing in socket (eugenol). The dressing should be removed within
48 hours and replaced until the patient becomes asymptomatic. (1. The gauze
provides an attachment for the obtundent paste so it stays in the socket 2. Eugenol is
the active component in most sedative dressings)
- Nonsteroidal anti-inflamatory analgesics should be prescribed if necessary /
ANTIBIOTICS ARE GENERALLY NOT INDICATED.
Dry socket is the most common complication seen after the surgical removal of a
MANDIBULAR MOLAR. Curetting a dry socket can cause the condition to worsen
because healing will be further delayed, any natural healing already taking place will
be destroyed, and there is a risk of causing the localized inflammatory process to be
spread to the adjacent sound bone. Can occur in 3%of mandibular third molar
extractions. Will heal with irrigation and local treatment for pain control.
FLUORIDE
- [ SOME IMPORTANT FLUORIDE DOSAGE FACTS ]
- 1. Estimated Toxic Dose--> 5 to 10 mg/kg
- 2. Estimated Lethal Dose (Adults)--> 2.5 to 5.0 gm (F- alone) & 5 to 10 gm (for F- in
NaF)
- 3. Estimated Lethal dose (kids)--> 500mg (for <3yrs) &
- 16mg/kg (for >3yrs)
- 4. Water fluoridation--> 0.7 ppm [ADA]
- 5. Water Fluoridation range--> 0.7 to 1.2 ppm [ADA]
- 6. Skeletal fluorosis starts at--> 3 ppm (chronic use of F-)
- 7. Dental fluorosis starts at--> 1ppm (chronic use of F-)
ANESTHETICS:
- Too much anesthetic in the bloodstream can cause toxicities to the CNS and
cardiovascular system.
- Toxicity: The CNS effects include restlessness, stimulation, tremors, convulsive seizures
followed by CNS depression, slowed respiration even coma. The cardiovascular
effects include bradycardia and reduction of cardiac output.
- Ester local anesthetic allergic manifestations include nasolabial swelling, itching, and
oral mucosal swelling.
- LA have NO effect on potassium at the nerve axon
LIDOCAINE TOXICITY
AMALGAM
1. Primary retention form—retention form preparation features lock or retain the
restorative material in the tooth: 1) Mechanical locking of the inserted amalgam into
surface irregularities of the preparation (even though the desired texture of the
preparation walls is smooth) to allow good adaptation of the amalgam to the tooth.
(2) Preparation of vertical walls (especially facial and lingual walls) that converge
occlusally. (3) Special retention features, such as locks, grooves, coves, slots, pins,
steps, or amalgam pins, that are placed during the final stage of tooth preparation.
2. Primary resistance form—resistance form preparation features help the restoration and
tooth resist fracturing as a result of occlusal forces. (1) Resistance features that assist in
preventing the tooth from fracturing. (a) Maintaining as much unprepared tooth
structure as possible (preserving cusps and marginal ridges). (b) Having pulpal and
gingival walls prepared perpendicular to occlusal forces, when possible. (c) Having
rounded internal preparation angles. (d) Removing unsupported or weakened tooth
structure. (e) Placing pins into the tooth as part of the final stage of tooth preparation
(note: this strategy is considered a secondary resistance form feature). (2) Resistance
form features that assist in preventing the amalgam from fracturing. (a) Adequate
thickness of amalgam (1.5 to 2 mm in areas of occlusal contact and 0.75 mm in axial
areas). (b) Marginal amalgam of 90 degrees or greater. (c) Boxlike preparation form,
which provides uniform amalgam thickness. (d) Rounded axiopulpal line angles in
class II tooth preparations.
MERCURY TOXICITY
Excessive saliva is a prominent toxic effect of mercury. The presence of mercury in the
body is determined by a urine test. Treatment may include gastric lavage with milk
and egg white or sodium bicarbonate, chelation with British anti-lewisite (BAL), and
fluid therapy. Note: British Anti-Lewisite (BAL) or Dimercaprol and penicillamine are two
drugs currently marketed for promoting the excretion of mercury, lead, and several
other agents. Mercury that is absorbed into the circulatory system may be deposited
in any tissue. Higher-than average accumulations occur in the BRAIN, LIVER and
KIDNEY. Mercury does not collect irreversibly in human tissues. There is an average
half-life of 55 days for transport through the body to the point of excretion. Thu
mercury that came into the body years ago is no longer present in the body.
SEQUENCE OF TEETH EXTRACTION

Maxilla before mandible
Distal before mesial
Start with third molar, second molar, second premolar, first premolar, lateral, central.
Finally, you extract the first molar then the canine as last teeth to be extracted.
The two teeth that are the most difficult to remove, the first molar and canine, should be
extracted last. Removal of the teeth on either side weakens the bony socket on the
mesial and distal side of these teeth, and their subsequent extraction is made more
straightforward.
Sham Sham's RQs
1) Distance between implants? 3mm

2) Hemophilia test – PTT
3) Mouthwash in children: NaF, Chlorhex (sodium fluoride used when there are caries)
4) Mouthwash given to a comprimsed child – Listerine, Chlorhex (there is over the
counter listerene for kids without alcohol - both NaF, if for disability NaF not there then
listerine)
5) Benzodiazepine moa - potentiate GABA, not inhibit. Potentiate the action of GABA –
Mosby: enhance the effect of y-aminobutyric acid (GABA) at GABAA receptors on
chloride channels; this increases chloride channel conductance in the brain (GABAA
receptors are ion channel receptors). Benzodiazepines produce their calming effects
by DEPRESSING THE LIMBIC SYSTEM & RETICULAR FORMATION through potentiation of
the central inhibitor neurotransmitter (neurons) gamma-amino-butyric acid (GABA).
Tolerance and physical dependence can occur with prolonged high dosage, but
they are much safer than barbiturates.
6) Abfraction – Mosby: Abfraction is tooth loss in the cervical area caused by
biomechanical loading. Occlusal loading resulting in tooth flexure, mechanical
microfractures, and tooth substance loss in the cervical area; may appear similar to
erosion.
7) Erosion - Mosby: Erosion (sometimes called corrosion)—usually in the cervical area of
facial surface of tooth; may be caused by acid beverages or citrus fruits. Erosion is
wear secondary to chemical presence.
8) Bucolingual space needed for 4mm implant- 8mm? 7mm was not given – 2mm on
bucal and 2 mm on lingual. So, for a 4 mm diameter implant, I need 4.0+1.9 + 1.9 = 7.8
mm. – Carranza: Assuming an implant is 4 mm in diameter and 10 mm long, the
minimal width of the jawbone needs to be 6 to 7 mm, and the minimal height should
be 10 mm (minimum of 12 mm in the posterior mandible, where an additional margin
of safety is required over the mandibular nerve). This dimension is desired to maintain
at least 1.0 to 1.5 mm of bone around all surfaces of the implant after preparation
and placement. (BL 6mm - MD 7 mm)
9) Alplrazolam: BDZ, sedative/antianxiety, medium duration of action benzodiazepine, it
Inc the frequency of opening of chloride channel in GABA receptors in the brain. It
Inc the effect of Gaba at Gaba 1.
10) Biphosphonate, there is difference between osteoradiorecrosis (with radiation
therapy) and osteonecrosis with bisphosphonate. Bronj (bispohophonate related
osteonecrosis of jaw)
11) Hip joint- premedicate or not - No need it. Dentin
12) 14 mm crowding- ortho and surgery, ortho only, surgery only - Ext and ortho should b
enough
13) Warfarin- wat test – INR
14) Patient smokes, is implant contraindicated? No
15) 5 year old child not cooperative, wat to do? conscious sedation? voice control?
General anesthesia?
16) Most common problem in clinic? Syncope
17) Mech of action. of fluoride - Replacing of HA with hydroxy fluoroaptite
18) Precations for hep patient? Standard precaution, no other precaution necessary
19) How to treat a patient. give an order ex: perio, endo, operative? ortho last - endo
perio operative ortho
20) OP PIC- osteosarcoma or ossifying fibroma? Ossifying fibroma: radiographically
appears as either a well-circumscribed lucency or a lucency with opaque foci.
Osteosarcoma sunburst/ossifying fibroma wellcircumscribed rl/ro
21) Currete used for mesial surface of tooth – 11-12
22) Forcep not used for extraction of root - not 23. 23 is cow horn.
23) Commonly contraindication for surgery recently? Bisphosphonates
24) Primary molar differs from permanent in cervical constriction – T
25) Most common organism in implant failure; same as regular dentition
26) Dislodged clot; sedative dressing
27) Treatment of ANUG: Debridement, H2O2/ chlorhexidine rinses, antibiotics if systemic
symptoms (fever, lymphadenopathy). If it is systemic Metronidazole, amoxicillin.
28) How to treat a patient with implant supoorted dentures: fluouride - yes Fl for abutment
in overdenture, need options to decide the answer. Not for implant.
29) Epinephrine mech of action - epi stimulates both alpha 1,2 and beta 1,2 receptors.
Epinephrine is used to treat anaphylactic shock. It stimulates alpha 1-adrenergic and
2-adrenergic, beta 1- adrenergic and 2-adrenergic receptors. B2 receptor stimulation
aids in relieving bronchospasms.
30) Battle sign - Battle's sign, also mastoid ecchymosis, is an indication of fracture of
middle cranial fossa of the skull, and may suggest underlying brain trauma. Battle's
sign consists of bruising over the mastoid process, as a result of extravasation of blood
along the path of the posterior auricular artery.
31) Pejrre robin sy drome - Retrognathia, glossoptosis, cleft palate. Google: Pierre Robin
sequence is a set of abnormalities affecting the head and face, consisting of a small
lower jaw (micrognathia), a tongue that is placed further back than normal
(glossoptosis), and blockage (obstruction) of the airways. The three main features are
cleft palate, retrognathia (abnormal positioning of the jaw or mandible) and
glossoptosis (airway obstruction caused by backwards displacement of the tongue
base).
32) Gingivectomy icsion - external bevel. Its excision starts from apical of pocket (JE), but
coronal to mucogingival junction, secondary healing.
33) Cauliflower shaped lesion - Verrucous carcinoma, condyloma accuminata,
papilloma.
34) Asymptomatic periodontitis, longstanding, asymptomatic or mildly symptomatic
lesion. It is usually accompanied by radiographically visible apical bone resorption.
Bacteria and their endotoxins cascading out into the apical region from a necrotic
pulp cause extensive demineralization of cancellous and cortical bone. Occasionally,
there may be slight tenderness to percussion or palpation testing. The diagnosis of
asymptomatic apical periodontitis is confirmed by the following: (1) General absence
of symptoms. (2) Radiographic presence of radiolucency. (3) Confirmation of pulpal
necrosis. A totally necrotic pulp provides a safe harbor for the primarily anaerobic
microorganisms—if there is no vascularity, there are no defense cells. Asymptomatic
apical periodontitis traditionally has been classified histologically as apical granuloma
or apical cyst. The only accurate way to distinguish them is by histopathologic
examination.
35) Primary- cold or percusiion or ept
36) Permanent - ? thermal or ept - tricky question, EPT for perio and thermal for endo
37) Which perio conditions we need antibiotics – Localized Agressive periodontitis (ANUG
only if systemic involvement).
38) Ranitidine - H2 antagonist, used to treat GERD
39) Methotrexate- Antimetabolite antineoplastic agent, anticancer drug with folic acid.
40) Diazepam - BDZ, sedative, anxyolitic, long duration of action.
41) Which ka most common epilelsy in children - Petit mal
42) Status epileptic medication - Diazepam
43) Maxillary sinus which view – Waters
44) Buccal frenum - Triangularis or buccinators
45) Pontics - Most aesthetic is Ovate most common is modified ridge
46) Succedaneous tooth - All permanent except 1st, 2nd and 3rd molar
47) Most common emergency in dental – Syncope
48) Pregnant women which nerves get suppressed - ?
49) Apexogenesis does what? maintenance of pulp vitality to allow continued
development of the entire root. Apical closure occurs approximately 3 years after
eruption. The key is to allow the body to make a stronger root. This procedure relates
to teeth with retained viable pulp tissue in which the pulp tissue is protected, treated,
or encouraged to permit the process of normal root lengthening, root wall thickening,
and apical closure. Nonsurgical endodontic therapy can be performed more safely
and effectively to treat the pulpal disease. Indications: (1) Immature tooth with
incomplete root formation and with damaged coronal pulp and healthy radicular
pulp. Contraindications: (1) Avulsed teeth. (2) Unrestorable teeth. (3) Teeth with
severe horizontal fracture. (4) Necrotic teeth. Prognosis—good when pulp capping or
shallow pulpotomy is done correctly; conventional pulpotomy is not as successful.
Success rate depends on the following: (1) Extent of pulpal damage. (2) Restorability
of the tooth
50) Apexification: not vital pulp therapy because the tooth is pulpless. 2. Definition—
method to stimulate the formation of calcified tissue at the open apex of pulpless
teeth. 3. Indication—infected teeth with open apices in which standard
instrumentation techniques cannot create an apical stop to facilitate effective
obturation of the canal. Technique—disinfection of canal followed by induction or
placement of an acceptable apical barrier. a. Calcium hydroxide and MTA have
been used to create an apical barrier. (1) Calcium hydroxide may be used to induce
apical hard tissue formation. A thick paste of calcium hydroxide must be placed in
the canal and replaced every 3 months until a hard tissue barrier forms, against which
gutta-percha may be placed to fill the canal. This traditional technique may require 1
year for hard tissue formation. MTA can be packed into the apical 3 mm of the canal,
and the remainder of the canal can be filled with gutta-percha at the same
appointment. MTA has established biologic outcomes in terms of healing and root-
end closure at least comparable to teeth treated with calcium hydroxide.
Advantages of MTA compared with calcium hydroxide—treatment can be
completed in less time, improved patient compliance, reduced cost of clinical time.
RQs
Q1- What will not set off an event in a child with sickle disease
Trauma Cold Infection Nitrous oxide
Q2-What not to do in veneer:

try in paste for shade
apply silane to inner surface
apply bonding agent
etch enamel with hydroflouric acid
Q3-What is the purpose of making a record of protrusive relation and what function does
it serve after it is made
A. To register the condylar path and to adjust the inclination of the incisal guidance.
B. To aid in determining the freeway space and to adjust the inclination of the incisal
guidance.
C. To register the condylar path and to adjust the condylar guides of the articulator so
that they are equivalent to the condylar paths of the patient.
D. To aid in establishing the occlusal vertical dimension and to adjust the condylar guides
of the articulator so that they are equivalent to the condylar paths of the patient.
Q4-9 year old child with POOR oral hygiene needs ortho treatment, what do we do?
A- no treatment B- removable appliances C- fix appliances D- semi fix appliances
Q5-You will let the patient to sign the informed consent when?
a) after you discuss the treatment plan
b) directly after the diagnosis
c) after done with extraction procedure
Q6-Patient evaluated after perio therapy wht would u check

Attachment loss Pocket depth Bleeding on probing Oral hygiene
If q asking what the dentist will check on pt mouth to evalute success of treatment will be
C, bleeding in probing: The best criterion to evaluate the success of scaling and root
planning is NO EVIDENCE OF BLEEDING ON PROBING. Bleeding on probing indicates
inflammation in the tissue. The amount of inflammation present is used to determine
the effectiveness of periodontal instrumentation and home care by the patient.
If q asking the rate of success depend on what ? So D, Patient oral hygiene – the best
indicator of success of a periodontal flap procedure is postoperative maintenance
and plaque control by the patient.
Q7-Researcher has set alpha at 0.05. Results
showed p value 0.01 and researcher
rejected null hypothesis. What kind of error
is it? - They had set the value at 0.05 and
result came out 0.01which is less than the
set value so it's a null hypothesis and since
they rejected it which means there was
incorrect rejection which is type 1 error
Q8- Proscar (finestride) is used to treat? Benign prostatic hyperplasia

Q9-Motion sickness medication – Scopolamine
Q10-3 year old 5mm intruded - Observe, just 3 yrs not at all any damage to permanent.
Q11- Most common respiratory emergency – Hyperventilation
Q12-Upper first PM forceps - For maxillary premolars can be 150, 65, 286. For mandibular
premolars 151
From 13-47 from other RQ
Q48-Balanced occlusion use for what? Complete Denture
Q49- Incisal guide table? There was no removing or lifting pin in the option - Incisal guide
table: construction of a custom that preserved anterior guidance, from Mosby.
Anterior guidance must be preserved by means of construction of a custom incisal
guide table, especially when restorative procedures change the surfaces of anterior
teeth that guide the mandible in excursive (lateral, protrusive) movements, from
Mosby.
Q50- Anterior guidance purpose? Protects posterior teeth in lateral function
Q51-Longitudinal studies what factors are least important?
Q52-Pka depends upon? Ionized and non ionized ions, Onset of action. Low pka--- more
free ionized---faster onset
Q53- Whats the purpose of posterior disocclusion? its christensen phenomena, to avoid
non working interfrence which is destructive
Q54- Finish margin of pfm? Pfm - chamfer/ shoulder
Q56-Renal failure which pain killer? Tylenol, Oxycodone for hepatic.
Q57-Wat are the reason for the crossbite? Retained primary tooth, construction of Max
Q58- Lesions most commonly seen in jaw? PA lesions?
Q59- Pyogenic granuloma by which bacteria? Pyogenic granulomas (PGs) are benign
vascular lesions that occur most commonly on the acral skin of children. The term
pyogenic granuloma is a misnomer. Originally, these lesions were thought to be
caused by bacterial infection; however, the etiology has not been determined.
Q60- Prevelance and incidence question? simple one - Prevalance: total number of
cases
incidence: New number of cases
Q61-Palatal tori question? horshoe was there in the option, Yes horseshoe/ U shaped
major connector used for RPD
Q62-10% calcium hydroxide varnish best use where? Amalgam restoration, zinc
phosphate, in the walls of preparation cavity, not cavosurface areas
Q63-Conjugation does wat? covalent bonding with glucuronic acid to make water-
soluble for excretion
Q64-Trisomy 21? Down Syndrome
Q67-Sibilant sound when to check? DD: phonetics are tried in at the time of the "wax try-
in of the trial denture" - wax trial with teeth set
Q68-Osteomylitis which bacteria? Staph.areus
Q69-Facebow record? Maxilla&hinge axis - it transfers the relationship of maxillary arch
and temporomandibular joint to the casts. It records the upper model's (maxilla)
relationship to the External Acoustic Meatus, in the hinge axis.
Q70-Lingual bar? Shaped like a half-pear tapered toward the tissue in the superior border
and has its greater bulk at the inferior border. For a lingual bar, the depth of the
vestibule should exceed 7 to 8 mm. This is the simplest and most commonly used
major connector. – Mosby
Major conector of RPD, indicated for lingual vestibule of 7mm minimum
Q71-CD wat type of occlusion? Balanced
Q72-what will have wavelength ? Hue
Q73- Neutometesis - Severe nerve damage, neuromatosis- cause tumors on nerve, also
called neurofibromatosis, both the nerve and the nerve sheath are disrupted
Q74-median? Placing the number in value order and find the middle, or example:
1,1,1,2,2,4,6. the median is 2. nothing to do with average
Q75- Palatal expansion does not need a labial bow why? Cause it has no effect on
palate, not for expansion.
Q77- Albuterol side effect? Xerostomia
Q79- fluxetine action? Ssri - Prozac (fluoxetine) is an antidepressant belonging to the
selective serotonin reuptake inhibitor (SSRI) class of drugs. Prozac is mainly used for
the treatment of major depression, obsessive-compulsive disorder, and panic disorder
Q81-best imaging for condyle: Reverse towne
1.Metalloceramic crown which type of bevel

Chamfer 1mm (lingual?)
Chamfer 1.5mm
Shoulder 1mm
Shoulder 1.5mm (labial)
Metal ceramic restorations PFMs - A chamfer finish line and all margins should be placed
supragingivally when possible. The necessary thickness of metal substructure is
0.5mm. The minimal porcelain thickness is 1- 1.5mm. Thus, the tooth reduction required
for a PFM crown is -1.5-2.0mm. The labial shoulder width is ideally 1.5mm. The tooth
preparation reduction for metal-ceramic restorations (1.5 to 2.0 mm) must provide
space for metal (0.5 mm) and porcelain (1.0 to 1.5 mm).
2.Benadryl do what: Antitissive,h1 blocker,anesthetic, cause Xerostomia (anticholinergic,

antihistamine, sedative).
3.Electrosurgery for..hemorrhagie and excess tissue, Side effect -- ging recession.
4.Where go item when swallowed by accident - Right bronchus
6.Demineralization of enamel A. ph of plague less 6.4 B.Dentin ph 6.4 C.Start at
subsurface D. go like enamel rods
7.Junctional epithelium attached by Fibers Or hemidesmosom
8.Pinkham pre-cooperational child is - Lacking cooperative ability (the “pre-cooperative”
patient) a. Very young children with whom communication cannot be established nor
comprehension expectedb. Children with specific debilitating or handicapping
conditions
9. Main reason of Osteoporosis US A.nutrition B.genes C.environment
10.Sedation is for- Anxious
11.Which is least has lichenoid eruption
1.erythem 2.amalgam tatto3.drug rn
Amalgam produced lichenoid reaction. So answer is A
12.Water contamination with amalgam cause: Delayed expansion
13. AORS is mean??? Adjusted Odd Ratios
14.Reciprocal anchorage done by… Reciprocal – Type of anchorage when two units of
teeth move towards each other with equal distance. For example in Diastema by
using elastic bands.
15.Oxycodone hypotension and itching by – Itchin by Histamine release.
Oxycontin (oxycodone hydrochloride) is an opioid drug used for the management of
moderate to severe pain, usually for an extended time period. Oxycontin is not an "as
needed for pain (PRN) drug.
16. Porcelain bevel types: Shoulder and chamfer, Chamfer and beveled shoulder,
Chamfer nad chamfer
Unlike the PFM restoration which accepts any marginal design (bevel, chamfer,
shoulder), marginal tooth preparation for the ALL-ceramic crown or porcelain jacket
crown MUST BE A SHOULDER.
17.Tx initial for large subgingival caries - Glass ionomer filling
18. Intial tx for local aggresive perio – Tetracycline
19 Which one is. Acidogenic bacteria - Strep mutants acidigenic , & aciduric
20.Most common odontogenic tumor
Ameloblastoma Amelob fibroma Odontoma Adenomagoid tumor
(ameloblastoma is most common epithelial odontogenic tumor)
21.Incisial and coronal parts to be matched in porcelain metal crowns done by:
Internal coloring of porcelain
External glazing
Polishing and grinding to change light reflection
Firing under high temp
22.Uncarious short premolar for retainer under fpd
Crown Inlay Onlay ¾
24.Ian lingually located,tube of xray moved inferiorly and beam sup, location of nerve:
Mesial Distally Apically Occlusialy
25.Attachemen loss in furcation primary etiology - Oral biofilm
26.Taurodontism in which stage - Morpho -shape
27.Which one centrally acting muscle relaxant
Dandtrolene, Diazepam
28.Stimulated salivary flow - 1ml per min
29.Has only md incisor.beat shape of occlusion...
Balanced in centric Balanced in working Group function Canine function
30.Intial for caries: Bacteri carbohy susceptible toot, Bacteria polysaccharide enamel
MOST COMMON epithelial odontogenic tumor in children – mucoepidermoid
31.Antabuse - Aldehide dehydrogen, antabuse inhibits the enzyme Aldeyhyde
dehydrogenase, this is used to treat alchoholism. Its actually called acetaldehyde
dehydrogenase
32.Beclometasone for asthma
Short acting - its short acting, used only during attacks
Less potent than cortisole
33.Fiber post - Elsatic as dentin
34.Pt try to hide fear and anxiety, what we look for to inderstand it - Micro expression
35.Wheel chair people what is true:
Sliding transport the best
Ask pt to remove catheters
Ask pt do not buckle up
Wheel chair transfer is mot appropriate
36.IG mechanism of action
37.Maslow theory - Theory of human motivation
1. how do you treat traumatic bone cyst

a. leave it alone b. excise c. give meds
Treatment: consists of opening the lesion, curettage, and closure. It may contain blood,
serosanguineous fluid, debris composed mainly of a blood clot, or may be
completely devoid of solid material.
2. Which cyst is associate with anterior cyst w/ crown - dentigerous cyst (follicular cyst) or
eruption cyst
3. Common cyst is lower anterior teeth and teeth is vital - periapical cemento dysplasia
4. Know different between amelogenesis imperfecta and dentinogenesis imperfect
AI: ectodermal - DI: mesenchymal
5. Which of the following represents the basic constituent of the most root canal sealer
a. zinc oxide b. zinc stearate c. polyvinyl resin d. polycarboxylate e. zinc oxyphosphate
6. Aging of the pulp is evidenced by an increase in
a. vascularly b. cellular elements c. fibrous elements d. pulp stones
7. In the normal dental pulp, which of the following histologic features is least likely to
appear
a. cell-free zone of weil b. palisade odontoblastic layer c. lymphocytes and plasma cells
d. undifferentiated mesenchymal cells
8. the most commonly found salivary gland tumor is
a. adenocystic carcinoma b. pleomorphic adenoma c. muco epidermoid carcinoma
9 the action f the Hawley appliance is mainly
a. intrusion b. tipping c. bodily movement
10 a light force applied to the periodontal ligament during orthodontic treatment is
considered
a. intermittent b. direct c. continuous d. indirect
For tooth movement, the force need not be continuous, but it is critical that the force be
applied for a minimally acceptable period of time to elicit the biologic response
necessary. The amount of force (heavy or light) determines the biologic pathway of
tooth movement and the formation or lack of formation of a hyalinized zone with
undermining resorption.
11 the fluoride concentration in most dentifrices range from
a. 1-5 ppm b. 900-1500ppm c. 450-700ppm d. 4000-6000ppm
12 in a full upper denture the post palatal seal is determined by
a. the technician b. the depth of the vibration line c. 2-3mm
13 how is scrap amalgam is stored - under sulfide
14 the leas likely situation for a carcinoma to occur in the oral cavity is
a. floor of the mouth b. alveolar ridge c. lateral border of the tongue
15 histologically, the loss of the rete peg often is a sign of
a. pemphigus b. lichen planus c. pemphigoid d. syphills
16 which of the following represents the predominate type cell type in crevicular
epithelium
a. mast cell b. PMN c. macrophage d. lymphocyte e. plasma cell
17 which of the organisms are involved with periodontal disease
a. P. gingivilits b. E. species c. C. rectus d. Bacteroid e. all of the abov
18 Each of the following has been associated with gastric limitation, except
a. acetaminophen b. alcohol c. ibuprofen d. indomethacin
19 The most common reason for fracture of an amalgam in class 2 pedo molar toth
a. insufficient deth b. saliva contamination during condensation d. line angle too sharp
(sharp axis-pulpal line angle)
20 the best reason for RPD over fixed partial denture
a. hygiene b. cooperation c. esthetic
21 where is the gold directed on an MO onlay spruce
a, faces pulpal axial line angle b. occlusal floor c. pulpal floor d. gingival floor
You never have it at a 90 degree angle, if you direct to the pulpal, gingival or occlusal it
would be a 90 degree which will create a hot spot. So it needs to be attached at an
angle to allow flow of gold.
22 Which injection post the greatest risk for a hematoma – PSA
23. For anterior crown the finish line should be
a-at cervical edge b-below cervical edge c-between cej and epithelium lining
d-between crest and attached gingiva
24. Behaviour modifiaction definition - a type of psychotherapy that attempts to modify
observable, maladjusted behavior patterns by substituting a new response or set of
responses to a given stimulus. Psychologists have developed many techniques to
modify patient behavior by using the principles of learning theory. Examples of
techniques/methods used mainly in pediatric dentistry. – A procedure that slowly
develops behavior by reinforcing successive approximations to a desired goal.
25. Reciprocal anchorage? Elastic bands to close diastema
26. 3mm crowding in 8 yr child , what is the treatment plan?
a-extraction of canines and observe b-exraction of primary canine and give lingual arch
c-give lingual arch wire
27. Sequestra seen in – osteomyelitis
28. Morpphine over dose causes all except?
a-somnolence b-constipation c- pinpoint pupils
29. Gingival retraction cord disadvantages?
30. antiviral given oral also cure mucous and systemic disaesa? Cotrimazole, fluconazole
31. Side effects of oral sedation
32. Nitroglycerine side effects
33. Necrotisizing sialometaplasia - Found on hard palate caused by ischemia to minor
salivary gland
34. 15 year old has fever, malaise, vesicles,l ymphadenopathy?
a- cat scartch disease b-acute herpetic gingivostomatis
35. Which bacteria causes elastenase, collagenase?
a- strep b- staph c-gingivalis
(Pseudomonas aeruginosa is the answer, but i don't have that in my choices)
36. Automated defibrilator, how does it work?
a- monophase function
b-2 shocks
c-contraindicated below 12 year old
d- discharge when needed
37. W hich antibiotic work on gingiva?
a- erythromycin estolate,
b-erythromycin stearate
c- azithromycin
38. For which factor is least likely to refer endo case
Dilacerations
Calcification
Inability to obtain anaesthesia
Mesial inclination of molar
39. To prevent dimeraliztion of enamel from orthodontic treatment, which method is
expensive?
a-flouride varnish every 6 months
b- 6 months prophylais
c-prescribed mouth wash
d- community fluoride water
40. patient has brown spot on lower left and with the explorer it is retentive?
a- floweble resin
b- amalgam
c- composite
d-pit and fissure sealant
41. Patient is having white flakes on her soft palate , gone when rubbed. using albuterol
inhaler regularly since 1 week due to soccer game, what is your diagnosis?
candidiasis. albuterol->dry mouth->alter pH-> oportunistic candid-> candidiasis
42. bis-phosphate used in all except?
A) Prostate cancer to bone
b) breast cancer to bone
c) osteomyelitis (ans)
D) metastatic
43. Which one is schedule 2?
1- Vicodin (3)
2- hydrocodon + Acet (3) hydrocodone containing products are being considered to be
reclassified as Schedule II drugs
44. Which impression has water as by product?
Polyether
Hyrdrocoilled
Silicon addation
Condseation sillion
ANS: should be polysulfide - Polyether, by product alcohol - Addition silicon no by
product.
45. Pain on half of the face, that comes once a month and its?
46. Periodontal problems mostly assoicted with
Hypertension Smoking, Deibetes plaque
47. freacture on the orbit of the left eyes which border of the maxillary sinus will it effect?
Superior
Inferior
Postier
Anterior
48. What was Chess and Thomas categories of Childern Temprture?I (Activity , rhythmicity,
distraction, approach)
49. Stages of AIDS and no. of Leukocyte count.
50. Treacher Collin Syndrome - cleft palate, shortened soft palate, malocclusion, anterior
open bite, enamel hypoplasia
51. Optimum treatment for palatal papillary hyperplasia?
a) Radical dissection
b) Electrosurgery
52. Difference between snuff dipper and nicotina stomatitis - Snuff is by smokeless
tobacco and present in the buccal mucosa, nicotina stomatitis is present on palate
therefore called smokers palate too.
53. Aspirin and Yinseng? What happens if given together – Bleeding
54. Prostaglandin analogue? Misoprostol
55. Clinical test for Rheumatoid arthritis
56. Sjogrens syndrome is associated with? Lymphoma? T - Sjögren's moderately increases
risk for non-Hodgkin's lymphoma
57. Area of least attached gingival? Which tooth - Mand premolar
58. Brown tumors associated with which disease – Hyperparathyrodism, giant cell tumor
of the bone. Brown tumors may be rarely associated with ectopic parathyroid
adenomas[4] or end stage renal osteodystrophy.
59. Internal component of implant
60. Rubber dam retainer which property- options were 1 modulus of elasticity, 2 elastic
deformation, 3 permanent deformation
61. Traumatic cyst treatment?
a.Aspirational
b.Marsupialization
c.Curettage (dd)
d.no treatment
62. A 14 year old patient presents to your office for multiple extractions. Patient’s mother
informs you that her son took 325 mg aspirin the night before for a headache. Which
of the following holds true regarding performing multiple extractions on the
patient? a. Do the extractions b. Wait 2-5 days c. Wait 7-10 days d. Wait 12-14 days
63. Use of a gold casting instead of dental amalgam should be considered in the
restoration of an MOD carious lesion on a maxillary second molar when
A. greater sealing of the cavity is desired.
B. the preparation is wider than a third of the intercuspal distance.
C. esthetics is the primary concern of the patient.
D. All of the above
64. Primary risk factor for periodontitis
Tobacco (dd)
Diabetes
Smoking is one of the most significant risk factors currently available to predict the
development and progression of periodontitis.
65. How do you diagnose periodontitis ?
Bitwings
PA (dd)
Pano
Yes PA to diagnose periodontitis it is the standard for PDL disease.... for bone loss DD
mentioned Bitewings is the best
66. 1) If a tooth is not a candidate for full coverage crown , onlay is the best choice.
2) Conservative onlays have superior retention compared to full crowns .
A- both are true B- 1 true n 2 false C- 1 false n 2 true D- both false - if tooth not
candidate to full coverge crown , so its not indicated to onlay ( dd)
67. Minimum ferrule effect = 1.5mm
68. Lower denture is loose whats wrong with it? (over extended, under extended????
Overextended
69. The denture base completely covers what muscle
a. Medial pterygoid
c. Masseter
d. Buccinator
70. Which of the following are false regarding meperidine
Select all that apply – A. most abused drug by health professionals B- most widely used
narcotic in American hospitals C- less potent than morphine and produces slight
euphoria with miosis D- promethazine is contraindicated in pts taking meperidine. E -
used for obstetric anesthesia
All true mentioned in ddsurgery except , c and d is false ( no miosis, used with
promethazine)
Preet Kanwal's RQ + Mary Esma’s Post
1. Drug interaction of Aspirin with atenolol - long term NSAID use (longer than 1 week)
decreses effect of atenolol – Mosby: NSAIDs can inhibit the antihypertensive effect of
ACE inhibitors, B blockers, and diuretics.
2. External incision bevel: Gingevectomy
3. Amitriptyline: TCA (tricyclic antidepressant so tx for depression)
4. Aminophilline: bronchodilator so tx asthma
5. Atenolol: Cardio selective Beta 1 blocker
6. Question regarding tilted molar type of denture:
7. Ortho case regarding identification of class 1 class 2 class 3
8. Side effects of antibiotics: Fungal infection
9. Lichen planus, smokers palate
10. Erythroplakia, leukoplakia - precancerous condition
11. CI of nitrous oxide: COPD (Safe for asthma), nasal congestion, upper respiratory tract
infection, intestinal obstruction, deformity of nasal structure and drug dependency.
Pregnancy is NOT absolute contraindication. Mental retardation is also a
contraindication. Sickle cell is not a CI.
12. Bevels in composite: Increase surface area, Increase retention, Aesthetic. Is called
esthetic bevel, it reduce microleakage, improve esthetic, increase bond strength (dd)
bevel angle is 45-60 (in dpm)
13. Bevels in amalgam: bevels for composite cavosurface --- amalgam only for gingival
and axiopulpal ---- bevel only in permanent not primary
14. 200 patient last year 300 this year incidence 100 ÷ 1000 = 0.1 = 10%
15. Common lymphoma of jaw - Burkitt in jaws
16. Greatest reccurrence of cancer of oral cavity? Squamous cell carcinoma
17. Heparin – PTT - HEparin PTT....HEmophilia A PTT...learn this 2 together(HePTT)
18. Coumarin – PT/INR
19. Distance between Implant and tooth – 1.5mm
20. Palatalgingival groove is seen in which teeth - Max lateral
21. Bacteria found on acute pulpitis - anaerobic
22. Synostosis- late closure of sutures, no closure at all,? Early - Synostosis (plural:
synostoses) is fusion of two bones. It can be normal in puberty, fusion of the epiphysis,
or abnormal. When synostosis is abnormal it is a type of dysostosis. Synostosis within
joints can cause ankylosis. (Eg. Craniosynostosis - prematurely fuses).
23. Alot of questions about rapport – mutual sense of trust and openness between
indiviuals that, if neglected, compromises communication. Rapport is reciprocal,
patients are more likely to respect a clinician’s beliefs and opinions if he or she is
willing to truly listen to and respect theirs.
24. Trigeminal neuralgia not common in age before 30? T/F – over 50 years of age
TN = Prototypic neuropathic fascial pain: Typically there is a trigger point and the pain
presents as electrical, sharp, shooting, and episodic (seconds to minutes in duration).
Most commonly seen in patients over 50 years of age. Carbamazepine (Tegretol) is still
the mainstay of treatment.
25. Trigeminal neuralgia is characterized by all except - dull constant pain
26. Trismus which space is involved - trismus is main sign of masticatory space infection
(masseteric space, pterygomandibular space, temporal space) - DD
27. Aspirin overdose which symptom didnt belong: pyretic (fever) was answer. bcaz
aspirin is antipyretic. Present: bleeding from gi, Tinnitus, Nausea and vomiting, Acid
base disturbance or metabolic acidosis, Decrease tubular reabsorption of uric acid,
Salicylism, Delirium, Hyperventilation
28. Turners tooth local trauma or infection
29. 74 yr old patient needs a check up but first you gotta talk with his doctor bcause of his
medical chart which organization is in charge of that? Some options... Osha,
medicaid services, health insurance portability accountability act (hippa)
30. Modeling? make child observe her siblings or other px
31. Newborn whith 2 white lesions located in median
palatal raphe: congenital epulis, something of
the newborn? Epstein pearl present in median
palatal Raphe in newborn
32. Lesion with suspected malignancy: incisonal
biopsy
33. A pic of a patient with ulcerative papilas red in
the whole mouth and red macules in the skin
and patient felt tired: leukemia, peripheral giant
cell geanuloma?
34. Syndorme with eyes bulging out - Crouzon
35. Pic of dentinogenesis imperfect -
36. Supernumerary teeth in what stage - Initiation
37. First sign of development of teeth 6th week?
Dental lamina
38. If patient has been on penicilin and comes with fever and more pain, change
antibiotic but clindamycin wasnt an option, options included erythromycin and
tetracycline.
39. Most potent bronchodilator - Isoproteronol
40. Stages of treatment: Emergency... Maintenance And all that
41. T test: 2 means
42. Chi square: 2 categorical variables
43. Cohort retro and perspective: Risk factor, Retro= historical.
44. Case control (ODD): rare disease.
45. Exam that failed to prove 5 cases that were positive for disease: false negative
46. Chroma: Saturation of color
47. Patient whit green and orange stains: medications, diet,? Poor oral hygiene
48. Cleft lip and palate in caucasians 1:100 or 1:500
Cleft lip alone 1:1000
Cleft palate alone 1;2000
Both 1:700 0r 1:800
49. Difference between fear and anxiety: fear is focal anxiety is generalized, fear
unknown anxiety known, ??? fear is known anxiety unknown
50. Which thing decreases or increases in age dont remember but i answered value -
Chroma increase, value decrease and hue unchanged
51. Untreated decay frequently in black? more caries in hispanic- more untreated caries
in black due to lack of finance (mosby)
52. Functions of the collimator in rx: Reduce exposure
53. Intruded primary central 5 mm with 3 yrs of age: Observe
54. Apexogenesis do not : root lengethening, root vascularization
55. Internal bleach: external or internal cervical reabsorption? external cervical resorption
56. One wall defect? Hemiseptum
57. Chancre what it resembles? I put squamous cell carcinoma
58. Nitrous oxide contra indication: sicke cell anemia or hemophilia? SCA is not CI, not
absolute but relative - to prevent sickle cell crisis
59. The setting of vinyl polysiloxane silicone can be retarded by latex gloves, eugenol?
60. Imbibition in hydrocolloids? Imbibition (absorption of water from the air) and syneresis
(loss of water to the air or surrounding environment) occur with both,, so its true it
occur with hydrocolloids (dd). But mostly we see it in clinic with alginate, and
popularity of agar impression is limited becoz it need special equipment.
61. Bone morphogenic protein? BMP are present in DFDBA bone graft which makes it
osteogenic
62. Alot of questions about perio connective tissue and flaps
63. Which procedure cannot be done in the distal of the 2 mnd molar to increase
attached gingiva in a moderate pocket something like that - Distal widge, cant be
done if we dont have adequate attached gingiva,,, while Apf we use it to increase
attached gingiva
NBDE YesIcan August 2017

1. Analog (definition) - Is a replica of the actual implant, for lab purpose
2. Distance between implants - 3mm - between mental nerve 5mm - between vital
tissue 2mm - buccal, lingual, maxillary sinus, nasal cavity and inferior border all are
1mm - between adjacent natural teeth 1.5 - 2-3mm below cej of the adjacent tooth
3. Taurodentism (definition) - apical enlargement of pulp
4. Cross sectional study (3 questions to identified what type of study) – descriptive study,
used for prevalence and incidence, there is no correlation in these studies, no cause
and effect relation.
Cross-sectional study—study in which the health conditions in a group of people who are,
or are assumed to be, a sample of a particular population (a cross section) is
assessed at one time. Consider the hypothesis that drinking alcohol increases the risk
of developing oral cancer. If researchers chose to conduct a cross-sectional study to
explore this hypothesis, they might examine a group of men who drink alcohol and
compare the occurrence of oral cancer among men who are not alcohol drinkers.
The researchers could then determine whether there is an association between the
presence of oral cancer and alcohol. Although this study is relatively quick and
inexpensive, its potential to contribute to a judgment of causation is limited because it
cannot determine whether the outcome (in this case, oral cancer) occurred before
the men started drinking or if it developed as a result of some other cause (e.g.,
metastasis).
5. Clinical trial (2 questions)
a.Clinical trials—Clinical trials attempt to evaluate the effects of a treatment. A clinical

trial aims to isolate one factor (e.g., a new drug) and examine its contribution to a
patient’s health by holding all other factors as constant as possible. Well-designed
clinical trials use a double-blind design in which neither the subject nor the
investigator knows to which group a subject belongs. is design helps prevent the
potential for a biased interpretation of treatment effect (better or worse) that might
occur if either the investigator or the subject knew to which treatment group (i.e.,
placebo or experimental agent) a subject belonged. Clinical trials compare the
incidence of disease and side effects between the groups in the study to draw
inferences about the safety and efficacy of the treatment or treatments under
investigation.
b. Community trials—in a community trial, the group as a whole is studied rather than the
individuals in it. The more similar the communities, the more valid the results. A known
example of a community trial was the 1945 Newburgh-Kingston water fluoridation trial.
In this study, NaF was added to the water of Newburgh, New York, and DMFT was
compared with Kingston, New York, which was non uoridated.
6. Hazard communication paper ( 2 questions, one to identify which institutions created

it (OSHA) and one to identify what materials are named hazardous) - chemical
hazard MSDS, For general hazard OSHA. MSDS regulated by OSHA through Hazard
Communication Standard.
Hazardous chemicals—the OSHA hazard communication standard requires

employees to receive training about the risks of using hazardous chemicals and the
safety precautions required when handling them. Employees must be trained in
identification of hazardous chemicals and PPE to be used for each chemical. This
training must occur within 30 days of employment or before the employee uses any
chemicals and annually thereafter. Just as with the blood-borne pathogen standard,
a written plan identifying employee training and detailing specific control measures
used in the work- place must be compiled for hazardous chemicals. Penalties can be
imposed on the employer if the office is not in compliance.
7. Chemical sterilization - Gluteraldehye 10 hrs
8. Informed consent (autonomy)
9. Veracity (they gave me the concept) - Principle: Veracity (“truthfulness”). The dentist
has a duty to communicate truthfully.
10. Radio resistant cells - Nerve was the answer
11. Cherubism - Bilateral jaws expansion, tx: no treatment
12. Ectodermal dysplasia ( 2 questions, they used words like anhidrosis (no sweat glands)
and Hypothricosis (decrease in hair)
Hereditary ectodermal dysplasia.1. X-linked recessive condition that results in partial or

complete anodontia. 2. Patients also have hypoplasia of other ectodermal structures,
including hair, sweat glands, and nails. Microdontia.
13. Most common side effect of nitrous oxide (Nausea)

14. INR ( What it measure? extrinsic pathway, intrinsic pathway…..) 0.8 -1.3 normal - for
surgery on patients taking anticoagulants 2-2.5
15. A child 16 kg how much LA ( options 34-48-72-115) 16*4.4 is 70.4
16. Ludwing angina ( 2 or 3 questions , what space is not involve, antibiotic they gave me
options of meds) - Sub mental, sub lingual, sub mandibular space involved, Retro
pharyngeal not involved. Penicillin, metronidazole, clindamycin, and ciprofloxacin
are often the antibiotics of choice.
17. Patient in dialysis do dental treatment day after dialysis
18. Suppression of cortisol (was a weird question, options, 20mg, 200 mg, 10mg, 1mg for 2
weeks in 2 years)
19. The more common site of caries: pit and fissures
20. Arthroscopy (they gave a short case question) - Steroid injections, disc manipulations,
have a look in joint space
Surgical treatments for temporomandibular disorder . 1. Overview—surgical

treatments of the TMJ include arthrocentesis, arthroscopy, disc repositioning, disc
repair or removal, condylotomy, and total joint replacement. Arthroscopy involves the
placement of two cannulas to allow access for intracapsular instrumentation of the
superior joint space. Disc manipulation, disc release, posterior band cautery, and disc
repositioning and stabilization techniques all have been described. Arthroscopy
appears to be an effective modality in a select group of surgical patients and offers a
potentially less morbid access to the joint.
21. Gardner syndrome - Supernumeary teeth, multiple polyp, intestinal polyp, osteomas.
22. Indirect rest instead amalgam to get better… For ideal contour, I think indirect
restoration instead of amalgam
23. More common PSICHIATRIC pathology in older ( Mania, depression, )
24. Vertically face divided (5, 3)
25. Penumbra (They gave the concept) - Penumbra is lack of sharpness of the film. It is a
fuzzy, unclear area that surrounds a radiographic image and is affected by focal spot
size (smaller the better), film composition (larger the size of crystals less sharp the
image), and movement during the exposure.
26. Osteomyelitis Staph -- infection from in to out -- radiolucent--- pain after ext -- pen v I.
V Inflammation of bone (and bone marrow) or osteomyelitis is common in the jaws.
Most lesions are associated with extension of periodontal or periapical inflammation.
Others are associated with trauma to the jaws. Pain, paresthesia, and exudation are
typically present.
27. Patient said “I don’t have time to quick smoking (contemplation,
precontempation…)
28. Down coding and unbundling
29. Most crucial in replantation after avulsion ( time, open or closed apex…)
30. Harder area to floss (mesial of first pm)
31. Bimaxillary protrusion (the gave me the concept) - Bimaxillary protrusion refers to a
protrusive dentoalveolar position of maxillary and mandibular dental arches that
produces a convex facial profile.
32. Pka has effect on… The lower the pKa (dissociation constant) of the local anesthetic,
the faster the onset of action, Low pka --- more free base--- fast onset.
33. Which is not radiopaque (AOT, Ameloblastic fibroma, Odontoma)
34. Least likely to recur - AOT
35. Anticancer drug with effect in acid folic - Methotrexate
36. RPI I bar fracture what do you do? Soldering
37. Brown tumors – Hyperparathyroidism, brown tumor of hyperparathyroidism is called
giant cells lesion too, histologically resembles to central giant cell granuloma.
38. Macroglosia is not common in …. Hyperthyroidism
39. Clean tongue to prevent… odor
40. Sulfas MOA - stimulate insulin release from beta pancreatic cells (sulfonylureas
hypoglycemic drugd). About sulfonamides antibiotic (inhibit PABA folic acid
synthesis).
41. Differents questions of neurofromatosis (2 or 3) (What do you not see? Café au lait,
lisch nodules of the iris, super numerary are SEEN.
42. X ray to light and to dark
43. Geographic tongue (they gave me a short description) - Geographic tongue (benign
migratory glossitis, erythema migrans) 1. Common (2% of population) benign
condition of the tongue of unknown cause. 2. Appears as white annular lesions
surrounding atrophic red central zones that migrate with time. 3. Occasionally
symptomatic (mild pain or burning). 4. No treatment necessary.
44. Nicotinic stomatitis (they gave me description) Nicotine stomatitis (Figure 4-4). 1. White
change in palate caused by smoking. 2. Red dots in the lesion are inflamed salivary
duct orifices. 3. Not considered premalignant, unless related to “reverse smoking”
(lighted end in mouth).
45. Retentive claps (suprabulge, infrabulge…)
46. Initial treatment of LAP (antibiotics, antibiotics+ SRP, SRP alone..)
47. Lefort 1 ( the answer was maxillary sinus)
48. Questions of apexogenesis and apexification (they gives you a short case and you
have to decide) Apexogenesis --> Vital tooth / Apexification --> non-vital
49. Treatment of ranula - excise
50. Liquid in Glass ionomer - Polyacrylic acid
51. Source of epithelium for grafts - donor
52. Half erupted third molar in a 18 years old patient, WHY do you extract that molar? (to
avoid chronic pericoronaritis, because thirds molars can produce crowding in
anterior, to treat pocket on the distal of second molar and other option)
53. Tooth with crown best pulpal test - Thermal test
54. Nsaid who does not affect palettes – Celecoxib, selective cox 2 inhibitors.
55. Multiple Myeloma first sign – bone pain
56. Melanoma common localization - Palate and gingiva, no tx.
57. Reciprocal anchorage - used for closure of midline diastema, use of Crossbite
elastics.
58. Pictures of Dentigerous cyst, leukemia, amelobrastic fibroma
59. PM with 3 canals – max 1PM
60. Outline shape of prep of mandibular first molar (triangular, ovoid, trapezoid…)
61. Slob rule - Same lingual opp buccal
62. Disadvantage of partial thickness flap - thin flap so tear easily, can get lost easily,
Difficult to elevate.
63. Most stable in moisture - PVS
64. More common reason of amalgam failure - if ask for failure water contamination, if
ask for fracture then cavity preparation. The contamination of the amalgam by
moisture during trituration and condensation is unquestionably the principal cause of
failures.
65. Antibiotic seen in GCF (no tetracycline in options) Gingival crevicular fluid:
Azithromycin
66. Gingivectomy where to do incision - External incision, at the base of the pocket.
67. Perio maintenance interval (3months, 4, 6…)
68. True about Niti over stainless steel (options something like harder, more adaptable in
curvatures (keep shape), flexibility….) Shape memory is the ability of nitinol to
undergo deformation at one temperature, then recover its original, undeformed shape
upon heating above its "transformation temperature".
69. Intrapulpal anesthesia – back pressure
70. Supernumerary teeth seen in, Anterior maxilla ... Occlusal radigraph best, Gardener,
Down syndrome, Cledocranial Dysplasia.
71. Treatment without consent - Battary
72. Least probable canal ledges (short, small, large, curved)
73. Med who increase cardiac output (beta blockers, alpha, ace…) – beta agonists,
digitalis - It increases the force of contraction of the heart by inhibiting Na+,K+-ATPase
and indirectly increasing intracellular calcium.
74. Wheezing seen in ( asthma, COPD)
75. Common between Aspirin and acetaminophen) - Antipyretic and analgesic
76. Montelukast Moa - Leukotriene receptor antagonist
77. Culture of sensitivity used to… Bact resistant
78. That question of 3 years old with 5 mm intrusion (they did not give to much details)
leave it
79. Most common emergency in dental office - Syncope! 90% - Hyperventilation 9%
80. Herpetic gingiva stomatitis (short description) - Acute herpetic gingivostomatitis
diagnosed early (within 3 days of onset) is treated immediately with antiviral therapy
(acyclovir, 15 mg/kg ve times daily for 7 days). All patients should receive palliative
care, including plaque removal, systemic NSAIDs, and topical anesthetics. Proper
nutrition should be maintained. Patients should be made aware of the contagious
nature of this disease when vesicles are present.
81. What do you look at Gardners (osteomas)
82. Ignoring a patient bad behavior - extinction
83. #8 with radiolucency increase in size for all of the following except (apical scar)
84. Occlusion (3 questions where is located the interference? Where to grind, balanced
occlusion concept - Occlusion, in a dental context, means simply the contact
between teeth. More technically, it is the relationship between the maxillary (upper)
and mandibular (lower) teeth when they approach each other, as occurs during
chewing or at rest.
85. More common cells in cellulitis – leukocytosis (white cells above the normal range in
the blood)
86. Most common tooth lost due to periodontitis - Max 2nd molar, maxi first most affected
by periodontitis and max 2nd most common lost.
87. Pathology with early teeth lost - Papillion-Lefevre syndrome, Chediak-Higashi
syndrome, hypophosphatasia, neutropenia, leukemia and in some cases Langerhans
cell histiocytosis
88. Epinephrine avoid in …. multiple sclerosis, Hypertension, thyroidism
89. Side effect of albuterol - Candida and xerostomia
90. Dental lamina ( 2, 6, 8, 12 weeks)
91. Best bone to implant located in - Mand ant, type 1
92. Implants: high torque low speed, low speed high torque…)
93. Repair of veneer - Micro etch, etch, silane, bonding
94. Cause of mucocele - trauma
95. Pulp necrosis what type of resorption (inflammatory, replacement, surface..)
96. K sparing drugs - Eplerenone (Inspra), Spironolactone (Aldactone), Triamterene
(Dyrenium)
97. Patient with SCC and he said something like “ Are you saying that I have cancer?
How do you respond? (Do you want to call someone to be with you now? This has
better prognosis than others cancers. Others options)
98. Common salivary gland tumor - Pleomorphic Adenoma (mixed tumor)
99. Properties of Zinz polycarboxilate, and other with GIC
100. Staffne cyst - Depression of mandible on lingual side. Below IAN. Stafne (static)
bone defect a. Diagnostic radiolucency of the mandible secondary to invagination of
the lingual surface of the jaw. b. Located in the posterior mandible below the
mandibular canal. (Static, Psyduo, Mand Fossa, No treatment, Round and RL)
101. Nystatin Moa - binds to ergosterol
102. Primary teeth who resemble mandibular first molar - Mand.2nd
103. What to use with disable kid (voice control, consistency)
104. Patient with bradycardia what to give him (atropine, epinephrine..) – Use atropine,
and anticholinergic, if bradycardia is present (DD). Atropine has direct inhibitory
effect on vagal mediated sympathetic stimulus resulting into reflex tachycardia, even
though Epinephrine do also have effect but it causes Cardiac Arrthymia.
105. A question said something like more cost effective fluoride treatment - community
water fluoridation.
106. During extraction more common (fracture, hemorrhage…)
107. Incisal guidance - Vertical and horizontal overlap
108. Nsaid preferred for kids - preferred nsaid for kids is Ibuprofen, if not NSAID then
acetaminophen.
109. Nsaid who does not affect platelets – Acetaminophen, Naproxen, Celecoxib
110. Index of caries – DMFT (decayed missing filled tooth)
111. Question of periapical cemento osseos dysplasia which one is not true?
112. Allograft concept - this graft material is obtained from cadaver bone that is
processed to ensure sterility and to decrease substances in the bone that can trigger
host immune response. However, this process destroys the osteoinductive capability of
the bone, whereas the osteoconductive property of the graft remains. Although
allograft avoids the need for a second surgical site, a greater amount of the grafted
material is resorbed compared with autografts. Allogra materials include undecalci
ed, freezedried bone allogra (osteoconductive material) and decalci ed, freeze-
dried bone allogra (osteogenic material owing to the presence of bone mor-
phogenetic proteins that are exposed during the demineralization process).
113. Which is not used in cast restauration - irreversible impresiom mater?
114. Anug (2 quesntions, onhe for treatment and one they gave me a short description)
115. Acute necrotizing ulcerative gingivitis. 1. Characteristics. a. Painful, bleeding
gingival tissues. b. Blunting of interproximal papillae. c. Pseudomembrane on the
marginal gingiva. d. Fetid breath. e. High fever. Caused by fusiform bacilli
(spirochetes) and other anaerobes. Most common in teenagers and young adults.
Responds well to debridement, oxidizing mouth rinses, and antibiotics. Treatment of
acute necrotizing ulcerative gingivitis includes evaluation of the medical history,
application of topical anesthetic followed by gently swabbing the necrotic lesions to
remove the pseudo-membrane, and removal of local factors such as calculus (o en
with ultrasonic instruments unless contraindicated by the medical history). Systemic
antibiotics should be prescribed only if there is evidence of lymphadenopathy or
fever. The patient should be instructed to avoid alcohol and tobacco, rinse with
chlorhexidine, get adequate rest, remove bacterial plaque gently, and take an
analgesic as needed for pain. Patients should return in 1 to 2 days for reevaluation
and further debridement. Patient should be seen again approximately 5 days later for
reevaluation; further counseling regarding diet, rest, and tobacco use; reinforcement
of oral hygiene instruction (including chlorhexidine rinses); and periodontal evaluation.
116. Belladone alkaloids ( contraindications) - Belladonna alkaloids and phenobarbital
combination is used to treat cramping and spasms in the stomach and intestines.
Contraindications: acute edema of the lungs, mechanical stenoses of GI tract,
megacolon, narrow angle glaucoma, prostate adenoma and tachycardic
arrhythmias.
117. Stridor seen in - laryngospasm
118. Efficacy concept - intrinsic effect
119. More common in men (diabetes, hemophilia, hypertension…)
120. What is not a benefit of ¾ crown one a Full crown - time for placement
121. Alveolar osteitis treatment – Analgesic, sedative dressing, no antibiotics.
122. Treatment contraindicated in trough trough furcation, - GTR. We do guided tissue
regeneration for class 2 furcation... but through and through furcation either class 3 or
4 and we can't do GTR
123. Least effective reducing interproximal plaque – water pick
124. Morphine side effects - respiratory depression, constipation, dysphoria, toxic:
miosis, coma, resp depr.
125. Most common reason of cardiac arrests in children: respiratory failure
126. Bur used to polish porcelain - diamond
Tons of questions of pulpal pathology, flaps indications and contraindications, side
effects of medsGuys thanks for your everything. Some extra advice, check flaps
deeply. As you can see I can't remember to much of farma because I hadn't too
much and I'm bad on it. But about farma read about cancer treatments, radiation
and biophosphanates, what meds can cause dry mouth, smoking cessation meds. I
got a few ones from mdb reworded but mostly the same. I found it a good resource
to practice and learn. I did Kaplan q bank and I loved it.
I got like 6 cases. One a kid with so many many meds!! He had kidney transplant. Was
11 years old. They ask me about medications he was taking and which one was
causing him gingival hyperplasia. He had 170/110 of BP or something really close. They
ask which of his pathologies demand send him to emergency. - cyclosporine for
gingival hyperplasia and I pick BP for emergency
Another case of and old men with many heart conditions A lot of meds too. They ask
me about meds and prostho and ortho I think. Not sure because I got two cases of
old men. One of them had a first molar missing and second and third molar tilted to
the space. They asked me what type of coast I DO NOT use on the second premolar
(20) options distal I bar, distal facial wrought wire, mesial circumferential, mesiofacial
something else. Ortho question was about move molars and premolar and about
them at space. What meds was causing him dry mouth.
And alcoholic case young guy. Teeth in really bad shape. Many perio questions on him
about what to do in this teeth, or what not to do.
One case of 14 years old girl with canine out of arch. She was asthmatic. What angle
case? What to do with canine or extract and appliance or expand or appliance? She
had a first molar with deep groove and a little be dark. What to do on that molar?
Sealant, amalgam, nothing...
Every single case had patient management questions. Two sentences to decide if
both true, both false, first true second false, first false second true. I used a lot the
highlights with the mouse to keep in mind key words.
The alcoholic patient was 18 month clean. They asked me if he was cured. They ask if
for example the cardiac patient should be premeds due to.. something that doesn't
need premed although he has something else to be premeditated for. I don't know if
I'm explaning well. But they play with your mind. If you read the case and the patient
has something that alerts you that ok this patient needs premedication but in the
question the ask like this patient needs antibiotics due to his angina. So you have to
read carefully.
I got a case of a young guy 43 years old I think. He was not happy with his teeth. He
has diastema and they ask why do not close this space. Because closing diastema is
hard in adults, because he has deep bite or something like that and many others
options
I had that question of US population. There's in US 55% or more women than men.
More than 75% of people who lives in home care are women X percent of women
after 65 are marriage... I
choose the 75% .... one because that is a big number, two because is hard to me to
believe that more moms are in home care centers (dads used to behave worst )
im sorry guys I don't know the correct answer.
KARA PAL RQs (JULY 19)
1. K sparing drug? Spironolactone, amiloride, triamterene - K+-sparing diuretics

qreduce the driving force for K+ movement into the lumen.
2. Virax in oral cavity? Virax (acyclovir) - Acyclovir is an antiviral agent with activity
against Herpes simplex virus types 1 and 2, (HSV-1 and HSV-2) and varicella zoster virus
(VZV).
3. What procedures you cant do in AIDS patient? No prophylaxsis, because candida
4. Opiods effects: Miosis, constipation, cns depression, also respiratory depression, and
ONLY MEPERIDINE mydriasis
5. Papoose contraindication: Long - term restraining, Mentally or physical abnormal
6. Battery? - treat without informed consent
8. Which study doesn’t show cause and effect – cross sectional, observational study
9. Drugs those block prostaglandins has increased effect on gastric mucosa? - Non
selective COX inhibitors
10. Bimaxiallry protrusion - Both arch procline. When u see facial profile lip incompetence
lips strain n prominence lip profile
11. Combination syndrome: Kelly syndrome, maxillary CD opposing mand anterior
natural teeth Cc:- flaby max ant bone resorption - extrusion of mand teeth. Loss of
bone from the anterior part of the maxillary ridge, overgrowth of the tuberosities,
papillary hyperplasia in the hard palate, extrusion of the lower anterior teeth, the loss
of bone under the partial denture bases.
12. Characteristics of band and loop: -Doesnt prevent sobre-eruption of opposing tooth. -
Its non functional
13. Least fracture resistant? lithium, feldpathic, zirconia - The order of chipping resistance
(from least to greatest) was: feldspathic porcelain and a leucite glass ceramic (which
were similar), followed by the lithium disilicate glass ceramic and the two resin
composites (which were similar), and finally the zirconia which had the greatest
resistance to chipping.
14. Pka has effect on what? Onset of Action. Low pKa = fast onset, High pKa = slow onset
15. 16 kg of 3 year old how many mgs LA to give? 16*4.4=70.4mg
17. Patient with bizarre behavior and disorientation you give what? insulin, glucose,
thyroid - disorientation and confusion most commonly indicate hypoglycemia which
needs glucose
18. Initial stages of sedation what patient feels? Tingling of hands
asymptomatic VITAL TOOTH. Radiopacity may be caused by low-grade pulp irritation.
This process is asymptomatic and benign. It does not require endodontic therapy.
20. 2 questions on Periapical Cemento osseous dysplasia - Reactive process of unknown
cause that requires no treatment. Commonly seen at the apices of one or more
mandibular anterior teeth. No symptoms; teeth vital. Most frequently seen in middle-
aged women. Starts as circumscribed lucency, which gradually becomes opaque.
An exuberant form that may involve the entire jaw is known as florid osseous
dysplasia.
21. What cyst in roots of mandibular premolar? Traumatic bone cyst
22. What lesions are not radiopaque? AOT, Ameloblastic fibro odontoma
23. Least likely to occur? AOT, odontogenic myxoma
24. Which anticancer drugs has effect on folic acid? Methotrexate
25. Radiographic pictures Rg ameloblastic fibro odontoma - Unilocular or multilocular
lucency, well-defined radiolucency often associated with an unerupted tooth.
26. 9 year old kid swollen gingiva, recurrent skin infections: May be Impetigo, pemphigus?
27. What is complication of maxillary molar extractions: Sinus perforation, Fracture
tubeocity
28. What is easily curable? macule, hematoma, ...
30. RPD I bar fractured what you do? - Construct a new one
31. What does conjugation do to a drug? – Phase II. Makes it more water soluble to
enhace excretion.
32. Patient with flared maxillary incisors and diastemas, to improve esthetics what you
evaluate first? Radiograph, Diagnose wax up, probing depth
33. Downcoding and upcoding – Down when insurance company bills your treatment to
the cheaper procedure. Up - when you type your treatment to be more expensive
than actual value to the insurance company.
34. Brown tumors: Hyperparathyroidism
35. Which conditions have macroglossia? Cretinism, acromegaly, beckwith - wiedeman
syndrome, down syndrome, hypothyroidism.
36. You don’t do RCT with PA radiolucency in which patients? Diabetes?
37. Systemic antifungal drugs ? Fluconazole, keroconazole, amphotericin B.
38. Why do you clean tongue? esthetics, prevent odor (Halitosis. Bad breath)
39. What bacteria in chronic periodontitis? P gingivalis, intermediate, treponema
denticolla, forsythia.
40. Nasal obstruction what sedation you cant give? Inhalational - True nitrous
contraindicate
41. Sulfonamide MOA - COMPETE with PABA to inhibit PABAs actions, which prevents
bacterial folic acid synthesis to inhibit cellular growth.
42. Traumatic neuroma – ORAL TRAUMATIC NEUROMA - a lesion (soft tissue tumor) caused
by trauma to a peripheral nerve, usually appearing as a very small nodule/swelling
(O.5 cm in diameter) of the mucosa near/over the mental foramen on the alveolar
ridge in edentulous areas, lips, & tongue. MOST COMMON SITE IS OVER THE MENTAL
FORAMEN IN EDENTULOUS PATIENTS, but they can occur wherever a tooth has been
extracted. Extraction sites in the anterior maxilla & posterior mandible are common
sites. In the oral cavity, the traumatic neuroma may be due to trauma from a surgical
procedure (i.e. tooth extraction, from a local anesthetic injection, or accident). A
nodule or swelling PAINFUL WHEN PALPATED, as applied digital pressure elicits a
response described as an "electric shock". Multiple neuromas on the lips, tongue, or
palate may indicate the patient may have MEN III (Multiple Endocrine Neoplasia
Syndrome). Treatment: surgical excision of the nodule with small proximal portion of
the involved nerve. Recurrence is uncommon.
43. Patient wore denture for 10 years and there is 6*3 white lesion on buccal of mandible?
Biopsy, or observe - Any lesion red or white doesn't go away for 2 weeks we should do
biopsy.
44. Treatment of concussion? Baseline vitality tests and radiographs. Occlusal
adjustment. No immediate treatment is needed. Let the tooth “rest” (avoid bite), then
follow-up.
45. Primary maxillary incisors intruded 5mm what you do? On 2-3mm we were waiting to
reerupt, so probably in younger patients reposition, older like above 5y/o extraction.
46. Radiolucency in primary molar furcation area? Pulpectomy - If 1st molar extraction
47. Most common caries location? Pits and fissure
48. Features of arrested caries? Hard, dark, shiny
49. Composite characteristics? Rough, glass filler
50. Opaque porcelain features? Mask the metal and provide chemical bonding with
metal
51. Phelobith location? nerve, vein (I assume phlebitis) - Phlebolith is a Calcification in a
vein
52. Lefort 3 fracture what side gaze is limited to? Laterally, medial or downward - LeFORT
III (Transverse Fracture or Craniofacial Oysfunction)-a fracture in which the entire
maxilla and one or more facial bones are completely separated from the craniofacial
skeleton . These patients have restricted mandibular movement. (nasoethmoidal)
LeFORT II (Pyramidal Fracture)- a unilateral or bilateral fracture of the maxilla in which the
body of the maxilla is separated from the facial skeleton and the separated portion is
pyramidal- shaped. Signs: periorbital edema, ecchymosis, subconjunctival
hemorrhage, and nose bleeding. A common finding is paresthesia over the
distribution of the infraorbital nerve. (Zygomaticomaxillary)
53. Lefort 1? LeFORT I (Horizontal Fracture} – a horizontal segmented fracture of the
alveolar process of the maxilla in which the teeth are usually contained in the
detached portion of the bone, causing an OPEN BITE. A LeFort I osteotomy is most
commonly used to correct maxillary retrognathia. (intramaxillary)
54. Axillary freckling seen in? Nerofibromatosis
55. Radiographic image of lateral wall of nasal fossa
56. radiographic is too light? Why? - underexpost. may be too old solution
57. If you take radiograph 10 Ma with 1 sec exposure and you take another x ray with 0.5
sec what mA will you give to get same density radiograph? 5, 10 or 20 –
qmAs = mA X time (sec) 10= x. 0.5 x=10/0.5 x = 20
58. Serpentile something feature? migratory glossitis – (Geographic tongue)
59. HIV infection feature? I put Usually asymptomatic in initial stages (lymphocytes
reduction)
60. Normal skeletal and class 3 dental what could be the reason? Loss of primary
mandibular 1st molar or incisor crowding or thumb sucking
61. 3mm lack of mandibular arch how you treat? Disk distal of molar, I put lingual arch
and observe
62. Max 2nd molar less keratinized tissue, which graft will you give? - lateral /pedicle
flape?
63. Most common crown root fracture tooth – max anterior
64. Primary mandibular 2nd resembles to? Permanent first
65. If you have ledge while doing RCT what you do? Bypass with smaller instrument
66. Access opening of Mandibular molar? Trapezoidal
67. Modified widman flap? Full thickness 3 incisions used to expose bone defects
68. When we don’t do gingivectomy? (aka gingivectomy contraindication) Bone surgery
needed, inadequate attached gingiva, apical to the mucoging junction
69. Mouth breather features? class 2 occlusion, adenoid facies, open bite, dry perioral
tissues.
70. 7-8 questions on studies
71. 2 questions on OSHA
72. Which study FDA do to check drugs? Randomized clinical trials.
73. 4 questions desensitization kind of terms.
74. Behavior shaping question, patient say I don’t wanna quit smoking?
precontemplation stage - The behavioral change process occurs in several stages. a.
Precontemplation — an individual is not considering a behavior change.
Contemplation — an individual begins to consider a behavior change. Preparation
— preparing to take steps to change (o en expresses a desire to change a behavior).
Action — an individual is engaged in taking action toward behavior change (o en
requires support for his or her e orts). Maintenance — an individual attempts to
maintain a changed behavior.
75. Eg of secondary prevention? Amalgam and composite restorations - Secondary
prevention is the elimination or reduction of a disease after it occurs. An amalgam
restoration is considered secondary prevention because tooth decay is removed and
a restoration is placed.
76. Where you give General A.? 2 year old kid needs lot of restoration
77. Most common periodontal failure? Max PM, Max molar, Mand PM, and Mand molars
- max molars due to trifurcation
78. Twisted questions on Meperidine and MOA read it carefully - Meperidine. a. Can be
used orally. More potent than codeine but less potent than morphine. A metabolite,
normeperidine, is a CNS stimulant. Not recommended for long-term pain relief.
Contraindicated with MAO inhibitors. t1/2 ~ 3 hours. - MEPERIDINE (DEMEROL) - a
SYNTHETIC narcotic (opioid) agonist that is weaker than morphine, but equally
addictive. It's duration of action is shorter than morphine, and it is the only narcotic
agent that does NOT cause miosis (pupillary constriction). Demerol is used as an IV
supplement during conscious sedation procedures, but is less potent than morphine
and much less potent than fentanyl. Demerol is also used as an oral medication to
control pain after dental surgery. Oemerol treats moderate- to-severe pain (acute
dental pain) and may be used as a preoperative medication to relieve pain and
allay anxiety. Length of Effectiveness: IV or 1M (3hrs) and not very effective given
orally. When combined with promethazine it is know as Mepergan Fortis.
Meperidine can cause seizures, tremors, and muscle spasms. Synthetic Meperidine
Oerivatives: Fentanyl (Sublimaze) - a synthetic potent opioid analgesic used primarily
as an IV sedative during conscious sedation procedures or procedures requiring
general anesthesia. It is 80-1OOx more potent than morphine.
79. What pain killer drug is safe in pregnant patient? tylenol
80. When does dental lamina starts? 2 weeks of utero, 6 weeks, 12, 10
81. What stage supernumerary occurs? initiation, histo, apposition
82. What % of community water fluoridation? 74% - Mosby
83. Mechanism of fluoride? options weren’t the regular one we read, very twisted terms
they used – Topical effect of constant infusion of a low fluoride concentration into the
oral cavity = enamel remineralization. Fluoride converts hydroxyapatite fluorapatite
by substituting OH' for Fl'. Fl decreases the solubility of hydroxyapatite crystal, while
increasing the crystal size. Fluoride ion is easily exchanged with the hydroxyl ion in the
lattice structure of enamel because FI is slightly smaller than OH- with a greater affinity
for hydroxyapatite crystals than OH-. Fluoride inhibits glycolysis where sugar is
converted into acid by bacteria (fluoride ion inhibits enzymatic production of
glucosyltransferase).
84. Multiple myeloma feature? bone pain? Yes, first sign, Punch out lesion, Bence jhon
proteins,
85. 2 question on best bone for implant? Type 1
86. What is implant abutment? it is connecting element b/w crown and implant fixture
87. You making FPD and you see 1 prosthesis in Radiograph is completely seating on
implant what you do? Screw the implant, take another RG, section the FPD
88. Disadvantages of cemented implant restoration? need more occlusal space
89. Fearful patient how do you respond? gradual desensitisation
90. Leading question, open ended and reassurance ? leading question: you are not
affraid, do you? (not recomendable to use) - open ended: how are you feeling? (let
the pt to communicate and its the best choice - reassurance: what advantages or
disadvantages do you see in tx plan? (making sure pt understood).
91. Modeling in fearful kid ? let another person to show him who to behave, like brother or
stuuf
92. Buccal limitation of mandibular denture - masseter
93. Lingual limitation of Mandibular denture? Genioglossus, Frenum, Mylohyoid, Sup
constrictor, Platoglossus
94. ANUG resembles what? I put herpetic stomatitis - recurrent herpes-stomatitis
mimicking acute necrotizing ulcerative gingivitis (ANUG).
95. When do you do elective RCT?
96. Lefort 1 includes what structure? Maxilla, hard palate, there is a sign of bilateral
hematoma on palate = guerin sign
97. Smokeless tobacco causes what? Leukoplakia - verrucus carcinoma
98. Max anterior teeth placed too superior and too anterior what sound will affect? F and
v
incline, lingual? - yes 1.5mm
100. What is not included in the consent? Cost
101. Epinephrine contraindicated in thyroid? in hyperthyroidsm yes
102. (Few questions on some recent study questions. Never heard and don't
remember)
103. Dental hygienist and 3 doctors in practice, dental hygienist screwed the case
who will be legally blamed? dental hygenist and the doctor "supervising"
104. Abcess include marginal and interproximal gingiva called? Gingival abscess,
pericoronal, periapical
105. What is the indication of half erupted third molar in 18 years old? dental
hygenist and the doctor "supervising"
106. Another question on complication of maxillary molar extraction: 1st molar root
in sinus, 2nd molar related with maxillary tuberosity fracture.
107. You can avoid ledge if canal is: Small, large, short or curved - short less
incidence of ledge and long more incidence
108. External bevel incision? gingivectomy
109. Ear pain refer to? Mandible molars
110. Lots of pharma questions
111. An athlete having pain and soreness on tmj when he wake up? MPDS -
myofacial pain. Myofascial Pain Dysfunction (MPD) Syndrome-the most common
cause of TMJ pain. It is a disease primarily involving the muscles of mastication. MPD
often responds to an acrylic night guard (occlusal separator or occlusal appliance)
along with a soft diet, limited talking, and elimination of gum chewing. Moist heat
applied to the face and non-steroidal anti-inflammatory agents are also helpful
during the acute phase.
112. Sublingual varicosities? Twisted options - age
113. Radiograph of dentigerous cyst - Dentigerous Cysts (Primordial or Follicular
Cysts)-cysts associated with the crowns of unerupted teeth, probably the result of
degenerative changes in the reduced enamel epithelium. Well-defined usually
unilocular radiolucency.
114. Distance between two implants: 3 mm
115. # of granulocyte for surgery? 1500 - Any ANC < 1500 cells / mm3 is considered
neutropenia, but <500 cells / mm3 is considered severe - For platelet 50.000 in dd
surgery
116. Periodontitis common in? African American, males
117. Nursing bottle caries? Options were so new and confusing never heard before
sorry don’t remember - Max incisors and molars, mandibular protected by tongue.
Early childhood caries – ECC: definition by the American Academy of Pediatric Dentistry
(AAPD)—the presence of more than one decayed (noncavitated or cavitated),
missing (owing to decay), or filled tooth surface in any primary tooth in a child
younger than 6.
Severe ECC: a. Younger than 3 years—any sign of smooth surface decay. b. Ages 3 to 5.
(1) One or more cavitated, missing (owing to caries), or filled smooth surface in
primary maxillary anterior teeth. (2) A decayed, missing, or filled surface (DMFS) score
of greater than 4 (age 3), greater than 5 (age 4), or greater than 6 (age 5). Previously
termed “baby bottle syndrome” or “nursing bottle caries.” Typical presentation of
“baby bottle syndrome.” a. Caries are present on maxillary anterior teeth and
primary molars. The mandibular incisors are unaffected because of the tongue
covering these teeth during feeding. History often reveals that the child is consistently
put to bed with a nursing bottle containing milk or a sugar-containing drink. AAPD
recommendations. a. Infants should not be put to sleep with a bottle. Ad libitum
nocturnal breast-feeding should be avoided after the first primary tooth begins to
erupt. Parents should be encouraged to have infants drink from a cup as they
approach their first birthday. Infants should be weaned from the bottle at 12 to 18
months of age. Repetitive consumption of any liquid containing fermentable
carbohydrates from a bottle or no-spill training cup should be avoided. Oral hygiene
measures should be implemented by the time of eruption of the 1rst primary tooth. An
oral health consultation visit within 6 months of eruption of the 1rst tooth and no later
than 12 months of age is recommended to educate parents and provide anticipatory
guidance for prevention of dental disease. An attempt should be made to assess
and decrease the mother’s or primary caregiver’s Streptococcus mutans levels to
decrease the transmission of cariogenic bacteria and lessen the infant’s or child’s risk
of developing ECC. In children younger than 2 with moderate to high caries risk, a
smear of fluoridated toothpaste should be used. All children age 2 to 5 should use a
pea sized amount of fluoridated toothpaste.
118. Oral infections in what leukemia: Chronic Monocytic Leukemia
119. Treatment of ranula? Enucleation, If recurrence removal of gland
120. What is mucocele? Stupid options extravasation of fluid, common in lower lip,
due to trauma to ducts of minor salivary glands.
121. Too deep PPS (Posterior palatal seal)? I put Gag - also unseated of denture
122. Beta 1 selective actions - decrease heart rate
123. Some medicine name I don’t remember, it was something like, given in lung
patients for better functions and improve asthmatic effects. Mechanism of it?
theophilline? albutamol? salbuterol? montelukast?
124. LA mechanism include all except? Read everything about it
125. Exhale wheezing sign of what? wheezing on expiration is asthma
126. Montelukast drug moa? Block the action of leukotrienes - leukotriene receptor
antagonist (LTRA) used for the maintenance treatment of asthma and to relieve
symptoms of seasonal allergies.
127. Anti-depressants?
128. Dentures major connector function Where to place rest? Stability and rigidity,
on marginal ridge
129. What happen if temp of developing solution is too high ? Dark image
130. Inc water:powder ratio in gypsum does what? Increases working/setting time,
Decreased setting expansion, decreases strength – The increase in water:power ratio
decreases the number of nuclei of crystallization per unit volume and increases the
amount of space between crystalizing nuclei, thus increasing porosity when drying.
131. Which bur is not good for porcelain?
132. Most porcelain liable to fracture: a.PFM b.zirconia c. pressed leucite, d.silicate
core
133. Common between gardener and peutz -- a polyps b odoronta c pigmentation
134. Epinephrine inc anxiety? yes, anxiety has elevated HR and epinephrine can
make the feeling worst
135. Cevimeline - For treatment of xerostomia
136. Russell bodies - multiple myeloma
137. Sarcoidosis resemble - tb
138. Can we give chlorhexidine to ADHD (attention deficit hyperactivity disorder)
child ? no
139. Pigeon chest seen in? Rickets - Pectus carinatum can also be caused by
vitamin D deficiency in children (Rickets) due to deposition of unmineralized osteoid.
140. Bond strength and more lasting of resin is more in: Dentin Enamel Both
141. Rifampin is contradicted to pregnant women? yes or no
142. Sodium hypochlorite properties: No chelating, Removes organic material
143. Tooth most involved in vertical root fracture: Max. 1st premolar..for sure..Guys it
vertical root fracture.
144. Part of facial nerve affected during TMJ pain: temporal, masseter zygomatic
cervical
145. Pemphigoid and pemphigous difference: Pemphigus- nikolsky sign and
suprabasilar cleft / Pephigoid - subbasilar cleft
146. What flow of saliva affects denture from seating – Thick
147. What would reverse LA: Phentolamine (non selective alpha blocker), its A
alpha adr antagonist
148. Tricyclic antidepressants inhibits: drugs of FIRST choice to treat UNIPOLAR
DISORDER (depression). Tricyclics inhibit neuronal reuptake of NE & Serotonin (5-HT) in
the brain, which results in potentiation of their neurotransmitter actions at post-
synaptic receptors.
149. Patient has PFM crowns and amalgam restoration, apply:
1% (not sure) neutral sodium fluoride - 2% of naf, ph= 9.2
150. What not to do in veneer:
try in paste for shade
apply silane to inner surface
apply bonding agent
etch enamel with hydroflouric acid
151. Recent research shows the relationship between periodontal disease and:
cardiovascular disease
152. Xerostomia causes all of the following except:
A.smooth surface caries
B.candiosis
C.leukoplakia
D.salivary gland infection
153. Pulpal anesthesia - Back pressure
154. Primary teeth with occlusal convergence - Max first molar
155. Short crown resistance and retention - Buccal groove
156. Xerostomia drug receptor: muscarinic
157. HIV patient prophylaxis which we cant do: Candida prophylaxis
158. White lesion on 75 yr old pt, from 19 years, what to do? Biopsy or cytology?
Relining and Observe
159. Filler disadvantage - Difficulty in polishing, decrease esthetics also
160. Bur for porcelin cutting: Diamond burs
161. Retentive arm where angaged - At the infrabulge area
162. Best material for cervical lesion – GIC
163. Occlusal rest: On marginal ridge for support
164. Orthodontic treatment consequences: Resorption
165. Systemic desensitization: teaches the person to replace the feelings of anxiety
with feelings of relaxation when the object or behavior is present.
166. Precontempling: Pt not willing to quit the habit
167. Which changes in lingual papillae results in Benign Migrating Glossitis (aka:
geographic tongue)? a) atrophy filiform b) hypertrophy filiformc) atrophy fungiform d)
hypertrophy fungiform
168. Treatment for Benign Migratory Glossitis: a. Perform Biopsy b. Administer Topical
Corticosteroids c. Reassure the patient that no treatment is required d. Administer
antibiotic therapy with ciprofloxacin(Cipro) for 10 days.
169. An ameloblastoma is most likely to develop in the wall of a dentigerous cyst.
170. Sequence treatment: Endo, perio, operative, surgery and ortho
Radiographic appearances:
1-Ground Glass appearance--> Fibrous dysplasia
2-Punched out radiolucencies--> Multiple Myeloma
3-Cotton Wool Appearance--> Paget's Dz
4-Tooth Floating in Air--> Eiosinophilic Granuloma
5-Snow Appearance--> Calcifying Epithelial Odontogenic Tumor(CEOT)
6-Honey Comb Appearance--> Odontogentic Myxoma
7-Soap Bubble Appearance--> Aneurysmal Bone Cyst, Cherubism
8-Scooped out radiolucencies at mid root level--> Histiocytosis X
9-Scalloped radiolucencies around the roots of teeth--> Simple bone cyst aka traumatic
bone cyst
10-Beaten Metal appearance on the skull--> Crouzon Syndrome
11-Enlarged marrow spaces--> Sickle cell Anemia
13-Widened PDL with dissolving bone--> Non-Hodgkin lymphoma
14-Moth-Eaten radiolucency--> external resorption
15. Salt and pepper appearance radio-graphically-COC
16.Gosth teeth appearance- Regional Odontodisplasia
17. Hair on end -Thalassemia
19.Cherry blossom- Sjogren syndrome
20.Sunburst pattern- osteosarcoma
21.Abnormal widening of PDL - scleroderma and osteosarcoma
22. Teeth floating in space - hand shuller chrestien
Sukh Singh’s RQs (JUNE 2015)
1. Lots of questions on pt management.

2. Fluoride supplement for 7 year old with no fluoridation in water = 1.0mg/day
3. 9 year old lost 2nd premolars. With space maintainer. = 9 yrs no premolars if so, band
and loop
4. Antibiotics and their side effect. Which was not matched correctly.
5. Which of following antibiotic use is restricted due to its side effect: tetracyclin,
chloroamphenicol, PNC, cephalexin = Chloroamphenicol, causes aplastic anemia
6. Pt allergic to both ester and Amine which LA would you use: Diphenhydramine can
be used as an alternative to ester and amide local anesthetics in minor procedures of
short duration.
7. Prilocaine causes methemoglobinemia = Oxidizing agents such as prilocaine are the
most common cause of acquired toxic methemoglobinemia.
8. Epinepherin in 1.8, 2% 1:100k.
9. Now working and working incline interference.
10. What is the important factor when reducing a cusp. Outline form, retention form,
resistance form or convinence
11. Medazolam overdose, which drug u give = Flumazenil - Flumazenil (Mazicon), a
benzodiazepine antagonist, used to reverse effect of benzodiazepines in the event of
an overdose.
12. Contraindication of nitrous sedation: Head injury, bowel obstruction, pneumothorax,
middle ear and sinus infections, COPD (emphysema or bronchitis – NOT ASTHMA,
there ARE NOT contraindications for the use of nitrous oxide sedation in asthmatic
patients), first trimester of pregnancy, with whom communication is difficult (autistic
patients), having a contagious disease since it is difficult to sterilize entire tubes.
13. Patient has Bisphosphonate-related osteonecrosis of the jaw (BRONJ) bronj and bone
is exposed, what is treatment? A) hyperbaric oxygen, B) sc/rp C) chlorhexidine rinse
and oral antibiotics D) ALL
14. Best test to determine a irreversible pulpitis – Thermal, cold test both reversible n
irreversible will show response but the diff is that if the stimuli is removed pain is
subsided within 5sec fr reversible. Cold test-lingering pain 15sec / Heat test to
differentiate from reversible.
15. How would you differentiate between a reversible pulpitis and periodontal lesions =
Pulp vitality test
16. How would you treat necrotizing ulcerative gingivitis with no obvious systemic
symptoms – NUG: Tissue debridement with topical or local anesthetic, rinsing with
chlorhexidine or diluted hydrogen peroxide (h2o2) and oral hygiene. If systemic:
antibiotic therapy with metronidazole or penicillin.
17. Focal distance increased from 8 to 16 Howard that intensify = Intensity = 1/4 of
distance. So when distance increases, intensity decreases.
I1 = D2 I1 = (16)2 256/64=4 4 TIMES DECREASED
I2 D1 I2 = (8) 2
18. Side effects of corticosteroids: Clouding of the lens in one or both eyes (cataracts),
High blood sugar, which can trigger or worsen diabetes, Increased risk of infections,
Thinning bones (osteoporosis) and fractures, Suppressed adrenal gland hormone
production.
19. Doing composite restoration you have 1 mm of remaining dentin thickness what
would you use for lining if any = glass ionomer cement for greater than 0.5 mm
20. Best restorative material for 13-year-old with posterior small occlusal caries not
involving interproximal areas.
21. Main cause of alveolar osteitis (dry socket): Thought to develop because of increased
fibrinolytic activity causing accelerated lysis of the blood clot - Fibrinolysis of clot
22. Main sign or symptom associated with dry socket. The patient develops severe, dull,
throbbing pain 2 to 4 days after a tooth extraction. The pain is often excruciating, may
radiate to the ear, and is not relieved by oral analgesics. (Dull throbbing pain, foul
smell, slough).
23. How convulsions are managed in dental setting: Secure the patient and avoid injuries,
proper airway.
24. Difference between fear and anxiety.
25. Pt with folded arms and looking down what do u say.
26. Child gets their dexterity by what age to brush unassisted: This is an adult job. No child
has adequate dexterity for brushing teeth until age 6-9(average 7) yrs and flossing 10
years. Tooth brush dexterity 7 yrs.
27. Systemic fluoride won't benefit which tissue- root, occlusal, inter-proximal, smooth
surface.
28. Main features of achondroplasia: ACHONDROPLASIA-the most common type of
DWARFISM. Clinically, the child appears very short (around 50 inches), fingers are
stubby, bowed legs, bulging of the forehead, bossing of the frontal bones, saddle-like
nose, and mandibular prognathism.
29. Which is not important about designing tx plan for frail woman - age, dexterity,
previous dental tx, ability to remove.
30. 1.5-2.5 year child more prone to injuries due to: accidental prone, Overprotective
parent. Abuse. No fully coordinated development.
31. pt in for #8 crown. Missing 1-4 and 12-16. How would u record occlusion: Old dental
records
32. 5 year old cavity prep, Haitian accidentally exposures mesiobuccal I'll come on what
is the best course tx. Options were pulotomy with stainless steel crown, Pulp With
calcium hydroxide followed by stainless steel crown, root canal treatment – (DPC is a
relative contraindication in primary tooth)
33. 12-year-old patient who had crown fracture with exposed pulp comes the following
day. For treatment, what is the best treatment: In young patients with immature, still
developing teeth it is advantageous to preserve pulp vitality by pulp capping or
partial pulpotomy. Also, this treatment is the choice in young patients with completely
formed teeth. Calcium hydroxide is a suitable material to be placed on the pulp
wound in such procedures.
34. A nine-year-old child suffering from some spontaneous pain on primary molar, it is
determined and this is non-vital what is the best treatment for that tooth: pulpectomy-
keep it as a space maintainer
35. Two points of Frankford plane-Porion to orbitale
36. Minimum distance of the implant two vital tissue: Generally Implant is placed at least
2mm away from any vital structure and min 5 mm ANTERIOR to mental foramen
because of anterior loop on inferior alveolar nerve
37. Order of treatment for mild to moderate chronic periodontitis: Mild: oral hygiene
instructions, moderate: scaling and root planning
38. Minimal interval for Perio therapy. 1 month. 3 month 6 month 12 month. After
periodontal treatment, the first recall visit should be scheduled at 3 months. With
excellent plaque control and maintenance of periodontal health, the interval can be
lengthened to 4-6 months.
39. Questions on OSHA and their standards for blood borne.
40. Questions on ethic principle, justice, non-malevolence, veracity, and beneficence.
41. Phases of periodontal therapy
42. Couple question on sensitivity and specificity of the disease: Sensitivity & Specificity
are INVERSELY proportional. As the specificity of a test increases, the sensitivity
decreases. Sensitivity: ability of the test to diagnose correctly a condition or disease
that actually exists. Sensitivity measures the proportion of people with a disease who
are correctly identified by a positive test. Sensitivity is defined as the number of true
positives (TP) divided by total number of potential positive findings (true positives and
false negatives) in the sample. Sensitivity = TP/TP + FN.
Specificity: ability of the test to classify health. Specificity is defined by the number of true
negative (TN) results divided by the total number of false positive (FP) + true negative
(TN) results in a sample. Specificity = TN/FP + TN.
43. Question on type of studies for example case control randomized controlled trial.
44. Few questions on chroma, Hue, value
45. Which is not risk factors of oral cancer: HIV, smoking, alcohol, HPV.
46. If a patient has an adverse reaction to medication who do you report to CDC, FDA,
OSHA, EPA.
47. Epstein-Barr virus is associated with what: BURKITT'S LYMPHOMA, Epstein-Barr Virus is
also associated with infectious mononucleosis, & orally hairy leukoplakia. In Africa,
the Epstein-Barr virus (EBV) has been linked to Burkitt lymphoma, as well as to a form
of acute lymphocytic leukemia. In the United States, EBV most often causes infectious
mononucleosis (“mono”).
48. Oral Hair leukoplakia is most commonly found which which disease: HIV
49. Malignant carcinoma is associated with which gland parotid, sublingual,
submandibular, minor oral salivary gland: Most series report that about 80% of parotid
neoplasms are benign, with the relative proportion of malignancy increasing in the
smaller glands.
50. Frequency of cleft lip and palate in Caucasian
51. Which race is associated with occlusal caries white, blacks, Native Americans,
Hispanic.
52. Length of manual toothbrush can penetrate sulcus close compared to floss
53. Which would be least effective and cleaning furcation, toothpick, soft brush, water
pick, interdental brushes
54. Another few questions and furcation
55. Least favorable solvent to store avulsed tooth. Milk, saliva, water Hans solution.
56. Extraction order of maxillary posterior teeth: 3rd molar, 2nd molar, 1st molar
57. Extraction of manibular third molars in association with IAN canal
58. Which structure is least likely to show on intro oral radiographs Mundibular foramen,
mental foramen, hamulus notch.
59. Which radiograph is best to evaluate bone loss: Bitewing - Periapical Film- film of
choice to evaluate root surfaces, supporting bone, and PDL space (not for occlusal or
proximal caries).
60. Supernumeraries occur at which stage- initation.
61. Best test for patient with warfarin. Inr, PT time etc.
62. Questions on adrenal crisis. Addison's Disease-caused by HYPOSECRETION of
aldosterone & cortisol. For adrenal crisis, treat with 2ml of cortisol (hydrocortisone) .
Corticosteroids represent replacement only in Addison's Disease.
63. Question bout space between palate and the metal frame try in but good fit on
master cast. What's the reason. Shirnkage of alloy, distortion of master impression etc.
64. Space maintenance on pt missing mans lateral in overall spaced dentition
65. Indication for 3rd molar extraction.
66. Pain on biting and eating. Thermal and ept test normal. Sharp pain on MB cusp only
and fine with biting on other cusps. - Fracture off mb cusp
67. Question bout crown lengthening.
68. Most etiological factor for progression it periodontitis. Calculus, bacteria/biofilm
Etiological: plaque( bac) - Contributing :calculus
69. Max denture extended to far buccally will get interference from- coronid process.
70. Soft tissue transillumination in young child to see. Siolathasis, leukemia, herpetic
gingivistomatitis one more option I forgot.
71. Caries start at. Pits fissure, interproximally. Above contact point. Below contact point.
72. Which is not important when determine caries rate. Oral hygiene, frequency of
carbohydrate, quantity of carbohydrates. Amount of cariogenic bacteria.
73. Cervical cavity prep. Kidney shaped
74. How to test the root caries. Softness, dicolouration. Two more options.
75. Auriculotemporal nerve damage consequences. FREY'S SYNDROME
(AURICULOTEMPORAL SYNDROME) - an unusual/uncommon phenomenon that arises
due to damage of the auriculotemporal nerve and subsequent reinnervation of the
sweat glands by parasympathetic salivary fibers. Frey's syndrome can occur after
surgery (i.e. removal of a parotid tumor, ramus of the mandible, or infection of the
parotid that has damaged the auriculotemporal nerve (branch of V3). Gustatory
sweating (sudoracion gustative) is the chief complaint. Patient exhibits flushing and
sweating of the involved side of the face during eating.
76. Which is the antibiotic prophylaxis for patients with allergic to penicillin- Clindamycin
77. Drug that not reduce saliva. Propanol, atropine, scopolamine and one more which is
similar to atropine
78. Most common type of arthritis. Osteoarthritis, rheumatoid arthritis osteoporosis
79. Bout mandibular fracture and displacement: Fracture of angle of mandible displaced
in which direction in edentuluous pt: Anterior and superior
80. Best test for pt on coumarin therapy. PT - INR
81. Facial height is divided into 3rds, 1/2, fifths.
Shreya's post
https://www.youtube.com/watch?v=u6UnG7gzscA&t=0s
https://www.youtube.com/watch?v=qnPz3Cvztvo&feature=youtu.be
INTERFERENCES CORRECTIONS
WORKING BULL (INNER INCLINES) BULL (INNER INCLINES)
LUBL (OUTER INCLINES)
NON-WORKING LUBL (INNER INCLINES) LUBL (INNER INCLINES)
PROTRUSIVE DU (DISTAL INCLINES DU (DISTAL INCLINES
FACIAL CUSP UPPER) FACIAL CUSP UPPER)
ML (MESIAL INCLINES ML (MESIAL INCLINES
FACIAL CUSP LOWER) FACIAL CUSP LOWER)
CENTRIC INTERFERENCE MU (MESIAL INCLINES UPPER) MU (MESIAL INCLINES UPPER)
(FORWARD SLIDE) DL (DISTAL INCLINES LOWER) DL (DISTAL INCLINES LOWER)
1. Lingual cusp of upper molar hit lingual inclines of facial cusp of mandibular molars,
which movement? Non working: Balancing side (non-working side) interferences
generally occur on the inner aspect of the facial cusp of mandibular molars.
2. Contact on lingual portion of buccal cusp of mandibular molar, what kind of
interference? Non working
3. Wear facets on lingual inclines of maxillary lingual cusp and facial inclines of
mandibular facial cusp on left side?
a) Left working interface
b) Protrusive interface
c) Right non working interface
d) Left working interface
4. Wear on buccal of maxillary premolars due to, due to mandibular movement?
working
nonworking
5. The mesiobuccal incline on the mesiobuccal cusp of mand molar has wear: this is
because of movement in which direction(s) !!!
1. Working and protrusive movement
2. Non working and protrusive movement
3. None of the above
6. Tooth 30 gold crown has wear located on the MB cusp of the MB incline, cause
A. protrusive and working side movement
B. protrusive and non-working side movement
C. only protrusive
D. Non-working side movement
7. Max molar on mesial slope of mesial lingual cusp where do you have wear on lower
teeth? Mesio buccal cusp of lower molar
8. The mesial angle of the ML of max 2nd molar occludes with what on the man 2nd
molar
a. Mesial MB cusp
b. Distal MB cusp
c. Mesial DB cusp
d. Distal DB cusp
9. Which periodontal procedure we cannot do in AIDS patient? Flap
10. Which bur not used in porcelain? Carbide
11. Sublingual varicoses -age or hypertension: Age or hypertension – Varicosities or
varices, are abnormally dilated and tortuous veins. Age appears to be and important
etiologic factor because varices are rare in children but common in older adults. The
most common type of oral varicosity is the sublingual varix, which occurs in two thirds
of people older than 60 years of age.
12. Vertical root fracture common in which tooth: Mand 1 molar
13. Which bacteria cause elastase and collengase: P gingivalis
14. From where caries start to progress? inner surface, outer surface, DEJ, dentin
15. Kenedy class 3, type1, which would provide best stability? rest, baseplate, major
connector, retainer - major connector for stability and especially single palatal or
anterior posterior platat strap is used for class 3. Primary function of rest is to provide
vertical support and single palatal strap is indicated in Kennedy 3 for stabilization.
16. Radiographs for Paget's disease? Lateral (Cotton wool appearance)
17. Which is not good for a 25 year old patient in a behaviour modification.,?!
A) operant conditioning B) carrotstix
18. Modified widman flap by primary or secondary? Primary when we approximate the
ends, like flap and suture, secondary we leave it open with out approximation if ends ,
like tooth extraction, scaling and root plannig , gingivectomy. Two basic methods of
wound healing (soft tissue): 1. Primary intention (also called primary closure): Involves
minimal re-epithelialization and collagen formation, allowing the wound to be
“sealed” within 24hrs. Healing occurs more rapidly with a lower risk of infection and
with less scar formation and less tissue loss than wounds allowed to heal by secondary
intention. Examples include: well-repaired and well-reduced bone fractures. 2.
Secondary intention (also called secondary closure): involves re-epithelialization via
migration from wound edges, collagen deposition in the connective tissue,
contracture, and remodeling. The site fills in with granulation tissue. Healing is slower
and results in scarring and wound depression. Examples include: extraction sockets,
poorly reduced fractures and large ulcers.
19. External bevel which used in gingivectomy is apical to pocket (junctional epi) but
coronal to mucogingival junction. Internal bevel runs apical to the crest of alveolar
bone , below mucogingival.
20. Infection of premolars drains to submand or subling? Buccal space, sublingual space
and pterygomandibular space.
21. Worst cantilever? Worst cantilever is central to lateral (not lateral to central) we
always cantilever pontic to abutment
22. How to differentiate chronic apical abscess and chronic apical periodontitis?! Both
are necrotic, so pulp vitality is negative, but for chronic apical periodontitis there may
be slight tenderness to percussion or palpation testing.
23. Initiallly caries bacteria? Stcococus, lactobacil, str salivarious, sangius?? For intial
caries its streptococcus mutans, sanguis is initial bact in plaque
24. How to decrease penumbra? To decrease penumbra use smaller focal spot, less film
to object distance, increase target to film distance.
25. Incidence of oral cancer more on?
Black male
White male
26. Thick cortical with dense trabecular bone? What type? D2, type two
27. Test with 2 continuous variable? Chi or T? 2 continuous variable: person correlation – 2
categorical variables: Chi square – 2 constant variable: linear regression.
28. Percentage of N2O and O2? In dd surgery 2 cards mention its 60%, in ada website its
70%, couple of friends had the exam and same q its either 60% in options or 70% , so it
will not come both options (For nitrous maximum 70% , and oxygen 30%)- For kids
nitrous not exceed 50%
29. Nitrous oxide is contraindicated for children with sickle cell anemia? T or F
30. Fluoride highest value? max 3 ppm in DD pedo
31. Fluoride average value: systemic: 0.7-1.2 ppm
32. Healing after scaling and root planning - regeration, long junctional epithium, repair /
Periosurgery – regeneration / Flap, by repair and forming long junctional epi - Srp is
by new connective tissure reattachment.
33. Bacteria in day 2: Gram + cocci and rod
34. Battle sign where? Mastoid echymosis, fracture of middle cranial fossa
35. What to do first in a patient with hearing problem.,?! Interpreter
36. Lymphoma in jaw name: burkitt's lymphoma
37. Operative considerations to be taken in Albright syndrome? Bisphosphonates are
used to prevent recurrent fractures and they act as antiresorptive agents
38. In kidney disease-cretine increase or decrease? Increase
39. Withdrawal of odontoblast process mainly in response to chemical, mechanical injury
40. Pigmentation related syndrome.,?!
1. Albright syndrome
2. Neurofibromatosis
41. Which drugs Shouldn't be taken during renal failure.,??? Aspirin, nsaids
42. Which is not imp about design, for frail women (weak and debilitated)? age,
dextrity,ability to remove
43. Most retained deciduous: Primary 2nd molar
44. Definition of ductility: Deform under tensile strength - Malleability under compressive
strength
45. Green colour change in porcelain indicates: silver
46. Toxic dose of fluoride.,???? 5mg/kg
47. Conditions where we have to use anaesthesia without epinephrine.,????
hypertension, multiple sclerosis, hyperthyroidism
48. In a class 2 patient with 8mm over jet, which surgery has to be performed.,?!
1. Genioplasty
2.maxillary setback
3. Sagital back
4.maxillary expansion
49. Rigidity or support nd rigidity or stability? For major connector its rigidity and stability
50. Radiolucency in primary molar at furcation area: extr/ pulpectomy?
51. Interaction bw meperdine nd mao? seizures, coma
52. Which is called whn pt charge several procedure at onces?
Upcoding. bundling, unbundling, downcoading
53. Numbeness on right lower molar ,where trauma- angle, symphysis, condyle, coronoid
54. 5mm intrusion in primary teeth what to do? No treatment and let the tooth to reerupt.
55. Bone drill temp -29, 36, 57, 70
56. Lingual flange recorded by whom: Superior pharyngeal constrictor
57. Trismus which muscle: Massser if massetric space infection - Medial prerygoid due to
IAN block puncture
58. What anesthesia posterior soft palate? Lesser palatine
59. Bur use to polish porcelain? Diamond
60. Antibiotics given in impacted tooth? Before extraction, after extraction, healing
delayed, acute suppression
61. Aspirin should stop dts 81 mg before extraction? True or false - yes as in dd, stopped 7
days before extraction
62. Frequency of cleft lip nd palate in causacian is high true or false
63. Bill out for a core build up and crown and insurance says build up is only covered,
what is this?
Bundeling
Unbundling
Upcoding
64. Downcoding
65. Dentist not reporting the waiver of copay to insurance
overbilling
downcoding
upcoding
bundling - unbundling
66. Downcoding is reimbursing less money than dentist
deserves. Upcoding is charging more than total
deserving. How it is different from bundling and
unbundling? Bundling is terming multiple procedures as
one and paying for that single one. Unbundling is
separating / disintegrating single big procedure into
several smaller ones and charging for each.
67. Multiple procedures cut down to increase
reimbursement
A. Unbundling B. Bundling C. Downcoding D. Upcoding
68. Unbunding: When dentist charge more than the actual benefits by charging a
separate fee for each component
69. Upcoding: is fault practice where the doctor bill higher than what was done.
Insurance company pays more than wat it has to pay
70. Downcoding- here the insurance company pays less by changing the code to a
lesser cost procedure
71. Dentist has done two procedures but the third party pays only for one procedure
what is it called a)underbilling b)overbilling c)upcoding d)downcoding
72. A study is designed to determine the relationship between emotional stress and ulcers.
To do this, the researchers used hospital records of patients diagnosed with peptic
ulcer disease and patient diagnosed with other disorders over the period of time from
January 2014- January 2017. The amount of emotional stress each patient is exposed
to was determined from these records. This study is :
a Cross Sectional
b Cohort
c Historical Cohort
d Clinical Trial e Case – Study
73. Which is true of intrapulpal anesthesia.
1. Produce anesthesia after 30 sec
2. It does not cause discomfort
3. Produce anesthesia by pressure
74. Deep bite most common in caucasians race T/F
75. Open bite most common in Blacks T/F
76. Is thyroglossal duct cyst congenital? T
77. Which development cyst in the neck would move when u swallow – epidermoid,
dermoid, thyroglossal
78. Intraligamentary LA needs an Antibiotic Prophylaxis in patients with risk of Endocarditis.
T/F
79. Which antibiotic okay to give in myasthenia gravis
Penicillin
Azithro
Erythro
Impenem
80. Which sterilization technique do not dull instruments? dry heat
81. Whats the most common tooth to erupt in a crossbite? Maxillary Lateral Incisor
82. Most common impacted anterior tooth--- maxillary canine
83. Most common impacted tooth --- lower 3rd molar then upper 3rd molar and maxillary
canine then mnd 2nd pm
84. Most common supernumerary tooth — mesiodens
Most common ectopically erupted tooth — maxillary permanent first molar followed by
canines - Man: canine & 2 pm
85. Most common malignancy of oral cavity—squamous cell carcinoma
86. Most common benign tumour of oral cavity — fibroma
87. Most common retained tooth – primary mandibular second molar
88. Most common recurring cyst— odontogenic keratocyst
89. Most common cyst in oral cavity— periapical cyst
90. Most common lichen planus- reticular lichen planus
91. Most common dermatosis to affect oral cavity- lichen planus
92. Most common chemical burn in oral cavity –aspirin burn
93. Most common topical fluoride in adults – stannous fluoride
94. Most common topical fluoride in children—1.23 APF gel.
95. Most common burshing technique- scrub technique
96. Most common developments cyst- nasopalati ne cyst
97. Most common complication of GA (op)-nausea
98. Most common used drug for petitmal epilepsy- no treatment
99. Most common used drug for grand mal - phenytoil
100. Most common drug used for temporal epilepsy- carbomezepine
101. Most common treatment for cyst – enucleation
102. Most common used clasp-simple circlet clasp
103. Most common used face bow in fpd- kinematic
104. Most common complication of RA involves TMJ-fibrous ankylosis
105. Most common salivary malignancy in children – mucoepidermoid carcinoma.
106. Most common salivary malignancy in palate area- ACC
107. Most common type of haemophilia--- haemophilia A
108. Most common type of gingivitis in children--- eruption gingivitis
109. Most common type of cerebral palsy is – athetoid/ spastic
110. Most common nerve involved in C sinus thrombosis – abducent nerve
111. Most common type of impaction ---mesoangular
112. Most common benign epithelial tumour---- papilloma
113. Most common complication of surgical extraction of lower third molar — loss of
blood clot
114. Most common used instrument grasp — pen grasp
115. Most common susceptible tooth for caries— mandibular first molar
116. Most common contrast media - iodine in oil
117. Most common cause of light radiographs — exhausted developer
118. Most common cause of failure of RCT— inadequate cleaning and shaping -
debridement
119. Most common isolated yeast strain from RCT— Candida
120. Most common bacteria found in root canals --- gram positive
121. Most common part of oral cavity affected by L planus –buccal mucosa.
122. Amantadine for Parkinson D T/F (prevents dopamine reuptake)
123. Which type of study cannot be used to determine cause and effect? Cross
sectional
124. Consent comes under the ethical principle? Autonomy
125. Pit and fissure sealant best retained on which teeth? max molars, mand molars,
max pms, mand pms
126. Which is the most common non odontogenic cyst in the oral cavity?
Nasopalatine
127. Clinically Lichen planus can be commonly confused with
A.scc B.verruca vulgaris C.desquamative gingivitis D.histoplasmosis
128. Traumatic cyst treatment? Aspirational, Marsupialization, Curettage
129. For flexibility which clasp use- cast alloy, wroght wire, basemetal

Rima Gandhi's post
1. Adrenal crisis: Hypoglycemia, hypotension, syncope, confusion, slurred speech.

Treatment is 100 mg hydrocortisone hemisuccinate
2. Allergic to LA: Allergic reactions to local anesthetic are usually caused by an antigen-
antibody reaction (Type III). Administer dinphenhydramine (Benadryl)
3. Patient allergic to both Esters and amides - which Local Anesthetic would you use? A.
No need of LA B. Ibuprofen IV C. NO sedation 4.Diphenhydramine
4. Hypertensive pt. Does of LA? Epinephrine? 0.04 mg epinephrine.
5. Hypertensive emergency - mecamylamine and nitroglycerin (parenteral)
hypertensive urgency - nifedipine (oral) - sublingual captopril in hypertensive crisis
6. Anaphylactic crisis: Epinephrine 0.3 mg IM or 0.1mg IV
Hypoglycemia: Conscious and unconscious pt: Conscious Orange juice - Unconscious IV
50% dextrose in water - Unconscious pt 1 mg glucagon IM
Or 50 ml of 50% glucose by rapid IV infusion
7. Acute asthma attack: Albuterol/oxygen
8. Acute asthma unconscious pt: Epinephrine
9. Hyperglycemia – insulin
10. Cardiac arrest: 911, Cpr, Oxygen then epi
11. Laryngospasm: Succinylcholine
12. CHF treatment: Diuretic, Inotropic, Vasodilator
13. Angina or heart attack: Sublingual nitroglycerin
14. Syncope: Pallor first sign - Trendelenburg position - For pregnant pat- lay her on left
side with right hip up
15. Lidocaine toxicity. Symptoms and management: CNS depression and acute allergic
rxns - treated with diazepam
16. Diuretic pt. What to avoid Digoxin: People with heart failure who take digoxin are
commonly given medicines called diuretics, which remove excess fluid from the
body. Many diuretics can cause potassium loss. A low level of potassium in the body
increase the risk of digitalis toxicity
17. Renal disease pt..what to avoid - Antibiotics of choice in such pt: Avoid mepridine
aspirin Nsaids acetaminophen morphine
18. Myasthenia gravis pt - Antibiotics of choice - Treatment – Precaution: Penicillin,
Contraindicated: mainly fluroqinolones.
19. Cerebral palsy or What to avoid: Antianxiety drugs
20. Parkinson disease: Levodopa carbidopa
21. Hearing impeared.. First to do: Get translator
Nbde Target’s Post
1. Small elevation around his anterior caries teeth? what it is ulcer or fistula ? Fistula
2. Posterior tongue in relation to occlusal plane while in rest? lower and retruded
3. Hepatitis which test: Hbs (surface) antigen
4. Circumferential clasp: generally used on a tooth-supported removable denture
5. Patient with Class II Kennedy PD, good oral hygiene and low caries index you would
use: a. Circumferential clasp b. Back action clasp c. Cast clasp
6. Wrought wire: Wrought wire clasp have greater tensile strength than cast clasps and
hence can be used in smaller diameters to provide greater flexibility without fatigue or
fracture
7. White lesion who wore denture for 15 years? Old denture, adjust and check in one
week.
8. Lesion with chronic inflammatory cells and epithelial lining filled with fibrous wall:
Granuloma - Cyst if continuous epithelial lining
9. Voice control doesn’t include - option 1) raising voice 2) gaining child attention? 3)
mild punishment
10. Sulfonylurease moa: Increase insulin production
11. Size of radiolucency increase with tooth 8 which cannot be the reason 1) apical scar
2) change in angulation 3) proximity to incised canal 3) canal leakage
12. Schedule 2 drug: vicodin, percocet, hydrocodiene + ibuprofen ? better Percocet than
Vicodin.
13. Draining pus from mandibular region which muscle news to be dissected? Abscess is
drained by a horizontal incision, made 2–3 cm below the angle of mandible. Blunt
dissection along the inner surface of medial pterygoid muscle towards styloid process
is carried out and abscess evacuated. A drain is inserted.
14. Coil spring for uprighting: open coil spring to upright a
molar. Coil spring tends to "spin" premolars unless
precautions are taken.
15. A coil spring used over an arch wire segment to regain
space should deliver a force of: A 40 to 60gms B 90 to
120gms C 150 to 300gms D 375 to 450gms
16. A buccal coil spring is used to regain space between 1st
premolar & 1st molar. The most common post treatment
complication is:
A. Pain B. Gingival irritation C. Tendency for the 1st molar to
intrude D. Tendency for the 1st premolar to rotate
17. What determines epithelium of graft? Donor epithelium - type of epithelium is
determined by donor epithelium (either keratinised or nonkeratinized), epithelium is
formed by recipients epithelium or donor basal cells.
18. Tachycardia seen in: Side effect from anticholinergic drugs.
19. Dental abnormalities in down syndrome > class 3 ear infection macroglossia
20. Initial symptom of HIS – herpes: fever, blister on lips
21. Moa of benzodiazepines? Enhance GABA - it facilitates the action of GABA
22. Not an advantage of distraction osteogenesis over osteotomies? Long time, require 2
appointment
23. Advantage of partially covered crown over fully covered? Less reduction of tooth
structure, we can do pulp vitality test
24. Tramadol/cyclobenzaprine adverse reaction with will be? Tramadol oral and
cyclobenzaprine oral both increase affecting serotonin levels in the blood. Too much
serotonin is a potentially life-threatening situation. Severe signs and symptoms include
high blood pressure and increased heart rate that lead to shock.
25. International normalized ratio (INR) is closely related to prothrombin time (PT). PT and
measures such as prothrombin ratio and IRN are measures of the extrinsic pathways of
coagulation. The PT/INR are used to determine the clotting tendency of blood. The
INR measures the effect of warfarin (Coumadin), a vitamin K antagonist, effects of
vitamin K deficiency, on clotting. PT measures Dicoumarol (INN) or dicumarol (USAN)
26. Which antibiotic works on gingiva? I think question is asking about antibiotic
bioavailability in gingiva: Doxycycline
27. Automated defibrillator? Can be given when required, Discharge when needed. The
modern automated external defibrillator (AED) abolishes the need for the operator to
have ECG interpretation skills. Analize the ECG signal. They evaluate the frequency,
amplitude, and shape of the ECG waves. They are designed to be used by people
with little training. Automated external defibrillators are available for adult and
pediatric patients.
28. Automated defibrilator, how does it work? a- monophase function b. 2 shocks c.
contraindicated below 12 year old d. discharge when needed
29. Which bacteria causes collangenase? “Clostridium perfringens” secretes
collagenase, a proteinase of “Bacteroides gingivalis” has been reported to induce
secretion of tissue collagenase, this is suggested to be involved in the etiology of
periodontal disease. “Porphyromonas gingivalis” belongs to the phylum Bacteroidetes
and is a nonmotile, Gram-negative, rod-shaped, anaerobic, pathogenic bacterium.
30. 15 year old has fever, malaise vesicle and lymphadenopathy? Primary herpetic
gingivostomatitis: Initial infections of HSVI, in some patients, the initial infection with
these viruses produces no noticeable clinical signs and can go undetected clinically.
In other patients, however, the symptoms resulting from this initial infection can be
quite severe, and it is these severe symptoms that are know as primary herpetic
Gingivostomatitis. Primary herpetic gingivostomatitis is contagious and requires careful
attention to prevent its spread. The initial infection with HSVI usually occurs in childen
or in young adults, but it can occur at any age. Primary herpetic gingivostomatitis
signs: Oral pain, difficulty in eating and drinking, swollen, red, bleeding gingiva,
painful oral ulcers, in the more severe clinical manifestation, this infection is
associated with symptoms such as pain, elevated temperature, a vague feeling of
discomfort (malaise), headache, and swollen lymph nodes (lymphadenopathy).
31. Antiviral given oral for mucous and systemic diseases? Acyclovir
32. Gingival cord disadvantages? Technique sensitive as the instrument offers poor tactile
sensation • It can potentially damage the periodontium.
33. Gingival retraction cord is placed ______ crown prep is completed and is removed
_____ final impression taken. A. After, after B. After, before – Before taking the final
impression after the crown preparation is completed, retraction cord is placed into
the gingival sulcus to enable retraction of the soft tissue. The impression will more
adequately include the cervical margin of the preparation.
34. Why do we need to keep sulcus dry when placing gingival retraction cord? Dry tissue
makes it easier to see the details of the gingival tissue and place the retraction cord.
The use of chemomechanical tissue retraction involves a cord impregnated with a
homeostatic agent such as epinephrine or aluminum chloride. The homeostatic agent
will assist by shrinking the tissue temporarily and controlling bleeding, but the
displacement of the tissue is the primary method of action.
35. Opioid causes constipation through: 1-brain receptor 2-stomach receptor 3-spinal
cord receptor - GIT receptors: Opoid increase nonpropulsive contractions in the
middle of the small intestine (jejunum) and decrease longitudinal propulsive peristalsis
- motions critical to moving food through the intestines. This results in food that fails to
travel through the digestive tract thus constipation. Morphine and other opioids in GI:
decreased peristalsis.
36. Somnolence: OPIOIDS
37. Sequestrum seen in: A sequestrum is usually a complication of osteomyelitis and
represents devascularisation of a portion of bone with necrosis and resorption of
surrounding bone leaving a 'floating' piece. The sequestrum acts as a reservoir for
infection and as it is avascular is not penetrated by antibiotics. It usually requires
excision if cure is to be achieved. This is not seen only in osteomyelits, but also in
eosinophilic granuloma, fibrosarcoma and lymphoma.
38. 3mm crowding in year old: observe
39. If a child has 3mm crowding on the lower and permanent canines haven’t erupted,
what do you do? Observe
40. Mand incisors crowding 3mm at 8 years: A.grind distal of primary mand canines
B.extract primary mand canines C.Lingual arch and observe
41. Anterior teeth finish line? Subgingival
42. Tooth borne appliances: Bionator, activator, herbst etc
43. Tissue borne appliances: Functional appliance – Frankel
44. Saw palmetto is contraindiacted with Coumadin, aspirin, blood thinners,
anticoagulants. For surgery should discontinue use of saw palmetto at least 2 weeks
before surgery due to the herb's anticoagulant effects. Saw palmetto may interact
with anticoagulants, antiplatelets, finasteride, hormonal contraceptives and hormone
replacement therapy (HRT)
45. Ginseng is contraindicatied with: Ginseng is contraindicated in acute infections,
especially those involving fever and during anticoagulant therapy.
46. According to ADA classification for alloy, a noble alloy has more than ---% nobel
metal content? 1. - 60% 2. - 75% 3. -25%
47. Large inlays and onlays comes under which classification of ADA ? A= CLASS 2
48. Porcelain adheres to metal primarily by which bond ? chemical bond (COVALENT
BOND) - The mechanical bond is a physical interlocking of porcelain and metal
made possible by microscopic irregularities in the metal. How does porcelain bond to
the alloy? Ceramic adheres to metal primarily by chemical bond.
49. Standard ¾ crown preserves which area? Buccal
50. Butt joint is the BEST or POOREST type of finish line? Poorest
51. The path of insertion of anterior ¾ crown should parallel the long axis of the tooth ?
T/F A = FALSE The path of insertion of anterior ¾ crown should parallel the incisal ½ -
2/3 of labial tooth not tooth’s long axis; if parallel to long axis, will cause more gold to
be displayed
52. Which finish line is preferred on the Cast gold restoration? A= Chamfer
53. Acrylic resins EXPANDS when immersed in water & become DISTORTED when dried
out??? T/F A= True
54. Heat (accelerator) decomposes what into free radicals which initiate polymerization
of MMA to PMMA? A = benzoyl peroxide (initiator)
55. Porcelain veneer can be given In High Caries patient???? T/F A= False
56. Gold or Porcelain, which one is more preferred for bruxit patient ? A= Gold
57. Portion of pontic approximating ridge should be as convex as possible? True
58. Which type of pontic is best for esthetics? A= modified Ridge Lap
59. Which pontic are used in case of the concave ridges? A= Ovate pontic
60. Is it fine if the pontic contacts during non- working movement ? No, it should not
61. Pontic should be convex MD and concave FL? T/F A= True
62. What displaces gases & removes corrosion products by combining w/ them or
reducing them? A= Flux (Borax)
63. Whats is the Ideal C:R Ratio for FPD? A= 1:2
64. In Case of mobile teeth in an aged patient splint natural teeth & implants in a FPD?
T/F A= No…… As the Implant has no PDL
65. Which is the most critical characteristic which is matched first in case of porcelain ?
A= Value (Brightness)
66. Which stain is most often used to change the Hue (shade) A= Orange
67. Labial Bar should be 3 or 5 mm below the ginivigal margin ? A = 3
68. In case of lower RPD which requires lessere gigival height ??? Ligual Bar or Lingual
Plate? A= Linual Plate
69. If vestibuler is less than 5 mm than which is more preferred Lingual plate of lingual bar
? A= Lingual Plate
70. Indirect Retainers prevernts the horizontal dislodgement of the Ditsal extentions base?
T/F A= false= Prevents Horizontal displacement
71. Which retainer are the most esthetic in RPD? Intra or Extracoronal ? A= Intra
72. If patient has missing 4 teeth except mandibular incisor which one you will prefer?
RPD or FPD ? = RPD
73. If denture falls when smiling, buccal notch& flange underextended ? False =
Overextended
74. Most effective time to check phonetic ? Wax Try In
75. Average interocclusal space at rest ? = 3 mm
76. ExcessiveVDO= dec reeway space; DecreasedVDO=incr freewayspace??? T
77. Best impressurion technique for pt w/loose hyperplastic tissueis to register tissue in
which position ??? Active or Passive ?? = Passive
78. What the role of Antifulx ? A =Restricts flow of solder soft graphite pencil.
79. Gypsum + Water= Endo or Exothermic ??? = Exothermic
80. MasseterMuscle–contracts or relaxes during swallowing? =Contracts
81. Which is not Determinants of Occlusion: 1)TMJ, 2)Occlusal Surface of teeth
3)Neuromuscular System 4) CO ?? = CO( Centric occlusion)
82. Who have more palatal tori ??? male or female?? = Female
83. Diabetes majorly impairs which cells ? RBC? WBC? PLATELT ? = WBC
My test questions 072017 – UMAIR SEYAL
1. Which immunoglobulin is concentrated in gingival clevicular fluid: IgG
2. Which of the following does NOT present itself in the form of Macroglossia:
Hypoparathyroidism / hyperparathyroidism – hyperthyroidism.
Causes of Macroglossia:
Congenital hyperplasia/hypertrophy. Tumors—lymphangioma, vascular malformation,
neurofibroma, multiple granular cell tumors, salivary gland tumors . Endocrine
abnormality. Acromegaly, cretinism. Infections obstructing lymphatics. Beckwith-
Wiedemann syndrome. Macroglossia, exophthalmos, gigantism. Amyloidosis
HYPOTHYROIDISM: orofacial findings include facial myxedema, an enlarged tongue
(macroglossia), compromised periodontal health. Amyloidosis, down syndrome,
Beckwith – Wiedeman syndrome, cretinism (hypothyroidism)
3. Which of the following is not associated with Melkersson-Rosenthal Syndrome?
A. Fissured tongue B. Granulematous cheilitis C. Macroglossia D. Facial paralysis
*** Classical triad of syndrome include Fissured tongue, Granulematous cheilitis and
Facial paralysis!
4. Working interference question: BULL rule – straight up asking about which cusps
occlude where in working interference.
5. Mandibular canal is on lingual of mandibular 3rd molar, by moving the x-ray sensor
inferiorly and x-ray direction superiorly which way will the canal appear to move: A)
Apical, B) Mesial, C) Distal, D) Coronal…….I picked A because SLOB rule
6. Dentist makes an xray of pt 3 molar at 0 degree vertical angulation that looks like the
superior border of mandibular canal contacts the apices of tooth. Dentist then makes
another xray at -2 degree angulation that suggest that mandibular canal is separated
from apices of 3 molar by several mm.Using information of these 2 xrays which is true
about relation of mandibular canal to the root apices of 3 molar? Mandibular canal
is: 1. superior and facial 2. superior and lingual 3. in contact with root apices 4. inferior
and facial
5. inferior and lingual
7. Informed consent can have all of the following EXCEPT: A) Informed consent must be
presented in advance of the treatment. B) Informed consent must contain treatment
options. C) Informed consent must be in written form. D) Informed consent must
contain risks and benefits of the treatment…..Weird right? I picked C – Consent may
be given in either of two formats: express and implied.
8. Which of the following are required informational elements for informed consent?
(Choose all that apply.) A. Explanation of the procedure in understandable terms B.
Reasons for the procedure and the benefits and risks of the procedure and
anticipated outcome C. Any alternatives and their risks and benefits, including no
treatment at all D. The costs of the procedure and the alternatives
9. Which of the following shows the best way of active listening? A) Rephrasing the
listener’s understanding of speaker’s communication. B) Active eye contact. C) By
sounding listener’s concern
10. Patient complains, “Why do I have to stay here for so long for you to do this, why
can’t you finish it already?” A) Because that’s how treatment works you idiot. B) That’s
how long it takes to provide quality care. C) It seems like you’re upset, may be we
can reschedule you for another day for longer appointment. D) It seems you are
upset, what are your concerns about the procedure we’re doing today?
11. Question on Type – I error, gave the test result value of 0.01 and the researchers
rejected the null hypothesis, what kind of error? Type – I / Provability of rejecting Ho
when, in fact, it is true. Accepting when it’s false is Type II. The possible values of the
probability of a type 1 error range from 1% to 0.1%. If the study is very concerned with
making a type 1 error, a lower value is used (0.01)
If the observed probability is less than or equal to .05 (5%), the null hypothesis is rejected
(i.e., the observed outcome is judged to be incompatible with the notion of “no
difference” or “no effect”), and the alternative hypothesis is adopted. In this case, the
results are said to be “statistically significant.” If the observed probability is greater
than 0.05 (5%), the decision is to accept the null hypothesis, and the results are called
“not statistically significant” or simply NS—the notation often used in tables.
12. Patient says, “My teeth hurt when I brush them”, what is an appropriate response?
don’t remember the options but it was easy one, something along the lines of oral
hygiene instructions etc.
13. Adolescent have trouble following OHI at home after getting braces. What is the most
effective way to make sure they follow the cleaning regimen? A) Ask the parents to
supervise them. B) Educate them about oral hygiene. C) Give them limited praise with
good progress at each appointment.
14. Porcelain porosity: because of Inadequate condensation
15. What is the most common process by which the porosity of porcelain is reduced?
1- condensation 2- sintering-sintered
16. Amalgam failure: Water contamination
17. What do we write the consult for: A) To gain certain information B) To gain clearance
C) To have a better relationship with patient’s physician, of course , because why not
-_- Much is written on communicating with the patient to discover why they have
consulted and to gain information about their illness.
18. Wheelchair bullshit was there too –Determine the patient’s needs, prepare the dental
operatory, prepare the wheelchair, perform the two-person transfer, position the
patient after the transfer, transfer from the dental chair to the wheelchair (use sliding, it
means every dental office should have this sliding passage for weel chair pt.)
19. What is the best method to transfer the dental "wheelchair" patient? sliding
20. Child starts throwing fits: Voice control
21. Mouth wash for disabled child? Naf or Chx or listerine? NaF
22. Disabled kid, best measure: Consistency
23. Unstimulated Salivary flow rate in an adult: A) 1L/min B) 0.1ml/ min C) 1L/min D)
10L/min
Unstimulated 0.1 - 0.5 ml/min - Stimulated >1ml/min (DD)
24. Stimulated Salivary flow rate in an adult: A) 10L/day B) 1L/day C) 0.5ml/day
25. Fluoride ppm in community water, average value: 1.0
26. Fluoride next to tooth: 4 minutes
27. Implant to implant: 3mm
28. Best Amalgam: High copper admix & spherical – smaller particle size results in higher
strength, lower flow, and better carvability. Spherical amalgams high in cooper
usually have the best tensile and compressive characteristics.
29. Copper contents over 6% (high copper alloys) eliminate the gamma-two phase by
forming a copper-tin phase resulting in superior properties.
30. Amalgam has a coefficient of thermal expansion approximately twice that of tooth
structure.
31. The tensile strength of amalgam is about one-fifth (1/5) to one-eight (1/8) of its
compressive strength.
32. Most common gland involved in salivary gland tumors: Parotid
33. Middle-aged male has a fluctuant mass in the midline of neck: A) Thyroglossal duct
cyst B) Brachial cleft cyst.
34. Question about what do you need for caries: Bacteria, supporting carbs and a
susceptible tooth
A) mucopolysaccharides B) macros C) levans D) proteins
36. Most common TMJ ankyloses caused by: A) Trauma B) Rheumatic arthritis C) random
shit
37. Histo differentiation involves which of the following: Amelogenesis and dentinogenesis
38. Blue sclera: Osteogenesis imperfecta
39. Cleidocranial dysplasia characteristic: supernumerary teeth
40. Ectodermal dysplasia: oligodontia – anodontia or oligodontia (partial anodontia)
41. Ectodermal dysplasia: scarce hair (Atrophic skin, defective hair, partial anodontia, &
hypoplastic sweat glands.)
42. Patient smokes pipe and has red bumps on palate: Nicotine stomatitis
43. Pseudoepithilomatous hyperplasia a characteristic of: A) SCC B) Verrucous C)
Pemphigus – Granular Cell Myoblastoma, The differential diagnosis of squamous cell
carcinoma (usual type) mainly includes pseudoepitheliomatous hyperplasia.
44. 85yr old elderly patient’s son brings the consent form that has name of the legal
guardian, what needs to be done before treatment? Contact the legal guardian who
has the power of attorney to get consent of treatment
45. Nerve involved in Bell’s palsy: VII – facial nerve
46. 4mm implant, how much do you need buccolingually: 6mm (1mm on each side)
47. Mandibular 3rd molar root lost: submandibular space
48. IAN block needle infection where: Pharyngeal, Pterygoid, medial pterygoid muscle -
pterygomandibular space, PSA its pterygoid plexsus. Masticator space infections are
almost always of dental origin, especially from the mandibular molar region . *Needle
tract infections after and IA block initially involve the pterygomandibular space.
49. Arch discrepancy after loss of which tooth: Mand 2nd molar
The MOST RAPID LOSSES IN ARCH PERIMETER are usually due to a MESIAL TIPPING &
ROTATION of the permanent first molar after removal of the primary second molar.
When the primary second molar is lost, ALWAYS MAINTAIN SPACE until the second
premolar arrives.
50. Which of the following is clinical sign of Leukemia: Bleeding from gums, pale
conjunctiva, fever
51. The research concludes that patients who use chlorhexidine have better oral health
than those who do not, however, other researchers say there is not much difference in
oral environment of those who use chlorhexidine or not? Paraphrased the question
but you get the jest of it……Double Blind
52. High school kids have: Marginal gingivitis
53. Cardiac arrest in children: Respiratory depression
54. Veneer facial reduction – 0.5mm
55. PFM buccal margin depth – 1.3-1.5mm was the only option that made sense
56. Patient comes back after 1 year of composite restoration with pain and sensitivity: I
picked Microleakage
57. Kid has occlusal caries on posterior molar which material will you use to restore: I
picked Amalgam because it’s better than Composite resin, however, Resin saves
more tooth structure sooooooo whatever floats your boat I guess.
58. Endo and Perio diff: Pulp vitality test
59. Endo and Perio tx: Endo first followed by Perio
60. Acromegaly causes: Excessive growth of mandible
61. Radiograph to check integrity of Zygomatic arch: CT – Do not pick Lateral
cephalometric (Submentovertex for fracture the best, but CT always better)
62. TMJ radiograph: MRI
63. MRI us used to view: disc of TMJ
64. Bechet’s syndrome associated with: Herpes simplex, Aphthous ulcers, Leukemia –
Recurrent herpetiform consists of clusters and ulcers. Patients with frequent
recurrences should be screened for diabetes mellitus or Bechet's Syndrome.
65. Mechanical damage to teeth: Abfraction
66. Chemical damage to teeth: Erosion
67. Bradycardia treatment: Atropine - Atropine is the first drug used to treat bradycardia
in the bradycardia algorithm.
68. Which is NOT used to inhibit salivary secretion: Pilocarpine - In dentistry, cholinergics
drug treat dry mouth (Xerostomia) by inducing salivation. Cholinergic drugs used are:
Pilocarpine (Salagen)- a cholinergic agonist and alkaloid indicated to treat
xerostomia caused by salivary gland hypofunction caused by radiotherapy for head
and neck cancer by stimulating salivary flow. Common side effects: excess sweating,
nausea, heartburn, and diarrhea due to the drug's cholinergic nature. Cevimeline
(Evoxac) - a cholinergic agonist indicated to treat xerostomia in patients with
Sjogren's Syndrome. Common side effects: increased sweating, nausea, heartburn,
diarrhea due to the drug's cholinergic nature. Specific for the M3 receptor on the
salivary glands.
69. Which is contraindicated in nitrous: nasal congestion
70. Target lesions: Erythema multiform
71. Radiograph to identify: the soft tissue tip of nose along the root tips of centrals
72. Radiograph to identify: external auditory meatus
depths of >4mm. B) location of anterior restorations. (I picked this instead of A
because chemotherapy causes xerostomia which leads to class V lesions) C)
location of partial denture flange
74. Over titration of Amalgam leads to: reduced working time etc etc - the longer the
trituration time the more streinght.
75. Buccal limit of mandibular denture: Masseter
76. Lingual limit of mandibular denture: mylohyoid, genioglossus, palatoglossal and
superior constrictor.
77. Case of mandibular denture and question about the efficient way of increasing
retention of the denture, this patient had partial denture with only molars and she was
tight on money so I picked extending the buccal shelves into the vestibules a bit more
because the denture flanges looked pretty short of the vestibule on both sides. There
was an option for implant too but I did not go for it due to patient’s financial concern.
Your choice really!
78. Cavernous thrombosis - infection via anterior triangle?? Canine space infections and
deep temporal space infections can result in cavernous sinus thrombosis via the
ophthalmic veins. (Mosby)
79. To anesthetize anterior teeth, which other injection would you have to administer on
top of nasopalatine nerve block? ASA nerve block
80. Tooth mostly involved in perio relapse: Max 1st molar due to trifurcation
81. Maxillary first molar is the tooth most likely to benefit from occlusal sealant placement.
82. One week after cementation of an MOD onlay on a maxillary molar adjacent to an
existing amalgam, the patient reports sensitivity to cold and pressure of the tooth. The
most likely cause is hyperocclusion.
83. Premolar with 3 roots: Max 1st
84. Which of the following is NOT true about vertical root fracture: a) It is common
occurrence in post and core teeth only. b) Extraction of the tooth is usually the only
treatment for it – there was a third option but from what I recall it was a true statement
so I went with this.
85. What’s the status of pulp when the pain goes away quickly following the removal of
stimulus:
a) normal b) reversible pulpitis c) necrotic d) irreversible pulpitis
86. Fluoride form for kids under 3yrs of age: drops
87. Best place for implant: lower anterior
88. Warfarin and Coumadin test: a) PTT b) Prothrombin to thrombin c) Tissue factor 8
d) international normalized ratio
89. Oral hairy leukoplakia: filiform
90. Best solution to keep avulsed tooth in: Hank’s or whatever it’s called - HBSS - Hank's
Balanced Salt Solution.
91. Treatment for flared out front teeth of 7yr old: No treatment because of ugly duckling
phase
92. Picture of flared out anteriors asking Class: Class II division I
93. Opioids affect: Chemotactic center - Opiates have been demonstrated to reduce
chemotaxis, phagocytosis, and the production of cytokines and chemokines.
94. Alkylating anticancer drug’s side effect: a) nephrotoxicity b) uric acid retention c)
bone marrow suppression – I thought bone suppression was the side effect of non-
alkylating anticancer drugs yet I ended up picking this just because I felt like it. - an
alkylating agent irreversibly inactivates cellular nucleic acids (DNA) and proteins. A
chemotherapeutic drug (Alkylating Agent) with adverse effects of nausea and
vomiting (75%-100%; dose-related), alopecia, xerostomia, and changes within the oral
cavity tissues (i .e. mucositis). • Mucosititis - a common reaction to cancer
chemotherapy involving inflammation of the mucous membranes. During
chemotherapy and radiation therapy, mucosal tissues begin to desquamate and
ulcerate. The mucosal integrity is broken and is secondarily infected by oral flora.
Palliative treatment is indicated for mucosititis.
95. Ginseng contraindicated for: salicyclic acid
96. Side effect of Zoloft: salivary hypofunction?? Selective Sserotonine Reuptake Inhibitors
(SSRIS): Fluoxetine (Prozac), Paroxetine (Paxil), Sertraline (Zoloft), Fluvoxamine (Luvox),
Citalopram (Celexa) & Escitalopram (Lexapro). Adverse Effects: nausea, headache,
anxiety, agitation, insomnia, and sexual dysfunction. SSRls do not have secondary
anti-cholinergic effects, thus do not cause any significant dry mouth. Selective
Serotonin Reuptake Inhibitors (i.e. Prozac) do not have an effect on NE in tissues and
interaction with a vasoconstrictor like EPI is not a problem.
97. Pseudomembranous colitis: Clindamycin usage
98. Biotransformation definition - The interaction between a drug and the living organism
in which the body brings about a chemical change in the drug. Biotransformation (or
drug metabolism) Process of converting a drug into one or more metabolites.
99. First Pass Effect - Enteral Administration (via the intestine or GI tract): Oral route is
most known for its significant hepatic "FIRST PASS" metabolism. Oral Route
Disadvantage: drugs must be absorbed (usually from the small intestine) before they
can be transported to their site of action. Blood from the intestinal tract passes first to
the liver (some drugs are metabolized in the liver "first-pass effect", while others may
be stored there to be released slowly). This consideration makes it clear that oral
administration is not suitable in emergencies or other occasions when a rapid effect is
needed. Emotional stress decreases the rate of absorption of a drug when given
orally.
100. Therapeutic effect: Safety
101. Which is False about medications taken parenterally (by injection)? They are very
reliable since you know exactly how much effect gastrointestinal system has on the
ingested meds.
102. Lack of indirect retainer: will result in denture being lifted away from tissue when
pressed on one side
103. Tuberosity hitting retromolar pad: surgery on tuberosity
104. Why not use fovea as indicator for posterior limit: because you don’t want to block
the minor salivary glands since fovea represents openings to those minor glands
105. When to remove the palatal torus: when it covers posterior palatal seal
palatal area. What will be the best course of action: Use horseshoe design to avoid
the torus
107. Most common gland for sialolith: Submandibular
108. Most common salivary gland tumor: Pleomorphic
109. Gingival graft contraindicated when: a) pocket is below the alveolar crest b)
pocket is below free gingival groove c) excessive keratinized tissue
110. Patient swallowed a crown where is it most likely for it to end up: a) left bronchus b)
right bronchus c) trachea d) paranasal sinus
111. Picture to identify Fluorosis
112. Graft between same species but genetically different individual: Allograft
113. Anesthetic that is vasoconstrictor: Cocaine
114. Cross allergy for anesthetics: know esters and amides - For patients allergic to ester
and amide local anesthetics, DIPHENHYDRAMINE is a safe and effective alternative.
Lidocaine and Mepivacaine are most likely to show cross-allergy.
115. Which anesthetic is good without vasoconstrictor: Mepvicaine
Prognosis: A) fixed bridge from #10-12. B) RPD with pontic for #11 – I picked this,
however, I think I should have picked A, your call. C) Implants
117. Rifampin used for: tuberculosis
118. Penicillin moa: transpeptidase – Inhibits Transpeptidase, stage 3 in cell wall synthesis
119. Manic depression: lithium - Antimania drugs are used to treat manic-depressive
illness. A. Drugs: 1. Lithium. 2. Carbamazepine. 3. Valproic acid. 4. Lamotrigine. B.
Mechanisms of action. 1. Lithium works inside the cell to block conversion of inositol
phosphate to inositol.
120. Parkinson’s: lack of dopamine – In Parkinson's disease, nerve cells in the BASAL
GANGLIA DEGENERATE, causing decreased dopamine production.
121. Lidocaine: Ventricular arrhythmia - Ventricular arrhythmias can be treated by an
intravenous injection of lidocaine
122. Lidocaine calculation question
123. Oral contraceptives failure: Rifampin - Rifampin lowers the effectiveness by
decreasing the birth control hormone levels (ethinyl estradiol and progestin) in women
taking oral contraceptives.
124. Aplastic Anemia: Chloramphenicol - CHLORAMPHENICOL (CHLOROMYCETIN) - a
broad-spectrum antibiotic that can cause BONE MARROW DISTURBANCES (aplastic
anemia) thus, has LIMITED USE due to its side effects.
125. Bone penetration, which drug: Clindamycin – For endodontic infections that do not
respond to penicillin, clindamycin is recommended as it produces high bone levels,
and is effective against anaerobic bacteria.
126. Grand mal seizure: Phenytoin - Phenytoin (Oilantin)-treats tonic-clonic (grand mal)
seizures. Also, Carbamazepine (Tegretol) = Trigeminal neuralgia and tonic-clonic
seizures (grand mal)
127. ADA recognizes as dental specialty: dental public health
128. Informed consent: Autonomy
129. Child has signs of abuse, you try to question the mother but she seems reluctant.
What do you try to pay attention to while talking to her? Answer was something like
pay attention to micro-expressions, you’ll know when you’ll see it.
130. Improvement after Endo treatment is most likey after: 1 year
131. Telling patient about risks and benefits of a treatment is a part of: Autonomy
Avneet G Aulakh’s RQs JULY 2017
3. Primary tooth has the most effect on space loss: Upper canine, Upper first molar,
Upper second molar, Lower first molar, Lower second molar
4. Disadvantage of widman flap and know the procedure of widman flap
Horizontal incisions for full-thickness flaps— three horizontal incisions are usually
associated with a full-thickness flap design. (1) The first is the internal bevel incision -
depending on the goal, this incision can be made 0.5 to 1 mm from the free gingival
margin (apically displaced flap), 1 to 2 mm from the free gingival margin (modifed
Widman flap), or just coronal to the base of the pocket (undisplaced ap). It also is
known as the reverse bevel incision. This incision removes the pocket lining, conserves
the outer dimension of the gingiva, and produces a thin sharp flap margin that can
be adapted to the bone - tooth junction. (2) The second is the crevicular incision —
made from the base of the pocket to the crest of the alveolar bone. The combination
of the internal bevel and crevicular incisions creates a collar of tissue around the
teeth. (3) The third is the interdental incision —this incision separates the collar of
gingiva from the tooth. Reflection of the flap after placement of these three incisions
allows for visualization of the alveolar bone. The modified Widman flap uses the three
horizontal incisions described previously but is not reflected beyond the mucogingival
line. This flap design allows for removal of the pocket lining and exposure of the tooth
roots and alveolar bone but does not allow for apical repositioning of the flap.
5. Modified Widman flap is a replaced flap. T/F - A replaced flap (also called
repositioned flap and modified Widman flap) is one that is repositioned in or near its
original location
6. Which of the following is the best for alveolar bone and root debridement?
1) mucoperiosteal flaps 2) modified Widman flap 3) partial thickness flap
Three incisions are made in the modified Widman flap — internal bevel, crevicular, and
interdental. It is designed to provide exposure of the tooth roots and alveolar bone.
7. Modified widman flap is an undisplaced flap? T/F - THE UNDISPLACED FLAP Ø Most
commonly performed type of periodontal surgery. Ø It differs from the modified
Widman flap in that the soft tissue pocket wall is removed with the initial incision; thus
it considered an internal bevel gingivectomy.
8. Which graft uses the three horizontal incisions but is not reflected beyond the
mucogingival line? A)Undisplaced flap B)Apically displaced flap C)Modified Widman
flap D)Pedicle graft
9. Which would eliminate pockets? a) modified widman flap b) apically positioned flap
c) undisplaced flap
10. Which of the following flap techniques is used to eliminate or reduce pocket depth?
select all that apply 1- modified widman flap 2- undisplaced flap 3- apically
displaced flap - MWF - remove pocket lining not pocket depth, it says used in order to
simplify instrumentation and removal of the lining, the reduction in pocket depth is
due to the healing shrinkage.
MWF: Facilitates instrumentation but does not attempt to reduce pocket depth. The
modified Widman flap (MWF) facilitates instrumentation but does not attempt to
reduce pocket depth. The reduction or elimination of pocket depth is the main
purpose of two flap techniques: the undisplaced flap and the apically displaced flap.
The decision of which to perform depends on two important anatomic landmarks: •
Pocket depth • Location of the mucogingival junction *** These landmarks establish
the presence and width of the attached gingiva, which is the basis for the decision.
The modified widman flap has been described for exposing the root surfaces for
meticulous instrumentation and for removal of the pocket lining. This flap uses the
three horizontal incisions but is not reflected beyond the mucogingival line. Note: It is
not intended to eliminate or reduce pocket depth, except for the reduction that
occurs in healing by tissue shrinkage. The undisplaced (unrepositioned) flap, in
addition to improving accessibility for instrumentation, removes the pocket wall,
thereby reducing or eliminating the pocket. This is essentially an excisional procedure
of the gingiva. Note: Currently, the undisplaced flap may be the most frequently
performed type of periodontal surgery. It differs from the modified Widman flap in that
the soft tissue pocket wall is removed with the initial incision; thus it may be considered
an internal bevel gingivectomy." The undisplaced flap and the gingivectomy are the
two techniques that surgically remove the pocket wall. The apically displaced flap
also improves accessibility and eliminates the pocket, but it does the latter by apically
positioning the soft tissue wall of the pocket. Therefore, it preserves or increases the
width of the attached gingiva by transforming the previously unattached keratinized
pocket wall into attached tissue. Remember reduction or elimination of the pocket
DEPTH: apically and undisplaced, and the 2 techniques to remove the pocket WALL is
undisplaced and gingivectomy. dont get confuse.
11. Bacteria in red complex: P. gingivalis, T. forsythensis, T. denticola
12. Predominant cells in GCF: GINGIVAL CREVICULAR FLUID (GCF) - in health, GCF is a
transudate that emerges from the gingival sulcus. GCF may contain a variety of
enzymes and cells, particularly desquamating epithelium & neutrophils (PMN) being
shed through the sulcus. An increase in GCF flow is the first detectable sign of
inflammation. Once inflammation has occurred, GCF is called inflammatory exudate
which contains a higher level of serum proteins and leukocytes.
13. There were 3 ques regarding composite like composite is intact but discolored what
will u do: In our study, 60.5% of the composite fillings with brown discolorations at the
margin were caries free. That means, if there are discolorations of the margins of
composite fillings without any evidence of decay, the filling does not need to be
removed completely.
14. You have a class 3 composite that is fully functional, margins intact, just some
discoloration at margins... what do you do? 1- replace it 2-cut 1mm and fill 3-just
polishing
15. Which of the following causing discoloration along the gingival margin of a PFM
crown? A) Copper B) silver - Gingival - copper - Anywhere else in the crown- silver
16. Whats the difference between Cementoma, cemento-osseous dysplasia and
cementoblastoma? Cementoma = cemento osseus dysplasia = periapical cemental
dysplasia , the lesion is within the bone , osseus deposition , it is a reactive lesion
rather than neoplastic, response of periapical bone to some local factors (trauma
from occlusion), two or more teeth affected. - Cementoblastoma = true cementoma,
is cemental deposition attached to the tooth most common in the mandible posterior,
neoplasm, always radiopaque, one tooth. - Radiographically: cementoblastoma:
mand posterior teeth , integerated with the root of the tooth , can not differentiate
the root from the lesion . Single tooth. Always opaque. To distinguish
cementoblastoma forom condensing osteitis (CO) – in CO you can distinguish the root
outline - Periapical cemento dysplasia (cemento osseous dysplasia): mand anterior
teeth, the lesion is close to the root. 2 or more lesions must be there. The lesion has 3
stages 1) radioleucent 2) radiopaque pits 3) completly radiopaque.
17. Cemento osseous dysplasia ... more in ant mand middle age African females ... You
have to choose exception - Clinical Features: occurs at the apex of vital anterior
teeth, affecting women over age 30yrs (especially BLACK women) more than men.
Asymptomatic, usually multiple, small periapical areas of radiolucency in the
mandibular incisor area. Depending on the stage, a cementoma may appear
radiolucent, mixed radiolucent & radiopaque, or completely radiopaque.
18. Cleft palate, mand hypoplasia and tongue obstruction - PIERRE-ROBIN SYNDROME -
an inherited disorder with the following findings in the NEONATE: Micrognathia-
smallness of the jaws. Glossoptosis - downward displacement or retracted tongue.
Breathing problems & Cleft Palate. PIERRE ROBIN SYNDROME - a hereditary disorder
that presents micrognathia (smallness of the jaws), glossoptosis (downward
displacement or retraction of the tongue), & a high-arched or cleft palate. Most
children require orthodontics.
19. Conditions associated with multiple supernumerary teeth: Gardener's syndrome,
Down's syndrome, Cleidocranial dysplasia, & Sturge-Weber Syndrome.
20. Polyps is seen is which of the following condition? A) Garden syndrome. B) Petuz
jegher. C) Crohn’s. D) All of the above.
21. Which is related to taurodontism 1. cleidocranial dysplasia 2. gardener syndrome 3.
downs syndrome 4. amelogenesis imperfect, ONLY TYPE IV
22. Multiple Osteomas of jaw are seen in: a. Gorlin Goltz syndrome b. Peutz Jeghers c.
gardener syndrome d. cleidocranial dysplasia - Gardner's...in A we would see multiple
OKCs
23. Cafe ul lait is seen in: A. gorlin syndrome B. gardeners syndrome C. PJS (peutz jeghers
syndrome) D all
24. Gardener syndrome: Clinical - osteomas, odontomas, fibromas, epidermal cysts,
supernumerary/ impacted teeth, intestinal polyposis (very serious complication) - R/g
--- multiple osteomas which give COTTON WOOL APPEARANCE.
25. What is common in gardener syndrome and cleidocranial syndrome?? 1. intestinal
polyps 2. intraoral pigmentation 3. impacted supernumerary teeth 4. osteoma of skull
and jaw
26. Neurofibromatosus - for syndromes they gave u option u have to recognize - VON
RECKLINGHAUSEN'S DISEASE (NEUROFIBROMATOSIS) - the most outstanding feature is
NEUROFIBROMATOSIS (condition of multiple tumors of nerve tissue origin). VRD is a
relatively common inherited autosomal dominant trait characterized by multiple
neurofibromas, cutaneous cafe-au-Iait macules, bone abnormalities, & CNS changes.
Clinical Signs: presence of 6 or more cafe-au-Iait macules > 1.5cm in diameter
indicates VRD unless proven otherwise. Treatment: there is no satisfactory treatment.
The lesions run a high-risk of transforming into a malignancy. A single neurofibroma
presents at any age as a non-inflamed, asymptomatic nodule that occurs on the
tongue, buccal mucosa, & vestibule. This single nodule is removed by surgical
excision, and rarely occurs. Cafe au lait spots, axillary freckling, lisch spots (iris
spots).
27. Pt (young child) w/nodules on right side of tongue that are fluid filled the rest of the
mouth is WNL(within normal limits)no other systemic signs. A neurofibromatosis B
Lymphangioma C Granular cell tumour
28. Café au lait is seen in all except which one? a) Fibrous Dysplasia b) Neurofibromatosis
Type 1 c) Melkerrson-Rosenthal syndrome d) McCune Albright Syndrome
29. There was picture with multiple periapical radiolucencies - for answered cemebto
osseous dysplasia may be the Florida one. Periapical Cemental Dysplasia (periapical
cement – osseous dysplasia): The most common presentation is a middle age female
with multiple periapical radiolucencies in relation to lower anterior teeth.
30. What make penicillin allergic: beta lactam ring, which causes the allergy. Sometimes,
patients with penicillin allergy produce the IgE antibody to the side chain of the drug
and not to the beta-lactam ring
31. Montelukast (Singulair) is a bronchodilator used for asthmatic attach by which
mechanism of action: A. Histamine competitive antagonism B. Beta 2 adrenergic
agonism C. Baroreceptor reflex D. Leukotrienes receptor antagonism – antagonizes
leukotriene receptors thus dreasing bronchoconstriction and inflammation
32. Antidepressants serotonin: Tricyclic antidepressants are generally considered to be
the drugs of first choice for treatment of depression. These drugs inhibit the neuronal
reuptake of NE and SEROTONIN in the brain. It inhibits the reuptake that means
antidepressants make serotonin stay in brain for a longer time.
33. Selective serotonin re-uptake inhibitor drug with the longest half-life (SSRI)? Fluoxetine
(Prozac)
34. Which two groups of antidepressant drugs has the highest incidence of dry mouth?
1)Tricyclic antidepressant 2) selective serotonin reuptake inhibitors 3)serotonin and
norepinephrine reuptake inhibitors 4)MAO inhibitors – DD#56 These two categories of
antidepressant drugs induce significant dry mouth in up to 75% of patients taking
these medications. These effects are due to the secondary anticholinergic nature of
these agents.
35. Girl with gingival bleeding and recurrent infection - leukemia - Acute lymphocytic
(lymphoblastic) leukemia-largely confined to children (it is the most common
leukemia in children. Lymph node enlargement is common. In 75% of cases, the
lymphocytes are neither B nor T cells, but are called "null" cells. Bone and joint pain
are common in children.
36. Least recurrence options were AOT, odontogenic myxoma, ameloblastoma, okc - The
AOT (ADENOMATOID ODONTOGENIC TUMOR) is a benign epithelial tumor with a
dense fibrous connective tissue capsule, which does not recur once removed.
37. Which of the following isn’t developmental: a) OKC b)AOT c)dentigerous cyst
d)residual cyst
38. Questiom regarding dentist and placebo I had no idea ..
39. Dentures major connector function: Major connectors: The function of the major
connector is to connect all the RDP components of one side of the arch with the
opposite side to unite them. Provides stability to resist displacement while in function.
Major connector should be rigid and not be placed on movable tissue. Undercut
areas and soft and bony prominences (e.g., tori, median palatal suture) should be
avoided, removed, or relieved, depending on the severity. Relief should be provided
to prevent tissue impingement secondary to distal extension denture rotation.
40. RESTS - the primary purpose of any rest (occlusal, cingulum, or incisal) is to provide
VERTICAL SUPPORT for the RPD.

41. A minor connector is a rigid component that connects the major connector or base
with other components of the partial denture such as rests, indirect retainers, and
clasps.
42. Lingual Bar-more popular than a labial bar. A lingual bar is placed so its upper border
is at least 4mm below the gingival margins. When severely tipped premolars and
molars are present, an alternate framework design or crowns are recommended.
Lingually inclined mandibular premolars interfere most frequently with mandibular
major connectors.
43. Lingual Plate- a lingual bar that has been extended upward to cover the cingula and
interproximal spaces between mandibular anterior teeth. It should be thin and follow
the contours of the teeth and embrasures. The upper border should be located at the
middle 1/3 of the lingual surface of the teeth and extend upward to cover
interproximal spaces to the contact point. Severe anterior crowding is a
contraindication for using a linguoplate.
44. ADA classifies alloys as follows: Type I: used for small inlays. Type II: larger inlays
&onlays.
Type III:onlays, crowns, and short-span FPDs. Type IV: thin veneer crowns, long-span FPDs
&RPDs.
45. Where to place rest: occlusal, cingulum (lingual), or incisal
46. What happen if temp of developing solution is too high: reduces development time.
Set timer—typically 5 minutes at 68° F. shows effect of temperature on development
time.
Developers (1) Phenidone is as the first electron donor that reduces silver ions to metallic
silver at the latent image site. (2) Hydroquinone provides an electron to reduce
oxidized phenidone back to its original active state so that it can continue to reduce
silver halide grains to metallic silver.
47. 8yr old boy ..crowding in incisors ...canines r yet to erupt ..what to do ?? extraction of
primary canines ..stripping ..place lingual Arch and observe
Space maintenance (in cases where primary teeth have been lost and space is
otherwise adequate). a. Band and loop. b.Distal shoe (before eruption of a
permanent molar). c. Lingual arch. d. Nance appliance (maxillary arch). Space
regaining (localized space loss)— indicated when space loss is minor (<3 mm):
Removable appliance with finger springs to tip teeth distally, Headgear (for the
maxillary arch), Activated lingual arch (for the mandibular arch), Lip bumper (for the
mandibular arch), Limited fixed appliances: Followed by placement of a space
maintainer after space is regained.
Moderate crowding (<4mm): arch expansion (this is a controversial topic), extraction
of primary canines: Borrows space until permanent teeth erupt. Lingual arch
necessary if mandibular primary canines are extracted because the permanent
incisors will upright lingually and space will be lost. Severe crowding (>4mm): serial
extraction – usually reserved for large space discrepancies (>10mm per arch)
48. Sequence of extractions. (a) Extraction of primary incisors, if necessary. (b) Extraction
of primary canines to allow permanent incisors to erupt and align. c) Extraction of
primary 1rst molars to encourage eruption of the permanent 1rst premolar (ideally,
before the permanent canine erupts). (d) Extraction of permanent 1rst premolars to
allow the permanent canine to erupt and align.
49. Best way to gain max info about pain..options were tell me about ur past dental
experience ....so this hurts u ....I answered 1 one on the basis v shouldn't ask direct
ques
50. Spontaneous pain at night pt wake up..had lingering pain from cold from a week
options were irreversible pulpits or pulp necrosia - NECROTIC PULP (PULP DEATH) - may
have no painful symptoms and does not respond to EPT at any current level, but the
tooth sometimes responds to heat, but will not respond to cold. A tooth affected with
a necrotic pulp may have no painful symptoms and may appear discolored. EPT is
valuable because there will be no response at any current level. Treatment: RCT or
extraction.
51. Patient was having diastema ...in que they ask what is that radiolucencies between
upper incisors .... Options were intermax suture inciaive canal and follicle of
mesiodense: incisive foramen - A small ovoid or round radiolucent area located
between the roots of the maxillary central incisors / superior foramina - Two small
round radiolucencies located superior to the apices of the maxillary central incisors /
median palatal suture - A thin radiolucent line between the maxillary central incisors
52. There was questions on impression material regarding their hydrophobic and phillic....I
don't remember exactly
53. Inc water powder ratio in gypsum does what: Water-Powder Ratio: this is an important
factor in determining physical properties. When a high proportion of water is used, the
powder particles are farther apart, resulting in less expansion with a retarded setting
time and weaker product. Dental plaster requires 2x more water has a higher setting
expansion than dental stone. • When mixing gypsum products always SPRINKLE the
powder into the water to produce better powder mixing and to reduce air bubbles. •
When gypsum products are mixed with water, heat is given off (exothermic reaction)•
Exposure of a stone cast to tap water should be minimized to prevent eroding of the
cast. Water Temperature: colder the water, the LONGER setting time.
54. Simple ques regarding pulpectomy
55. I had couple questions to differentiate between irreversible pulpits and pulp necrosis
...so learn their sign and symptoms well
56. Porcelain adheres to metal primarily by a CHEMICAL BOND. A covalent bond is
established by sharing 02 with elements present in the porcelain (silicon dioxide (Si02)
and metal alloy (oxidizing elements like silicon, indium, &iridium).
57. Resistance form in a cavity preparation is achieved by pulpal and gingival walls
perpendicular to occlusal forces and proper angulation of cavity walls.
58. Which bur is not good for porcelain?????
59. Distance between implants 3mm, 1.5 implant – tooth, implant 4mm width.
60. Adv of implant over fpd

61. Less recurrent caries propioception there were two more options I forgot
62. 5mm intrusion of primary tooth - Unless it can be determined that the primary tooth is
impinging on the permanent successor, intruded primary teeth are left alone in the
hopes that they will spontaneously reerupt. Intruded permanent teeth have a poorer
prognosis. If there is an open apex, an intruded permanent tooth should be closely
monitored for spontaneous eruption. An intruded permanent tooth with a closed
apex should be repositioned orthodontically, and a calcium hydroxide pulpectomy
should be performed 2 weeks after the injury.
63. A 4-year-old had traumatic intrusion of tooth E, and 50% of the crown is visible. What is
the treatment? A. Reposition, splint, and endodontics /react-text B. Reposition, splint,
and formocresol pulpotomy /react-text C. Reposition and splint /react-text D. None of
the above – Wait for spontaneous reeruption. DD SAYS FOR NATIONAL BOARDS
ANSWER NO TREATMENT AND LET IT REERUPT
64. Sodium hypochlorite properties: Sodium hypochlorite (NaOCl). a. Indications. (1)
Disinfection of root canal. (2) Dissolving organic matter — proteolytic material. (3)
Does not remove smear layer. (4) Concentrations vary from 0.5% to 6%.
65. After crown on mand molar mandible gets deflected to working side ..They ask u to
mention cusp and inclines of mandible involved
66. Best way to decrease fear of child. I said sit down to child's level - When treating a
child who is obviously afraid, the dentist should permit the child to express his fear
(identify the fear). All behavioral patterns are motivated by anger and fear. The crying
child is NOT an abnormal child. Anger is easier to treat than fear. Fear is most likely
exhibited by a young child on his first visit to the dentist, and is related to anxiety over
being separated from a parent. The PARENT (not the dentist, has the greatest
influence on the child's reaction at this initial visit. Child Control Techniques: Angry
Child: Separate the parent and child, and place the child in the chair abruptly and be
firm. Use "hand-over-mouth" technique (HOME) after getting the parent's permission!
Display authority and command the child's respect by continuing with treatment even
if he/she is uncooperative. Comfort the parent at the end of the visit, and compliment
the child at the end of the visit. Fearful Child: • Have the parent stand quietly behind
the chair. • Dentist must be consistent in tonal quality. • Allow the child to express his
fears (identify the fear). • Change the child's focus off fear. • Lastly, sedation. Tell-
Show-Do.
67. A S2-year old women requests extraction of a painful mandibular 2nd molar. She tells
you she has not rested for two days and nights because of the pain. Her medical
history is unremarkable, except that she takes 20mg of Prednisone daily for Erythema
Multiforme. To treat this patient, you would give steroid supplementation and remove
the tooth with local anesthesia and sedation. • The fear here is that the patient may
not have sufficient adrenal cortex secretion (adrenal insufficiency) to withstand the
stress of an extraction without taking additional steroids (this hold true for any patient
treated for any disease with steroid therapy). • Erythema Multiforme- hypersensitivity
syndrome characterized by polymorphous eruption and mucous membranes.
Macules, papules, nodules, vesicles, or bullae and target ("bulls-eye-shaped") lesions
are seen. A severe form of this condition is "Stevens-Johnson Syndrome". These
patients may be receiving moderate doses of systemic corticosteroids, thus may be
unable to withstand the stress of an extraction. Consultation with their physician is
absolutely necessary before treating these patients.
68. Dentist asks a child u want me to help you to sit on the chair ...how to define this
situation one option was perceived.
69. Helplessness - rest I don't remember
70. Tooth most involved in vrf: incomplete fracture – mandibular first molar. Horizontal root
fractures occur more commonly in maxillary central incisors and result from the direct
application of traumatic force to the face, alveolar processes, or teeth. In contrast,
vertical fractures usually involve the molar teeth in adults. Mandibular molars and
maxillary premolars are the teeth that most frequently have occult vertical root
fractures. Max/mand PMs, mesial root of mandibular molars, mandibular incisors,
mesio buccal root of maxillary molars. Demographic studies have shown that the
most common teeth implicated in vertical fracture are mandibular first and second
molars (42% of all fractures).
71. A tooth with a vertical root fracture has a POOR prognosis. Studies show most vertical
root fractures are caused by using too much condensation force during obturation
with gutta-percha. Vertical root fracture has a poor prognosis. 1. Occurs along the
long axis of the tooth. 2. Often associated with a severe periodontal pocket in an
otherwise periodontally sound dentition. 3. Can be associated with a sinus tract. 4.
Can be associated with a lateral radiolucency extending to the apical portion of the
root fracture. 5. A fracture can be identified only with visualization, and surgery is
often necessary to confirm the fracture. C. How vertical fractures occur. Can occur
after the cementation of a post. 2. Can be the sequela of excessive condensation
forces during obturation of an underprepared or overprepared canal. a. Prevent
fracture via appropriate canal preparation. b. Prevent fracture via balanced pressure
of condensation forces during obturation. D. Treatment of vertical root fractures. 1.
Removal of the involved root in multirooted teeth or extraction. Results in extraction of
single-rooted teeth.
72. Most important in prognosis of tooth ...clinical attachment - The MOST critical factor to
determine if a tooth should be extracted or have surgery (prognosis) is AMOUNT OF
ATTACHMENT LOSS (the amount of apical migration of the epithelium attachment).
Amount of attachment loss is the most important factor in the determination of a
prognosis of a tooth with periodontal disease (more accurate than probing depth,
tooth mobility, and presence of furcation involvement).
73. Gingivectomy CI and technique: GINGIVECTOMY - surgical procedure that eliminates
pocket depth by resecting the tissue coronal to the pocket base. The final aspect of
the gingivectomy is to bevel (contour) the wound's coronal margin to provide the
most physiological shape and marginal thickness so adequate oral hygiene
techniques can be performed. Indications: treating pseudopockets, hereditary
gingival enlargement, suprabony pockets, and hyperplasia caused by Dilantin
therapy. Contraindications: infrabony pockets (defects) and lack of attached tissue.
Limitations include compromised esthetics with longer teeth, lack of access to bony
defects, and having a broad, open wound post-surgically. Factors to consider when
electing to perform a gingivectomy rather than a periodontal flap: pocket depth (if
the base of the pocket is located at the mucogingival junction or apical to the
alveolar crest, do not perform a gingivectomy); need for access to bone; and
amount of existing attached gingiva.
74. There was a question regarding pain on biting ..I answered cracked tooth - Prolonged
sensitivity to heat, cold, and pressure after cementing a crown or fixed bridge is
usually related to OCCLUSAL TRAUMA. If CR occlusion is high, patient complain of
cold sensitivity and pain on biting down hard. Endodontically treated teeth restored
with a cast post, core, and crown are subjected to the high incidence of VERTICAL
ROOT FRACTURE. The main symptom is almost always PAIN WHEN BITING, and the
radiograph usually appears normal.
75. Adv of stainless steel over ni titanium: SS files r more fracture resistant than Ni-Ti files
76. Maxillary Incisors &Canines: ALL have 1 root, 1 canal, & a distal axial inclination. Thus,
when penetrating along the long axis of the tooth, the bur must be slightly angled
toward the distal surface to avoid perforation of the mesial portion of the root. (DD)
77. MOD amalgam ...fracture on occlusal surface but not at isthmus wat to do ...options
were polished out of occlusio..n observe .. take mo re do piece separate and rest I
forgot - Fracture of a Class II amalgam restoration at the junction between the
occlusal and proximal portions is the result of inadequate resistance form. When
placing a Class II amalgam in a primary tooth, with isthmus width should be 1/3 of the
intercuspal width. If an amalgam fracture occurs, it is most likely to occur here. A
successful amalgam restoration requires 90- degree amalgam margins. Amalgam
margins less than 90 degrees result in increased potential for fracture of the amalgam.
Greater than 90-degree amalgam margins are good for the amalgam, but the
corresponding enamel margin is less than 90 degrees and potentially undermined
and prone to fracture. Because the amalgam is not bonded to the tooth, it must be
retained in the tooth with undercuts, in either the primary or the secondary
preparation. An amalgam restoration needs a minimum 1-mm thickness in nonstress
areas and 1.5- to 2-mm thickness in areas that may be under load. The preparation
must provide this dimension. Except for class V amalgams, the prepared walls
generally converge to the exterior.
78. Shape of mand access prep: Mandibular central incisors and canines – OVAL,
mandibular PMs – OVAL, mandibular molars – TRAPEZOIDAL.
79. If pt injects LA intravs wat will happen ..there was an option tachycardia I answered
that - LIDOCAINE is the local anesthetic that may manifest its toxicity clinically by
initial depression and drowsiness (rather than stimulation and convulsion). The initial
effect on the brain for local anesthetics is usually stimulation, then depression.
However, it is possible that the excitatory phase of the reaction may be extremely
brief, or may not occur (this is true especially with lidocaine and mepivacaine)
causing patients to feel drowsiness. *lidocaine & Mepivacaine can also show cross-
allergenicity. Usually, the FIRST clinical sign of mild lidocaine toxicity is NERVOUSNESS.
Mild toxicity can be caused by an intravascular injection, unusually rapid absorption,
or too large a total dose of the local anesthetic. Clinical manifestations of a mild
lidocaine toxicity related to CNS excitation. Nervousness (increased anxiety),
talkativeness, muscular twitching, perioral numbness, increased HR, BP, RR. Lidocaine
can skip the excitatory phase and go straight to the depression phase (drowsiness). If
the clinical manifestations do not progress beyond these signs with retention of
consciousness, no definitive therapy is needed. The lidocaine will undergo
redistribution and biotransformation, and the blood level will fall below the toxic level
in a short time. Treatment of a sustained convulsive reaction to a local anesthetic
includes oxygen and Diazepam IV. If proper equipment and adequately trained staff
are unavailable, do not attempt injections. Possible side effects of lidocaine systemic
absorption (not necessarily toxic levels) are tonic-clonic convulsions, respiratory
depression, and decreased CO.
EPI treats bronchospasm associated with hypotension (i.e. anaphylaxis). EPI is the
agent of choice to treat/reverse anaphylactic reactions (given sublingually or
subcutaneously) because it has desirable vasopressor activity, bronchodilator
properties, and has a rapid onset of action. EPI has stimulatory effects on a & b
adrenergic receptors. EPI treats hypersensitivity reactions. Common EPI side effects:
headaches, agitation (anxiety), and tachycardia. EPI is used with caution in patients
with high BP and hyperthyroidism. These patients may have an increased sensitivity to
EPI.
80. The major reason that EPI vasoconstrictor is added to local anesthetics is to prolong
the activity/duration of the local anesthetic (anesthesia) by decreasing the rate of
diffusion and absorption from the injection site. EPI is ineffective in treating
hypotension because of its alpha receptor stimulatory actions on the vasculature
which could cause an even further elevation of BP. EPI does not reduce anxiety, but
increases anxiety because it has CNS stimulatory effects.
81. They give childs age and asked for max dosage of lidocaine ...multiply it with 4.4 * kg
82. How to differentiate between apical and perio abscess
83. Remember drugs that Dec salivation: Anticholinergic drugs block receptor sites for
acetylcholine and decrease salivary flow and respiratory secretions during surgery.
Scopolamine, Atropine, and Benztropine decrease saliva flow and secretion from
respiratory glands during general anesthesia. Decrease saliva flow during dental
procedures (anti-sialogue) and the secretion from respiratory glands during general
anesthesia: Atropine is the most commonly used anti-cholinergic drug for these
purposes. Scopolamine penetrates the CNS more readily than Atropine, but is rarely
used. A patient pre-medicated with Atropine will exhibit mydriasis (dilated pupils).
84. Ledge wat to do - bypass it and continue with ...use larger file to get rid of it...use bur
to get rid of it ... Prebend the tip of a small file, lubricate, and try to negotiate around
the ledge. Ledges can sometimes be bypassed; the canal coronal to the ledge must
be sufficiently straightened to allow a file to operate effectively. This straightening
may be achieved by anticurvature filing (file away from the curve). The dentist pre-
curves the lfie severely at the tip and uses it to probe gently past the ledge.
Otherwise, the dentist cleans to the ledge and fills; the patient is warned of the poorer
prognosis.
85. What band and loop does provide ..vertical stop - "Band &Loop" Space Maintainer-
most often used when the PRIMARY FIRST MOLAR must be prematurely extracted.
Used after a unilateral loss of a primary first molar. It consists of a band that is usually
cemented to a primary second molar. Attached to the band is a loop that extends to
the canine's distal surface.The loop prevents mesial migration of the primary second
molar. Note: limited strength allows only single tooth-space maintenance.
86. Space Maintenance: A 9 year old patient had an extraction of the primary
mandibular first molar. The ideal treatment at this time is PLACE ASPACE MAINTAINER.
Although this can be done with either fixed or removable appliances, fixed
appliances are preferred in most situations because they eliminate the factor of
patient cooperation. If the space is unilateral, it can be managed by a unilateral
fixed appliance ("band & loop" space maintainer). If molars on both sides have been
lost, and the permanent incisors have erupted, it is usually better to place a lingual
arch space maintainer.
87. Collagenase and elastase by which bacteria: Porphyromonas gingivalis - Plaque
bacteria produces ENZYMES (hyaluronidase, collagenase, chondroitin sulfatase,
elastase, andproteases) that may initiate periodontal disease. • Collagenase-
enzyme produced by Bacteroides species that catalyzes collagen degradation
(hydrolysis). • Hyaluronidase-enzyme produced by Streptococcus mitans & salivarius
that destroys the amorphous ground substance. • Chondroitin Sulfatase-enzyme
produced by Diptheroids that also destroys amorphous ground substance.
88. Bacteria in 2 day of plaque - Bacterial Colonization: Gram + rods and cocci - DD:
Cocci still dominate but there are increasing numbers of filamentous forms and
slender rods. Gradually the filamentous forms replace many of cocci.
Within a short time after cleaning a tooth, the pellicle coated tooth surface is colonized
by gram (+) bacteria (i.e. Streptococcus sanguis, Streptococcus mutans, &
Actinomyces viscosus - rods). These are the primary colonizers. 1. Primary Plaque
Colonizers: DAY 1- GRAM (+) facultative bacteria that are the constituents of EARLY
(YOUNG) plaque, appearing within a short time after cleaning a tooth. Streptococcus
sanquis, Streptococcus mutans, & Actinomyces viscosus. 2. Secondary Plaque
Colonizers: are GRAM (-) bacteria (Fusobacterium nucleatum, Prevotella intermedia,
& Capnocytophaga species). Tertiary Plaque Colonizers: consists of GRAM (-),
ANAEROBIC RODS that appear 1 week after plaque accumulation (Porphyromonas
gingivalis, Campylobacter rectus, Eikenella corrodens, Actinobacillus
actinomycetemcomitans/AA, and oral spirochetes (Treponema species).
89. There we're 2 que regarding cervical burnout: CERVICAL BURNOUT (due to decreased
X-ray absorption) - a phenomenon caused by relatively low x-ray absorption on the
mesial or distal surfaces of teeth, between the edges of the enamel and adjacent
crest of the alveolar ridge. Because of this diminished x-ray absorption, these areas
appear relatively radiolucent will ill-defined margins. It is caused by the normal
configuration of the affected teeth (CEJ) which results in decreased x-ray absorption
in those areas. These radiolucencies should be anticipated when viewing x-rays of
almost any tooth, and must not be mistaken for a carious lesion.
90. Pt had less caries risk .. having stains and catch ..wat to do ...observe or gic
91. 40 yr pt with all 32 teeth no cavities . Has stain and catch in pit of molar ? What u do?
A. Watch and observe
92. They ask u to recognize plaque in radiographs
93. Most common area for caries ...pit and fissure or apical to contact ....
94. Angle of instruments in SRP (Scale & Root Planing): Angulation refers to the angle
between the face of the bladed instrument and the tooth surface. During scaling and
root planning, optimal angulation is between 45 and 90 degrees. For subgingival
insertion of a bladed instrument such as a curette, angulation should be as close to 0
degree as possible.
95. The BEST CRITERION to evaluate the success of SRP is NO BLEEDING ON PROBING (since
BOP indicates active inflammatory periodontal disease).
96. Sharpening: The angle between the blade face and stone is kept at 100-110°. When
sharpening instruments with a flat stone, the angle between the instrument and stone
is 100-110°.
97. When sharpening instruments, the ________ of the blade should be placed at a ______
angle to the sharpening stone. Choose Your Favorite: Working end, 90° - Bevel, 45° -
Bevel, 90° - Working end, 45° / OPERATORY When sharpening an instrument, the bevel
of the blade is placed at an angle of 45 degrees to the sharpening stone. This ensures
maximum efficiency of the blade to sharpen the instrument.
98. MOST common reason for amalgam failure ...preparation - The most frequent cause
of failure of dental amalgam restorations is improper cavity design.
99. Common reason for failure of composite in posterior: LOW WEAR RESISTANCE is the
property of filled resins that is primarily to blame for the failure of Class II composite
restorations. One of the most common causes of failure in posterior composite
restorations is occlusal wear.
100. Venner break down ... How to fix back ...microetch, etch, silane, bonding
101. They asked u treatment plans on anterior teeth like PFM crown .... All ceramic
..composite
102. How water contamination affects amalgam: Amalgam failure >> water
contamination
DELAYED EXPANSION of amalgam restorations is associated with insufficient trituration
& condensation, and amalgam contamination by moisture during trituration and
condensation (MAIN cause of failures). If moisture is incorporated into an alloy that
contains zinc, the water reacts with the zinc to produce hydrogen gas. The resulting
pressure from the liberated gas produces severe expansion of the amalgam, causing
amalgam to protrude from the cavity preparation, post-operative pain, and excessive
corrosion. Amalgam's compressive strength is greatly reduced when contaminated
with moisture.
103. There was case on asthmatic pt: Two types of asthma exist (allergic asthma) the
most common, and idiosyncratic asthma. Avoid using aspirin, NSAlDs, aspirin,
barbiturates, narcotics, and erythromycin (if the patient is taking Theophylline).
Corticosteroids treat asthma, Albuterol: b2 selective agonist. Administered orally or by
inhalation. Primarily used in long- term treatment of obstructive airway diseases,
emergency treatment of bronchospasm, or to delay premature delivery. Only EPI
combines with 2 receptors to vasodilate bronchioles (treats asthma), skeletal muscle,
uterus (relaxation), increase blood glucose (gluconeogenesis, glycogenelysis). NE
usually combines weakly or not at all to b2 receptors. Nitrous oxide is SAFE to
administer in asthmatics. Inhalation of a selective beta2-agonist (Terbutaline,
Albuterol) is the preferred treatment for an acute asthmatic attack. Management of
an Acute Asthmatic Episode during oral surgery: Terminate all dental treatment and
position the patient in an erect or semi-erect position. Patient should administer their
own bronchodilator using an inhaler. In most severe asthma attacks or when the
patient's bronchodilator is ineffective, EPI (O.3ml of a 1:1,000 dilution) can be injected
1M or SC. Administer oxygen and monitor vital signs.
104. Proximal retention of amalgam:
Axial wall depth. A, If no retention grooves needed, axial depth 0.2 mm inside
(internal to) dentinoenamel junction (DEJ). B, If retention grooves needed, axial depth
0.5 mm inside (internal to) DEJ. Retention form in class II amalgam preparation:
Occlusal convergence of buccal and lingual walls of the occlusal and proximal
extensions. Dovetail design of the occlusal outline, retention looks or grooves.
105. When placement of proximal retention locks in class II amalgam preparations is
necessary, which of the following is not correct? A. One should not undermine the
proximal enamel. B. One should not prepare locks entirely in the axial wall. C. Even if
deeper than ideal, one should use the axial wall as a guide for proximal lock
placement. D. One should place locks 0.2 mm inside the denti-noenamel junction
(DEJ) to ensure that the proximal enamel is not undermined. Retention locks, when
needed in class II amalgam preparations, should be placed entirely in dentin, not
undermining the adjacent enamel. They are placed 0.2 mm internal to the DEJ, are
deeper gingivally (0.4 mm) than occlusally (i.e., they fade out as they extend
occlusally), and translate parallel to the DEJ. If the axial wall is deeper than normal,
the retention lock is not placed at the axiofacial or axiolingual line angles, but rather is
positioned 0.2 mm internal to the DEJ. If placed at the deeper location, it may result in
pulp exposure, depending on the location of the axial wall depth.
106. There was a question regarding probing depth inc in inflammation: Bleeding:
physiologically, bleeding from the gingival sulcus should not be caused by gentle
provocation. Bleeding in the absence of local irritants may indicate a systemic
disease. Bleeding is the most reliable indicator of gingival or periodontal
inflammation.
107. The two MOST critical parameters for the prognosis of a periodontally involved
tooth are ATTACHMENT LOSS (most critical) and tooth mobility.
108. Tooth #30, a probing pocket depth on the facial is 6mm, the free gingival margin is
2 mm apical to the CEJ. Attachment loss of this tooth? a. 6mm b. 2mm c. 8mm d.
4mm – To measure attachment loss use a periodontal probe from an established
reference point (CEJ or restoration margin) for initial measurement. Probings are
repeated after appropriate time intervals and any changes are noted (i.e. if a
probing depth is 4mm and recession is 3mm, total attachment loss = 7mm).
109. Axial walls on onlay: For a cast onlay or inlay, ALL axial walls must be convergent
or there will be an undercut (DD). For an MOD onlay preparation, axial walls must
slightly converge from the gingival walls to the pulpal wall (for the same reason the
onlay would not seat if the axial walls diverged).
110. From facial to lingual, the axiopulpal line angle of an onlay preparation is longer
than the axiogingival line angle.
111. The function of the direct retainer is to retain the removable partial denture by
means of the abutments. Stabilization is provided by the minor connector. Support is
provided by the rest. The indirect retainers improve the efficiency of the direct
retainers. Direct retainers do not add strength to the major connector.
112. What can't be used as retainers in FPD inlay, onlay, partial crown, full crown (ALL
can be used!) - The use of inlays as bridge retainers has died out – mainly because a
tooth that is suitable for an inlay would also be suitable for a resin-retained wing and
therefore the conventional bridge would be contraindicated.
113. Potassium sparing diuretic - Spironolactone, a potassium-sparing diuretic useful in
treating edema and heart failure, is a competitive antagonist at the aldosterone
receptor.
114. What do you often need to supplement with diuretics? Potassium
115. Which of the following are Potassium sparing Diuretics: 1-Spirinolactone 2-
Triamterene, 3-Amiloride 4- all
116. Spironolactone and eplerenone. 1. True antagonists of aldosterone. 2. Similar in
effects to amiloride and triamterene.
117. Which of the following drugs blocks the aldosterone receptor? A. Amiloride B.
Triamterene C. Losartan D. Spironolactone E. Furosemide - Aldosterone antagonists:
spironolactone, eplerenone. Spironolactone, a potassium-sparing diuretic useful in
treating edema and heart failure, is a competitive antagonist at the aldosterone
receptor.
118. The most important toxic effect of potassium sparing diuretics is: Hyperkalemia
119. Primary tooth with shortest occlusal table options were between max and mand
molar: Greater convergence of the buccal and lingual walls results in a
proportionately narrower occlusal table. This is more pronounced in the MAXILLARY
FIRST PRIMARY MOLAR than second primary molar.
120. Pt came back after a month with discolored margins what could be the reason?
discoloration due to leakage.
121. What opaque porcelain doesn't do - Opaque porcelain must mask the dark oxide
color and provide the porcelain-metal bond. Bond strength depends on good
wetting of the metal surface. Masking must be accomplished with the minimum
thickness of opaque—about 0.1 mm— leaving maximum space to develop a natural
appearance with body and incisal porcelains. DD: The opaque is applied first to mask
the metal and to give the restoration its basic shade.
122. Which layer of porcelain mask the dark oxide color? 1. Incisal 2. Body 3. Opaque -
123. Which layer of porcelain provides most Color or shade? 1. Opaque 2. Incisal 3.
Body
Body or dentin porcelain contains most of the color or shade and is used generally to
build most of the crown. Incisal porcelain is the most translucent layer of porcelain.
The restoration is bulked out (overcontoured) to compensate for the 20% shrinkage,
which occurs during firing.
124. What is function of opaque porcelain EXCEPT a. mask metal framework b. to help
come up with a base/stump shade c. for initial bond to metal d. to decrease
contamination of additional porcelain with metal in ensuing firing and baking
procedures.
125. Cusp involved in non working interference LUBL (inner inclines)
126. Function of post: the primary purpose of the post is to retain a core in a tooth with
extensive loss of coronal structure. Posts do not reinforce the tooth, but rather weaken
it further by additional removal of dentin and by creating stress that predisposes to
root fracture. Post preparation. The primary purpose of the post is to retain a core in a
tooth with extensive loss of coronal structure. The need for a post is dictated by the
amount of remaining coronal tooth structure. Posts do not reinforce the tooth but
further weaken it by additional removal of dentin and by creating stress that
predisposes to root fracture. At least 5 to 7 mm of remaining gutta-percha is
recommended.
127. Why v record protusive relationship: A protrusive record registers the anterior-
inferior condyle path at one particular point in the translatory movement of the
condyles. Some clinicians use this type of record to determine the amount of space
between maxillary and mandibular teeth or occlusal rims to maintain balanced
occlusion throughout the mandibular functional range of movement when articulating
teeth. Christensen’s phenomenon refers to the distal space created between the
maxillary and mandibular occlusal surfaces of the occlusion rims of dentures when the
mandible is protruded. It is caused by the downward and forward movement of the
condyles. BB - The purpose of making a record of protrusive relation is to register the
condylar path and to adjust the condylar guides of the articulator so they equal the
patient's condylar paths. The mandible can protrude -10 mm. The protrusive record is
probably the LEAST reproducible maxillomandibular record.
128. What is the purpose of making a record of protrusive relation and what function
does it serve after it is made: A. To register the condylar path and to adjust the
inclination of the incisal guidance. B. To aid in determining the freeway space and to
adjust the inclination of the incisal guidance. C. To register the condylar path and to
adjust the condylar guides of the articulator so that they are equivalent to the
condylar paths of the patient. D. To aid in establishing the occlusal vertical dimension
and to adjust the condylar guides of the articulator so that they are equivalent to
the condylar paths of the patient.
129. After dpc place gic liner over caoh
130. They ask u to recognize class 123 relationship
131. Where to place retentive arm: The terminal end of the retentive arm is optimally
placed in the middle of the gingival 1/3 of the clinical crown. However, it is
acceptable to place it at the junction of the gingival and middle 1/3 of the clinical
crown. When the partial is completely seated, the retentive arm should be passive
and applying no pressure on the teeth.
132. Undercut for co-cr retentive clasp arm is A.0.75 mm B.0.5mm C.0.25 mm
133. Flexibility of the retentive clasp arm does not relate to: A. Length B. Cross section
C. Material D. Degree of taper E. Under cut area
134. In case history: mentioned pt is receiving fluoridated water ...but having plaque
....in treatment options were like add more floride ...floride gels ...oral hygiene
reinforcement.
135. They gave picture of condyles on panoramic and asked if pt have osteoarthritis
rheumatoid arthritis...2 were more I forgot - Degenerative Joint Disease
(Osteoarthritis)-organic degeneration of the TMJ's articular surfaces.
136. Football player use mouth guards, now he is having pain ..and he is not able to
open jaw in the morning ...I answered myofacial pain syndrome ...there was arthritis
also but I choose mps
137. There was questions on rubber dam holes I don't remember exactly - The hole to
be punched in the rubber dam for the tooth being restored should be facial to the
normal alignment with the adjacent teeth. Highest chance of mikroleakage in rubber
dam holes are too closed.
138. Abscess ... penicillin vk. Treatment of the acute periodontal abscess is determined
initially by whether there is localization of the abscess (if there is, drainage is the
treatment). If the abscess is not localized, the patient is placed on antibiotics
(Penicillin V) and instructed to rinse with warm saline. Clindamycin can be used in
penicillin allergic patients.
139. Composite with stains and pits ..but other wise intact ...wat to do
140. Marginal stain on class 3 composite, how would u treat? REPAIR ?? or replace? - Its
Replace.. marginal stain caused by microleakage.
141. 40 y pt w/ all 32 teeth. No cavities. Has stain & catch in pit of molar. what do you
do?
a. watch and observe b. sealant c. composite
142. Liquid in gic: The powder (calcium- aluminofluorosilicate glass) reacts with a liquid
(polyacrylic acid) to form a cement of glass particles surrounded by a matrix of
fluoride elements. Glass ionomer and polycarboxylate both contain polyarcylic acid.
143. Color stability tegdma: tegdma inc color stability and dec viscosity produced by
bisgma (BisGma has questionable color stability)
144. IRM (Zinc Oxide Eugenol Cement) with PMM - Type III ZOE (Reinforced ZOE): a
temporary filling material (lRM) and thermal insulating base. The powder is composed
of zinc oxide and finely divided polymer particles (polymethyl- methacrylate) in the
amount of 20-40% by weight. The zinc oxide powder is surface treated by an aliphatic
monocarboxylic acid like propionic. Eugenol is the liquid. This combination of surface
treatment + polymer reinforcement results in a material that has good strength and
toughness which markedly improves abrasion resistance. Good for basing large and
complex cavities as it withstands the pressure of amalgam condensation, with
minimal effect on the pulp.
145. Chelation-a chemical phenomena common to zinc oxide-eugenol and
polycarboxylate cements.
146. The cement which has antibacterial property is: Glass informer cement. Copper
oxide cement. Zinc Polycarboxylate cement. Zinc phosphate cement. Zinc oxide
Eugenol cement.
147. Not used for cast rest: irreversible impression material
148. Irreversible or reversible impression material
149. Safety valve of no allow 70 percent of nitrous oxide and 30 oxygen
150. Characterstics of autistic child: repetitive questions, repetitive behavior.
151. Cardiac arrest in children:
152. Most common reason for cardiac arrest in children – respiratory depression
153. Minimum anc count for surgery
154. Minimum granulocyte count: Generally accepted reference range for absolute
neutrophil count (ANC) in adults is 1500 to 8000 cells per microliter (µl) of blood.
155. Topical antifungal options fluconazole clotrimazole miconazole griseofulvin –
Clotrimazole and miconazole used topically to treat candidiasis.
156. Does premedications required options were cardiac stent, heart murmurs, pt had
knee replacement within 2years - High-Risk Patients with prosthetic joints for
Hematogenous Total Joint Infection: ALL patients during the first 2 years after joint
replacement require antibiotic premedication. If more than 2 years after prosthetic
joint replacement pass with no complications, then premedication is NOT required.
157. MI within 6 months.:. Antibiotic prophylaxis given or not? DD: YES
158. Distance for lateral cephalometric: 4feets, 6 feets, 60 inches - The distance b/n x
ray source and the mid-sagittal plane of patient is fixed at 5 feet(60 inches), 6 feet is
the distance between operator and patient.
159. Tooth removed socket tissue is examined ..they found lymphocyte neutophills,
(granulocytes), and hemophiillc precursors ...I answered leukemia
160. Tooth removed ..tissue is examined ...they found inflammatory cells granulocyte
etc ...options were scar cyst granuloma
161. Pt had fracture and numbness on side on nose cheeks...fracture site floor of
maxillary sinus roof of orvit ..medial wall of maxillary sinus ...
162. A patient experiences numbness of the left upper lip, cheek, and the left side of
the nose following a fracture of his midface. This symptom follows a fracture through
the A. nasal bone. B. zygomatic arch. C. maxillary sinus. D. infraorbital rim.
163. Lower lip numbness is seen in what kind of mandibular fracture, ANGLE T/F (angle
and body)
164. There were half radiolucencies line on ramis ..identify ..fracture , air space ,two
options were more ...
165. They can ask if the quality of x-ray is good or poor
166. Bacteria present in gingiva in ANUG when tissue is not necrosed ..that confuses me
rods cocci spirochetes two options were more. Gingival crevices in ANUG show a
predominance of fusobacteria and spirochetes. Treponema denticola, prevotella
intermedia. ACUTE NECROTIZING ULCERATIVE GINGIVITIS (ANUG) - also called
"Vincent's infection" or "trench mouth" is a condition that presents pathognomic signs
and symptoms. Fusiforms, spirochetes, & Prevotella intermedia are involved in ANUG's
etiology. Treponema denticola is the intermediate-sized spirochete associated with
ANUG. Histologically, deeper areas of the lesion contain a zone of spirochetal
infection.
167. Pt is having asymptomatic brown macules on buccal mucosa – intradermal nevus
168. Common mole is - A- blue Nevus B- compound Nevus C- intradermal Nevus D-
junctional Nevus
169. Most common nevus in oral cavity: intradermal, intramucosal, compound, blue.
170. Melanocyte proliferation, inc melanin deposition: Increased in melanin-
pigmentation seen in: (a) Albright's syndrome (b) Addison's disease (c) peutz jegher's
syndrome (d) All of the above
171. Heat sensitive instruments sterlised by wat ..they didn't had ethylene oxide gas
option .... But they had glutaraldehyde option ...I'm not sure - Glutaraldehyde
Advantages: most potent category of chemical germicide, capable of killing spores
(after 10hrs), EPA registered as a chemical sterilant, and can be used on heat-
sensitive materials.
172. If prostaglandin is not there what will not happen ...it confuses me alot ..antipyresis,
dec blood flow to kidney , platelet inhibtion and last option I forgot – reduced platelet
aggregation.
173. Antiepileptic is used in which condition: Carbamazepine (Tegretol) - TRIGEMINAL
NEURALGIA, Diazepam (Valium) - agent of choice to reverse status epilepticus
induced by a local anesthetic overdose, Ethosuximide (Zarontin) - the preferred drug
for effectively treating absence seizures because it causes minimal sedation by
BLOCKING CALCIUM CHANNELS. Phenytoin (Oilantin) - treats tonic-clonic (grand
mal) seizures. The rate of gingival hyperplasia is diminished by proper oral hygiene.
Phenytoin is the most extensively used of all anti-epileptics, Phenytoin-induced
gingival hyperplasia is a common adverse effect, that may partially or completely
obscure teeth crowns
174. From where v can get large piece of graft ilium , ribs two options were more – iliac
crest
175. Least resistant to fracture ...I ans high leucite I saw this question in group I'm not
sure
176. Least resistant to fracture: a-pressed leucite b-feldspathic porcelain Leucite-
reinforced ceramic c-Castable glass d-Glass-infiltrated alumina e- Leucite-reinforced
ceramic
177. They ask how the position of mand foramrn shift relative to occlusal plane in kids -
infraocclusal
178. Antiviral for hsv cmv vzv = FOSCARNET (HSV, VZV, CMV)
Penciclovir (Denavir) - Herpes Simplex Virus Type 1 (HSV- 1). It is a cream formulation
indicated to treat recurrent herpes labialis (cold sores) in adults. This condition is
caused by HSV-l. Penciclovir is not available for systemic dosing. Acyclovir - inhibits
viral DNA polymerase/viral DNA synthesis. Available in tablets and creams to treat
HSV-1, HSV-2, & varicella zoster (chicken pox/shingles). Drug of Choice for HSV
Encephalitis, genital herpes, herpes labialis (cold sores) & varicella-zoster virus.
Valacyclovir (VALTREX)-PRODRUG of acyclovir given orally that is converted by 1st
pass metabolism into acyclovir. Treats HSV1&2, genital herpes, cold sores (herpes
labialis), &herpes varicella-zoster virus (shingles). Ganciclovir - inhibits viral DNA
polymerase/viral DNA synthesis. Treats Cytomegalic Retinitis (CMV retinitis) & CMV
prophylaxis in transplant patients (crosses BBB).
179. Bisphosphonates is not used in mutliple myeloma, Osteomyelitis, Metastatic
cancer to bone from prostate and breast
180. Kidney transplant How to check it's failure initially: Dec renin creatn increased uric
acid
181. Patient with renal transplant Caine to you for treatment to prevent the dental
caries. What treatment should be contraindicated in him A)application of pit and
fissure sealent
B)flouride topical C)gic rest D)ttt with chlorhexidine
182. Patient has renal transplant, white non scapable lesion on the side of the tongue,
shaggy frayed: a-hyperplastic candida b-idiopathic leukoplakia c-lichen plan
d-hairy leukoplakia (shaggy frayed) appearance
183. Patient who has undergone kidney transplantation is at an increased risk of
developing
A brown tumors B. Plasma cell gingivitis C erosive lichen planus D squamous cell
carcinoma - Brown tumor is a rare complication of secondary hyperparathyroidism. It
is exceptionally encountered after kidney transplantation.
184. Patient with kidney transplant needs prophy: Yes / no - No prophy but you cover
with antibiotic after procedure since they have reduced immunity.
185. What ASA classification: someone who has DM, hepatitis C, hypertension, renal
transplant 2 years ago. A,ASA 3 B.ASA4 C.ASA5 D,ASA6
186. Drug conjugation - more ionic - Conjugation of drugs results in polar, water-soluble
compounds that are rapidly excreted in urine. Thus, the parent drug is effectively
rendered inactive and transported out of the body by this process.
187. Types of reactions involved in drug metabolism. a. Phase I reactions involve
reactions such as oxidation, reduction, and hydrolysis. b. Phase II reactions involve
conjugation, in which a chemical substituent is added to the drug. The most common
type of conjugation reaction is glucuronide conjugation.
188. In phase-II reaction in drug meabolism, the drug molecule is conjugated with ---?
1- a base 2- an acid - acid (glucoronic acid) - decks
What contributes the most to a successful pulp capping ? a) exposure less than 0.75 mm
b) isolated field c) absence of bleeding d) use o
DAY 2:
1150. Middle aged guy with kidney failure due to Lithium overdose. What pain drug is
less expected to be nephrotoxic? Aspirin, Ibuprophen, Oxycodone, one more
1151. Why do we need ruler in lateral cephalogram? For magnification – scale
Calibration ruler for magnification correction. Ruler to standardize the magnification rate
of radiographs.
1152. In removal of palatine tori which structure can be damaged? Greater palatine
artery
1153. 10 y.o girl, with good OH, no caries but a child of divorced parents. How would
you rate her caries risk? Low, Middle, High - I took middle, because social history is
super important
1154. Q. about that 10 y.o child case, where upper canines were closely to errupt, but
primary canines were still there. They asked about the radiolucency that surrounded
the erupting teeth. Options were different kinds of cysts and tumors. - I took eruption
cyst.. I don’t know
1155. Hispanic guy, no insurance, needs tx. If you extract tooth 14, what is the most
expected complication? The tooth had RCT and a very big amalgam fllg: Sinus
perforation, Ridge fracture, Tooth fracture, Bleeding
1156. Pat. Allergic to sulfa, which meds. Are contraindicated? Next antibiotics:
Sulfamethoxazole-trimethoprim (Septra, Bactrim), Erythromycin-sulfisoxazole,
Sulfasalazine (Azulfidine), used to treat Crohn's disease, ulcerative colitis and
rheumatoid arthritis. Dapsone, used to treat leprosy, dermatitis and certain types of
pneumonia
1157. Middle aged Pat. With an one-tooth gap. If you want to close it orthodontically,
what will you expect? No bodily movement of the teeth, Rotation mesio-facially,
Rotation mesio-lingually, one more – I chose b
1158. A Q. about two small radioopacities in the bone where MD M1 was missing. There
were options about Odontogenic tumors, Root rests, Focal idiopathic osteosclerosis.
1159. Some simple easy questions on identifying structures on x-ray.
1160. Also Qs on diagnostics of teeth on x-ray, if it is a proximal caries or burnout. - If it is
on every tooth, it is most likely to be burnout!
1161. Qs about restorations on xray.
1162. Q on that child case which bite relationship it has. Distal, Mesial, End-to-end
1163. Test for kidney failure - creatinine
1164. Q on except for the 3molar incisor.
1165. How many teeth was the child missing.
1166. Q on RCT of a central maxillary incisor. What is true? I chose it will be difficult
compared to a normal case, because canal was really obliterated.
1167. Which tooth would most likely need a RCT when observing the xray? Easy!
1168. Pat. Bites down on his maxillary M1, which already had a super big amalgam
filling, and breaks off one of the cusps supragingivally. What tx.? – PFM
1169. On xray, opacity apical of a RC treated tooth. What could it be? Looked like
sealer.
1170. Pat. Has very strange bite, posterior crossbite, Class 2 relationship on the molars,
but almost perfect overbite. What is the most likely cause? I chose something with the
Canines. I forgot :-D
1171. How to treat his posterior cross bite?
Hyrax appliance (banded type)—for skeletal expansion, this is the most commonly used
type of rapid palatal expansion/rapid maxillary expansion appliance. Haas
appliance: However, difficulty in maintaining hygiene and possible inflammation of
the palate are considered disadvantages by some clinicians. Hawley-type removable
appliance with a jackscrew— for skeletal or dental expansion, this appliance may be
used to correct mild posterior crossbites in children and young adolescents. Quad-
helix and W-arch—generally for dental expansion, these appliances consist of heavy
stainless steel wire with four (quad-helix) or three (W-arch) helices that are
incorporated to increase the range and flexibility.
1172. Female pat. Wants all her teeth extracted, although they don't look as bad. Qs.
About what tx. Is appropriate.
1173. That 10 y.o girl had a very strange bite, with a skeletal midline deviation to the left.
They ask about the cause.
1174. On a lateral cephalogramm of the 10 y.o girl what is the radiolopacity that
crosses her posterior teeth? Maxillary sinus, Orbita, Zygomatic arch, Palatine process of
maxilla.
1175. Hispanic Pat, without insurance. Missing teeth, needs tx. What is the least tx
indicated? I chose sinus lift
1176. Qs about that 10 y.o girl who was asmathic. Meds.
1177. Old pat., heavy smoker with white patch on lip? Hyperkeratosis due to smoking.
1178. How to biopsy that hyperkeratosis? incisional
1179. Pat. With leukoplakia on lower side of the tongue. How to biopsy that? - In all
cases, leukoplakia must be completely excised since diagnosis cannot be made
clinically (DD)
1180. What structure can be damaged while biopsying the lower side of the tongue?
Medial to the hyoglossus: lingual artery, lateral to hyoglossus: submandibular duct, lingual
nerve, lingual vein, hypoglossal nerve.
1181. Pat. With HTN. Taking various meds. Long list. Lisinopril, Beta-bloker among those.
Which ones lowers his BP. - Lisinopril: ACE inhibitors, "inhibit" the conversion of inactive
Angiotensin I Angiotensin II (a vasoconstrictor). This causes peripheral vasodilation and
secondarily increases urinary volume excretion. Both actions cause reduced BP.
1182. Easy Q on tx. Of a RCT tooth with a big amalgam fllg.
1183. Elderly pat. With a super old bridge on lower back teeth. Has sensitivity when
drinking cold drinks. Which tooth most likely to be the reason? The bridge had 3
abutment teeth. On the x-ray one tooth he had a post, another one had a big
radiolucency and to me it looked dead! :-D So, it was the only molar, which looked
normal to me with a little subgingival calculus. So, I picked that!
1184. Pat. Taking antidepresants. Having heavy bruxism. What is least likely to do to
treat him. All options were correct, except the one saying to lower his medication! :-D
1185. Pat. With pigmentation above maxillary lateral incisor. What could that be and
how would you biopsy that? - I took excisional, because it was small! Probably 3:3mm
1186. A Q. about that elderly apt. taking various med. Including Aspirin 81mg. Would
you stop Aspirin before SRP? NO
1187. Middle aged woman who wanted all her teeth pulled out, had a radiolucency in
the canal of an endo treated upper canine. What could that be? Radiolucency in
the canal, guys! It was something with endo access and too much removal of
guttapercha
1188. Another Q about her, showing a lateral upper incisor with post and crown, asking
how that post looks on the x-ray. Too narrow, too long, too wide, too short
1189. Another Q about her. She had multiple fractured teeth, which were all previously
endo treated. Why does her oral situation looks like that. All except question. I took
external tooth trauma.
1190. Q. about that depressed guy, and his Amitriptyline med.
Tricyclic antidepressants are very likely to cause xerostomia. Amitriptyline is especially
potent in this regard. (Mosby) The most common CNS adverse reaction is
DROWSINESS. Anti-cholinergic adverse effects are dry mouth (xerostomia),
constipation, blurred vision, and tachycardia. Drug-induced xerostomia must be
treated palliatively with artificial salivary substitutes. – BB
EPI (vasoconstrictor) in local anesthetic injections must be used cautiously in patients
taking tricyclic antidepressants (Le. Elavil), Serotonin & NE reuptake inhibitors (Le.
Effexor) to avoid transient and significant increases in blood pressure. These
antidepressants greatly increase NE levels in tissues. In the presence of a
vasoconstrictor administered via a local anesthetic injection, the patient can
experience a significant elevation of blood pressure due to the vasopressor actions of
the combination. - BB
1191. Case Q, on picture it is obvious Class I relationship of 1st molars (MB cusp of upper
1st molar occludes mesial buccal groove of 1st mand molar)...answered Class I, but
later there was another Q saying that on cephalometrics pt has ANB=6...so what are
we supposed to do? Go back and change previous answer to Class II instead of Class
I? - SKELETAL CLASS 2 with dental class 1 (teeth may compensate for dental
disharmony) - SKELETAL CLASS 2, DENTAL CLASS 1
1192. Case Q, on picture there is a very deep overbite (upper incisors covered 2/3 of
lower incisors), but canines position looked Class I (cusp of upper canine occludes in
between lower canine and premolar) , and Q asked looking at anterior teeth what
Class this pt has? Class I, Class II - Class ll.....if anterior looks like cls 2 div 2 along with
deep bite +class 1 molar or canine relation termed as DECKBISS
1193. Case Q: On x-ray, there is max lat incisor with RCT done and crown, periapical RL
(looks like old RL 4 mm) and within RL RO in the middle...Q asked what was that:
hypercementosis? – need options
1194. Same Pt had this max upper lat inc and 1 st molar only left on that side. Pt
Decided to do RPD.
1) Because of the absence of canine it affects this lat inc long prognosis. T/F
2) Because this upper denture has no vertical stop with mandible on that side it affects
this upper lat inc long prognosis. T/F
1195. Another pt has mild crowding in lower ant teeth, narrow arch, no crowding in
maxilla, but narrow arch, very little overbite (like 1mm), long face...Q asked she
expected to have all, except: dolicho face, deviated septum, insufficient lips, obtuse
nasolabial angle, one more option....(maybe related to vertical occlusion ) - It can’t
be obtuse angle because of the flarring of teeth
1196. Pt has mand premolar and edentulous posterior to it. What you won’t place on it
restoring the space: distal rest with a buccal retentive clasp, mesial rest with bar
placed on facial mesially, mesial rest with bar placed on center of tooth, one more
option not significant I ruled out.
1197. Pt is scared, nervous, delays your appointments, comes to the office but does not
open up to you, pt is very dissatisfied by previous treatments, several ways of
describing a number of scenarios and a number of way pt talks to you, how will you
respond to him/her? How will you bring his/her concerns to you? What is the first thing
to do? Etc, almost 20-25 questions only on this basis
1198. You are doing a wheel chair transfer, which of the following will you not do?
Sliding method or scrolling method something I forgot exactly what it was, but other
options were obvious to do, I chose not to use the belt of the pt.
1199. Pregnant pt, 2-5 questions. When is the best time to treat her? Best time 2 nd
trimester during pregnancy. What meds can u give her or not? acetaminophen you
can. What is most likely to lead her present with a syncope? pressure on IVC
1200. Old pt, 84 yo, what is your primary concern? Talk to him as politely and simple
language as u can, involve him in his decisions for tx plan, involve a guardian in his tx
plans, etc
1201. Stubborn pt, comes in coz of dissatisfaction of his previous several dentists. Despite
of so many changes he still seeks for better prosthesis, what makes u determine if he
will be satisfied by your tx or not? Several verbal communications in options, I chose
the most affirmative and agreeing to what the pt was saying, to build rapport and
form of trust is most imp (somewhere around that).
1202. Pt on anti hypertensive drugs, anti diabetic drugs, some numerical readings,
looked normal to me so I chose to proceed with the tx
1203. Pt on no significant med history, past history of some surgeries, blood pressure
comes out to be a little high, what will you do next? Call his physician, ask him if he is
okay, schedule him for a recall, measure BP after 15 mins and see what comes up
1204. Pt has AIDS, his viral load is 1,000, T-cell count is 30, what will be your inference? His
viral load is too high and he is on no condition to get tx, he has no problems taking
any tx, his T-cell count is too low and that might put him at a risk of infection
1205. AIDS pt in first stage. Which of the following will you notice? He is highly infectious,
he is moderately infectious, he is symptomless in this stage, he will show up with
opportunistic infections
1206. Pt on coumarin, what lab test will you look for? PT
1207. Malignancies to the oral cavity from the rest of the body are most likey to end up
in which region? I said floor of the mouth, others were bony landmarks and side of
tongue and corner of lip.
1208. Which equipments in the dental health clinic will need a signed something? UV
light, halogen light, lasers, high speed hand pieces
1209. Pt comes in with signs of physical assault, whom shall u contact first? Police or
concerned local committees or something like that, talk to pts guardian or do nothing
1210. Denture wearing pt has pink raised lesions on the palate, what can it be? Epulis,
fibroma, papillary hyperplasia, etc
1211. Tori on upper palate, extending to the post palatal seal, what decides whether
you remove it or not? Tori extension affecting the stability of the denture, undercuts
affecting the retention of the denture, size of tori - If it extend to posterior palatal seal
means affects retention, answer b
1212. Ortho forces applied, what is least likely to happen? Differentiation of cells due to
chemical influences in the pdl, zones of oxygen tension and oxygen deficit are
created, changes in pdl blood supply, changes in pulpal response or something like
that. (Application of orthodontic forces will provoke a haemodynamic response in the
pulp).
1213. Pt comes to you with a catheter, which fo the following will facilitate your tx? Ask
the pt to remove the cath, you remove the cath, leave it as it is and take detailed
history again, some other options I don’t remember
1214. Drugs not to give to a pregnant lady, NO N2O and tetra or BDZ in option, so know
all
1215. Pt only visit dental office for emergency treatment, all will help him to change his
behaviour into routine check ups instead of emergency visits only by dentist Except-
positive reinforcement, operant conditioning, educate the patient, give him
knowledge regarding oral hygiene maintaince ( something like that) – Reinforcement
means behavior increases, we don’t want that.
1216. Pedo, 1 was routine examination but found caries and what was tx for each
tooth, about his behavior and patient management, simple stuff, space
maintenance, number of permanent teeth seen on pano. She had a shunt placed
some years ago, but no questions in that significance I saw. His pano had a oval
radiolucency near the condyle on both the sides , asked for what it was and options
were all anatomical landmarks like external auditory meatus or transverse canal etc
1217. Pedo, 2 was a girl with class 3 in primary teeth, although intraoral pics didn’t show
primary 2Ms, but anterior were edge to edge so look for stuff like that to answer the
questions. She lost a lot of space, they asked me the cause of space loss, and space
management, not space maintenance, so look for small words in the questions to
answer wisely, asked me her facial profile, her oral hyhient practices were prro, how to
motivate her? Voice control, negative or positive reinforcement, etc. again simple
1218. Adult-1 was a man with mand tori identification on pano, with no significant med
history but takes bisphosphonates, so everything went in that direction, for how would
you modify your plans, not much hard or any new questions
1219. Adult-2 lady, had ortho done when she was teenager, now has upper front teeth
lost, she is about 40’s now, reason for spaces, she had chelitis angularis, reason to that,
and she had facia palsy, what would you tell the pt about the prognosis of this long
term disease? Simple prostho management, placement of clasps, materials to be
used, some teeth look likt their restorations are old, what will you treat these teeth
with? This one was a little confusing coz her radiographs and no. of teeth seen on
xrays didn’t match her clinical teeth, but was manageable coz didn’t ask me
anything about that doubtful quadrant.
1220. Adult-3, 50 up pt, she had trauma some time ago and lower 3 teeth were
discplored, upper right CI was RCt, apicectomy treated and she also had tori, but
almost all teeth present, what will you do about the tori, what about the fractured
crown, redo or repair, the upper CI periapical lesion did not heal in 2 years what can
it be? And how to treat it? And other were simple RCT bleaching and crowns
questions
1221. Adult-4, young lady with regular dental tx, on OCP, what meds not to prescribe,
and she had a palatal lesion, they asked me differentials, she had unknown swellings
in mand right post, vital teeth, differentials asked, extracted the third molar but cant
resolve the lesion, was OKC, coz microscopy said they found epithelial cells and
inflammatory cells, other regular questions on pdl management phases, she had Hep
A treated previously, what should u keep in mind, I said it is not a blood borne disease,
other things looked irrelevant, and if any special care or precautions needed etc
1222. Adult-5, 90 something year old man comes with his son as guardian, he has had
tube ligation done, some anti hypertensive tx, several teeth missing, mand psot ridge
knife edge, he thinks his dentures doesn’t fit any more, stuff about his prostho tx, but
he had this one radiopacity between two teeth, asked for dx I probably wrote
idiopathic osteosclerosis or something, but check this one!
1223. Adult-6, pt with very very poot OH, and retained root pieces, 3M present but no
first or second molars in some places, lower both 3M were semi-impacted and
mesioangulated, he had ameloblastoma, he had this drug for depression, for
allergies, etc, and his treatment was based on early, and late treatment plans, kinds
of prostho tx, clasps, crowns, materials of choice, etc
1224. Case 1 A lady of 50s..black pigment on palate.
1) which black pigment is not present in oral caivty
a) Lentigo
b) other IDK
LENTIGO MALIGNA à usually occurs in the elderly. It is most common in sun damaged
skin on the face, neck, and arms (Hutchinson freckle).
2) Pt has some non- painful, hard, movable swelling in the floor of the mouth (pic shown)
pt is not aware about it: a) Sialolith b) Lymphoepithelial cyst c) Ranula
3) Pt has some non-painful lesion in 2nd molar region. Pt is not aware of the lesion. I could
have which of the following D/D any but NOT
a) Radicular cyst
b) Lateral periodontal cyst
c) Periapical cyst (tooth non vital, may be sensitive to percussion)
d) O Keratocyst - Multiple lesions found in children may be a component of the nevoid
basal cell carcinoma syndrome (Gorlin syndrome). THE CHIEF SITE OF INVOLVEMENT IS
THE MANDIBLE IN THE POSTERIOR BODY AND ASCENDING RAMUS. Often associated
with impacted tooth. Tendency to grow in an anterior-posterior direction without bony
expansion.
1225. CASE 2: A child with missing lower right 2nd primary molar...
1) Space loss is due to mesial & distal drifting of both ant & post teeth
2) what kind of occlusion option
a) class 1 on left class 2 right
b) class 1 on left class 3 on right
c) class 3 one left class 1 on right
3) Where does the chronic abscess seen in primary teeth
a) Furcation
b) Periapical
c) other options
4) How to maintain the space for the missing 2nd primary molar with drifting of two
adjacent teeth – My ans was we cannot as space is lost, we need space regainer its
an ASDA ques
1226. CASE 3: Another child case I don't remember finding
1) pt has multiple class 1 caries what filling – I picked Amalgam over other as amalgam is
preferred by the boards other reason composite has C factor and GiC has less
strength
1227. CASE 4: elderly male 40 pack year cigarette smoking history with multiple drugs
like gastric bypass, hypertension, other options
1) What can change this pt to stop the habbit (it had some rubbish options indirectly
prompting us to say that he will not quit habbit without dentist motivation)
a) Self motivation through behavior education
2) Behaviour of the society can be modified by
a) Surveying
b) Study conduction
1228. CASE 5: pt with upper and lower few teeth. Pt has financial restriction
1) How to raise his occlusion
a) by fabrication of upper complete denture
1229. Case on Management of transient ischemic attack- read the drugs – antiplatelet
agents are recommended over anticoagulants to reduce risk. Combining aspirin with
dipyridamole is suggested over aspirin alone. Clopidogrel is a reasonable substitute
for people allergic to aspirin. A transient ischemic attack (TIA) is a brief episode of
neurologic dysfunction caused by ischemia (loss of blood flow) – either focal brain,
spinal cord, or retinal – without infarction (tissue death). TIAs have the same underlying
cause as strokes: a disruption of cerebral blood flow (CBF). Symptoms caused by a TIA
resolve in 24 hours or less. Antiplatelet medications such as aspirin are generally
recommended. They reduce the overall risk of recurrence by 13% with greater benefit
early on. The initial treatment is aspirin, second-line is clopidogrel (Plavix), third-line is
ticlopidine. If TIAs recur after aspirin treatment, the combination of aspirin and
dipyridamole may be recommended. Some people may also be given modified-
release dipyridamole or clopidogrel. An electrocardiogram (ECG) may show atrial
fibrillation, a common cause of TIAs, or other abnormal heart rhythms that may cause
embolization to the brain. An echocardiogram is useful in detecting a blood clot
within the heart chambers. Such people may benefit from anticoagulation
medications such as heparin and warfarin.
1230. Case 1) 11 years old, kidney dialysis for 10 years and got transplant 1 year ago. He
had Hodgkin lymphoma 5 years ago, mitral valve and regurgitation. He is taking lot of
complex medicines I don’t rem the name. RG and clinical pictures show he has
amelogenisis imperfecta
1) All are immunocompromised drugs except: know all immunocompromised names and
corticosteroids: Glucocorticoid, hydrocortisone, methylprednisolone, prednisone,
(triamcinolone, beclomethasone, budesonide, flunisolide) these are inhaled
corticosetetiod for astham treat. Other immunosuppresive, cyclosporin, azathioprine,
methotrexate, cyclophosamide
2) What drug can cause amelogenisis imperfecta? tetracycline
3) why his third molars are missing? he is 11 year still third molar not erupted
4) Bilateral radioopacity in mandible whats the dx?
5)in a Rg canine was short in length whats the dx? AI, DI, Dentin dysplasia
6) does he need Ab before procedures? no need to antibiotic
7) why he has gingival enlargement? He was taking cyclosporine too, cyclisporine lead
to gingival enlargment
1231. Case2) 14 years old, all 4 canines erupted buccally and has pigmented macules
on her cheek, asthmatic taking albuterol
1) albuterol can cause all except? I put increased salivary secretion
2) small white lesions on palate? Cause of inhaler its candidiasis
3) is nitrous oxide is contraindicated? NO
4) Will you explain the whole ortho tx to her parents and post complications like she may
need gingival grafts? YES
5) The reason of pigmentation on her cheek? Proliferation of melanocites, proli of
basement cells, deposition of melanin or foreign body
6) will ectopically canine resorb #7 roots - YES
7) Anb 6, class 1, 2, 3?
8) Clinicall picture what class, it was class 1
9) Features of her face has everything except? I put incompetent lips, her lips looked fine
to me
1232. Pt has all canines erupted ectopic, but the rest of occlusion looks fine, what
should be done: Expansion of both jaws to place canines, extract canines and leave
premolars on place , extract premolars and with fixed ortho move canines on their
place
1233. If she decided to extract premolars what forceps not to used?
-151 -150 -23 -286
1234. There was a q about the profile? It was convex depending in the photograph
1235. Another q asking what is the preventive treatment for this patient
-sealant for #3,14, 19, 30 -encourage the patient to use brushing and dental floss
-use mouth wash -one more option
1236. What is the most costly to do to prevent declassification around the braces
-varnish every 6 month
-scaling every 3 month
-daily systemic supplement
-using mouthwash
1237. Another q asking what is the treatment of choice for tooth #19 if it is already
catch the prob during examination
-compsite filling
-sealant
-no treatment
1238. Case3, 45 years male, 2 pack smoke a day, dry mouth, lot of carious teeth, went
successful rehab for bad alcohol habits, seems he doesn’t drink now
Q1) will you prescribe Acetaminophen/oxycodone in this patient? I put no
Q2) missing canine will make max rpd compromised? YES
3) If you use #7 in rpd will it compromise the tooth? Yes cause no posterior teeth and no
canine
4) Rg picture shows tori in maxilla and mandible both
5) 2*3 radioopacity on LI which has RCT on it, is it hypercementosis and will you biopsy it
There was a photo here showing the patient has preparation about 0.5 from facial and
incisal and a q ask about what type of restoration the patient lost
-crown
-Veneer
-composite
1239. Case 4) middle age female, smokes daily and she is fed up from falling
restorations evrytime and she wants to extract her all teeth, psoriasis in hands and feet
Q 1) by doing what patient want, is conflict bw what two, autonomy, justice, nonm,
bene? autonomy, nonmalficiency
Q2) treatment options for her?
Q3) what clasp will you give in max RPD if you class II kennedy - RPI
Q4) why you can see condyles in PAN, bilateral fracture, osteoarthritis, rheumatoid
arthritis?
Q5) radiolunceny in bw 8 and 9 it was incisive foramen?
Q6) if you want her to quit smoking the day of extraction would be the quit date and you
give Chantix 1 week beore the quit date? T
7) some consent Qs
1240. An Old woman with Parkinson Disease came to the clinic with her hus-band. She
had distal caries on maxillary molar.
1. Out of all the symptoms of Parkinson's disease which symptom is not important to
dental treatment?
A. Rapid Eye blinking
B. Tremor
C. Muscle rigidity
D. Loss of Automatic Movements
2. While working, the patient moved, and the dentist injured her near the cheek.
Which artery was injured and caused bleeding?
A. Buccal artery of maxillary artery
B. Labial artery of ECA
C. Facial artery of ECA
3. What is the first important thing to do after the patient starts to bleed?
A. Stop bleeding
B. Call an oral surgeon
C. Call her husband.
D. Inform patient
1241. A 32 years old lady with cervical neoplasia comes to your clinic for ulcers on one
side of her palate. Drug history of taking oral contraceptives.
1. Action of Oral contraceptives? Oral Contraceptives: Ovulation is inhibited by
suppression of FSH and LH.
A. Dec. Lh
B. Inc Lh
C. Inc Fsh
D. Dec. Fsh
2.What could be the cause of the ulcer
A. CMV
B. EBV
C. HPV
3. Patient is most likely to have which neoplasia
A. HIV
B. Cervical cancer
C. Rubeola
4. What can be done for diagnosis of this viral disease except?
A. Saliva examination
B. Examination of fluid from vesicles
C. Oral examination
5. Epithelium of this ulcer
1242. Cases with asthma women. She takes albuterol.
What can she has: xerostomia.
She had an attack what can you give her, choose three
a.epinephrine
b.oxygen
c.steroids
d. beta2 agonist
Reason of asthma- read about that – constriction of brionchole. And inflammation of
brionchole. Read it – it was q about true or false. What happens in asthmatic
bronchiole – constrict.
One q was a patient broke his tooth – max 1 pm. He had excellent hygiene. Tooth broke
2 mm under the gingiva. It has big amalgam filling. What you do:
a.extraction and prosthesis
b. RCT and post and crown.
c.temporary filling and observe
d. splint this crown to the tooth
Many q about cases like: what you will do in this patient with his tooth 14 – decay – tret,
don’t tret, observe.
Pic of decay and you should recognazie it in the rvg or pic.
A. Orthokeratinised
B. Parakeratinised
C. Nonkeratinised
1243. Case with the man with allergy to penicyline and clindamycine..He had a joint
replacement . He doesn’t need prophy for that.
Q was if he need prophy for treatment what you give him - Azitomycin
He has terrible pain in the face. During the night too. It lasts 5 sec. It comes and go away.
What is it a.acute sinuses sinues b.tooth ache c. Neuralgia – ans
1244. Case with 5 years old girl
She had all first molars and erupting max central. Second central incisors – had accident
and was avulsed.
What you do with concussion
a. extract
b. observe and control max central
c. splint
Q about her age. Is her dental age;
a. the same as bone age
b. elder tooth age than bone age
c. younger ………………
d. it can’t be connected
She had dark changes in her gingiva;
a. racial changes sth like this - ans
b. Peutz jegher syndrome
Q about sth on her gingiva above her central incisor.
It was sinus tract. Because of her accident 3 mouth earlier.
She has lateral crossbite – how to treat it. – maxillary expansion
Can you give her for daily use CHX – T/F
You should show her and her parent how to brush T/F
1245. Man with hyperlipidemia. Triglyceride is high. What do you suspect: metabolic
syndrome.
Metabolic syndrome can cause cancer of all except one:
a. thyroid
b. colon
c. renal
d. sth else. The same q as in group.
1246. Treatment of this patient: Initial therapy (OHIs – SRP – Caries control – crown
lengthening)
1247. Man smoking. He had also rheumatoid disease. He has hypertension. Tekes
Propranolol. Is taking Chantix. What he can have: xerostomia, dysguesia.
Which drug causes dry mouth - Chantix
1248. You give him LA with epi – what happened – blood pressure elevated
1249. It doesn’t work – what else can you give him:
a. bupropion Zyban
b. nasal spray
c. nicotine gum
1250. Which ASA classification he is – class II. RA (ASA classification) II
Picture of mucosa in lower lip – hyperthrofia
1251. Sequence of tx plan (emergency – caries control – reevalute – definitive
treatment – maintenance ) ECRDM
1252. Pic of amalgam filling:
a. corrosion
b. bad condensation
c. bad trituration
1253. Gingival tattoo
1254. Children with cleft palte – class III malocclusion. Pano and cephalo. Given SNB -
73 and ANB -2 what angle class is it.
1255. There is an arrow in the pano of hyoid bone and q is show where is hyoid bone on
the cephalo. There where 4 arrows and you should mark it. Was B ;)
1256. Picture of this child 11 years old, Maxilary central ok but lateral in crossbite. Sth like
this.
How to treat – maxillary expander?
Patient had lateral crossbite – why - maxilla to small and lateral shift to the right side.
What to do with teeth S – teeth was ok, let it don’t treat but observe
Profile of this child in cephalo
How many teeth is missing – you shoul count it.
Had also some supranumerary – count them.
Can’t implant in cleft palate.
Tooth is painful – mand first molar. What to do:
a. extract - ans
b. pulpotomy
c. don’t do anything
What you will d
1257. Obese man with hypertension - 190/110 Didn’t treat it. Haven’t been in doctor 10
years. No medicaments. He is going to the restroom 2 per night.
1258. What do you suspect - diabetes type II
1259. MOA of sulforynoureas.
1260. What is the first think you will do to treat this patient:
A. caries
B. perio
C. Extractions
D. Refer to the physicans
1261. What contribute to the future risk of caries in this patient, exept one, which one:
a. bad oral hygiene
b. many sweets and bad diet (AMOUNT)
c. not having dental appointment
d. past caries and current caries
e. changes in saliva
1262. Many q the same as in day 1. I have cases about:
1.Child with ADHD, What is he taking – amphetamine. He can’t sleep and eat because of
this treatment.
He had insomnia, why – amphetamine (indirect acting symphatomimetic)
Not to many things during one appointment.
Don’t use tell show do. – F, we use it.
ADHD is most common with: males not female
Read patient management about ADHD children
Q about if you can give child with ampfo NO. Or should you lower the dose of
amphetamine. No need to adjust dose
1263. Day 2 is tougher than day 1. Read a lot about drug interactions with epi.
Bisphosphonates anti hypertensive drugs.
1264. One case i got about 8yr 7 months child with supernumerary anterior teeth.
Patient had class 2 skeletal and class dental malocclusion due to missing canine
teeth.
1265. Questions were. Extracting the supernumerary tooth when
1266. When to start ortho treatment for anterior cross bite
1267. How to correct patients molar relationship which were in dental class 2
malocclusion.
1268. SNA was 87 and SNB 82- what will we call 1) mandibular protrusion 2) maxillary
protrusiom 3) mandibular retrusion 4) maxillary retrusion.
1269. This case really frustrated me up.
1270. patient had Hep A 20 years ago what lab test you need? Correct answer :
nothing ! We don't care about his hep A 20 years ago !
EXTRA INFO REGARDING TIME AND BREAKS :

Day 1 exam has 2 session of 3:30 min..100 ques 15 min break 100 ques 30 min break...100
ques 15 min break ...100 ques and done
Day 2 exam has 57-67 ques 15 min break.....47 ques done...
You cannot go back to any of ques once you finish those ques...Good luck to every one
will post more if I remember anything else...
I had 9 case 5 case before break with about 52 ques....4 case after break with about 48
ques
Himani Rqs ( Aug 18-19, 2018)
Do MANGO and RITA file
1. Lots of q with least and except

2. Body dismorphic disorder? Mental illness involving obsessive focus on perceived flaw in
appearance, contraindicated for implants
3. 8mm anterior open bite. Which surgery? Lefort 1
4. Gastric ulcer? Ranitidine H2
5. Contraindications of pulpotomy? Leukemia, recent MI, Diabetes all
6. Mental foramen?
• Below 1st pm
• between 1-2nd pm
• below 2nd pm
7. Monoplane occlusion- no curve of spee
8. Varicosities- elderly
9. Pt. with emphysema. Recent MI. taking warfarin. What is not indicated?
• Give 2 carpuscles of 2% LA
• Lay the pt horizontally
• Do not give 2 appt in a week
10. Pt. with sinus tract and radiolucency. Endo with antibiotic coverage
• Curettage
• Anibiotics
• Saucerisation
• No tt
11. Pt comes for evaluation after perio, 6mm pockets what to do? Good OHI- flap, bad then SRP
12. FLap for gingivectomy external bevel incision
13. Test for newly erupted tooth cold test
14. Old pt with posterior cross bite. Tt?
• Quad helix
• Palatal expander
15. Rapport? Bond, empathy
16. Meaning of rephrasing?
• Quote exact
• Interpretation of what speaker said
17. What do u do to achieve autonomy in pt? informed consent and value pts decision
18. Max permissible dose?
19. Displacement of odontoblastic process? dessication
20. Tough q on arbitrary facebow?
21. Lots of facebow. Not from files.
22. Caries risk assessment. Exception q?
23. Pictures- ear lobe, geographic tongue, FD
24. Lots of endo and perio
Betty Wilson (Aug 17-18, 2018)
1. Do recent rqs, like 2-3 months before your exam date.

2. Lots of pt management, perio.
3. Methotrexate? Anticancer drug, side effect- bone marrow suppression
4. Led light? Less wt.
5. 6mm pocket what to do? Flap
6. Flumanezil? Antidote for BZD’s
7. Chroma saturation
8. Hue wavelength
9. Xray for maxillary sinus disease anatomy?
10. Xray for condyle?
11. Regular occlusion q’s
12. Class 2 inlay wall? Diverging from gingival to pulpal
13. Radiograph of hyoid bone, ear lobe
14. Picture of erythroplakia
15. Ceph q on day 2
16. Weird drugs q’s, don’t know the names.
17. Carbocaine? Mepivacaine- LA without vasoconstrictor
18. Opioids adverse effects? Respiratory depression, miosis, constipation
19. Drugs contraindicating with TCA? MAO, epinephrine
20. N2O side effects? nausea
21. Diuretic related to potassium? spironolactone
22. Status epilepticus? Diazepam not in option phenytoin or midazolam
23. Finasteride? Proscar- Treatment for BPH
24. Interleukin in perio? IL-1
25. Epulis fissaratum resembles what? Irritation fibroma
26. Histoplasmosis- oral lesion? Tb
27. Basic of facebow?
28. Know LA complete in and out.
29. Something not used in perio ans was Metrogel.
30. Tori
31. Exostosis
32. Sealants – micromechanical bond
CACTUS FILE
Hi guys! These are RQ’s (from FB) and my notes. If you see mistakes, find out the right
answers.
Good luck!
1. T test: 2 means
2. Chi square: 2 categorical variables
3. Cohort retro and perspective: Risk factor, Retro= historical.
4. Case control (ODD): rare disease.
5. Exam that failed to prove 5 cases that were positive for disease: false negative
6. Difference between fear and anxiety: fear is focal anxiety is generalized, fear
7. unknown anxiety known, ??? fear is known anxiety unknown
Cross sectional study – descriptive study, used for prevalence and incidence, there is no
correlation in these studies, no cause and effect relation.
Cross-sectional study—study in which the health conditions in a group of people who are,
or are assumed to be, a sample of a particular population (a cross section) is
assessed at one time. Consider the hypothesis that drinking alcohol increases the risk
of developing oral cancer. If researchers chose to conduct a cross-sectional study to
compare the occurrence of oral cancer among men who are not alcohol drinkers.
The researchers could then determine whether there is an association between the
cannot determine whether the outcome (in this case, oral cancer) occurred before
the men started drinking or if it developed as a result of some other cause (e.g.,
metastasis).
Clinical trials—Clinical trials attempt to evaluate the effects of a treatment. A clinical
1
investigation.
b. Community trials—in a community trial, the group as a whole is studied rather than the
6. Hazard communication paper ( 2 questions, one to identify which institutions created
it (OSHA) and one to identify what materials are named hazardous) - chemical
hazard MSDS, For general hazard OSHA. MSDS regulated by OSHA through Hazard
Communication Standard.
Hazardous chemicals—the OSHA hazard communication standard requires
employees to receive training about the risks of using hazardous chemicals and the
safety precautions required when handling them. Employees must be trained in
identification of hazardous chemicals and PPE to be used for each chemical. This
training must occur within 30 days of employment or before the employee uses any
chemicals and annually thereafter. Just as with the blood-borne pathogen standard,
2
a written plan identifying employee training and detailing specific control measures
used in the work- place must be compiled for hazardous chemicals. Penalties can be
imposed on the employer if the office is not in compliance.
informed consent (autonomy)
8. Veracity (they gave me the concept) - Principle: Veracity (“truthfulness”). The dentist
has a duty to communicate truthfully.
9. Ignoring a patient bad behavior – extinction
10. What to use with disable kid (voice control, consistency)
11. Which study doesn’t show cause and effect – cross sectional, observational study
12. Downcoding and upcoding – Down when insurance company bills your treatment to
the cheaper procedure. Up - when you type your treatment to be more expensive
than actual value to the insurance company.
13. Which study FDA do to check drugs? Randomized clinical trials
14. Behavior shaping question, patient say I don’t wanna quit smoking?
precontemplation stage - The behavioral change process occurs in several stages.
a.Precontemplation — an individual is not considering a behavior change.
Contemplation — an individual begins to consider a behavior change. Preparation—
preparing to take steps to change (o en expresses a desire to change a behavior). Action
— an individual is engaged in taking action toward behavior change (o enrequires
support for his or her e orts). Maintenance — an individual attempts to maintain a
changed behavior.
15. Fearful patient how do you respond? gradual desensitization
16. Which is not good for a 25 year old patient in a behaviour modification.,?!
A) operant conditioning B) carrot stick
17. Test with 2 continuous variable? Chi or T? 2 continuous variable: person correlation – 2
categorical variables: Chi square – 2 constant variable: linear regression.
18. Which is called when pt charge several procedure at onces?
Upcoding. bundling, unbundling, downcoading
19. Bill out for a core build up and crown and insurance says build up is only covered,what is
this?
Bundeling
Unbundling
Upcoding
3
Downcoding
20. Dentist not reporting the waiver of copay to insurance
overbilling
downcoding
upcoding
bundling - unbundling
21. Downcoding is reimbursing less money than dentist
deserves. Upcoding is charging more than total
deserving. How it is different from bundling and
unbundling? Bundling is terming multiple procedures as
one and paying for that single one. Unbundling is
separating / disintegrating single big procedure into
several smaller ones and charging for each.
22. Multiple procedures cut down to increase
reimbursement
A. Unbundling B. Bundling C. Downcoding D. Upcoding
23. Unbunding: When dentist charge more than the actual benefits by charging a separate fee
for each component
24. Upcoding: is fault practice where the doctor bill higher than what was done.Insurance
company pays more than wat it has to pay
25. Downcoding- here the insurance company pays less by changing the code to a lesser cost
procedure
26. Dentist has done two procedures but the third party pays only for one procedure what is
it called a)underbilling b)overbilling c)upcoding d)downcoding
27. A study is designed to determine the relationship between emotional stress and ulcers.To
do this, the researchers used hospital records of patients diagnosed with pepticulcer
disease and patient diagnosed with other disorders over the period of time from January
2014- January 2017. The amount of emotional stress each patient is exposed to was
determined from these records. This study is :
a Cross Sectional
b Cohort
4
c Historical Cohort
d Clinical Trial e Case – Study
28. Which type of study cannot be used to determine cause and effect? Cross
Sectional
29. Voice control doesn’t include - option 1) raising voice 2) gaining child attention? 3)
mild punishment
30. The research concludes that patients who use chlorhexidine have better oral health than
those who do not, however, other researchers say there is not much difference in oral
environment of those who use chlorhexidine or not? Paraphrased the question but you get
the jest of it……Double Blind
31. Child has signs of abuse, you try to question the mother but she seems reluctant.
What do you try to pay attention to while talking to her? Answer was something like
pay attention to micro-expressions, you’ll know when you’ll see it.
32. Which of the following would be the null hypothesis for a study comparing periodontal
disease in patients who brushed their teeth and rinsed with a chlorhexidine placebo and
another group that brushed their teeth with a chlorhexidine rinse afterwards?
(1)No difference between the placebo and chlorhexidine rinse
(2)There is a difference between the placebo rinse and the chlorhexidine rinse
(3)There is a difference between the periodontitis of the chlorhexidine group and the
placebo group
(4)No difference between the periodontal disease of patients brushing their teeth
and rinsing with a placebo vs those brushing and rinsing with chlorhexidine. – ans
33. Characterstics of autistic child: repetitive questions??, repetitive behavior.
34. Which study can show incidence? Descriptive
35. systemic desensitization? Grafual exposure to fearful stimuli, exposure can be combined
with relaxation exercises
36. Prevelance can be related with which case study? Descriptive
37. Cause and effect which case study? Analytical
38. OSHA blood borne pathogens? msds sheet
39. null hypothesis in chi test? True
5
40. p value in null hypothesis above 0.5 means is? statistical insignificant
41. Purpose of statistical tests in clinical trials is? to reject null hypothesis
42. Which if the following has problem in recall bias? Randomised control study
43. WHich case study used in rare disease investigation? Case control
44. Histogram shows? Variance
45. Hazard communication standard was prepared by? OSHA
diagnostic test that correctly identifies 20% of screened patients as being dx? Specificity
46. What does identify persons with the disease? Sensitivity
47. Sample size is irrelevant to ( case history - cross sectional ????- cohort study - case
study?????)
48. Rapport is ( persistent eye contact , Active listening)???
49. For dentist to avoid a lawsuit he needs? Competence
50. **** positive predictive value- people who are correctly diagnosed as having the
disease,
51. ****negative predictive value- people who are correctly diagnosed as not having the
disease
52. Multiple procedures cut down to inc reimbursement – unbundling, bundling,
downcoding, upcoding? Unbundling
53. new and old cases of smoking is called – incidence, prevelance, relative risk, pupulation
at risk? Prevelance
54. Modeling – peer person+positive reinforcement? peer person+giving information
(reinforcement is not modeling, it is operant conditioning )
55. Pt says himself he can cope with dental treatment - Cognitive dissonance, congnitive
restructuring, operant, sensitization? congnitive restructuring
56. Showing Child t/t on other sibling – modeling, sensitization, positive reinforcement,
operant? Modeling
57. FDA launch drug? random clinical trail
58. Double blind study nt present –both control group present, minimal bias, pt don’t known
which group he belongs, investigator don’t know which group, All of the above? All of
the above
59. Unbundling ? Separate payment
6
60. Upcoding ? Charge more than dentist works
61. Value ? negative calculation
62. Systemic desensitization model? hierarchy of slowly increasing anxiety stimulus
63. Rapport? active listening
64. Drug testing? clinical trials
65. Cohort study,cross -sectional study? Cohort fatal, Prospective follow group of people
over time and see who develops the disease, Retrospective study a population or
community that have ,had exposure
66. Introduce instruments and tools Desensitization gradually? True
67. Downcoding and upcoding? Down- when insurance company bills your treatment to the
cheaper procedure. Up- when you type your treatment to be more expensive than actual
value to the insurance company
68. which study FDA do to check drugs? Randomized clinical trials.
69. behavior shaping question, patient say I don’t wanna quit smoking? Precontemplation
stage
70. Fearful patient how you respond? Gradual desensitization
71. Leading question, open ended and reassurance? leading question: you are not affraid, do
you? (not recomendable to use) - open ended: how are you feeling? (let the pt to
communicate and its the best choice -reassurance: what advantages or disadvantages do
you see in tx plan? (making sure pt understood)
72. After successive trials, child goes thru instruments and hands an instrument to dentist.
What does it show? Desensitization, modeling...? Modeling
73. Gold standard for behaviour modification? Systemic desensitization, modeling, voice
control? Systemic desensitization (in anxiety and pain control), modeling (less used
according to dd and mosby),
74. FDA is conducting a clinical trial about a new drug on animals and human. What is the
phase 3 of this study? to find the effective dose of the drug
75. which one does not show the dispersing of date? Median
76. primary principle of behavior modification? behavior has consequences
7
77. when a patient who is frighten by endo surgery says by herself “I am strong and I can
handle this situation” what does happen? She manages her stress level because she
activates her Self-reliance.
management and dental modifications? ASA-2
79. If a patient is taking Chantix what else need to be included in his smoking quitting
regimen? Behavioural counseling
80. Identify what materials are named hazardous? EPA for outside hazards and OSHA for
inside
81. Thomas and chess- classification of kids? easy, difficult and slow to warm up kids
behaviour into routine check ups instead of emergency visits only by dentist Except?
positive reinforcement, operant conditioning, educate the patient, give him knowledge
regarding oral hygiene maintaince? positive reinforcement
83. In operant conditioning, positive reinforcement involves the addition of a reinforcing
stimulus following a behavior that makes it more likely that the behavior will occur again
in the future.
84.
8
85. Dmft for what study? community trials
86. Calculating the specificity for disease containing and non containing pts in a study was
asked, options in %, simple math? Specificity means those who don’t have so, TN/TN +
FP *100
87. Angry child, shows this behavior on the second but was cooperative on the first appt,
what is the best method to control this behavior? N2O tx, GA, papoose board, voice
control? Voice control
88. 4-6 years? Fear of unknown
89. Case study – # of cases is not important
90. Unbundling – charging for full mouth x rays instead of panoramic
91. The best way for dealing with manipulative pt – distraction
92. When the PID length is changed from 8" to 16", the target-receptor distance is doubled.
According to the Inverse Square Law, the resultant x-ray beam is:
(1)1/4 as intense
(2)1/8 as intense
(3)four times more intense
93. Company offers dental insurance to its employees that can go to selected dentist,
what is this example of? Closed planel********
94. If you have two distribution that are asymmetrical that’s means
a) normal
B) skewed is the ans
c) bimodal
95. Community periodontal index use for some researcher they should contact
a) Scip
B) HRRSA
c) CPITN is the ans
96. for the FDA to approve a new drug to be in the market they have to do some test to make
sure from its
96. effectivness thats by
9
C) randomized clinical trials is the ans
97. WHICH is not ethical to charge more?
A) difficult pt is the ans
98. Prevalence of caries higher based on-
1-Socioeconomic status
2-urban
3-rural living (suburb)
4-?
99. Pt has muscle dystrophy :

 pt. may be prone to falls and injuries
 antibiotic prophylaxis not typically required unless pt. is on corticosteroids
 wheelchair protocols
 warm towel to alleviate muscle cramping in dental chair
 -adjustments to dental chair - special cushions - lumbar/cervical rolls
 pt has difficulty brushing due to lack of dexterity
 pt may be on bisphosphonate treatment
10
 anesthetic agents used cautiously muscles are already weak
11
12
13
14
Challenge
CHAPTER 1: DIAGNOSTIC PROCEDURES

1. Anesthetic testing is most effective in localizing pain to which of the following?
a. Specific tooth
b. Mandible or maxilla
c. Across the midline of the face
d. Posterior tooth
2. Areas of rarefaction are evident on radiographic examination in which of the

following?
a. When the tooth is responsive to cold
b. When the tooth is responsive to percussion
c. When a tooth fracture has been identified
d. When the cortical layer of bone has been eroded
3. Irreversible pulpitis is often defined by which of the following?

a. Moderate response to percussion
b. Painful, lingering response to cold
c. Short, painful response to cold
d. Short, painful response to heat
4. The majority of patients with symptoms of severe odontogenic pain have a

diagnosis of which of the following?
a. Periodontal abscess
b. Irreversible pulpitis
c. Acute apical periodontitis
d. Acute apical abscess
5. Medical history of coronary heart disease is significant for which of the following
reasons?
a. It contraindicates endodontic treatment.
b. Many heart medications impact dental treatment.
c. It indicates the need for premedication with antibiotics.
d. It contraindicates local anesthetic with epinephrine.
6. The best approach for diagnosis of odontogenic pain is which of the following?
a. Radiographic examination
b. Percussion
c. Visual examination
d. A step-by-step, sequenced examination and testing approach
7. Of the following, which is the most likely to have referred pain?

a. Irreversible pulpitis
b. Reversible pulpitis
c. Acute apical periodontitis
d. Phoenix abscess
8. A sinus tract that drains out on the face (through skin) is mostly likely from which
of the following?
a. Nonodontogenic pathosis
b. A periodontal abscess
c. Periradicular (i.e., endodontic) pathosis
d. Pericoronitis of a mandibular, third molar
9. Which of the following statements regarding a test cavity is accurate?

a. It is the first test in diagnostic sequence.
b. It often results in a dull-pain response.
c. It is used when all other test findings are equivocal.
d. It should be performed with local anesthetic.
10. Percussion of a tooth is a test for which of the following?

a. Pulpal inflammation
b. Pulpal necrosis
c. Acute periradicular inflammation
d. Chronic periradicular inflammation
11. Pulp stones are consistent indicators of which of the following?

a. Periodontal inflammation impacting the pulp
b. Pulpal inflammation
c. Older patient
d. Pulp that has been injured in the past but has recovered
e. None of the above
12. Radiographically, which of the following statements regarding acute apical

abscess is most accurate?
a. It is generally of larger size than other lesions.
b. It has more diffuse margins than other lesions.
c. It often contains radiopacities (i.e., calcification).
d. It may not be evident.
13. In which of the following may a false-negative response to the pulp tester occur?
a. Primarily in anterior teeth
b. In a patient with a history of trauma
c. Most often in teenagers
d. In the presence of periodontal disease
14. The lateral periodontal abscess is best differentiated from the acute apical abscess
by which of the following?
a. Pulp testing
b. Radiographic appearance
c. Location of swelling
d. Probing patterns
15. The acute apical abscess is best differentiated from the acute apical periodontitis
a. Pulp testing
b. Radiographic appearance
c. Presence of swelling
d. Degree of mobility
16. Chronic apical periodontitis is best differentiated from acute apical periodontitis
a. Pulp testing and radiographic appearance
b. Pulp testing and nature of symptoms
c. Radiographic appearance and nature of symptoms
d. Pulp testing, radiographic appearance, and nature of symptoms
17. The abrupt change (arrow) in radiographic appearance in the following

illustration probably indicates which of the following?
a. Calcific metamorphosis
b. A dense accumulation of diffuse calcification
c. An increased density of overlying bone
d. A bifurcation into two canals
18. The patient in the following illustration reports severe, throbbing pain in the
mandibular right molar region. The pain is exaggerated by cold. Which tooth and which
tissue is likely the source of pain?
a. First molar and pulp
b. First molar and periapex
c. Second molar and pulp
d. Second molar and periapex
19. Of the following cold-testing agents, which is the least effective in producing a
response?
a. Bathing a tooth in ice water
b. Dicholorodifluoromethane (DDM)
c. CO2 snow (i.e., dry ice)
d. Ethyl chloride
20. Which of the following statements regarding internal resorption is accurate?

a. The condition is usually accompanied by symptoms.
b. It is continuous.
c. It is self-limiting.
d. It is usually visible in its early stages.
e. It is treated only if time shows it to be progressive.
CHAPTER 2: OROFACIAL DENTAL PAIN EMERGENCIES:

ENDODONTIC DIAGNOSES AND MANAGEMENT
1. Which of the following statements regarding the degree of pulp pathosis is
accurate?
a. It can be determined by the level of pain a patient experiences.
b. It can be related to the level of response of the electrical pulp tester.
c. It can be correlated best when a diagnosis of irreversible pulpitis is established.
d. It does not correlate well with the level of pain a patient perceives.
2. A key measure as to the degree (i.e., intensity) of pain is to determine which of

the following?
a. Painful stimulus with cold
b. Painful stimulus with heat
c. Painful stimulus on biting
d. Increasing pain
e. Pain affecting patient's lifestyle
3. In describing the sensory innervation of the dental pulp, which of the following
statements is accurate?
a. A-delta fibers are high-threshold, myelinated fibers that transmit sharp,
momentary pain.
b. C fibers are low-threshold, unmyelinated fibers that produce pain in response to
inflammatory mediators.
c. The domination of C-fiber stimulation produces pain that is not well localized.
d. The sharp, well-localized pain to cold testing is conducted by both A-delta and Cfiber
stimulation.
4. Which of the following induces hyperalgesia in local-nerve fibers?

a. Prostaglandin and serotonin
b. Lysosomal enzymes
c. Calcitonin gene-related peptide
d. Substance P
5. Each of the following statements is correct regarding trigeminal neuralgia, except
for one. Which is the exception?
a. The onset occurs in midlife and is unilateral in location.
b. The pain occurs unilaterally but often involves more than one division of the
trigeminal nerve.
c. The pain is characteristically sharp, lasts for several hours, and is induced by a
trigger point.
d. The pain mimics pain of pulpal origin in that thermal sensitivity and tingling is
often encountered just before an attack.
6. A patient complains of dull and constant pain that lasts 3 days on the left side of
the face. The patient notes the pain increases on positional changes, such as bending over
and when jogging. The most likely diagnosis is which of the following?
a. Myocardial infarction
b. Maxillary sinusitis
c. Atypical facial pain
d. Irreversible pulpitis
7. Which of the following most likely indicates pain that is not of pulpal origin?
a. Unilateral pain that radiates over the face to the ear
b. Pain that has paresthesia as a component
c. Pain that is described as throbbing and intermittent
d. Pain that is increased during mastication
8. A complete medical history is essential when treating an emergency dental patient

for which of the following reasons?
a. To identify patients with conditions that would contraindicate root canal treatment
b. To determine conditions that might require modifications in the approach to
treatment
c. To protect the health care team from potential blood-borne pathogens and other
infectious diseases the patient may have
d. For medical and legal protection and to determine if the medical status will affect
the prognosis for root canal treatment
9. When a patient complains of severe pain that cannot be localized:

a. The pain is most likely periradicular in origin and likely to persist even when the
necrotic pulp is removed.
b. Treatment procedures should be delayed and the condition managed with
analgesic medications.
c. The cause is most likely nonodontogenic in origin.
d. Selective administration of local anesthesia can lead to a definitive diagnosis.
e. The pulp of more than one tooth will be involved and the pathosis produce a
synergistic-hyperalgesia response within the central nervous system (CNS).
10. A patient's chief complaint is severe pain from the mandibular, right first molar
(tooth no. 30) when eating ice cream and drinking iced tea. Clinical examination reveals
MOD amalgam restorations in all posterior teeth. The margins appear intact and no
cracks or caries is detected. Pulp testing indicates all teeth in the quadrant are responsive
to electrical-pulp testing. Application of cold fails to reproduce the symptoms. Which of
the following actions should be taken?
a. The patient should be dismissed and asked to return when the symptoms increase
and the pain to cold becomes prolonged.
b. Initiate root canal treatment by performing a pulpotomy or pulpectomy on tooth
no. 30.
c. Place a rubber dam on individual teeth and apply ice water.
d. Remove the restoration in tooth no. 30, place a sedative restoration, and prescribe
a nonsteroidal, anti-inflammatory agent.
11. A patient complains of pain to biting pressure and sensitivity to cold in the
maxillary, left, posterior quadrant that subsides within seconds of removal of the
stimulus. Clinical examination reveals teeth nos. 2 and 3 exhibit occlusal amalgams.
Which of the following test or actions is most appropriate based on the chief complaint?
a. Periapical radiographs of the posterior teeth
b. Examination with transillumination
c. Electrical pulp testing
d. Percussion and palpation testing
12. A practitioner refers a patient for root canal treatment. The clinician should obtain
a new preoperative radiograph during which of the following situations?
a. When the film from the referring dentist is more than 1 month old
b. In cases when an emergency treatment procedure was performed
c. When the film from the referring dentist reveals a radiolucent area that has a
"hanging drop" appearance
d. Immediately before examining the patient
13. Which of the following is true regarding the periodontal ligament injection when
treating a tooth with a pulpal diagnosis of reversible pulpitis?
a. There will be a decrease in pulpal blood flow when anesthetic agents with a
vasoconstrictor are used.
b. Damage to the supporting structures can cause continued symptoms.
c. The periodontal-ligament injection is contraindicated when block or infiltration
injections are not effective.
d. The periodontal ligament injection can be used as primary anesthesia in teeth that
exhibit single roots, regardless of the number of canals.
14. A patient describes pain on chewing and sensitivity to cold that goes away
immediately with removal of the stimulus. The mandibular, left, second molar (tooth no.
18) exhibits a mesial, occlusal crack. The tooth is caries free, and no restorations are
present. Periodontal probing depths are 3 mm or less. Which of the following statements
is correct?
a. The pulpal diagnosis is normal pulp, and the tooth should be prepared and
restored with a MO-bonded amalgam.
b. The pulpal diagnosis is reversible pulpitis, and the tooth should be restored with a
crown.
c. The pulpal diagnosis is irreversible pulpitis, and root canal treatment should be
performed, a bonded amalgam placed, and a crown fabricated.
d. A radiograph will likely reveal a radiolucent area associated with the mesial root.
e. The prognosis for the tooth is unfavorable.
15. Treatment of severe, throbbing pain associated with the maxillary, left, first molar
(tooth no. 14) is best managed by which of the following?
a. Pulpotomy
b. Partial pulpectomy
c. Pulpectomy
d. Analgesic agents
e. Analgesic and antibiotic agents
16. Which of the following statements regarding leaving a tooth open for drainage in
cases of an acute, apical abscess is accurate?
a. It is the recommended method of managing the emergency patient.
b. It may adversely affect the outcome of treatment.
c. It is appropriate, providing the patient is also placed on an antibiotic.
d. It should be considered in addition to soft tissue incision and drainage.
17. With acute, apical abscess, antibiotic administration is indicated in which of the
following?
a. Primarily only when there is diffuse swelling
b. When there is swelling to any degree (i.e., localized or diffuse)
c. 2 to 3 days before beginning treatment of the tooth
d. Only if there is purulence draining from an incision
18. A 21-year-old model requires emergency treatment of a soft, fluctuant swelling

over the facial alveolar process of the maxillary, left, lateral incisor (tooth no. 10). The
swelling is visible because of a high-lip line. Which of the following statements is correct
regarding performing incision and drainage?
a. The incision should be placed vertically and go directly to bone.
b. The incision should be horizontal in the attached gingiva at the base of the
swelling.
c. If drainage occurs with the initial incision, blunt dissection is not necessary.
d. The placement of a drain is necessary for 24 to 48 hours.
19. Which of the following statements regarding incision and drainage of an

indurated swelling is accurate?
a. They should be delayed until it becomes fluctuant.
b. They can reduce pain caused by tissue distention.
c. They provide a purulent exudate for culture and sensitivity testing.
d. They are not indicated, because antibiotic treatment will result in resolution of the
lesion.
20. Flare-ups during root canal treatment are more commonly associated with which
of the following?
a. Teeth with vital-pulp tissue when compared to teeth with pulp necrosis
b. Teeth with apical radiolucent areas when compared to teeth with normal
periapical tissues
c. With single-visit endodontic procedures
d. Symptomatic teeth exhibiting pulp necrosis
e. Multirooted teeth
21. Of the following reasons, when is apical trephination through the faciobuccal,
cortical plate advocated?
a. To release exudate
b. As a routine procedure for relief of pain when the offending tooth has been
obturated
c. For treatment of severe, recalcitrant pain
d. Between multiple-visit endodontic procedures to prevent the occurrence of a
flare-up
22. A 22-year-old, white man requires root canal treatment for pain and swelling in
the mandibular, anterior area (see illustration). He notes that his dentist has been treating
teeth nos. 25 and 26 for several months and that swelling has occurred after each visit for
cleaning and shaping. Clinical examination reveals swelling located on the alveolar
process in the area of the incisor teeth. Teeth nos. 25 and 26 are tender to palpation and
percussion. The clinician should perform which of the following?
a. Diagnostic tests on the other incisor
b. Open teeth nos. 25 and 26, débride these teeth, and place calcium hydroxide as an
antimicrobial intracanal medicament
c. Open teeth nos. 25 and 26, débride these teeth, and perform incision and drainage
d. Open teeth nos. 25 and 26, débride these teeth, and leave the teeth open for
drainage
e. Perform incision and drainage and prescribe an antibiotic for supportive care
23. A cusp fractures in a noncarious, nonrestored premolar so that dentin is exposed.

When this exposed dentin is contacted by cold fluids, the patient experiences brief, sharp
pain. Which of the following pulp status is likely?
a. Normal and uninflamed
b. Reversibly inflamed
c. Irreversibly inflamed
d. Innervated only by A-delta fibers
24. Corticosteroids have their major pharmacologic effect as which of the following?
a. Antimicrobial agent
b. Analgesic
c. Antiinflammatory agent
d. Agent to reduce swelling
e. Agent to prevent spread of infection
CHAPTER 3: NONODONTOGENIC OROFACIAL PAIN AND

ENDODONTICS: PAIN DISORDERS INVOLVING THE JAWS
THAT SIMULATE ODONTALGIA
1. Peripheral pain impulses in the dental pulp are transmitted centrally via which of
the following pathways?
a. Peripheral nerve, trigeminal nucleus, trigeminal ganglion, thalamus, cortex
b. Peripheral nerve, trigeminal ganglion, mesencephalic nucleus, thalamus, cortex
c. Peripheral nerve, trigeminal ganglion, trigeminal nucleus, mesencephalic nucleus,
cortex
d. Peripheral nerve, trigeminal ganglion, trigeminal nucleus, thalamus, cortex
2. Each of the following statements regarding trigeminal neuralgia is correct, except

a. The empiric evidence suggests vascular compression of the trigeminal ganglion as
a cause of trigeminal neuralgia.
b. The pain involves all three divisions of the trigeminal nerve equally.
c. There is an electrical quality of the pain.
d. The pain is severe, often shooting into the bone and teeth.
e. The standard medical therapy is carbamazepine (i.e., Tegretol).
3. Which of the following statements regarding cluster headaches is correct?

a. Vessels that encircle nociceptive fibers compress the fibers during
vasoconstriction, causing pain.
b. The pain is usually unilateral and involves the maxilla, sinus, and retro-orbital
area.
c. Cluster headaches frequently involve females between 40 and 60 years of age.
d. The pain, which is severe and lasts for 30 to 45 minutes, can occur at anytime.
4. Each of the following has been shown to benefit patients with cluster headaches,
except for one. Which is the exception?
a. Nifedipine
b. Prednisone in combination with lithium
c. Hyperbaric oxygen
d. Alcohol
e. Sumatriptin
5. A 57-year-old man complains of pain in the mandibular, left, posterior quadrant.

The patient relates sporadic, spontaneous pain during his waking hours for the past 1 to 2
weeks. Upon examination no dental cause can be identified. Which of the following
would be the most likely cause of the pain?
a. Cluster headache
b. Myalgia
c. Cardiogenic jaw pain
d. Temporal arteritis
e. Otitis media
6. Each of the following statements regarding maxillary sinusitis is correct, except

a. Pain is often referred to all teeth in the maxillary, posterior quadrant with
percussion sensitivity being a common finding.
b. The maxillary sinusitis may be initiated by a tooth with a necrotic pulp located in
the maxillary, posterior area.
c. Treatment of the sinusitis requires referral to an otolaryngologist and antibiotic
therapy.
d. The Waters view radiograph may be of diagnostic value in demonstrating fluid.
e. An allergen-induced inflammation of the sinus is an immediate-type
hypersensitivity reaction mediated by IgE.
7. Which of the following statements regarding sialolithiasis is correct?
a. The sialolith develops in patients that often exhibit increased levels of serum
calcium.
b. Pain may mimic pulpal pain in the maxillary, posterior teeth because sialolithiasis
is most frequently noted in parotid duct.
c. An occlusal radiograph provides more diagnostic information than a panoramic
film.
d. Sialolithiasis has been associated with kidney stones and gallbladder stones, so
patient's exhibiting this disorder should be referred to a physician for evaluation.
8. Which of the following statements regarding myofascial pain is correct?
a. Trigger points found in the superficial aspect of the masseter may refer pain the
maxillary teeth and mandibular teeth.
b. Trigger points have been noted only in the masseter muscles and temporalis
muscles.
c. Initial treatment consists of finding occlusal discrepancies and performing an
equilibration.
d. Meniscus displacement and intraarticular adhesions are the cause, and corrective
surgery provides long-term success.
9. Each of the following statements regarding malignant lesions of the head and
neck is correct, except for one. Which is the exception?
a. Although paresthesia is an ominous symptom, motor deficits are rare.
b. Metastatic lesions may develop from the lung, breast, and colon.
c. Radiolucent areas detected on radiographs are frequently poorly marginated.
d. Multiple myeloma may produce pain in the affected bone.
10. Which of the following statements regarding atypical orofacial pain is false?
a. The pain is often chronic, difficult to localize, and there is no identifiable cause.
b. The pain has no specific symptoms that lead to a diagnosis.
c. Patient's with atypical orofacial pain may give a history of having endodontic
treatment that did not alleviate the pain.
d. Patient's with atypical orofacial pain complain of pain in other areas of the body.
e. Neuralgia-inducing cavitational osteonecrosis (NICO) is distinct from atypical
orofacial-pain disorders.
11. Which of the following statements accurately describe phantom tooth pain?
a. It occurs in 10% of the patients having endodontic treatment.
b. It may be a form of deafferentation pain.
c. It has been shown to have a psychopathologic component.
d. It has been associated with tooth extraction but does not occur with extirpation of
the pulp.
CHAPTER 4: CASE SELECTION AND TREATMENT
PLANNING
1. Which of the following statements regarding the use of electronic-apex locators is
accurate?
a. The patient is physically impaired.
b. Anatomic structures overlay the root apex.
c. A pregnant patient wishes to avoid exposure to x-rays.
d. All of the above statements are accurate.
2. Antibiotic prophylaxis is suggested for patients with a history of which of the
following?
a. Coronary bypass surgery
b. Atrial fibrillation
c. Artificial heart valve replacement
d. Myocardial infarction
e. Rheumatic fever
3. Elective endodontic treatment is contraindicated in which of the following?
a. Patient is a borderline diabetic.
b. Patient has had a heart attack within the last 6 months.
c. Patient has had numerous opportunistic infections secondary to HIV infection.
d. Patient has an implanted pacemaker.
4. Which of the following accurately describes external resorptions?
a. They are untreatable.
b. They can only be distinguished surgically from internal resorptions.
c. They appear to be superimposed over the root canal.
d. They always require root canal treatment.
5. Referral of difficult cases is indicated in which of the following?
a. The general dentist does not have the indicated equipment.
b. The general dentist does not have the indicated training and experience.
c. The general dentist is not sure what procedures are indicated.
d. All of the above
6. Which of the following statements regarding one-appointment root canal
treatment is accurate?
a. It is best performed in association with trephination or root end surgery.
b. It may predispose the patient to postoperative flare-ups.
c. It is equally successful as multiple-appointment root canal treatment.
7. Single visit is equivalent in outcome to multiple visits (to complete RCT) with
what situation?
a. Vital pulp with acute pain
b. Necrotic pulp with acute pain
c. Necrotic pulp without pain
d. Necrotic pulp with a draining sinus tract
8. Root end surgery is indicated for endodontic failure in which of the following?
a. The dentist suspects a missed canal.
b. There has been coronal leakage.
c. A cast post and core and a well-fitting crown are present.
d. All of the above
9. Prognosis for root canal treatment is worse when the patient is experiencing
which of the following?
a. Pain as a symptom
b. Interappointment flare-up
c. Class III mobility and loss of bone support (i.e., probing defects)
d. Small, periradicular, radiolucent lesion
10. When is endodontic treatment is contraindicated?
a. The patient has no motivation to maintain the tooth.
b. The canal appears to be calcified.
c. A large periapical lesion is present.
d. The tooth needs periodontal crown lengthening before restoration.
11. With pregnancy, the safest period to provide dental care is during which month?
a. First
b. Second and third
c. Fourth to the sixth
d. Seventh and eighth
e. There is no period that is most safe.
12. A preoperative finding that predisposes to a decreased prognosis (i.e., lowersuccess
rate) is which of the following?
a. The tooth is in hyperocclusion.
b. The pulp is vital.
c. The pulp is necrotic with no periradicular lesion.
d. The pulp is necrotic with a periradicular lesion present.
e. Treatment is in an elderly patient.
CHAPTER 5: PREPARATION FOR TREATMENT
1. Which of the following statements describes human immunodeficiency virus
(HIV)?
a. HIV is more easily transmissible than Hepatitis B.
b. HIV is more fragile than the Hepatitis B virus.
c. HIV is a good model for infection control practices.
2. Which of the following statements regarding Occupational Safety and Health
Administration (OSHA) standards is accurate?
a. The standards are established to protect the dentist.
b. They mandate that employees be offered the HIV vaccine.
c. They include engineering and work practice controls.
d. They do not impose financial penalties.
3. Which of the following statements regarding informed consent information for
endodontic therapy is accurate?
a. It must be freely given.
b. It includes prognosis for the recommended treatment and also the alternatives.
c. It includes the opportunity to ask questions.
d. All the above statements are accurate.
4. Which of the following statements regarding radiation exposure from a single,
full-mouth survey is accurate?
a. It is half that of a single chest film.
b. It is comparable to a barium study of the intestines.
c. It would be sufficient to cause skin cancer if all exposures were at one site.
5. While exposing films, dental personnel should do which of the following?
a. Stand back at least 6 feet in an area that is 90 to 135 degrees from the beam
b. Stand behind a plaster, cinderblock, or 1-inch drywall barrier
c. Wear a lead apron
6. The recommended antibiotics for a patient with a total joint replacement who is
allergic to penicillin or cephalosporin is which of the following?
a. Amoxicillin
b. Erythromycin
c. Clindamycin
d. Tetracycline
7. The most effective method for controlling pain that often occurs after cleaning
and shaping is to administer which of the following?
a. Analgesic shortly before the procedure
b. Equal amounts of the analgesic before and during the procedure
c. Analgesic at the conclusion of the procedure
d. Analgesic with instructions to the patient to take if necessary
8. Which of the following statements regarding the long-cone paralleling technique
is accurate?
a. It minimizes distortion of tooth dimension.
b. It minimizes superimposition of the infraorbital rim for maxillary molars.
c. It requires the film be placed directly touching the tooth without bending the film.
9. Radiographic contrast can be directly affected by altering which of the following?
a. Milliamperage
b. Exposure time
c. Kilovoltage
d. Angulation
10. An advantage of digitized radiography in endodontic treatment is which of the
following?
a. Image quality is better for working length radiographs.
b. X-ray generating source is not required.
c. Radiation exposure is reduced.
11. In which of the following situations is a rubber dam not placed?
a. When the clamp impinges on the gingiva, causing discomfort
b. When the chamber or canal may be difficult to locate on access
c. When the tooth is rotated, preventing placement of a clamp on the indicated tooth
d. None; there are no situations in which a rubber dam is not placed.
12. To enhance crown preparation and retention when an infrabony defect exists,
crown lengthening is completed by which of the following?
a. Electrosurgery
b. Gingivectomy
c. Laser surgery
d. Apically positioned flap, reverse bevel
13. Of the following, which statement accurately describes radiograph units?
a. It should be optimally capable of using 70 kVp.
b. It should be pointed (i.e., cone) in shape.
c. It should be collimated to reduce exposure level, not to exceed 7 cm at the skin
surface.
d. It should have a filtration equivalent of 10 mm of aluminum.
14. With the cone moved to the distal and directed toward the mesial, which of the
following accurately describes the mesiobuccal root of the first molar?
a. It is projected mesially on the film.
b. It is projected distally on the film.
c. It does not move.
d. It is projected lingually on the film.
15. The cone angulation in the following illustration is which of the following?
a. Mesial
b. Distal
c. Parallel
d. Bisecting
16. The radiopaque structure overlying the buccal roots in the following illustration is
a. Zygoma
b. Floor of the maxillary sinus
c. Coronoid process
d. Eyeglass frame
17. Which of the following is the best way to "move" the structure in the previous
illustration away from the buccal apexes of both molars? Reposition the cone
a. Inferiorly (i.e., decrease the vertical angle)
b. Superiorly (i.e., increase the vertical angle)
c. Mesially (i.e., the beam is directed more distally)
d. Distally (i.e., the beam is directed more mesially)
18. Why does the tooth in the following illustration appear elongated?
a. There was excessive, positive-and-vertical angle to the cone.
b. There was insufficient, positive-and-vertical angle to the cone.
c. The film was not parallel to the tooth.
d. The film was bent.
19. The radiopaque structure (arrow) in the following illustration is which of the
following?
a. Condensing osteitis
b. Trabeculation
c. Lamina dura
d. Root surface
20. The view in the following radiograph is a mesially angled (beam is directed
distally) film. The unobturated root is which of the following?
a. Buccal root
b. Lingual root
21. Of the following, the best way to identify the source of the radiolucency (arrow)
in the following illustration is which of the following?
a. Pulp test
b. Incisional biopsy
c. Excisional biopsy
d. Observation over time to evaluate for changes
CHAPTER 6: ARMAMENTARIUM AND STERILIZATION
1. The patient is exposed to the least amount of radiation when which of the
following is used?
a. Digital imaging
b. Ektaspeed film
c. Ultraspeed film
2. Patients with a latex allergy can be treated how?
a. Safely without a rubber dam
b. With a rubber dam if there is no direct skin contact
c. With a nonlatex, rubber dam
3. The temporary restorative material, Cavit, is which of the following?
a. Type of zinc oxide-eugenol (ZOE) material
b. Superior to other materials in in vitro resistance to bacterial leakage
c. Prepared by mixing a powder and liquid
d. More durable than intermediate restorative material (IRM) or composite
4. The best way to clean dental instruments before sterilization is by which of the
following?
a. Ultrasonic cleaning for 5 minutes in a perforated basket
b. Hand scrubbing, using a brush and heavy rubber gloves
c. Rinsing under a forceful water spray
5. Steam sterilization is achieved when the load has reached which of the following?
a. 250° C for 15 minutes
b. 250° F for 15 minutes
c. 250° C for 30 minutes
d. 250° F for 30 minutes
6. An advantage of rapid-steam autoclave over traditional autoclave is which of the
following?
a. Rapid-steam autoclave will not corrode steel instruments.
b. Rapid-steam autoclave is safe for all types of materials.
c. Instruments do not have to be air dried at the end of the cycle.
d. Rapid-steam autoclave has a shorter sterilization cycle than traditional autoclave.
7. Of the following, which statement accurately describes a chemical vapor
sterilizer?
a. It uses a reusable chemical.
b. It requires adequate ventilation in the area where it is used.
c. It achieves sterilization when heated to 270° F at 20 psi for 10 minutes.
d. It does not destroy heat-sensitive materials.
8. An approved method for reducing microorganisms in water output from dental
units is which of the following?
a. Filters at the water source
b. Flushing the water line before attaching it to the hand piece or syringe
c. Retrograde (i.e., reverse) flushing of all water lines
d. Careful sterilization of water lines within hand pieces and syringes between
patients
e. Installation of sterile water delivery systems
9. Gutta-percha is best sterilized by which of the following?
a. Immersion in full-strength sodium hypochlorite
b. Immersion in rubbing alcohol
c. Dry heat
d. Bead sterilizer
10. The effect of sterilization on endodontic files is which of the following?
a. Negative and proportional to the number of times sterilized
b. Neutral; no effect is seen on physical properties
c. Positive; it restores to the files flexibility lost over time
11. The most reliable agent for destroying microorganisms is which of the following?
a. Chemical sterilizing agents
b. Hot water
c. Ultrasonics
d. X-ray irradiation
e. Heat
12. A good, two-stage technique (i.e., two burs in sequence) for access through a
porcelain fixed-to-metal crown is which of the following?
a. Stainless steel (SS), round-diamond, coated fissure
b. Diamond-coated, round-carbide, end-cutting fissure
c. SS fissure, carbide, end-cutting fissure
d. carbide, round-diamond, coated, round fissure
e. SS, round-carbide, end-cutting fissure
13. An advantage that nickel titanium (NiTi) has over SS for intracanal instruments is
a. Lower cost
b. More resistance to breakage
c. Sharper
d. More uniform in shape
e. More flexibility
CHAPTER 7: TOOTH MORPHOLOGY AND CAVITY
PREPARATION
1. Which of the following statements describes dens-endente?
a. It occurs primarily in maxillary, lateral, incisor teeth.
b. It requires the use of a long-shank bur for access because the pulp chamber is
located in the middle portion of the root.
c. It results in an untreatable, periodontal pocket.
d. It produces an evagination of dentin and enamel in mandibular premolars.
2. The incidence of three roots and three canals in maxillary first premolars is which
of the following?
a. Less than 1%
b. 3%
c. 6%
d. 10%
3. Vertucci noted in maxillary second premolars which of the following?
a. When two canals were present and join at the apex, the lingual canal is the
straightest.
b. The incidence of two canals at the apex was high, approaching 75%.
c. The incidence of accessory canals found in the furcation was 59%.
d. Histologically, calcification correlated with the radiographic narrowing of the
canal space.
4. In their study of maxillary molars, Kulild and Peters noted which of the
following?
a. Although two canals were often present in the mesiobuccal roots, the canals
merged apically.
b. The use of magnification did not increase the number of canals found clinically in
this tooth group.
c. The orifice to a second canal in the mesiobuccal root was distal to the main orifice
in a line connecting the mesiobuccal canal to the palatal canal.
d. A high incidence of two canals with separate foramina in the mesiobuccal root
(71%).
5. When treating a mandibular incisor with two canals evident on the preoperative
radiograph, which of the following statements are true?
a. The internal morphology of the canals will be ribbon shaped.
b. A facial-access opening might be considered.
c. The canals often remain separate and distinct throughout the root.
d. The access opening should be triangular with the apex at the cingulum.
6. Which of the following teeth is most likely to exhibit C-shaped morphology?
a. Maxillary first premolar
b. Maxillary first molar
c. Mandibular first premolar
d. Mandibular first molar
7. In their study of mandibular molars, Skidmore and Bjorndal noted which of the
following?
a. The access opening should be rectangular.
b. When there were two canals in the distal root, they remained distinct with
separate apical foramina.
c. The incidence of four canals was over 50%.
d. The mesiobuccal canal was located under the mesiobuccal cusp tip and exhibited
the straightest morphology.
8. The mandibular, second molar should be restored with a crown after endodontic
treatment for which of the following reasons?
a. The pulp chamber is relatively large in comparison to the crown, making the tooth
susceptible to fracture.
b. The tooth is in close to the insertion of the muscles of mastication, and the
percentage of preexisting fractures is high.
c. There is a tendency for the buccal cusps to shear off under occlusal loading.
d. Providing a post can be placed in the distal root to strengthen the root.
9. Which of the following statements regarding the mandibular, second molar
exhibiting a C-shaped morphology is correct?
a. The root morphology varies with two separate-and-distinct roots being a common
finding.
b. Research indicates that the presence of a C-shaped canal is most common in
Caucasians.
c. The C-shaped molar exhibits a ribbon-shaped orifice with a 180-degree arc
beginning in the mesiobuccal area and forming an arch extending lingually to the
distobuccal.
d. The mesiolingual canal is often noted to be separate and distinct, exhibiting a
separate foramen.
10. A 30-year-old male patient is being treated for a maxillary central incisor that he
traumatized as a teenager. Radiographically, the canal appears calcified and there is
evidence of apical pathosis. After attempting access the canal cannot be located despite
drilling into the middle third of the root. Which of the following statements regarding
further treatment is false?
a. Radiographs may indicate the orientation of the access opening within the root.
b. The risk of perforation will be greatest on the lingual surface, should the clinician
continue.
c. The clinician should consider obturating the coronal segment and performing root
end surgery.
d. Because canals become less calcified as they proceed apically, a pathfinder might
be used to negotiate the residual canal space.
CHAPTER 8: CLEANING AND SHAPING THE ROOT
CANAL SYSTEM
1. Which of the following statements regarding shaping procedures is false?
a. Shaping is performed after cleaning of the apical one third of the canal to ensure
patency.
b. Shaping facilitates placement of instruments to the working length by increasing
the coronal taper.
c. Shaping permits the a more accurate assessment of the apical, cross-sectional
canal diameter.
d. Shaping is a necessary procedure because calcification occurs from the coronal
portion of the canal to the apex.
2. Which of the following statements best describes the Profile Series 29 files?
a. The Profile Series 29 files conform to the International Standards Organization
(ISO) specifications for instrument design.
b. The instruments exhibit a constant percentage change between successive
instruments.
c. The Profile Series 29 files were designed to facilitate preparation of the coronal
portion of the radicular space.
d. The instruments are most useful in the larger sizes because there is a smaller
change in diameter between the files.
3. Each of the following are direct advantages of pre-enlarging the radicular space,
a. It provides better tactile control of instruments when negotiating a small, curved
canal.
b. It removes the bulk of tissue and contaminants before apical preparation.
c. It facilitates obturation.
d. It provides a reservoir for the irrigant.
4. The result of root canal treatment in establishing patency is which of the
following?
a. It revents procedural errors, such as canal blockage and transportation.
b. It causes irritation of the periodontal attachment apparatus and increased
postoperative pain.
c. It enlarges the apical terminus and increases the potential for extrusion of
obturating materials.
d. It requires insertion of a file 1.0 to 2.0 mm beyond the canal terminus.
5. Which of the following statements regarding gauging and tuning is correct?
a. Gauging is performed in the coronal portion of the canal to confirm the coronal
enlargement is complete.
b. Tuning identifies the most apical, cross-sectional diameter of the canal.
c. Gauging and tuning verify the completed shaping of the apical portion of the
canal.
d. Gauging and tuning produces a uniform, cylindric diameter to the canal in the
apical 2 to 3 mm that enhances obturation and sealing.
6. Which of the following statements best describes the Quantec files?
a. The instruments have a constant helical angle and three flutes.
b. The recommended rotational speed is 1000 to 2000 RPM.
c. The instruments exhibit a constant rate of taper along their length.
d. The instruments exhibit varied tapers with a constant D0 diameter of 0.25 mm.
7. Which of the following statements regarding the use of chelating agents in canal
preparation is correct?
a. Aqueous solutions are preferred to viscous suspensions in canal preparation.
b. Viscous suspensions are more effective in preventing accumulation of tissue and
dentinal debris.
c. Viscous suspensions contain the highest concentration of
ethylenediaminetetracitic acid (EDTA) and are most effective in removing the smear
layer.
d. Aqueous solutions are most efficient as lubricants and, therefore, preferred to
viscous suspensions during canal preparation.
e. EDTA, in concert with sodium hypochlorite, causes a nascent release of oxygen,
which kills anaerobic organisms.
8. Which of the following statements regarding an endogram is false?
a. An endogram would provide information on the extent of internal resorptive
lesion.
b. The visualization of fractures and leaking restorations is attributed to the
incorporation of Hypaque in the irrigating solution.
c. Conventional radiography and digital radiography may both be used in producing
an endogram.
d. The endogram is used to confirm the correct working length.
9. During the early phase of root canal preparation, which of the following is true?
a. The initial scouter file that moves easily through the canal should be advanced to
the estimated working length.
b. The initial scouter file may not advance to the estimated working length because
of the rate of instrument paper.
c. The initial scouter file should be advanced with a reciprocating action using apical
pressure when resistance is encountered.
d. The initial scouter file is used before the introduction of a viscous chelator in
cases exhibiting vital tissue.
10. Which of the following statements is correct regarding coronal canal preparation
in endodontic treatment?
a. Nickel-and-titanium (NiTi) rotary instruments are preferred to Gates-Glidden
(GG) drills because they remove dentin uniformly from the canal wall.
b. NiTi rotary instruments are best used in a step-back fashion.
c. Both GG drills and NiTi rotary instruments should be used large to small, because
this develops a preparation that is centered in the root.
d. GG drills used in a step-back technique can relocate the canal away from the
furcal wall.
11. When using the balanced-force technique for canal preparation, which of the
following statements is accurate?
a. The cutting stroke involves apical pressure and a counterclockwise rotation.
b. Clockwise rotation balances the tendency of the file to be drawn into the canal
during the cutting stroke.
c. Dentin is engaged with a counterclockwise rotation and cut with a 45- to 90-
degree, clockwise rotation.
d. It requires the use of a crown down technique.
12. Extending a no. 10 file with a 0.02 taper 1.0 mm beyond the apical foramen will
result in which of the following?
a. It opens the apical foramen to a minimum diameter of 0.12 mm.
b. It increases postoperative discomfort to occlusal forces.
c. It reduces the percentage of change from a no. 10 file to a no. 15 file by 50%.
d. It eliminates the natural constriction of the foramen and increases the chance for
an overfill.
CHAPTER 9: OBTURATION OF THE CLEANED AND
SHAPED ROOT CANAL SYSTEM
1. Of the following, the least important determinant of root canal treatment success
is which of the following?
a. Proper placed restoration after root canal treatment
b. Healthy periodontium
c. Three-dimensional (3-D) obturation of the root canal system
2. Paraformaldehyde-containing obturating materials result in which of the
following?
a. Eliminate bacteria that remains in the canals
b. Mummify tissue remnants in the canals
c. Reduce posttreatment pain
d. Are below the standard of care for root canal treatment
3. It is preferable to not extrude sealer beyond the apex for which of the following
reasons?
a. The sealer usually does not resorb.
b. The sealer often stains or tattoos the tissue.
c. The sealer is a tissue irritant and may delay healing.
d. The sealer promotes bacterial growth.
4. Gutta-percha in contact with connective tissue is which of the following?
a. Relatively inert
b. Immunogenic
c. unstable
d. Carcinogenic
5. The primary reason to use a sealer and cement is which of the following?
a. Attainment of an impervious seal
b. Canal disinfection
c. Lubrication of the master cone
d. Adhesion to dentin
e. All of the above
6. Considering lateral versus vertical condensation, studies have shown which of the
following?
a. Lateral condensation results in a better seal.
b. Vertical condensation results in a better seal.
c. Both consistently fill lateral canals.
d. Sealability with either largely depends on the shape of the prepared canal.
7. A problem with nickel-and-titanium (NiTi) spreaders is which of the following?
a. Tendency to buckle under compaction pressure
b. Tendency to break during condensation
c. Creation of greater wedging forces, leading to root fracture
d. They do not penetrate as deeply as stainless steel (SS) spreaders under equal force
8. Moderate extrusion of obturating materials beyond the apex is undesirable
because of which of the following?
a. There is more likelihood of postoperative discomfort.
b. Sealer and gutta-percha cause a severe, inflammatory reaction in periradicular
tissue.
c. The prognosis is poorer.
d. All of the above
9. In which of the following is one-visit root canal treatment not recommended?
a. The pulp is necrotic and not symptomatic.
b. The pulp is necrotic and symptomatic.
c. The pulp is necrotic and there is a draining sinus tract.
d. The pulp is vital and symptomatic.
10. When is an application of heater-injected gutta-percha potentially beneficial?
a. When there is an open apex
b. When there are aberrations or irregularities of the canal
c. When the clinician cannot master lateral condensation
d. When the canals are curved and small after preparation
11. Which of the following statements accurately describe an adequate apical seal?
a. It can only be achieved with lateral condensation.
b. It depends on placing the compacting instrument close to the apical terminus.
c. It can be achieved in small, nontapering canal preparations.
12. Which of the following statements accurately describe the continuous-wave
technique?
a. It uses a heat carrier that can both compact and heat gutta-percha.
b. It is superior to other warm-compaction techniques.
c. It has been shown to provide a better prognosis than cold-compaction techniques.
d. It has been shown to have no adverse effects on the periodontium.
13. An advantage of the continuous-wave technique over warm, vertical compaction
a. The continuous-wave technique is faster.
b. The continuous-wave technique adapts better to canal irregularities.
c. The continuous-wave technique is not technique sensitive.
d. No special devices are necessary.
14. The most likely cause of a gross overfill is which of the following?
a. Lack of an apical seat or stop
b. Use of excessive amounts of sealer
c. Use of excessive apical pressure on the spreader
d. Use of a master cone that is too small
15. The obturation of the incisor shown in the following illustration is inadequate
because of which of the following?
a. It appears short of the prepared length.
b. There is variable radiodensity (i.e., incomplete condensation) throughout its
length.
c. There is a space between the temporary restoration and the gutta-percha.
d. The diagnosis was pulp necrosis and chronic apical periodontitis; the canal should
be filled to the apical foramen.
16. The dark tooth in the following illustration has a history of trauma and root canal
treatment. It is likely that the discoloration is primarily caused by which of the following?
a. Remnants of necrotic tissue
b. A leaking restoration
c. Blood pigments in the dentinal tubules
d. Obturating materials not removed from the chamber
17. Of the following, what is the most likely cause of failure of root canal treatment
on the lateral incisor in the illustration?
a. The silver point corrodes.
b. The canal is filled too close to the apex.
c. There is coronal leakage.
d. The silver point does not adapt to the prepared space.
CHAPTER 10: RECORDS AND LEGAL RESPONSIBILITIES
1. Concerning making changes in a patient record, which of the following statements
is accurate?
a. Any changes are forbidden.
b. Deletions are permitted if erased completely as soon as they occur.
c. Corrections are permitted, if dated.
2. Standard of care, as defined by the courts, is which of the following?
a. Requires absolute perfection
b. Describes what any careful-and-prudent clinician would do under similar
circumstances
c. Does not allow for individual variations of treatment
d. Is equivalent to customary practice
3. The doctrine of informed consent does not require which of the following?
a. Patients to be advised of reasonably foreseeable risks of treatment
b. Patients to be advised of reasonable alternatives
c. Patients forfeit their right to do as they see fit with their body.
d. Patients be advised of the consequences of nontreatment.
4. Which of the following statements accurately describe a periodontal examination
of a patient referred for endodontic treatment?
a. It should performed on the entire dentition.
b. It must be performed at least on the tooth to be treated.
c. It is necessary only if there is evidence of periodontal disease.
d. It is necessary only if requested by the referring dentist.
5. A dentist may legally do which of the following?
a. Refuse to treat a new patient, despite severe pain and infection
b. Be bound to see a former patient on recall after treatment is completed
c. Discharge a patient from the practice at any time
d. Refuse to treat a patient who has an outstanding account balance
6. If a patient with human immunodeficiency virus (HIV) requests that the dentist
not inform the staff of the condition, the dentist should do which of the following?
a. Refuse to treat the patient
b. Tell the staff in private, and then treat the patient with extra precautions
c. Not tell the staff but treat the patient with great caution
d. Not tell the staff and require the patient to assume liability should anyone contract
the virus
7. A specialist may be held liable if which of the following occurs?
a. Informs the patient that the general practitioner performed substandard care
b. Fails to disclose to the patient or referring dentist evident pathosis on teeth other
than those the specialist is treating
c. Fails to locate a small canal that is not evident radiographically
d. Mistakenly initiates treatment on the wrong tooth in a difficult diagnostic
situation
8. Of the following, which is the best way for clinicians to avoid legal actions by
patients?
a. Tell patients they have no malpractice insurance.
b. Attend continuing education courses to remain informed of current techniques.
c. Refer all major patient complaints to peer review.
d. Demonstrate genuine interest in the welfare of the patient.
9. Computerized treatment records may not be signed electronically.
a. True
b. False
10. Suing to collect fees is a proven route to being counter sued for malpractice.
a. True
b. False
11. Standard of care for routine endodontics is set by which of the following?
a. The state's dental licensing agency
b. Endodontists
c. The community of general dentists
12. A patient continues to have pain after a dentist uses the technique of
Paraformaldehyde paste pulpotomy on a tooth with a necrotic pulp and apical pathosis
and then places a crown. In this situation, which of the following statements is true?
a. The dentist is liable for malpractice because unacceptable treatment procedures
were followed.
b. The dentist is not liable if the patient is now referred to the appropriate specialist
who can treat the case.
c. The dentist is not liable if the dentist performs additional treatment for no fee.
CHAPTER 11: STRUCTURE AND FUNCTIONS OF THE
DENTIN AND PULP COMPLEX
1. In the process of tooth development, which of the following statements are true?
a. The basement membrane separating the inner dental epithelium from the dental
mesenchyme is composed of type I and III collagen.
b. Blood vessels become established in the dental papilla during the cap stage.
c. Mature ameloblasts appear before odontoblasts mature. However, the formation
of enamel takes place following the deposition of dentin.
d. The II collagen mRNA increase with odontoblastic differentiation.
e. Ameloblasts form enamel spindles near the future dentinoenamel junction (DEJ).
2. von Korff fibers are best described as which of the following?
a. The first-formed collagen fibers formed between preodontoblasts.
b. Unmyelinated sensory fibers in the cell-free zone of Weil
c. Odontoblastic processes interposed between ameloblasts
d. Silver-stained ground substance located between odontoblasts
3. Which of the following statements regarding root development is false?

a. Root development begins after completion of enamel formation.
b. The inner epithelium, the stellate reticulum, and outer enamel epithelium form
Hertwig's epithelial root sheath.
c. The dental sac disintegrates upon induction of dentin formation and remnants
persist as the Epithelial Rests of Malassez.
d. Accessory canals in the root are formed when there is discontinuity in the root
sheath.
4. Which of the following statements regarding dentin is correct?

a. Mantle dentin is the first formed dentin and has collagen fibers that run
perpendicular to the DEJ.
b. Dentin deposited after eruption is termed secondary dentin.
c. Dentinal tubules make up 50% of the dentin volume and they exhibit extensive
terminal ramifications.
d. Calcification of dentin results in an organic component composed of
noncollagenous matrix components.
5. Which of the following statements regarding the tubular structure of dentin is
correct?
a. Peritubular dentin and intertubular dentin are the same composition, except for the
fact peritubular dentin lines the tubule.
b. Peritubular dentin has a lower-collagen content when compared to intertubular
dentin and is more susceptible to removal by acids.
c. Intertubular dentin is more highly mineralized when compared to peritubular
dentin.
d. Peritubular dentin defines the tubule size and is common to all mammals.
6. Which of the following statements regarding dentin permeability is true?
a. Remains constant regardless of the depth of a cavity preparation because of a
pulpal tissue pressure of 10.3 mm Hg
b. Increases as the pulp and dentin border is approached (primarily because the
tubular surface area increases)
c. Is lower in radicular dentin because of tubular sclerosis
d. Increases near the pulp and dentin border as the hydrostatic pressure in the tubules
decreases
7. Which of the following statements regarding tight junctions in the odontoblastic
layer is true?
a. They regulate permeability of extracellular substances between the odontoblastic
layer and the predentin.
b. They permit low-resistance pathways for electrical excitation when the
odontoblastic process is distorted.
c. They provide a mechanism for intracellular materials to be exchanged.
d. They are infrequent but when found are located in the basal portion of the cells.
8. Which of the following statements regarding production of collagen by the
odontoblast is correct?
a. Type I collagen is manufactured in the cellular cytoplasm, packaged by the Golgi
complex, and released by reverse pinocytosis.
b. Tropocollagen is synthesized in the rough endoplasmic reticulum (RER) and
packaged in the Golgi complex. Vesicles consisting of collagen fibrils migrate into the
odontoblastic process and are released.
c. The Golgi complex packages collagen precursors (e.g., proline) into vesicles that
are released into the predentin. These then precipitate to form tropocollagen and,
eventually, collagen fibrils.
d. Synthesis begins in the RER with procollagen being packaged in the Golgi
complex. Vesicles are formed and release tropocollagen in the predentin matrix.
9. Which of the following statements regarding dendritic cells is false?
a. Dendritic cells are similar to Langerhans' cells and play a significant role in
induction of T-cell immunity.
b. Although not normally present in the healthy pulp, dendritic cells appear during
inflammation and, like macrophages, are phagocytic.
c. Considered accessory cells, the dendritic cell participates in antigen recognition
and presentation.
d. Dendritic cells are primarily found in lymphoid tissues.
10. Which of the following statements regarding the extracellular matrix of the pulp is
false?
a. The extracellular matrix changes with eruption of the tooth as the chrondroitin
sulfate concentration decreases and the hyaluronic acid and dermatan sulfate fraction
increase.
b. The proteoglycans regulate the dispersion of interstitial solutes.
c. The state of polymerization of the ground substance regulates osmotic pressures.
d. The water content of the extracellular matrix is relatively low, giving the tissue a
colloidal consistency and limiting movement of components within the tissue.
11. Teeth with immature root development often are unresponsive to electrical pulp
testing because which of the following?
a. Myelinated fibers are the last structures to appear in the developing pulp.
b. Predentin and intratubular fibers are not present until root formation is complete.
c. There is a relative hypoxic condition of the pulp during developmental glycolysis.
d. Electrical stimulation of autonomic fibers decreases blood flow and depresses Adelta
fiber activity.
12. Each of the following statements support the hydrodynamic theory for pain,
a. Odontoblasts have a low-membrane potential and do not respond to electrical
stimulation.
b. Placement of local anesthetics on dentin does not alter the pain response.
c. There is a positive correlation between fluid movement in the tubules and the
discharge of intradental nerves.
d. Forty percent of the tubules in the area of pulp horns contain intratubular nerve
endings.
e. The presence of a smear layer decreases dentinal sensitivity.
13. Which of the following statements regarding a patient that has a sharp, short
sensation to cold that resolves immediately with removal of the stimulus is correct?
a. The patient's response indicates inflammation and tissue damage.
b. A-delta and C fibers are responsible for the painful sensation.
c. A-delta and A-beta fibers are being stimulated.
d. C-fibers are responding to the release of inflammatory mediators, such as
bradykinin and substance P.
14. Which of the following statements regarding pulpal bloof flow is correct?
a. Blood flow within the pulp is homogenous with arteriovenous anastomoses
maintaining an even flow.
b. Unmyelinated, sympathetic fibers innervating the arterioles and venules produce
vasoconstriction.
c. The pulpal blood flow is the highest of oral tissues because of the relatively high
metabolic activity of the pulp.
d. Accessory and lateral canals provide adequate collateral circulation.
15. Which of the following statements outlines the most significant factor influencing
the pulp's response to injury and compromised healing?
a. Inflammatory cells, such as polymorphonuclear leukocytes and B-lymphocytes,
are not found in the normal pulp.
b. There is a lack of a collateral circulation.
c. Odontoblasts are end line cells incapable of replication.
d. The fact that the pulp may not have a lymphatic system.
e. The environment of the dental pulp is low compliant.
16. Which of the following statements regarding age changes in the pulp are false?
a. There is a decrease in the cellularity and collagenous fibers, especially in the
radicular pulp.
b. Odontoblasts decrease in size and may disappear completely in some areas,
particularly the pulpal floor of multirooted teeth.
c. There is a reduction in the nerves and vasculature of the pulp.
d. There is an increase in peritubular dentin.
e. The pulp demonstrates an increased resistance to the action of proteolytic
enzymes.
CHAPTER 12: PATHOBIOLOGY OF THE PERIAPEX
1. Inflammation of the periapical tissue is sustained by which of the following?
a. Stagnant tissue fluid
b. Necrotic tissue
c. Microorganisms
d. All of the above
2. Acute, apical periodontitis is characterized by which of the following?
a. A focus of neutrophils within the lesion
b. A focus of granulomatous tissue in the lesion
c. A focus of lymphocytes, plasma cells, and macrophages in the lesion
3. A periapical, true cyst communicates with the root canal; however, a periapicalpocket
cyst does not.
a. True
b. False
4. The most important route of bacteria into the dental pulp is from which of the
following?
a. The general circulation via anachoresis
b. Exposure to the oral cavity via caries
c. The gingival sulcus
5. The least important factor influencing the pathogenicity of endodontic flora is
a. Microbial interaction
b. Endotoxins released after bacterial death
c. Exotoxins released by living bacteria
d. Enzymes produced by bacteria
6. Which of the following statements regarding neutrophils is accurate?
a. They are nonspecific phagocytes.
b. They have a single pathway for intracellular killing.
c. They are mobilized primarily to neutralize bacterial endotoxins.
d. All of the above are accurate.
7. Which of the following statements regarding T-lymphocytes are accurate?
a. They are thyroid-derived cells.
b. They concentrate in the cortical area of lymph nodes and also circulate in the
blood.
c. They are responsible for the cell-mediated arm of the immune system.
8. Which of the following statements regarding B-lymphocytes are accurate?
a. They were originally discovered in an avian gut-associated organ.
b. They account for the majority of circulating lymphocytes.
c. They produce antibodies.
9. The function(s) of macrophages include(s) which of the following?
a. Phagocytosis of microorganisms
b. Removal of small foreign particles
c. Antigen processing and presentation
d. All of the above
10. Which of the following statements regarding osteocytes is accurate?
a. They originate as monocytes in the blood.
b. They respond only to mediators released by osteoblasts.
c. They are mononuclear cells capable of bone demineralization.
d. They form a ruffled border away from the bone surface.
11. Which of the following statements regarding acute apical periodontitis is
accurate?
a. It is limited to the periodontal ligament (histologically).
b. It is detectable radiographically.
c. It may heal if induced by a noninfectious agent.
12. Which of the following statements regarding chronic, apical periodontitis is
accurate?
a. It is a neutrophil-dominated lesion encapsulated in a collagenous connective
tissue.
b. It may contain epithelial arcardes or rings.
c. It represents a continuous, slow process that is asymptomatic.
d. It is a predominance of B-cells over T-cells.
13. Which of the following statements regarding cholesterol crystals is accurate?
a. They may induce granulomatous lesions.
b. They are potentially associated with nonresolving apical periodontitis.
c. They are difficult for macrophages and multinucleated giant cells to remove.
14. Which of the following statements regarding periapical actinomycosis is
accurate?
a. It is caused by gram-negative organisms exhibiting branching filaments that end
in clubs or hyphae.
b. It is a fungal disease characterized by filamentous colonies called sulphur
granules.
c. It is most commonly an endodontic infection resulting from dental caries.
15. Extraradicular infections are not found in which of the following?
a. Solid, apical granulomas
b. Periapical-pocket cysts with cavities open to the root canal
c. Periapical actinomycosis
d. Acute, apical periodontitis
CHAPTER 13: ENDODONTIC MICROBIOLOGY AND
TREATMENT OF INFECTIONS
1. Pulpal and periradicular pathosis results primarily from which of the following?
a. Traumatic injury caused by heat during cavity preparation
b. Bacterial invasion
c. Toxicity of dental materials
d. Immunologic reactions
2. Which of the following statements regarding the organism producing pulpal
pathosis is correct?
a. The organisms are primarily facultative streptococci.
b. Single isolates (i.e., monoinfection) produce the most severe reactions
c. Isolates tend to be polymicrobial and anaerobic.
d. Organisms infecting the pulp tend to be aerobic, compared to organisms infecting
the periapex.
3. Which of the following best describes anachoresis?
a. The attraction of bloodborne microorganisms to inflamed tissue during a
bacteremia
b. The process of carious invasion, cavitation, and exposure of the pulp from
bacteria
c. Bacteria located in dentinal tubules, and the pulp that are seeded to the systemic
circulation, inducing disease in other areas of the body
4. Which of the following statements regarding strict anaerobes is accurate?
a. They are missing enzymes, catalase, and superoxide dismutase.
b. They function best at high oxidation-reduction potentials.
c. They can grow in the presence of oxygen.
5. The most common black-pigmented bacteria cultivated from endodontic
infections is which of the following?
a. Bacteroides melaninogaster
b. Fusobacterium nucleatum
c. Prevotella nigrescens
d. Porphyromonas intermedia
6. Treatment of actinomycosis israelii may include which of the following?
a. Root canal treatment
b. Root end surgery
c. Antibiotics
d. All of the above
7. Which is true regarding microbial virulence factors?
a. Fimbriae assist in bacterial aggregation.
b. Pili break off and form extracellular vesicles filled with enzymes.
c. Lipopolysaccharides is found in the liposomes of gram-positive bacteria.
d. All of the above.
8. Which of the following statements regarding polyamines is accurate?
a. They are produced by bacteria and host cells.
b. They may be found in infected root canals.
c. They are more concentrated in teeth with spontaneous pain.
9. Which of the following statements regarding fascial space infections is accurate?
a. They are associated with radiographically visible periradicular lesions.
b. They occur in potential spaces between fascia and underlying tissue.
c. They occur when a tooth apex is located coronal to a muscle attachment.
10. Which of the following statements regarding Ludwig's angina is accurate?
a. It involves the submental, sublingual, and submental space of the right or left side.
b. It can progress into the canine and infraorbital space.
c. It can result in airway obstruction.
11. Antibiotics are recommended for which of the following?
a. Sinus tracts
b. Acute, apical periodontitis
c. After root end surgery
d. None of the above
12. Incision and drainage is indicated which of the following?
a. For sinus tracts
b. When the swelling is diffuse and indurated
c. For acute, apical periodontitis
d. All of the above
13. Incision and drainage of cellulitis is effective because of which of the following?
a. It provides a pathway of drainage to prevent spread of infection.
b. It relieves increased tissue pressure.
c. It provides relief of pain.
d. It increases circulation to the area and improves delivery of antibiotics.
e. All of the above statements are accurate.
14. Which of the following statements regarding potassium penicillin V is accurate?
a. It has a broader spectrum than amoxicillin.
b. It may be dosed at 4-hour intervals for severe infection.
c. It will select for resistant organisms, especially in the GI tract.
d. It has up to a 25% allergy rate.
15. Which of the following statements regarding metronidazole is accurate?
a. It is effective against facultative and anaerobic bacteria.
b. It cannot be given with penicillin because of disulfuram reaction.
c. It cannot be taken with lithium or alcohol.
16. Which of the following statements regarding clindamycin is accurate?
a. It is an alternative to potassium penicillin V in allergic individuals.
b. It is effective against facultative and anaerobic bacteria.
c. It is rarely associated with pseudomembranous colitis in doses recommended for
endodontic infections.
17. Which of the following statements regarding the American Heart Association
(AHA) guidelines for prophylactic antibiotic coverage is accurate?
a. They are the standard of care for clinicians.
b. They are based on controlled clinical studies.
c. They are not a substitute for clinical judgment.
18. The AHA recommends antibiotic prophylaxis for which of the following?
a. Surgery
b. Instrumentation beyond the apex
c. Periodontal-ligament injection
d. All of the above
19. Which of the following statements regarding he theory of focal infection is
accurate?
a. It was propounded by Dr. William Hunter in 1910.
b. It was referred to infections found around poorly made restorations.
c. It was used to explain diseases for which there was no cure.
d. It results in needles tooth extraction.
20. Which of the following is correct in relation to the periradicular lesion formed in
response to dental caries and subsequent pulp necrosis?
a. Bacteria are commonly found in the granuloma.
b. T-helper cells predominate over T-suppressor cells.
c. Formation of the granuloma is mediated through a specific immunologic
response.
d. The release of interleukins can mediate bone resorption.
CHAPTER 14: INSTRUMENTS, MATERIALS, AND DEVICES
1. Which of the following statements regarding pulp stimulation with cold is
accurate?
a. It is best accomplished with carbon dioxide snow (i.e., dry ice).
b. It is an accurate assessment of pulp vitality.
c. It directly stimulates the pain fibers in the pulp.
d. It is best determined with a blast of air.
2. With regard to electrical pulp testing, which of the following is true?
a. Positive responses can be used for differential diagnosis of pulp pathosis.
b. The device uses a pulsating, alternating current with a duration of 1 to 15 ms.
c. The device uses a low current with a high-potential difference in voltage.
d. Gingival and periodontal tissues are more sensitive to testing than the pulp.
3. Which of the following statements regarding digital radiographs is accurate?
a. They are produced by a charged coupled device and do not require x-rays.
b. They have the advantage of being manipulatable, which facilitates interpretation.
c. They have greater resolution than traditional film.
d. They are captured by a sensor that has a greater surface area than traditional film.
4. Which of the following statements regarding nickel and titanium (NiTi)
instruments is accurate?
a. They exhibit a high elastic modulus, which provides flexibility.
b. When stressed, they exhibit transformation from the austenitic crystalline phase to
a martensitic structure.
c. They cannot be strained to the same level as stainless steel (SS) without
permanent deformation.
d. They are easier to prebend before placement in the canal than SS.
5. A barbed broach is most useful for which of the following?
a. Removal of cotton, paper points, and other objects from the canal
b. Removal of vital tissue from fine canals
c. Initial planing of the canal walls
d. Coronal-orifice enlargement before establishing the correct working length
6. In comparing K-type files with reamers, which of the following statements
regarding K-type files is accurate?
a. They have more flutes per millimeter, which increase flexibility.
b. They differ, because the file is manufactured by twisting a tapered, square blank.
c. They are more effective in removing debris.
d. They are the least flexible when comparing instruments of the same size.
7. Based on instrument design and method of manufacturing, which of the following
is most susceptible to fracture?
a. K-type file fabricated from tapered, square SS blank
b. K-flex file fabricated from rhomboidal SS blank
c. Hedström file fabricated from round SS blank
d. Reamer fabricated from triangular SS blank
8. Which of the following statements regarding Hedström files are accurate?
a. They are manufactured by machining a round cross-sectional wire.
b. They are effective when used in a reaming action.
c. They are safer than K-type files, because external signs of stress are more visible
as changes in flute design.
d. They are aggressive because of a negative-rake angle that is parallel to the shaft.
9. Which of the following statements regarding the Profile rotary instruments is
accurate?
a. They are used at a range of 1500 to 2000 rpm.
b. They are NiTi instruments manufactured in half sizes.
c. They exhibit sizes that are ISO and ANSI standardized.
d. They incorporate radial lands in the flute design.
10. Which of the following statements regarding the best apex locators is accurate?
a. They require training with the instrument to become proficient.
b. They are sensitive to canal contents.
c. They measure the impedance between the file and the mucosa.
d. On average, they are accurate to within 0.5 mm of the apex.
11. Piezoelectric, ultrasonic devices differ from magneto-strictive devices in which of
the following?
a. The piezoelectric unit transfers more energy to the files.
b. The piezoelectric unit produces heat that requires a coolant.
c. The piezoelectric unit uses a RispiSonic, ShaperSonic, and TrioSonic file system.
d. The piezoelectric unit vibrates at 2 to 3 kHz.
12. Which of the following statements regarding ultrasonic root canal instrumentation
is accurate?
a. It should be performed in a dry environment.
b. It poses little risk of file breakage.
c. It is not very useful for dentin removal.
d. It is most useful in small canals where file contact with the wall is maximized.
13. Which of the following statements regarding sodium hypochlorite used as a root
canal irrigating solution is accurate?
a. It is buffered to a pH of 12 to 13, which increases toxicity.
b. It exhibits a chelating action on dentin.
c. It should be used in higher concentrations because of the increased free chlorine
available.
d. It is a good wetting agent that permits the solution to flow into canal irregularities.
14. When ethylenediaminetetraacetic acid (EDTA) is used as an endodontic irrigant,
which of the following statements is accurate?
a. It must be completely removed after use to prevent continued action and
destruction of dentin.
b. It is a rapid-and-efficient method of removing the smear layer.
c. It acts on organic-and-inorganic components of the smear layer.
d. It penetrates deep into dentin and enhances root canal preparation.
15. Calcium hydroxide is advocated as an interappointment medication primarily
because of which of the following
a. Its ability to dissolve necrotic tissue
b. Its antimicrobial activity
c. Its ability to stimulate hard-tissue formation
d. Its ability to temporarily seal the canal
16. Which of the following statements is accurate regarding gutta-percha points is
accurate?
a. They contain 40% to 50% pure gutta-percha.
b. They adhere to dentin when compacted.
c. They can be heat sterilized.
d. They are not compressible.
17. An advantage to AH26 as an endodontic sealer is which of the following?
a. The release of formaldehyde on setting
b. Low toxicity
c. Long working time, but quick setting (i.e., 1 to 2 hours) at body temperature
d. It can be distinguished from gutta-percha radiographically
18. N2, Endomethasone, and Reibler's paste are sealers that do which of the
following?
a. Produce liquefaction necrosis in the periradicular tissues
b. Induce healing in the apical pulp wound after vital pulp extirpation
c. Can cause periapical inflammation
d. Do not produce a seal when used in combination with a core material
19. Which of the following statements is accurate regarding TERM is accurate?
a. It seals as well as Cavit.
b. It is the material of choice when strength is a requirement.
c. It is a zinc oxide-reinforced material that can be light cured.
d. It has a eugenol component that is antibacterial.
20. The root end is ultrasonically prepared during endodontic surgery for which of the
following reasons?
a. It results in apical cracks at low settings.
b. It results in larger, but cleaner, cavity walls.
c. It can make a deeper cavity more safely than a bur.
d. It does not require as acute an angle of root resection.
CHAPTER 15: PULPAL REACTION TO CARIES AND
DENTAL PROCEDURES
1. The most common response in the dentin deep to caries is which of the following?
a. Increased permeability
b. Alteration of collagen
c. Dissolution of peritubular dentin
d. Dentinal sclerosis
2. Relatively few bacteria are found in a pulp abscess because of which of the
following?
a. Immune response of pulp tissue
b. High tissue pH in the adjacent inflammation
c. Mechanical blockage of sclerotic dentin
d. Antibacterial products of neutrophils
3. A periodontal ligament injection of 2% lidocaine with 1:100,000 epinephrine
causes which of the following?
a. The pulp circulation ceases for about 30 minutes.
b. The pulp circulation remains the same.
c. The pulp circulation increases markedly.
d. The pulp circulation decreases slightly.
4. The highest incidence of pulp necrosis is associated with which of the following?
a. Class V preparations on root surface
b. Inlay preparations
c. Partial veneer restorations
d. Full-crown preparations
5. A disadvantage of acid etching dentin (regarding effects on the pulp) is which of
the following?
a. Dentinal tubules are opened, thereby increasing permeability.
b. Acid penetrates to the pulp and kills large numbers of cells.
c. Acid penetrates to the pulp and damages the vessels.
d. Acid softens the dentin and increases microleakage at the restoration dentin
interface.
6. The response of the pulp to a recently placed amalgam without a cavity lining is
usually which of the following?
a. Slight-to-moderate inflammation
b. Moderate-to-severe inflammation
c. Slight but increasingly severe with time
d. None
7. The smear layer on dentin walls acts to prevent pulpal injury for which of the
following?
a. It reduces diffusion of toxic substance through the tubules.
b. It resists the effects of acid etching of the dentin.
c. It eliminates the need for a cavity liner or base.
d. Its bactericidal activity acts against oral microorganisms.
8. A reaction that tends to protect the pulp from injury from dentinal caries is which
of the following?
a. A predictable stimulation of sensory nerves resulting in pain
b. A decrease in permeability of dentin
c. An increase in numbers of odontoblasts under the tubules affected by the caries
d. A buffering (i.e., neutralization) by ground substance of bacterial toxins
e. A decrease in pulpal metabolism
9. Hypersensitivity is best relieved or controlled by which of the following?
a. Opening the tubules to permit release of intrapulpal pressure
b. Root planing to remove surface layers that are hypersensitive
c. Applying antiinflammatory agents to exposed dentin
d. Blocking exposed tubules on the dentin surface
10. Deeper cavity preparations have more potential for pulpal damage because of
1. Tubule diameter and density increases; therefore there is increasing permeability.
2. There is more vibration to pulp cells.
3. Odontoblastic processes are more likely to be severed.
a. 1 only
b. 3 only
c. 1 and 3
d. 2 and 3
e. 1 and 2
11. Agents that clean, dry, or sterilize the cavity are which of the following?
a. Best used in deep cavities
b. Indicated when a patient reports symptoms
c. Generally very damaging to the pulp
d. Generally not useful
12. Of the following, which is the best way to prevent pulp damage during cavity
preparation?
a. Retain the smear layer
b. Use sharp burs with a brush stroke
c. Use adequate air coolant
d. Use adequate water coolant
13. Which is the major reason why Class II restorations with composite are damaging
to the pulp?
a. Microleakage occurs at the occlusal surface.
b. Microleakage occurs at the gingival margin.
c. Toxic chemicals are released from the composite and diffuse into the pulp.
d. Polymerization shrinkage distorts cusps and opens gaps.
14. A pulp has been damaged and is inflamed because of deep caries and cavity
preparation. What material placed on the floor of the cavity aids the pulp in resolving the
inflammation?
a. Calcium hydroxide
b. Zinc oxide-eugenol
c. Steroid formulations
d. None; there is no material that promotes healing.
15. A cusp fractures and exposes dentin but not the pulp. What is the probable
response in the pulp?
a. Severe damage with irreversible inflammation
b. Mild-to-moderate inflammation
c. Pain but no inflammation
d. No pulp response
16. The following illustration shows a section of pulp and dentin underlying an area
of cavity preparation, which was done 1 day previous. The best description of the pulp
reaction is which of the following?
a. There is no reaction; the pulp appears normal.
b. The odontoblast layer is disrupted, and there is mild inflammation.
c. Odontoblasts are aspirated into tubules, and there is mild inflammation.
d. Odontoblasts are absent, and there is extravasation of erythrocytes.
17. This is an area of pulp close to a carious exposure (see the following illustration).
The inflammatory response is primarily which of the following?
a. Acute
b. Chronic
c. Giant cell
d. Vascular
18. The early inflammatory cell infiltrate response of the pulp to caries involves
primarily which of the following?
a. Neutrophils
b. Macrophages
c. Neutrophils, plasma cells, and lymphocytes
d. Macrophages and lymphocytes
e. Lymphocytes, plasma cells, and macrophages
19. Hypersensitivity of the pulp after restoration placement indicates which of the
following?
a. Acute inflammation in the pulp
b. Chronic inflammation in the pulp
c. Microleakage at the restoration and tooth interface
d. Stimulation of sensory nerves by hydrodynamics
e. Tubules are blocked by restorative material or smear layer or both
CHAPTER 16: TRAUMATIC INJURIES
1. If several teeth are out of alignment after trauma, the most reasonable explanation
a. Luxation
b. Subluxation
c. Alveolar fracture
d. Root fracture
2. Initial vitality testing of traumatized teeth is most useful to which of the
following?
a. It establishes a baseline for comparison with future testing.
b. It determines whether root canal treatment is indicated.
c. It determines if the blood supply to the pulp is compromised.
d. It predicts the prognosis.
3. A normal periapical radiograph of a traumatized tooth is useful for which of the
following?
a. It visualizes most root fractures.
b. It visualizes concussion injuries.
c. It gathers baseline information.
d. It locates foreign objects.
4. Which of the following statements regarding crown infraction is accurate?
a. It may indicate luxation injuries.
b. It is rarely seen on transillumination.
c. It seldom requires a follow-up examination.
d. It describes the process of coronal pulp necrosis.
5. Which of the following statements regarding uncomplicated crown fracture is
accurate?
a. It is an indication for a dentin-bonded restoration.
b. It requires baseline pulp testing.
c. It involves root canal treatment if the exposed dentin is sensitive to cold stimulus.
d. It has a questionable long-term prognosis.
e. It is managed differently in young versus older patients.
6. Which of the following statements regarding complicated crown fractures is
accurate?
a. Exposure to the oral cavity permits rapid bacterial penetration through the pulp.
b. Inflammation is limited to the coronal 2 mm of the exposed pulp for the first 24
hours.
c. The tooth is normally managed by root canal treatment and restoration.
7. Which of the following statements regarding replacement resorption is accurate?
a. It results from direct contact between root, dentin, and bone.
b. It is managed by surgical exposure and repair with a biocompatible material.
c. It results when at least 75% of the root surface is damaged.
d. It can be avoided by timely endodontic intervention.
8. Pulp necrosis is most likely to occur after which of the following?
a. Midroot fracture
b. Intrusive luxation
c. Concussion
d. Complicated crown fracture
9. Which of the following statements regarding cervical root resorption is accurate?
a. It is a common, self-limiting result of luxation injury.
b. It causes significant pulpal symptoms.
c. It can be arrested by root canal treatment.
d. It may extend coronally to present as a pink spot on the crown.
10. Which of the following statements regarding internal root resorption is accurate?
a. It is more common in permanent than deciduous teeth.
b. It is simple to differentiate from other types of resorption.
c. It is characterized histologically by inflammatory tissue with multinucleated giant
cells.
d. It is ruled out when there is no response to pulp testing.
11. A luxated tooth should be splinted in which of the following situations?
a. If the tooth is mobile after splinting
b. Until the root canal treatment is completed
c. With the composite as close to the gingiva as possible
d. All of the above
12. Which medium of storage for an avulsed tooth is best for prolonged extraoral
periods?
a. Hanks balanced salt solution
b. Milk
c. Distilled water
d. Saliva
13. The most important factor for managing avulsion is which of the following?
a. Extraoral time
b. Decontamination of the root surface
c. Prompt initiation of root canal treatment
d. Proper preparation of the socket
14. Tooth mobility after trauma may be because of which of the following?
a. Displacement
b. Alveolar fracture
c. Root fracture
d. Crown fracture
e. All of the above
15. Which of the following is true about thermal and electrical tests after trauma?
a. Sensitivity tests evaluate the nerve and circulatory condition of the tooth.
b. False-positive tests are more likely than false-negative tests.
c. It may take up to 9 months for normal blood flow to return.
d. None of the above statements are accurate.
16. Which of the following statements regarding internal root resorption is accurate?
a. It is rate in deciduous teeth.
b. It is initiated by odontoblasts.
c. It is seldom confused with external resorption.
d. It is usually asymptomatic.
17. Which of the following statements regarding avulsed teeth is accurate?
a. They can be treated endodontically outside the mouth in limited circumstances.
b. They should be rigidly splinted for 3 to 4 weeks to allow periodontal support to
mature.
c. They generally do not require antibiotic treatment at the time of replantation.
d. They should have apexification attempted when the apex is not closed.
CHAPTER 17: ENDODONTIC AND PERIODONTIC
INTERRELATIONSHIPS
1. According to Gutmann, molar teeth are most likely to have accessory and lateral
canals:
a. Branching from the main canal to form an apical delta
b. In the apical one third of the root
c. On the lateral surface of the root
d. In the furcation
2. Which of the following statements regarding palatogingival grooves is false?
a. The incidence of palatogingival grooves ranges from 10% to 20% of the
population.
b. The maxillary lateral incisor is affected more that the central incisor.
c. The grooves extend apically in varying distances, with less than 1% reaching the
apex.
d. Pulp necrosis frequently occurs in teeth with palatogingival grooves because of
the lack of cementum covering the dentin.
3. The prognosis for a tooth with a perforation is affected by all of the following
factors, except for one. Which is the exception?
a. Location of the perforation
b. The time of repair
c. The ability to seal the defect
d. The ability to perform root canal treatment on the remaining canals
e. The placement of a post to retain the core after perforation repair
4. Which of the following statements best describes retrograde periodontitis?
a. Inflammation from the periodontal sulcus migrates apically, causing pulp
inflammation and eventually pulp necrosis
b. Pulp necrosis occurs, and the toxic irritants cause inflammation that migrates to
the gingival margin, creating a periodontal pocket.
c. Irritants gain access to the periodontal tissues at the site of a vertical-root fracture,
producing tissue destruction that mimics periodontitis.
d. Pulp necrosis results in the formation of an apical, radiolucent lesion
characterized by the loss of the apical lamina dura.
5. Which of the following statements best describes the effect periodontal disease
has on the dental pulp?
a. There is a direct correlation between the severity of the periodontal disease and
the percentage of pulps that become necrotic.
b. When periodontal disease or the treatment of the disease exposes a lateral or
accessory canal, complete pulp necrosis will result.
c. Although periodontitis can cause pulp inflammation and necrosis, treatment
procedures have little effect on the pulp.
d. Periodontal disease that does not expose the apical foramen is unlikely to produce
significant damage to the pulp.
6. Which of the following statements regarding the primary endodontic lesion with
secondary periodontic involvement is correct?
a. Pulp necrosis occurs initially and an apical lesion forms. Apical migration of
periodontal disease results in communication between the two lesions.
b. Treatment consists of performing endodontic treatment, which is followed by a 6-
month recall examination. If the periodontal component is still present, periodontal
therapy is initiated.
c. The primary endodontic lesion with secondary periodontic involvement exhibits a
poorer prognosis when compared with the primary periodontal lesion with secondary
endodontic involvement.
d. Pulp necrosis occurs and forms a sinus tract through the periodontal ligament that,
over time, permits the accumulation of plaque and calculus on the root.
7. Which of the following statements regarding root resection is false?
a. Success depends primarily on treatment planning and case selection.
b. Failures occur primarily because of continued periodontal breakdown.
c. The long-term prognosis for the pulp in teeth with vital-root resection is poor.
d. Endodontic treatment should precede resection of a root.
8. Which of the following statements regarding guided tissue regeneration (GTR) is
false?
a. GTR is an effective adjunct to treatment of periodontal disease but has limited
value in treating endodontic pathosis.
b. The combined endodontic periodontic lesion has the least favorable prognosis for
GTR because of the relationship of the lesion to the gingival margin.
c. Bioresorbable membranes exhibit results similar to nonresorbable membranes.
d. Evidence suggest that GTR enhances bone formation by preventing contact of
connective tissue with the bone.
9. A 24-year-old female patient has drainage from the gingival sulcus of her
maxillary, right, central incisor (tooth no. 8). Three years ago she relates a porcelain
fused-to-metal bridge (nos. 6 to 8) was placed because of a congenitally missing, lateral
incisor. Clinical examination reveals a 12 mm probing defect on the lingual aspect of
tooth no. 8. Additional probing depths are 3 mm or less. Pulp testing reveals that no. 6,
no. 8, no. 9, no. 10 are responsive to CO2 snow. Radiographic examination reveals a
diffuse radiolucent area along the mesial lateral root surface extending from the crestal
tissue to the apex. Which of the following is the most likely cause of this lesion?
a. Vertical-root fracture
b. Palatogingival groove
c. Pulp necrosis
d. Periodontitis
e. Osteogenic sarcoma
10. A 51-year-old woman seeks evaluation of swelling of the buccal tissue opposite
her mandibular, right, first molar (tooth no. 30). She relates a history of having a full-gold
crown placed 2 months ago. She states that she has had pain for the past week and that
the swelling began yesterday. Clinical examination reveals swelling in the buccal
furcation area of tooth no. 30. Probing depths are 3 to 4 mm, except for a 6-mm defect in
the furcal area of tooth no. 30. Pulp testing with CO2 snow reveals teeth nos. 28, 29, and
31 respond. Tooth no. 30 is not responsive. Radiographic examination reveals normal
apical structures, however, there is a radiolucent area in the furcation of tooth no. 30.
This area was not evident on the film taken before placement of the crown. Based on this
information what diagnostic classification is most appropriate?
a. Primary endodontic lesion
b. Primary periodontic lesion
c. Primary endodontic lesion with secondary periodontic involvement
d. Primary periodontic lesion with secondary endodontic involvement
e. Concomitant endodontic and periodontic lesion
CHAPTER 18: ENDODONTIC PHARMACOLOGY
1. Odontogenic pain is usually caused by which of the following?
a. Noxious physical stimuli
b. The release of inflammatory mediators
c. Stimulation of sympathetic fibers in the pulp
d. Edema produced in a ridged, noncompliant root canal system
2. Which of the following best describes the neural innervation of the dental pulp?
a. A-delta fibers transmit pain to the trigeminal nucleus.
b. C fibers transmit pain to the superior cervical ganglion.
c. Sympathetic fibers are not blocked with application of local anesthetic agents.
d. A-delta fibers play the predominant role in encoding inflammatory pain.
3. Nociceptive signals are transmitted primarily to which of the following?
a. Nucleus caudalis
b. Limbic system
c. Reticular system
d. Superior cervical ganglion
4. Pain that refers from an inflamed maxillary sinus to maxillary molars is likely to
the phenomenon of which of the following?
a. Convergence
b. Sublimation
c. Nociception
d. Information transfer
e. Projection
5. Which of the following statements is true regarding descending fibers?
a. They inhibit transmission of nociceptive information.
b. They are not affected by endogenous opioid peptides.
c. They transmit information from the cerebral cortex to the thalamus.
d. They are sympathetic fibers that modulate blood flow in the pulp after sensory
stimulation.
6. Hyperalgesia is characterized by the following, except for one. Which is the
exception?
a. Hyperalgesia is primarily a central mechanism.
b. Spontaneous pain is present.
c. The pain threshold is reduced.
d. Hyperalgesia produces an increased pain perception to a noxious stimuli.
7. Regarding etodolac (i.e., Lodine), which of the following statements is correct?
a. The drug exhibits minimal gastrointestinal irritation when compared to ibuprofen.
b. When compared with ibuprofen, etodolac has a more profound analgesic action.
c. Studies indicate etodolac is unique, because the drug does not have a peripheral
analgesic mechanism of action.
d. This drug can be prescribed for adult patients with aspirin hypersensitivity.
8. Which of the following statements regarding activation of the opiate receptor is
accurate?
a. It blocks nociceptive signals from the trigeminal nucleus to higher brain centers.
b. It blocks transmission of signals from the thalamus to the cerebral cortex.
c. It induces the release of endorphins.
d. It blocks the release of dynorphins.
9. Opioids are frequently used in combination with other drugs because which of the
following?
a. The nonsteroidal, antiinflammatory drugs in combination with the opioid act
synergistically on the opiate receptor.
b. The combination permits a lower dose of the opioid, which can reduce side
effects.
c. Opioids do not act peripherally.
d. Opioids are not antipyretic.
10. Which of the following is true for the use of codeine as an analgesic agent?
a. Codeine prescribed in 60-mg doses is more effective than 650 mg of aspirin.
b. Codeine prescribed in 30-mg doses is more effective than 600 mg of
acetaminophen.
c. Codeine prescribed in 30-mg doses is more effective than a placebo.
d. Codeine prescribed in 60-mg doses is more effective than a placebo.
11. Management of pain of endodontic origin should focus on which of the
following?
a. Removing the peripheral mechanism of hyperalgesia
b. Providing an adequate level of nonsteroidal, anti-inflammatory analgesic agent
c. Prescribing an appropriate antibiotic in cases where pain is the result of infection
d. Using long-acting, local anesthetic agents to break the pain cycle
12. Which of the following best describes a "flexible plan" for prescribing analgesic
agents?
a. A maximal dose of an opioid is administered. If pain persists, the opioid is
supplemented with a non-steroidal, antiinflammatory agent or acetaminophen. Doses
are then alternated.
b. A maximal dose of a nonsteroidal, antiinflammatory agent or acetaminophen is
administered. If pain persists, the drug is supplemented with an opioid. Doses are then
alternated.
c. Patients are advised to take the maximal dose of a nonsteroidal, antiinflammatory
agent a day before the appointment and then as necessary for postoperative pain.
d. Patients are advised to take an opioid agent a day before the appointment and then
as necessary for postoperative pain.
13. Nonsteroidal, antiinflammatory agents administered in combination with
cyclosporine may result in which of the following?
a. They increase the risk of nephrotoxicity.
b. They induce bone marrow suppression.
c. They decrease the activity of the cyclosporine.
d. They result in increased concentrations of the nonsteroidal agent in the blood
plasma.
14. Nonsteroidal, antiinflammatory agents administered in combination with
anticoagulants may result in which of the following?
a. Increase the prothrombin time
b. Result in a decreased bleeding time
c. Increase the bioavailability of the anticoagulant
d. Produce no adverse effect
15. Indomethacin administered in combination with sympathomimetic agents results
in which of the following?
a. Decreased blood pressure.
b. Increased blood pressure.
c. Decreased water retention
d. Decreased absorption of indomethacin, requiring a higher dose
16. Peripheral afferent nerve fibers in an inflamed pulp may respond to mediators by
a. Reducing the concentration of those mediators
b. Decreasing responsiveness to nociceptive stimuli
c. Decreasing the number of anesthetic molecule receptors
d. Decreasing numbers of ion channels
e. Sprouting of terminal fibers
17. Two nonsteroidal antiinflammatory drugs (NSAIDs) that have minimal adverse
gastrointestinal side effects are which of the following?
a. Etodolac and ibuprofen
b. Etodolac and rofecoxib
c. Ibuprofen and ketoprofen
d. Ketoprofen and etodolac
e. Ibuprofen and rofecoxib
18. To minimize posttreatment pain, when are analgesics most effective when
administered?
a. As a pretreatment
b. Immediately after treatment
c. When the anesthetic begins to wear off
d. When the patient first perceives pain
e. When the pain is the most intense
19. Prophylactic administration of antibiotics to control adverse posttreatment
symptoms in prospective, controlled, clinical trials on asymptomatic patients has been
shown to be which of the following?
a. Ineffective
b. Effective if given in high doses
c. Effective only if given pretreatment
d. Effective if given in conjunction with intracanal antibiotics
CHAPTER 19: ENDODONTIC MICROSURGERY
1. A 45-year-old man has a radiolucent area associated with his maxillary, right,
central incisor (tooth no. 8) and facial swelling. He relates traumatic injury as a child with
root canal treatment during his teenage years. Subsequent to this treatment he fractured
tooth no. 8 playing basketball in his early thirties. Root canal retreatment was necessary
and the tooth was restored with a cast post, core and crown. Which of the following is the
most appropriate treatment sequence?
a. Incision and drainage followed by nonsurgical retreatment and fabrication of a
new restoration
b. Root end surgery and a postsurgical antibiotic
c. Management of the infection and performance of root end surgery when the
swelling subsides
d. Incise and drain the swelling, prescribe an antibiotic, and follow the patient on
recall examinations
e. Tooth extraction and implant placement
2. Each of the following statements on the reasons two radiographs are
recommended for evaluation of a tooth to be treated surgically is correct, except for one.
Which is the exception?
a. Two films permit the evaluation and location of normal anatomic structures.
b. The root length can be assessed.
c. The size of the lesion can be determined.
d. Root curvatures can be viewed.
e. The depth of the overlying bone can be determined.
3. When a vessel is severed, initial hemostasis results from which of the following?
a. Contraction of the vessel wall
b. Formation of a platelet plug
c. The conversion of prothrombin to thrombin
d. The conversion of fibrinogen to fibrin
4. The anesthetic of choice when performing endodontic root end surgery on a
patient with mild cardiovascular disease is which of the following?
a. 1.5% etidocaine 1:200,000 epinephrine
b. 0.5% marcaine 1:200,000 epinephrine
c. 2% lidocaine 1:100,000 epinephrine
d. 2% lidocaine 1:50,000 epinephrine
e. 4% prilocaine plain
5. The primary beneficial action of epinephrine when performing root end surgery is
a. It effects the drug on alpha-1 receptors in the alveolar mucosa.
b. It effects the drug on beta-1 receptors of skeletal muscle.
c. It decreased systemic uptake of the anesthetic solution.
d. It prolonged the duration of anesthesia.
6. Which of the following statements regarding flap reflection is correct?
a. The horizontal incision for the mucogingival flap is made perpendicular to the
cortical bone.
b. The rectangular flap design is most appropriate in the posterior areas.
c. The mucogingival flap with an anterior-releasing incision is preferred in posterior
areas.
d. The type of vertical-releasing incisions distinguish the mucogingival flap from the
Luebke-Oschsenbein flap.
e. The semilunar flap has the advantage of providing an esthetic result without scar
formation.
7. Which of the following hemostatic agents activates the intrinsic coagulation
pathway?
a. Ferric sulfate
b. Calcium sulfate paste
c. Microfibrillar collagen
d. Bone wax
e. Epinephrine pellets
8. Which of the following is the recommended hemostatic technique to control
bleeding during root end surgery?
a. Local anesthesia with 2% lidocaine 1:50,000 epinephrine, epinephrine saturated
pellets, ferric sulfate, calcium sulfate paste
b. Local anesthesia with 2% lidocaine 1:50,000 epinephrine, ferric sulfate,
microfibrillar collagen, bone wax
c. Local anesthesia with 2% lidocaine 1:100,000 epinephrine, ferric sulfate,
microfibrillar collagen, Telfa pad
d. Local anesthesia with 0.5% marcaine 1:200,000 epinephrine, ferric sulfate,
calcium sulfate paste
9. Each of the following statements is correct regarding the use of the H 161
Lindemann bone cutter for root end surgery is correct, except for one. Which is the
exception?
a. It reduces frictional heat when resecting bone.
b. It has more flutes that conventional burs, so cutting is faster and more efficient.
c. When used with the Impact Air 45 hand piece splatter is decreased.
d. It has fewer flutes and is less likely to clog.
10. Which of the following statements regarding root end resection is correct?
a. The root should be resected at a 45-degree angle to ensure adequate access and
visibility.
b. The apical 2 mm should be removed to ensure that apical ramifications are not
present.
c. Root end resection should precede apical curettage.
d. Resection of the root should be as perpendicular to the long access of the root as
possible.
11. Which of the following statements regarding the isthmus between canals is
correct?
a. Although often noted between canals, failure to include this area in the
preparation does not affect the prognosis of a tooth.
b. The incomplete isthmus should be prepared with a tracking groove before
ultrasonic preparation.
c. Isthmus incidence is not affected by the amount of the root resection but increases
as the bevel approaches 45 degrees.
d. When using a surgical operating microscope, the absence of an isthmus at 16 × to
25 × is evidence that no connection between canals exist.
12. Which of the following statements regarding ferric sulfate is correct?
a. Ferric sulfate acts by producing a tamponade effect and is absorbed by the body
over 2 to 3 weeks.
b. Ferric sulfate exhibits an alkaline pH.
c. Applied to the osseous surface, ferric sulfate causes agglutination of blood
proteins.
d. Ferric sulfate induces osseous tissue formation.
13. Which of the following statements regarding root end preparation is false?
a. The ideal preparation should extend 3 mm into the root and follow the long axis
of the tooth.
b. The lingual wall of the preparation is the most difficult area to evaluate.
c. Ultrasonic preparation has the potential to induce micofractures in the dentin.
d. KiS tips have enhanced cutting efficiency for root end preparations because of a
zirconium nitride coating.
e. Ultrasonic root end preparation may thermoplasticize the remaining gutta-percha.
14. Which of the following statements regarding root end filling materials is false?
a. Super EBA is preferred as a root end filling material over IRM because it lacks
eugenol.
b. IRM is preferred over amalgam.
c. Mineral trioxide aggregate (MTA) is not adversely affected by contamination
with blood.
d. Periapical healing with MTA results in cementum formation over the material.
e. Composite resins appear to be acceptable, providing a dry-opening field can be
maintained.
15. Which of the following statements is correct regarding treatment for a 73-year-old
woman who develops ecchymosis after root end surgery?
a. Instruct the patient to place warm compresses over the area three to four times
daily.
b. Place the patient on an antibiotic to prevent infection of the area.
c. Prescribe an antiinflammatory analgesic to enhance the healing process.
d. Explain the cause of the problem to the patient and provide reassurance.
CHAPTER 20: MANAGEMENT OF PAIN AND ANXIETY
1. The majority of life-threatening systemic complications arise in which of the
following?
a. During or immediately after injection of local anesthetics
b. In conjunction with surgical procedures, such as tooth extraction
c. During the pulp extirpation phase of root canal treatment
d. As a result of bleeding from patients with known bleeding disorders
2. Which of the following tooth groups is the most difficult to anesthetize?
a. Mandibular premolars
b. Maxillary premolars
c. Maxillary molars
d. Mandibular molars
3. Which of the following is not a factor affecting the onset of local anesthesia?
a. Diffusion of the local anesthetic through the lipid-rich nerve sheath
b. The pKa for the anesthetic agent
c. The pH of the tissue
d. The protein-binding ability of the local anesthetic
4. A decrease in the tissue pH causes which of the following?
a. It increases the free base of the local anesthetic agents.
b. It results in fewer anesthetic molecules entering the nerve sheath.
c. It changes the pKa value for a given local anesthetic.
d. It cecreases the protein-binding of the local anesthetic.
5. Failure to obtain adequate anesthesia after an appropriately administered nerve
block is most likely the result in which of the following?
a. pH changes in the pulp tissue caused by inflammations
b. Morphologic neurodegenerative changes and inflammatory mediators
c. Insufficient volume of local anesthetic injected
d. Tolerance to the anesthetic agent
6. When comparing amide and ester local anesthetic agents, which of the following
is true?
a. Esters are more likely to produce systemic toxicity when compared to amides.
b. Amides are more allergenic when compared to esters.
c. Amides are more effective than esters.
d. Esters and amides are equally effective.
7. A patient is anesthetized using a posterior superior alveolar (PSA) nerve block to
perform endodontic treatment on the maxillary, first molar. Adequate anesthesia is not
obtained. In this situation the clinician should consider which of the following?
a. Anesthetizing the anterior, superior nerve
b. Anesthetizing the middle, superior nerve
c. Performing a palatal infiltration
d. Repeating the PSA
8. An infiltration injection is given for a maxillary, second premolar. Adequate
anesthesia is not obtained. Which injection should be considered?
a. Anterior superior alveolar (ASA) block
b. PSA block
c. Palatal infiltration
d. Maxillary (division II) block
e. Greater palatine nerve block
9. Infiltration in the mandible may be an effective technique in treating the which of
the following?
a. Central incisor
b. Canine
c. First premolar
d. Second molar
10. In performing the Akinosi technique, which of the following are accurate?
a. The needle is inserted at the height of the mucogingival junction of the most
posterior, maxillary tooth.
b. The needle is passed lingual to the mandibular ramous until is bone is contacted.
c. Injection at the neck of the mandibular condyle is the objective.
11. The Stabident local anesthesia system is used for which one of the following
reasons?
a. As a true intraosseous injection
b. As a modified periodontal ligament injection
c. To limit the adverse reactions to vasopressor components of local anesthetic
cartridges
d. As a method to administer intrapulpal injections painlessly
12. Prescriptions for analgesic agents should provide which of the following?
a. Instructions for administration at regular intervals
b. Instructions for taking the medication when patients experience pain
c. Administration instructions for patients in pain the day before initiating root canal
treatment to ensure adequate blood levels
d. Immediate preoperative administration of opiates when pulpal pain is present
13. For emergency treatment of patients with pulp pathosis, oral sedation should be
considered during which of the following?
a. When deep sedation of the fearful patient is desired
b. When barbiturates with oral sedation should be considered
c. When oral sedation with midazolam may provide an amnesia effect
d. When a short-acting agent permits the patient to leave without an escort
14. Which of the following statements regarding the use of nitrous oxide inhalation
sedation is accurate?
a. It produces significant analgesic effect when used in conjunction with local
anesthetics.
b. It is difficult in managing endodontic patients because of the application of the
rubber dam.
c. It should be considered if oral sedation cannot be used.
d. It should be used only when an auxiliary of the same sex as the patient is present
to assist.
15. Which of the following statements regarding supra-periosteal injection
(infiltration) is accurate?
a. It is effective for most maxillary teeth.
b. It is more effective in the presence of infection
c. It is ineffective for both adults and children in anesthetizing mandibular teeth.
d. It is targeted mesial and distal to the apex of the involved tooth.
16. Which of the following statements regarding regional nerve block is accurate?
a. It achieves anesthesia by blocking efferent nerve impulses.
b. It may be more effective because it is deposited in normal, rather than inflamed,
tissue.
c. It is exemplified by the long buccal nerve block.
d. It requires use of an agent without vasoconstrictors.
17. Which of the following statements regarding the anterior middle superior alveolar
(AMSA) nerve block is accurate?
a. It anesthetizes all branches of the maxillary nerve.
b. It can be delivered by a computer-controlled system or by traditional needle and
syringe.
c. It anesthetizes buccal and palatal bone, but not soft tissue.
d. It occasionally anesthetizes the orbicularis oris.
18. If the dentist thinks there may be considerable posttreatment pain, the clinician
may do which of the following?
a. Prescribe antibiotics
b. Reanesthetize with a long-acting anesthetic
c. Prescribe antianxiety medications
d. All of the above
19. Which of the following statements regarding oral sedation is accurate?
a. It has a quick onset of action.
b. It has a significant number of adverse reactions.
c. It has a reasonably short duration.
d. It is difficult to titrate to ideal levels.
CHAPTER 21: TOOTH-WHITENING MODALITIES FOR
PULPLESS AND DISCOLORED TEETH
1. The whitening mechanism for bleaching teeth is thought to be which of the
following?
a. A result of the degradation organic molecules of high molecular weight that
reflect a specific wavelength of light
b. Related to changes in the inorganic hydroxyapitite crystals
c. Related to the dissolution of the stain
d. A result of removal of free-metal ions, such as iron and copper
2. Which of the following statements is correct regarding the incidence of cervical
resorption after internal bleaching?
a. Cervical resorption can be as high 25% when Superoxyl and heat are used.
b. Lesions develop rapidly and can be detected 1 to 2 months after bleaching.
c. The incidence of cervical resorption increases in patients who are 25 years old
and older.
d. Although cervical resorption is often attributed to bleaching, it is more likely
caused by a previous traumatic injury to the involved tooth.
3. Each of the following is an intrinsic form of tooth discoloration, except for one.
Which is the exception?
a. Endemic fluorosis
b. Hereditary opalescent dentin
c. Tetracycline staining
d. Peridex staining
4. Which of the following statements regarding microabrasion is correct?
a. The agent used in the technique is 30% hydrogen peroxide, which can be obtained
in proprietary products, such as Prema.
b. The technique is useful in treating white-and-brown-spot surface lesions.
c. Microabrasion should not be used before placement of bonded restorations.
d. Requires a local anesthetic and frequently produces postoperative thermal
sensitivity.
5. When performing a walking bleach procedure, which of the following statements
is accurate?
a. The dentin should be etched before placement of the bleaching agent to increase
permeability of the tubules and enhance the bleaching action.
b. The sodium perborate paste should be covered by a minimum of 2 mm of Cavit or
IRM.
c. A barrier over the obturating material is not required.
d. The definitive bonded restoration should be placed at the visit in which the
sodium perborate paste is removed.
6. Which of the following statements regarding power bleaching is false?
a. Power bleaching often uses a liquid rubber dam composed of a light cured resin
gel.
b. Vitamin E can be used to neutralize the oxidizing effects of hydrogen peroxide
that comes in contact with soft tissues.
c. Power bleaching can often be performed by trained dental auxiliary personnel.
d. After fabrication of custom trays with appropriate reservoirs, patients apply a
bleaching gel every 2 hours during their waking hours.
CHAPTER 22: RESTORATION OF THE ENDODONTICALLY
TREATED TOOTH
1. Which of the following statements regarding the density of dentinal tubules (per
square millimeter) is accurate?
a. It remains constant as they progress from the periphery to the pulpal dentin
junction with a decreasing diameter.
b. It remains constant as they progress from the periphery to the pulpal dentin
junction with an increasing diameter.
c. It decreases as they progress from the periphery to the pulpal dentin junction,
maintaining a constant diameter.
d. It increases as they progress from the periphery to the pulpal dentin junction with
an increase in diameter.
e. It increases as they progress from the periphery to the pulpal dentin junction,
maintaining a constant diameter.
2. Which of the following statements regarding teeth restored with crowns is
correct?
a. When teeth exhibiting no caries, fracture, or other causative factors are restored
with crowns, those serving as abutments exhibit a higher rate of necrosis.
b. The periodontal status of teeth restored with crowns is not a significant factor in
the pulpal prognosis.
c. Should pulp necrosis occur in teeth restored with crowns, the process occurs
rapidly, usually within the first 3 years after cementation.
d. The amount of occlusal reduction is a more significant factor in inducing pulpal
pathosis when compared to axial reduction.
e. Pulpal pathosis becomes significant when the remaining thickness of dentin is less
than 1.5 mm.
3. Which of the following would best fit the definition of the "stressed pulp
syndrome"?
a. A tooth recently prepared for a porcelain fused-to-metal crown that (with
placement of a provisional crown) exhibits severe pain to thermal stimulation
b. A tooth that is asymptomatic but has had numerous restorations placed over a
period of years because of recurrent caries
c. A nonrestored tooth that exhibits probing depths of 4 to 5 mm
d. A tooth that is not responsive to pulp testing with CO2 and EPT
4. Each of the following is a concern when restoring an endodontically treated molar
with minimal remaining tooth structure, except for one. Which is the exception?
a. Increased chance for root fracture
b. Greater potential for recurrent caries
c. Infringement on the biologic width
d. The altered light refraction
e. Changes in collagen cross linking
5. A tooth requires a post, core, and crown for adequate restorative treatment. Which
of the following is the most important factor in the restorative equation?
a. Dowel length
b. Dowel width
c. The surface configuration of the dowel
d. The core material
e. An adequate ferrule
6. A patient requires a post and core for restoration of a narrow, mandibular, central
incisor tooth with 1 mm of structure above the gingival level. Which of the following
would be the most appropriate dowel for this situation?
a. Cast post and core
b. Carbon fiber post with a composite core
c. Parallel stainless steel (SS) post with an amalgam core
d. Threaded dowel with a composite core
7. Which of the following statements regarding the carbon fiber dowels is false?
a. They are radiolucent.
b. They have a modulus of elasticity similar to dentin.
c. They provide esthetic qualities similar to metal dowels.
d. The carbon fiber dowels are more resistant to fracture.
8. Which of the following statements regarding the zirconia dowel is accurate?
a. It is easily removed from the canal by ultrasonics and special burs.
b. It is readily seen on radiographs.
c. It requires a composite core.
d. It is similar to dentin in elasticity.
9. The most appropriate time to determine the precise method for restoring the
endodontically treated tooth is which of the following?
a. When the initial diagnosis and treatment plan is established
b. During the endodontic treatment procedures
c. After completion of the root canal treatment
d. After the initial-crown preparation
10. Which of the following statements regarding post space is correct?
a. The post space for passive dowels must provide intimate contact between the
dowel and the dentin wall.
b. Post space should extend into the root to a depth 3 to 5 mm from the apex.
c. The post space required for fabrication of a dowel and core using a direct
technique requires removal of more tooth structure than the proprietary dowel systems
because of the need to remove undercuts.
d. Direct composite-reinforced systems require the least amount of preparation.
CHAPTER 23: PEDIATRIC ENDODONTICS: ENDODONTIC
TREATMENT FOR THE PRIMARY AND YOUNG, PERMANENT
DENTITION
1. The basic morphologic difference between primary and permanent teeth is which
of the following?
a. Thickness of dentin between pulp and enamel is greater in primary teeth
b. Enamel is thicker in primary teeth
c. The pulp chamber is comparatively smaller in primary teeth
d. The pulp horns are higher in primary molars
2. Radiographically, which of the following statements regarding primary teeth is
accurate?
a. Pathologic changes in the periradicular tissues are most often apparent at the
apexes than the furcation of molars.
b. The presence of calcified masses within the pulp is indicative of acute pulpal
disease.
c. By the time internal resorption is visible the only treatment is extraction.
d. Pathologic bone-and-root resorption is always indicative of nonvital pulp.
3. Which of the following diagnostic tests is usually reliable for determining pulpal
status of primary teeth?
a. Thermal pulp tests
b. Electrical pulp tests
c. Percussion
d. None are reliable in children.
4. Which of the following statements regarding indirect pulp therapy is accurate?
a. It is indicated only in the treatment of teeth with deep carious lesions in which
there is no clinical evidence of pulpal degeneration or periapical pathosis.
b. It removes much of the bacteria present in dentin.
c. It includes placing calcium hydroxide or zinc oxide-eugenol (ZOE) over the
remaining caries and permanently restoring the tooth with amalgam.
d. It involves all of the above.
5. Direct pulp capping is recommended for primary teeth with which of the
following?
a. Carious exposures
b. Mechanical exposures
c. Calcification in the pulp chamber
d. All of the above
6. Symptoms of pulp abnormalities in primary teeth include which of the following?
a. Pain to percussion
b. History of spontaneous pain
c. Variations in mobility
d. All of the above
7. A calcium hydroxide pulpotomy performed on a young, permanent tooth is
judged to be successful during which of the following?
a. When the patient is asymptomatic
b. When the tooth responds to pulp testing
c. When normal root development continues
8. Formocresol pulpotomy on a primary tooth is indicated during which of the
following?
a. When there is a history of spontaneous toothache
b. When the inflammation or infection is confined to the coronal pulp
c. When the pulp does not bleed
d. When there is only apical pathosis
9. The effect of formocresol on the pulp tissue is controlled by which of the
following?
a. Concentration used
b. Method of application
c. Length of time applied
d. All of the above
10. An increasingly popular technique for pulpotomy in primary teeth is which of the
following?
a. Formocresol
b. Calcium hydroxide
c. Electrosurgery
d. Laser surgery
11. Glutaraldehyde may be preferred to formocresol for primary pulpotomy because
of which of the following reasons?
a. It has less systemic distribution beyond the pulp.
b. It has a better prognosis.
c. It is not antigenic.
d. It is less readily metabolized.
12. Which of the following is an indication for root canal treatment of primary teeth?
a. Radiographic evidence of internal root resorption
b. Periapical lesion
c. Dentigerous cyst
d. Mechanical or carious perforation of the chamber floor
13. Which of the following statements regarding access opening on primary incisors
is accurate?
a. They are from the facial surface.
b. They are from the lingual surface.
c. They are from the incisal edge.
d. They are different for maxillary teeth and mandibular teeth.
14. Which of the following is true in placing zinc oxide-eugenol in a primary tooth?
a. Techique is not important
b. The overfill has a poorer prognosis than a flush fill.
c. The paste should be mixed to a thick consistency.
d. All are true.
CHAPTER 24: GERIATRIC ENDODONTICS
1. As related to dental visits by the older patient, which of the following statements
are accurate?
a. Older patients have fewer visits per year than younger patients.
b. The number of visits by older patients should decrease in the future.
c. Most visits are for comprehensive procedures.
d. Dental visits of older patients are for less-complicated procedures when compared
to younger patients.
2. Which of the following statements regarding secondary dentin formation in the
radicular pulp in an older patient is accurate?
a. It is less likely to occur in response to abrasion than in younger patients.
b. It may result in complete pulp obliteration.
c. It may compromise the blood supply and cause pulp necrosis.
d. It does not require an irritant.
3. In the older patient (as compared with a younger patient), regarding pulpal
inflammation from caries, which of the following statements is accurate?
a. It is less likely to be as painful as in a younger patient.
b. It usually progresses more slowly.
c. It is less likely to occur.
d. It is more likely to be acute than chronic.
4. Pulps in older patients tend to be less responsive to thermal stimuli because of
which of the following reasons?
a. Sensory nerves in dentin degenerate with time.
b. Sensory nerves in pulp lose their myelin sheath as a result of long-term, repeated
injuries.
c. With age, patients become less alert and, therefore, less responsive to external
stimuli.
d. Pulpal calcifications block external stimuli from reaching receptors.
e. Pulps tend to have less sensory innervation in older teeth.
5. An abrupt midroot radiographic disappearance of a canal usually indicates which
of the following?
a. Bifurcation in the canal
b. Secondary dentin formation apically
c. Concentrations of dystrophic calcifications apically
d. Diminished (often unnegotiable) sized canal
6. In the older patient (as compared with the younger patient) the exit of the canal
(i.e., apical foramen) is which of the following?
a. Closer to the radiographic apex
b. Closer to the true apex
c. Easier to detect tactilely
d. More variable because of cementum formation
7. Which of the following statements regarding single-visit root canal treatment in
an older patient is accurate?
a. It should be avoided because there is more likely to be an increase in
postappointment pain.
b. It should be avoided because it decreases successful prognosis.
c. It is acceptable if it is more convenient for the patient.
d. It should be avoided to place an intracanal medicament.
8. Success of root canal treatment in older patients (as compared with younger
patients) is which of the following?
a. Better
b. Poorer
c. Equivalent
d. Unknown (has not been investigated)
9. In the older patient root canal treatment (as compared to extraction) is which of
the following?
a. Usually more emotionally traumatic
b. Usually more tissue traumatic
c. Often less expensive in the long run
d. More likely to result in postappointment complication
10. A postsurgical condition that tends to occur more frequently in older patients is
a. Ecchymosis (i.e., discoloration) of soft tissues
b. Infection of the surgical site
c. Loss of sutures because of more friable tissues
d. Continued hemorrhage of the incision site
e. Loss of consciousness
11. When should periapical radiographs be prescribed?
a. Before discussion of the chief complaint
b. After discussing the chief complaint with the patient
c. Just before the clinical examination
d. After completing the clinical examination
12. With aging, which of the following statements are accurate?
a. Lateral canals enlarge and become more clinically significant.
b. Gingival recession exposes cementum and dentin, which is less resistant to caries.
c. The cementodentinal junction locates progressively more coronally.
d. All of the above occur.
13. In geriatric patients, which of the following statements are accurate?
a. There is a direct correlation between the nature of response to electrical-pulp
testing and the degree of inflammation.
b. There is a reduced volume and increased neural component of the pulp.
c. Tooth discoloration usually is not indicative of pulpal death.
d. Diffuse pain of vague origin is unlikely to be odontogenic.
14. In evaluating success and failure of endodontic treatment in aged patients, a
consideration is which of the following?
a. The bone of the aged patient is more mineralized than that of a younger patient.
b. Overlooked canals are seldom a problem because they are usually calcified.
c. There may be failure even though the patient has no symptoms.
d. Cold sensitivity is the usual symptom that indicates a missed canal.
15. Which of the following statements regarding endodontic surgery in older patients
is accurate?
a. It requires more anesthetic and vasoconstrictor than in younger patients.
b. It may be somewhat easier because the vestibule is deeper.
c. It is risky because inadequate blood supply may result in postsurgical
osteomyelitis.
d. It has been demonstrated to be much less successful than in younger patients.
16. The radiolucent structure at the periapex of the premolar in the following
illustration is likely which of the following?
a. A maxillary sinus
b. An endodontic apical pathosis
c. A fibroosseous lesion
d. A bony trabecular pattern
17. The elevated structure facial to the crowned first molar in the following
illustration is likely which of the following?
a. Acute apical abscess
b. Periodontal abscess
c. Fibroma
d. Exostoses
CHAPTER 25: NONSURGICAL ENDODONTIC
RETREATMENT
1. Canals may be missed during treatment because of which of the following?
a. Calcification
b. Anomalous location
c. Inadequate access
d. All of the above
2. Radiographically, which of the following statements regarding canals that appear
calcified are accurate?
a. They are seldom able to be instrumented.
b. They have a different appearance than the surrounding dentin.
c. They should be opened up with rotary rather than ultrasonic instruments.
3. The major reason for failure, requiring retreatment, is which of the following?
a. Persistent pain
b. Draining sinus tract
c. Restorative indications
d. Microleakage
4. Presence of excess gutta-percha beyond the apex is usually caused by which of
the following?
a. Use of too small a master cone
b. Excessive heating and compaction during warm, vertical condensation
c. Destruction of the natural apical constriction
5. Lateral or furcal canals are which of the following?
a. Commonplace
b. Not able to be mechanically cleaned
c. Not routinely obturated
d. Seldom the sole cause of endodontic failure
e. All of the above
6. Retreatment has the most favorable prognosis during which of the following?
a. When the cause of failure is identified and is correctable
b. When the patient is asymptomatic
c. When gutta-percha was used instead of paste
d. When a surgical microscrope is used
7. For silver point removal, ultrasonics are used for which of the following reasons?
a. To break up cement surrounding the point
b. To reduce the level of dentin on the floor of the chamber to expose the point
c. To break up the silver point into small pieces, which can then be flushed out
d. To loosen the silver point by applying the vibrating instrument directly to the
silver cone
8. How should rotary instruments be used for the removal of gutta-precha?
a. To remove all the gutta-percha the length of the canal
b. At the highest speeds
c. In reverse of the canal preparation direction
d. In portions of the canal where the instruments fit passively
e. In portions of the canal where the instruments fit snugly
9. If a cervical root perforation occurs during the treatment and the canal preparation
is incomplete, the generally preferred time for repairing the defect is which of the
following?
a. Immediately, that is, before proceeding with further preparation
b. After cleaning and shaping is complete but before obturation
c. Immediately after obturation
d. After an appropriate recall period, to assess the status of the tissues
10. Removal of objects can be facilitated by:
a. Straight-line access
b. A good light source
c. Magnification
d. All of the above
11. Carrier-based gutta-percha removal and retreatment is:
a. Generally easy, because all components are soluble
b. Very difficult, because the gutta-percha is insoluble
c. Usually by using a combination of techniques
d. Impossible
12. Type III transportation is best managed by:
a. Extraction
b. Apexification with calcium hydroxide
c. Forming an artificial barrier with a material, such as MTA
d. Obturation, as best as possible, then surgery
CHAPTER 26: DIGITAL TECHNOLOGIES IN ENDODONTIC
PRACTICE
1. A disadvantage of digital cameras relative to film-based cameras is that the digital
cameras:
a. Are very expensive to purchase
b. Are more expensive to operate
c. Have inferior image resolution
d. Have a greater delay in obtaining images
e. Are very complicated to operate
2. An advantage of conventional radiographic film relative to digital radiographic
imaging is that film:
a. Generally produces an image of superior quality
b. Is easier to duplicate (reproduce)
c. Requires less radiation exposure
d. Accurately depicts the extent of caries
e. Produces an image more quickly
3. The Internet is usable in dentistry for all of the following except:
a. Inter-doctor consultations
b. Online scheduling of patients
c. Patient access to his/her dental records
d. Online ordering of supplies
e. Transmission of insurance claims
4. The Clinical Chairside Workstation is used for:
a. Storing and displaying clinical information
b. Electronically determining shades for porcelain crowns
c. Selecting and mixing cements
d. Communicating by voice with the front desk
5. The pre-registration specialized system is designed to:
a. Obtain early registration for professional meetings
b. Remind patients of recall appointments
c. Automatically contact insurance companies to determine coverage limits of a
patient
d. Record pertinent data on a referred patient prior to any appointment
e. Any of the above are possibilities
TEST YOUR KNOWLEDGE
Questions 1 to 3 relate to the following radiograph.
The patient does not have symptoms. All teeth shown in the radiograph respond to pulp
testing, except the canine.
1. The radiolucent structure (arrow) at the apex of the canine is likely which of the
following?
a. Maxillary fracture
b. Apical pathosis
c. Nasopalatine duct
d. Nutrient canal
2. The radiographic appearance internally indicates which of the following?
a. Two likely superimposed canals
b. Dentinogenesis imperfecta
c. Dense accumulations of linear calcifications
d. Calcific metamorphosis
3. The recommended treatment and reason for the treatment is which of the
following?
a. Root canal treatment; there is pulp pathosis.
b. Root end resection and root end filling; there is pathosis, but the pulp space is too
small to attempt root canal treatment.
c. No treatment; there is no pathosis.
d. Extraction is prescribed.
Questions 4 to 8 relate to the following illustration.
Tooth no. 30 (first molar) causes the patient prolonged pain to cold and episodes of
spontaneous pain. The tooth responds to probing with an explorer into the carious lesion.
There is no pain to percussion or palpation and no swelling. Periodontal probing is within
normal limits.
4. What is the pulpal diagnosis?
a. Reversible pulpitis
b. Irreversible pulpitis
c. Necrosis
d. Unknown, pending further information
5. What is the periapical diagnosis?
a. Normal
b. Acute apical periodontitis
c. Chronic apical periodontitis
d. Acute apical abscess
6. What is the likely appearance of the pulp histologically?
a. Coronal pulp is necrotic; radicular pulp is inflamed.
b. Coronal pulp is inflamed; radicular pulp is normal.
c. The entire pulp is inflamed.
d. The entire pulp is necrotic.
7. What is the likely appearance of the periapex histologically?
a. Normal structures
b. Acute inflammation; no bone resorption
c. Acute inflammation; bone resorption
d. Chronic inflammation; bone resorption
8. What minimal immediate treatment is indicated?
a. None. Schedule the patient for future evaluation.
b. Complete canal preparation at this visit.
c. Remove the caries and place a sedative temporarily.
d. Perform pulpotomy or partial pulpectomy.
Questions 9 to 13 relate to the following photograph and radiograph.
A 50-year-old woman comes to the clinic complaining of sharp sensitivity with chewing on
the lower left second molar. She reports a period of cold sensitivity 6 months prior but has
not had any cold tenderness for several months. The third and first molars respond to pulp
testing; the second molar does not respond. There is no pain to palpation, but the tooth is
tender to percussion on the cusps and tender to biting on a bite stick. There is an isolated 6-
mm probing defect on distal. (Photograph: The shallow occlusal alloy has been removed.)
9. What is the pulpal diagnosis for tooth no. 18?
a. Normal
b. Hypersensitive
c. Irreversible pulpitis
d. Necrosis
10. What type of bacteria would likely be found in the pulp?
a. Gram-positive aerobes
b. Gram-negative anaerobes
c. Mixed flora
d. None
11. What is the likely cause of the patient's pain?
a. Inflamed pulp
b. Apical abscess
c. Cracked tooth
d. Periodontal abscess
12. What additional tests are indicated?
a. Cold test
b. Heat test
c. Test cavity
d. Transillumination
13. What type of permanent restoration is indicated?
a. Occlusal amalgam
b. Occlusal bonded complete
c. Pin-retained amalgam
d. Full-cast crown
Questions 14 to 20 relate to the following photograph and radiograph.
The patient reports "a bad toothache for 2 days. I can't bite on these lower, right, front
teeth." There is pain on pressure and palpation in the region of the lateral incisor and
canine. The premolar (small amalgam) is asymptomatic. The lateral and premolar respond
to pulp testing; the canine does not respond. There is no swelling. There is an aphthous
ulcer on the facial attached gingiva of the lateral. All probings are normal. The lateral and
canine have moderate mobility.
14. Which tooth and tissue are the probable source of pain?
a. Lateral incisor and pulp
b. Canine and pulp
c. Canine and periapical tissue
d. Lateral incisor, canine, and periapical tissue
15. What is the likely pulpal and periapical diagnosis for the lateral incisor?
a. Irreversible; phoenix abscess
b. Normal; chronic apical periodontitis
c. Necrosis; phoenix abscess
d. Reversible; normal
16. What is the likely pulpal and periapical diagnosis for the canine?
a. Irreversible pulpitis; phoenix abscess
b. Normal; chronic apical periodontitis
c. Necrosis; phoenix abscess
d. Necrosis; suppurative apical periodontitis
17. Which teeth (tooth) require(s) endodontic treatment?
a. Lateral incisor only
b. Canine only
c. Both the lateral incisor and canine
d. Neither at present
18. Which bacteria have been related to this pathosis?
a. Gram-negative rods; anaerobic
b. Gram-positive rods, anaerobic
c. Gram-negative cocci; aerobic
d. Gram-positive cocci; aerobic
19. Of the following inflammatory cells, which would likely predominate
periapically?
a. Lymphocytes
b. Polymorphonuclear neutrophilic leukocytes
c. Plasma cells
d. Macrophages
20. Looking at the radiograph and clinical photograph, what is the likely cause of the
pulpal and periapical pathosis?
a. Incisal attrition
b. Cervical erosion
c. Caries
d. Impact trauma
The patient reports severe, continuous pain in the mandibular, right quadrant. She states
that the pain began when she was drinking iced tea last evening and the pain has not
subsided. She slept poorly last night. Medical history is noncontributory.
Amalgams were place a few months earlier after removal of deep caries on both molars.
She has increased pain on lying down. The pain is not relieved with analgesics. She cannot
localize the pain to an individual tooth. Pulp testing shows response on the premolar and
second molar. The first molar does not respond. Cold-water application causes intense,
diffuse pain in the region. Percussion and palpation are not painful. Probings are normal.
21. Which tooth (teeth) is (are) the most likely cause of her pain?
a. Premolar
b. First molar
c. Second molar
d. First and second molars
22. What is the pulpal and periapical diagnosis for the first molar?
a. Necrosis; chronic apical periodontitis
b. Necrosis; phoenix abscess
c. Irreversible pulpitis; chronic apical periodontitis
d. irreversible pulpitis; acute apical periodontitis
23. What is the pulpal and periapical diagnosis for the second molar?
a. Irreversible pulpitis; normal
b. Irreversible pulpitis; acute apical periodontitis
c. Irreversible pulpitis; acute apical abscess
d. Normal; normal
24. What would be the minimal emergency treatment on the offending tooth (teeth)?
a. Remove the amalgam and place a sedative dressing. Prescribe analgesics and
antibiotics.
b. Do a complete canal preparation. Place a cotton pellet of formocresol.
c. Reduce the occlusion and prescribe antibiotics.
d. Perform a pulpotomy and place a dry-cotton pellet.
25. Inferior alveolar injection is indicated. If the offending tooth (teeth) is (are) not
anesthetized, what is the likely reason?
a. There is a decreased pH in the region favoring formation of cations.
b. The anesthetic solution is diluted by the inflammatory fluids.
c. There may be morphologic changes in the nerves that originate in the inflamed
areas; these nerves becomes more excitable.
d. Because of inflammation, there is increased circulation in the area; this carries
away the anesthetic very rapidly.
The patient has no adverse signs or symptoms. Surgery was several years ago. There are no
probing defects. The canine responds to pulp testing.
26. What diagnosis is likely?
a. Chronic apical periodontitis
b. Foreign-body reaction
c. Apical radicular cyst
d. Scar tissue
27. What is the likely cause?
a. Continued irritation from an undébrided, unsealed canal
b. Adverse reaction to corrosion of the amalgam
c. Coronal leakage
d. Perforation of both cortical plates.
28. What should the treatment plan be?
a. Replace the crown; retreat the canal.
b. Perform another surgery and place another root end material.
c. Place the patient on antibiotics to resolve the lesion.
d. No treatment is needed.
Questions 29 to 35 relate to the following clinical photograph and radiograph.
A 58-year-old woman has swelling in the maxillary anterior area that has steadily increased
for 2 days. She denies thermal sensitivity and tenderness to biting pressure. The swelling is
between teeth nos. 9 (central incisor) and 10 (lateral incisor). There is normal mobility, and
probing depths are 4 to 5 mm with the distofacial surface of tooth no. 9 probing 8 mm.
There is no tenderness to percussion, but there is tenderness to palpation. Pulp tests reveal
that teeth nos. 8, 9, 10, and 11 are responsive to electrical-pulp testing and to thermal
stimulation with carbon dioxide snow (i.e., dry ice).
29. Based on this information, the clinical photograph, and the radiograph, what is the
pulpal diagnosis for tooth no. 9?
a. Normal
d. Necrotic
30. Based on this information, the clinical photograph, and the radiograph, what is the
pulpal diagnosis for tooth no. 10?
a. Normal
d. Necrotic
31. What is the periradicular diagnosis for tooth no. 9?
a. Normal
b. Chronic apical periodontitis
c. Chronic suppurative, apical periodontitis
d. Acute apical periodontitis
e. Acute periodontal abscess
32. Which of the following is the most likely the cause of swelling associated with
teeth nos. 9 and 10?
a. Pulp necrosis
b. Periodontal disease
c. A developmental groove defect
d. Vertical-root fracture
e. Peripheral giant-cell granuloma
33. Which of the following is most important in determining if this lesion is of
periodontal origin or of pulpal origin?
a. Percussion
b. A periapical radiograph
c. Periodontal mobility and mobility assessment
d. Pulp testing
e. Periodontal probing
34. Treatment of this case requires which of the following?
a. Periodontal scaling, root planing of the area, and drainage
b. Root canal débridement of tooth no. 9, followed by incision and drainage
c. Analgesic treatment and antibiotic treatment until the involved tooth can be
localized
d. Flap reflection to inspect the root for a vertical root fracture or lateral canal
e. Surgical excision and biopsy
35. Which of the following statements is true regarding the effects of periodontal
treatment procedures on the dental pulp?
a. Scaling and root-planing procedures remove cementum, expose dentinal tubules,
which are invaded and result in pulp inflammation.
b. Citric acid application appears to produce pulpal inflammation when used in
conjunction with reattachment procedures.
c. Hypersensitivity may result from scaling but is a sign of pulpal pathosis or
inflammation or both.
d. Scaling and root-planing procedures may produce deposition of tertiary dentin.
ANSWER KEY
Chapter 1
1. b;
2. d;
3. b;
4. b;
5. b;
6. d;
7. a;
8. c;
9. c;
10. c;
11. e;
12. d;
13. b;
14. a;
15. c;
16. d;
17. d;
18. c;
19. d;
20. b.
Chapter 2
1. d;
2. e;
3. c;
4. a;
5. b;
6. b;
7. b;
8. b;
9. b;
10. c;
11. b;
12. b;
13. a;
14. b;
15. c;
16. b;
17. a;
18. a;
19. b;
20. d;
21. c;
22. a;
23. b;
24. c.
Chapter 3
1. d;
2. b;
3. b;
4. d;
5. c;
6. c;
7. c;
8. a;
9. a;
10. e;
11. b.
Chapter 4
1. d;
2. c;
3. b;
4. c;
5. d;
6. c;
7. d;
8. c;
9. c;
10. a;
11. c;
12. d.
Chapter 5
1. b;
2. c;
3. d;
4. b;
5. a;
6. c;
7. d;
8. a;
9. c;
10. c;
11. c;
12. d;
13. c;
14. a;
15. c;
16. a;
17. a;
18. d;
19. c;
20. b;
21. a.
Chapter 6
1. a;
2. c;
3. b;
4. a;
5. b;
6. d;
7. b;
8. c;
9. a;
10. b;
11. e;
12. b;
13. e.
Chapter 7
1. a;
2. c;
3. a;
4. d;
5. b;
6. c;
7. a;
8. b;
9. d;
10. b.
Chapter 8
1. a;
2. b;
3. c;
4. a;
5. c;
6. d;
7. b;
8. d;
9. b;
10. d;
11. a;
12. a.
Chapter 9
1. c;
2. d;
3. a;
4. c;
5. e;
6. d;
7. a;
8. d;
9. c;
10. b;
11. b;
12. a;
13. a;
14. a;
15. a;
16. d;
17. d.
Chapter 10
1. c;
2. b;
3. c;
4. b;
5. a;
6. a;
7. b;
8. d;
9. b;
10. a;
11. b;
12. a.
Chapter 11
1. c;
2. a;
3. b;
4. a;
5. b;
6. b;
7. a;
8. d;
9. b;
10. d;
11. a;
12. d;
13. c;
14. b;
15. b;
16. a.
Chapter 12
1. c;
2. a;
3. b;
4. b;
5. c;
6. a;
7. c;
8. a;
9. d;
10. a;
11. c;
12. b;
13. b;
14. c;
15. a.
Chapter 13
1. d
2. c
3. a
4. a
5. c
6. d
7. b;
8. d
9. b;
10. c
11. d
12. b;
13. e
14. b;
15. c;
16. c;
17. c;
18. d;
19. e;
20. b.
Chapter 14
1. a;
2. c;
3. a;
4. b;
5. a;
6. a;
7. c;
8. a;
9. c;
10. e;
11. a;
12. c;
13. a;
14. b;
15. b;
16. d;
17. b;
18. c;
19. a;
20. d.
Chapter 15
1. d;
2. d;
3. a;
4. d;
5. a;
6. a;
7. a;
8. b;
9. d;
10. c;
11. d;
12. d;
13. b;
14. d;
15. b;
16. b;
17. a;
18. e;
19. d.
Chapter 16
1. c;
2. a;
3. c;
4. a;
5. b;
6. b;
7. a;
8. b;
9. d;
10. c;
11. a;
12. a;
13. a;
14. e;
15. c;
16. d;
17. b.
Chapter 17
1. b;
2. a;
3. e;
4. b;
5. d;
6. d;
7. b;
8. a;
9. b;
10. a.
Chapter 18
1. a;
2. a;
3. a;
4. a;
5. a;
6. a;
7. a;
8. a;
9. b;
10. d;
11. a;
12. b;
13. a;
14. a;
15. b;
16. e;
17. b;
18. a;
19. a.
Chapter 19
1. c;
2. e;
3. a;
4. d;
5. a;
6. d;
7. c;
8. a;
9. b;
10. d;
11. b;
12. c;
13. b;
14. a;
15. d.
Chapter 20
1. a;
2. d;
3. d;
4. b;
5. c;
6. c;
7. b;
8. a;
9. d;
10. a;
11. a;
12. a;
13. c;
14. d;
15. a;
16. b;
17. c;
18. b;
19. d.
Chapter 21
1. a;
2. a;
3. d;
4. b;
5. b;
6. d.
Chapter 22
1. d;
2. a;
3. b;
4. d;
5. e;
6. a;
7. d;
8. b;
9. d;
10. d.
Chapter 23
1. d;
2. c;
3. d;
4. d;
5. b;
6. d;
7. c;
8. b;
9. a;
10. c;
11. a;
12. b;
13. b;
14. d.
Chapter 24
1. c;
2. d;
3. a;
4. e;
5. a;
6. d;
7. c;
8. c;
9. c;
10. a;
11. d;
12. b;
13. c;
14. c;
15. b;
16. a;
17. d.
Chapter 25
1. d;
2. b;
3. d;
4. c;
5. e;
6. a;
7. a;
8. d;
9. a;
10. d;
11. c;
12. d.
Chapter 26
1. c;
2. a;
3. c;
4. a;
5. d
Test Your Knowledge
1. d;
2. d;
3. c;
4. b;
5. a;
6. b;
7. a;
8. d;
9. d;
10. c;
11. c;
12. d;
13. d;
14. c;
15. d;
16. c;
17. b;
18. a;
19. b;
20. a;
21. c;
22. a;
23. a;
24. d;
25. c.
26. d;
27. d;
28. d;
29. a;
30. a;
31. e;
32. b;
33. d;
34. a;
35. d.
ENDODONTICS 
 
 EPT – stimulates nerve endings with low current and high potential difference in voltage; stimulates A 
delta fibers; no gloves should be used because causes false negative.   
 Results from EPT:  ‐chronic pulpitis = higher current than normal 
‐acute pulpitis = lower current than normal (acute inflammation 
mediators lower the pain threshold). 
‐hyperemia = lower current than normal, but higher than acute 
pulpitis. 
 False positives – pus‐filled canal or nervous patient. 
 False negatives – trauma, insulating restoration, or wearing gloves.  
 Trauma causing deep intrusion to a permanent tooth causes pulp necrosis and conventional RCT. 
 SLOB Rule – root farther (buccal) from film will move to same direction cone is directed; lingual 
surface is always closest to the cone so buccal is always farthest.   
 Referred Pain ‐   Forehead: max. incisors 
Nasolabial: max. canines and PMs.  
Temporal: max. 2nd PM. 
Ear: mand. molars 
Mentalis: mand. Incisors, canines, and PMs.  
 Hemophilia is NOT a contraindication to endo.  
 Special case – trauma with pulp obliteration but PDL normal; asymptomatic and no EPT response; 
TX= observe as long as tooth asymptomatic and no PA changes.   
 
ACCESS: 
 mand. molar = trapezoidal, most common tooth for RCT; tipped ML so overprepared ML access; in 
40% of cases, may have 2 canals in distal root;  
 max molar = triangular, highest RCT failure, MB root is most complex of all teeth, because under MB 
cusp and must be accessed from DL position; M→P line is longest; 59% have MB2; the most common 
curvature of the palatal root is toward the facial.  
 Lingual wall of mandibular teeth most often perforated. 
 U‐shaped radiopacity overly apex of palatal root of max 1st molar is zygomatic process.  
 Facial access on primary max incisors recommended.  
 Mand. incisors and max 1st PMs most cautious for access because common in perforations. 
 Perforations into furcations of multi‐rooted teeth have the poorest prognosis.  
 
TEETH CHARACTERISTICS: 
 Max. 1st PM – lingual root may be wider; 2 roots=60%; thin oval access, common perf on mesial 
concavity. 
 Max. 2nd PM – more accessory canals than 1st pm; thin oval access; 85% has 1 root; overfilling either 
max. PMs will enter the maxillary sinus.  
 Mand. 1st PM – 25% have 2 canals and 2 foramen. 
 Mand. 2nd PM – 97% have 1 canal. 
 Mand. Canine – slight labial incline so access toward lingual; thin MD, wide BL;  access opening is a 
large oval with greatest width placed incisogingivally.   
 Max. Canine – longest tooth.   
 Max. lateral incisor – 55% has distal/lingual root curvature.   
 Max. Anterior ‐ teeth have slight distal inclines; all max. anteriors ALWAYS have 1 root! 
 Mand. Incisors – may have 2 canals with the labial being the straighter one; may have distal/lingual 
curvature.  
 Vital Teeth that don’t need RCT:  1. Cementoma, 2. Traumatic bone cyst, 3. Globulomaxillary cyst.  
 Pulp capping: only most successful with pinpoint exposures;  
 Poorest prognosis when perforation into furcation of multi‐rooted tooth.   
 Recapitulation: using MAF after each increase in file size to remove any dentin filling not removed by 
irrigation.   
 Obturation only 2nd to canal debridgement. 
 
ENDO Liquids: 
 Sodium Hypochlorite (1%, 2.6%, or 5.25%) – germicidal solvent and antimicrobial; GP points can be 
disinfected in 5% NaOCl for 1 minute; toxic to vital tissues; 3 roles: 1) good tissue solvent. 
2) antimicrobial effects 
3) lubricant    
 Hydrogen Peroxide (3%) – bubbly solution removes debris b/c certain chemicals physically foams 
debris from canal (effervescent effect) and liberates oxygen so destroys anaerobes. 
 Urea Peroxide (Gly‐Oxide) – decomposition; better than hydrogen peroxide and for narrow/curved 
canals for slippery effect of glycerol; better tolerated by tissue than NaOCl and more germicidal than 
H2O2 so EXCELLENT for tx of canals with normal PA tissue and wide apices.  
 Chloroform – the vapor is very dangerous and used to dissolve gutta percha.  
 Glass Bead Sterilizer – sterilized endo files in 15 sec at 220oC. 
 EDTA (17%)– ethylene diamine tetra‐acetic acid; not good irrigation solution; decalcifying process is 
self‐limiting and stops as soon as chelator is used up; can remain active up to 5 days so must 
irrigate/inactivate with NaOCl at the end of the appt; chelating agents – calcify tissues in order to 
clean root surface for gutta percha and sealer to adapt;  
 chelating agent acts by substituting sodium ions that combine with dentin to form soluble salts 
for calcium ions that are bound in less soluble combination creating softer canal edges to 
facilitate canal enlargement.   
 EDTA removes the mineralized portion (decalcify) of the smear layer. 
 EDTAC – EDTA and cetavlon; greater antimicrobial action but greater inflammatory potential; 
inactivator – NaOCl.   
 RCPrep – EDTA and urea peroxide so BOTH chelation and irrigation; for adequate RC debridgement, 
must achieve glassy smooth walls of canal; foamy solution with natural effervescence.  
 Most common cause of RCT failure is inadequate disinfected RC; 2nd most common cause is poorly 
filled canals.   
 MTA – mineral trioxide aggregate; calcium and phosphorus; long setting time and difficult to 
manipulate; increase pH; most superior retro‐filling/retrograde material.  
 Mta seals apical portion of root canal and is always after apicoectomy alone will not yield a 
good result.   
 Advantages:  1)RO 
2) hydrophilic 
3) biocompatible 
4) induces hard tissue formation.  
 
BROKEN FILES: 
 If broken file past apex, surgery is performed. 
 If broken file in apical 1/3 and no RL, then no surgery is needed but recall is a must.   
 If broken file in apical 1/3 but RL is present, then surgery is performed; prepare and obturate to the 
point of blockage and then perform an apicoectomy without! retrofilling.  
 Best prognosis if vital and no PA lesion.  
 Easier to retrieve an instrument if it wedged coronal or at the curvature of the canal but very difficult 
if instrument has past canal curvature.   
 
INSTRUMENTATION: 
 3 types of Instrumentation:   1. Filing (push&pull) – produces irregular shaped canals. 
2. Reaming (repeated rotation) – produces round shaped canals. 
3. Circumferential Filling (push and pull with emphasis on scraping 
canal walls) – enhances preparation  for flaring.  
 Narrowest diameter at DCJ (.5‐1.0mm from apex); widest diameter = orifice.  
 Broaches – for pulp tissue and soft material removal not for canal enlargement.   
 Files (stainless steel) – cut COUNTERCLOCKWISE; strongest of file but cut the least aggressively.   
 K‐File – most useful instruments for removing hard tissue to enlarge canal; clockwise‐
counterclockwise motion while pressure placed apically; K‐flex file = modified K type file.   
 Reamers – fewer flutes than files and removes debris CLOCKWISE but places material 
COUNTERCLOCKWISE; shave dentin using only a reaming action to enlarge canals.  
 Hedstrom stainless steel files – for filing action only and much faster than other files because sharp 
edge but must be careful; modification is S‐file.  
 Very light apical pressure is applied when using nickel titanium rotary files.  
 Rotary instruments work faster and improve access early in tx compared to heated instruments. 
 Endo first then perio, unless the case is of a primary periodontal lesion;  common clinical finding of 
periodontal problem is pain to lateral percussion on a tooth with a wide sulcular pocket.   
 Tooth must be asymptomatic and DRY at the time of obturation.   
 Debridement is the most crucial aspect of RC tx; want glassy, smooth canal walls.  
 Most common cause of RCT failure is inadequate disinfecting of RC system; 2nd most common cause of 
failures (40%) is leakage from poorly filled canals.  
 
OBTURATION: 
 If an accessory canal isn’t totally filled during obturation, then observe and evaluate every 3 mo.  
 Main fct of RC sealer is to fill discrepancies between core filling material and dentin walls.  
 ZOE Based Sealer – lubricant, bonding agent, and antimicrobial activity; disadv: staining, slow setting, 
non‐adhesion, and solubility;  
 All sealers are radiopaque from metallic salts in sealer.   
 If GP past apex, file used beyond apex to avoid breaking cone; a broken cone in PA area can cause 
orthograde retx failure.  
 How to remove GP:  1) rotary 
2) ultrasonic 
3) heat 
4) heat and instrument; 
5) file and chemical.  
 Indications for using solvent‐softened custom gutta percha:  
1. Lack of apical stop 
2. Abnormally large apical portion of the canal. 
3. Irregular apical portion of the canal. 
 Don’t use if tugback is <1mm and DOESN’T produce better apical seal than normal GP.  
 
VERTICAL FRACTURES:  
 diffuse RL/halo surrounding root due to bony attachment apparatus; most common cause is due to 
too much condensation; inlays have been show to cause vertical fractures. 
 Diagnostic aids:  1) fiberoptic light 
2) wedging the tooth 
3) persistent periodontal defects. 
4) patient bite on bite stick.   
 An additional radiograph taken with steep 45o vertical angulation in addition to conventional 90o.  
 Vertical fractures thru root has poor almost hopeless prognosis.  
 Anterior tooth root fractures usually in HORIZONTAL plane and may be visible in xray.  
 
BLEACHING:  
 Superoxol: most common bleaching agent for RCT teeth; 30% solution of hydrogen peroxide and 
distilled water; apply to heat to superoxol cotton til tooth lightens; heat liberates oxygen.   
 bleaching effect is due to direct oxidation of stain‐producing substances. 
 Complications: cervical root resorption, acute apical periodontitis (#1 complication), and 
enamel and dentin color changes.  
 Bleaching causes color change in enamel and dentin. 
 Walking Bleach Technique – Sodium Perborate and 2‐3 drops of superoxol in tooth chamber for 4‐7 
days and repeat prn.   
 Hydrogen Peroxide (30‐50%) – most effective bleaching agent, in alkaline medium.   
 
FLAPS: 
 Submarginal Curved Flap (semilunar flap) – not used for anterior root end surgery;   
 Disadvantages:  1) limited access & visibility 
2) tearing of incision corners 
3) if large lesion, then incision occurs over defect and scarring occurs. 
4) incision extent is limited by attachments.  
 Submarginal triangular and rectangular flap – requires 4 mm of attached gingiva and healthy 
periodontium; flap is raised by scalloped incision in attached gingiva with 1 or 2 vertical incisions; 
scarring but access is good; not as much recession.   
 Full Mucoperiosteal Flap – maximal access and visibility so most ideal flap; raised from gingival 
sulcus; difficult to reposition and suture and may have recession. 
 Indications for Periradicular Surgery:  1) non‐negotiable canal, blockage, curvature. 
2) complications from procedural accidents. 
3) failed tx from irretrievable posts/root fillings. 
4) horizontal apical fractures causing apical necrosis. 
5)biopsy. 
 
LESIONS & BACTERIA: 
 Blow‐out Lesions (non‐vital) – all probing normal until swelling probed and suddenly drops; tx = RCT. 
 Narrow Sinus Tract Lesions (non‐vital) – Probing normal except 1 narrow area; tx = RCT 
 Periodontal Lesions – probing defect is conical shape and needs RCT and perio if needed; pain to 
lateral percussion; eventhough perio lesion, must do endo first then perio.   
 Pulp‐chamber retained amalgam must be 3 mm into each canal for retention; 
 RCT teeth have more fractures because loss of structural integrity.  
 Bacteria infected in root canals:1) eubacterium. 
2) fusobacterium 
3) porphyromonas 
4) peptostreptococcus 
5) prevotella 
 Streptococcus initiates lesion to pulp exposure but STRICT ANAEROBES play role in periapical 
pathoses.  
 Virulence Factors involved in periradicular pathosis: 
1. Lipopolysaccharide‐ found on gram negative surface.  
2. Enzymes – neutralize antibodies and complement components. 
3. Extracellular vesicles – involved in bacterial adhesion, proteolytic activities, hemaglutination & 
hemolysis. 
4. Fatty acids – affect chemotaxis and phagocytosis.  
 CYSTs – inflammatory response with epithelial lining; well‐defined RL limited by continuous RO 
sclerotic border of bone; associated with chronic infected and sometimes mobile teeth.   
 Central, fluid‐filled, epithelium‐lined cavity, surrounded by a granulomatous tissue and & 
peripheral fibrous encapsulation.  
 Osteomyelitis – From PA infection with diffuse spread into medullary spaces with necrosis of bone; 
tx= drainage and antibiotic;  
 acute max = well localized infection; acute mand = more diffuse & widespread infection;  
 severe pain, fever, and lymphadenopathy with loose and sore teeth.  
 Progresses rapidly and little radiographic evident until 1‐2 weeks and then appears “MOTH‐
EATEN” radiolucency.  
 Tx = drainage and antibiotics.   
 Periodontal Abscess – positive for palpation and percussion and response from EPT;  
 Gram neg. rods like Capnocytophagia, Vibrio‐corroding, and Fusobacterium. 
 Gingival Abscess – from mastication; tx = OH and dental tx. 
 Apical Scar – PA granuloma, cyst or abscess that heals with scar tissue; well‐circumscribed RL & non‐
vital; tooth is non‐vital, so needs RCT. 
 Radicular Cyst – pre‐exiting granuloma; NON‐VITAL so needs RCT.  
 THREE VITAL TEETH LESIONS so NO RCT! –    
1) Cementoma – anterior area of mandible; RL lesion that calcifies; disorder of production of bone 
and cementum‐like tissue in tooth areas of jaw.   
2) Traumatic Bone Cyst – no epithelia lining; asymptomatic and RL appears scalloped around roots 
of teeth; intramedullary hemorhage, blood clot liquefies and leave empty space;  
3) Globulomaxillary Cyst – jct. of globular and maxillary processes of maxilla; pear‐shaped RL btw 
L.I. and canine roots; may be fissural cyst or OKC.  
 Phoenix Abscess (recrudescent abscess) – develops as granulomatous zone; diagnose with percussion 
and xray; large PA RL and is an acute exacerbation of chronic apical periodontitis.   
 Granuloma – granulomatous tissue with PDL due to pulp death so RCT needed; no symptoms; can 
result in abscess and only differs from cyst by histologic examination; well‐defined RL.  
 
RADIOLOGY: 
5. Faster film (E‐speed) requires less radiation but quality image.  
6. Increase kVp causes decreased patient’s skin dose; needs to be 70kVp or higher.  
7. Collimation – restriction of x‐ray beam size so doesn’t exceed 2.5 in at pt’s skin.   
8. Max radiation does – 50 mSv per yr/whole body. 
9. Stand at least 6’ away in area that lies b/w 90‐135o to the x‐ray beam (an area of minimum 
scatter radiation). 
 
PULP & DENTIN: 
 Decreases with age – size of pulp and # of reticular fibers (less cellular and more fibrous). 
 Increases with age ‐ # of collagen fibers and calcifications; apical portion of pulp contains more 
collagen than the coronal portion.   
 Pulp stones are associated with chronic pulp disease from advanced carious lesions and large 
restorations. 
 Pulp has myelinated (sensory) and unmyelinated (motor) nerve fibers – they are afferent and 
sympathetic; no proprioceptors! 
 Pulp only free nerve ending with only receptor for pain! 
 Predentin – adjacent to odontoblast layer of pulp, 10‐47 µm of dentin remains unmineralized; if layer 
lost, predisposes to internal resorption by odontoclasts.   
 Mantle Dentin – 1st formed dentin because odontoblast layer gets organized.  
 Circumpulpal Dentin – Most dentin formed.   
 Secondary Dentin – forms after tooth eruption and during life.   
 Tertiary/Reparative Dentin – irregular dentin formed in response to injury.   
 Primary function of pulp is dentin formation! Also nutrition for dentin and 
induction (forms dentin to enamel) 
 In pulp, type 1: type 3 collagen ratio is 55:45%; type 5 collagen in small amts.  
 Type 1 collagen predominates in dentin; odontoblasts make type 1 and 
fibroblasts in pulp make type 1 and 2.  
 4 Pulp Zones:   1) Odontoblastic layer – outermost layer w/ odontoblasts(A);  
adjacent to predentin & mature dentin (F). 
2) Cell‐Free Zone (zone of weil) – rich in nerves (D) (incl nerve 
plexus of raschkow) & capillaries (C); 
3) Cell‐Rich Zone – innermost pulp layer with fibroblasts (E).   
4) Central zone (pulp proper) – larger nerves and blood 
  vessels;  
 Cells in pulp – fibroblasts, odontoblasts, histiocytes and lymphocytes. 
 Cells in diseased pulp – PMNs (after pulp exposure), plasma cells, basophils, 
eosinophils, lymphocytes and mast cells.  
 Pulpal inflammation is a chronic cellular response with plasma cells, macrophages, and lymphocytes; 
After pulpal exposure, PMNs (acute inflammatory cells) are attracted to the area.   
 Vital Pulp is resistant but non‐vital pulp is fertile ground for micro‐organisms.   
 Pulp Nerve Fibers:  1) A – delta Fibers = large, myelinated nerves that perceive quick, sharp,  
momentary pain and dissipates quickly. 
2) C Fibers = small, unmyelinated nerves that perceive dull throbbing ache 
with diffuse pain and can be referred pain; not easily provoked but signifies 
irreversible local tissue damage;  
 Unmyelinated fibers regulate the lumen size of blood vessels. 
 
PULPAL DIAGNOSIS: 
 Best method to elicit the most accurate thermal response is to individually isolate the suspected teeth 
with a rubber dam and then bathe each tooth in hot or cold water.   
 Irreversible Pulpitis – bending over/lying down intensifies pain; often no PA lesion;  
 SPONTANEOUS, diffuse pain; intensifies with heat and relief with cold;  tender to percussion. 
 Thermal test are the best aid to diagnose an irreversible pulpitis.  
 Reversible Pulpitis – requires irritant to evoke pain and pain removed when stimulus is removed; 
NOT SPONTANEOUS; pain with cold not hot; usually sedative filling or new restoration is enough tx; 
most common cause is bacteria.   
 Pulpal hyperemia is an excessive accumulation of blood in the pulp due to vascular congestion. 
 **most effective way to reduce pulp injury during tooth preparation is to minimize 
dehydration of dentin!!! 
 Necrotic Pulp – no symptoms but may sometimes respond to heat; EPT is valuable b/c there will be 
no response at any current level;  
 Chronic Apical Abscess (suppurative apical periodontitis) – long‐standing, low‐grade infection of PA 
bone from RC; painless; may follow an acute alveolar abscess or unsatisfactory RCT. 
 diffuse RL (unlike cysts and granulomas which are well‐defined RL) and PDL widening; slightly 
loose, tender to percussion;  
 often cause of sinus tract in gingival tissue of kids; tooth pain stops upon drainage;  
 NON‐VITAL so RCT.  
 30‐50% of bone calcium must be altered before RL presents; the alteration occurs at the jct between 
the cortical and cancellous bone.   
 Periapical abscess is the most common of the all dental abscesses.  
 Acute Apical Abscess – pus collection in alveolar bone; sequence of symptoms:  tender tooth to severe 
throbbing pain to percussion with swelling; loose tooth, fever; no response to EPT or cold but may 
respond to heat; tx = drainage and debride the canals and then at a later date perform RCT and give 
PCN but if not pcn then clindamycin = increases bone levels but chance of pseudomembranous colitis.  
 ER Tx = drainage, antibiotics and analgesiccs and then RCT at a later date.  
 Hyperplastic Pulpitis – red/cauliflower growth of pulp in and around carious exposure caused by 
chronic irritation and vascular supply.  
 Caries spread laterally at DEJ to increase organic content and involve many dentinal tubules, Tomes 
fiber‐react causing fatty degeneration and later decalcification(sclerosis); once odontoblasts are 
involved, pulpal changes occur;  
 Only reliable clinical evidence that secondary dentin as formed is decreased tooth sensitivity.   
 
RESORPTION:  
 Pulpal inflammation often causes internal resorption when dentinoclasts (undifferentiated connective 
tissue cells) resorb the tooth structure in contact with the pulp. 
 External Resorption – always with bone resorption;   
 Etiology:   1) trauma 
2) pulp inflammation 
3) ortho 
4) impacted teeth 
5) bleaching 
6) non‐vital teeth 
 Bowl‐Shaped Resorption (inflammatory resorption) – involves dentin and cementum; tx – immediate 
RCT; CaOH every 3 mo and after 1 yr, obturate with CaOH sealer; 
 Pulp doesn’t play a role in cervical root resorption.  
 Surface Resorption – acute injury to PDL and root surface; heals itself.   
 Replacement Resorption – resorption of root surface and bone causing ankylosis; often seen in 
replant cases; accompanies dento‐alveolar ankylosis, characterized by progressive replacement of 
root by bone (no pdl); signs: no mobility, metallic percussion sound, and infraocclusion.   
 Bowl‐shaped, surface, and replacement resorption all can be caused by replantation! All 3 are types of 
external root resorption.  
 Internal Resorption – asymptomatic but seen in xrays as irregular RL anywhere along the canal; once 
pulp is removed, resorption ceases; may respond to pulp vitality tests; Tx = pulpectomy;  
 Undifferentiated connective tissue pulp cells are activated to form dentinoclasts that resorb 
the tooth structure in contact with the pulp. 
 Etiology:   1) trauma 
2) caries 
3) pulp capping with CaOH 
4) cracked tooth – pink tooth 
5) partial removal of pulp (pulpotomy) 
 Pink tooth syndrome is often a sign of internal resorption and cervical root resorption; characterized 
by pinkish tooth due to granulation growth undermining the coronal dentin.   
 
PULP TX: 
 Apexification – induce further root development in PULPLESS tooth by stimulating formation of hard 
substance at apex → CaOH creates alkaline env’t to promote hard tissue deposition; 
 Procedure – access tooth, remove pulp tissue, CaOH‐methylcellulose paste injected into the 
canal to cervical level; double seal cement to close cavity and recall after 3 mo.; if apex forms  
then RCT. 
 May be required after pulpectomy;  
 Apexogenesis – maintain pulp VITALity during pulp tx to allow root development; for immature teeth 
with incomplete root formation with damaged coronal pulp but healthy radicular pulp. 
 Place CaOH/MTA over radicular pulp and recall every 3 mo til root forms then complete RCT; 
 Root Submersion – resection of a tooth’s root 3 mm below alveolar crest; prevents resorption and 
maintain better proprioception; Indications:  1) rampant caries. 
2) periodontal conditions 
3) failure of prosthetic cases 
4) requiring better denture control.  
 Crown lengthening indications – sub G caries, perforations, and resorptions.  
 Pulp Capping: success is recognized by formation of complete barrier of dentin at exposure site; 
 Dycal = CaOH2 
 If pulp capping fails and tooth becomes symptomatic, it maybe impossible to treat with routine 
endo due to severe calcifications in the root canal; perforations more common in the RCT. 
 IPC – wait 3‐4 before tooth is reopened and decay is removed;  
 DPC – very successful in immature teeth; perform if small exposure (<1mm) and if exposure 
was <24hrs; perform partial pulpotomy if >1mm and >24 hr.  
 Pulpectomy – removal of pulp and fill with ZOE if want roots to resorb or place temporary until RCT 
can be completed.  
 Pulpotomy ‐ Uncontrolled bleeding with pulpotomy – perform pulp amputation at a more apical level.  
 Indications for pulpotomy:  1) carious primary tooth (healthy radicular pulps) 
2) carious perm tooth with underdeveloped roots. 
3) if RCT isnt available.  
3) ER tx for perm. tooth with acute pulpitis.  
 Only temporary procedure for perm teeth.  
 Apicoectomy – obliquely resecting most apical portion of root with buccal bone around apex 
removed; retrograde amalgam filling; common reason for apicoectomy and retrofilling is tooth with 
post and needs to be retreated; 
 indications: reverse filling, gain access to pathosis, poorly filled apex;  
 Retx for post, core, and crown requires curretage, apicoectomy and retrofill;  
 Periapical Curretage – same as apicoectomy but doesn’t remove apex; removal and examination of 
diseased tissue and determining extent of lesion are objectives of curretage.  
 
AVULSION:  
 5 Factors:  1) Time: w/in 30min, little resorption vs over 2 hrs which increases the failure rate.  
2) Storage Media: influence viability of PDL cells; milk best b/c pH =6.5‐6.8; saline and 
saliva is ok.   
3) Tooth Socket: no curettage or forced replantation.  
4) Root Surface: no scrapping, dried, or added chemicals.   
5) Splint Stabilization: splint for maximum of 2 wks for initial PDL attachment.  
 Intentional Replantation: extract and do RCT and replant; not a substitute for endo surgery. 
 Indications:   1) cant do normal RCT 
2) obstruction of canal.  
3) Perforating internal and external resorption 
4) Previous tx failed.  
 If REPLANT w/in 2 hrs: RCT 10‐14 days after with CaOH; replace every 3 mo and then obturate after 
1 year.  
 If REPLANT after 2 hours: RCT before replant, soak in 2.4% fluoride (fluoride slows the resorptive 
process) at pH 5.5 for 20 min, currette blood clot and irrigate with saline, wash tooth with saline, 
replant and splint for 4‐6 weeks.   
 Main cause of failure of replanted teeth is external root resorption; ankylosis can also cause failure 
but better prognosis than external root resorption. 
 After 60 min of dry storage (or water) of an avulsed tooth, few PDL cells survive.  
 Saliva can be storage up to 2 hrs but milk can store up to 6 hrs.  
 Transplantation – transfer of a tooth from one alveolar socket to another in the same person or into 
another person; transplanting partially developed root teeth has better prognosis;   
 
POSTS: 
 Major disadv of posts is they weaken tooth structure. 
 Need at least 4mm of GP to preserve apical seal. 
 Threaded posts increase chance of fracture while parallel/tapered posts are preferred. 
 Pins increase stresses and microfractures in dentin. 
 Cusps adjacent to lost marginal ridges should be restored with onlay.  
 RCT cause destruction of coronal tooth structure and reduce structural integrity; minimum 
preparation of RCT tooth is ONLAY.   
 
 
 
 
 
 
 
OPERATIVE 
CARIES: 
 Main cause of caries is bacteria or plaque formation; following cleansing of tooth, new plaque growth 
accumulates mainly on interproximal surfaces;  
 Rate at which carious destruction of dentin progresses is slower in adults than in young people, due to 
generalized dentinal sclerosis which occurs w/ aging; 
 Zones of Dentin Lesion: from innermost to outermost layers;  
1. Zone 1 – normal dentin w/ no bacteria; 
2. Zone 2 – subtransparent dentin – zone of demineralization  but capable of remineralization 
and no bacteria; 
3. Zone 3 – transparent dentin – softer than normal dentin & same as zone 2;  
4. Zone 4 – turbid dentin – bacterial invasion & not able to remineralize; 
5. Zone 5 – infected dentin – decomposed dentin filled w/ bacteria; 
 Zones of Enamel Lesion: 
1. Translucent Zone – deepest zone; 
2. Dark Zone – no polarized light; demineralization; 
3. Body of Lesion – largest part of lesion which also has demineralization; 
4. Surface Zone – unaffected by caries;  
 Root Surface Caries = senile caries; spreads on surface rather than depth; use GI;  
 Secondary Caries = recurrent caries; margins of existing filling;  
 Defense mechanisms of pulp to irritation: 
1. Sclerotic Dentin – peritubular dentin formation; INITIAL defense; 
2. Reparative Dentin – irritation dentin fromation;  
3. Vascularity  inflammation 
 Lactobacillus produce levan (polymer of fructose) not dextran;  
 Strep Mutans, Mitis, Sanguis, & Salivarious initiate decay; they produce dextran sucrase 
(glucosyltranferase) – catalyzes formation of glucans from dietary sucrose;  
→ Glucans = dextrans & mutans; Glucan forms plaque which hold lactic acid, produced from 
strep, against tooth;  
 Strep Mutans produces great amounts of lactic acid & stimulated by sucrose;  
 Cariostatic – stops caries; Cariogenic – causes caries, like bacteria Strep mutans & Lactobacilli casei; 
 Cariogenic Bacteria must be acidogenic (produce acid) & aciduric (tolerate acid environment) & 
ability to form protective matrix (dextran);  
→ Strep Mutans & Sobrinus are two most common cariogenic bacteria found in man; 
 Predominant Bacteria Found in Plaque:   
1) Strep Sanguis – found earliest but NOT primary etiological agent in caries; 
2) Actinomyces viscosus & naeslundii 
3) Strep mutans (primary etiological agent), mitis, & salivarious 
4) Veillonella, Lactobacilli casie, & Fusobacterium 
 Demineralization pH = 5.5; Remineralization pH > 5.5;  
 Saliva helps prevent caries by:  1) diluting acid 
2) reservoir for Ca & PO4 ions for remineralization 
3) reservoir for Ca, PO4, & Fluoride ions & other ions for 
hypermineralization of enamel;    
 Pit & fissures cares are most susceptible areas on tooth for plaque retention so highest prevalence of 
all caries; smooth surface areas are 2nd most susceptible;  
 Acute Caries/Rampant Caries – rapid progressing, mostly children, lesion has small entrance but deep 
& narrow large lesion; may have pain; 
 Chronic Caries – slow progression; mostly adults; dark pigment w/ leathery dentin & shallow lesion; 
 Root Surface/Senile Caries – older patients & that attack cementum & radicular dentin; spreads more 
on surface rather than depth; best prevention is to maintain periodontal attachement;  
→ Gingival recession is most related to initiation of caries in elderly;  
 An incipient carious lesion on interproximal surface is usually located GINGIVAL to the contact area; 
 Residual Caries – caries that remains in completed prep either by dentist’s intension or accident; 
 Secondary/Recurrent Caries – decay appearing at & under restoration margins;  
 Maxillary 1st Molar is tooth most likely to benefit from occlusal sealant placement;  
 Least likely microbial species found in dental plaque is Staph Aureus; 
 
OPERATIVE: 
 BW is best xray for diagnosing lesion of DL of canine; can use wedge to diagnose also;  
 Kissing Lesions – prepare larger 1st & fill smaller 1st; access & shade better when done in both appts; 
 Occlusal Reduction:    Amalgam  Gold    PFM 
o Working cusps:    2.5‐3mm  1.5mm   1.5‐2mm 
o Non‐working cusps:  2mm    1mm    1.5‐2mm 
 Direct Pulp Cap – CaOH hopefully stimulates reparative dentin bridge; 
 Indirect Pulp Cap – waiting time after placing CaOH & IRM = 3‐4 months hoping for secondary dentin 
formation;  
 Class 1 carious lesions are least likely to occur on lingual surfaces of mandibular incisors;  
 
INSTRUMENTS: 
 Carbide Burs – slight (‐) rake angle & edge angle of 90o; rotate rapidly before contacting tooth; used 
for cavity preps & best at HIGH SPEEDS;  
→ the greater # of blades causes less efficient cutting but smoother surface; 
 Steel Burs – used mainly for finishing procedures; 
 Rotary instrument that produces roughest tooth surface after use is crosscut tapered fissure bur at 
slow speed;  
 Bur blades – each bur blade has 2 sides & 3 important angles;  
 Rake face – faces direction of bur rotation;  Clearance face – faces away from bur rotation; 
 Edge Angle – angle formed b/w rake face & clearance face;  
 Rake Angle of Bur – angle b/w line connecting edge of blade to axis of bur & rake face; most 
important design characteristic of a bur blade; 
→ (‐) angle = when rakeface ahead of radius; minimizes fractures; for hard materials like amalgam;  
→ (+) angle = when radius ahead of rakeface; for soft materials, like acrylic;  
 More cutting blades causes less efficiency but smoother surface & vice versa;  
 Bur Formula =   10                     –                           85                        –     8            –            14  
     =blade width(1.0mm)   cutting edge angle(85 )     blade length(8mm)    blade angle(14o) 
o
 Nib – working end of non‐cutting instrument (ball burnisher, condenser, etc.) 
 Angling the shank of instrument so cutting edge of blade w/in 2mm of long axis of handle;  
 Files are used to trim excess filling material, especially at gingival margins;  
 The # of bevels that make up cutting edge can classify hand cutting instruments:  
→ hatchets & chisels have single bevel while excavators are 2 beveled; 
 Excavators: remove caries & refine internal parts of preparation; 
1. Hatchet Excavator – cutting edge of blade in same plane as handle; primarily for anterior 
teeth for preparing retentive areas; 
2. Hoe Excavator – cutting edge of blade perpendicular to axis of the handle; 
3. Angle Former – cutting edge at an angle other than 90 degrees to blade; 
4. Spoon Excavator – can be sharpend w/ handpiece stones; 
 Chisels: used mainly to cut enamel; 
1. Stright, Slightly curved, or Binangle – primarily used for planing/cleaving enamel; 
2. Enamel Hatchets – chisel bladed instrument w/ cutting edge in plane of handle; 
3. GMTs – similar to enamel hatchet but has curve blade & angled cutting edge; 
 Hand instruments transferred to dentist held by assistant b/w thumb & forefinger;  
 
AMALGAM: 
 The most frequent cause of failure of dental amalgam restoration is improper cavity design; 
 Amalgam coefficient of thermal expansion 2x that of teeth; 
 Amalgam tensile strength 1/5 to 1/8 it’s compressive strength; more abrasion resistant than 
composite; Most amalgam restorations show slight setting expansion; 
 If amalgam chips during carving, it’s b/c amalgam was condense AFTEr its working time elapsed; 
 Vaporization of amalgam during condensation of amalgam; greatest potential hazard of chronic 
mercury toxicity come from inhaling mercury vapor;  
 Amount of mercury after condensation affects:  1) Porosity of restoration 
2) Compressive strength of restoration 
3) Corrosive resistance of restoration 
4) Surface finish 
 Amount of mercuring in set amalgam related to how much mercury‐rich matrix is left after 
condensation; most important consideration of amalgam’s strength is MERCURY CONTENT;  
 The smaller the condenser point, the greater pressure exerted on the amalgam; 
 High mercury content (if  >55%) shows severe marginal breakdown; ideally = 43‐50%; 
 Moisture contamination of amalgam results in severe expansion of amalgam & corrosion; If amalgam 
w/ moisture, the zinc forms hydrogen gas; also ↓ compressive strength;  
 Amalgam contaminated by moisture during trituration & condensation are the MAIN CAUSE of 
fractures; amalgam compressive strength greatly reduced when contaminated w/ moisture;  
 For Amalgam → ↑ trituration time = ↓ setting expansion; correct trituration, ↑ strength but 
inadequate titration, ↑ corrosion; better to overtitrate than undertitrate;  
→ Properly triturated amalgam is shiny, wet, smooth, & homogenous; 
→ Purpose of trituration is coat the alloy particles w/ mercury; objective of trituration is to bring 
about an amalgamation of the mercuyr & alloy;  
→ During tritration, oxide film is rubbed off and clean metal is readily attacked by mercury; 
 AMALGAM:  ↓ setting expansion =  ↓ free mercury & partical size 
↑ trituration time & condensation pressure 
      ↑ strength =     ↑ condensation pressure & trituration time 
            ↓ voids & partical size   
 Amalgam RXN =   Silver‐tin Alloy + Mercury → Silver‐tin Alloy + Silver‐Mercury     +    Tin Mercury 
             Ag3Sn (gamma)    Ag3Sn(gamma)    Ag2Hg3(gamma‐1)     Sn3Hg (gamma‐2)  
→ Gamma (30%) – unreacted alloy; STRONGEST & LEAST CORROSION; SilverTin; 
→ Gamma1 (60%) – matrix of unreacted alloy; 2nd strongest; Silver Mercury; 
→ Gamma2 (10%) – WEAKEST & softest phase; most corrosion; TinMercury; add copper to 
reduce gamma‐2; copper reacts w/ tin to prevent gamma‐2; 
 Components:  1) Silver – 4070%; ↓ setting time, ↑ expansion & strength 
2) Tin (opposite of Silver) – 2527%; ↓ expansion & strength, ↑ setting time; 
component in amalgam that causes CONTRACTION; 
3) Copper – 6%/less; ↓ creep & corrision & gamma‐2 formation, ↑ strength & less 
marginal breakdown;  
4) Mercury – 3%/less; initiates & activates reaction w/ alloys;  
5) Zinc – 1%/less; ↓ oxidation of other elements; 
6) Palladium  ‐ 1%/less; ↓ corrosion 
7) Indium – 1%/less; ↓ surface tension 
 Factors that influence final mercury content of a restoration:   
1. Original Mercury‐alloy ratio 
2. Amount of trituration 
3. Condensation pressure & time  
 Creep – deformation w/ time in response to stress; one of the main cause of marginal fractures of 
amalgam; overtrituration & undertrituration can cause ↑ creep; timedependent;  
→ High copper & low mercury content & ↑ condensation pressure all ↓ creep;  
→ Creep of metal indicates that the metal will deform under static load. 
 Marginal leakage of amalgam restorations ↓ w/ age;  
 Discolored, corroded, superficial layer of amalgam is SULFIDE; 
 Amalgam is BRITTLE but posses good compressive strength; brittleness of amalgam is why the 
occlusal margins aren’t beveled;  
 Class V Amalgam ‐  1) Retentive grooves on gingivoaxial & incisoaxial line angles; 
2) Outline deformed trapezoide or kidney shaped; parallel arcs if possible; 
3) NON‐PARALLEL MD walls but PARALLEL OG walls; 
4) All walls DIVERGE;  
5) MD walls PARALLEL to transisional line angles but never beyond line 
angles; direction of MD walls determined by direction of enamel rods; 
6) axial wall should be uniformly deep into dentin & CONVEX to conserve 
tooth structure & minimize pulp irritation; 
 2mm b/w pulp & amalgam pulpal floor;  
 MD walls of Class 1 amalgam diverge (same as direct gold & gold inlays) to prevent unsupported 
enamel at MD marginal ridges; width of marginal ridges for PMs = 1.6mm, for Molars = 2.0mm; 
 Extend outline form before excavating any caries; 
 Reverse “S” curve is curve put into B or L walls so wall meets external tooth surface at 90o angle;  
 All walls meet tooth surface at 90o angle/butt joint; 
 For class 2, B & L walls of proximal section converge occlusally but is determined primarily by 
position of adjacent teeth in relation to tooth being restored;  
 When prepping class 2 on mand. 1st PM, bur tilted lingual to prevent hitting facial pulp horn & 
maintain dentinal support of lingual cusp;  
 Gingival cavosurface margin beveled only if it is placed in enamel; bevel is no wider than enamel; 
 Convenience Form – form of cavity prep takes to aid the operator in preparing, placing, or finishing 
the restoration; 
 Retention Form – resist dislodgement or displacement of the restoration; B & L walls of Class 2 prep 
CONVERGE occlusally to prevent amalgam dislodgement; 
→ Occlusal dovetail & retention grooves in proximoaxial line angles provide resistance to 
dislodgement; grooves placed in axiobuccal & axiolingual line angels & extend axial wall height; 
 Resistance Form ‐ take to resist forces of mastication to prevent fracture of restoration & tooth; flat 
walls at right angles of tooth’s long axis help achieve resistance form; 
→ When restoring cusp w/ amalgam, requires at least 2 mm of cusp be removed to provide 
resistance form;  
 For Class 2 prep, should have independent retention & resistance form for both proximal & occlusal 
portions;  
 Most detrimental to strength of posterior tooth in a cavity prep is ↑  in FL width;  
 Matrix band removed PRIOR to final carving; most difficult tooth to adapt matrix band is mesial of 
maxillary 1st PM; matrix band thickness = 0.002 inches; 
→ wedging action b/w teeth should provide enough separation to compensate for thickness of 
matrix band;   
→ proper proximal contour is provided by carving restoration & adapting contoured matrix;  
→ primary function of matrix is to restore anatomical contours & contact areas; 
 Amalgam restorations should be finished & polished to reduce marginal discrepancies which reduces 
chance of recurrent decay; heat generation during polishing should be avoided;  
 Amalgam is POOR THERMAL INSULATOR so explains why cold sensitivity is most common problem 
encountered after placing amalgam restoration; 
 
PINS: 
 Pins – 1‐1.5mm inside cavosurface margin; >.5mm inside DEJ; 2mm into dentin & 2mm into amalgam; 
→ Should be inserted into DENTIN ONLY; they are retained by dentin’s leasticity;  
→ should be placed PARALLEL to external surface of tooth; 
→ Function to retain restorative material; retention of pin ↑ as the diameter ↑;  
→ One pin per missing axial line angle is used; pins can WEAKEN restorative material when used; 
→ Optimum pin placement is at the ling angles of the tooth where tooth‐to‐root mass is greatest 
& risk of perforation is minimal; 
→ Threaded pins used to retain amalgam should NOT BE PARALLEL to each other or long axis of 
tooth;  
 Indications for Pins:  1) Class II amalgam prep where 1/more cusps have been lost 
2) very large class III amalgam prep 
3) Class V amalgam prep that far exceeds minimal dimensions 
4) prep for amalgam build‐up over which a crown will be placed 
 Contraindicated for young teeth w/ large pulps & teeth w/ reversible pulpitis; 
 If pulp is hit when drill pin hole, obtain hemostatis, dry w/ paper point, place CaOH and find better 
pin hole location;  
 Pins Types:  1) Cemented – pinhole > pin 
2) Friction Lock – NOT RCT TEETH; pinhole < pin; 
3) SelfThreading – most common & most retentive; hole size just under screw 
diameter;  
 TMS system has 4 pin sizes (regular, minim, minikin, & minuta) which are availabe in titanium or 
stainless steel plated gold;  
 
GOLD: 
 Most ductile & malleable metal; 
 Chamfer bevel = hollow ground bevel; scooped out bevel to create more bulk of restoration material; 
 Gold – retention from design of prep & friction b/w cavity wall & casting;  
→ Retention directly proportional to length (3mm) & parallelism of axial wall (6o taper);  
 Gold Constituents:  1) Gold ‐ ↓ corrosion, ↑ ductility & malleability 
2) Copper ‐ ↑ hardness; orange color; ranks 3rd in malleability; 
3) Silver – modified red color; ↓ temp, ↑ ductility & 2nd in malleability 
4) Platinum ‐ ↑ temp, ↑ tensile strength, ↓ coefficient of thermal expansion 
5) Palladium ‐ ↑ temp & hardness; absorbs hydrogen gas; whitening effect; 
6) Zinc – prevents oxidation 
7) Iridium – grain refiner; ↑ tensile strength & hardness;  
 High Gold Alloys: 1) Type 1 = 83% noble metal; soft & easily burnished b/c ↑ ductility; for inlays; 
2) Type 2 = 78% noble metal; medium, for onlays; 
3) Type 3 = 75% noble metal; hard, for crowns; when heated to cherry red color & 
quenched immediately, ↑ in malleability & ductility but ↓hardness & strength; 
4) Type 4 = 75% noble metal; bridges & RPDs; 
 Medium Gold = 25‐75% gold/noble metals;  Low Gold = 25% or less gold; 
 Gold Substitute Alloys – do not contain gold, but called PASSIVE b/c they form protective surface 
oxide film layer that provides maximum corrosion resistance;  
 Karat – the number of pure gold parts of a gold alloy, based on 24 parts (100% gold) as unit;  
 Pure gold is only used in gold foil; 
 Fineness – measured based on parts of pure gold per 1,000 = pure gold;  
 Class V Prep for Gold:   
1. Sharp internal line angles & small retentive undercuts at axio‐occlusal & axio‐gingival line 
angles; this is main characteristic in proper RETENTION;  
2. M & D walls flare & meet the cavosurface at 90o; M & D walls placed at line angles; M & D walls 
diverge facially; 
3. Conves axial wall w/ .5mm into dentin; occlusal wall slightly deeper than gingival wall b/c 
there is a thicker layer of enamel in occlusal wall; 
 Class V Gold –   Retention form → sharp internal line & point angles;  
Resistance form → flat MD walls & convex axial walls;  
 Both Retention & Resistance form of Class V gold is SAME for Direct Gold;  
 Gold Foil – oldest type of gold formed by rolling & beating gold into thin sheats, this causes elongation 
which give fibrous appearance; available in sheets, cylinders, & pellets;  
→ used for bulk filling & finishing veneer for mat gold;  
→ always microscopic voids due to improper condensing & using oversized pellets; 
→ surface hardness, tensile strength, & yield strenght are all increased during condensation of 
gold foil; good condensation with less force is accomplished w/ small point/condenser; 
→ direct gold is heated prior to condensation to drive off moisture & volatile compounds;  
→ Indications:  1) Ideal Lesion – no greater than 1‐2mm into dentin 
2) Ideal Pulp – at least 2mm of dentin b/w restoration & pulp 
3) Ideal Periodontium – no tooth mobility 
 Direct Gold ‐ ↑ coefficient of thermal conductivity (12x amalgam); #1 indication for direct gold is 
small class 3 lesion;  most important in adaptation of gold is direction force is applied;  
 Class III Cavity Prep for Direct Gold:  (use LINGUAL approach) 
1) Outline form is horizontal slot positioned gingival to contact area; 
2) Retention form from sharp internal anatomy 
3) Resistance form is provided by flat walls 
 Material of choice for class III on distal of canine is amalgam or direct gold;  
 Disadvantages of Gold:  1) ↑ thermal conductivity (12x that of amalgam) 
2) expesive & non‐esthetic 
3) time consuming & technique senstive 
4) need to use cement which is weakest part of cast gold restoration  
 Onlays – inferior retention than full crowns due to crown’s greater axial surface area; restores large 
lesions that involve more than 1/3 intercuspal dimension & at least 50% of crown remains or loss of 
cusps w/ at least 1mm dentin supporting remaining cusps;  
→ Parallelism of axial walls is primary retentive feature in only prep; sharp point & line angles 
increase onlay retention; 
→ Shoeing a functional cusp is NEVER INDICATED; it is minimal/partial cusp coverage via a 
finishing bevel on cusp crest; Cap a cusp is preferred b/c complete coverage of cusp;  
→ From facial to lingual, the axiopulpal line angle of an onlay prep is longer than the axiogingival 
line angle;  
 Always bevel/plane margins or wall junctions of onlay cavity to remove unsupported enamel AND 
compensate for casting inaccuracies; bevel DOESN’T minimize need for gingival extension; 
→ Bevel used mainly to improve marginal adaptation;  
→ 3 types of bevels:  1) short bevel – cuts only external 1/3 of enamel prisms 
2) full bevel – involves entire thickness of enamel 
3) wide bevel – involves full thickness of enamel & some dentin 
 Most effective means for verifiying enough occlusal clearance is wax bite chewin;  
 Inlay – lack of undercuts is the characteristic common to all class II gold inlay preps; an occlusal 
lock/dovetail should be done to prevent proximal dislodgement; marginal ridges need to be rounded; 
→ All margins are beveled resulting in 40o marginal metal;  
 Crystalline Gold/Mat Gold – formed by electrolytic precipitation yielding a crystalline structure 
resembling trees/links of chain; used for bulk fillings; flow & adaptation not as good as other gold; 
 Powdered Gold – formed by atomizing; granules in this materal have spherical shape; can be placed 
in very short time period; denser than foil thuse easier to manipulate & condense; 
 Cohesion of gold at room temperature is example of ATOMIC ATTRACTION; 
 
COMPOSITE: 
 Dental adhesion = dental bonding; 
 Adhesive joint – adhesion of intermediate material w/ 2 surfaces;  
 Adhesive Potential – smaller the angle, the greater the wetting & potential for adhesion;  
 Composite < Amalgam for compressive strength & occlusal wear; serious limitation is polymerization 
shrinkage;  
 Amount of stress for composite depends on CFactor = ratio of bonded:unbonded areas;  
 Composite:  ↓ wear resistance is primary cause of failure of class II composite restorations; difficulty 
in finishing these restoration is the softness of the resin & hardness of the filler;  
→ Contraindicated in pts w/ heavy occlusion or bruxism; 
→ The most desirable finished surface for composite is obtained w/ aluminum oxide disks; 
 Composite Resins – are dimethacrylate monomers & polymerize by addition mechanism initiated by 
free radicals, which generate by chemical activation or external energy;  
 Disadvantage of Methyl Methacrylate ‐ ↓ resistance to abrasion & ↑ thermal coefficient of expansion; 
 In comparison to poly (methyl‐methacrylate acrylic), composite has ↓ coefficent of thermal 
expansion, ↓polymerization shrinkage, ↑ compressive strength, & ↑ stiffness; 
 Biphenol Aglycidyl methacrylate – component common to most composite resins, sealants, 
bonding & glazing agents, & resin cements for ortho bands;  
 Chemical Activated (self‐cure) Resins: 2 pastes = benzoyl peroxide(initiator) + tertiary amine 
(activator);  
 Light Activated Resin – (VLC) → diketone photoinitiator (camphoroquinone) & amine activator; 
 Visible Light Cure Composites (VLC)‐ have α‐diketone initiator which absorbs energy from visible 
light (peak intensity = 474 nm; blue light) and then ketone reacts w/ amine to produce free radicals;  
→ Increment thickness most affects curing a light‐activated composite resin; 
→ Most popular way to polymerize matrix monomers using an external energy source to activate 
polymerization process; VLC have completely displaced UV light systems;  
→ Light energy range = 410‐500nm; curing light is used at wavelengths 400500nm;  
→ Light needs to be held w/in 2mm of resin to be effective; provides DENSER restorations than self‐
cure resins b/c no mixing required so no air bubbles;  
→ Most hazardous to retina so can cause retinal damage; Must have protection w/ pts who had 
recent cataract removed; with darker resin shades, cure a little longer; 
→ Most serious limitation is POLYMERIZATION SHRINKAGE;  
→ Advantages:  1) greater depth of resin can be cured  
2) Resin can be polymerized thru enamel 
3) intensity of visible light remains relative constant;  
 The light source affects ther perception of color b/c the light source must contain the color’s 
wavelength to be matched in order to see that color; 
 Composite Components: 
1. Filler – barilium silica glass/quartz/zirconium silica; combined w/ 5‐10% weight of colloidal 
silica; reduces polymerization shrinkage & increases hardness;  
2. Matrix – difunctional monomers;  
i. Bis‐GMA – highly viscous (Sealants are generally comprised of BisGMA) 
ii. Urethane Dimethacrylate (UEDMA) 
iii. Tri‐ethylene Glycol Dimethacrylate (TEGDMA) → added to reduce viscosity; 
3. Coupling Agent – silane provides adhesive b/w inert filler & organic matrix;  
 Composite Fillers ‐  1) Macrofill = 10‐100 microns; first composite resins made; 
2) Midifill (small particle) = 1‐10 microns;  
3) Minifill = .1‐1 micron 
4) Microfill (fine particle) = .01‐1 micron; SMOOTHEST FINISH & greatest 
resistance to occlusal wear;  
5) Hybrid = mixture, usually MIDIFILL or MINIFILL w/ MICROFILL; 
 Hybrid Resin Composites – highly filled w/ glass & SiO2; good esthetics; use silica fillers to ↑ hardness 
& wear resistance but highly polishable;  
 ↑ filler in restorative composites & ↓ filler in flowable composites; 
 the higher filler & BIS‐GMA, the greatly reduced coefficient of thermal expansion;  
 Only advantage of unfilled resins = ↓ coefficient of thermal conductivity; common cement bases; 
unfilled resins have high coefficient of thermal expansion = 7‐8x that of tooth;  
 Unfilled resins are the SOFTEST of all restorative materials; also lower modulus of elasticity;  
 Unfilled resins have the greates extent of marginal leakage related to temperature change;  
 Dentin Conditioner – primarily removes the smear layer of dentin & etch the intertubular dentin to 
produce microspaces w/in dentin surface; placed after enamel is etched 
 Primer – hydrophilic monomer (ie→ hydroxyethyl methacrylate – HEMA); penetrates smear layer & 
fills intertubular dentin; 
 Bonding Agent – unfilled resin adhesive (BIS‐GMA, HEMA);  
 Generations of Adhesives:  ‐‐ 4th Generation – 3 step etch & rinse adhesives 
‐‐ 5th Generation – 2 step etch & rinse adhesives 
‐‐ 6th Generation –   Type 1 → 2 step w/ primer & adhesive separate; 
      Type 2 → 1 step 
‐‐ 7  Generation – 1 step 
th
 Bonding of composite to dentin depends on difunctional coupling agents; 
 Acid Etch – when used, all enamel margins should be beveld for more surface area and to enhance the 
seal & retention to reduce microleakage; purpose of acid etch is more surface area & roughen surface; 
→ the acid cleans surface debris so better wetting of enamel by resin;  
→ acid‐etch composites have best initial seal but over time seal weakens so AMALGAM has best seal 
over time;  
→ it increases retention & adaptation by:  1) ↑ surface area; 
2) conditioning surface for better wetting; 
3) creating surface irregularities for better mechanical 
locking;  
 In class 3 composite prep, retention points should be placed ENTIRELY in dentin w/ grooves placed 
along gingivoaxial & incisoaxial line angles; small rounded retentive areas are preferred; 
 Outline for of composite class V resembles amalgam class V except that the composite internal angles 
are much more ROUNDED; 
 Whenever possible, used composite syringe to place composite to reduce trapping air in restoration; 
 Most important factor in preparing & restoring Class II composite is MOISTURE CONTROL;  
 Material most likely to cause an adverse pulpal reaction whe placed directly in a deep cavity prep! 
 Normal wear mechanism of the resins is best explained by abrasion of matrix, , exposure of filler, & 
dislodgement of filler particles; 
 
CEMENTS: 
 Chelation of Calcium ions on tooth by ionized Polyacrylic acid side‐groups is principal mechanism of 
chemical adhesion to tooth structure;  
 Solubility of Cements → Zinc Polycarboxylate > Zinc Phosphate > GI Cement; 
 Cements main function in cast restorations is seal the cavity, NOT retention; 
 Low coefficient of thermal conductivity is property most characteristic of curren available cements; 
 Glass Ionomer Cement – good thermal indicators; disadv – higher film thickness; limited strength and 
wear resistance but ↓ strength; often used for root surface cavities; doesn’t polish as well; 
→ Powder= fluoroaluminosilicate glass; Liquid= Polyacrylic Acid(adhesive & biocompatible);  
→ ↑ solubility when first mixed so very technique sensitive;  
→ micromechanical bond w/ composite resins; also for Class V restorations w/ composite 
“sandwich technique”; only GIC used as cement & permanent restoration; 
→ good thermal insulator (so no pulpal protection needed);  
→ “fluoridesponge” – b/c can absorb fluoride when local ionic concentrations are high, then 
slowly release fluoride when the environment concentration decreases;  
→ ↓ compressive strength, tensile strength, & hardness compared with composite;  
→ 3 Types:  1) Conventional GIC – luting agent 
2) Light‐cured GIC – liner or base; preferred b/c of extended working time; 
3) Resin‐modified Light Cured GIC ‐ Fuji 
 Zinc Phosphate – Powder = Zinc Oxide; Liquid = orthophosphoric acid; acidic (pH = 3.5) & can 
cause irreversible pulpal damage; shrinks slightly upon setting; oldest luting agent; 
→ Retention = mechanical interlocking; SUPERIOR STRENGTH;  
→ ↓ compressive strength when mixed faster; cold slab ‐ ↑ working time & ↓ setting time; 
→ setting time ↑ when less water; provides an anti‐bacterial effect; 
→ can be used as base or liner if HIGH COMPRESSIVE strength is needed;  
→ if zinc phosphate cement based used w/ restoration, varnish is applied PRIOR to placing base; 
→ CAN be used under composite;  
→ if high powder‐liquid ratio, ↓ viscosity, stronger final set & ↓ solubility; powderliquid ratio is 
most important variable of cement’s STRENGTH (the more powder, the stronger);  
 Zinc Polycarboxylate Cement – chelation of calcium ions provides chemical adhesion; NOT irritating 
to pulp; thick & short working time; first cement developed for adhesion to tooth structure; 
→ Powder = Zinc Oxide + Magnesium Oxide; Liquid = Polyacrylic acid & copolymers;  
→ Compressive strength less than ZnPO4 but tensile strength greater than ZnPO4;  
 ZOE/IRM: ↑ strength & abrasion resistance; ↓ solubility; pH of ZOE = 7 so least irritating of cements; 
Powder = Zinc Oxide & Liquid = Eugenol;  provisionals are usually cemented w/ ZOE cement! 
→ eugenol has palliative effect on pulp but not a thermal insulator; 
→ placed on dentin/enamel prior to bonding b/c it compromises bonding; 
→ retains about 20% by weight of polymethyl methacrylate in powder component; 
→ pts may be allergic to oil of cloves in eugenol; not for DPC b/c can irritate pulp; 
→ Carboxylic acid is the component that could replace eugenol in a zinc oxide paste; 
→ inhibits composite polymerization setting rxn b/c of eugenol; used for: 
1. Intermediate Restorations 
2. Base under non resin restorations 
3. Deciduous teeth restorations 
4. Restorative emergencies 
→ 4 Types of ZOE:  1) Type I = temporary cement 
2) Type II = permanent cement 
3) Type III = reinforced ZOE for temporary filling & thermal insulating base 
4) Type IV = cavity liner 
 
LINERS & BASES: 
 Bases – material 1‐2mm thick that function as barrier agains pulpally irritating agents, provide 
thermal insulation, & provide adequate resistance to compressive forces of mastication; 
→ Serve as replacement or substitute for protective dentin destroyed by caries & cavity preparation;  
 Primary base under amalgam/composite is CaOH but under gold is ZnPO4/ZnPolycarboxylate/GI; 
 Primary base not used under polycarboxylate cements b/c doesn’t irritate the pulp;  
 Most common used secondary base is placing ZINC PHOSPHATE over CaOH base that has been placed 
over pulpal exposure (DPC);  
 Cements used as bases should be mechanically stronger so mixed with maximum powder content; 
 Only distinction b/w base, cement, & cavity liner is final thickness: 
→ Cement = 15‐25 microns, Liners = 5 microns, Base = 1‐2 millimeters;  
 The most important consideration for pulp protection in restorative techniques is the thickness of 
remaining dentin; Selecting the approriate base or liner to restore the axial wall of a Class II 
restoration depends on the biological effect required & thickness of remaining dentin;  
 Cavity varnish reduces initial microleakage of amalgam restoration; 
 Cavity Liners → used to seal dentin tubules; 3 types: 
1. Copalite (cavity VARNISH)→ not good under resin; cavity varnish; solution liner = 1‐5 microns; 
a. Cavity Varnish Functions: reduce marginal leakage, prevent acid penetration, protect 
pulp tissues, & prevent mercury penetration;  
2. Dycal (CaOH) → suspension liner = 20‐25 microns;  
3. ZOE →  suspension liner; prevents thermal shock; 
 Suspension liners are thicker than solution liners;  
 CaOH → ability to stimulate formation of secondary dentin; RADIOLUCENT; most commonly used 
suspension liner that prevents thermal shock;  
 When using acid‐etch to restore class IV fracture, exposed dentin should be covered w/ CaOH liner; 
 
MATERIAL’S TRAITS & INVESTING: 
 Brittle materials have high compressive strength but low tensile strength;  
 Alloy – mixture of 2/more materials mutually soluble in the liquid state; solidifies thru a range of 
temperatures;  
 Modulus of Elasticity – measures stiffness or rigidity of material; Modulus of elasticity is the ratio of 
stress to strain;  
 Ductility – ability of metal to easily be worked into desired shapes; expressed in percent elongation; it 
depends on plasticity & tensile strength; ductility↓ with temp ↑;  
 Malleable – metal being able to be hammered into a thin sheed w/o rupture; depends on plasticity; 
malleability ↑ w/ ↑ temperature; 
 Coefficient of Thermal Expansion: tendency of material to change shape w/ temp. changes;  
→ Tooth = 11.4 ppm/oC 
→ Gold = 14.4 ppm/oC 
→ Amalgam = 22‐28 ppm/oC 
→ Composite = 28‐35 ppm/oC 
→ Unfilled Resins = 81‐92 ppm/oC 
 Consequence of thermal expansion & contraction differences b/w restorative material & adjacent 
tooth structure is percolation; 
 Perculation – cyclic ingress & egress of fluids @ restoration margins;  
→ ↑percolation = ↑recurrent decay;  
 Elastic Limit – greatest stress a material can be subjected to and still return to its original dimensions 
when the forces are released;  
 Proportional Limit – the greatest stress produced in a material such that the stress is directly 
proportional to the strain; ↑proportional limit = more resistance to permanent deformation; 
→ Similar to elastic limit; can interchange the terms;  
 Adhesive Potential – predicted by measuring the spreading/wetting of the adhesive over a substrate 
surface; done by determining contact angle of drop of adhesive as it spreads out; 
→ Smaller the angle, the greater wetting & potential for adhesion 
→ 2 types of adhesion: physical forces (van der Waals) & chemical forces (chemisorption) 
 when a liquid wets a solid completely, the contact angle b/w the liquid & sold is 0o;  
 Toughness – total energy absorbed to the point of fracture; it is affected by yield strength, tensile, 
strength, percent elongation, & modulus of elasticity; brittleness is opposite of toughness; 
 Resilience – energy that a material can absorb before the onset of plastic deformation; 
 Percent elongation of metal is measure of ductility & is related to permanent strain at fracture; 
→ Property that most closely describes ability of cast gold inlay to be burnished is percentage 
elongation; 
 Yield Strength > Proportional Limit > Elastic Limit 
 Quenching advantages →  1) Maintains Castings malleability & ductility 
2) casting easier to clean 
 Annealing – soften material by heating; metal becomes tough & less brittle;  
→ 3 stages – recovery, recrystallizaiton, & grain growth; 
 Tempering – hardening by heat treatment;  
 Gypsum Investment Expansion ↓ when:  1) older investment 
2) ↑ water:powder ratio 
3) ↓ spatulation 
4) ↑ time b/w mix & water bath 
 Components of Gypsum Investments:   
1. Refractory Filler – silicon dioxide like quartz or cristobalite (60‐65%); provides thermal 
expansion for investment;  
2. Binder ‐ α‐calcium hemihydrate (30‐35%); adds strength; 
3. Modifiers – like magnisium oxide, NaCl, boric acid, graphite, or potassium sulfate 
 Thermal expansion is the main cause of mold expansion which compensates for solification shrinkage 
of specific alloy; Variables that Influence Gypsum Expansion: 
→ Older investment = ↓ expansion 
→ ↑ water powder ration = ↓ expansion 
→ ↑ spatulation time = ↑ expansion 
→ ↑ time b/w mixing & immersion in water bath = ↓ expansion 
 Thinner mix of gypsum investment causes ↓ setting expanion, ↓ strength, ↑ setting time, & ↑ porosity; 
 Sprue – diameter > 1.5mm; diameter of sprue should be >/= to the thickest part of patter; sprue 
attached at 45o angle to thickest part of pattern;  
 Invest wax pattern immediately to avoid shape changes due to relaxation of internal stresses in wax;  
 Types of Inlay Wax → Type A (hard, low flow), Type B (medium flow), Type C (soft, high flow; for 
crowns or onlays);   
→ Contains: Paraffin wax(soft & main ingredient), Gum Dammar(medium), & Carnauba wax (hard); 
 Zones of Flame ‐ from inner to outer zones   → mixing zone  (cool & colorless) 
→ combustion zone (green/blue & surrounds inner 
core) 
→ reducing zone (hottest zone & only part of flame that 
should be used to heat the alloy)  
→ oxidizing zone (if contacts metal, a dull film of dross 
–scum on molten metal, develops over metal surface)  
 Example ‐ Porcelain at of PFM is separated at porcelain‐metal interface, separation may be caused by 
degassing metal at too low temp or fusing opaque coat of porcelain at too low a temp; 
 Properties usually found in materials consisting of ionic bonds are brittleness & high melting point 
(not weakness); 
 
FLUORIDE & SEALANTS: 
 Fluoride concentration in community water depends on air temperature & water consumption; 
 Forms of fluoride in water:  1) Sodium Silicofluoride 
2) Hydrofluorosilic Acid (well water) 
3) Sodium Fluoride 
 Fluoride supplements recommended if communal fluoride water conc < .7ppm for up to 13 yo;  
 
 FLUORIDE:  1) Creates Fluoroapatite 
2) Inhibits acid production that causes decay 
3) ↑ enamel remineralization  
4) Inhibits production of glucosyltransferase (dextran sucrase) 
5) Bacteriocidal Action 
 Fluoride ion easily exchanged for hydroxyl ion in enamel b/c fluoride is slightly smaller than hydroxyl 
ion & fluoride ion has greater affinity for hydroxylapatite crystal than hydroxy ion;  
 Fluorosis is enamel hypoplasia; IRREVERSIBLE; doesn’t occur after most teeth erupted but can 
occur in primary or permanent teeth; 
 Fluoride conc > 4mg/L = toxic; convert ounces to grams = 8.2 ounces x 28.35 (constant) = 232 grams; 
 Probable Toxic Dose for Fluoride = > 5mgF/kg; 
 Fluoride is excreted by kidneys;  
 Prenatal fluoride not approved by FDA but DOESN’T cross placenta;  
 Fluoride may corrode surface of titanium implants;  
 Systemic distribution of fluoride may affect tooth morphology; 
 Daily Use Fluoride Gel = 0.4% Stannous Fluoride & 1% neutral NaFl; used for root caries, xerostomia, 
radiation therapy, & teeth for overdenture;  
 3 Types of Topical Fluoride:    
a. Acidulated Phosphate Fluoride  1.23% NaFl + 1M orthophosphoric acid; pH = 33.5; most 
common in practice; may affect existing restoration by removing the glaze;  
b. Sodium Fluoride – 2%; over the counter 0.05% recommended; pH = 9.2;  
c. Stannous Fluoride – 8%; poor taste & may cause staining; pH = 2.12.3; 
 Daily application of 1.23% Acidulated Fluoride in fitted trays for 4 min is MOST EFFECTIVE way to 
increase the fluoride content in the external layers of teeth;  
 Low viscosity sealants wet acid etch teeth best (30‐50% Phosphoric Acid); 
 Retention of fissue sealants is chiefly the result of mechanical microretention; 
 Fluoride therapy & occlusal sealants modify the HOST the most; 
 Sealant Properties closer to Unfilled Resins; Components: 
→ Monomer → Bis‐GMA 
→ Initiator → benzoyl peroxide 
→ Accelerator → amine 
→ Opaque Filler → titanium oxide 
 
MISCELLANEOUS: 
 Woodburry RD frame has more retraction but Young’s frame (u‐shaped) is more popular; 
 Isolate a minimum of 3 teeth w/ RD; for tooth being clamped, hole is 1 size larger than the holes over 
teeth without a clamp; punching holes too close together in RD may cause damage to gingival papilla; 
 When using #212 clamp for class V, punch hole larger and slightly FACIAL to other holes in arch; 
 Pregnant pts have more inflamed gingiva;  
 DENTIN   1) Primary Dentin – form initial shape of tooth; deposited b/f completion of apex;  
2) Secondary Dentin – formed after apex completed (regular dentin – slow formation rate); 
3) Tertiary Dentin – aka Reparative Dentin – formed by replacement of odontoblasts; 
irregular shape & limited to site of irritation; composition same as secondary dentin; 
4) Sclerotic Dentin – when dead tracts/empty tubules calcify;  
 Dentin is less dense than gold, enamel, amalgam, & porcelain; 
 Galvanic Shock – brief & sharp electrical sensation when 2 different materials contact (like amalgam 
& gold); 1 microamperes = 500 mV; gradually subsides & disappears in a few days;  
 PM contacts from facial view → Junction of occlusal & middle third;  
 Molar contacts from faical view → Middle third;  
 Posterior teeth occlusion view of contacts → slight BUCCAL of middle third; this creates a wide 
lingual & narrow facial embrasure;  
 In posterior teeth, gingival tissues fill cervical embrasure; it is normally “col” shaped from F‐L cross 
section view;  
 Height of Contour – thickest portion or point of greatest circumference of the tooth viewed from 
occlusal surface;  
 Bleaching – InOffice = 35% hydrogen peroxide (4‐10 min cycles);  
→ AtHome = 10% carbamide peroxide;  
→ Extrinsic stains → vital bleaching; bleaching affects color change in both dentin & enamel; 
→ Best stains for bleaching: yellow > brown > orange > grey;  
→ Materials for “walking bleaching” are sodium perborate & 30% aqueous Hydrogen peroxide; 
 Green & orange stains on maxillary incisors are usually attributed to poor oral hygiene; 
 Anticholinergic drugs cause xerostomia b/c block receptor sites for acetylcholine;  
 LA reduces saliva in mouth b/c reduces anxiety & sensitivity;  
 Clinical Signs of Occlusal Trauma: Mobility, Thermal Sensitivity, Attrition, & Facial Recession;  
 Glycerin, Kaolin, & Sodium Fluoride can all treat root sensitivity;  
 Hydrodynamic Theory – pain results from indirect innervation caused by dentinal fluid movement 
in tubules, stimulating mechanoreceptors near predentin;  
 Zinc Chloride – most likely to cause NECROSIS of the sulcular epithelium & adjacent layer of CT when 
impregnated into cord for gingival retraction; epi, alum sulfate or alum chloride don’t cause necrosis; 
 Good hygiene & fluoridation will least protect groove defects;  
 Most sensitive area of tooth during cavity preparation is DEJ; 
 a hyperemic pulp may respond to low levels of current from an EPT;  
 Reversible pulpitis changes to Irreversible pulpitis primarily b/c of invasion of microorganisms; 
 Drugs that act as anti‐sialogogues (anti‐salivary agents) – Atropine & Methantheline (Banthine); 
 Use of Propantheline Bromide (Pro‐Banthine) to control salivary secretions is contraindicated in 
pts w/ glaucoma or cardiovascular distress;  
 Reversible Hydrocolloids have the LONGEST SHELF‐LIFE;  
 The syringe material that is most rigid and most difficult to remove from the mouth is POLYETHER; 
 Most effective way to reduce injury to the pulp during restoration procedure is to minimize 
dehydration of dentinal surface;  
 Dentist adjusts the shade of a restoration using a complementary color; this procedure results in a 
decreased value! 
 Dextranase – the enzyme when incorporated into a mouthwash is most likely to interfere w/ 
microbial aggregation in the plaque mass;  
 
 
 
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ORAL SURGERY 
 
 Erythromycin not acceptable antibiotic for prophylactic. 
 If allergy to PCN & clindamycin, use cephalexin, clarithromycin, or azithromycin. 
 Normal Pulse = 72; BP = 120/80 
 Temp: Oral = 98.6, Axillary (least accurate) = 97.6, Rectal (most accurate) = 99.6, Aural = 99.6. 
 ASA Classifications: 
1. Normal healthy pt. 
2. Mild systemic disease/significant health risk factor (smoking, alcohol, obesity) 
3. Severe disease but not incapacitated 
4. Severe systemic disease that is constant threat to life. 
5. Moribund pt. not expected to survive unless operation. 
6. Brain‐dead pt. whose organs removed for donation. 
 Tests for admitting to hospital for surgery: CBC, WBC count, urinalysis, and if G.A. then chest x‐ray, 
and over 40 yrs, then EKG. 
 
PATHOLOGY: 
 CBC:  1) Hematocrit: M=40‐54%, W=37‐47%; # of RBCs in your blood;  
 minimal for surgery is 30% 
2) Leukocytes: 5‐10,000/mm3; dental infection=15‐20,000/mm3. 
3) Hemoglobin: M=14‐18g/dL, W=12‐16g/dL 
4) Total Erythrocytes: M = 5x106/mm3, W = 4.5x106/mm3. 
5) Template Bleeding time = 1‐9min;  
6) PT time = 11‐16min – best test to determin if O.S. can be done w/ pt on COUMADIN; Pt 
must be w/in 5‐7 secs of control sample.  
7) PTT Time = 25‐36 sec; best test for hemophila; detects coagulation defects of intrinsic 
system; 
8) Platelets = 140,000‐440,000/mL 
• Platelets at 50‐100,000 is ok if platelet fct is healthy. 
• Thrombocytopenia =<50,000/mm3 which is contraindicated for surgery. 
9) Urine pH = 6; Specific Gravity = 1.005‐1.025 
 Hydrocortisone (glucocorticoid) ‐ 20 mg secreted by adrenal cortex/day; stimulated by ACTH (ant. 
pituitary); increases in concentrations under stress but decreases with excess steroids in system.  
 Cushing’s Syndrome – hormone disorder caused by prolonged exposure to high levels of cortisone 
(glucocorticoid) causing hypercortisolism; rare but more in females ages 20‐50 yrs. 
• 10‐15ppl out of 1 million affected each year; most common cause is pituitary adenomas.  
• Causes moon face, fat pads, buffalo hum, obesity, and purple striae. 
• Causes muscle weakness, bruising, weight gain, and growth retardation, excess hair. 
• Increase in BP, osteoporosis, fractures, impaired immune fct, glucose intolerance, and psychosis. 
 Erythema Multiforme – hypersensitivity syndrome of polymorphous eruption of skin/mucous 
membranes; macule, papules, vesicles, “BULLS‐EYE” shaped bulla. 
o Severe form = Steven’s Johnson Syndrome. 
o Tx = corticosteroids (consult DR b/f treating these patients) 
 Pts on Steroids: 
• Small doses (5mg/dy) will have suppression if been on regimen for month. 
• 100mg cortisol/day (20‐30mg Prednisone/day) will have abnormal cortical fct for a week. 
• Short term therapy (ie high doses for 1‐3days) will not alter cortical fct.  
• Adrenal crisis – IV/IM of hydrocortisone and supportive tx for decrease BP. 
• Person who has been on supressive steroids will take 1 year to regain full adrenal cortical fct.  
 Pts taking chronic daily does of steroids (>10‐20mg/day of prednisone) should be considered for 
steroid supplementation for oral surgery.  
• If currently taking steroid, double daily dose of steroid for surgery day. 
• If less than 2 weeks after steroids stopped, double dose of steroids on surgery day. 
 As dehydration progress – turgor (fullness) of skin loss, then oliguria (decrease in urine), then severe 
cell dysfunction – water shifts from intracellular to extracellular space, particularly in brain.  
o BP falls w/ continuous dehydration.  
 Diabetes Mellitus – mostly carbs/glucose & lipids owing to lack of insulin secretion by beta cells of 
pancreas; if well‐controlled, not susceptible to infections but difficulty containing infections. 
o Hypoglycemic Symptoms: tachycardia, sweating, nausea, tremulousness, hunger. 
o Diabetes is most common pancreatic endocrine disorder/ metabolic disease. 
o Type 1 pt – absolute deficiency of insulin due to destruction of B cells. 
o Type 2 pt – resistance of insulin’s action in peripheral tissues. 
o Causes Polydipsia(excessive thirst), Polyuria(excessive urination), & Polyphagia(excessive 
hunger).  
o Tx = for conscious pt – oral carbohydrate/sugar 
o Tx = for unconscious pt – 1mg glucagon IM or 50ml of 50% glucose IV.  
o #1 cause of Kidney Disease (40%); high bp is 2nd common cause.  
o Well‐controlled diabetes are no more susceptible to infections than pts w/o diabetes but it 
is more difficult containing infections due to their altered leukocyte function. 
 Dypspnea: difficulty breathing; Apnea: transient absence of breathing; Hyperapnea: deep & rapid 
breathing. 
 Hyperventilation – ↓CO2 from blood causing decrease BP & fainting; hypocapnea (loss of CO2).  
 Hypoventilation – ↑CO2 in blood; hypercapnea (excess CO2) 
 CHF – 50% of ventricular ejection; usually left ventricle fails first;  
o most common sign of left CHF is pulmonary edema;  
o most common sign of right CHF is pedal edema or abdominal swelling. 
o Earliest & most common sign–Paroxysmal Nocturnal Dyspnea(pt wakes up gasping for air). 
 Usually a post‐infarction pt is not subjected to oral surgery w/in 6 months of his infarction. 
 Pts taking diuretcis/vasodilators are prone to orthostatic hyptension and avoid excessive EPI. 
 Normal blood pH = 7.33‐7.44; normal blood bicarbonate to carbonic acid ratio = 20:1. 
 Bicarbonate‐carbonic acid ratio normal is 20:1.  
 Acidosis – deceased blood pH; CNS depressed; 10:1 ratio indicating uncompensated acidosis – always 
occurs during CPR;  
 Alkalosis – increased blood pH; over excitability of CNS causing tetany.  
 Metabolic Acidosis = ↓bicarbonate; too much acid or too little base; causes CNS depression so 
disorientation, the comatosed; causes are Chronic renal failure, diabetic ketoacidosis, lactic acidosis, 
poisons, and diarrhea.  
 Respiratory Acidosis = increase CO2 b/c decreased resp. rate b/c poor lung function. 
 Tx for Metabolic & Respiratory Acidosis = sodium bicarbonate. 
 Metabolic Alkalosis – ↑bicarbonate; too much base/too little acid; causes overexcitability of the body. 
o Etiology – diuretics, cusshing’s syndrome, vomiting;  
 Respiratory Alkalosis – decreased CO2 b/c increased resp. rate. 
 Tx for Metabolic & Respiratory Acidosis = aluminum chloride. 
 Status Asthmaticus – severe form of asthma; if not tx, then chronic partial airway obstruction which 
may lead to respiratory acidosis.  
 Rheumatic Fever – Sequela of previous Group A – β‐hemolytic Staph infection of Upper Respiratory 
Tract; exudative & proliferative inflammatory lesion (NOT INFECTION) of connective tissue, esp. 
heart, joints, blood vessels, & subcutaneous tissue; Tx = PCN and rest. 
• Common in children 5‐15 yrs; Carditis may cause permanent valve damage, like MVP; 
• Diagnosis made when 1 major & 1 minor criteria (JONES CRITERIA) are met: 
o Major – carditis, arthritis, chorea, erythema margnatum, and subcutaneous nodules. 
o Minor – fever, arthralgias, history of RFD, EKG, and lab test. 
 Hemophilia A & B – takes long time for blood to clot and abnormal bleeding occurs; sex‐linked 
recessive (males affected & females carriers)  
A. Often <25 yrs; deficiency of factor VIII (anti‐hemophilic factor). 
B. (Christmas disease) Deficiency of factor IX (plasma thromboplastin component). 
C. (Rosenthal’s Syndrome) Deficiency of factor XI (plasma thromboplastin antecedent). 
o **true hemophiliac has increased PTT, normal PT & bleeding; however pts on anticoagulant 
therapy (wafarin, heparin, aspirin, or NSAID) will have prolonged PT and bleeding time.  
 Von Willibrand’s Disease – autosomal dominant bleeding disorder caused by deficiency in von 
Willebrand factor – binds to factor VIII and adhedes platelets to collagen.  
 Thrombocytopenia – most common cause of hemorrhagic/bleeding disorders; abnormally low # of 
platelets (<150,000); Abnormal reductions of platelets caused by any of these 3 processes: 
1. Platelet production by bone marrow 
2. Trapping of platelets by the spleen 
3. Faster tha normal destruction of platelets.  
• S&S – petechiae, nosebleeds, GI bleeding, tendency to bruise, urinary tract bleeding. 
• 2 concerns w/ these pts – post‐op hemorrhage and adrenal insufficiency (due to steroid tx). 
• Excessive bleeding causes formation of hematomas which increases chance of infection. 
• Drugs that potentiate bleeding after extraction:  1) aspirin 
2) anti‐coagulants 
                3) broad‐spectrum antibiotics 
                4) alcohol 
                5) anticancer drugs. 
 Pts on Anticoagulated Therapy – stop drugs for 5 days then perform surgery and restart the drug 
therapy THE DAY AFTER surgery if no bleeding is present. 
 COPD – emphysema & chronic bronchitis & asthma or any combination of those 3 diseases; airway 
obstruction that is chronic & progressive; causes secondary pulmonary hypertension.  
1. Bronchial Asthma – disorder marked by dyspnea & wheezing expiration from narrowing airways. 
2. Emphysema – often w/ chronic bronchitis; labored breathing and increased chance of infections. 
3. Bronchiectasis – copious purulent sputum, hemoptysis, and recurrent pulmonary infection. 
4. Chronic Bronchitis – excessive bronchial mucous and productive cough (universal sign of chronic 
bronchitis) w/ sputum for 3 mo/more in at least 2 consecutive years w/out any other disease.  
 COPD & aspirin may cause Hemoptysis – bursting of RBC. 
 Chronic Bronchitis – causes hyperplasia of bronchial submucosal glands & bronchial smooth muscle 
hypertrophy quantified by Reid Index; predisposed w/ lung cancer;  
• associated w/ smoking; productive cough w/ wheezing; so need to be UPRIGHT during O.S. 
• COR PULMONALE (enlarged RV of heart);  
• airway narrowing & obstruction of bronchial tree.  
 Emphysema – “BARREL‐CHESTED” appearance; b/c distal air spaces become enlarged & lungs 
hyperinflated; destruction of airsacs in lungs where oxygen exchanged; 
• shortness of breath and difficulty exhaling.  
 End‐Stage Renal Disease – perm. & almost complete loss of kidney fct <10%; toxins slowly build‐up; 
• On steroid therapy, increased post‐op infections, increased bleeding tendency. 
• Oral surgery performed 1 day after dialysis; Consult dr. for prophylaxis.  
• Do not use NSAIDS; avoid drugs metabolized/excreted by kidneys.  
 Atelectasis – mucous/foreign object obstructs airflow in mainstem bronchus causing collapse of 
affected lung tissue; often 36 hrs. post‐op w/ mild dyspnea, low grade fever, hypoxia, & can lead to 
pneumonia;  
• most common ANESTHETIC COMPLICATION occuring in 1st 24 hrs. 
• Tx = incentive spirometer, pt. takes long deep breaths to expand the lung.  
 Pneumothorax – air leaks into pleural space causing lung to recoil from chest wall; dyspnea, chest 
pain, need chest x‐ray; can occur as post‐op complications from aspiration of vomit into trachea. 
• Tx = remove air from pleural space w/ chest tube/small needle.  
 **Pneumonitis (inflammation of lungs) & atelectasis – 2 most common causes of fever in pt. w/ G.A. 
 Calcium regulated by parathyroid hormone causing increased bone resorption with increased Ca 
levels; calcium also regulated by kidney tubules and GI mucosa (↓pH =↑Ca);  
• ↓Ca causes hyperirritability of nerves and muscles.  
• ↑Ca = ↓PO4 
• Ca increased in hyperparathyroidism, glomerulonephritis, hypervitaminosis D, & malignant 
diseases (ie multiple myeloma); Ca decreased in diabetes mellitus.  
 Phosphorus concentration regulated by parathyroid hormone = ↑PTH =↑ Phosphorus in urine =↓ 
phosphorus in plasma.  
 Good health = Ca:Phosphorus ratio is 10:4. 
 Insulin = ↓ glucose; glucagon = ↑ glucose. 
 Fasting glucose >140 and nonfasting glucose >200 = diabetes; Normal Glucose – 70‐120mg/dl. 
 Glucose regulated by liver w/ hormones from pancreas, adrenal medulla and cortex.  
 Blood glucose increased w/ glucagon and decreased w/ insulin; glucose not in urine but filtured b/c 
reabsorbed in PROXIMAL CONVOLUTED TUBULE of kiney 
 Osteomyelitis – inflammatory process w/in medullary bone that involves marrow spaces; caused by 
STAPH AUREUS; less in maxilla b/c rich blood supply; pus is produced in bone so may cause abscess.  
• Suppurative osteomyelitis – acute, chronic, or infantile osteomyelitis. 
• Nonsuppurative osteomyelitis – chronic sclerosing, Garre’s Osteomyelitis and actinomycotic 
osteomyelitis. 
• Can affect adults(vertebrae & pelvis) /children(long bones) – affects adjacent ends of bones like 
femer & tibia or humerus & radius. 
• Garre’s Osteomyelitis – in children/young adults; causes periosteal thickening and peripheral 
reactive bone formation resulting from mild irritation/infections; clinically‐ bony, hard non‐
tender swelling and associated w/ painful carious tooth. 
• Acute Osteomyelitis – reduced blood supply predisposes bone to osteomyelitis; like in mand. 
 Dentigerous cyst – associated w/ crowns of unerupted teeth; AKA follicular or primordial cysts; result 
of degenerative changes in reduced enamel epithethelium.  
o Unerupted 2nd mand. molar on 14 y/o w/ dentigerous cyst around crown…tx – uncover 
crown and keep it exposed. 
o Eruption cyst form when tooth is erupting – tx = simple incision/deroofing.  
 Characteristics of Malignancies:  1) erythroplasia – lesion red/speckled red & white 
2) ulceration 
3) duration > 2 wks; >40yrs. old pt 
4) rapid growth, bleeding, induration, fixation. 
 Early carcinoma frequently appears as area of erythroplasia (red but not ulcerated area of mucous 
membrane). 
 Squamous Cell Carcinoma = 90% of oral cavity and oropharyngeal malignancies;  
o most common site is LIP (25‐30%, also GOOD PROGNOSIS); often ulcerated. 
o 2nd most common site is tongue, often anterior tongue (lateral border). 
o 3rd most common site is floor of the mouth; often older men who smoke/drink. 
 
EMERGENCIES: 
 Reducing cardiac output is MAIN FACTOR in all types of shock;  
 S&S of shock: tiredness,cofusion, cold skin, sweaty, bluish, pale, rapid but weak pulse, and BP drops. 
 Characterizations of Shock:  1) increased HR & vascular resistance 
2) decreased cardiac output 
3) tachycardia 
4) adrenergic response 
5) ischemia/mental change 
 Stages of Shock:  1) Compensatory stage – increase HR and peripheral resistance. 
2) Progressive stage – metabolic acidosis 
3) Irreversible/Refractory stage – organ damage, survival not possible.  
 Categories of Shock:  1) Hypovolemic Shock – produced by decreased blood volume. 
2) Cardiogenic Shock – caused by massive MI; circulatory collapse from 
pump failure of L.V.; 
3) Septic Shock – severe infection from endotoxin of gram – bacteria. 
4) Neurogenic Shock – severe injury/trauma to CNS. 
5) Anaphylactic shock – severe allergic rxn. 
 Epinephrine is given during shock b/c prevents release of substances from mast cells & antagonizes 
the action of histamine & leukotrienes of smooth muscle.  
 LA is sedative/depressant on CNS; toxicity causes drowsiness, slurred speech, coma, culvusions, resp. 
depression, decreased cardiac output; initial effect may be stimulation, agitation, talking, ↑BP, ↑HR, 
↑Resp; Tx = oxygen and diazepam IV. 
 First CLINICAL SIGN of mild lido toxicity is NERVOUSNESS! 
 First CNS manifestation of LA toxicity is short CNS excitation then drowsiness then unconsciousness 
and resp. depression/ arrest; CV effects are depressant causing dec. BP. 
 Allergic rxns to LA is from either the LA or methylparaben (preservative); if there is allergic rxn to LA, 
use dipheynylhydramine/benadryl; allergic rxns to LA caused by antigen‐antibody rxn.  
o Presents w/ swelling, itching, and oral mucosa swelling.  
 Syncope = transient cerebral hypoxia; tx = oxygen 3‐4L/min;  
• MOA = increases amounts of catecholamines causing decrease peripheral resistant, tachycardia, 
sweating; so syncope caused by overcompensating for increase BP so creates bradycardia.  
• Most common early sign of syncope = pallor/paleness 
• Oxygen indicated for all syncope unless caused by hyperventilation and contra for COPD. 
• Inhaled ammonium irritates the trigeminal nerve sensory endings causing reflex stimmulation of 
medullary respiratory & vasomotor centers;  
• Types: Vasovagal, Neurogenic, Orthostatic, Hyperventilation.  
 Hyperventilation in anxious dental pt. leads to carpopedal spasm = spasm of the hands, thumbs, foot, 
or toes. 
 Asthma – dyspnea, cough, & wheezing caused by bronchospasm which results from hyperirritability 
of tracheobronchial tree; If bronchodilator doesn’t work during asthma attack use EPI (.3ml of 1:1000 
dilution), then oxygen; Sit pt in erect or semi‐erect position during asthma attack.  
 Epinephrine is drug of choice in acute allergic rxn w/ bronchospasm and hypotension. 
 If asthmatic, avoid: aspirin, NSAID, barbs, narcotics, erythromycin; use B2‐agonist (albuterol) for 
asthma tx.  
 If CPR is effective, then pupils constrict; **if too much pressure on xyphoid process – liver injured! 
 If interrupt chest compression – fall of BP to 0 and reduced blood flow. 
 For BP cuff – bladder length and width of cuff should be 80% and 40% of arm circumference. 
 BP – 5mg Hg higher when sitting; difference in arms bp is 20%; inflate cuff 30mg HG until pt. radial 
pulse disappears; the sphygmomanometer should be reduced at 2‐3mm/sec. 
 Most common error in recording BP is applying cuff too LOOSELY and gives false elevated reading. 
 Activate EMS immediately for adults and after 1 min for infant and child. 
 Rescue breathing (has pulse but not breathing) ‐ 1 breath every 5‐6 sec (every 3 sec for child) or 10‐
12 breaths/min (15/20 for child/infant). 
 For compressions, depress sternum 1.5‐2mm(1‐1.5 child, .5‐1 for infant); 30 compression q 2 breaths 
for adult & kids but 15 compressions q 2 breaths for 2 rescuers; (80 ‐100/min) and 5:1 for infant.  
 In anaphylaxis, pt should be in Trendelenburg position – body laid down and inclined at 45o w/feet 
& legs above head. 
 Meperidine/Demoral – narcotic used to relieve moderate/severe pain and a cough suppressant. 
o Most widely used narcotic in hospitals; 
o Most abused drug by health professionals.  
 Concomitant administration of Meperidine & MAO inhibitors (like Phenelzine) can cause life‐
threatening hyperpyrexic rxns that can end up in seizures/coma.  
 
ANESTHESIA: 
 Nitrous (blue tank!) = blood/gas partial coefficient of 0.47 so poorly soluble in blood and lack of 
potency; excreted unchanged by lung; only inorganic anesthetic; primary disadv: lack of potency. 
• Mainly effects reticular activating system and limbic system and CNS; room air = 21% oxygen so 
need pt. to receive this much oxygen when getting NO. 
• First symptom of nitrous is tingling of hands; good for timid/scared kids. 
• Keep reservoir bat 1/3 to 2/3 full; only inoganic substance. 
• Inhalation anesthetic w/ fastest onset of action! Oldest gaseous anesthetic; 
• Nausea is most common side effect; diffusion hypoxia if not give 100% O2 at end of procedure; 
100% oxygen CONTRAINDICATED in COPD pt. 
• Most common complication of nitrous is behavioral problem. 
• In conscious sedation, pt retains all reflexes but doesn’t under G.A. 
 Full cylinder of oxygen = 600L at 2000psi (green tank!) 
 Spirometer measures respiratory air volumes: 
1. Functional Residual Capacity – amt of air remaining in lungs at end of expiration; nitrous takes 
longer if more FRC; FRC = ERV + RV. 
2. Tital Volume – amt of air remaining in lungs at end of expiration. 
3. Expiratory Reserve Volume – amt of air forced out of lungs in max. expiration. 
4. Inspiratory Reserve Volume – amt of air inhaled at max. inspiration. 
5. Vital Capacity = TV + ERV + IRV. 
6. Residual Volume – volume of air remains in lungs at all times (can’t be measured) 
7. Total Lung Capacity  = VC + RV 
 Pulmonary volumes 20‐25% less in females than males and larger in athletic ppl so nitrous 
adjustments needed.  
 Stages of Anesthesia: 
I. Amnesia & Analgesia – administration of anesthesia; verbal responses (best monitor). 
II. Delirium & Excitement – loss of consciousness & onset of total anesthesia; may become 
violent with irregular BP & Respirations. 
III. Surgical Anesthesia – regular pattern of breathing and total loss of consciousness; eye 
mvmt stops!; when signs of resp or CV failure first appear; this stage has 4 PLANES! 
a. Pt has no pain reflexes. 
IV. Premortem– signals danger; decrease BP; cardiac arrest imminent; medullary paralysis! 
a. Eyes are greatly enlarged/maximally dilated pupils. 
 Induction Phase: Stage I & II of G.A.; Maintenance Phase: keeps pt in surgical anesthesia; Recovery 
Phase: begins when surgery complete and anesthetic terminated and end when anesthetic eliminated 
from body.  
 Most resistant part of G.A. is medulla oblongata (CV, vasomotor, resp. center) 
 Most controllable root of GA is inhalation; sedation can be reversed rapidly when using inhalation. 
 Emergency most often experienced during outpatient G.A. is respiratory obstruction. 
 Minimum Alveolar Concentration (MAC) – alveolar concentration of anesthetic where 50% of pt 
unresponsive to surgical stimulus.  
 Meyer Overton Theory – anesthetic begins when reaches certain molar conc. in hydrophobic phase. 
 Second Gas Effect – potent agents administered with nitrous so agents delivered in increased amts to 
alveoli as gas rushes to replace nitrous absorbed by pulmonary blood.  
 Eyes greatly enlarge and nonreactive to light – circulation to brain has stopped! 
 Eyes taped shut during GA to prevent corneal abrasion. 
 Cyanosis/↑Pulse – indicates oxygen is needed during GA. 
 During G.A., pt loses laryngeal reflex so if blood & saliva collect near the vocal cords, they close 
(laryngospasm); this is an adverse effect of ketamine; 
o Laryngospasm – acute spasm of vocal cords and epiglottis that can result in airway 
occlusion and death.  
o Tx = oxygen & succinylcholine (cholinergic) – a skeletal muscle relaxant. 
 Stridor (CROWING SOUNDS) – universal sign for laryngeal obstruction; cerebral blood permits up to 2 
min of consciousness and lack of oxygen but neurologic damage at 3‐5 min.  
o Invasive tx =  1) Tracheotomy – for long‐term airway, not ER airways. 
2) Cricothyrotomy – for ER airway (last resort); for anaphylaxis; 1st epi, then 
oxygen, then cricothyrotomy if loses consciousness. 
 Common barbituates for induction of anesthesia:  
• Thiopental = 2.5% solution; 3‐5mg/kg produces loss of consciousness w/in 30 secs & recovery in 
5‐10 min; ½ life = 6‐12 hrs; IV is irritating. 
• Methohexital (Brevital)= 1‐2 mg/kg produces loss of consciousness in less than 20 sec & recovery 
time 4‐5 min; ½ life = 3 hrs; less lipid soluble & less ionized at physiological pH;  
o metabolized in liver & excreted by kidney; causes hiccoughs – most common side effect;  
o MOST COMMON DRUG for G.A. anesthesia.  
 Primary advantage of IV sedation is ability to titrate individualized dosages. 
 Main target of INHALATION ANESTHETIC is brain; Lipophilic molecules; administration of anesthetic 
preceded by IV/IM barbituate w/ endotracheal intubation; 5 volatile liquids that require vaporization 
& may irritate respiratory tract & cause malignant hyperthermiaI; they cause ↓in arterial pressure. 
1. Enflurane – less potent but rapid onset with risks of seizures; CNS irritant effect. 
2. Halothane – powerful but toxin in adult liver; sensitizes heart to catecholamines. 
3. Isoflurane – combo with IV anesthetics; can cause heart irregularities. 
4. Sevoflurane – good for kids, less irritating with rapid awakening. 
5. Desflurane – heating component; irritating so used w/ IV agents but awaken faster than 
any other inhalant; has low blood:gas partition coefficient, but not used to induce 
anesthesia. 
 Drugs to avoid in pts taking barbituates: phenothiazines, alcohol, antihistamines, & antihypertensives 
b/c these drugs enhance CNS depression of barbituates. 
 At IV of barbituate, last tissue to become saturated as a result of redistribution is FAT (not vascular). 
 Barbituates overdose may occur b/c its effective dose is close to the lethal dose; barbituates can cause 
hyperanagesia (sensitivity to pain). 
 Most effective tx for resp. depression from overdose of barb is oxygen under positive pressue.  
 Best anesthetic technique used in O.S. to avoid aspiration during G.A. is endotracheal intubation w/ 
pharyngeal packs.  
 Effects Speed of Induction of inhalation anesthetics:  1) Solubility 
2) Gas Partial Pressure 
3) Ventilation Rate 
4) Pulmonary Blood Flow 
5) Arteriovenous conc. gradient 
 Malignant Hyperthermia: autosomal dominant, pharmacogenetic disease of skeletal muscle; no signs 
til given anesthesia; triggers are inhalation agents and depolarizing muscle relaxants. 
o sudden rapid rise of temp, tachycardia, sweating, cyanosis, increased CO2, and muscle rigidity; 
o Tx = Dantrolene – impairs calcium dependent muscle contraction. 
 IV Sedation ‐ optimum site is median cephalic vein (lateral aspect of ant. of elbow); avoid brachial 
artery b/c will cause burning, blotch skin & weak pulse.  
o w/ 21 gauge needle, use valium = 1ml/min = 5mg of valium (contraindicated w/ glaucoma); 
o injection discontinue when eyelids droop; Verrill’s Sign = 50% ptosis; 
o signs sedation working = blurry vision, slurred speech, and verrill’s sign.  
 Neurolept Anesthesia – and unconsciousness produced by combining Neuroleptic & Narcotic & NO; 
The neuroleptic and narcotic provide neurolept analgesia while the neuroleptic and NO provide 
anesthesia & unconscious state; 
o Pt. sedated but conscious and can answer questions; induction of anesthesia is slow but 
consciousness returns quickly. 
o Nitrous & Ethylene are useful ONLY for sedation & analgesia. 
 Postop Hypotension causes:  1) anesthesia/analgesic on myocardium 
2) intravascular hypovolemia 
3) rewarming vasodilation 
4) hypothyroidism 
o Tx = narcan (narcotic antagonist) or atropine (anticholinergic) if bradycardia.  
 Postop Hypertension causes:  1) post‐op pain/anxiety 
2) hypercapnia (too much carbon) or hypoxia (lack of oxygen) 
          3) overdistention of bladder 
 For psychogenic rxn use following Rx 1 hr b/f appt: 
1. Diazepam (Valium): 5‐10mg orally 
2. Pentobarbital (Nembutal): 50‐100 mg orally 
3. Secobarbital (Seconal): 50‐100 mg orally 
4. Promethazine (Phenergan): 25 mg orally 
 Dissociative Anesthesia – method of pain control to decrease anxiety and produce trancelike state 
which feels like they are separated from their body but not asleep; useful in children. 
o Produces amnesia during procedure. 
o Tx = ketamine – trancelike state for 10‐30 min but pain control 30‐45min; sedative often 
given b/f ketamin to reduce anxiety; ketamine increases saliva, BP, & HR & causes 
delerium. 
 Enteral sedation: use of pharmacoligical method to produce a minimally depressed level of 
consciousness. 
 Somatogen Rxn: rxn from organic pathophysiologic causes. 
 Phlebitis ‐  irritation/inflammation of vein; maybe caused by propylene glycol in valium; common in 
smokers and women taking BCP; Tx = elevate limb, moist heat, IV antibiotics (Cefazolin – 1g) or anti‐
coagulants; S & S: 
1. Vessels feel hard, thready, or cord‐like 
2. Extremely sensitive to pressure 
3. Surrounding area may be erythematous and warm to touch 
4. Entire limb may be pale, cold, and swollen. 
 
LOCAL ANESTHESIA: 
 Nerve loss of fct from LA affects in order from first to last: 
• PAIN>TEMP(cold then warm)>TOUCH>DEEP PRESSURE>PROPRIOCEPTION>SKELETAL MUSCLE. 
 Loss of sympathetic fibers occur first; smaller and myelinated fibers are the first to fail to conduct. 
 Sensory Fibers (pain) – high firing rate and long action potential duration.  
o ie: A delta and C fibers – small diameters so blocked sooner. 
 Motor fibers fire at slower rate and shorter action potential. 
o ie: A alpha motor fibers – to skeletal muscle so blocked last. 
 Vasoconstrictors like epi act on alpha receptors to constrict arterioles; 
o ie: cocaine – increases pressor activity of epi & norepi. 
 Vasoconstrictor in LA: 
1. limits uptake of anesthetic into vasculatures so increase duration of LA & decrease systemic 
effects.  
2. Reduces toxicity b/c less LA is needed. (DOESN’T REDUCE CHANCE OF ALLERGIC RXN!) 
3. Reduce rate of vascular absorption thru vasoconstriction 
4. Help make LA more profound by increasing concentrations of LA at nerve membrane.  
 The presense of vasoconstrictor doesn’t prevent an intravascular injection/systemic absorption. 
 Lidocaine, prilocaine, & etidocaine are for pregnant/lactating women. 
 Novocaine = procaine = ester LA; procaine was prototype ester LA used.  
 Volatile anesthetics not concern for COPD but nitrous is; nitrous is not contraindicated for asthma. 
 1cc of 2%lido = 20mg lido, .01mg epi, 6mg NaCl, .5mg Na–metabisulfate (preservative to stabilizes 
epi), 1mg methylparaben(preservative), NaOH to stabilize pH. 
 1.8cc of 2% lido = 36mg lido, .018 mg epi, 10.8mg NaCL, .9mg Na‐metabisulfate, 1.8 methyparaben, & 
NaOH. 
 Amide LA – biotransformation in liver but 20% excreted unchanged. 
o Longest DOA = bupivacaine (marcaine). 
 Ester LA – biotransformation in blood plasma by pseudocholinesterase.  
o Tetracaine is commonly used; 
 LA – produces anesthesia by reversibly binding to & inactivating Na channels; stops depolarization; 
site of action of LA is lipoprotein sheath of nerves. 
• So LA decreases membrane’s permeability to Na and decreases membrane’s excitability and 
prolongs refractory period.  
• More effective when pH>7; effectiveness depends on lipid solubility b/c 90% of nerve cell 
membrane is lipid; potency of LA increases w/ increased lipid solubility. 
• LA in ionized (cation) & non‐ionized (base) with non‐ionized for blocking Na channels; more non‐
ionized form has faster onset of action while ionized/acidic, like w/ inflammation, causes delay in 
onset; pH of LA = 7.8 
• When injection of LA in solution of increased pH due to buffers in body causes increase percent of 
noncharged LA so can readily penetrate lipid barriers; ↓pKa =↑ pH = ↑ onset of action. 
• Max dose of 2% lido w/ 1:100k epi = 3.2 mg lido/lb.; 1kg = 2.2 lbs. 
• For carbocaine w/o epi, max dose = 3.0 mg/lb. 
• Max dose of epi in cardiac pt. is 0.04mg or .2mg of levonordefrin. (equals 1 carp of 1:50,000 or 2 
carps of 1:100,000 epi). 
 Trismus is caused by IA injection below mandibular foramen into medial pterygoid muscle; arises 1‐6 
days after injection; IA injection into the Parotid gland may cause Bell’s Palsy. 
 Buccinator pierced when giving IA.  
 If IA causes tingling or complete numbess of lower lip, may be due to trauma/piercing of nerve trunk 
by needle; more often occurs w/ mental block; may last 2wks‐6mos but usually complete recovery. 
 PSA (AKA – tuberosity block/zygomatic block) ‐ blocks 1st, 2nd, & 3rd molars but need greater palatine 
inj for palate and infiltration for MB canal of 1st molar.  
 MSA ‐  block max. PMs & MB of 1st molar. 
 ASA – blocks max. centrals, laterals, & canines. 
 Long buccal inj. must be given to extract all molars and 2nd PM, don’t need to for canine and 1st PM if 
giving IA & lingual block. 
 Greater Palatine nerve – branch of V2 that profides soft tissue innervation to the posterior 2/3 of the 
hard palate; inject b/w 2nd & 3rd max. molars, 1cm from palatal gingival margin toward midline. 
 
ANALGESICS: 
 Analgesics are under 2 categories = NSAIDS & Narcotics. 
 Phenothiazines (anti‐psychotic) are dangerous when mixed with sedative drugs (benzodiazepines/ 
tranquilizers) b/c phenothiazines can potentiate their action.  
 Chloral Hydrate – sedative/hypnotic for pedo sedation. 
 Proproxyphen (Darvon) – oral synthetic opoid analgesic structure similar to methadone. 
o Darvon Compound‐65 = aspirin + caffeine + propoxyphene; AKA Talwin Compound (no 
euphoria). 
 Acetominophen + Propoxyphen = Darvocent + Wygesic; used for tx of sever pain in dental procedures. 
 Analgesics to avoid w/ RENAL disease = aspirin, acetaminophen, NSAIDS, meperidine, morphine.  
 Barbituate Therapeutic Functions – anesthesia, anticonvulsant, anxiety; Rx interactions with barbs, 
CNS depressors, alcohol, and opoids. 
 Anticholinergics: Tertiary’s more readily penetrate CNS than quaternary. 
• Tertiary = atropine (penetrates CNS poorly & most common for DENTISTRY), scopolamine, 
benzotropine, dicyclomine, and trihexyphenidyl. 
• Quaternary = glycopyrrolate, ipratropium, probanthine. 
• In dentistry (often atropine), they DECREASE saliva, secretions from resp. glands (for G.A.), 
bradycardia. 
• they interfere w/ binding of Ach at its receptor;  
 Pts premedicated w/ ATROPINE will exhibit mydriasis (dilated pupils); atropine is contraindicated 
for glaucoma and nursing mothers. 
 Scopolamine (anticholinergic)– effective for preventing motion sickness; prolongs amnesia, psychic 
sedation, and decreases salivation; structurally similar to acetycholine; mydriasis (dilation of pupils). 
o depresses CNS so used as sedative before anesthesia and ad anti‐spasmodic. 
 
ANATOMY:  
 Lymph Nodes: all pass to deep cervical LN. 
• Parotid LN: lymph from scalp above parotid, ant. wall of external auditory meatus, and lateral 
parts of eyelids and middle ear. 
• Submandibular LN: lymph from front of scalp, nose, cheek, upper & lower lip, ant. 2/3 of tongue, 
paranasal sinuses, floor of the mouth, max. & mand. teeth & gingiva. 
o Paranasal sinuses – series of mucous membrane lined air spaced that lighten skull & 
enhance voice resonance; within frontal, ethmoid, sphenoid, maxillary bones. 
• Submental LN: lymph from tip of tongue, floor of mouth below tip of tongue, mand. incisors & 
gingiva, center part of lower lip & skin & chin.  
• Lymph drainage: 
• Superficial cervical LN → Deep Cervical LN → Rt/Lt Jugular Lymph trunks → thoracic duct or  
↓→ right lymphatic duct. 
 Lymphadenopathy is most common swelling of submandibular triangle.  
 Hard palate perforated by following foramina: 
• Incisive foramen: posterior to max. incisors; nasopalatine nerves & sphenopalatine artery. 
• Greater Palatine: medial to 3rd molar; greater palatine nerves and vessels. 
• Lesser Palatine: posterior to greater palatine foramen; lesser palatine nerves and vessels. 
 Palatal Nerves: 
o Sensory – supplied by CN V‐2 ‐  Ant. Hard Palate = nasopalatine nerve. 
Post. Hard Palate = greater palatine nerve 
Soft Palate = lesser palatine nerve. 
o Motor – supplied by motor root of CN V – tensor veli palatine muscle. 
‐other muscles innervated by CN X via pharyngeal plexus. 
 Facial Nerves: from pons transverses facial canal of temporal bone and exits cranium thru 
stylomastoid foramen; 4 COMPONENTS: 
• Branchial Motor – muscles of facial expression, post. digastric, stylohyoid, and stapedius. 
• Visceral Motor – parasympathetic to lacrimal, submandibular, and sublingual glands. 
• Special Sensory – taste on anter. 2/3 of tongue, palate. 
• General Sensory – general sensation from skin of concha of auricle and small area behind ear. 
 Pterygomandibular Raphe – where superior pharyngeal constrictor and buccinator insert; passes b/w 
tip of hamulus and internal surface of mandible at point posterior/superior limit of mylohyoid ridge. 
o Length of raphe increases as mandible moves. 
 Deep tendon of temporalis and superior pharyngeal constrictor form V‐shaped landmark for IA. 
 Glossopharyngeal Nerve supplies parasympathetic secretomotor innervation for PAROTID GLAND; 
• start from lesser superficial petrosal nerve and leaves thru FORAMEN OVALE w/ V‐3;  
• these preganglionic fibers synapse at otic ganglion and join auriculotemporal nerve (V‐3) to 
distribute to gland.  
 Parotid Gland – largest gland and purely SEROUS (like von Ebner’s); 
divided by stylomandibular tunnel into deep “to ramus” and 
superficial “to ramus” lobes;  
• drained by STENSON’s DUCT = which drains opposite max. 2nd 
molar and pierces buccinator but crosses masseter.  
• Arteries of Parotid are external carotid, superficial temporal, 
and maxillary arteries. 
• Lymph drainage to superior deep jugular LNs. 
• Mumps = viral disease of parotid gland 
 External Carotid Artery supplies most of the head & neck, except 
brain (internal carotid & vertebral arteries); Splits into… 
1. Maxillary Artery – to muscles of mastication, all teeth, and 
palatal & nasal cavity. 
2. Superior Temporal Artery – supplies scalp. 
 IA artery & Palatine arteries are branches of maxillary arteries; 
 Mandibular teeth supplied by IA artery; Maxillary teeth – post = PSA artery, ant = ASA & MSA arteries. 
 Lingual Artery Branches: 
a. Suprahyoid – supplies suprahyoid region. 
b. Dorsal Lingual – supplies dorsum of tongue. 
c. Sublingual – supplies floor of the mouth & sublingual gland. 
d. Deep Lingual – supplies anterior 2/3rds of tongue ; *terminal artery. 
 Vertebral arteries arise form subclavian arteries and join basilar artery which is blood supply to brain 
stem & circle of willis.  
 Venous return on both arches is Pterygoid Plexus of Veins. 
 Submandibular Glands: located in submandibular/digastric triangle; innervated by CN VII which runs 
in chorda tympani & lingual nerve (V3) & synapses in submand. ganglion (same for sublingual gland). 
• Submandibular/WHARTON’s Duct – emerges from anterior end of deep part of gland and passes 
forward along side of tongue and beneath mucous membrane of floor of mouth. 
• Blood supply from external carotid artery and facial artery. 
• MIXED gland with mucous & serous cells. 
 Sublingual Gland – numerous small ducts (RIVIAN DUCTS) that open 
into the floor of the mouth secreting mostly MUCOUS acini w/ 
serous demilunes;  
• smallest salivary gland that contains mostly mucous.  
• Blood supply from sublingual artery.  
• consists mostly of Mucous acini capped with serous demilunes 
and is therefore categorized as a MIXED gland. 
• S‐times sublingual ducts join to form Bartholin’s Duct which 
drains into submandibular ducts. 
 Von Ebner’s Glands – around circumvallate papilla of tongue to 
wash food after tasted; PURELY SEROUS – only gland w/ parotid. 
 Genial tubercles (4 of them) – lingual surface of mandible midway b/w superior & inferior borders; 
area of muscle attachment for suprahyoid muscles, if removed, tongue will end up flaccid, so genial 
tubercles are never removed! 
 Carotid Sheath – deep to SCM, extends from base of skull to 1st rib and sternum; it contains: 
1. Carotid artery 
2. Internal jugular vein 
3. CN X 
4. Deep cervical LNs 
 Facial (3) & Retromandibular (1) Vein  Internal Jugular (6) +Subclavian  brachiocephalic  
Superior Vena Cava  Right Atrium of the heart. 
 Mylohyoid Muscle – V‐3; inferior to sublingual gland but superior to submand. gland; elevates: hyoid 
bone, base of tongue, and floor of mouth;  
• Gets in way of doing PA of mand. molars. 
• Mylohyoid and genioglossus detached when floor of mouth lowered surgically. 
 Olfactory Nerve – sense of smell 
 Optic Nerve – sense of sight 
 Occulomotor Nerve – motor supply to all muscles, controlling lense shape & pupil size EXCEPT 
superior oblique muscle. 
 Trochlear Nerve – motor supply to superior oblique muscle of the eye. 
 Trigeminal Nerve – largest of 12 CNs; principal general sensory nerve to head & face. 
I. Opthamic Div (Superior Oblique Fissure) – sensory to cornea, scalp, eyelids, mucous membrane 
of paranasal cavity. 
II. Maxillary Div (Foramen Rotundum) – sensory for skin over maxilla, upper teeth & gums, mucous 
membrane of nose, max. sinus, & palate. 
III. Mandibular Div (Foramen Ovale) – innervates EIGHT muscles; motor of muscles of mastication, 
sensory from skin of face over mandible, lower teeth & gums, TMJ, mucous membrane of floor of 
mouth and anterior of tongue.  
• V3 innervation:   
o Cheek & Mand. buccal gingiva – long buccal nerve (sensory) 
o TMJ, Auricle, & external auditory meatus – auriculotemporal nerve (sensory) 
o Floor of mouth, mand lingual gingiva, ant. 2/3rd of tongue – lingual nerve (sensory) 
o Mand. teeth, skin of chin & lower lip – IA (sensory & motor) 
• 3 Nuclei of Trigeminal Sensory Nuclear Complex: 
1. Mesencephalic Nucleus – mediates proprioception (ie. Muscle spindle) 
2. Main Sensory Nucleus – mediates general sensation. (ie. Touch) 
3. Spinal Nucleus – mediate pain & temp from head & neck. 
• Proprioceptive first order neurons of the TMJ are in the mesenphalic nucleus of trigeminal nerve. 
• Branchiometric motor fibers innervate muscles of mastication, ant. digastric, mylohyoid, tensor 
tympani, tenso veli palatini. 
 Buccinator fuction is to compress cheeks agains the molar teeth for sucking & blowing. 
 Innervation of the Tongue ‐  Motor – Hypoglossus (XII) 
Sensory – Ant 2/3rd    ‐ Taste = chorda tympani (VII)  
                ‐ Sensation = lingual branch of V3 
             ‐ Posterior ‐ Taste & Sensation = Glossopharyngeal Nerve (IX) 
 Abducens Nerve – motor supply to lateral rectus muscle. 
 Facial Nerve – facial expression, submand., sublingual, & lacrimal glands; taste for ant. part of 
tongue (via chorda tympani), palate, & floor of the mouth and sensory input for outer ear;  
• exits cranium thru stylomastoid foramen. 
• Passes THROUGH parotid gland. 
• Facial nerve trauma destroys ability to contract facial musles on affected side of face and taste. 
 Vestibulocochlear Nerve ‐  1) vestibular division = balance and head position. 
2) cochlear division = sense of hearing 
 Glossopharyngeal Nerve – motor to stylopharyngeus muscle and PAROTID salivary gland; taste of 
post. 3rd of tongue; sensory – bp receptors of carotid artery; sensory to tonsile, nasopharynx, & 
pharynx.  
 Vagus Nerve – motor to pharynx, larynx, trachea, bronchi, lung, heart, esophagus, stomach, intestines, 
liver, pancreas, kidneys. 
 Accessory Nerve – motor to SCM & trapezius, muscles of soft palate, pharynx, & larynx. 
 Hypoglossal – motor supply to muscles controlling tongue EXCEPT palatoglossus muscle!!  
• Injury to hypoglossal nerve produced paralysis and atrophy on affected side which will deviate 
to that side; Dysarthria (inability to articulate) may also be found; 
• This injury is due to unopposed action of genioglossus muscle (pulls tongue forward); 
genioglossus muscle arises lateral and inserts at mandible midline. 
• If genioglossus paralyzed, tongue may cause suffocation. 
 CN 3, 7, 9, 10 all have parasympathetic activity. 
 Lateral Pterygoid Injury – mand. will deviate toward side of injury; when ankylosis of condyle or 
unilateral condyle fracture. 
o Will deviate AWAY from affected side w/ condylar hyperplasia from malocclusion. 
o Tx = closed procedure involving intermaxillary fixation. 
o Lateral Pterygoids – open, protrude, and move mandible side‐to‐side! 
o For RIGHT lateral excursive mvmts – LEFT lateral pterygoid is primary mover. 
 Bone of maxilla MORE POROUS than mandible so can be infiltrated anywhere.  
 Maxillary Sinus opens into Hiatus Semilunaris – groove in middle meatus of nasal cavity & contains 
frontal nasal duct & ant. ethmoid air cells. 
o Develops after perm. teeth erupted and continues growth thru adulthood.  
o Innervated by V2 – ASA, MSA, PSA & infraorbital nerve. 
 Max. Sinusitis – pain in midface, cheek, & pain on percussion of max. posterior teeth. 
 Ethmoid Sinusitis – pain b/w eyes & near bridge of nose. 
 Frontal Sinusitis – forehead pain. 
 Sphenoid Sinusitis – pain behind eyes or back of head.  
 Tx for sinusitis: Ampicillin if cause is URI; PCN & amoxicillin if caused by odontogenic foci.  
 Pterygomandibular Space – b/w med. Pterygoid muscle & mand. ramus w/ roof of lateral pterygoid 
muscle; contains IA nerve & artery & lingual nerve. 
o When draining abscess of pterygomandibular space intraorally, buccinator often incised. 
 Infratemporal Fossa – behind maxilla; roof – greater wing of sphenoid; medial – lateral pterygoid 
plate; limited by coronoid process & ramus of mandible; 
• Communicates w/ pterygopalatine fossa thru pterygomaxillary fissure (cleft b/w lateral pterygoid 
plate & maxilla). 
• Communicates w/ orbit thru inferior orbital fissure (b/w maxilla & greater sphenoid wing). 
contains some muscles of mastication, max. artery, pterygoid venus plexus, mand. nerve, otic 
ganglion, & chorda tympani. 
 Pterygopalatine fossa – small space behind & below orbital cavity; maxillary nerve & artery pass thru 
it. 
 Submandibular Space – drains infection from mand. PMs and molar b/c below mylohyoid muscle. 
o Bound ant. & medial by tongue. 
o Bound laterally by deep cervical fascia 
o Bound inferiorly by hyoid bone 
o Split into sublingual (superior) & submaxillary (inferior) space by mylohyoid muscle; 
medial part of submaxillary space = submental space. 
o Submental space drains median of lower lip, tip of tongue, and mouth of floor; drains 
infections of mand. incisors & caninies b/c apices lie ABOVE the mylohyoid muscle.  
 Masticatory Space = masseteric space, pterygomandibular space, and temporal space; infections of 
this space usually dental origin (esp. mandibular molar region); needle tract infection from IA enter 
pterygomandibular space.  
• S&S of masticator space infection – TRISMUS, pain, and swelling; signs peak 3‐7 days w/ 
spontaneous intraoral drainage on 4th & 8th day. 
 Ludwig’s angina – most common neck space infection (sublingual, submental, & submandibular). 
 Lymphadenopathy is most common cause of swelling of the submandibular triangle tissues.  
 Cavernus Sinus Thrombosis – blood clot w/in cavernus sinus which is a large channel of venus blood 
and contains CN III, IV, V1, V2, & VI; caused by Staph Aureus infection. 
• Infections of the face can cause septic thrombosis (often in opthalmic vein b/c no valves) of 
cavernous sinus; furunculosis & infected hair follicles are frequent causes.  
• TE of max. anterior teeth w/ infection can cause this; life‐threatening! 
• Pts. presents w/ proptosis, orbital swelling, neurologic signs, and fever.  
 
TMJ: 
 TMJ not hyaline cartilage, just dense FIBROUS 
CONNECTIVE TISSUE;  
 TMJ: has ginglymoarthrodial joint meaning it has hinge‐
like rotation and gliding mvmts; 4 components: 
1. Mandibular Condyle – functional part is superior & 
anterior head of condyle and covered with fibrous 
connective tissue; surface covered w/ vascular layer of 
fibrous C.T.; long axis oriented mediolaterally. 
2. Articular Fossa – anterior 3/4th of larger mandibular fossa; 
nonfunctional part of joint; bounded in front by 
articular eminence & behind by temporal bone; concave! 
3. Articular Eminence – ridge extends mediolaterally in front of mand. fossa; functional part of joint; 
lined w/ thick fibrous C.T.; convex! 
4. Articular Disc/Meniscus – biconcave, fibrocartilaginous disc b/w condyle & mand. fossa; gliding 
surface of condyle and central point is avascular and NO nerves (only periphery). 
 Articular disc varies in thickness; has 2 thicker band than central bands: 
• Posterior band – thickest band and attached to retrodiscal tissue; Retrodiscal Tissue (bilaminar 
zone) – posterior loose connective tissue; highly vascularized & innervated.  
• Anterior band – contiguous w/ capsular ligament, condyle, & superior belly of lateral pteryogoid 
muscle.  
 Posterior aspect of condyle is round and convex while anterior inferior aspect is concave. 
 Condyles are NOT symmetrical/identical;   
 Palpate external posterior surface w/ mouth open when examining.  
 Condyle held in place by collateral/discal ligaments (restricts mvmts of disc away from condyle during 
function) at medial and lateral poles of condyle. 
• Held in position anteriorly by lateral pterygoid muscle. 
• When collateral ligaments become torn, condyle displaced anteriomedially causing clicking 
sound & disc displacement.  
 Arteries to TMJ:   1) superior temporal artery 
2) max. artery & external carotid artery 
3) smaller masseteric 
4) posterior deep temporal 
5) lateral pterygoid arteries anteriorly 
 Venous drainage thru diffuse plexus around capsule. 
 Fibrous capsule of TMJ – innervation Auricular Temporal Nerve (V3) 
 Anterior region of TMJ – masseteric nerve (V3) and posterior deep temporal nerve (V3) 
 SENSORY innervation of TMJ – trigeminal nerve; Anterior TMJ supplied by Masseteric nerve, 
Posterior TMJ supplied by Auriculotemporal nerve; NO motor innervation. 
 TMJ Ligaments: 
1. Temporomandibular Ligament (lateral ligament) – 
provides lateral reinforcement & prevents inferior & 
posterior displacement of condyle; *main stabilizing 
ligament and only ligament provides DIRECT support. 
a. From articular eminence to condyle. 
b. Keeps condyle head in place if fractured. 
2. Sphenomandibular Ligament – attaches to lingula of 
mandible; most often damaged in IA block; limits mvmt. 
a. IA nerve passes lateral to this ligament. 
3. Stylomandibular Ligament – attaches to angle of mand 
and styloid bone. 
 3 groups responsible for Displacing Condyle: 
1) Masseter, med. Pterygoid & temporalis ‐ ELEVATE MANDIBLE so upward & medial displacement. 
2) Digastric, mylohyoid, geniohyoid, and lateral pterygoid – DEPRESS MANDIBLE so inferior & 
posterior displacement.  
3) Lateral Pterygoid – forward & medial displacement; however, right lateral pterygoid cant contract 
during protrusion.  
 Crepidation from degeneration of condyle (maybe osteoporosis). 
 Dull thud – self‐reducing subluxation of condyle. 
 Preauricular – best surgical approach to exposing TMJ. 
 Submandibular Approach (Risdon Approach) – surgical approach for ramus of mandible and neck of 
condyle.  
 Trauma is common cause of TMJ ankylosis but ankylosis is most common complication of Rheumatoid 
Arthritis. 
 Disorders of TMJ: 
1. Myofascial Pain Dysfunction: main cause of TMJ pain; unilateral dull pain that increases with 
muscular spasm; masticatory muscle spasm and limited jaw opening;  
a. Complaints: referred pain, headache, otalgia(ear pain), tinnitus, burning tongue.  
b. Often due to stress; Tx = nightguard. 
2. Internal Derangement: when disc pulled anteriorly by superior head of lateral pterygoid muscle;  
a. With reduction – disc anterior at rest but returns when opening and closing; pain and 
clicking may occur; 1/3 of population; normal opening or “S” shaped. 
b. w/o reduction – disc always anterior, no sound but max opening < 30mm. 
c. Subluxation/dislocation/open lock – pt cant close after keep open for a long time due to 
posterior band stretching and joint traveling in front of eminence; 
d. Tx = conservative for 4‐6 wks and the consider surgery; 95% improve w/o surgery. 
e. There isnt a reproducible reciprocal click; most disc displacements are ANTERIOR & 
MEDIAL. 
3. Degenerative Joint Disease (osteoarthritis): 1o/2o trauma; old ppl b/c of wear and tear; 
asymptomatic unless it is in young ppl where it is more severe; 
 
BIOPSY: 
 After tissue remove for biopsy, place in 10% formalin (4% formaldehyde) that’s 20x the volume of the 
tissue. 
 Biopsies:  Incisional – take only part of lesion. 
Excisional – entire lesion removed. 
Needle – aspirational biopsy 
Exfoliative Cytology – pap smear  
 All oral ulcers caused by trauma will heal in 2 wks so biopsy needed if longer than 2 weeks;  
 also biopsy: pigmented lesions, tissue associated w/ paresthesia, & when a lesion enlarges, 
hyperkeratotic changes in lesion, if doesn’t responsd to antibiotics for 14 days, or persistent swelling. 
 Always aspirate a central bone lesion to rule out vascular lesion. 
 Stethoscope is used to listen for bruit (unusual sound that blood makes when it rushes past an 
obstruction (called turbulent flow) in an artery). 
 All leukoplakias should be biopsied because they are premalignant. 
 Block preferred for anesthesia rather an infiltration for biopsy; anesthesia > 1cm away from lesion. 
 Get some normal tissue as well as diseased for biopsy. 
 
IMPLANTS: 
 BoneImplant Integration: 
1. Fibrous‐Osseous Integration: connective tissue encapsulated implant w/in bone; success rate 50% 
over 10 yrs; not see often w/ newer materials. 
2. Osseousintegration: direct connection b/w living bone & implant (w/o soft tissue); ONLY 
endosseous & transosseous implant; most predictable longterm stability; uses radiographic & 
light microscopic analysis;  
3. Biointegration: implant interface w/ bioactive materials (hydroxyapetite) or bioglass that bonds 
directly to bone; develop bone faster than non‐coated but cant tell after 1 year.  
 Best time to augment soft tissue to develop keratinized tissue around implant is stage II surgery. 
 Guided Tissue Regeneration: surgically eliminated bony defect around implant to decrease C.T. 
growth while increasing bone; don’t heat bone >116oF/47oC. 
 For successful implant: 
1. need adequate transfer of force and biocompatibility. 
2. Histologically 35‐90% bone contact, C.T. adhesion above bone, and non‐inflamed JE. 
 For implant, use low speed and high torque handpieces; use superfloss/yarn.   
 Need 10mm bone height to place endosseous/root form implant; need 2mm b/w apex of mand. post. 
implant & IA canal; implants placed 3mm apart and 1mm apart away from adjacent tooth;  
 Titanium/Titanium alloy are most common for 2‐stage endosseous implants; 
 Smoking affects healing of bone & tissue so NO IMPLANTS! 
 Pt. w/ uncontrolled systemic disease – use extreme caution w/ implant placement. 
 Max. ant. implants – highest failure rate; 
 Mobility is most common sign of implant failure. 
 Max. amount of taper for draw of overdenture = 15o. 
 2 types of Implant Placement: 
1. Submerged – 2 stage surgical procedure to uncover fixture. 
2. Nonsubmerged – only 1 stage. 
 3 Categories of Implants: 
1. Endosseous Implants – surgically inserted into jawbone; most used implant; 2 forms:  
a. Root‐formed implants – cylindrical shape, titanium; 3 phases – surgical, healing, & prosthetic. 
i. Most popular! 80% of all implants are ENDOSSEOUS (into bone). 
b. Blade Implants – flatter in appearance for insufficient bone width but adequate depth; 
titanium; either single/2 stage; 
2. Subperiosteal Implants – rides on bone; fits on top supporting structures under mucoperiosteum.  
3. Transosseous Implants – inserted into jaw bone but penetrates entire jaw and emerges at 
opposite entry site(usually chin); indications: very atrophic mandible. 
 
EXTRACTIONS: 
 Maxillary 3rd occasionally displaced to:  1)Max. Sinus – use caldwell‐luc approach to remove. 
2) Infratemporal space – may need oral surgeon. 
 If root tip 2‐3mm or less gets into max. sinus then NO tx needed.  
 Palatal root of max. 1st molar most often dislodged into max. sinus.  
 Caldwell‐Luc Approach – opening made into max. sinus by incision into canine fossa above PM roots; 
figure 8 sutures, antibiotics, nasal spray & decongestant. 
 Most frequently impacted teeth are mandibular 3rds, the max. 3rds, then MAX canines. 
 Root tip of mand. 3rd molar disappears into submandibular space.  
 IA nerve often lies buccal to roots of mand. thirds;  
 bone rarely removed from lingual aspect of mandible b/c likeihood of damaging lingual nerve.  
 When removing mylohyoid ridge, be careful to protect lingual nerve.  
 Most common causes of paresthesia to lower lip is removal of mand. 3rd molars. 
 Extract max b/f mand and post b/f ant. 
 After removing max. teeth, upper jaw should be at same height as dentist’s shoulders.  
 Mandibular arch parallel to floor when doing mand. extractions.  
 Contraindications for Extractions:  ‐acute infection w/ uncontrolled cellulitis 
‐acute pericoronitis or stomatitis or ANUG 
‐malignant disease or irradiated jaws. 
 Direction of luxating primary Max. molars – palatal;  perm. max molars – buccal. 
 If perm PM wedged b/w bell‐shaped roots of primary tooth – section & remove. 
 Do NOT use cowhorns on mand. primary molars.  
 Dead Space: wound in area that remains devoid of tissue after wound closure; usually fill w/ blood 
causing hematoma & high potential for infection;  
• Tx = resolves on its own or open and drain. 
• Eliminate by: close wound in layers, apply pressure, use drains to remove bleeding, place packing 
into void til bleeding stops. 
 Fracture of maxillary tuberosity most common result from extraction of erupted max. 3rd molar; if 
tuberosity fracture but intact, reposition and suture;  
• ***beware of lone molar – often ankylosed & emits atypical, sharp sound on percussion. 
 When removing mand. tori – use envelope flap design w/ no vertical component. 
 Maxillary Tori often seen b/f age 30 & more in females; removal of max. palatal tori: 
o Stent fabricated; Use double Y‐incision 
o Use osteotome to remove small portions 
o Use bur/bone file to smooth area 
o Irrigate & loosely place sutures & use stent to prevent hematoma & support flap.  
o Most often located at midline of hard palate.  
 Classifications of Impactions: w/ difficult of removal from easy to hard w/ MAND 3rds: 
o Mesioangular (43%) 
o Horizontal  (3%) 
o Vertical (38%) 
o Distoangular (6%) 
• OPPOSITE for max. molars!!! Distoangular is easiest! 
• Most mand. 3rds angled in lingual direction. 
 If sinus communication after TE – no add’l surgical tx… 
• Post‐op:  avoid nose blowing for 7 days. 
Open mouth when sneezing 
Avoid vigorous rinsing 
Soft diet for 3 dys. 
• Meds: 1) Afrin (local decongestant), 2) antibiotics (amoxicillin), 3) actifed (systemic decongestant) 
 If sinus opening moderate (2‐6mm), place figure 8 suture over socket. 
 If sinus opening larger (>7mm), close socket w/ flap procedure. 
 Class II lever used for tooth extractions. 
 Luxation – loosening of tooth by progressive severing of PDL; luxation forces perpendicular to long 
axis of tooth; can use rotational forces on single rotted teeth.  
o Mvmts firm and primarily to the facial w/ secondary mvmts to the lingual.  
 Teeth resistant to crush but not resistant to shear so beaks applied to line parallel w/ long access of 
tooth.  
 Ideal time to remove impacted 3rds – when roots 2/3rds formed b/c bone more flexible and no root 
curves & rarely fracture; around age 17‐21 yrs. old. 
 Older individual have most postoperative difficulties. 
 Bite on tea bag if bleeding persists after TE; the tannic acid promotes hemostasis.  
 Autotransplanting teeth – often 3rd molar replacing carious mand. 1st molar;  
o Most important criteria is adequate bone support in recipient sign. 
o Best result if donor tooth’s roots are 1/3 to 2/3 completed root development. 
o Most likely cause of failure is chronic, progressive external root resorption. 
o Universal sequelae of allogenic tooth transplant is ankylosis & root resorption. 
 Periocoronitis – causes food debris & bacterial waste products and tissue often traumatized during 
mastication; max 3rds most frequent contributing factor to pericoronitis of mand. 3rds. 
• S&S – pain, bad taste, inflammation, pus; can be a recurrent condition and an abscess can form 
unless cause is removed. 
• Definite criteria for removing 3rd molars; Tx = irrigate area, place on antibiotics and rinse with 
warm saline solutions and once symptoms relieved, then extract.  
 Post‐op Ecchymosis – trauma to underlying blood vessels > 1cm; common after TE’s in elderly pts b/c 
fragile vessel walls; pt. complains of diffuse, non‐painful, yellowing discoloration of skin; may first 
present as bluish lesion;  more predisposed in pts w/ clotting & bleeding disorders; tx = heat. 
 An abscess should NOT be contraindicated to a TE b/c infections resolve quickly after tooth is 
removed. 
 Conditions that require prophylaxis prior to oral surgery: (NOT pacemakers) 
1. Prosthetic heart valve 
2. Rheumatic Valve disease 
3. Most congenital heart malformations. 
 
INCISIONS & SUTURES: 
 Advantages of interrupted suture: most common, independent, strength, & flexibility; if one sutures is 
loose, the other ones stay put; disadv: time.  
 Advantages of continuous suture: ease and speed of placement, distribution of tension over whole 
suture; more watertight closure.  
 Sutures should NOT be closed under tension and should be 2‐3mm apart; suture placed from mobile 
tissue into fixed tissue and from thin into thick tissue.  
 Suture size based on strength & diameter; as diameter decreased, the 0s added or numbers followed 
by 0s = 000 = 3‐0 ‐‐‐‐same size; 9‐0 has least strength and smallest diameter.  
 B/c sutures are foreign body, smallest diameter suture sufficient; most OS use 3‐0 or 4‐0 sutures. 
 Resorbable sutures evoke intense inflammatory rxn; not for skin wounds; recommend non‐
resorbable for TE sites and remove in 5‐7 dys. 
 Monofilament sutures consist of material from single strand and resist infections; RESORBABLE: 
• Plain gut – sheep intestine, susceptable to rapid digestion but retained for 57 days; most severe 
tissue rxns w/ this suture material.  
• Chromic gut – chromatized to be more resistant to digestion and retained for 914 days; moderate 
tissue rxn.  
• Polyglycolic Acid – doesn’t enzyme break down, undergoes slow hydrolysis, less stiff but more 
expensive.; minimal tissue rxn. 
 Polyfilament sutures – multiple fibers either braided or twisted; NON‐RESORBABLE: 
o Silk – braided, black, inexpensive, good handling but severe tissue rxn. 
o Nylon – strong, not used orally but is suture material of choice for facial lacerations. 
o Polypropylene – least tendency for inflammation but fair handling. 
o Non‐resorbable sutures should be removed in 57 days.   
 Vertical releasing incision made at tooth line angle. 
 3 types of incisions:  1) linear – straight line incision for apicoectomies. 
2) releasing – adding vertical leg to horizontal incision; for TE & 
augmentations; incision along tooth line angle.  
3) semi‐lunar – curved incision for apicoectomies. 
 #15 scalpal universally used for OS procedures.  
 Sutures over single extraction socket are NOT usually placed unless papillae have been excised, 
bleeding from gingiva, or gingival cuff torn/lose;  
 Most common cause of post extraction bleeding is failure of patient to follow post‐extraction 
instructions.  
 Osteoradionecrosis ‐ Most serious complication after extractions from areas previously irradaited; 
condition of non‐vital bone that can result in tissue injury;  
 
HEALING: 
 5 stages of healing – (same as soft tissue – inflammation → fibroplasia → remodeling) 
1. Clot formation 
2. Granulation tissue (can be retarded by Glucocorticoids) 
3. Connective tissue 
4. Fibrillar bone 
5. Bone recontouring. 
 Stages of Wound Healing: 
1. Inflammatory Stage (vascular & cellular phase) – neutrophils & lymphocytes predominate w/ 
macrophages(most important inflammatory cell for wound healing). 
2. Proliferative Stage (fibroblastic stage) – collagen & new blood vessels produced; mediated by 
fibroblasts.  
3. Maturation Stage (remodeling stage) – collagen fibers continue to increase tensile strength. 
 Bone heals by primary and secondary intention like soft tissue: 
1. Primary Intention – endosteal (in bone) & periosteal (w/in connective tissue covering bone) 
proliferation; occurs when incomplete fracture or reapproximating fracture ends of bone; little 
fibrous tissue w/ minimal callous formation.  (Ie – well repaired reduced bone fractures) 
a) Minimal re‐epithelization and collagen formation; allows wound to be sealed w/in 24 hrs. 
2. Secondary Intention – endosteal proliferation; used when fracture bones >1mm apart; lots of 
fibrous tissue & callus is formed (which ossifies). (Ie – TE sockets, poorly reduced fractures) 
b) Re‐epithelization via migration from wound edges; site fill w/ granulation tissue; slower 
healing; 
 Bone healing in 3 overlapping phases: 
1. Hemorrhage – first 10 days. 
2. Callus formation – 10‐20 days primary callous; 20‐60 days secondary callous. 
3. Functional Reconstruction – 2‐3 years to completely reform a fracture. 
 3 Phases of Hemostasis: 
1. Vascular – vasoconstriction, begins immediately after injury. 
2. Platelet – platelets and vessels become sticky; mechanical plug of platelets seal off cut vessels; 
seconds after injury.  
3. Coagulation – blood loss in surrounding areas coagulate thru extrinsic and common pathways 
while vessels in area of injury use intrinsic and common pathways; slower than other pathways. 
 5 ways to obtain hemostasis – hemostat on vessel, heat cut vessels, suture ligation of vessel, 
pressure dressing, vasocontrictive substances like epi.  
 Dry Socket – increased fibrinolytic activity causing increased lysis of blood clot; most 
commonly following TE of mand. molars; causes: smoking, mouthrinses, hot liquids, trauma, oral 
contraceptives. 
• Symptoms – pts develops severe, dull throbbing pain 2‐4 days after TE; foul odor and taste and 
extraction site filled w/ necrotic tissue which delays wound healing.  
• Tx =   ‐flush w/ warm saline but no currettage. 
‐Place eugenol sedative dressing & replace every 48 hrs til asymptomatic. 
‐Analgesics but NO antibiotics needed.  
 3% hydrogen peroxide agent for debridement of intraoral wounds. 
 Order of tx for acute infection = localize infection, IND, then culture; if infection produces 
cellulitis of region involved, called induration (appears hard, dense, and brawny). 
 Incision & Drainage – only performed for acute infection if localization of infection has 
occurred. 
o Culture after InD if antibiotics is not sufficient to resolve abscess.  
 
FRACTURES: 
 most common cause for facial fractures = auto accidents (80%); highest incidence of fractures in 
young males ages 15‐24.  
 Fracture type prevalence:  ‐Zygomaticomaxillary complex (40%) – tripod fracture 
‐Lefort Fracture I (15%), II (10%), III (10%). 
‐Zygomatic arch (10%) 
‐Maxilla alveolar process (5%), Smash Fractures (5%) 
 Control of airway is vital to any treat of pt w/ facial fractures. 
 4 reason fracture doesn’t heal: 
1. Ischemia – poorly vascularized so ischemic necrosis after fracture. 
2. Excessive mobility – healing prevented & pseudoarthritis or pseudojoint occurs.  
3. Interposition – of soft tissue and occur b/w fractured ends 
4. Infection – compound fractures have tendency to become infected.  
 Fat embolism often sequela of fractures. 
 Inappropriate healing: delayed healing (>6wks), non‐union, mal‐union. 
 Mandible must be immobilized for 3‐6 wks for fractures: (4 forms) 
1. Barton Bandage – simplest form; used 1st aid measure til definitive therapy. 
2. Intermaxillary Fixation – use prefabricated arch bars and wire teeth together; class way to 
mobilize fracture after closed reduction; most common technique for IMF is to use 
prefabricated arch bars.  
3. External Skeletal Fixation – if IMF not satisfactory, use screws, pins, and use cold cure acrylic 
bar to hold screws in place. 
4. Direct Intraosseous Wiring – combing w/ IMF and traditionally used after open reduction.  
 Closed reductions often for condylar neck fractures; often used when both fragments have teeth; 
 Zygomatic arch fractures – best seen by submental vertex view; may cause damage to superior 
orbital fissure; complications: parasthesia, hematoma of sinus, & impaired occular muscle balance. 
 Zygomatic complex fractures are most common midface fracture but 2nd most common facial fracture 
behind nasal bone fractures.  
 Infraorbital Rim Fractures: presents w/ numbness of upper lip, cheek, and nose. 
o Water’s view best to evaluate orbital rim areas.  
 S&S of Mand. Fracture:  malocclusion, lower lip numbness, mobility, pain, bleeding at fracture.  
 Open reduction – direct exposure and reduction of fracture thru surgical incision; 
• Procedure: open reduction then direct intraosseous wiring with IMF for 3‐6wks. 
• Most common site is angle of mandible; Performed for displaced angle or body fractures.  
• Best used to reduce a fracture when teeth are missing in one or more of the fractured segments. 
 Fracture of angle of edentulous mandible often displaced 
anteriorly and superiorly. 
 Le Fort Fractures: from severe frontal blows; associated 
w/ intracranial damage, CSF leak; types: 
I. Horizontal fracture thru maxilla just above max. teeth; causing open bite! 
II. Fracture which maxilla separated from facial skeleton w/ separated bone being pyramidal in 
shape and includes palate and max. teeth; S&S  ‐ edema, ecchymosis, hemorrhage, and nose 
bleeding. 
III. Horizontal fracture where entire maxilla and 1/more facial bone separated from upper face; pts. 
have restricted mand. mvmt.  
 Blows to maxilla cause maxilla to be driven backward and downwards; may cause open bite or 
impingement of airway. 
 Location & extent of fracture based on direction & 
intensity of blow & points of weakness in mand.  
 Common sites for fractures:  Body ‐ 30‐40% 
Angle ‐ 25‐31% 
Condyle – 15‐17% 
Symphysis – 7‐15% 
Ramus – 3‐9% 
Coronoid – 1‐2% 
 Bilateral dislocated fractures of condylar necks cause 
anterior open bite and cant protrude mandible. 
 Unilateral fracture thru neck of condyle caused forward displacement of head of condyle. 
 Mandibular Fractures:  
1. Simple – divides bone in 2 parts w/ no external communication; it’s a closed fracture w/no 
laceration of mucosa/facial tissue. 
2. Compound – open fracture that communicates w/ outside env’t; may have lacerations of oral 
tissue; infections are common. 
3. Communited – multiple fracture of single bone; 
may be single/compound. 
4. Greenstick – fracture only thru corticol portion of 
bone w/o complete fracture of bone; closed 
fracture; often in children w/ orbital and frontal 
fractures common. 
 Most common complication of fracture is infection. 
 Most common sign of mand. fracture= malocclusion.  
 First step to treat mid‐facial fractures is to re‐
establish a proper occlusal relationship. 
 Line of fracture determines whether muscle will be 
able to displace the fracture segments from original 
position:   
• favorable fracture – if fracture line prevents fracture displacement by muscle pull. 
• unfavorable fracture – if fracture line results in muscle pull displacing fracture.  
 Maxillary fractures have a greater tendency to produce facial deformities than mandibular fractures.  
 
GRAFTS:  
 Ideal graft is replaced by host bone and assists osteogenic processes of the host.  
 3 forms of grafts: 
1. Cortical Grafts – withstand early mechanical forces but require more revascularizing.  
2. Cancellous Grafts – increase healing rate; most abundant supply from iliac crest; disadv – inability 
to provide mechanical stability. 
3. Corticocancellous Grafts – provides mechanical stability and increase osteogenesis but not as well 
as cancellous grafts b/c layer of nonporous corticol bone. 
 Iliac crest provides bone marrow for grafting mandible and maxilla and ridge augmentation. 
 Costochondral rib graft for cartilaginous part simulating TMJ & condyle. 
 For fixating bone grafts – bone plates, biphasic pins, titanium mesh, and intraosseus wire. 
 Greatest osteogenic potential occur w/ autogenous cancellous graft and hemopoietic marrow.  
 Classes of Grafts: 
1. Autogenous Graft – tissue from same individual; common in OS but frequently present 
surgical/technical problems;  
i. Mandible is most commonly resected for oncological surgery of all facial bones.  
2. Allogenic Grafts – tissue from individual of same species but not genetically related; often human 
cadaver bone; 3 forms: 
i. Fresh frozen – rarely used b/c transmission of disease. 
ii. Freezedried – osteoconductive but no osteogenic or osteoinductive capabilities; used in 
conjuction w/ autogenous grafts. 
iii. Demineralized Freezedried – lack strength but has osteoconductive and osteoinductive 
capabilities; exposed bone morphogenic proteins.  
3. Xenogenic Grafts – tissues from donor of another species. (both xenogenic and allogenic grafts are 
most common grafts for rejection). 
4. Isogenic Grafts – tissue from same species and genetically related to recipient. 
5. Alloplastic Graft – synthetic, inert, man‐made synthetic materials;  
i. often hydroxyapatite is used to augment the mandible; granular/particle is used; it is 
biocompatible & non‐resorbable; hydroxyapatite bonds physically and chemically to bone;  
ii. May cause chin prominence erosion and unpleasant cold sensation in implant region. 
 3 processed bone repairs/regenerates: 
1. osteogenesis – ability to form new bone in graft by transplanting viable osteoblasts. 
2. osteoconduction – ability of graft to allow vascular and cellular invasion by host. 
3. osteoinduction – ability of graft to stimulate differentiation of mesenchymal cells into 
osteoblasts at recipient site.  
 Sliding Genioplasty – surgically improving a person’s chin; horizontal sliding osteotomy; 
removing horseshoe shaped piece of chin bone and sliding either forward/backwards and fixing it 
with screws. 
a. Problems with alloplastic materials for genioplasty: migration, erosion, & cold sensation. 
 High‐speed hand pieces can cause tissue emphysema or air embolus when removing bone during O.S.; 
the tissue emphysema can be caused by air pressure syringes or atomizing spray bottles. 
 Main reason to use water irrigation when cutting bone is b/c heat generated by drill affects bone 
vitality and don’t want to burn bone. Duh.  
 Marsupialization, decompression, and Partsch operation refer to creating a surgical window in wall of 
cyst which is uncovered or deroofed and emptied.  
• Marsupialization is tx for ranula when cyst is large and close to vital structures; if recurrent ranula 
also excise sublingual gland; cyst lining made continuous with oral cavity.  
 Enucleation – total removal of cyst and preferred tx of cysts; tx for 
congenital & odontogenic cysts & mucoceles.  
 Operculectomy – removal of operculum – flap of tissue over 
unerupted/partially erupted tooth. 
 Frenum provides support or restricts mvmt; 3 Frenectomy Techniques: 
1. Diamond excision &  2. Z‐Plasty – both effective when 
mucosal & fibrous tissue is narrow; these techniques 
relax the pull of the frenum. 
3.   V‐Y advancement – preferred when frenal attachment 
has wide     base; less scarring and good for lengthening 
tissue. 
 Mandibular Ramus Sagittal Split Osteotomy – common 
performed mand. orthognathic procedure; used to either 
advance or set back the mand.;  
o position of condyle UNCHANGED;  
o for correcting Class 2 malocclusion. 
 Vertical Ramus Osteotomy – to set mand. posteriorly for prognathism. 
 Vertical Body Osteotomy – TE mand. teeth (PMs) bilaterally and set mand. back.; corrects class 3 
malocclusion. 
 Le Fort I Osteotomy – most common to fix max. retrognathia.  
 Step Osteotomy – for mand. prognathism, retrognathism, asymmetry, and apertognathia; 3 
independent pieces.  
ORTHODONTICS 
OCCLUSION: 
 Class I – MB cusp of max. 1st molar lines up w/ BUCCAL GROOVE of mand. 1st 
molar; Orthognathic profile; 70% of population;  
→ Most prevalent characteristic of Class I malocclusion is CROWDING; 
→ If crowding <4mm – strip some enamel off interproximals of mand. teeth.  
→ If crowding >4mm – extraction; 
 Class II – MB cusp of max 1st molar b/w Mand. 2nd PM & 1st Molar; max. 
canine mesial to mand. canine; retrognathic profile (overbite); 25% of 
population; convex profile;   
→ Div 1 – ALL max. incisors protruded in extreme labioverision & mand. 
incisors tipped forward; 
→ Div 2 – Max. centrals tiped palatally & in retruded position 
(linguoversion) but Lateral incisors tipped labially & mesially 
(labioversion); if this only occurs unilaterally = SUBDIVISION;  
 Class III – MB cusp b/w mand 1st molar & 2nd molar; max. canine distal to 
mand. canine; prognathic profile (underbite); max. incisors tipped lingually.  
→ “f” or “v” sounds affected by Class III malocclusion; 
 Pseudo‐Class III Malocclusion – mandibular incisors forward in relation to 
maxillary incisors when in C.O. but can move mandible back w/out strain.  
→ Most instances edge to edge; tx = elimination of CO‐CR discrepancy.  
 Sunday Bite – forward postural position of mandible which is adopted by 
people w/ people w/ Class II profiles in order to improve esthetics;  
 Physiological Occlusion – may not be ideal occlusion but its an occlusion that adapts to stress of 
function & can be maintained. 
 Pathological Occlusion – cant function w/out contributing to own destruction; may cause:  
1. Excessive tooth wear 
2. TMJ problems 
3. Pulpal changes 
4. Periodontal changes 
 Bimaxillary Dentoalveolar Protrusion – in both jaws the teeth protrude; Signs are 
1. Separation of lips at rest 
2. Severe lip strain 
3. Prominence of lips in profile view 
 Common dental condition that can benefit from ortho tx prior to prosthetic tx is long‐term loss of 
mand. 1st molar; better to tip 2nd molar distal than move mesial.  
 On a child, if permanent 1st molar extracted, best approach is to allow 2nd molar to mesial drift into 
that area; 
 
PRIMARY & MIXED DENTITION: 
 Mixed Dentition Analysis (Transitional Analysis) – determines space available vs space required; 
based on tooth size; Procedure: 
1. Measure MD of mand. incisors & add together 
2. Measure space available 
3. Subtract #1 from #2; a negative number indicates crowding;  
4. Measure the space available for the canine &  premolars on each side of the arch 
5. Calculate from the prediction table the size of the canine & premolars. 
6. Subtract #6 from #5 on each side; negative number indicates crowding. 
7. Then add these 3 numbers together (# from incisor crowding/space, # of right canine & PM 
crowding/space, # of left canine & PM crowding/space); (‐) = crowding, (+) = space! 
 Moyer’s Mixed Dentition Analysis – predicts size of unerupted canines & PMs by looking at MAND. 
INCISORS that have already erupted; the incisors determine both mand & max posterior teeth.  
→ Predicts the amount of crowding AFTER the permanent teeth erupt.  
→ Both MAX & MAND space determined from MAND. incisors.  
 Mandibular anterior crowding usually results from tooth size‐arch length deficiency; 
 Supervision of child’s occlusion most critical at ages 7‐10 because malocclusion most identifiable in 
children 7‐9 yo.  
 Leeway Space – serves to accommodate PERMANENT CANINES (which are larger than primary);  
→ the difference in sum of MD width of primary canine, 1st molars, 2nd molars & permanent canine, 
1st PM, & 2nd PM. 
→ Mand. leeway space = 3‐4mm; Max. leeway space = 2‐2.5mm. 
 Permanent successors often smaller than primary successors;  
 Late Mesial Shift of 1st molar – loss of arch length when primary 2nd molar are lost & 1st permanent 
molar shifts into leeway space.  
 Permanent MAND. canines erupt FACIALLY/RIGHT IN LINE to primary canines;  
 In max. & mand. arches, perm. tooth buds for incisors lie LINGUALLY & APICALLY to prim. incisors 
causing mandibular incisors to erupt LINGUALLY; 
 Permanent teeth normally move OCCLUSALLY & BUCCALLY while erupting; 
 Max arch = 128mm; Mand. arch = 126mm. 
 Primary molar relationship = STEP relationship; 
 Mesial Step (primary teeth)= distal surface of mand. 2nd molar is mesial to distal surface of max. 2nd 
molar; normally results in Class I occlusion of perm. teeth;  
 Flush‐Terminal Plane – the NORMAL relationship of primary molars in primary teeth; most common 
initial relationship; when distal surfaces of mand. & max. 2nd molars are end to end relationship;  
→ permanent teeth don’t erupt immediately in normal occlusion, first Class II, but around 10/11 yo 
(during late mesial shift), the move into Class I occlusion;  
→ if late mesial shift doesn’t occur, then stays in Class II occlusion.  
→ Terminal plane relationship determines future anteroposterior positions of permanent 1st molars! 
 Distal Step – creates permanent Class II occlusion;  
 Mesial Step, Flush‐Terminal Plane, Distal Step are all determined by observing 2nd Primary Molars! 
 Child w/ class III malocclusion, they will have edge to edge contact w/ primary incisors; 
 Primate Space – Max. arch = b/w Lateral incisors & canines. 
Mand. arch = b/w canines & 1st molars.  
→ Spacing is normal thru out the primary dentition, but these areas are the most NOTICEABLE. 
→ Caused by growth of dental arches.  
 If no spacing & primary teeth were in contact b/f loss, a collapse in arch after loss of primary incisors 
is almost certain;  
→ not true for loss of perm. incisors – space closure occurs rapidly whether spacing/not.  
 Most common cause of malocclusion – inadequate space management following early loss of prim. 
teeth;  
 Premature exfoliation of primary canine may indicated arch length deficiency & may cause lingual & 
lateral collapse/migration of mandibular anterior teeth;  
 Premature loss of primary max. 2nd molar produces Class II malocclusion;  
 As child matures, face becomes less convex.  
 The most reliable indicator of readiness of eruption of succedaneous tooth is extent of root 
development;  
 
OPEN BITE & CROSSBITE: 
 Thumbsucking may cause Class II malocclusion, unilateral/bilateral crossbite, constricts MAX. 
arch, anterior crossbite, proclination of max. incisors, & retroclination of mand. incisors.  
→ As the hand rests on the chin, it retards mandibular growth, causing Class II.  
→ Constriction of the maxilla due to pressue from buccinator, NOT negative pressure;  
 ANTERIOR OPEN BITE (APERTOGNATHISM)is most common sequelae of digital sucking habit; 
assymmetrical w/ normal posterior occlusion; it is a malocclusion;  
 Skeletal open bite (long face syndrome) is most often associated w/ mouth breathing.  
 Ant. crossbite rare b/c mandibular growth lags behind maxillary growth, unless Class III relationship; 
most often associated w/ retention of primary teeth; 
 Cross bite is associated w/ jawsize discrepancy, hereditary, reverse overjet, & scissor bite;  
 Neither crossbite or open bite are caused by tongue thrusting.  
 Anterior Crossbite in primary teeth is indicative of 1)Skeletal Growth Problem & 2) Class III 
malocclusion; Results from:  1) Labial situated supernumerary tooth 
2) Trauma 
3) Arch Length Discrepancy 
→ should always be treated in mixed dentition stage;  
→ most often associated with prolonged retention of a primary tooth; 
→ most essential factor in correction is amount of MD space available.  
→ More common in african‐americans, while open bite is more common in caucasians.  
 Delayed treatment of anterior crossbite can cause loss of arch length and the most important factor is 
space availability mesial distally.  
 Anterior crossbite best retained by normal incisor relationship achieved by treatment (the overbite) 
not appliances; Anterior crossbite – easily retained after ortho tx by overbite achieve during tx.  
 Overbite (deep bite) – vertical overlapping; Overjet – horizontal overlapping.  
 Reverse overjet – Class III malocclusion w/ > 2 max. anterior teeth in linguoversion;  
 Scissorbite (bilateral lingual crossbite) – from narrow mandible or wide maxilla; when posterior 
mand. teeth lingual to maxillary teeth.  
 Open bite may cause tongue thrust swallowing but tongue thrust swallowing doesn’t cause anterior 
open bite; 
 Posterior Crossbite:  ‐‐ Transverse plane problem 
‐‐ corrected ASAP 
‐‐ Thoroughly diagnosed as dental, functional, or skeletal orgin. 
‐‐ maybe corrected w/ palatal expansion – causes diastema & expansion of 
nasal floor;  
‐‐ Maybe associated w/ mandibular shift 
‐‐ correct in 1st stage of tx along with MILD ant. crossbite (2nd stage is severe). 
‐‐ skeletal crossbite demonstrates smooth closure to C.O. 
‐‐due to prolonged thumb sucking & anterior crossbite! 
 The MOST COMMON active tooth movement in primary dentition is to correct a posterior crossbite – 
a TRANSVERSE plane of space problem.  
 1st step of treatment for crossbite is maxillary expander – 1‐2 months of turn key then another 3 
months; then braces are used b/ of spacing produced by expansion; 
 An anterior open bite may make it difficult to make sounds – th, sh, ch; also s, & z (due to lisp). 
 Large diastema can also cause a lisp so difficult to produece s & z sounds;  
 Irregular incisors can make it difficult to produce sounds t & d.  
 Class III can cause difficulty with F & V sounds.  
 
BONE GROWTH: 
 Don’t confuse bone growth and bone formation; Once bone is formed, it then grows by appositional 
growth = growth by addition of new layers on top of previous formed layers;  
 Bone formation begins in embryo where mesenchymal cells differentiate into either fibrous 
membrane or cartilage; 2 paths of bone development: 
1. Intramembranous Ossification – in membrane of CT; osteoprogenitor cells in membrane 
differentiate into osteoblasts & a collagen matrix is formed undergoing ossification. 
a. How mandible & maxilla are formed; also flat bones of skull & clavicle.  
2. Endochondral Ossification – take place in HYALINE CARTILAGE; cartilage cells replaced by 
bone cells (osteocytes replace chondrocytes), matrix is laid down & Ca & PO4 are deposited;  
a. Forms long & short bones – ethmoid, sphenoid, temporal bones;  
 Mandible & Maxilla grow DOWN & FORWARD; 
 Mandible Growth   1) growth in condyle increases anteroposterior dimension of mandible. 
2) increase resorption of anterior border of ramus 
3) increase apposition of bone on posterior border of ramus 
4) apposition of alveolar bone increases superior/inferior dimension of 
mandible.  
→ Space b/w jaws is provided by growth of condyle – major site of VERTICAL GROWTH due to 
cartilage proliferation; 
→ Resorption occurs along anterior surface of ramus while bone apposition occurs along 
posterior surface of ramus; 
→ Mand. main growth site – CONDYLAR CARTILAGE; The “V Principal” of growth is illustrated 
with growht of mandibular ramus;  
→ Growth at mand. condyle during puberty usually results in increase in posterior facial height. 
→ The main growth thrust is UPWARD & BACKWARD directiong causing the body of the 
mandible to move DOWNWARD & FORWARD, same as Maxilla; 
 Maxilla Growth    1) growth at spheno‐occipital & sphenoethmoidal junctions. 
2) growth at nasal cartilaginous septum 
→ Sutures for secondary growth:  1) Frontomaxillary suture 
2) Zygomaticotemporal suture 
3) Pyramidal process of palatal bone 
4) Alveolar process. 
→ Maxillary arch elongates, moves posterior, and increases height.  
→ Posterior movement is due to resorption of labio‐alveolar sufrace & apposition of the lingual 
surface;  
 Posterior bone remodeling at ramus ceases before 3rd molar eruption often causing impaction;  
 Cartilage Growth: 
1. Appositional Growth – recruit fresh cells (chondroblasts) from perichondral stem cells & add 
new matrix to surface. 
a. Appositional growth occurs below covering layer of bone (periosteal); periosteum has other 
fibrous layer & cellular inner layer of osteoblasts which lay down bone;  
2. Interstitial Growth – mitotic division & deposition of more matrix; chondrocytes already 
established in cartilage;  
a. ie – Condyle (hyaline cartilage), nasal septum, sphenooccipital synchondrosis;  
b. Hyaline cartilage differs from bone in that hyaline cartialge may grow by interstitial growth.  
 At age 6, greatest increase in mandible size occurs distal to 1st molars; 
 Bone deposition in tuberosity region responsible for lengthening arch & posterior mvmt; 
 Alveolar growth responsible for increase in height of maxillary bones; 
 Incisor crowding due to LATE mandibular growth. 
 Alveolar process bone exists only to support teeth so if tooth fails to erupt, alveolar bone will never 
form in that area; if tooth extracted, alveolus resorbs.  
 Late mandibular growth is theory that best explains why there is a strong tendency for mandibular 
anterior crowding in later teens & early 20s;  
→ The concept is that incisor crowding develops as the mand. incisors & possibly the entire 
mand. dentition move DISTALLY relative to the body of the mand. late in mand. growth; 
→ Mandible undergoes more growth in late teens than in the maxilla; 
→ Late incisor crowding occurs in ppl w/o 3rds so not a factor in crowding but late mandibular 
growth is a critical variable.  
 Most rapid losses in arch perimeter are usually due to mesial tipping & rotation of permanent first 
molar after removal of primary second molar.  
 
ORTHO PROCEDURES/TREATMENT: 
 Most important aspect of ortho = RETENTION; accomplished w/ fixed/removable appliances; 
 Gradual withdrawal of ortho appliance is of NO value! 
 Indirect Method of Bonding Brackets is more technique sensitive and reduces chairside time; controls 
FLASH (excess of resin); used when visibility is a problem;  
 35‐50% unbuffered phosphoric acid is used as bonding agent before direct bonding of orthodontic 
brackets (for 1 min).  
 topical flouride should NOT be used before etching b/c it decreases solubility of enamel; 
 Indications for using Bands instead of Bonding Brackets: 
1. Better anchorage for greater tooth movement 
2. Teeth that need both lingual & labial attachment 
3. Short clinical crowns 
4. Tooth surfaces that are incompatible w/ successful bonding.  
 GI cements are replacing Zinc Phosphate because 1)Fluoride releasing & 2) Retentive Strengths. 
 Frozen Slab Technique – allows more powder into liquid increasing strength.  
 Cross‐Elastics – from maxillary lingual to mandibular labial can be used to correct single‐tooth 
crossbite;  
 Serial Extraction – orderly removal of selected primary/permanent teeth; 
→ For severe Class I malocclusion in mixed dentition w/ insufficient arch length; if >10mm. 
→ 1st extract Primary Canines, 2nd – Primary 1st Molars, 3rd – Permanent 1st PMs;  
→ key to success is to extract the 1st PMs before the permanent canines erupt.  
→ must leave 6‐15 months b/w extractions; for support & retention, use for… Mandible – 
lingual arch, Maxilla – Hawley Appliance.  
 
ANGLES: 
 Facial Profile Analysis (Poor man’s Ceph Analysis) – same info as lateral ceph but less detailed; give 
the following info:  1) Anterior/Posterior Position/Protrusion of Jaws 
2) Lip Posture & Incisor Prominence 
3) Vertical Facial Proportions 
4) Inclination of Mandibular Plane Angle 
 Within lower 1/3 of anterior face height, the mouth should be about 1/3 of the way b/w nose & chin. 
 Steep Mandibular Plane Angle – correlates w/ long anterior facial vertical dimension & anterior open 
bite malocclusion;  
 Flat Mandibular Plane Angle – correlates w/ short anterior facial vertical dimension & anterior deep 
bite malocclusion.  
 Max‐Mand Plane Angle – angle b/w mand. plane & max. plane = 27o (+/4); greater the value, the 
longer the face height.  
 High mandibular plane angle is most significant complication of molar uprighting – can cause 
increased open bite & loss of anterior guidance;  
 Long face predisposes to Class II, while short face predisposes to Class III. 
 SNA Angle – angle formed by line from SELLA TURNICA to NASION to Pt. A;  
→ SNA > 82o = Max. Prognathism. 
→ SNA < 82o = Max. Retrognathism. 
 SNB Angle – angle formed by line from SELLA TURNICA to NASION to Pt. B; defines sagittal location of 
mand. denture base; 
→ SNB > 80o = Mand. Prognathism 
→ SNB < 80o = Mand. Retrognathism 
 ANB Angle:             ‐  ANB angle = 2o = Class I 
‐ ANB angle < 0o = Class III 
‐ ANB angle > 4o = Class II 
 Physiological/developmental age judged by wrist/hand x‐ray; Landmarks – 1) Ulnar Sesamoid 
    2) Hamate Bones 
 Frankfort‐Horizontal Plane – connects Porion (mid point of upper contour of metal ear rod of ceph) & 
Orbitale (lowest point on inferior margin of orbit); best representation of natural orientation of the 
skull;  
 Some important Ceph. Landmarks: 
• Sphenocciptal Synchondrosis – junction b/w occipital & basisphenoid bones. 
• Sella – midpoint of cavity of sella turnica; 
• Pt. A = subspinale = innermost point of premaxilla 
• Pt. B = supramentale = innermost point on contour of mandible; 
• Pogonion – most anterior point of contour of chin 
• Menton – most inferior point on mandibular symphysis (bottom of chin) 
• Gonion – lowest posterior point of mandible w/ teeth in occlusion 
• Nasion – anterior pt of intersection b/w nasal & frontal bones; 
 Ceph includes measurements from hard & soft tissue; 
 Most stable area to evaluate craniofacial growth is ANTERIOR CRANIAL BASE because of its early 
cessation of growth. 
 Cephs often show 7‐8% magnification; good for tooth‐tooth, bone‐bone, & tooth‐bone relationships. 
 
APPLIANCES: 
 Band & Loop – has limited strength so only replaces 1 tooth; most often used when PRIMARY FIRST 
MOLAR prematurely extracted.  
 Distal Shoe – used when 2nd PRIMARY MOLARS lost very prematurily & prior to eruption of 1st perm. 
molars; prevents mesial tipping of permanent molar;  
 Lingual arch space maintainer – used if loss of bilateral molars but incisors erupted; 2 bands around 
either prim. 2 molars or perm. 1st molars & wire rests on cingula of incisors;  
→ DOESN’T restore function & should be completely passive.  
 Nance Appliance – for premature bilateral loss of max. primary teeth; small acrylic button that rest on 
palatal tissues that are attached to bands that are bilaterally cemented on permant max. molars;  
→ Prevents MESIAL rotation & drifting of perm. max. molars it is attached too.  
 Removable appliances arent used often b/c appliance not being work or easily broken/lost. 
 Quad Helix Appliance – fixed appliance, not functional but contains 4 helices (2 ant, 2 post); for 
POSTERIOR CROSSBITE w/ digit sucking habit; 
 Functional Appliances are either tooth‐borne or tissue‐bourne; 
 Tooth Borne Appliances: 
A. Activator – advances mand. into edge to edge postion to induce mand. growth & inhibit max. 
growth; improves deep bite in Class II cases;  
B. Bionator – trimmed down version of activator appliance for comfort; 
C. Herbst – fixed/partially removable; metal rod & tube telescopic apparatus attached bilaterally 
to max. 1st molar & mand. 1st PM; used to posture mandible forward & induce growth;  
D. Twin Block – 2 piece acrylic appliance to posture mandible forward w/ help of occlusal incline 
& guiding planes & bite blocks(determines vertical separation); 
 Tissue Borne Appliances: 
A. Frankel Functional Appliance – serves to EXPAND ARCH by padding against pressure of lips & 
cheeks; protrudes mand. forward & downward; REMOVABLE functional appliance used for 
abnormal soft tissue patterns; 
 Best method for tipping max &mand. anterior teeth is with FINGER SPRINGS which are attached to 
removable appliance; most common problems:  1) lack of pt cooperation 
2) Poor design/lack of retention 
3) Improper activation 
4) Root apex movement 
 Force of Spring = F α  dr4/13; d = distance of spring, r = radius of spring; force of spring is inversely 
proportional to length of spring.   
 Z Springs – can also be used for tipping but excessive heavy force & lack of range of motion; 
 Buccal Springs – used to try & regain space by pushing a tooth mesial/distally, but may cause 
rotation of that tooth;  
 Maxillary incisor rotation not fixed til after all permanent teeth have erupted except for crossbite 
which should be corrected ASAP.  
 Whip‐Spring Appliances – used to de‐rotate 1 or 2 teeth; 
 Fixed Ortho appliances offer controlled tooth movement in all 3 planes of space; 
 3 planes of space in malocclusion – Antero‐posterior, Transverse, & Vertical; 
 Removable Appliances – generally restricted to tipping teeth; 
a. Attached Removable Appliances: 
i. Active Appliance – contains extraoral traction devices (headgear), lip bumpers, 
active plates, vacuum formed appliances;  
ii. Passive Appliance – contains bite planes, splints, & retainers. 
b. Loose Removable Appliances. 
 Indications for Removable Appliance:  1) Retention after comprehensive tx 
2) Limited tipping movements 
3) Growth modifications during mixed dentition 
 Components of Removable Appliance:   
1) Retentive Component – retains appliance’s function w/ clasps. 
2) Framework/Base – acrylic, provides anchorage 
3) Tooth‐moving elements – spring/screws 
4) Anchorage Component – resists active components 
5) Active components – springs, screws, elastics;  
 For appliances to be effective, must be capable of exerting torque. 
 4 basic components of Fixed Appliances:  1) Bands 
2) Brackets 
3) Archwires 
4) Auxilliaries (elastics/ligatures) 
 Alloys for ortho – Stainless steel (can be supplied soft & w/ good formability), ChromiunCobalt 
(increased strength & spring), & Titanium.  
 Ideal wire material should possess:  ‐‐ Increased strength 
‐‐ Decreased stiffness 
 Increased range 
‐‐ Increased Formability 
 Loops & helices incorporated in archwires to increase activation range;  
 Edgewise Appliance – bands on all teeth, tubes on last molar & brackets on all teeth; 1 labial used as a 
time ‐ .0125x.028 in diameter, which fits in bracket slott of .022” wide from top to bottom; 
→ Best appliance for tx of comprehensive malocclusions of permanent dentitions;  
→ Variations include double/tandem brackets & narrow (.018) slottle brackets. 
→ Components ‐   1) Siamese twin bracket – maxillar anter. Teeth 
2) Broussard buccal tube – segmented arch technique to intrude teeth. 
3) Straight wire bracket 
4) Bracket w/ .022x.028 rectangular slot; 
→ Straight‐wire Appliance – version of edgewise w/ features that allow placement of ideal 
rectangular archwire w/o bends;  
 1  order bend in ortho wire is HORIZONTAL PLANE; 
st
 Begg Appliance – uses round wires which fit loosely in vertical slot of bracket;  
 Hawley Retainer – incorporates clasps on molar teeth & a characteristic bow w/ adjustment loops, 
spanning from canine to canine; palatal coverage w/ acrylic – major source of anchorage; 
→ Tx for pt w/ excessive overbite; can be max or mand.  
→ MOST COMMON REMOVABLE RETAINER.  
 
HEADGEAR: 
 Advantage of extraoral anchorage (headgear) is it permits posterior movement in an arch and doesn’t 
touch opposing arch; 
 Req’d force for anchorage= 250g for 10hrs/day; Req’d force for traction= 500g for 14‐16 hrs/day.  
 Headgear extraoral components – neck strap, chin cup, & head cap. 
 Headgear intraoral components – facebow.  
 Facebow – intraoral headgear component; has outer & inner bow; inner bow relates to resistance of 
tooth & effects anchorage/traction;  
 High‐Pull Headgear – produced distal & upward force on maxillary teeth & maxilla; headcap & 
facebow; Helps w/ Class II, Div. I Malocclusion w/ open bite.  
 Cervical‐Pull Headgear – neck strap & facebow; produces distal & downward force on maxillary teeth 
& maxilla; possible extrusion of max. molars;  
→ causes opening of bite & 1st molar moves distally & forward growth of maxilla decreases;  
→ for Class II, Div. I malocclusion.  
 Straight Pull Headgear – places force in straight distal direction from maxillary molar; for Class II, Div 
1 malocclusion; 
 Reverse Pull Headgear – extraoral component supported by chin, cheek, forehead; for Class III 
malocclusion, for protruding maxilla.  
 
PATHOLOGY: 
 Hyperparathyroidism – causes premature exfoliation of primary teeth;  
 Primary Failure of eruption is caused by eruption mechanism itselft but can be caused by: 
1. Hereditary Gingival Fibromatosis 
2. Down’s Syndrome 
3. Rickets 
 Localized caused of failed/delayed eruption are:  1) Congenital Absence 
2) Abnormal Position of Crypt 
3) Lack of space 
4) Supernumerary tooth 
5) Dilacerated roots. 
 Prolonged ortho tx has long been associated w/ caussation of inflammatory periodontal disease; 
 Mouth Breathing causes: 
1. Skeletal Open Bite (longface syndrome) – worsens over time;  
a. anterior open bite = APERTOGNATHISM. 
2. Narrow face 
3. Narrow oropharyngeal space 
4. Chronic rhinitis, deviated nasal septum. 
5. Tonsilitis, allergies 
 Conditions w/ multiple supernumerary teeth:  1) Gardner’s Syndrome 
2) Down’s Syndrome 
3) Sturge‐weber syndrome 
4) Cleidocranial Dysplasia 
 Supernumerary teeth have predilection 2:1 for males; most common site is b/w CENTRALS;  
 An impacted mesiodens can cause diastema but an INVERTED mesiodens can cause delayed eruption 
of centrals;  
 Oligodontia – absence of 1/more teeth; more females than males; smaller than avg tooth size ratio.  
 
MISCELLANEOUS: 
 Dental arch form determined by interaction of environmental influences on genetic pattern.  
 Malocclusion is MOST OFTEN hereditary.  
 98% of 6 year olds have diastema while 49% of 11 year olds do too; 
 Diastema closes after canines erupt if <2mm but if >2mm willl not close so need tx: 
→ If abnormal frenum – do ortho tx THEN do a frenectomy. 
→ Use lingual arch w/ finger springs 
→ Use Hawley appliance w/ finger springs 
→ Cemented ortho band w/ inter‐tooth traction. 
 Maxillary canine is most commonly impacted tooth after thirds; in older pts, there is an increased risk 
that impacted tooth is ankylosed. 
 Tx of impacted tooth – during surgical exposure, flaps reflected so tooth is ultimately pulled into arch 
thru KERATINIZED TISSUE not alveolar mucosa; 
 Ectopic Eruption – tooth erupts in wrong place; common in MAX. 1st MOLARS & MAND. INCISORS; 
→ Common in Class II in 2‐6% of population & correctin in 60% of population; 
→ If max. 1st molar – tx is place brass wire b/w primary 2nd molar & permanent 1st molar;  
 Uprighting a molar can take 6‐12 months: 
→ Tx – fixed edgewise ortho appliance w/ .022” or .018” wire sizes 
→ Tipped 2nd molar should be banded b/c masticatory forces; 
→ Severly lingually tipped mand. molar MORE DIFFICULT to control & upright. 
→ High mandibular plane angle also make it very difficult to upright a molar (may cause open bite). 
→ Stabilization should last til lamina dura & PDL reorganize (2‐6 months);  
→ Retention w/ well‐fitted provisional. 
→ Slow progress in molar uprighting – due to occlusal interference; 
 6 Types of Tooth movement: 
1. Tipping – crown moves in 1 direction & root tip in opposite direction (often w/ appliance); 
common w/ anterior incisor teeth; 
2. Translation (bodily movement) – root movement in same direction as tooth movement; difficult! 
3. Extrusion – displacement of tooth from socket in direction of eruption. 
4. Intrusion – movement into socket along long axis of tooth; difficult! 
5. Torque – root movement while crown is stable; Mesial distal root mvmt = AKA‐ UPRIGHTING. 
6. Rotation – revolving tooth along long axis; need adequate retention to prevent relapse.   
 Side toward tooth movement = osteoclasts – break down bone;  
 Side away from tooth movement = osteoblasts – bone forming cells. 
 Collagen fibers (like rubber bands) in supra‐alveolar tissue are responsible for relapse of 
orthodontically rotated teeth as well as redevelopment of spaces b/w orthodontically moved teeth 
→ Primary component of gingiva & get stretched during ortho tx. 
 Circumferential Supracrestal Fibrotomy – simple incision in sulcus to bone; incises collagen fibers 
inserted into root of tooth; eliminates potential relapse & allows new fibers to form in new position. 
→ Good candidate for procedure is a rotated maxillary lateral incisor.  
 Collagen fibers in SUPRA‐ALVEOLAR tissue are primarily responsible for relapse of orthodontically 
rotated teeth & for redevelopment of spaces b/w orthodontically moved teeth.  
→ Collagen fibers are main component of attached gingiva.  
 
OSHA & PATIENT MANAGEMENT 
 
BEHAVIORAL SCIENCE: 
 Behavior is determined, purposeful unit of activity; 
 4 major fields of behavior:  Personal Social, Motor, Language, & Adaptive; 
 Most researchers believe changes in behavior are a prerequisite to changes in attitude;  
 The most effective way to teach oral hygieve skills is by having pt participate in repeated supervised 
trainining sessions; 
 Maintaining a 4 year old child’s healthy dentition starts w/ educating the parent; 
 Behavior Modification – type of psychotherapy that attempts to modify observable, maladjusted 
behavior patterns by substituting a new response or set of responses to a given stimulus; 5 Types: 
1. Classical Conditioning (pavlovian/respondent conditioning) – a form of learning in which a 
previously neutral stimulus comes to elicit a given response through associative training; 
a. Operates by associating one stimulus w/ another; 
2. Operant Conditioning – consequence of a behavior is in itself a stimulus that can affect future 
behavior; a form of learning where the person undergoing therapy is rewarded for correct 
response & punished for incorrec response; 
a. 4 types: Positive & Negative reinforcement, omission, & punishment; 
b. Behavior Shaping (successive approximation) – an operant conditioning technique in which a 
new behavior is produced by providing reinforcement for progressively closer approximations 
of the final desired behavior; sometimes called Stimulus Response Therapy;  
3. Aversion Conditioning – technique in which punishment or painful stimuli are used in 
suppression of undesirable behavior; ie – Hand over mouth technique;  
4. Observational Learning (modeling/behavior shaping) – behavior acquired through initiation of a 
behavior observed in a social context;  
a. 2 stages – observational learning acquisition and actual performance of behavior; 
5. Systemic Desensitization – a technique used to eliminate maladaptive anxiety associated w/ 
phobias; construction by the person of a hierarchy of anxiety producing stimuli & general 
presentation of these stimuli until they no longer elicit an initial response of fear;  
 Flooding – intense & prolonged exposure to a feared stimulus while using coping skills;  
 Biofeedback – teaching 1 to have control over his or her physiological arousal thru the use of 
auditory/visual monitoring of arousal level;  
 Cognitive Coping (reframing) – assisting pts in changing their thinking about something to a more 
adaptive or realistic thinking style;  
 The Premack Principle – making a behavior that has a higher probability of being performed 
contigent upon (used a reinforcement) the performance of a less frequent behavior may increase 
performance of the less frequent behavior;  
 Extinction – identifying the positive consequences or reinforcements that maintain a behavior & 
ceasing or withholding these reinforcments or consequences;  
 Incompatible behavior/stimulus control  ‐ use of an incompatible behavior to decrease the 
frequency of an undesirable behavior;  
 Eye contact is the primary non‐verbal cue that 2/more people use to regulate verbal communication;  
 The best way to show a pt you care about what they are telling you is to use eye contact; 
 When presenting treatment plans always use open‐ended questions; they are the MOST EFFECTIVE 
way to help pts understand the proposed tx plan;  
 Constructive Aggression – an act of self‐assertivenes in response to a threatened action for purpose 
of self‐protection & preservation; 
 Destructive Aggression – act of hostility unnecessary for self‐protection/preservation directed 
toward an external object or person;  
 Anxious pts are usually considered the most difficult pts; most pts who are anxious have a traumatic 
experience in dental/medical setting;  
 Fear – anticipation of a threat elicited by an external object; it is distinguished from anxiety on the 
basis of the person’s ability to locate the threatening agent & recognize the presence of a behavior 
that will reduce perceived danger; 
 Stress – general disturbance in psycho‐physiological adaptation; mostly associated w/ response 
aspects;  
 Overprotective parents usually have children who are shy, docile, & manageable;  
 Health Belief Model  ‐ conceptual framework that describes a person’s health behavior as an 
expression of his/her health beliefts; suggests that individuals will act to prevent disease only when 
they belive they are susceptible to disease; Components of the model: 
1. Person’s own perception of susceptibility to a disease/condition. 
2. Likelihood of contracting that disease/condition. 
3. Person’s perception of severity of consequences of contracting the condition/disease. 
4. Perceived benefits of care & barriers to preventive behavior. 
5. Internal/external stimuli that result in appropriate health behavior by the person. 
 
OSHA: 
 Standard/Universal Infection Control Precautions – method of infection control which all human 
blood & certain body fluids (saliva in dentistry) are treated as if show to be infectious for HIV, HBV, 
HCV, & other bloodborne pathogens; first recommended by CDC in 1987; 
 Occupational Safety & Health Administration (OSHA) – federal agency created by congress in 1970 to 
protect workers from hazards in the work place; they are concerned w/ REGULATED WASTE in 
dental office; 
 Hazardous Waste – waste causing harm/injury to environment; doesn’t have to be toxic/poisonous; 
 Infectious Waste – waste that contains strong enough pathogens in sufficient quantity to cause 
disease;  
 AIDS prompted OSHA to adopt Bloodborne Pathogens Standard for Dentistry – a comprehensive rule 
that sets forth the specific requirements OSHA believes will prevent the transmission of bloodborne 
diseases to EMPLOYEES not patients or employers;  
 OSHA directs that uniform clothing worn in dental office is laundered at dental office or by an outside 
service, NOT employee’s home;  
 Only in dental procedures is SALIVA considered a potentially infectious material;   
 Fluid‐resistant gowns are not required unless it is anticipated that large amounts of blood, saliva, or 
other body fluids will soak thru gown to the employee’s clothing;  
 When handling chemical agents or cleaning a dental office, always wear protective eyewear, mask, & 
heavy duty utility or nitrile gloves; 
 CDC suggests new mask for each patient; masks should have at least 95‐99% filtering efficiency for 
small particle aerosols 1‐3m;  
 HIV is MOST INFECTIOUS TARGET of standard/universal blood precautions but HBV is MOST 
INFECTIOUS BLOODBORNE PATHOGEN, not most infectious agent;  
 HBV – poses the greatest occupational healthcare worker risk for bloodborne infection;  
→ HBV concentrations in blood of a chronic carrier can range b/w 1‐100 million virions/ml, in 
contrast to significantly lower viral loads shown for both HIV & ADS infected pts;  
→ Exposed employees who have declined the HBV vaccine can change their mind at any time & 
receive FREE vacination; 
→ Exposed employees who have begun their HBV vaccine series can work at their job even though 
the series is not complete; 
→ Dentist must provide “at‐risk” employees w/ protection from HBV; federal standard for 
occupational exposure to bloodborne pathogens REQUIRE employers to proved the HBV vaccine; 
→ Employe may refuse vaccination but OSHA will require proof that employee has refused; 
→ Employers must offer the vaccination to a new employee w/in 10 working days of initial 
assignment to a position involving exposure; Training must be provided prior to offer of vaccine;  
→ HBV infection commonly occurs by sex, prenatal transfer, & percutaneous inoculation; 
 HCV – transmitted primarily in infected blood via accidnetal needle‐sticks, blood transfusions, or drug 
addicts sharing contaminated syringes;  
→ Historically, drug users, ppl receiving tansfusions, organ recipients, & hemophiliacs receiving 
Factor VII or IX are at high risk for the virus, but now ppl getting tattoos & piercings are at risk; 
→ Viral conc detected in HCV infected pts range b/w numbers for HBV & HIV; 
 Occupational Exposure – any reasonably anticipated skin, mucosal, eye, or parental contact w/ blood 
or other potentially infectious fluids during the course of one’s duties while at work;  
→ Infection control training records & medical records if employee involved in occupational 
exposure must be maintained;  
→ Medical records must be maintained for duration of employement plus 30 years & strictly 
confidential;  
→ if you go out of business or new owner, must notify Director of National Institute of Occupational 
Safety & Healthy at LEAST 3 months b/f you intend to dispose records & offer to transmit the 
records to NIOSH;  
 Exposure Incident – specific occupational incident involving eyes, mouth, other mucous membranes, 
non‐intact skin, or parenteral contact w/ blood or potentially infectious materials;  
→ Any injury from a contaminated sharp is the most common exposure incident. 
→ EmployER must provide EmployEE with any meds needed after or before exposure, CONSELING, 
and evaluation weeks after incident;   
 Exposure Control Plan – requires that every employer have a written exposure control plan to 
elimate/minimize employee exposure to bloodborne diseaseas;  
→ Must be updated at least ANNUALLY & whenever necessary to reflect office changes; 
→ The plan must be provided to OSHA upon request; 
 Employers must ensure that ALL employees w/ occupational expsosure participate in training 
program at NO cost, during working hours, w/ material for education, literacy, & language of 
the employee!  
 Contaminated sharps are any object that can penetrate skin, like needles, scalpels, broken glass, 
broken capillary tubes, & exposed ends of dental wire;  
 AntiRetraction Valves – used on handpiece & air‐water syringe hoses to prevent retraction of fluid 
back into the tubing; prevents pts fluid from getting into water lines; 
→ CDC recommends minimum of 20‐30 secs of flushing wanter lines b/w patients and several 
minutes if the system has been idle for awhile, like over the weekend; 
 FDA – branch of Health & Human services that determines which drugs & medical services can be 
marketed in US; also responsible for regulating handpieces & recommending sterilization procedures 
to CDC;  
 DEA – branch of Department of Justice that determines degree of control for substances w/ abuse 
potential; 
 The most commonly used dental materials deemd hazardous by OSHA are mercury, nitrous, & 
chemicals used to develop film; 
 Amalgam scrap is stored in tighly sealed containers covered w/ sulfide solution;  
 Acceptable max exposure level allowed by OSHA for nitrous is 1000ppm; 
 Material Safety Data Sheet – document that contains info concerning hazardous chemicals; chemica 
manufacturers & importers are required to obtain a MSDS for each hazardous chemical; 
→ Must be readily accessible to employees 
 EPA – regulates waste TRANSPORATION from dental office;  
 OSHA considers part‐time, temporary, & probational workers as employees;  
 
PUBLIC HEALTH: 
 Quality Assessment – measure of the quality of care provided in a particular setting; limited to 
appraisal of whether or not standards of quality have been met; 
 Quality Assurance – measurement of quality of care & IMPLEMENTATION of all necessary changes to 
maintain/improves the quality of care rendered; contains 3 Concepts: 
a. Structure – layout & equipment of facility; 
b. Process – the actual service the dentist provides for pts; 
c. Outcome – change in health status that occurs b/c of care delivered; 
 Sensitivity & Specificity are INVERSELY proportional; as the specificity of a test increases, the 
sensitivity decreases;  
 Sensitivity – ability of test to diagnose correctly a condition/disease that actually exists; measures 
the proportion of people w/ a disease who are correctly identified by a positive test; 
→ Defined as # of true positive (TP) divided by total # of potential positive findings (true 
positives & false negatives) in sample; Sensitivity = TP/(TP+FN) 
 Specificity – ability of test to classify health; defined by # of true negative results dived by total # of 
false positive & true negative results in sample; Specificity = TN/(FP + TN) 
 Prevalence – # of OLD cases of disease present in population at risk at a specific period of time; the 
proportion of persons in population suffering from particular disease at given point in time; 
→ Expressed as percentage of population; 
 Incidence – # of NEW cases of specific disease occurring w/in a population at certain amount of time; 
expressed as a rate (cases)/(population)/(time); incidence is a rate that requires a unit of time;  
→ Incidence is a RATE & prevalence is a PROPORTION; 
 Frequency = a count; 
 Abuse – dentist are morally, ethically, & legally obligated to report a suspected case of child abuse; 
dentist’s first & immediate responsibility is to protect the child; 
→ Dentist also ethically obligated to identify & refer cases of domestic violence; 
→ 68% of battered women injuries involve face, 45% the eyes, & 12% the neck; 
 Managed Care – arrangement where 3rd party payer mediates b/w doctors & patients negotiating fees 
for services & overseeing types of tx provided;  types = HMO, PPO, & IPA; 
→ PPO (preferred provider orgnaization) – typically involves contracts b/w insurers & dentist 
and patients can choose their dentinst depending on if the dentist participates in PPO; 
→ Participants of HMO are much more limited in their dentist selection b/c they have to stay 
w/in network; 
 Capitation   fixed monthly payment paid by carrier to a dentist based on # of pts assigned to dentist 
for treatment; fee is same regardless of how much or how often care is delivered; 
→ Most popular managed care payment method;  
 HMO = capitation; PPO = reduced fee for service;  
 Dental Index – data collection instrument used to numerically express oral health status of 
population; 8 Indices: 
1. DMFT Index (Decayed‐Missing‐Filled Teeth) → irreversible index (measures that cant be 
reversed like caries) applied only to PERMANENT teeth;  
i. It yields a groups caries susceptibility; received universal acceptance & is probably the best 
known of all dental indices;  
2. DEFT Index (Decayed‐Extracted‐Filled Teeth) → used for PRIMARY TEETH; 
3. DMFS Index (Decayed‐Missing‐Filled Surfaces) → same as DMFT but records involve tooth 
surfaces; 
4. Gingival Index (GI) – reversible index used to asses severity of gingivitis based on color, 
consistency, & BOP;  
i. Gingivitis most commonly scored w/ Gingival Index of Loe & Silness which grades 
gingiva on 4 surfaces of each tooth based on inflammation & bleeding; 
ii. GI, Papillary, Marginal & Attached Gingival Index (PMA Index) – measurement w/in 
gingiva; records the prevalence & severity of gingivitis in school children;  
5. Periodontal Index – reversible index that measures conditions that can be changed, like plaque & 
bleeding; condition of gingival (less weight) AND BONE (more weight) estimated for each tooth;  
6. Simplified Oral Hygiene Index – reversible index used to measure oral hygiene status by 
estimating tooth surface covered w/ material alba &/or calculus;  
7. Plaque Index (PI) of Silness & Loe – reversible index to assess THICKNESS of plaque at the 
gingival margin; scores from 0 to 3;   0 = tooth surface is plaque free 
1 = plaque not observed on tooth but is on probe 
2 = thin plaque observed on tooth 
3 = heavy accumulation of plaque on tooth;  
→ Extensively used but not universally accepted;  
→ 80‐90% of children have perio disease by age 15; most common form is localized acute 
gingivitis;  
8. Sulcus Bleeding Index – used to determine bleeding & gingival health;  
 Vital Statistics – quantitative methods to monitor & evaluate the life history of a specific population;  
→ identifies community health needs, estimates healthcare costs, & evaluates health program 
effectiveness;  
→ data monitored is mortality, morbidity, natality, birth‐death ratio, & crude death ratio;  
 3 Principles of Public Heath – problem exists, solutions exists, & solutionsto problem is applied;  
 most important concept of Winslow’s definition of public health is promotion through organized 
community heath; 
 Dental public health is a form of dental practice that serves the community as a patient rather than 
serving the individual;  
 Fundamental principles of public health are prevention, costefficiency, & teamwork; 
 Prevention is major objective of public health programs; more ethical to prevent disease than cure it; 
 Randomized Study – study where ALL subjects have equal chance of being assigned to either the 
study or control group; 
 Blind Study – study where subjects are unaware if they are in a test or control group; this is achieved 
by using placebos;  
 Cross‐Sectional Study – study in which the health conditions in a group of people who are, or are 
assumed to be, a sample of a particular population (a cross‐section) is assessed at one time; 
 Case Control Study – people w/ a condition (case) are compared w/ people w/o it (control) but who 
are similar in other characteristics;  
 Cohort Study – 2 types: prospective cohort study & retrospective cohort study; 
→ Prospective Cohort Study – a general population is followed thru time to see who develops the 
disease, & then the various exposure factors that affected the group are evaluated;  
 Ie – studying a sample of subjects who don’t yet have cancer but measuring the risk factors of 
each subject that may predict the subsequent outcome. 
→ Retrospective Cohort Study – used to evaluate the effect that a specific exposure has had on a 
population; measuring the risk factors of subjects who had the outcome of interest;   
 The ethical principles found in the ADA’s Principles of Ethics & Code of Professional Conduct are: 
1. Justice – the quality of being impartial & fair; 
2. Autonomy – to inform patient about treatment, be truthful, & protect their confidentiality; 
3. Beneficence – to be kind & give highest quality of care one is capable of providing;  
 Good Samaritan Law – law enacted in all states that provides IMMUNITY from suit for specified health 
practitioners who render emergency aid to victims of accidens, provided there is no evidence of gross 
negligence; Not all states include dentists in Good Samaritan Law; 
 Mean = average; Median = middle measurement in set of data; Mode = most frequent measurement; 
 Range = the simplest measure of variability; Variance = method of ascertaining the way individual 
values are located around the mean; Standard Deviation = typical/avg deviation from the mean;  
 Chi‐square test – measure association between 2 categorical variables;  
 T‐test – used to analyze the statistical difference b/w 2 means;  
 
INFECTION CONTROL: 
 Opportunistic Infection – infection caused by normally non‐pathogenic microorganisms in a host 
whose resistance has been decreased/compromised; 
→ Percentage of ppl living w/ wide variety of immun compromised conditions continues to increase; 
 Exposure is not synonymous w/ infection; Do not disinfect when you can sterilize; 
 It is not possible/necessary to sterilize all environmental surfaces that become contaminated 
during patient care;  
 Sterilization of all clincal instruments & inanimate surfaces NOT manditory; 
 Bactericidal agents preferred over bacteriostatic chemicals;  
 Sanitization – type of antimicrobial treatment (used for drinking water) to lower total microbial load 
to safe public health levels;  
 Sterilization – process of killing/removing all microorganisms, including spores, on an object/in a 
material; limiting requirement is destruction of heat‐resistant spores; abscess of all living forms; 
 Heat is most efficient, reliable, & biologically monitorable sterilization method; 
 Pre‐Cleaning – MOST IMPORTANT STEP in instrument sterilization b/c debris acts as a barrier to the 
sterilant & sterilization prcces;  
→ Ultrasonic instrument cleaning is safest & most efficacious method of precleaning; 
 Immersion of dental instruments in cold disinfectants will not destroy spores/hepatitis viruses; 
 Liquids are generally sterilized by filtration; most common filter is composed of nitrocellulose & has 
pore size of 0.22m;  
 Rapid Heat Tranfer Sterilization – very fast cycle time, no dulling of instruments & drys 
instruments after cycle; forced air, dry heat convection ovens are are appropriate for sterilizing heat‐
stable instruments & other reusuable items used in patient care;  
→ Higher temp than other dry heat units; can sterilize much faster than traditional dry heat 
sterilizers;  
→ Requires 375oF (191oC) for 12 min for wrapped instruments & 6 min for unwrapped instruments; 
 Dry Heat Sterilization – Dry heat destroys microorganisms causing coagulation of proteins;  
→ requires 320oF (160oC) for 2 hours or 340oF (170oC) for 1 hour;  
→ instruments must be dry before using this sterilization & ethylene oxide sterilization; 
→ doesn’t dull or corrode instruments but long cycle & poor penetration; 
 Autoclave – destroys bacterial by denaturation of high protein‐containing bacteria; 
→ Requires 250oF (121oC) for 15‐20 min under 15psi or 270oF (134oC) at pressue of 30psi for 3 min 
(flash cycle); flash cycle best indicated for unwrapped instruments;  
→ the pressure greatly speeds up the protein denaturation process; only 10 min required to destroy 
all bacterial but increased time allows penetration when instruments wrapped in thick towels;  
→ Spore testing for autoclave units recommended WEEKLY; the spores Bacillus Stearothermophillus 
are used;  
→ Spores are resistant to boiling (100oC) so temp increased & pressure needed;  
→ This kills even highly heat resistant spores like Clostridium Botulinum;  
 Unsaturated Chemical Vapor Sterilization – requires 270oF (132oC) for 20‐40 min; yields 20lbs of 
sterilizing vapor pressure; Doesn’t rust or corrode instruments; 
→ doesn’t use distilled water, uses solution of alcohol, formaldehyde, ketone, acetone, & water to 
produce the sterilizing vapor;  
 Glutaraldehyde (2%) – an alkalizing agent highly lethal to essentially all microorganisms; takes 10 
HOURS to kill SPORES when instrument placed in 2% glutaraldehyde solution;  
→ long time, allergenic, & extremely toxic to tissues;  
→ used in hospital to sterilize respiratory therapy equipment;  
→ Faceshields disinfected w/ Iodophors or Glutaraldehydes; 
→ This disinfectiant often 28‐30 day life span; 
 Ethelene Oxide Gas Sterilization – kills by alkylating proteins & nucleic acids & proteins; used 
extensively in hospitals to sterilize heat‐sensitive materials like surgical instruments & plastics; 
→ Slow process taking 10‐16 hours; toxic to humans & flammable, so limited use;  
→ Highly penetrative, doesn’t damage heat‐sensitive material, evaporates w/o leaving residue; 
 Antiseptics – chemical safe to be administered to external body surfaces or mucous membrane to ↓ 
microbial numbers; cant take internally; similar to disinfectants but can be applied to living tissue; 
→ Best relates to handwash agent like chlorhexidine gluconate, parachlorametaxylenol, 
idophors, & triclosan;  
→ Alcohol is MOST WIDELY USED ANTISEPTIC & reduces the number of microorganisms on 
skin surface in wounded area; it acts by:   1) denaturing proteins 
2) extracts membrane lipids 
3) dehydrating agent 
→ Even some viruses (lipophilic) are inactivated by alcohol;
→ Alcohols are bactericidal, tuberculocidal, & economical; NOT sporicidal; it evaporates too 
quickly and diminished activity against viruses in dried blood, saliva, & other secretions;
→ Isopropyl alcohol is major form used in hospitals;  
→ Ethanol – widely used to clean skin prior to immunization or venupuncture; 
→ Iodine – MOSTE EFFECTIVE skin antiseptic used in medical practice that acts as an 
oxidizing agent, & irreversibly combines w/ proteins;  
→ Phenol was original disinfectant but rarely used today b/c too caustic; 
 Disinfection – process of reducing the # or inhibiting growth of microorganisms, especially pathogens 
to the point where they don’t pose a threat of disease; not all pathogens or spores! 
 Disinfectants – antimicrobial chemical agents used to destroy/kill microorganisms when applied to 
inanimate objects/surfaces; not safe on living tissues;  
→ Ie – Alcohol, Chlorhexidine, & Quaternary Ammonium Compounds; 
→ Water‐based disinfectants are better than alcohol‐based disinfectants;  
→ Pump spray disinfectants are better than aerosol spray disinfectants;  
→ Quaternary Ammonium Compounds – cationic detergents used as disinfectant & antiseptic 
agains gram (+) bacteria which are most susceptible to destruction; inactivated by anionic 
detergents (soaps & iron found in hard water); ie – Benzalkonium Chloride; 
→ Cleaning surfaces prior to disinfection is required to REDUCE concentration of pathogens; 
→ Mycobacterium Tuberculosis is the marker microorganism for intermediate surface 
disinfection; 
→ Chlorhexidine Gluconate & Triclosan   handwash agents w/ broad antimicrobial effect; 
have substantivity or residual action on washed tissues for extended periods of time; 
 Chlorine – powerful OXIDIZING agent that inactivates bacteria & most viruses by oxidizing free 
sulfhdryl groups; active component of hypochlorite & used as disinfectant; 
 Pasteurization – tx of dairy foods for short intervals using HEAT to kill certain disease‐causing 
microorganisms; target of pasteurization is to destroy Mycobacterium Tuberculosis; 
 Concentration & Time are critical factors that determine effectiveness of antimicrobial agent;  
 Individuals predisposed to readily developing hypersensitivity rxns can become SENSITIZED to latex 
allergnes more readily than people w/ few or no allergies; 
 Hevea Brasiliensis – water‐soluble macromolecules that can leach out of latex gloves when a person 
perspires or may be detected on surfaces of other product containing natural rubber latex; 
→ These proteins cause Type IV, IgE mediated reactions to natural rubber latex;  
→ Products designated HYPOALLERGENIC are no longer labelled latex alternatives since they 
contain latex w/ a chemical coating over the latex;  
 Irritation Dermatitis is MOST COMMON form of an adverse epithelial rxn noted for healthcare 
professionals; 20‐30% of healthcare workers suffer occasional or chronic dermatitis on their hands; 
 Americans w/ Disabilities Act – both state & federal statues define disability as having “a physical or 
mental impairment that substantially limits one/more major life activities of the individual, a record 
of such impairment exist, & the patient is regarded as having such impairment.” 
→ Dentists CANNOT deny anyone care due to disability & cannot dismiss employees due to 
disability. 
→ Dental offices must undergo structural changes to allow access for the disabled. 
→ HIV pts are protected under this act; 
 
 
 
PEDIATRIC DENTISTRY 
 
TOOTH ANATOMY: 
 Primary mand. 1st molar – like no other tooth; difficult to do a Class II, no central fossa; 
 Primary mand. 2nd molar – greatest FL diameter of all primary teeth.  
 Primary max. central incisor – NO MAMELONS; incisocervical height < MD width. 
 Primary mand. central incisor   similar to permanent LATERAL incisor. 
 Primary mand. lateral incisor – similar to permanent CENTRAL incisor. 
 Primary max. 1st molar – FL diameter > MD diameter (different than other primary molars); 5th 
cusp; often resembles permanent max. PM; oblique ridge; MB – largest pulp horm; MB cusp > ML 
cusp; grooves form H pattern w/ 3 fossa; has 3 Roots, resembling perm. 1st max molar.  
 Primary max. canine – mesial cusp ridge > distal cusp ridge & mesial cusp longer & sharper; both 
facts differ than permanent canines.  
 Permanent Max. Canines – most likely to be crowded out of maxillary arch. 
 Permanent Mand. 2nd PMs – most likely to be crowded out of mandibular arch! 
 Facial part of remaining primary root is longest. 
 Labial & Lingual cervical ridges prominent on all primary incisors! 
 Largest primary tooth – mand. 2nd molar; Smallest primary tooth – mand. lateral incisor.  
 Largest permanent tooth – Max. 2nd molar; Smallest – mand. central incisor.  
 Primary molars –   1) B & L surfaces are flatter  
2) Shorter & narrower MD at cervical 1/3 
3) Longer & slender roots.  
 Primary Anteriors ‐  1) Wider MD & shorter IC 
2) root tapers more rapidly 
 Enamel ends abruptly at cervical line on all primary teeth;  
 Lateral incisor is most common PRIMARY congenital missing tooth.  
 Primary teeth less opaque on xray than permanent teeth b/c > inorganic (Ca+, Phosphorus, 
hydroxyapatite) content; Organic content is collagen type 1.  
 Enamel on primary molars = 1mm while permanent molars = 2.5 mm of enamel.  
 Sum of MD widths of primary molars in any 1 quadrant is 2‐5mm greater than perm. teeth that 
succeed them (premolars);  
 Last primary tooth to be replaced by permanent tooth is maxillary canine.  
 Occlusal table on primary molars are narrower facial lingually. 
 Cementum (thicker apically than cervically) & PDL fibers increase as you age; 
 Child Gingiva ‐  1) more red, 2) less stippling, 3) flabbier tissue, 4) rounded/rolled gingiva, 5) PDL 
runs parallel to teeth, 6) alveolar bone thinner;  
 
ERUPTION & CALCIFICATION: 
 Primary teeth begin to form at 6 weeks in utero; Permanent teeth begin to develop 4 months in utero. 
 When tooth erupts, ½ ‐ 2/3 of root formed; apex fully formed in 2‐3 yrs (perm teeth); root completely 
forms in 18 months for primary teeth.  
 all 20 primary teeth begin calcification at 4‐6 months in utero; 10 months for complete calcification;  
 primary teeth begin to form at 6 weeks; All Primary teeth calcification in utero! 
 After permanent teeth have reached full occlusion, small tooth mvmts occur to compensate for wear 
on contacts (mesial drift) & occlusal surfaces (deposition of cementum at root apex).  
 Hard tissue formation of primary teeth at 18 weeks;  
 Succedaneous tooth – permanent tooth that moves into position formerly occupied by primary 
tooth; NEVER MOLARS! 
 Tooth buds generally initiated after birth – PMs, 2nd molars, & 3rd molars.  
 Best tx for permanent tooth trying to erupt but primary tooth is still in places is EXTRACTION; 
 Primary tooth takes 1.5 to 2 months from eruption to occlusion; CANINES take the longest; 
 Calcification of roots by age 3 or 4; Calcification of primary teeth during 2nd TRIMESTER. 
 After primary teeth fall out, extra space on Mand = 3.1mm/quad (6.2) & Max = 1.3mm/quad (2.6). 
 Mand. 3rd molars are last to begin calcification at 8‐10 years.  
 Girls teeth erupt before boys; girls reach puberty 2 years before boys.  
  
  
 
TOOTH DEVELOPMENT: 
 Tooth development initiated by mesenchyme’s inductive influence on overlying ectoderm;  
 Enamel of tooth from ectoderm while other tissues of tooth from mesenchyme. 
 Ectodermal cells responsible for crown root & shape;  
 Histogenesis of Tooth: once ectomesenchyme influences oral epithelium to grow into 
ectomesenchyme & become tooth germ: 
1) Elongation of inner enamel epithelium cells to enamel organ 
2) Differenciate into odontoblasts 
3) Deposition of first layer of dentin 
4) Deposition of first layer of enamel 
5) Deposition of root dentin & cementum 
 
 Korff’s Fibers – rope‐like fibers at periphery of pulp dealing w/ formation of dentin matrix. 
 Lobes  –  primary  centers  of  calcification;  separated  by  developmental  grooves  in  posterior  teeth  & 
developmental depressions in anterior teeth.  
→ Anterior teeth – 3 labial & 1 lingual lobe 
→ PMs – 3 labial & 1 lingual lobe (Mand. 2nd PM – 3 labial & 2 Lingual) 
→ 1st Molars – 5 lobes – 1 for each cusp. 
→ 2nd & 3rd Molars – 4 lobes – 1 for each cusp. 
→ No mamelons in permanent teeth unless malocclusion like anterior open bite! 
 Hertwig’s Epithelial Root Sheath – determines #, size, & shape of roots; inductor of dentin 
formation in developing root;  
→ Uniform growth = single root tooth; Medial growth = evaginations/multi‐rooted teeth; 
→ formed when outer enamel epitheilium & inner enamel epithelium combine at cervical loop 
region to form this bilayered structure. 
 6 stages of Tooth Development: 
1) Induction – induction, 5th week, formation of dental lamina from epithelium & mesenchyme. 
2) Bud Stage – proliferation, 8th week, dental lamina into 10 buds per arch; shape of tooth 
evident & enamel organ forms; 
3) Cap Stage – proliferation & differentiation (either morphodifferentiation or 
histodifferentiation), 9th & 10th week;  
a. tooth germ complete w/ enamel organ, dental papilla (pulp & dentin) & sac.  
4) Bell Stage – 11th & 12th week; dental papilla (either outer cells or central cells); dental sac  has 
increase in collagen; 4 cell types in enamel organ: 
i. OEE – cuboidal 
ii. IEE – columnar 
iii. Stelate Reticulum – star‐shaped 
iv. Stratum Intermedium – flat to cuboidal 
5) Appositional Stage – deposite specific dental tissues (enamel, dentin, cementum, & pulp). 
6) Maturation Stage – mineralization at DEJ & continues til tooth development 2 years later. 
 
FRACTURES: 
 Ellis Fractures   1) Class I – little/no dentin; tx – enamelplasty/bonding. 
2) Class II – fracture crown w/ lot of dentin but no pulp; tx – restore w/ CaOH & GI. 
3) Class III – fracture w/ pulp exposure; tx – Pulp therapy & restore.  
4) Class IV – fracture entire crown; tx – pulpectomy & SSC. 
5) Class V – tooth avulsed. 
6) Class VI – fracture root but not crown. 
7) Class VII – displacement of tooth. 
8) Class VIII ‐ fracture crown en masse (as a whole). 
9) Class IX – injury to primary teeth.  
 Prognosis less favorable in horizontally fracture primary teeth versus permanent teeth; 
 Fractured maxillary anterior teeth most often in kids w/ Class II, Division 1 malocclusion.  
 Chief cause of failure of replantation of permanent teeth is EXTERNAL RESORPTION.  
 Thickness of dentin in primary teeth = ½ of dentin in permanent teeth.  
 
VITAL PULP THERAPY: 
 Pulpotomy:  
→ No pulpotomy if tooth painful/swelling. 
→ Formocresol Pulpotomy – tx for primary teeth w/ carious exposure; success of formocresol 
pulpotomy for primary tooth depends primarily on vital root tip;  
• ZOE is placed over chamber & restored;  
• allows resorption & exfoliation of primary tooth but preserves space maintainer;  
• formocresol causes surface fixation of pulp tissue accompanied by degeneration of 
odontoblasts. 
→ CaOH Pulpotomy – not often used on primary teeth b/c alkaline pH can irritate pulp causing 
internal resorption; must be symptom free; forms NECROTIC dentin layer under CaOH. 
• for permanent teeth w/ carious exposure but immature root development & healthy pulp in 
root canals.  
 Pulpectomy – canals debrided, enlarged, & disinfected; filled w/ ZOE so it will resorb when roots 
resorb; tx of choice when there is periapical pathology.   
 Apexogenesis – vital pulp to encourage physiological development & formation of root end; MTA 
used;  
 Contraindications for IPC ‐  1) Spontaneous Pain 
2) Furcation involvement 
3) Pulp Involvement; 
4) Primary teeth 
 Chronic pulp infection in primary molars is noted in x‐rays as a change in bony furcation.  
 
OPERATIVE: 
 Primary  molars  have  exaggerated  cervical  constriction  &  enamel  rods  in  gingival  1/3  extend 
OCCLUSALLY from DEJ so no gingival bevel!! But Axio‐pulpal line angle BEVELED! 
 Class 2 Amalgam on primary teeth ‐  1) Box broader cervical than occlusal 
2) B/L/G walls break contact & can fit explorer thru it. 
3) B & L walls create 90o angle w/ enamel.  
4) Flat pulpal floor 
5) isthmus = 1/3 of intercuspal width.  
 If amalgam fracture occurs, it is most likely to occur here; prefer rounded angles in prep! 
 “Extension for Prevention” – only for amalgam, because you can use sealant for composite;  
 For SCC, reduce cusp 1‐1.5mm, while proximal surfaces are reduced & caried gingivally to extent that 
contact w/ adjacent teeth is broken; 2 types – Pretrimmed SSC or Precontoured SSC; 
o Remove sharp line angles and distinct buccal bulge especially in primary 1st molar.  
 Larger pulpal space in primary teeth limits depth of amalgam prep. Duh. 
 Cervical constriction in primary molars make gingival floor not ideal & difficult to adapt matrix band 
to the tooth.  
 Facial & lingual walls of proximal box should be paralles to external surfaces & converge slightly.  
 
LA/DRUGS/MEDS: 
 Mandibular foramen in child is slightly below plane of occlusion and more anterior than adults; 
 Max dose of lido in kids = 4.5mg/kg per appointment.  
 Bupivacaine/Marcaine should NOT be used on kids. 
 Most frequent inhalation agent for sedating pts = NITROUS; earliest symptom of conscous sedation is 
Light Headedness;  
 
 
EMERGENCY TREATMENT: 
 Emergency Treatment for Fractures of Permanent teeth w/ immature apices: 
1. Class I – smooth enamel edges and restore. 
2. Class II – apply CaOH & restore. 
3. Class III – apply CaOH & place temporary; if large, perform CaOH pulpotomy; after apex closes, 
do pulpectomy; 
4. Class IV – CaOH pulpotomy and after apex closes, due pulpectomy; 
 Intruded primary anterior tooth – NO TX; repositioning of primary teeth not recommended; However, 
if the intruded incisor is contacting the perm. tooth bud(take xray), then prim. tooth should be TE’ed. 
 Darker primary teeth from trauma is due to pulp bleeding & diffusion of BILIVERDIN in dentin 
tubules; if discolored primary teeth is asymptomatic & no radiographic changes, the NO TX.  
 Underdeveloped motor coordination is most common cause of dental trauma in kids 1.5‐2.5 yrs old. 
 Root fractures of primary teeth are UNCOMMON b/c more pliable alveolar bone; However, if root 
fracture, same tx as perm teeth but LESS favorable prognosis; Splinting is NOT recommended for 
primary teeth;  
 THERMAL test is most reliable in primary teeth but pulp vitality isnt commonly tested in these teeth. 
 
FLUORIDE: 
 CDC recommends at least 0.7ppm of fluoride be present in drinking water; max amt = 1.2ppm.  
 Water fluoridation & supplements may affect tooth morphology;  
 Types of fluoride added to water:  1) Sodium fluoride 
2) Hydrofluosilicic acid 
3) Sodium silicofluoride 
 As fluoride concentration increases beyond 1ppm, then increase in fluorosis prevalence but no 
increase in reduction of dental decay; 
 43 states have water fluoridation, 62% of population; Fluoridation cost 72 cents/person/year.  
 School water fluoridation concentration is 4x the city water due to less water consumption at school. 
 The most cost‐effective method of delivering fluoride to 6‐12 year old children (in non‐fluoridated 
community) is through school water fluoridation.  
 Over the counter fluoride rinces: ACT, Fluoriguard, Prevident; all contain 0.2‐0.5% NaF. 
 Fluoride in toothpastes: 1) Stannous Fluoride 
2) Sodium Monofluorophosphate 
3) Sodium Fluoride 
4) Sodium Fluoride & Calcium Phosphate 
 Fluoride concentration in USA is 0.1% (1,000ppm) = .22% NaF = .76% NaMFP = .4% SnF2.  
 Most desirable form of Fl‐ is fluorohydroxyapatite (less acid soluble, more resistant to caries) & most 
efficient means of forming this rxn is prolonged exposure of enamel to ↓concentration of fluoride.  
 Major mechanism of fluoride is caries inhibition which increases remineralization of enamel;  
 Fluoride also inhibits glycolysis (where sugar is converted to acid by bacteria);  
 Fluoride is BACTERICIDAL; decreases enamel solubility; least effective on root surfaces; 
 Fluoride works by stopping or even REVERSING tooth decay; greatest effect on newly erupted teeth.  
 Enamel demineralization starts at pH = 5.5.  
 Greatest concentration of fluoride ions exist on outermost layer of enamel;  
 Acute fluoride toxicity tx = syrup of IPECAC to induce vomiting & call 911; calcium binding products 
like milk decrease absorption. 
 Death by acute fluoride toxicity is cardiac failure & respiratory paralysis; fluoride toxicity shows up in 
the bones as OSTEOSCLEROSIS;  
 Child lethal dose = 15mg/kg; Adult lethal dose = 4‐5gm; completely weight dependent;  
 Fluoride absorbed thru stomach & small intestine & excreted by kidney; 
 Fluoride’s main effect occurs AFTER the tooth has erupted above the gingiva! 
 3 types of TOPICAL FLUORIDE: 
 Sodium Fluoride (NaF) – 2%; neutral/basic pH of 9.2; acceptable taste; 29% efficacy;  
 Stannous Fluoride (SnF2) – 8%; doesn’t etch porcelain; BAD TASTE & stains silicate 
restorations; pH = 2.1‐2.3; main advantage – SINGLE APPT but not used in U.S. 
 Acidulated Phosphate Fluoride – 1.23%; acceptable taste (bitter w/o flavoring) but 
damages porcelain & contraindicated in implant restorations;  
a. MOST COMMONLY used in practice;  
 
 Fluorosis – irreversible diffuse symmetric HYPOMINERALIZATION disorder of ameloblasts during 
CALCIFICATION period of tooth development.  
 
SEALANTS: 
 Fissue sealants succeed by altering host susceptibility.  
 Low viscosity sealants wet acid‐etched tooth surfaces the best;  
 Sealants need MICRO‐MECHANICAL RETENTION;  
 Acid etched w/ 30‐50% phosphoric acid;  
 Properties of sealants are closer to unfilled direct resins than filled resins like composite;  
 Sealants are best retained on max & mand PREMOLARS! 
 The principal feature of a sealant required for success is adequate retention.  
 Components of Pit & Fissure Sealants: 
a. Bis‐GMA – monomer diluted w/ TEGDMA to reduce viscosity. 
b. Initiator – Benzyol Peroxide in self‐cured sealants & Diketone in visible‐like cured. 
c. Accelerator – amine is self‐cured. 
d. Opaque Filler – small amounts of titanium oxide  to make different color than enamel. 
 
PEDS PATHOLOGY: 
 Cleft Palate & Lip are MOST COMMON craniofacial malformation, accouting for 50% of all defects! 
 Cleft Palate – failure of fusion of palatal shelves of Max. process w/ primary palate; more FEMALES; 
impairs speech & swallowing; occurs during 1st trimester of preganancy (6‐9 wks) 4 classes: 
1) Class I – only soft palate 
2) Class II – Soft & hard palate 
3) Class III – Class 2 & alveolar process 
4) Class IV – Class 3 & through alveolus on both sides of premaxilla. 
 Cleft Lip – failure of medial nasal swellings & maxillary swelling to fuse; Left > Right; more males; lip 
& primary palate develop @ 4‐5 weeks gestation period; during 4‐6 wks of pregnancy; 4 classes: 
1) Class I – unilateral notching of vermillion 
2) Class II – Class 1 & extends to lip. 
3) Class III – Class 2 & extends to floor of nose. 
4) Class IV – bilateral clefting of lip.  
 Atrophic Gingivitis – recession w/out alveolar bone loss; minor gingival inflammation; 
 Cretinism – HYPOTHYROIDISM due to absence of thyroxine from thyroid gland; defective mental & 
physical development; curved spine & pendulous abdomne; features are coarse; thickened lips.  
→ Underdeveloped mandible & overdeveloped maxilla w/ enlarged tongue; 
→ Anterior open bite & flaring; delayed eruption; unerupted but fully developed perm. teeth. 
 ADHD – M:F = 10:1; 3‐5% of children; child doesn’t usually need special dental treatment;  
→ Tx = Methylphenidate (Ritalin) – CNS stimulant; Amphetamines (Dextropamphetamine). 
 Scarlet Fever – EXOTOXIN‐mediated disease arising from group A βhemolytic strep infections; mostly 
in 4‐8 yrs old; strep throat, fever, headache, nausea, vomiting, pain, & fatigue;  
→ Strawberry tongue – enlargement of FUNGIFORM papillae above the level of desquamating 
filiform papillae; appearance of unriped strawberry; tx = PCN. 
 Diptheria – acute contagious disease caused by Bacterium Corynebacterium Diptheria, characterized 
by production of systemic toxin; damaging to heart & CNS; immunization available.  
 Nursing Bottle Caries / Baby Bottle Tooth Decay – most affect MAX. INCISORS; rampant decay 
from sleep‐time bottle feeding & activity of strep mutans;  
 Congenital Porphyria – autosomal recessive; skin become light brown & sensitive to sunlight & 
photosensitivity expressed as large bullous lesions;  
→ teeth are pink/brown but scarlet under UV light due to excessive porphyrins in blood during 
mineralization; 3 complaints:  1)Photodermatitis 
2)Neuropsychiatric complaints 
3)Visceral complains (abdominal pain/cramping) 
 Down’s Syndrome – underdeveloped midfacial regions; Class III; open bite; chronic mouth breathing, 
delayed tooth eruption, ↑rate of missing teeth; roots short & conical; heart defects are common;  
→ Need comprehensive preventive plan; difficulty accepting dental care but cooperation 
improved by using gradual exposure to dental office;  
 Type 1 Diabetes – body cant properly use/store glucose; body completely stops producing insulin; 
Xerostomia, infections, poor healing, ↑periodontal disease, burning mouth syndrome, blindness;  
 Apert Syndrome – cranial/limb anomalies; skull, midface, hands, & feet malformations; Shovel‐shaped 
incisors; Lefort 3 surgery for retruding midface; supernumerary teeth, Class III malocclusion.  
 Autism presents in the first 3 years of life; neurological disorder that affects brain function; 4x more 
prevalent in males than females;  
 Crouzon Syndrome – autosomal dominant craniofacial disorder; maxillary hypoplasia, crossbite; 
dysmorphic facial features;  
 Rieger’s Syndrome – delayed sexual development & hypothyroidism; hypodontia, underdeveloped 
premaxilla, cleft palate, & protruding lower lip;  
 Treacher Collins Syndrome – mandibular facial dysostosis (disorder of developing bone); autosomal 
dominant; sunken cheekbones, receding chin, malformed ears, mandibular hypoplasia, narrow face.  
 Seizures – grand mal (2‐5 min) is most common (90%); 3 phases of seizures: 
1) Aura – smell, taste, vision, hearing, emotions 
2) Ictus – larger event; tx = supine position, BLS, oxygen (if cyanotic) 
3) Postictal – drowsiness & confusion; brain recovery; tx = IV of 25‐50ml of 50% dextrose, 
then 10 mg IV of Diazepam;  
 Hemangioma is most common benign tumor of infants; vascular birthmarks that are biologically 
active so independent of child’s growth; 5x more common in girls;  
 3 stages of Odontogenic Infection: 
1) PA osteitis – inflammation w/in alveolar bone; NO soft tissue swelling but sensitive to 
percussion. 
2) Cellulitis – infection spreads from bone to soft tissue; inflammation & edema occurs; sensitive 
to palpation; may be caused by necrotic primary/permanent tooth; discolored tissue; bacteria 
– Group A Strep & Staph Aureus.  
a. Often Ludwig’s Angina in kids which causes DEHYDRATION! 
3) Supparation – inflammation localized to discrete, fluctuant abscess; 
 Conditions causing Delayed Exfoliation & Delayed Eruption: Cleidocranial Dysostosis, Ectodermal 
Dysplasia, Down’s Syndrome, Gardner’s Syndrome, Osteogenesis Imperfecta, Rickets, severe 
congenital heart disease, & mental retardation; Hypothyroidism, Hypopituitarism, 
Hypoparathyroidism, & genetics (most common reason for missing teeth);  
 
MISCELLANEOUS: 
 Child should have PANO by age 6; frequency of xrays depends on child’s risk of decay; 
 1st BWs should be taken when the spaces b/w the posterior teeth have closed.  
 Within 6 months of 1st tooth eruption – dental visit (b/f 1st birthday!); 
 30‐60% loss in mineralization b/f caries is radiographically evident.  
 At age 6, childs head is 90% of adults.  
 At birth ‐  1) jaw can accommodate all primary teeth 
2) width of face at greatest % of adults 
3) palate is flat 
4) can’t differentiate sour, salt, or bitter taste 
5) cranial vault very near size of adult 
6) brain & cranial base fully developed.  
 Tonsils in early life function to filter bacteria & program production of antibodies;  
 Age 6‐12, lymph tissue 200% of adult tissue; lymph tissue decreases at puberty while genital tissue is 
developing;  
 If permanent tooth bud is accidently extracted while removing primary molar, immediately orient the 
tooth bud, replant the bud using digital pressure, & suture.  
 Hydrodynamic Theory – pain results from indirect innervation caused by dentinal fluid movement 
in tubules which stimulates mechanoreceptors near the predentin.  
 The most personal behavior by the dentist is touching the patient gently in the arm.  
 The main advantage of using rubber dam is it AIDS in child management; it works for very 
nervous/anxious pts;  
 A very young child is best managed under GA; premedication w/ barbituate may cause paradoxical 
excitement in a young child.  
 Post‐anesthetic lip biting is common post‐treatment complication in children;  
PERIODONTICS 
 
 Tx of Perio‐Endo Abscess:  1) RCT – re‐evaluate in 2‐3 mo. 
2) Antibiotic 
3) Sc/Rp 
4) Perio surgury if needed 2‐3 mo. after RCT 
 Periodontal Cyst – cant be differentiated radiographically from periodontal abscess; common in 
mand. Canine/PM area; teeth vital; no periodontal pockets; presents as a local tender swelling; tx = 
excision.  
 Periodontal Abscess – vital teeth with deep pockets; acute pain that is constant, severe, and 
throbbing; increase in mobility; tx = PCN. 
 Periodontal Tx Planning: 
I) OHI, extraction of hopeless teeth, SRP, Occlusal adjustments/Nightguard, Splinting; RE‐Eval. 
II) Perio Surgery 
III) Restorative Phase 
IV) Maintenance Phase 
 
POCKETS:  
 Gingival Pocket – no apical migration of junctional epithelium; coronal expansion of marginal tissue; 
 Periodontal Pocket – Junctional epithelium to migrate apically along cementum; attachement loss! 
• Suprabony pocket – base of pocket coronal to crest of bone; horizontal destruction of bone; not 
intraosseous. 
• Infrabony pocket – base of pocke apical to crest of bone; periodontal osseous defect; 
angular/vertical destruction of bone; **contraindication of Mucogingival Surgery! 
 Infrabony/Intrabony pockets – vertical bone loss; classified as: 
1. 1‐walled = hemiseptum (only prox. walls present) or ramp (only F/L wall present). 
2. 2‐walled = interdental crater 
3. 3‐walled = intrabony defect; contraindication for mucogingival surgery. 
4. 4‐walled = circumferencial/moat defects. 
• 3 and 4 walled defects have best prognosis for treatment! 
• 0 (zero) walled defect = dehiscences and fenestrations; NO TX with osseous surgery! 
 Dehiscence – loss of buccal/lingual bone overlaying root portion of tooth leaving area covered by soft 
tissue only.  
 Osseous craters – concavities in crest of bone confied within facial or lingual walls; 1/3 of all defects 
and 2/3 of mandibular defects;  TX = osseous surgery and recontouring.  
 Horizontal bone loss parallels CEJ’s of adjacent teeth and is usually generalized while vertical bone 
loss is often localized.  
 Only way to determine # of walls surrounding tooth is exploratory surgery. 
 2 most critical parameters in prognosis of tooth – mobility and attachment loss.  
 Pseudopocketing – pocketing w/o attachment loss and marginal tissue moves coronally; pseudopicks 
are suprabony. 
 First detectable sign of inflammation is increase in sulcus fluid; bleeding is the most reliable indicator 
of gingival/periodontal inflammation.  
 Best criterion to evaluate success of SRP is NO BLEEDING on probing! 
 If after SPR pt returns in 1 wk, w/ hard & black deposits of calculus around gingival margin, indicates 
reduction in inflammation and old calculus is now exposed.  
 When the gingival margin coincides with the CEJ, the loss of attachment = the pocket depth.  
 
FURCATIONS & MOBILITY:  
 Classes of Furcations: (GLICKMAN FURCATION CLASSIFICATIONS) 
I. Incipient bone loss; probe feels depression of furcation opening.  
II. Partial bone loss; probe tip under roof of furcation; lesion is Culdesac, not tunnel! 
III. Total bone loss; thru and thru furcation (TUNNEL); furcation entrance isnt visible. 
IV. Grade III fucation but entrance visible.  
 Tx = guided tissue regeneration; Grade II furcations have good prognosis.  
 Max 2nd Molars have poorest prognosis. 
 Mobility Classes: 
0. No Mobility 
1. Barely distinguishable mvmt. (.5‐1mm) 
2. Mvmt 1‐2mm 
3. Mvmt > 2mm OR teeth depressed or rotate in socket.  
 
PERIODONTIUM ANATOMY: 
 Gingival unit = free gingiva + attached gingiva + alveolar mucosa  
 Attachment Apparatus = PDL + cementum + alveolar bone 
 Free gingival groove demarcates jct b/w free gingiva and attached gingiva; only present in 33% of 
adults. 
 Attached gingiva and free gingiva is KERATINIZED!  Gingiva 
coronal to the mucogingival junction is keratinized and 
gingiva apical is non‐keratinized.  
 Width of facial attached gingiva greatest on facial surface of 
MAX. L. Incisors and narrowest b/w MAND. Canines and 1st 
PMs.  
 Attached gingiva is coral pink color but it depends on degree 
of keratinization, thickness of epithelium, presence of 
melanin, and # of blood vessels.  
 Attached gingiva is measured by subtracting pocket depth 
from width of gingiva from free gingival margin to mucogingival margin. 
 Stippling – irregular surface texture of attached gingiva; intersection of 
epithelial ridges that cause depression and interspersing connective tissue 
papilla. 
• In healthy attached gingiva, it shows signs of stippling = orange‐peel 
appearance.  
 Gingival apparatus = gingival fibers + epithelia attachement. 
 Gingival Ligament = dentogingival + alveologingival + circular fibers. 
 Indifferent Fiber Plexus = in PDL; small collagen fibers that run indifferent 
directions. 
 Gingival fibers are type 1 collagen fibers that extend from cervical 
cementum into gingiva; just free gingiva but part of PDL; supports gingiva 
and keeps it closely adapted to tooth.   
• A‐ Circular Fibers – resist rotational forces; encircle tooth around most 
cervical part of root; insert into cementum, lamina propria, and 
alveolar crest 
• B‐Dentogingival Fibers – extend from cementum apical to epithelia attachement and course 
laterally.  
• C‐Dentoperiosteal Fibers – from cervical cementum over 
alveolar crest to periosteum of bone;  
• D‐Alveologingival Fibers – insert in crest of alveolar 
process and spread into free gingiva.  
 Gingival collagen different than rest of body with the 
collagen turnover not as rapid as PDL; collagen is 60% of 
gingival protein; but gingival collagen has significantly greater turnover rate than tendons and palate! 
 Epithelial Attachement – mediates attachment of reduced enamel epithelium (1o attachment) or 
junctional epithelium (2o attachment), namely internal basal lamina and hemidesmosomes; joins free 
gingiva to tooth surface.  
• The attachment apparatus that joins JE to tooth surface.  
 Junctional epithelium (.25‐1.35mm) ‐  stratified squamous, non‐keratinized epithelium that 
surrounds tooth like collar; 2 basal laminas; in healthy gingiva, JE is entirely on enamel above CEJ. 
• Firmly attached to tooth by hemidesmosomes; DOESN’T contain rete pegs while free gingiva does.  
• 10‐12 cells thick near sulcus and 2‐3 cells thick near apex. 
• Has a proliferative cell layer responsible for most cell divisions and in contact with C.T. 
• JE had desquamative/shedding surface located at coronal end and forms bottom of gingival sulcus. 
• Long JE refers to JE in disease.  
 The PDL is highly vascular & cellular connective tissue that surrounds the roots of teeth and bridges 
root cementum with alveolar bone; PDL is specialized rom of C.T. derived from dental sac.  
 PDL Principal Fibers (type 1 collagen) : connect root cementum to alveolar 
bone.  
A. Transeptal – tooth to tooth; keeps teeth aligned; not in facial aspect. 
B. Alveolar crest – cementum – alveolar crest; slants apically and resists 
LATERAL mvmt and counterbalance occlusal forces.  
C. Horizontal – runs perpendicular form bone to cementum; resists 
LATERAL mvmt. 
D. Oblique – slants occlusally from cementum to bone; resistant to 
MASTICATORY forces; 1/3 of fibers so most numerous. 
E. Apical – radiate apcial from cementum to bone; INITIAL resistant to 
OCCLUSAL forces.  
F. Irradicular – cementum‐furcation; only multi‐rooted teeth. 
 Sharpey’s Fibers – terminal portions of the collagen fibers that insert into 
cementum and alveolar bone; diameter > on bone side than cementum side. 
 The PDL is hour‐glass shaped w/ narrowest part in the middle of the root. 
 PDL fuctions:  ‐formative (connective tissue) 
‐remodeling (resorb cementum) 
‐sensory (proprioceptive and tactile sensitivity 
‐physical and nutritive 
• .2mm wide and decrease width as you increase in age; immature elastin = oxytalan +eluanin; 
• Oxytalan fibers run parallel to root surface in vertical direction and bend to attach to cementum in 
the cervical third of the root; regulates vascular flow.  
• Major cells of PDL:  1) FIBROBLASTS, macrophages, and ectomesenchymal cells. 
2) cementoblasts and clasts  
3) osteoblasts and clasts 
4) cell rests of malassez 
5) vascular and neural elements.  
• Nerve endings in PDL =  1) free unmyelinated nerves – convey pain 
2) encapsulated myelinated nerves – convey pressure.  
 4 traits that affect PDL health:  1) ant. teeth have slight/no contact in MIC. 
2) occlusal table <60% of overall F/L width of teeth 
3) occlusal table 90o to tooth’s long axis. 
4) mandibular crowns inclined 15‐20% toward the lingual.  
 Epithelial Rests of Malassez – groups of epithelial cells located in PDL; remnants of epithelial root 
sheath that remain following disintegration during root formation. 
 PDL is thicker in functioning teeth than non‐functioning teeth. 
 CEJ curves toward the apex F/L and away from apex M/D; curvature gets smaller as approach molars. 
• greatest contour of cervical lines and gingival attachements occur on the MESIAL surface of 
anterior teeth with the greatest cervical line curvature on the mesial of the max. central incisor.  
 Attached gingiva can withstand frictional forces but alveolar mucosa cant. 
 Functional Adequate Zone of Gingiva is keratinized and firmly bond to bone; 2mm or > in width and 
resistant to probing. 
 Keratinized Tissue (all stratified squamous epithelium) – hard palate, vermillion border of lips, 
dorsum of tongue, and gingiva.  
 Masticatory Mucosa – free & attached gingiva and hard palate; keratinized; 
 Lining/Reflective Mucosa – mucosa that lines most of the oral cavity; non‐keratinized epithelium.  
 Specialized Mucosa – covers dorsum of tongue and taste buds; keratinized. 
 Junction of lining mucosa with masticatory mucosa is Mucogingival Junction. 
 Alveolar Process (2 Parts). 
1) Alveolar Bone Proper – part of alveolar process that immediately surrounds the root of tooth and 
PDL fibers are attached;  
a. Perforates Cribiform Plate (2 layers) –  1)Compact Lameller Bone(spongy and compact) 
2)Layer of bundle bone (PDL fibers insert into it) 
2) Supporting Alveolar Bone – surrounds alveolar bone proper and supports the socket; 2 layers: 
a. Corticol Plate (thicker in mand.) 
b. Spongy bone (fills in b/w corticol plate of bone); it is not in ant. region or radicular buccal 
bone of max. post. teeth where cortical plate fused to cribiform plate.   
• Compact bone ‐  1) cribiform plate (socket) – bundle bone (PDL attaches) 
2) cortical plate (under gingiva)  
‐both are separated by spongy bone.  
 Epithelial attachement has no rete pegs. 
 Hydrodynamic Theory – root sensitivity caused from indirect innervation from dentinal fluid mvmt in 
tubules, which stimulates mechanoreceptors in pulp.   
 Vitamin C is needed for collagen formation for hydroxylation of proline to lysine.  
 CEMENTUM – thickness from 0.05‐0.6mm; radicular cementum (thicker than coronal) is cementum 
on root and coronal cementum is cementum on enamel; deposition of new cementum continues 
periodically throughout life so root fractures can be repaired.  
• Cellular cementum contains cementocytes and mostly in apical 1/3 of root and furcations; formed 
after tooth reaches occlusal plane. 
• Acellular cementum is cementum w/o cells and mostly in coronal 2/3 of root and thinnest at CEJ; 
major role is tooth anchorage; first formed cementum. 
• Main function of cementum: 1) can resorb but cant remodel! 
2) the attachements of principal fibers of PDL 
3) protects root surface from resorption 
4) compensates for loss of tooth structure from occlusal wear by 
apical deposition of cementum.   
5) reparative fct that allows reattachment of C.T. after perio tx.  
• 2 collagen fibers in cementum are sharpey’s fibers (perpendicular to cementum) and type 1 
collagen (parallel to cementum).  
 
PLAQUE & CALCULUS: 
 Layer of biofilm covers calculus which causes plaque to attach. 
 Plaque bacterial development: gram ⊕ facultative to gram – anaerobic bacteria. 
 Plaque ‐ accumulation of mixed bacterial community (>1010 bacteria/mg) in a DEXTRAN MATRIX;  
 PLAQUE = 80% water & 20% solids (95% bacteria); also contains calcium & phosphorus (from saliva) 
 Plaque is most likely to accumulate on INTERPROXIMAL tooth surfaces first.  
 Plaque – small # of epithelial cells, leukocytes, and macrophages; cells contain extracellular matrix 
with proteins, polysaccharides, and lipids;  
• Extracellular/dextran matrix is insoluble and sticky; 
• Gram ⊕ Facultative= S. Mutans and Sanguis and Actinomyces viscosus. 
• Gram – Anaerobic = Aa, Capnocytophypa species, Eikenella Corrodens, P. Gingivalis.  
• Pellicle – glycoprotein deposite (plaque).  
• Formation:  1) Formation of pellicle – albumin, lysozyme, amylase, IgA, proteins, & mucins. 
2) Bacterial Colonization –   1) primary colonizers = gram ⊕ ‐ S. Sanguis & Mutans & 
Actinomyces viscosus.  
        2) secondary colonizers = gram – at 1‐3 days of plaque 
              ‐‐Fusobactium, Prevotella, Capnocytophaga 
  3) tertiary colonizers ‐‐P. Gingivalis, Campylobactar,  
      Eikinella, Aa, & Treponema. 
3) Maturation Stage – bacterial intercellular adhesion results. 
4) Day 1‐2 = cocci 
5) Day 2‐4 = cocci dominant with filaments and rods. 
6) Day 4‐7 = increase in filaments and mixed flora begins. 
7) Day 7‐14 = vibrios and spirochets w/ WBC’s, more gram – anaerobes; 
     ‐signs of inflammation. 
8) Day 14‐21 = vibrios and spirochets in older plaque with filamentous forms; 
     ‐gingivits evident clinically. 
 Calculus = inorganic content of 70‐90% with Calcium, Phosphate, Magnesium and Carbonate.   
‐2/3 of the inorganic matter is hydroxyapatite;  
‐organic components are microorganisms, epithelial cells, leukocytes, and mucin.  
‐Calculus Formation takes about 12 days; it is formed by bathing the plaque in highly 
concentration solution of calcium and phosphorus from saliva.  
 Supra‐G Calculus – white/yellow; lingual of mand. Inc and buccal of max. molars the most b/c salivary 
gland; attaches by salivary pellicle; attached or tooth associated; Saliva & Diet alter its bacterial 
composition.  
• Gram positive facultative cocci – S. Sanguis and Mutans, Actinomyces Viscosus. 
 Sub‐G Calculus – dark color b/c blood breakdown products and more dense than Supra‐G calculus; 
formed from gingival fluid secretions; attaches by irregularities in Cementum; unattached or loosely 
adherent; Saliva & Diet DON’T alter its bacterial compostion. 
• Gram negative anaerobic rods/spirochets – P. Gingivalis, Fusobacterium Nuclatum, Prevotella 
Intermedia, Bacteroides.  
• Sub‐G root surface roughness doesn’t interfere with healing after SRP.  
 Microbiologic etiologic factor in periodontal diseases is PLAQUE while calculus is the most significant 
LOCAL contributing factor.  
 Primary reason to remove calculus is b/c it harbors plaque organisms.  
 S. Viridins is an alpha‐hemolytic streptococci that are common oral flora! 
 
INSTRUMENTS: 
 Most effective instrument of sub‐G Sc/Rp is sharp curet; working angle <90o or >45o. 
 RP promotes soft‐tissue attachement/reepitheliazation which occurs in 710 days.  
 Most important factor to determine amount of shrinkage is degree of edema. 
 Healing begins with blood clot formation and neutrophils predominate immediately after curettage 
(1st 12 hrs). 
 Chisel is best for removing supra‐G calculus interproximal for ant. teeth; single straight cutting edge 
with flat blade beveled at 45o.  
 Currettage – removal of sulcular epithelium and inflammed connective tissue; NEUTROPHILS 
predominate immediately after currettage; incidental currettage occurs during Sc/Rp.  
• Objective: Maximum shrinkage after gingival currettage of tissue that is edematous.   
• Contraindications for Currettage:  1) acute perio inflammation 
2) fibrotic tissue 
3) infrabony pockets 
4) mucogingival involvements 
5) when later wall is too thin.  
• In order for new attachment, need enough undifferentiated mesenchymal cells present, complete 
removal of calculus, and complete removal of junctional/pocket epithelium.  
• Gracey Curets: (60o to cutting surface) 
I. #1/2 & 3/4 – short shank distance and for ant. proximals and B/L posteriors. 
II. #5/6 – 2 different shank lengths but same as #1/2. 
III. #7/8 – universal (cutting surface is 90o) 
IV. #9/10 – B/L of PM & molars; long contra‐angle design. 
V. #11/12 – mesial of post. teeth.  
VI. #13/14 & #15/16 – distal of posterior teeth.  
 Graceys:  1) offset blade beveled 60‐70o. 
2) curved in 2 planes. 
3) 1 cutting edge.  
‐lower shank is parallel to tooth surface. 
 Universal: 1) not offset with 90o to shank. 
2) 2 cutting edges. 
3) curved in 1 plane.  
    ‐lower shank slightly tilted toward the tooth.  
 Curettes are smaller than scalers and have greater tactile sensitivity than scalers so best instrument 
for Sub‐G calculus detection & removal.  
 when sharpening, avoid producing “wire‐edge” by finishing with down stroke. 
 Properly sharped instrument with NO ROUND SURFACES will not reflect light.  
 when sharpening, lubricant allows metallic particles to be suspended in lubricant so prevents 
scratching/glazing of stone; use oil with national stones and water w/ artifical stones.  
 manual sharpening is preferred; 
 instruments whose cutting edge is >90o will slip over the calculus.  
 Sharpening gracey and universal curettes are essentially the same.  
 Curet – greater tactile sensitivity than scaler; cutting edge parallel and curved; smaller than gracey; 
first do short strokes and then long strokes.   
 Root planing strokes are longer and lighter than scaling strokes.  
 Periodontal Files: (cutting edge 90o) crush/fracture accessible Supra G calculus; best on B/L surface; 
good for distal of last molar; use Vertical Pull‐type strokes and can reduce amalgam overhands.  
 Hoes: (single and straight cutting edge 90o) only vertical pull‐type strokes; B/L surfaces are best;  
 Hoes and Files are used exclusively for HEAVY Supra‐G calculus removal but may be used sub‐G if 
gross calculus only and tissue is flexible and easily displaced; both have thick blades and lack of tactile 
sensitivity and adaptability; curettes used after hoe and files are used! 
 Most important plaque retentive factor is calculus! 
 Probe angle 10o to detect crater but mostly parallel to long axis of tooth; probe has 0.5 tapered shaft.  
 Periodontal probe is adapted in proximal areas so touches contact area with tip angled SLIGHTLY 
BELOW & BEYOND the contact area.  
 Clinical probing > histologic/pocket depth; accuracy +/= 1mm. 
 Most important reason for using periodontal probe is to determine ATTACHMENT LOSS! 
 Naber’s 2N or Hamp Probe are used to detect furcations.  
 Correct probe force is 10‐20 g so depresses thumb pad 1‐2 mm. 
 Record pocket depths > 3 mm and when gingival crest < 2mm at/below CEJ. 
 In healthy gums, crest of alveolar bone is 1‐2mm below CEJ. 
 Most common error during probing in EXCESSIVELY ANGLING the probe interproximally.  
 Probe should always be in contact with tooth and FLAT against the tooth. 
 Recession (gingival atrophy) is measured as positive value so if gingival margin coronal to CEJ then 
recession is negative.  
 Bacteremia can occur even with mastication or brushing, so must premedicate if probing.   
 Toothbrush trauma (abrasion) – usually occurs on canine and PMs; most common is left canine of 
right handed people; MOST COMMON etiology factor for gingival recession. 
• Dentin abraded 25x more than enamel and cementum 35x more.  
• Gingival Clefts – narrow groves that extend from crest of gingival to attached gingiva.  
 Most difficult arears to Sc/Rp are trifucations of Max. Molars.  
 Cementum, dentin and calculus are all removed during Sc/Rp. 
 In RP, working stroke begins at apical edge of junctional epithelium (base of sulcus/pocket). 
 Probing/Working Stroke is upward & downward movement w/in pocket.  
 Scaling storke is short and powerful PULL stroke; the motion to initiate a scaling stroek is from the 
FOREARM.  
 Common clinical changes 1 wk after SRP include reduced pockets and gingival inflammation. 
 3 Basic Strokes:  1) Exploratory/Assessment Stroke 
2) Scaling Stroke – short and powerful pull stroke. 
3) Root Planing Stroke – long overlapping pull strokes. (less pressure) 
 Order of strokes for Sc/Rp = vertical, oblique and then horizontal.  
 Correct angulcation of currette facial surface to tooth is 7080o.  
 straight shanks for anterior areas and contra‐angle shanks for posterior areas. 
 After perio tx, the 1st recal should be in 3 mo. and then can be lengthened to 4‐6 months. 
 Most difficult areas to scale are:   1)mesial of max. PMs 
2)proximals of mand. Incisors. 
3) trifurcations of max. molars. (MOST DIFFICULT!) 
 Best clinical aid to determin if Sub‐G calculus has been removed is explorer & BWs. 
 If Curette tip breaks off:  1) use another currette ina spoon‐like stroke to pull the fragment out of  
sulcus;  
2) take PA and place pt. UPRIGHT. 
3) check floor of the mouth and mucobuccal fold.  
4) best way to prevent curette breakage is proper sharpening technique.  
 Power‐Driven Scalers: use either magnetostrictive (ELLIPTICAL VIBRATION PATTERN) or 
piezoelectric technology (LINEAR VIBRATION PATTERN) to convert electrical energy to physical 
energy at tip; based on use/principal of HIGH‐FREQENCY SOUND WAVES; 
• vibrates from 25,000‐40,000 cycles/sec and amplitude = 10‐13 µm. 
• Use side of tip with water for cooling which causes water “cavitation” which releases dissolved 
gases.  
 Sonic intruments do not release heat the way untrasonics do, they are air‐turbine intruments that 
use air pressure to produce tip vibrations form 2,000‐6,000. 
 
OHI: 
 The primary cause of disease recurrence is dentist team failure to motivate pt to practice effective 
plaque control. 
 Dentinal hypersensitivity (cold sensitivity) is common after perio surgery due to clinical exposure of 
root surfaces; best tx = diligent OH! 
 Orange, green, and brown stains on anterior teeth are caused by poor OH! 
 Extrinsic Dental Stains:  1)brown stain – due to pellicle; color from TANNIN. 
2) black stain – chromogenic bacteria (actinomyces) 
3) green/green‐yellow stain – common in kids due to fluorescent bacteria. 
4) metallic stain – vary from green to black depending on metal.  
 Tooth brush must have soft, nylon bristles and a small head.  
 Methods for tooth brushing: 
1. Bass Method/Sulcular Technique – brush bristles place 45o to tooth and brush moved in back and 
forth motion for 20 strokes; PREFERRED METHOD FOR BRUSHING! 
2. Modified Stillman Method/Rolled Technique – brush resting partial on teeth and partially on 
gingiva; gingiva is blanched by tooth brush and moved back and forth strokes with brush moving 
coronally simultaneously. 
3. Charter’s Method – brush pointed away from gingival margin at 45o.  
 3 components of SUPERFLOSS: 1) stiff‐end threader – for under appliances 
2) spongy floss – b/w wide spaces 
3) regular floss – for interproximal plaque.  
 Tooth Paste Ingredients:   1) Fluoride 
2) abrasives – calcium phosphate or calcium carbonate 
‐removes stain & plaque 
3) surfactants/detergents – sodium lauryl sulfate (for foam) 
4) humectants – glycerin/water (for texture/moisture) 
5) binder/thickener – cellulose gum 
6) flavoring agents and sweeteners 
7) coloring agent – titanium dioxide 
 Chlorohexidine Gluconate 12% (peridex/perioguard) – 30 sec for 2x/day; helps control gingivits and 
greatest risidual concentration in mouth after its use; NOT teratogenic.  
• Causes reversible, yellow‐brown to brown stains in teeth, tongue, and resin restorations; impairs 
taste perception; the stain is due to presense of aldehydes & ketones.  
• Retention properties that are concentration and time dependent.  
• Its effectiveness due to greatest residual concentration in mouth after its use.  
 Gingivitis decreases with Phenolbased mouth rinses – LISTERINE and Quaternary Ammonium 
compounds – SCOPE & CEPACOL;  
o Phenol based rinses contain 20‐27% alcohol; essential oils are flavoring agents.  
 Perio Aid – tapered round tooth pick for tracing motion along gingival margins; cleans class II 
furcations. 
 Stim‐U‐Dent – balsa wood wedges for gingival massage, interdental recession, and dislodging 
interproximal debris. 
 Proxabrush – for interproximal brushing. 
 Interdental stimulator – rubber tip of smooth/ribbed conical shape; massages and stimulates 
circulation of interdental gingiva; don’t use if normal and filled gingiva.  
 Water Irrigation Devices – around bridges and ortho appliances; doesn’t remove all plaque.  
• Oral irrigation devices are contraindicated in pts with periodontal inflammation and pts requiring 
antibiotic premedication.  
 Polishing teeth is contraindicated in:  1) communicable disease 
2) respiratory problems 
3) green stains 
4) newly erupted teeth 
5) pt at risk for dental caries 
 Disinfectants/Antibiotics:  
1. Actisite – ethylene vinyl acetate flexible fiber impregnated with 12.7 mg of tetracycline HCl; for 7‐
10 days Sub G then removed.  
2. Atridox – biodegradable controlled release gel (7 dy)containing doxycycline; delivered via syringe. 
3. Perio Chip – gelatin chip contains 2.5 mg of chlorohexidine gluconate; bio‐absorbable over 8 days.  
4. Periostate – 2x/day tablet of 20 mg doxycline.  
 
PERIODONTAL DISEASE:  
 periodontal disease may be autoimmune disorder; periodontitis always begins w/ gingivitis! 
 BWs are most accurate to assess alveolar bone resorption 
 Smoking/nicotine – increase inflammation by reducing oxygen in gingival tissue and trigger 
overproduction of cytokines; smoking can cause bone loss and recession even in absence of 
periodontal disease; risk of periodontitis is directly affected by # of cigarettes smoked. 
o Smoking cigars and pipes carries equal risk as cigarettes. 
 Patients with diabetes have 15x’s increase risk of periodontal disease than nondiabetics; they have 
higher levels of specific inflammatory chemicals like interleukins.  
 Periodontal diseases is associated with:  1) Down’s syndrome 
2) HIV/AIDS 
3) Hormone imbalances 
4) uncontrolled Type 1 & 2 diabetes mellitus 
5) WBC disorders & Autoimmune diseases 
6) Medications 
7) Smoking 
8) Osteoporosis 
 Osteoporosis (loss of bone density) ‐ associated with periodontal disease in post‐menapausal women. 
 Criteria for diagnosis Gingivitis ‐  ‐color (most common color change is cyanosis ‐ bluish) 
‐contour (gingiva should be scalloped) 
‐tone (normal consistency) 
‐size (knife edge thickness) 
‐plaque/calculus 
• Gingivitis is the PREDOMINANT periodontal disease. 
• Best way to evaluate amt and distribution of plaque is with disclosing solution. 
• IgG is most abundant immunoglobin in gingival exudates and common in gingivitis. 
 3 stages of Gingivitis:   
1. Transient Stage – 2‐4 days after cessation of OH; margination of leukocytes on junctional 
epithelium. 
2. Developing Stage – collagen destruction increases and fluid fills in destruction with IgG; 
lymphocytes predominate and macrophages. 
3. Chronic Stage – Plasma cells predominant in lamina dura; IgG (from plasma cells) and IgA (from 
salive) and IgM (rarely). 
 Agranulocytosis & neutropenia associated with periodontal disease. 
 Localized Acute Gingivitis is most common form of gingival periodontal disease in school‐aged kids. 
 Pregnancy Gingivitis – common sign is gingival hemorrhage to gentle pressue;  
• increase levels of Prevotella Intermedia – this bacteria craves progesterone of its metabolism. 
• Gingival changes common in pregnancy because increase progesterone and increase in masts 
cells. 
• Sc/Rp, polishing and OHI ok during 1st and 2nd trimester. 
 Radiographic changes in Peridontitis:  1) loss of lamina dura 
2) horizontal/vertical bone loss 
3) widening of PDL 
 Inflammatory Gingival Enlargement – significant increase in pockets causing pseudopockets. 
 Dilantin Hyperplasia = progressive proliferation response to gingiva associated with use of sodium 
dilantin/Phenytoin; caused by plaque accumulation and increased accumulation of inflammatory 
cells;  50‐60% of people on dilantin will get hyperplasia; if OH is good, prolly wont obtain hyperplasia. 
 20% of people on calcium channel blockers will get gingival hyperplasia. 
 20‐30% of people on cyclosporin A (immunosuppressant) will get gingival hyperplasia. 
 Hereditary Gingivofibromatosis – rare genetic diseases causing generalized diffuse gingival 
enlargement, enough to cover the teeth; lack of inflammatory cells and proliferating capillaries. 
o Erythmatous changes are result of secondary bacterial involvement. 
 Tx for Inflammatory Gingival Enlargement and Hereditary Gingivofibromatosis is GINGIVECTOMY. 
 Aggressive Periodontitis (formerly Juvenile Periodontitis) – 2 forms: 
1. Generalized – 12‐25 yrs old; rapid severe periodontal destruction around most teeth and severe 
attachment loss; Prevotella Intermedia and Eikenella Corrodens. 
2. Localized – 12‐19 yrs old; rapid and severe attachement confined to incisors or 1st molars with 
absence of plaque; etiology – genetics or neutrophil dysfunction; Aa and Capnocytophaga (both 
are also associated with periodontitis in juvenile diabetes.  
• Good tx for Periodontitis with Aa bacteria is TETRACYCLINE! 
 Periodontitis progresses slowly and painlessly but is ARRESTED with proper therapy.  
 At least 30% of bone mass at the alveolar crest must be lost for a change in bone height to be 
recognized in xray; reduction in .5‐1mm thickness of cortical plate is sufficient to see bone 
destruction in radiograph.  
 Periodontitis cant be diagnosed w/o xrays but xrays are not definitive diagnostic tool with furcation 
involvement or interdental craters.  
 Desquamative Gingivitis – fiery red marginal and attached gingiva which demonstrates ulcerated and 
necrotic epithelium that sloughs off with air blasts. 
• Maybe manifestation of lichen planus or vesiculobullous disorder like pemphigoid. 
• Atrophic/eroded gingiva; loss of stippling; middle‐aged to elderly females. 
• Affects B/L attached tissue; rete pegs short/abscent. 
• Other Etiologies – allergy, crohn’s disease, psoriasis, or chronic ulcerative stomatitis.  
• Tx = steroids/corticosteroids depending on etiology; if dermatologic etiology then usually resolves 
when skin disease resolves.  
 ANUG – 18‐30 yrs; AKA – vincent’s infection or trench mouth; acute recurring gingival infection of 
complex etiology with necrosis of papilla; no attachment loss; 
• History of soreness/pain and bleeding gums form eating/brusing; fetor oris (odor), low‐grade 
fever, lymphadenopathy and malaise.  
• interproximal necrosis and pseudomembrane formation on marginal tissue; 
• Prevotella intermedia and Treponema spirochetes and Fusiform spirochetes. 
• Dominant WBC = neutrophils; predisposed if smoke or neglect. 
• Tx = debridgement, hydrogen peroxide rinses and antibiotics (PCN V, if not PCN, then 
tetracycline); pts with HIV and ANUG require gentle debridement and  antimicrobial rinses.  
 
BACTERIA: 
 The most likely source of bacteria found in diseased periodontal tissue is Sub – G plaque! 
 In healthy mouth, more than 350 species of bacteria, w/ periodontal infections linked to < 5%.  
 Periodontal HEALTH = gram positive NONMOTILE FACULTATIVE ANAEROBES. 
• S. Gordininii & Actinomyces 
 Periodontal DISEASE = gram negative MOTILE STRICT ANAEROBES. 
 Aggressive & Localized Aggressive Peridontitis ‐ Actinobacillus Actinomycetemcomitans (Aa) 
 Chronic Periodontitis – Porphyromonas Gingivalis 
 Deep Pockets and ANUG – Prevotella Intermedia, Treponema, Denticola, Sokranskii 
 Also associated with Periodontitis – Bacteroids Forsythus 
 Endotoxin – Lipopolysaccharide base in cell wall of gram negative bacteria; exists in plaque and 
gingiva; promotes bone resorption by decreasing osteogenesis and chemotaxis of neutrophils; 
 Plaque Bacteria produces enzymes that initiate peridontal disease:  
1) Collagenase – catalyzes degradation of collagen (produced by Bacteroides) 
2) Hyaluronidase (produced by S. Mitans & Salivarius) & 3) Chondroitin Sulfatase (produced by 
Diptheroids) – leads to destruction of amorphous ground substance. 
 Acute gingivitis = gram ⊕ bacteria like Actinomyces and Strep. 
 Chronic gingivitis = gram – bacteria like Fusobacterium, Prevotella, and Capnocytophaga.  
 Oxygen is major determining factor in different bacteria.  
 Oral cavity is sterile at birth but bacteria present at 10‐12 hrs after birth; 
• After 1 yr – S. Salivarious (most abundent), Staph, Neisseria, Actinomyces, Fusobacterium. 
• At age 4‐5, oral flora like adults.  
 
INFLAMMATION: 
 PMNs (neutrophilic leukocytes) are the first line of defense and first cells to migrate to gingival sulcus 
when inflammation is caused by plaque formation; while Polymorphonuclear Leukocytes are main 
cell components in CHRONIC inflammation.  
 bacteria that forms plaque/calculus relase toxins that stimulate immune system to overproduce 
powerful infection fighting factors called CYTOKINES: 
• cytokines are related to all periodontal disease: ie – TNF α, IL – 1B, IL – 4, and prostaglandin E‐2. 
• Cytokines are for healing but can cause inflammation from overproducing collagenase which 
breaks down proteins including connective tissue around teeth;  
• often have hyperinflammatory monocyte/macrophage phenotype.  
 Lymphocytes: 
1) B‐Cells – wbc that mature in bone marrow and migrate to lymphoid organs; antibody‐producing 
plasma cells involved in antibody‐mediated immunity; travels to spleen/lymph to differenciate.  
2) T‐Cells – wbc that mature in thymus and become thymocytes; important in cell‐mediated 
immunity and type 4 hypersensitivity rxns and modulation of antibody‐mediated immunity; 
a. Classes: T‐helper cells, Suppressor T‐cells, and cytotoxic (killer) cells.  
b. Pts with periodontal disease have T‐lymphocytes sensitized to plaque bacterial antigens. 
 Inflammation of Gingivitis: 1) Initial (2‐4 dys) – neutrophils. 
             2) Gingivitis (4‐7 dys) – lymphocytes, macrophages, IgG, and mast cells. 
             3) Chronic (wks – yrs) – increase in plasma cells (IgG) and B lymphocytes. 
 When gingivitis turns to periodontitis – gaine lymphocytes, plasma cells, and macrophages 
(represent transition b/w acute and chronic inflammation). 
 3 phases of Acute Inflammation –  
1) Vascular – vasocontriction, vasodilation, and increased vascular permeability; basophils, mast 
cells, and platelets. 
2) Cellular – first defense cells are leukocytes/neutrophils (via chemotaxis – chemotatic factors C5a 
and Leukotriene B4 {LTB4}); PMNs engulf matter by phagocytosis ‐ phagosome & phagolysosome. 
3) Repair – either by regeneration or replacement.  
 4 signs of Acute Inflammation ‐  1) redness – dilation of capillaries (from histamine) 
2) heat – increased blood flow 
3) swelling – increased capillary permeability (from histamine) 
4) pain – lysis of blood cells that trigger bradykinin and 
prostaglandins. 
 Mast cells increase in number with increased inflammation; releases heparin/histamine in response 
to injury/inflammation; mast cells participate in early phase of inflammation.  
o Major storage sights for histamine are mast cells, platelets and basophils.  
o Anaphylactic response is characterized by degranulation of mast cells.  
 Eosinophils are not in vascular phase but are predominant in allergic rxns and parasitic infections. 
 
TRAUMA & INFECTIONS: 
 Radiographic signs of reversible occlusal trauma:  1) widening of PDL 
2) thickening lamina dura 
3) angular bone loss 
4) root resorption 
5) hypercementosis 
 Other signs of occlusal trauma:  1) alternating repair and resorption of bone 
2) fibrosis of alveolar bone marrow spaces 
3) cemental resorption leading to dentinal resorption 
4) cemental tears 
          5) ankylosis 
          6) pulpal necrosis/calcification 
 Primary occlusal trauma – when occlusal trauma is principal etiology in changes in periodontium. 
• Early effect is hemorrhage and thrombosis of blood vessels in PDL. 
 Secondary occlusal trauma – when peridontium is already compromised by inflammation and bone 
loss so cant withstand occlusal forces well; 
• Early effect is mobility 
 Rosin in periodontal swelling used as filler for strength;  
 Types of periodontal dressings: 
a. Eugenol dressing (hard pack) = powder + liquid (eugenol); ie – PPC, Wards. 
b. Non‐Eugenol (soft pack) = base + accelerator; ie – Coe‐Pak & PerioCare; today periodontal 
dressings don’t contain eugenol b/c it causes its own tissue injury and necrosis. 
c. Light‐Cure = syringe; ie – Barricaid 
 Periodontal dressings have no well‐defined effect on process of wound healing or surgical outcomes; 
Must be removed in 7‐10 days.  
 After acute periodontal abscesses exude, they become chronic.  
 Bruxism: primary causes – occlusal prematurities, muscle tension, and emotional factors.  
• S & S: PDL widening and thickening of lamina dura, sore muscles, and jaw pain, difficulty 
opening mouth, increased mobility, and occlusal wear facets.  
 If periodontal abscess is localized then perform IND; if not then Rx antibiotics; the most prevalent 
symptom is acute pain and can cause rapid alveolar bone loss. 
 Splinting Teeth: primary reason for splinting is to IMMOBILIZE excessively mobile teeth for patient 
comfort; provides even distribution for occlusal forces; often on teeth with reduced periodontal 
support;  
• teeth tend to loosen B/L not M/D.  Types of Splints: 
1. External – ligatures, tooth bonding, etc.; unesthestic and unhygienic; lack durability and fit but no 
tooth structure is removed. 
a. Night Guards – primary purpose is to modify/control bruxism or to REDIRECT FORCES inot 
a non‐traumatic pattern; use CR occlusal splints. 
2. Intracoronal – amalgam/acrylic w/ embedded wire and acrylic for provisional splints; tooth 
structure removed; more serviceable than external splints but tend to break and plaque build‐up. 
 Steps in adjusting occlusion: eliminate prematurities in CR, in protrusive mvmt, and lateral 
excursive mvmt.  
 
 
PERIO SURGERY: 
 Autogenous free gingival graft – totally dependent on the bed of recipient blood vessels! This tx is 
good for increased width of attached gingiva for widening recession of gingiva and prophylactically to 
prevent recession in thin gingiva; 
 Allograft – graft taken from 1 human and placed in another human; a freeze‐dried decalcified bone 
graft aken from a human donor & placed in a periodontal defect in another human is also an allograft. 
 Hemopoietic marrow is the bone donor graft with the greatest osteogenic potential. 
 Free Gingival Graft – autogenous graft placed on viable connective tissue bed on B/L mucosa; donor 
site is often edentulous area or palatal area; success depends on graft being immobilized at 
recipient site. 
• Graft epithelium first degenerates, then sloughs, and reconstructed in a week; at 2 wks, the tissue 
reformed but maturation takes 10‐16 wks.  
• Top layer of graft is revascularized last; re‐epithelization occurs by proliferation of epithelial cells 
from adjacent tissue and surviving basal cells of the graft tissue.  
• Healing time is proportional to graft thickness and the greatest amt of thickness occurs in 1st 6 mo. 
• Free gingival graft is not as successful w/ deep wide recession so use laterally reposition 
flap/pedicle graft which has a greater predictability.  
• Often used in conjunction with frenectomy. 
• Rarely used on F/L of mand. 3rd molars.  
 Hemisection – vertical sectioning thru both crown and root; ofter Mand. Molars; ½ of tooth extracted 
and tx like premolar.  
 Root Amputation ‐  separating root from crown; mostly max. 1st & 2nd molars;  
 Both hemisection and root amputation result in irreversible pulpal damage requiring RCT after 
resection.  
 Osseous Recontouring – used to eliminate pockets! Also other treatment for eliminating pockets: 
a. Maintenance 
b. Bone grafts 
c. Reattachment – filled procedures 
d. Hemisection/root amputation 
 Palatal flaps cant be displaced!! 
 Flaps are most common perio surgeries and full thinkness flaps are most common! 
 Full‐thickness flaps are used where attached gingiva is thin (<2mm wide).  
 Partial thickness flap includes only mucosa and bone not exposed; used when a 
dehiscence/fenestration is present; used when attached gingiva is thick (base of flap is 2mm/more). 
 Internal Bevel Incision – the incision from which the flap is reflected to expose the bone/root; the 
incision…  1) removes pocket lining 
2) conserves relative uninvolved outer gingiva 
3) sharp thin flap margin for adapting tooth‐bone junction 
 Distal Wedge – simplest distal flap for retromolar reduction; performed after TE of 3rd s b/c bone fill 
is poor leaving periodontal defect; base of wedge is periosteum and apex is gingival surface; 
performed if: 
• Sufficient space distal to last molar 
• Max tuberosity 
• Mand retromolar triangle 
• Distal to last tooth in arch.  
 Gingivectomy – pocket depth eliminated by resecting the tissue coronal to pocket base; also 
bevel/contour the coronal margin; must have adequate attached gingiva and no infrabony defects.  
• Factors affecting surgery – pocket depth, access to bone, amt of attached gingiva.  
• When determining gingivectomy vs. periodontal flap – if base of pocket is located at the 
mucogingival junction or apical to the alveolar crest DO NOT perform a gingivectomy. 
 Gingivoplasty – reshapes gingiva and papilla for correcting deformities; objective is more 
physiological tissue contour not reduced pockets; common tx for ANUG.  
 Primary objective to surgical flap procedures is to provide access to root surfaces for 
debridement. 
 Modified Widman Flap – modification of replaced flap; full‐thickness flap; for open flap 
debridement and regenerative periodontal procedures; objectives: 
o Gain access 
o Reduce pocket depths 
o Preserve adequate attached gingiva 
o Provide env’t for healing by primary closure 
• Indications:  1) pockets with bases located coronal to mucogingival junction 
      2) little/no thickening of marginal bone 
      3) shallow to moderate pocket depths can be reduced. 
      4) where esthetics are important.  
 Reposition Flaps: 1) Replaced flaps, 2) MWF, 3) Excisional new attachement procedures. 
• Heal by repair & they are pocket reduction procedures that gain clinical attachment mediated by 
repair.  
 Positioned Flaps: when coronal margins of flap are lifted from an area adjacent to recipient site but 
flap isnt free’d up.  
• 1) laterally repositioned flaps, 2) coronally positioned flaps, & 3) apically positioned flaps;  
• vascular supply maintained so no necrotic sloughing; heal by repair.  
 Apically Positioned Flap: full thickness, mucoperiosteal flap; high degree of predictability and “work‐
horse” of perio therapy; indications: 
o Moderate to deep pockets 
o Furcation involved teeth 
o Crown lengthening 
• Flap is sutured more apically, so exposing alveolar margin to form broader zone of gingiva 
• Objective is to surgically eliminate deep pockets by positioning the flap apically while retaining 
the attached gingiva.  
• Max molars palatal surface – trim flap margin to proper length; 
• Contraindications: pt risk for root caries and unesthetic if tooth exposed. 
 Coronally Positioned Flap – full‐thickness flap exclusively used to restore gingival height and zone of 
attached gingiva over isolated areas of recession.  
 Pedicle Graft (lateral positioned flap) – first perio surgery for root coverage; defect covered by 
stretching flap laterally until free end comes over it; superior esthetics but less versatile;  
• base of graft remains attached to donor site for uninterrupted blood supply so position and 
repositioned flaps can be pedicle grafts; often full‐thickness flaps. 
• Indications:  1) widen zone of attached gingiva 
2) repair isolated recession 
• Advantages:  1) predictable correction/prevention of recession 
2) minor post‐op discomfort 
3) good esthetics. 
• Contraindications:  1) lacks attached gingiva 
2) donor site has fenestration/dehiscence of supporting bone. 
 Guided Tissue Regeneration – blocks repopulation of root surface to allow cells from PDL and bone to 
repopulate bone defect; use either: 
• Non‐resorbable barriers – expanded polytetrafluoroethylene (teflon) 
• Resorbable barriers – type 1 collagen, calcium sulfate (plaster of paris) , or polyactic acid.  
 Most common reason for free gingival graft failures = disruption of blood supply b/f engraftment and 
2nd reason is infection. 
 Double Papilla Flap = variation of laterally positioned flap; gingiva b/w teeth on either side are moved 
over exposed root; indications: 
o Trauma from brushing 
o Covering exposed root surfaces 
 Dental alveolar process less susceptible to permanent damage after surgical exposure than B/L plates 
of bone; 
 Four rules of flap design:  1) base of flap wider than free margin   
2) lines of incision not placed over any defect 
3) incisions that traverse bony eminence (canine) should be avoided. 
4) all corners of flap should be rounded. 
 Free Mucosal Autografts – when transplant of connective tissue w/o epithelial covering (differ from 
free gingival grafts); formation of keratinized tissue even if not keratinized recipient; often canines 
where little keratinized gingiva.  
 Osteoplasty – reshaping/recontouring bone that is non‐supportive bone (not attached to PDL); 
indications:  1)deep proximal pockets of buccal bone.         
      2) pockets on B/L/P surfaces where resorpion causes ledges 
      3) tilted 2nd molar adjacent to no 1st molar 
 Ostectomy – removal of osseous defects or infrabony pockets (below the crest of bone) by eliminating 
bony pocket walls; bone is supportive in nature; indications:  1) interproximal craters   
   
            2) deep interproximal pockets where neighbor areas are intact. 
            3) shallow infrabony defect (proximal) where reattachment  
            failed.  
o Contraindications:  1) if weakens support for adjacent tooth.  
 In some surgial procedures, it is necessary to leave interradicular bone exposed which may result in 
bone loss. 
 Without direct visualization provided by a flap, it is rare that a clinician can effectively root plane 
beyond 5mm of probing depth or into root furcations of lesser value.   
 Most critical factor in determining tooth prognosis is amt. of attachment loss! 
 Defects that “will hold water” offer excellent opportunities for bone graft containment and 
periodontal regeneration procedures.  
 Bone graft success depends on # of bony walls of defect; 3‐walled defect is best and worst is thru‐thru 
furcation of max. molar. 
 Best indicator of success of periodontal flap procedure is postoperative maintenance and plaque 
control by the patient.  
 Root resorption most likely side effect of autogenous bone graft. 
PHARMACOLOGY 
SYMPATHOMIMETICS: 
 Autonomic Nervous System: 
1. SYMPATHETIC (“fight or flight”) 
a. Preganglionic→CHOLINERGIC→Acetylcholine. 
b. Postganglionic→ADRENERGIC→NOREPI, EPI, & Dopamine (exception – innervation to 
sweat glands is cholinergic and secrete Ach) 
2. PARASYMPATHETIC (“rest & digest”)  
a. Preganglionic→CHOLINERGIC→Acetylcholine 
b. Postganglionic→CHOLINERGIC→Acetylcholine (Muscarinic Response) 
 Drugs that produce tissue responses resembling those produced by the sympathestic nervous system; 
adrenergic agonists; ie – dopamine, epi, norepi, isoproterenol, and phenylephrine. 
• α 1 – causes contraction & vasoconstriction of blood vessels so decreases hypotension;  
→ Controls hemorrhage(EPI/adrenalin), allergic shock(EPI/adrenalin), nasal 
congestion(phenylephrine – Neosynephrine); 
→ Contracts sphincter muscles in intestines, urinary bladder & uterus; while β relaxes those 
muscles; also in fat cells & platelets.  
• α 2 – nerve endings; found in presynaptic nerve endings to inhibits NE release and postsynaptic 
nerve endings to decrease sympathetic tone. 
• β 1 receptor – increases cardiac output & conraction via cardiac muscle; least common receptor. 
o Cardiac stimulation(isoproterenol – for asthma);  
• β 2 receptor – ↑dilation of bronchi and relaxation of arterioles; ONLY EPI!; also ↑blood glucose; 
bronchodilation (albuterol); Beta receptors mostly vasodilation & relaxation. 
• alphas predominantly excitatory while betas are excitatory in hear but inhibitory elsewhere. 
 Post Junction α1 – smooth muscle of iris, arterioles, veins, and GI tract (relaxes it!). 
 Pre Junction α2 – inhibits norepi release; found on post‐synaptic endings in CNS to↓sympathetic tone. 
 Post Junction β1 – in heart(mainly b1 receptors), intestine smooth muscle, and adipose tissue. 
 Post Junction β2 – bronchodilator and vascular smooth muscle. 
 Cranial nerves w/ parasympathetic activity – 3, 7, 9, & 10. 
 Catecholamines – sympathomimetic compounds composed of catechol molecule & aliphatic portion of 
amine; ie – epi, norepi, & isoproterenol: all direct acting catecholamines; also, Ach, Dopa, dobutamine, 
seratonin, GABA, opoids, & glutamate & aspartate; they pass blood brain barrier very poorly.  
 Epinephrine – catecholamine; physical properties unknown; rapid onset and prolongs duration of LA; 
stimulates α & β adrenergic receptors w/in sympathetic division of ANS. 
• Epi is the prototypical adrenergic agonist;  
• During anaphylaxis, extreme reduction in BP & bronchospasms, EPI stimulates α1 
(vasocontriction), stimulates β2 (dilates bronchioles), stimulates β1 (increase cardiac output). 
• it produces physiologic actions that are opposite the effects of HISTAMINE.  
• It also decrease blood volume in nasal tissues and relieves nasal, sinus, & throat congestion. 
• Restores cardiac activity in cardiac arrest; tx for glaucoma by reducing internal eye pressure. 
• Can be administered thru IV, sublingually, subcutaneously, or intramuscularly;  
• Contraindication – pts w/ ANGINA; side effects – headache, anxiety, tachycardia; caution in pts w/ 
high BP and hyperthyroidism.  
 Norepinephrine – catecholamine that works on alpha 1 & 2, and beta 1 receptors.  
o For vasoconstriciton in hypotension.  
 Isoproterenol – is b1 & b2 agonist and the MOST POTENT bronchodilator; cause cardiac stimulation. 
 Dopamine – immediate precursor to NE; catecholamine w/ 2 subtypes: D1 – activates adenylcyclase & 
D2 – inhibits adenylcyclase. 
o Dopamine & Dobutamine both used for shock & heart failure.  
 Seratonin – 5‐Hydroxytryptamine work thru 14 subreceptor “trytominergic” type neurons.  
 Glutamate & Aspartate – amino acids that have powerful EXCITATORY effect on every region in CNS;  
 Sympathetic activation of eye – mydriasis (dilation), heart – tachycardia (↑HR), salivary gland – thick, 
ropey saliva (↓saliva); activation of parasympathetic division of ANS causes opposite of these rxns! 
 Ephedrine – non‐catecholamine for urinary inconstinence & vasoconstriction in hypotension. 
 Phenylephrine – non‐catecholamine for mydriasis, vasoconstriction, & decongestion. 
 Oxymetazoline & Xylometazoline – causes nasal decongestion.  
 Adrenergic agonists are direct acting or indirecting acting (store and release NOREPI). 
 Amphetamines – sympathomimetic amines stimulate both CNS & PNS; pass readily thru CNS and 
release NE;  potent CNS stimulants; increase systolic & diastolic BPs and weak bronchodilators; Used 
for treatments in… 
1. ADHD – dexedrine, adderall (dextroamphentamine) instead of ritalin(methyphenidate). 
2. Narcolepsy – dexedrine (prevents daytime sleep) 
3. Weight Loss – lonamine (phentermine) 
 ADHD Treatment:  1) Methylphenidate (Ritalin) – mild CNS stimulant. 
2) Focalin – ner form of ritalin called Dexmethylphenidate. 
3) Concerta – long‐acting form of methylphenidate. 
4) Adderall – mixed amphetamine salts (mix of dextroamphetamine & 
amphetamine).  
5) Strattera – name for atemoxetine (1st non‐stimulant) 
6) Metadate CR – controlled delivery of methylphenidate.  
7) Dexedrine – Dextroamphetamine.  
 Selective Direct‐Acting Adrenergic Agonists: 
1. Phenylephrine  (Neo‐synephrine) – a1 selective agonist; nasal decongestant and tx orthostatic 
hypotension and prevents LA diffusion away from injection site; 100x less potent than epi.  
2. Clonidine (Catapres) – a2 selective agonist; anti‐hypertensive agent. 
3. Dobutamine – b1 selective agonists. 
4. Terbutaline – b2 selective agonist; administered orally, subcutaneously, or inhalation to treat 
longterm obstructive disease and ER tx of bronchospasm.  
5. Albuterol – b2 selective agonist; 
 α1 Adrenergic Blockers (‐ZOSIN)– cause tachycardia, vasodilation, ↓BP, and orthostatic hypotension. 
o Ie – Doxazosin(long DOA) & Prazosin ‐ ↑BP; Terazosin – tx for benign prostate hyperplasia.  
 Anti‐Hypertensives – 4 forms: 
1. β ‐ adrenergic blockers (‐OLOL): common side effect is drowsiness & weakness; 
a. Propranolol, Timolol, Nadolol– Block both β1 & β2 receptors; ↓BP by ↓CO; contraindicated 
in pts w/ asthma or COPD b/c cause fatal bronchospasm; also contraindicated in insulin‐
dependent diabetes pts b/ block hypoglycemia recovery. 
i. Propranolol – major anti‐anginal effect by blocking β‐adrenergic heart receptors; 
drug of choice for adrenergically induced arrythmias.  
b. Metaprolol (Lopressor) & Atenolol (Tenormin)– cardioselectively block β1 receptors. 
i. Metaprolol – B1 blocker for tx for angina & ↑BP; causes drowsiness. 
ii. Atenolol – B1 blocker w/ long DOA; tx for chronic angina & ↑BP; low lipid solubility 
and renally eliminated; long duration of action.  
iii. Both Metaprolol & Atenolo are longer‐acting & more predictable than Propranolol 
and safer to use in pts w/ asthma or bronchitis.  
c. Acebutolol (Sectral) – cardioselective B1 blocker & partial B2 blocker; tx for ↑BP & 
ventricular arrythmias; ↓solubility & mild intrinsic sympathomimetic (similar to Pindolol);  
2. α ‐ adrenergic blockers: cause tachycardia, lower BP, vasodilation, & orthostatic hypotension. 
a. NonSelective blockers: don’t treat cardiac conditions b/c can cause tachycardia & palpitations.  
i. Phentolamine Hydrochloride & Phenoxybenzamine Hydrochloride– block both α1 & α2 
for tx of presurgical management of pheochromocytoma (tumor of adrenal glands that 
releases excessive EPI & NE). 
b. Selective Blockers: blocks a1 to treat hypertension & benign prostatic hyperplasia(BPH). 
i. Doxazosin – blocks α1 to tx hypertension w/ long DOA. 
ii. Prazosin – blocks α1 but rarely used to tx hypertension. 
iii. Terazosin – blocks α1 to manage mild to moderate hypertension and BPH.  
iv. Tolazoline – blocks α2 for tx of pulmonary hypertension in newborn; causes direct 
peripheral vasodilation.  
c. Major adverse affect is hypotension;  
d. α ‐ adrenergic blockers can cause EPI REVERSAL; the anti‐adrenergics reverse pressor action 
of adrenalin/EPI; they block both EPI & NE but then EPI causes low BP b/c stimulates β2 
receptors too and they are not blocked by alpha blockers.  
3. Central Acting Agents: a2 selective AGONISTS that inhibit adrenergic nerve transmission thru 
actions w/in CNS; 
a. Clonidine, Guanfacine, Gaunabenz, Methyldopa. 
i. Clonidine – a2 selective agonist 
ii. Methyldopa – hypertensive tx for renal damage (good w/ diuretic); produces false 
transmitter that replaces NE; side effects – CV, CNS, GI, hepatitis, and cirrhosis.  
iii. Guanfacine & Guanabenz – stimulated centrally α2 and ↓SNS flow & reduce vascular 
resistance; Tx – antihypertensive; used either alone or w/ diuretic.  
4. Neuronal Depleting Agents: deplete catecholamine (NE) & seratonin from adrenergic terminals 
and in the brain;  
a. Reserpine (blocks NE, EPI & seratonin) & Guanethidine (blocks NE). 
 α blockers block epi(adrenaline) and the depressor response mediated by β2 receptors (↓BP). 
 α & β blocking agents act as COMPETITIVE INHIBITION on post‐junctional receptors. 
 Drugs for Asthma – β2 agonists (bronchodilate) – Epi, Albuterol, Salmeterol, and Metaproterenol. 
o Aminophylline – theophylline compound – bronchodilator & relaxes smooth muscle of bronchi. 
 
CHOLINERGICS: 
 Cholinergic drugs stimulate acetylcholine cholinergic receptors; they cause ↑ salivation, sweating, GI 
motility, miosis(constriction), ↑ flushing & bradycardia; ↑ secretions & muscle weakness! 
• Direct‐Acting (Esters & Alkaloids): Methocholine, Carbochol, Bethanecol, Pilocarpine. 
• Indirect‐Acting (Cholinesterase Inhibitors) : Neostigmine, Physostigmine, Edrophonium, & 
Pyridostigmine; 
• 2 Cholinergic AGONISTS drugs in Dentistry:   
1) Pilocarpine (Salagen)– tx for xerostomia from salivary gland hypofunction in cancer pts. 
2) Cevimeline (Evoxac)– specific for M3 receptor in salivary glands; tx of xerostomia in Sjrogen’s 
Syndrome. 
 3 classes of Cholinergic Agonists: stimulate muscarinic site & mimic Ach; if any of these cholinergic 
agents are administered b/f ACh, the action of Ach is enhanced & prolonged. 
1. Choline Esters:↓BP w/ generalized vasodilation; ↓HR, ↑GI tone, miosis thru ↓intraocular pressure; 
a. Acetylcholine Chloride – tx to produce miosis; methacholine (not used as much). 
b. Bethanecol – post‐op abdominal distension & urinary retention. 
c. Carbachol – tx to produce miosis. 
d. Methacholine – not used much anymore. 
2. Cholinergic Alkaloids: Muscarine, Pilocarpine, Nicotine, Lobeline; 
a. Pilocarpine ‐ most useful alkaloid for miotic & tx of glaucoma & xerostomia. 
b. Both Choline esters & Cholinergic alkaloids stimulate smooth muscle activity and both are 
direct‐acting cholinomimetic agents. 
3. Cholinesterase Inhibitors: inhibit acetylcholinesterase at both muscarinic & nicotinic sites 
(indirect acting cholinomimetic agents); cholinesterase inhiibitors also ↑secretions b/c they ↓ACh 
metabolism; they increase effects of Ach w/in autonomic nervous system & at NMJ.  
a. Physostigmine, Neostigmine, Endrophonium, Pyridostigmine, Malathion, Parathion. 
b. Endrophium – drug of choice in diagnosing myasthenia gravis b/c rapid onset and 
reversibility; distinguishes myasthenia gravis from cholinergic crisis b/c improves MG but 
worsens cholinergic crisis.  
c. Neostigmine & Pyridostigmine – tx for myasthenia gravis.  
d. Malathion & Parathion – insecticides.  
 Organophosphates (CHOLINERGIC)– esters of phosphoric acid & alcohol that inhibit cholinesterase;  
• Isofluorophate(glaucoma), Malathion(insecticide), Parathion(insectiside), 
Echothiophate(glauoma), Tabun(toxic nerve gas), Metrifonate(destroys intestinal worms). 
 Pralidoxime (Protopam) – anti‐cholinergic → cholinesterase reactivator which reverses muscle 
paralysis from organophosphate anti‐cholinesterase pesticide poisoning;  
o Reversed effects of overdose of anti‐chol agents used in tx of myasthenia gravis.  
o S&S of poisoning ‐ ↑salivation, bronchoconstriction, diarrhea, & twitching. 
 Stimulation of skeletal muscle by excess Ach eventually results in muscle paralysis. 
 Anti‐Cholinergics – block post‐ganglionic cholinergic fibers; cause XEROSTOMIA, MYDRIASIS, 
TACHYCARDIA & ↑ body temp, ↓ SPASMS of smooth muscle of bladder, bronchi, & intestines;  
• Anti‐chols ‐ no intrinsic activity, but cause xerostomia by blocking postganglionic cholinergic 
fibers and prevent Ach from occupying same receptor! 
• Contraindications ‐ glaucoma, CV problems, asthma, GI obstruction; 
• Ie‐ Beladona derivatives, Propantheline Bromide. 
• Glycopyrrolate (Robinul) – treats traveler’s diarrhea & anti‐secretory.  
• Benztropine Mesylate & Trihexyphenidyl HCl – treat Parkinson’s (anti‐parkinsonism). 
• Atropine sulphate – produces mydriasis & cycloplegia (paralysis of the ciliary muscle of the eye). 
• Scopolamine (pre‐op med) – prevents/reduces motion sickness. 
• Mecampylamine (Inversine)– nicotinic ganglion‐blocking agent.  
 Anti‐Sialogogues – drugs that control salivary secretions; anti‐cholinergics; also reduce spasms of 
smooth muscle and accelerate impulse conduction thru the myocardium by blocking vagal impulses. 
 Acetylcholine – chemical mediator of all AUTONOMIC ganglia & parasympathetic post‐ganglionic 
synapses; ACh alters cell membrane permeability & is secreted by cholinergic fibers; affects CNS by 
acting on these 2 receptors: 
1. Muscarinic Receptors: primarily in autonomic effector cells(heart, vascular endothelium, smooth 
muscle, presynaptic nerves terminals & exocrine glands) in CNS (also responds to Muscarine). 
2. Nicotinic Receptors: located in ganglia, skeletal muscle end plates & in CNS(also responds to 
nicotine); drugs like Ach mirror effects of para‐post‐ganglionic activity; 2 receptors: 
i. Receptors @Neuromuscular Jcts of somatic nervous system; Neuromuscular blockers act 
here. 
ii. Receptors @Autonomic Ganglia of both PSNS & SNS; Ganglionic blockers act here.  
 LA prevents/reduces liberation of Ach at neuro‐muscular jct of skeletal muscle; 
 2 types of Nicotinic Receptors: 
1. Neuromuscular Blockers – at neuromuscular jct of somatic system. 
2. Ganglionic Blockers – at autonomic ganglia (both symp & parasymp); rarely used because cause 
pronounced xerostomia, constipation, blurred vision, and postural hypotension. 
• Mecamylamine & Trimethaphan are used for ↑BP, ER ↑ in BP, & bloodless field surgery. 
 Neuromuscular Blocking Agents: produce complete skeletal muscle relaxation & facilitate 
endotracheal intubation; interact w/ nicotinic receptors at NMJ; two types: 
1. Nondepolarizing – competitively compete w/ Ach at nicotinic receptors & prevent Ach from 
stimulating motor nerves & can result in paralysis;  
a. prototype of Non‐depolarizing NMJ blocker = Tubocurare 
b. Mivacurium, Vecurium, Doxacurium, Pancuronium, Atracurium, Cisatracurium, & 
Rocuronium; Neostigmine & Pyridostigmine can reverse these! 
2. Depolarizing – noncompetitive;  
c. Succinylcholine (Anectine) – nicotinic agonist & depolarizes the neuromuscular end plate; 
prototype for Depolarizing NMJ blocking agent.  
 Used w/ caution in pts w/ ↓levels of pseudocholinesterase, which breaks down 
succinycholine – resp. failure may result; may cause muscarinic response like bradycardia 
& increased glandular secretions;  used if laryngospasm occurs during GA.  
 Spasmolytic Drugs (skeletal muscle relaxants) – relieve muscle spasms w/o paralysis; act on CNS & 
skelatal muscle cells; used in MS, cerebral palsy, cerbrovascular accidents/strokes).  
 Treatment for Chronic Muscle Spasms: 
1. Baclofen – derivative of GABA (site of action in reducing muscle spasms) that tx chronic muscle 
spasms; tx of MS & other spinal cord diseases; 
2. Carisoprodal (Soma) – tx of muscle spasms & acute TMJ pain. 
 Treatment of Acute Muscle Spasms: 
1. Cyclobenzaprine – relieves muscle spasm thru central action. 
2. Methocarbamol – centrally acting muscle relaxant to relieve acute pain & tetanus. 
 Quinidine – tx for nocturnal leg crapms; 
 
ANESTHESIA: 
 IV agents for GA: 
1. Barbituates – Thiopental, Methohexital,  Ketamine, Etomidate, Propofol. 
2. Benzodiazepines – Diazepam, Midazolam, Lorazepam. 
3. Neuroleptic Opoids – neurolept analgesics & fentanyl, and droperidol. 
 Nitrous (BLUE)– rapid onset w/ recovery in 5 min; less soluble in blood than alveolar air; considered 
sedative but not GA unless >80% which can cause hypoxia; gas at room temp & pressure. 
o Sweet smelling, colorless & inert gas; coupled w/ no less than 20% O2.(fail safe method). 
o Used to produce SEDATION & MILD ANALGESIA but must be coupled w/ LA.  
o Excreted unchanged by lungs; stored as liquid under pressure; onset of sedation = 5min. 
o Pt given oxygen for 5‐10 min after taken off Nitrous to prevent diffusion hypoxia.  
o Dose response for NO:  10‐20% ‐ extremity tingling  
20‐40%(usually 30‐50%) – sleepiness & relaxation 
>50% ‐ too much, nausea & sweating. 
o Contraindications – pts w/ URI, pregnancy(1st trimester), bronchitis, emphysema, and speech 
problems and pts w/ contagious diseases. 
o Most common complaint from pts on NO is mild NAUSEA. 
 Chloral Hydrate – only non‐barbituate sedative hypnotic agent & induces sleep;  
o DOESN’T RELIEVE PAIN. 
o Orally for preop management of anxious kids; kids excited and then sedated;  
o Rapid onset (15‐30 min) & DOA = 4 hrs; kids – 50mg/kg w/ max 1gm in 500mg/5mL solution.  
o unpleasant ordor & taste; prodrug & metabolized to trichloroethanol(displaces warfarin). 
 Toxicity of LA – causes bradycardia and decrease cardiac output; affects CNS & CV system; may cause 
restlessness, stimulation, tremors, seizures, CNS depression, slowed respiration, & coma. 
 Allergy to LA – may present as nasolabial swelling, itching, and oral mucosal swelling;  
 LA reversibly blocks sodium from going from outside to inside of axon; so LA decreases sodium 
UPTAKE thru the axon’s sodium channels; no effect on potassium; decreases pain by blocking 
propogation of nerve impulses;  
o Small, unmyelinated nerves (pain) affected 1st because greater surface volume.;  
o Nonionized free‐base form penetrate tissue; fat soluble/lipophilic drugs; converted to hydrophilic 
salts(water soluble) to prepare as injectable solution; pH=7.8. 
o ↓pKa = ↑pH = more free‐base available for injection. 
o At physiological pH of 7.4, 5‐20% of LA in free‐base form so enough to anesthetized.  
o Action of all LA’s depends on anesthetic salt ability to liberate free‐base 
o Max dose = 300mg; 4.4mg/kg for kids; Max carps →Lido – 8.3 carps, Mepivacaine (3%) – 5.6, 
Prilocaine(4%) – 5.6, Bupivacaine(.05%) – 10 carps.  
o 1kg = 2.3lbs; MAX DOSE of LIDO = 300mg or 4.4mg/kg for kids.  
o Amide LAs are metabolized in liver, so toxicity is more likely if amides given to pts w/ liver 
dysfunction.  
 ***POINT – potential action of all LA depends on ability of anesthetic SALT to LIBERATE FREE‐BASE.  
 Articaine (4% HCl) – amide LA; has ester group so could be inactivated by plasma cholinesterase; 
only amide metabolized in bloodstream; onset = 1‐6min & DOA =1hr;  
→ volume = 1.7mL & Max dose = 7mg/kg or 490kg.  
→ contraindicated in pts w/ bisulfite or LA amide allergy. 
 Prilocaine(Citanest) –intermediate DOA, longer acting than Lido but less potent & less vasodilation 
than Lido; metabolized as orthotoluidine ‐causes methemoglobinemia– not for hypoxic pts;  
o MAX DOSE = 400mg 
 Bupivacaine (Marcaine) – has longest DOA of any LA; Radiotoxic in some pts & used w/ causing in 
CV disease, elderly, & peds; MAX DOSE = 90mg 
 Lidocaine – anti‐arrythmic agent of the ventricle; acts on fibrillating ventricles to decrease cardiac 
excitability & spares the atria;  
 ***Lidocaine & Mepivacaine most likely to show cross‐allergy.  
 Mepivacaine (Carbocaine) – equal to lido in efficacy but ineffective as topical agent; short DOA and 
toxic to NEONATES; MAX DOSE = 300mg. 
 Ester LA – mainly used as topical (BENZOCAINE) due to allergies; procaine/novocaine metabolized & 
forms paraminobenzoic acid (PABA) which pts can be allergic to; no longer used in dentistry; rapid 
onset & short DOA except tetracaine which has longer DOA.  
 Cocaine – 1st LA ever; ester of benzoic acid; definite vasoconstriction; ONLY LA that increases 
pressor activity of EPI & NE by inhibiting catecholamine uptake by adrenergic nerve terminals.  
 Bisulfites (preservative for epi) can cause allergy in LA; only in LA w/ epi so 3% mepivacaine 
(carbocaine) doesn’t have epi so no bisulfites; most pts w/ allergy to LA have history of asthma and 
airway hyperactivity to sulfites. 
 
ANTIBIOTICS: 
 
 
 
 
 
 
 
 
 
 
 
 
• The following procedures were identified as having a higher incidence of bacteremia: dental 
extractions; periodontal procedures, including surgery, subgingival placement of antiobiotic 
fibers/strips, scaling and root planing, probing, recall maintenance; dental implant placement and 
replantation of avulsed teeth; endodontic (root canal) instrumentation or surgery only beyond the 
apex; initial placement of orthodontic bands but not brackets; intraligamentary & intraosseous local 
anesthetic injections; prophylactic cleaning of teeth or implants where bleeding is anticipated. 
 
 Other Conditions for YES for Prophylaxis: 
1. Tetrology of Fallot 
2. Total Joint Replacement ONLY if surgery w/in the past 2 years! 
 Other Conditions for NO for Prophylaxis: 
1. Rheumatic Heart Disease 
2. MVP w/ or w/o Regurgitation 
3. Septal Defects or Patent Ductus Arteriosus 
4. Hypertrophic Cardiomyopathy 
5. Bypass Graft Surgery 
6. Heart Murmurs & Kawasaki Disease 
7. Cardiac Pacemakers & Implanted Defibrillators 
 If a patient is already receiving antibiotic therapy with a medication that is also recommended for 
infective endocarditis (IE) prophylaxis, the guidelines state that it is prudent to select an antibiotic 
from another class rather than to increase the dose of the currently administered antibiotic. For 
example, if a patient is already taking amoxicillin, the dentist should select clindamycin, azithromycin, 
or clarithromycin for IE prophylaxis.If you don’t want to take antibiotic from different class then delay 
procedure 9‐14 days after pt completes antibiotic.   
 If unanticipated bleeding occurs, administer prophylaxis w/in 2 hours after procedure. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 # of Capulses for Antibiotics of Prophylaxis: 
→ Amoxicillin – 4 capsules (500mg/capsule) 
→ Clindamycin – 2 capsules (300mg/capsule) 
→ Cephalexin – 4 capsules (500mg/capsule) 
→ Cefadroxil – 4 capsules (500mg/ capsule) 
 Probenecid – used w/ antibiotic to delay renal clearance of antibiotic; interferes w/ organic acids at 
nephron & diminishes the PCN tubular secretion;  
→ affects PCNs & cephalosporins other β‐lactam antibiotics like Aztreonam & Imipenem. 
→ Drug of choice for tx of GOUT.  
 Antibiotics AFFECTING CELL WALL:  
→ PCN, Cephalosporins, Vancomycen, Imipenem, Cycloserine, Bacitracin, Aztreonam;  
 Penicillin – derivative of 6‐aminopenicilllanic acid & contains β‐lactam ring joined by thiazolidine 
ring; β‐lactam (3C & 1N) ring is responsible for antibiotic activity;  
→ synthesized from L‐cysteine & L‐valine. 
→ PCN is good for ANUG pts; 10% of population allergic to PCN.  
→ β‐lactam antibiotics – PCN, Cephalosporins, Carbepenems, & Monobactams.  
→ Excreted DIRECTLY into urine via renal tubular cell secretion.  
 Pen VK – antibiotic w/ narrow spectrum & bacteriocidal; good for minimizing resistance; used to 
treat ORAL infections b/c more acid stable; highest incidence of drug allergy;  
→ drug of choice for gram+ staphylococcal infection;  
 PCN G – PCN prototype due to basice 6‐aminopenicillanic acid molecule; add side chains to make it 
semi‐synthetic PCN – more stable and broader spectrum & more penicillinase resistant. 
→ PCN G Procaine (Crysticillin) – IM route 
→ PCN G Benzathine – IM route; tx for syphilis & prevent rheumatic fever; longer DOA.  
 Ampicillin (IV/oral) & Amoxicillin (oral) – both AMINOPENICILLINS (also Becampicillin) b/c 
characterized by amino substitution of PCN G; neither penicillinase resistant; extended spectrum PCN. 
→ AminoPCNs work against many gram (‐) more readilly than natural PCNs like Haemophilus 
influenzae, Escherichia coli, Proteus mirabilis.  
→ Both are preferred tx for UTI caused by enterococci; also tx for URI, otitis media, bronchitis, 
sinusitis, & bacterial cystitis.  
→ Ampicillin is good for pts who can take oral drugs and are NOT allergic to PCN;  
→ Amoxicillin significantly interacts w/ Methotrexate; Amox inhibits renal tubular secretion of 
methotrexate; methotrexate can cause ulceration of oral tissues. 
→ Amoxicillin ‐ ↑oral absorption, ↑serum levels, ↑half‐life, ↓GI effects than ampicillin; for gram+ 
cocci & gram (‐) bacilli.  
 Methicillin – part of the PCN family; not often used due to nephritis but give IV in sever PCN‐
producing STAPH infections;  
• MRSA (methicillin‐resistant Staph Aureus) – resistant to all antibiotics including vacomycin.  
• Methicillin, PCN G, & Carbenicillin are degraded by stomach acid.  
 Carbenicillin, Piperacillin, & Ticaillin – WIDEST broad spectrum of PCNs(Carbenicillin); all against 
gram (+) rods & cocci, like Pseudomonas, Proteus, Klebsiella, & Bacteroides;  
→ tx for UTI caused by Pseudomonas & Proteus;  given parenterally (IV). 
 Bacampicillin – tx for URI & LRI, UTI, & skin infections; hydrolyzed to amoxicillin when absorbed by 
GI; better absorption than ampicillin and less GI effects. 
 Bacitracin – gram (+) bacteria; for topical use b/c nephrotoxic.  
 Polymyxin B – cationic detergents that scrub bacteria cell membranes; topical use b/c nephrotoxity 
potential; against gram (‐) rods = Pseudomonas; triple antibiotic ointment for superficial lacerations; 
 Beta‐Lactamase – enzyme of gram (+) & (‐) bacteria that works agains PCNs & cephalosporins; adding 
clavulanic acid w/ PCN can inhibit the bacterial enzyme; MOA of enzyme is splitting open the β‐lactam 
ring structure to render the antibiotic ineffective.  
→ Augmentin – Amoxicillin & Clavulanic Acid. 
→ Unasyn – Amoxicillin & Sulbactum; IV or IM.  
 Penicillinase is a specific type of β‐lactamase, showing specificity for penicillins, by hydrolysing the 
beta‐lactam ring. 
 Penicillinase‐Resistant PCNs – Methicillin(IV), Nafcillin(IV), Oxacillin(IV), Cloxacillin(Oral), 
Dicloxacillin(Oral); they have protected β‐lactam ring which prevent penicillinase effects; 
• these PCNs are effective agains penicillinase‐producing Staph Aureus. 
• Ampicillin (unasyn) & Amoxicillin (augmentin) – block penicillinase from reaching beta‐lactam 
ring b/c contain clavulanate potassium & sulbactum. 
• Dicloxacillin – similar spectrum as Pen VK but active against penicillinase producing Staph.  
 IV PCNs – Methicillin, Carbenicillin, PCN G.  
 Acid Stable PCNs (Oral) – PCN VK, Amox., Amp., Nafcillin, Oxacillin, Cloxacillin, & Dicloxacillin.  
 Extended Spectrum PCNs – Aminopenicillins (Amp & Amox).  
 Broad Spectrum PCNs – Carbenicillin, Piperacillin, Ticarcillin – WIDEST spectrum of PCNs.  
 Cephalosporins: PCN‐like b/c affect cell wall; bacteriocidal; broad spectrum antibiotics(both gram(‐) 
& ⊕;  Increase in gram (‐) but decrease in gram (+) as you increase generations; 4 generations:   
1. 1st Gen. – Cephalexin, Cephradin, Cefadroxil, Cefazolin – used to as antibiotic 
prophylactic in pts w/ non‐immediate allergic rxn to PCN; Cephalexin & Cephradine are 
1st choice for prophylactic in pts not allergic to PCN w/ Total Joint Replacement w/in 2 yrs. 
2. 2nd Gen. – Cefaclar, Cefuroxime, Cefoxitin – tx for oro‐dental infections caused by gram 
(+) & (‐) bacteria and against anaerobic bacteria causing periapical abcesses.  
3. 3rd Gen. – Cefixime, Cefoperzone 
4. 4th Gen.  – Cefepime.  
→ Used in PCN‐allergic pts w/ Staph infections. 
 Imipenem – β‐lactam antibiotic from thienamycin & 1st drug classified as carbapenem antibiotic;  
→ tx for Enterobacter infections; combined w/ Cilastin for tx of severe/resistant infections, 
esp nosocomial infections. .  
 Aztreonam – synthestic β‐lactam antibiotic; against gram (‐) rods, like Klebsiella, Pseudomonas, & 
Serratia; synergistic w/ aminoglycosides. 
 10% of pts allergic to PCN are allergic to cephalosporins. 
 3 types of PCN allergic rxns: 
1. Anaphylactic Shock – 30 min; IgE mediated; characterized by urticaria, angioedema, 
bronchoconstriction, GI disturbances, & shock (hypotension); Tx immediately w/ EPI. 
2. Accelerated – 30‐48 hours after; uticaria(hives), pruritis, wheezing, edema. 
3. Delayed – 2‐3 days after; skin rashes; 8090% of PCN allergies.  
 Rash is most common sign of allergy to PCN.  
 Antibiotics INTERFERING W/ PROTEIN SYNTHESIS:  
→ Clindamycin(50S), Tetracycline (30S), Erythromycin(50S), Azithromycin, 
Aminoglycosides(30S), Linomycin, Clarithromycin, Chloramphenicol.  
 Clindamycin – bacteriostatic agains gram (+) like Staph & Strep & anaerobic gram (‐) like Bacteroid 
fagilis; causes diarrhea and pseudomembranous colitis caused by overgrowth of clostridium difficile.  
→ No cross allergenicity b/w PCNs & Clindamycin.  
 Tetracycline: limited oral treatment; can cause candidiasis and photosensitivity; absorption into GI 
tract inhibited by cations (Ca, Mg, Fe, & Al) so don’t take w/ milk, vitamins, or minerals; 3 types: 
1. Tetracycline – used for Local Aggressive(Juvenile) periodontitis, because good w/ AA 
bacteria, ANUG (if PCN is not used),  
a. acne, gonorrhea, syphilis, mycoplasma pneumonia, chlamydia, rickettsia, bronchitis. 
2. Minocycline – acne, anthrax, and meningococcal prophy; Ie – Arestin: used to tx periodontal 
pockets causing pocket to shrink. 
3. Doxycline – Syphilis, Rickettisa, Chlamydia, and mycoplasma infection. 
→ Contraindicated w/ child<8yrs & pregnant women while Doxycline & Minocycline – both 
contraindicated in pregnant women. 
→ BROAD‐SPECTRUM antibiotic, for Gram (+) and Gram(–) bacteria; Tetracyclines arrest rapid bone 
loss via tissue regeneration & enhanced repair due to their collagenase inhibiting effect.  
→ Absorption of tetracycline from GI tract inhibited by these cations – Ca, Mg, Fe, & Al; these cations 
form CHELATION PRODUCTS w/ tetracycline to prevent their absorption; so not given w/ milk, 
mineral supplements, or antacids.  
→ Adverse Effects – photosensitivity, nausea, diarrhea, fungal superinfections (Candidiasis), teeth 
discoloration, & enamel hypoplasia in kids.  
 MACROLIDE FAMILY OF ANTIBIOTICS – erythromycin‐type antibiotitics that are effective against 
Gram (+) but NOT gram (‐); GI upset;  includes azithromycin, clarithromycin, & dirithromycin 
 Erythromycin – causes 21% GI problems & tinnitus (deafness); metabolized in liver & excreted by 
bile; enteric coated – prevents release and absorption til reach intestines; poor oral bioavailability.  
a. 2 types: Erythromycin Stearate & Erythromycin Estolate; can cause liver toxicity. 
b. 2nd choice of antibiotic to PCN to tx Oro‐dental infections caused by gram (+) bacteria. 
c. Previously used as alternate to PCN‐allergic pts but no longer used due to GI upset, the 
most common side effect, so take with food;  
 Azithromycin (Zithromax ‐ 1x/day) & Clarithromycin (Z‐Pak ‐ 2x/day)– Azithromycin – 5% GI 
effects, Clarithromycin – 10% GI effects; prolonged elimination half‐life. 
• both have similar bacterial spectrums as erythromycin but better against H. influenza;  
• concentration on macrophages so good against Mycobacterium avium intracellulare.  
 Aminoglycosides (IV/IM)– may cause muscle weakness so may aggravate pts w/ myasthenia gravis, 
infant botulism, or Parkinsons; rapidly excreted by kidneys;  
→ causes ototoxicity & nephrotoxicity so must be used for serious infections.  
→ bacteriocidal & broad spectrum – aerobic gram (‐) infections.  
→ Streptomycin – 1st aminoglycoside for TB tx; rarely used.  
→ Gentamicin, Amikacin, Tobramycin, Netilmicin, Spectinomycin (tx for Gonorrhea). 
→ Neomycin (topically used b/c high toxicity potential) & Kanamycin (rarely used b/c of 
ototoxicity); 
 Chloramphenicol – broad spectrum gram(+) & (‐) & bacteriostatic; used as 2nd or 3rd line of drugs for 
serious infections b/c causes 3 toxicities:  1) aplastic anemia 
2) bone marrow suppression 
3) Gray’s syndrome (circulatory collapse)  
 Antibiotics INTERFERING W/ BIOSYNTHETIC PATHWAYS:  
→ Sulfonamides, Fluoroquinolones, Trimethoprim.  
 Sulfonamides (sulfa drugs) – similar structure to Para‐aminobenzoic acid (PABA), which is used to 
synthesize folic acid in bacteria, which is used to help bacterial cell growth; BACTERIOSTATIC.  
→ competes w/ PABA & inhibits folic acid synthesis, so inhibiting cell growth.  
→ Tx for UTI; Bactrim = Trimethoprim(antimicrobial) + Sulfamethoxazole (sulfonamide); 
Bactrim is drug of choice for UTI.  
→ NOT for dental infections;  
 Tuberculosis – caused by Mycobacterium Tuberculosis (needs combination of drugs since 
mycobacterium tends to develop resistants to any single anti‐tubular drug)). 
1. Isoniazid – 4 drug regimin w/ rifampin, pyrazinamide, & ethambutol; also used for 
prophylactic; may cause peripheral neuritis(paresthesia) caused by pyridoxine (vit B6) deficiency. 
2. Streptomycin – combo w/ isoniazid; aminoglycoside. 
3. Rifampin – prevents transcription; most potent anti‐leprosy agent. 
4. Ethambutol – in combo; may cause optic neuritis, hyperuricemia, & color vision disturbances.  
5. Pyrazinamid – in combo; enters CSF to treat tuberculosis meningitis.  
6. Rifabutin – active against MAI complex.  
 
 ANTIPROTOZOALS: 
1. Nitrazoxanide – tx of Giardia(diarrhea) which is common protozoan infection;  
a. tx of infections from Giardia Lamblia & Cryptosporidium Parvum.  
b. MOA – interfers w/ electron transfer rxn w/in protozoa that is essential to its metabolism. 
2. Atovaquone – tx of Pneumocystitis Carinii Penumonia (PCP), in pts intolerant to Co‐
trimazole(combination of Trimethoprime+Sulfamethoxazole – which is drug of choice for PCP by 
inhibiting folic acid synthesis.  
3. Eflornithine – orphan drug status for meningoencephalitic stage of Trypanosoma Brucei 
Gambiense Infection (Sleeping  Sickness).  
4. Furazolidone – tx of diarrhea from Giardia Lamblia or Vibrio Cholerae. 
5. Metronidazole – antibacteria & antiprotozoal for Trichomonas Vaginalis; affects cell walls! 
a. not true antibiotic b/c SYNTHETIC & lab fabricated;  
b. most effective Rx against anaerobic bacterial infections;  
c. causes dizziness, headaches, and nausea.  
 
 ANTIMALARIA AGENTS: 
1. Mefloquine ‐ against Plasmodium falciparum, P. vivas maraliae, P. ovale; active alone agains 
multi‐drug resistant Plasmodium flaciparum.  
2. Cloroquine – eradicates RBC forms by inhibiting plasmodial heme polymerase; tx for erythrocytic 
forms of Plasmodium falciparum & vivax; systemic amebic liver abscess & extraintestinal amebias. 
3. Quinine – back up agent for chloroquine used in combination w/ Fansidar chloroquine‐resistant 
malarial strains; adverse effects – Cinchonism ‐nausea, vomiting, vertigo, tinnitus. 
4. Atovaquone + Proguanil (Malarone) 
5. Sulfadoxine + Pyrimethamine (Fansidar) 
6. Halofantrine 
7. Pyrimethaminefolate antagonist: active against P.falciparum, P.malariae, & Toxoplasma gondii. 
 
ANTIVIRALS:  
 Viruses lack cell membrane, wall, & metabolic machinery, thus are Obligate Intracellular Parasites. 
 Oseltamivir(tamiflu) & Zanamivir(relenza): antiviral neuraminidase inhibitors; tx for influenza A & B. 
 Acyclovir (zovirax)– antiviral that inhibits DNA synthesis.   
 Herpes Simplex Type 1 Treatment: 
1. Penciclovir (Denavir) – CREAM; tx of recurrent herpes labialis (cold sores) for adults; inhibits 
herpes viral DNA synthesis which inhibits viral replication.  
2. Acyclovir – inhibits viral DNA polyermase/viral DNA synthesis; TABLET/CREAM to tx HSV‐1, 
HSV‐2, & varicella zoster(chicken pox/shingles);  
a. Drug of choice for HSV Encephalitis, genital herpes, herpes labialis, & varicella‐zoster virus;  
b. Enters CSF & accumulates during renal failure. 
3. Docuosanol(Abreva) & Lysine – anti‐virals that tx Herpes Labialis. 
4. Valacyclovir (valtrax) – PRODRUG of acyclovir given orally that is coverted by 1st pass 
metabolism into Acyclovir; tx for HSV‐1/2, genital herpes, cold sores & herpes zoster.  
5. Ganciclovir – inhibits viral DNA polyermase/viral DNA synthesis; tx Cytomegalic retinitis & CMV 
prophylaxis in transplant pts; cross BBB;  
 HIV – depletion of T‐cells (CD4); retrovirus w/ RNA as nucleic acid & uses reverse transcriptase to 
copy genome into DNA of host’s chromosomes; DNA segment is permenently incorporated into host. 
→ Tx – Didanosine (Videx), Zidovudine (Retrovir, AZT), Ritonavir (Norvir), Indinavir (Crixivan). 
 Nucleoside Reverse Transcriptase Inhibitors – stops HIV RNA from becoming DNA; drugs converted 
into AZT‐triphosphate analogs in cells to inhibit viral DNA synthesis & replication by inhibiting 
reverse transcriptase; may cause myelosuppression of bone marrow.  
→ Ie – Didanosine, Zalcitabine, Zidovudine, Stavudine, Lamivudine. 
 Protease Inhibitors – suppresses protease from cleaving viral precursors into peptides; 
contraindicated w/ pts taking Rifampin. 
→ Ie – Indinavir, Nelfinavir, Ritonavir, & Saquinivir 
 Non‐Nucleoside Reverse Transcriptase Inhibitors – non‐competitive inhibiting rxn of reverse 
transcriptase that is independent of nucleotide binding;   
→ Ie – Delavirdine, Adefovir, Efacirenz & Nevirapine.  
 Interferon – natural glycoproteins synthesized by recombinant DNA technology to activate host 
enzymes to block viral RNA translation and intervere w/ virus infecting cells.  
→ Tx for chronic Hep B&C, Genital papilloma, Kaposi’s sarcoma in HIV pts.  
 Amantadine & Rimantadine – anti‐viral that inhibit/block viral membrane matrix protein M2 ion 
channel; for prophy or tx of Influenza A virus; also enters CNS to tx Parkinson’s.  
 Ribavirin – inhibits viral mRNA synthesis; tx for serious Respiratory Synctial Virus infection for kids, 
influenza A&B, Hep C, & Sars; ORAL, IV, and Aerosol.  
 
ANTIFUNGALS: 
 Mycoses – chronic fungal infections; often superficial and subcutaneous.  
 Candida Albicans – inflammatory pruritic infection characterized by white, thick discharge (also 
causes angular cheilitis); normal inhabitant of oral cavity & vaginal tract; Drug of choice for tx = 
Nystatin.  
 List of Antifungals that alter cell membrane by binding to sterol in cell membrane: 
1. Clotrimazole – Mycelex Troche/Lozenge – for Oropharyngeal Candida; alters fungal cell membrane. 
2. Nystatin – Oral Suspension(swish & swallow)/Ointment – for Oral Candidiasis or Cutaneous; 
similar structure to Amphotericin B; alters fungal cell membrane.  
3. AmphotericinB – Cream/IV inj. – Cutaneous/Systemic Candidiasis; alters fungal cell membrane by 
binding to ergosterol in fungal membrane; anti‐fungal drug of choice for systemic fungal infections; 
→  may cause Kidney Toxicity; does not enter CSF. 
4. Ketoconozol – Cream/Tablet – Cutaneous/Oral Candidiasis; inhibits Ergosterol synthesis to disrupt 
fungal membrane; can inhibit/antagonize Amphotericin B antifungal effect;  
→ Given orally to treat Histoplasmosis, Nonmeningeal coccidiodomycosis, Blastomycosis, 
Dermatomycosis; toxicity may cause ENDOCRINE EFFECTS. 
5. Fluconozole – Tablet/Oral ‐ Esophageal Candida; inhibits erogosterol synthesis; crosses BBB and 
enters CSF; drug of choice for Mucosal Candida;  
→ tx for Blastomycosis, Histoplasmosis, & Cyptococcal meningitis in AIDS pts;  
6. Itraconazole – inhibits ergosterol synthesis; Broad‐Spectrum anti‐fungal give ORALLY; Drug of 
choice fo Blastomycosis & Paracoccidioidomycosis;  
7. Flucytosine – a PRODRUG that inhibits fungal DNA & RNA synthesis & cell division; give ORALLY to 
tx systemic mycosis of Chromoblastomycosis, Candidiasis, & Cryptococcus; enters CSF; 
 Nystatin & Clotrimazole alter fungal cell membrane by binding to sterols in the fungal cell 
membrane, increasing permeability & permitting the leakage of intracellular components. 
 
SEDATION: 
 Tranquilizers; Anti‐convulsants; Smooth Muscle relaxant; Preop sedative; induction agent & 
supplement for maintaining anesthesia; 
 Tranquilizers promote calmness & soothing but w/o sedation or depressant effects; 
o Major Tranquilizers – anti‐psychotic agents. 
o Minor Tranquilizers – anti‐anxiety agents (benzos) 
 Alleviate anxiety & induce sleep & IV causes CONSCIOUS sedation;  
 Benzodiazepines, Barbituates, Narcotics all produce sedation & have ability to produce dependence; 
 Benzos depresses limbic system & reticular formation thru strengthening GABA (gamma‐
aminobutyric acid, inhibitory neurotransmitter); NOT used during pregnancy. 
 Benzos used for anti‐anxiety, sedative, anti‐convulsant, & skeletal muscle relaxant; used for IV 
CONSCIOUS sedation during outpatient surgery.  
 Benzos are safer than barbituates; but causes fatigue, slurred speech, dry mouth, nausea, hypotension. 
 Most effective oral sedative drug used in dentistry; Benzodiazepines do not provide Anesthesia! 
 Oral Benzodiazepines:  1)Chloridiazepoxide (librium) – preop sedative 
2) Diazepam (valium) – preop sedative; anti‐anxiety 
3) Alprazolam (Xanax) – anti‐axiety, good for tx of Agoraphobia. 
4) Lorazepam (Ativan) – anti‐anxiety. 
5)Clonazepam (Rivotril) 
6) Temazepam (Restoril) 
 Benzodiazepines for Insomnia:  1) Flurazepam (Dalmane) & 2) Triazolam (Halcion) 
• Triazolam used as pre‐op sedative in dentistry and metabolized in liver by P‐450 isoform CYP3A4 
enzyme; antifungal agents can increase levels of triazolam b/c they inhibit CYP3A4 isoform for 
hepatic metabolism of triazolam.  
 Diazepam – preferred over barbituate as antianxiety; Tx for reversing status epilepticus caused by LA 
overdose; IV inj. into large vein; contra – glaucoma & psychosis; may cause withdrawal symptoms. 
o Propylene Glycol in the IV mix of valium is main cause of thrombophlebitis (vein clot). 
o Also used for muscle spasticity in pts w/ cerebral palsy. 
 Midazolam – liquid benzo used for pre‐op sedation in kids & as injectable for IV conscious sedation; 
very short half life; preferred over diazepam.  
 Flumazenil (Mazicon)– BENZO ANTAGONIST; reverses benzo in event of overdose.  
 Buspirone – oral anxiolytic; partial agonist on serotonic receptors (5‐hydroxytryptamine) & 
diminishes serotonergic action; fewer side effects & less sedation than benzos. 
• structurally & physically differ from benzos & barbs b/c not anti‐convulsant and doesn’t cause 
sedation and not physically dependent and not hypnotic;   
• slow onset ‐ up to 2weeks; may cause TARDIVE DYSKINESIA (involuntary mvmts); 
 Ethyl Alcohol – cuases diuresis by inhibiting production of ADH/Vasopressin; ethanol dilates blood 
vessels in skin, depresses CNS and may cause coma/death;  
• It is a sedative, a hypnotic drug; alcohol euphoria from removal of inhibitory activity of the cortex; 
• Synergistic w/ Diazepam, Meperidine, Pentobarbital, & Chlorpromazine.  
 Disulfiram (Antabuse) – manages ethanol abuse; inhibits aldehyde dehydrogenase (mitochondrial 
liver enzyme) so interferes w/ hepatic oxidation of acetaldehyde metabolism from alcohol. 
 Metronidazole also inhibits aldehyde dehydrogenase. 
 ANTICONVULSANTS: 
1. Phenytoin (Dilantin) (IV)– tx of tonic clonic (grand mal) seizures; may cause phenytoin‐induced 
gingival hyperplasia; produces Na+ channel blockade; most extensively used;  
2. Gabapentin – adjunct to treatment of partial seizures. 
3. Carbamazepine (Tegretol)– prophy for partial seizures (psychomotor) & temporal lobe seizures 
& tx for tonic clonic seizures & trigeminal neuralgia; produces Na channel blockade in order to 
treat trigeminal neuralgia; rare but may cause aplastic anemia. 
a. Adverse effects – diploma, ataxia, enzyme induction, blood dyscrasias.  
4. Diazepam (Valium) – tx for staticus epilepticus & emergency treatment for seizures. 
a. Adverse effects – drowsiness, dizziness, & ataxia.  
5. Valproic Acid (Depakene)– causes neuronal membrane hyperpolarization; prefered tx for 
complex partical seizures, absence seizures, & multiple seizure types;  
a. Adverse effects ‐ hepatotoxicity & dyscrasias, GI distress, lethargy, headache.  
6. Ethosuximide (Zarontin)– tx for absence seizures b/c causes minimal sedation by blocking Ca+ 
channels; adverse effects – GI distress, lethargy, & headache.  
• Most common anticonvulsants are CNS depressants; may cause respiratory depression. 
 BARBITUATES: depress neuronal activity in the midbrain reticular formation by ↑membrane ion 
conductance (Cl‐) & ↓glutamate‐induced depolarization & ↑inhibitory effects of GABA;  
→ may develop serious drug dependency; anti‐convulsant but NOT ANALGESIC! 
→ Barbituates are well‐absorbed orally; CNS depressant; metabolized in liver;  
→ cause of death – resp. failure due but reversed w/ O2 under positive pressue; so most important 
therapeutic measure taken in event of barb poisoning is to assure ADEQUATE RESPIRATION.  
→ Barbs exhibit steeper dose‐response relationships than benzos; 
→ ↓ ½ life of drug metabolized in liver b/c induce formation of liver microsomal enzymes that 
metabolize in drugs; 4 types classed by DOA: 
1. UltraShort Acting – IV for GA induction & Stage III surgical anesthesia. 
i. 5‐20min; thiopental (MOST COMMON, for anesthesia), methohexital, thiamylal; contra‐
PROPHYRIA, liver dysfunction, emphysema, drug addiction.  
2. Short Acting – oral for calming effect for pre‐op appts & insomnia; 
i. 1‐3hrs; secobarbital & pentobarbital; good for kids. 
3. Intermediate Acting – relieve dental anxiety w/ daytime sedation & tx for insomnia. 
i. 3‐6 hrs; amobarbital & butabarbital. 
4. Long Acting – tx of daytime sedation & epilepsy. 
i. 6‐10 hrs; phenobarbital(anti‐convulsant), mephobarbital, primadone. 
→ As decrease in DOA, increase in lipid solubility so Ultra‐short acting has highest lipid solubility and 
rapidly leaves brain for other tissues due to increased solubility (reason for short DOA);  
 Main target of INHALATION ANESTHETIC is brain; Lipophilic molecules; administration of anesthetic 
preceded by IV/IM barbituate w/ endotracheal intubation; 5 volatile liquids that require vaporization 
& may irritate respiratory tract & cause malignant hyperthermiaI; they cause ↓in arterial pressure. 
1. Enflurane – less potent but rapid onset with risks of seizures; CNS irritant effect. 
2. Halothane – powerful but toxin in adult liver; sensitizes heart to catecholamines. 
3. Isoflurane – combo with IV anesthetics; can cause heart irregularities. 
4. Sevoflurane – good for kids, less irritating with rapid awakening. 
5. Desflurane – heating component; irritating so used w/ IV agents but awaken faster than any 
other inhalant; has low blood:gas partition coefficient, but not used to induce anesthesia. 
 
NARCOTICS: 
 Opoids are analgesics, antitussives, antidiarrheals, & preanesthetic meds; DEA schedule II & III; opoid 
alkaloids = morphine & codeine; opoids raise pain threshold & tolerance;  
→ Opiods are most powerful drugs for pain relief; reduces amt of GA required for surgical 
anesthesia; strongest opioids – Morphine, Meperidine, Fentanyl, & Methadone.  
→ Side effects – sedation, drowsiness, dizziness, nausea (MOST COMMON SIDE EFFECT). 
→ Respiratory Depression is major disadv. Of opioids & most significant adverse rxn.  
→ Opoid Receptors: 
1. Mu – for morphine; the supraspinal analgesic activity of morphine is mediated primarily 
thru its influence on the Mu opioid receptor. 
2. Delta – for enkephalins 
3. Kappa – for dynorphins 
o Opoids bind to these receptors in brain to increase pain threshold.  
 3 types of Endogenous (produce naturally in body) Chemicals (produce morphine‐like effects to 
reduce pain): 
1. β‐endorphines – bind to opoid receptors and have potent analgesic activity. 
2. Enkephalins – bind to OPIOID DELTA receptors & more distributed than endorphines; role in pain, 
mvmt, & mood preception. 
3. Dynorphins ‐ most POWERFUL opioid found throughout CNS & PNS that bind to Kappa receptors; 
regulates pain at spinal cord level, influences behavior at the hypothalamic level, & regulate CV 
system.  
 Morphine(Opiates)  is the primary active agent in opium, an opium alkaloid; causes analgesia, 
drowsiness, euphoria, mental clouding, miosis, constipation, nausea, vomiting, & resp. depression. 
→ IV or IM (2‐3 hrs), oral (3‐4 hrs), sustained release is 8‐12 hurs; 
→ NOT used in dentistry due to its addictive liability.   
 Narcotic analgesics = effectively reduce pain (not‐inflammation) by working in brain to block 
ascending pain impulses that travel from perphery (PNS) into brain (CNS); opoids – common in 
dentistry is HYDROCODONE (simlar potency as morphine); ok w/ coumadin/warfarin. 
→ Hydrocodone + Acetaminophen = Vicodin, Lorcet, Lortab, Maxidone, Zydone. 
→ Hydrocodone + Ibuprofen = Vicoprofen; good for mod. to severe pain, good anti‐inflammatory. 
→ Oxycodone + Acetominophen =  Roxicent, Percocet, Tylox. 
→ Oxycodone + Aspirin = Combunox, Percodan **strongest pain med for outpatient basis.  
→ Oxycodone (similar potency as morphine) = Oxycontin 
→ Meperidine + Promethazine = Meperganfortis; 
→ Codeine + Acetaminophen = Tylenol #3; better than Empirin but poor anti‐inflammatory. 
→ Codeine + Aspirin = Empirin; avoid in asthmatics b/c codeine precipitates acute asthma attacks. 
 Most common side effect of opoids = nausea; also constipation, resp. depression, drowsiness, 
sedation, miosis, & euphoria. 
 Narcotics work in the brain(CNS) while ibuprofen & NSAIDS work in peripheral tissues (PNS); can be 
given in combination b/c 2 different mechanism completment each other for effective pain reduction;  
 Hydrocodone – Synthetic codeine derivative but more efficacious than codeine; poor anti‐
inflammatory & avoid in asthmatics.  
 Oxycodone – Synthetic codeine derivative but more efficacious than codeine; avoid in asthmatics; 
Highest dependency liability; 
 Codeine – less efficascous opium alkaloid analgesic; also antituissive that is weaker than morphine, 
less addictive, and less constipating; given ORALLY (3‐4 hrs). 
 Meperidine (Demerol) – synthetic opioid but less potent than morphine & short DOA & doesn’t cause 
miosis & cough suppressant; most abused drug by doctors; IV (for conscious sedation) or oral (3hrs) ; 
demerol tx for mod. to severe dental pain and may be used as pre‐op pain/anxiety reliever.  
→ Can cause seizures, tremors, & muscle spasms.  
 Fentanyl – transmucosal prep/lollipop lozenge (Actiq), patch (Duragesic), IV (Sublimaze); 100x more 
potent than morphine; IV for conscious/general anesthesia;  
 Pentazocine (Talwin)– chemically related to morphine but less potent; as strong as codeine; given 
ORALLY and lasts 4 hrs; blocks painkilling action of other opioids; 
 Propoxyphene – propoxyphene napsylate + acetaminophen; oral syntehtic opioid analgesic 
structurally similar to Methadone;  
 DarvocetN 100 = acetaminophen + propoxyphene; for pain control after dental surgery.  
 Darvon compound65 = aspirin + caffeine + propoxyphene.  
 Naloxone/Narcan, Nalmefine & Naltrexone (also for alcohol dependency)– all narcotic antagonist 
for narcotic overdose.  
 Methadone – also tx Heroin withdrawal.  
 
ANTIDEPRESSANTS & ANTIPSYCHOTICS: 
 Tricyclic Antidepressants – tx for unipolar disease (depression); inhibits neuronal re‐uptake of NE & 
serotonin so increase potentiation of neuotransmitter action; 
o Ie – best drug is Amitriptyline (Elavil) ‐ greatest anticholinergic; Desiparmine 
(Norpramin) has least anti‐chol effects; also Doxepin & Imipramine. 
o Side effects – drowsiness, xerostomia, constipation, blurred vision & tachycardia.  
o Highest incidence of DRY MOUTH w/ 75% of pts, due to secondary anti‐chol effect. 
 Selective Serotonin Reuptake Inhibitors (SSRI) = tx for depression; very high specificity for blocking 
re‐uptake of serotonin into pre‐synaptic cell so increasing time for attachement to post‐synaptic cell. 
o Ie – Fluoxetine (Prozac) – SSRI prototype & longest ½ life. 
o Ie – Paroxetine, Sertraline, Fluvoxamine – all tx for panic attacks, depression, & OCD. 
o Ie – Citalopram (Celexa) & Escitalopram (Lexapro) – tx for depression & anxiety.  
o Side effects – nausea, headaches, anxiety, agitation & SD. 
 LA & Tricyclic antidepressants & SSRI all increase NE in tissues so not good with LA & EPI due to ↑BP. 
 Tricyclic Antidepressants & SSRI are NE reuptake inhibitors so cause xerostomia in 75% of pts 
(secondary anticholinergic effects). 
 Lithium – tx for bipolar disorder (cyclical changes b/w manic & depressive phases of behavior); 
supresses MANIC phase; s‐times administered w/ anti‐depressants b/c cant handle depressive state 
alone; not used for acute manic episodes.  
 Monoamine Oxidase Inhibitors – tx for depression & parkinson’s; antagonizes monoamine oxidase 
which degrades naturally occuring monoamines(like EPI, NE, DOPAMINE, SEROTONIN);  
• Contraindicated w/ LA. 
• Interacts w/ Meperidine (demerol), EPI, EPHEDRINE (food w/ large amts of TYRAMINE). 
• Ie – Isocarboxazid(Morplan), Phenelzine(Nardil), Tranylcypromine(Parnate), 
Selegiline(Eldepryl). 
 ANTI‐PSYCHOTICS – tx of psychosis w/ schizophenia, paranoia, & manic‐depressive illness;   
1. Phenothiazines – block dopaminergic sites in brain; most effective antiemetic b/c depress 
chemoreceptor trigger zone to reduce nausea & vomiting; not for pts w/ CNS depression & 
epilepsy; may cause liver toxicity, hypotension, dry mouth; NOT anti‐convulsant! 
→ TARDIVE DYSKINESIA – involuntary motion of facial muscles, limbs, & trunck; effects basal 
ganglia; irreversible effect of phenothiazine; effects 20% of pts on drug>1yr;  
→ Extrapyramidal Syndrome – muscle spasms of oral‐facial region; results from blockade of 
dopamine receptors in brain; stop drug immediately. 
→ Chloropromazine & Thioridazine are phenothiazine prototypes that cause sedation, 
antiemetic (prevents nausea), α‐adrenergic blocker & potentiation of narcotics. 
→ Contra – severe CNS depression/epilepsy; caution in pts w/ liver disease.  
→ Adverse effects – hypotension, liver toxicity, xerostomia, tardive dyskinesia.  
→ These drugs will potentiate action of sedative drugs so use caution w/ sedation. 
2. Butyrophenones – Haloperidol (potent dopamine antagonist) & Droperidol; tx for schizo & 
Tourette’s. 
3. Thioxanthenes – less potent; Cloroprothixene & Thiothixene; tx for schizo. 
4. Diverse Heterocyclic Antipsychotics – antagonize dopamine & seratonin; more effective and less 
toxic than older Rx; effectively tx Schizophrenia but more expensive! 
→ ie‐ Molindone, Clozapine, Loxapine, Olanzapine, Risperidone, Quetiapine. 
 Neuroleptic Agents(anti‐psychotic) – tx of ACUTE manic episodes of bipolar disorder. 
 Ie – Chlorpormazine (phenothiazine) & Haloperidol – effect in extreme psychotic behavior. 
 Neuroleptanalgesics – neuroleptic‐opoid combinations that combine Fentanyl & Droperidol; Opoids 
provide analgesia & anesthesia;  
• Fentanyl – highly potent opoid used as premed/adjunct to inhalation agents; used w/ Droperidal 
& Nitrous to provide balanced anesthesia; Fentanyl come in transmucosal prep, transdermal 
patch, or as IV prep.  
• Innovar = Fentanyl + Droperidol; produces neurolepanalgesia w/ tranquilizing from Droperidole 
and analgesia from Fentanyl.  
 Propofol (Diprivan) – IV anesthetic w/ rapid onset/recovery (more rapid than barbs) & better 
tolerated; respiratory depressant but doesn’t produce vomiting/nausea and doesn’t increase 
intracranial pressure; safer for pregnant women but contra for kids! 
 Etimodate (Amidate) – advantage over other IV drugs is minimal resp/CV depressant effects; rapid 
induction/recovery; often used w/ opoids; maintains CV stability but high incidence of vomiting.  
 Ketamine – drug of choice for DISSOCIATIVE ANESTHESIA; causes catatonia amnesia & analgesia 
w/o loss of consciousness by blocking NMDA receptor & blocking excitatory effects; ONLY anesthetic 
that acts as CV stimulant; increase crebral blood flow & intracranial pressure; no bronchospasms; 
 
ANTIHISTAMINES: 
 Two types of Histamines: 
1. H1 receptors – allergic rxns. 
2. H2 receptors – gastric acid secretions; histamine stimulates parietal cells to produce HCL. 
 Antihistamines compete for receptor sites w/ natural histomine (found in all tissues); histamine is 
stored in preformed mast cells & basophils;  
• Histamine is released after response to IgE allergic rxns – role in hay fever, uticaria, angioneurotic 
edema; also controls acid secretion (HCl) in stomach. 
• H1 Blockers – both stimulate & depress CNS: two generations 
1. 1st Gen. – Diphenyhydramine (benedryl), Chloropheniramine, Tripelennamine (PBZ); 
broad action = antihistamine, anticholinergic, antiserotonergic, antibradykinin & sedative.  
2. 2nd Gen.– Cetirizine(Zyrtec), Fexofenadine(allegra), Loratadine(claritin), Desloratidine 
(Clarinex); they have poor CNS penetration so less drowsiness. 
• All H1 receptor antagonist block vasodilation, bronchicontriction, & capillary permeability. 
• H2 Blockers – compete w/ H2 receptors so only compete w/ histamine in GI tract; interferes w/ 
acid secretion in GI; all reversible COMPETITVE antagonists of H2 receptors w/ DOA = 12‐24 hrs. 
→ Block stomach acid secretions & treat duodenal ulcers by inhibiting histamine at parietal cells.  
→ Ie: Cimetidine(Tagamet‐may interact w/ hepatic metabolized drugs, may cause 
gynecomastia), Ranitidine(Zantac – for GERD), Famotidine(Pepcid), Nizatidine(Axid). 
→ Tx for acid‐peptic diseases, ulcers, Zollinger‐Ellison Syndrome (Hypersecretory disease) & 
GERD (but Omeprazole (Prilosec) is more effective which is a “proton‐pump” inhibitor). 
 HCl – produced by parietal cells of stomach thru pump w/in each cell which pumps protons into 
stomach; used for food digestion; H+ is pumped into stomach contents to make HCl for digestion. 
→ H+/K+ATPase pump which is inhibited by Omeprazole (Prilosec), Lansoprazole (Prevacid); 
so they reduce stomach acid formation by inhibiting proton‐pump of stomach’s parietal cells; 
→ Also reduced by inhibiting histamine is stomach at histamine type 2 receptors; ie‐ Ranitidine, 
Cimetidine, & Fomatidine.  
 
NSAIDS: 
→ Cyclooxygenase (COX) – enzyme produces prostaglandins; Prostaglandins derived from 
unsaturated fatty acids in cell membranes; 2 forms of COX enzymes: 
1. COX1: enzyme produces prostaglandins in GI tract and protects against ulcers; 
a. Ie – NSAIDS inhibit COX 1 & 2 so non‐selective COX inhibitors. 
2. COX2: enzymes produces prostaglandins at sites of surgery, infection, inflammation; no GI ulcers. 
a. Doesn’t affect clotting/platelet aggregation. 
b. Rofecoxib(Vioxx), Celecoxib(celebrex), Valdecoxib(Bextra) – COX‐2 inhibitor (not salicylates, 
not opiates, not NSAIDS); tx of rheumatorid & osteoarthritis & pain from dysmenorrhea. 
c. Piroxicam – NSAID for tx of rheumatoid & osteoarthritis;  
 Acetaminophen (TYLENOL) – weak COX inhibitor but also inhibits prostaglandin synthesis in CNS but 
reduces pain & doesn’t effect coagulation; Analgesic & Anti‐Pyretic, NOT ANTI‐INFLAMMATORY; 
categorized w/ NSAIDS but not necessarily one; good for pts w/ GI, bleeding disorders, asthma, young 
children, and pregnancy; less drug interactions but can cause hepatic necrosis.  
→ Drug of choice to relieve mild to mod. pain in pts taking anti‐coagulant b/c no platelet problems! 
→ Only OTC non‐inflammatory analgesic in the US.  
 Analgesic efficacy of combining acetaminophen & ibuprofen is greater than either acetaminophen or 
ibuprofen alone.   
 NSAIDS (COX Inhibitor)– inactivate enzyme prostaglandin endoperoxide synthase (cyclooxygenase) 
so decreases prostaglandin sythesis; ANALGESIC, ANTI‐PYRETIC, ANTI‐INFLAMMATORY; 3 types: 
1. Proprionic Acid Derivatives: Ibuprofen (motrin‐400mg of Ibuprofen, advil, rufen), Fenoprofen, 
Ketoprofen, Naproxen, Naproxen Sodium; all NON‐SELECTIVE COX inhibotors. 
→ Ibuprofen may interact w/ Warfarin(Coumadin) to cause unnecessary bleeding.  
→ Naproxen – anti‐inflammatory & analgesic and longer acting than ibuprofen but inhibits 
platelet aggregation; better w/ Type II diabetes pts.  
2. Acetic Acid Derivatives: Indomethacin, Sulindac, Tolmetin; 
3. Fenamic Acid Derivatives: Meclofenamate, Mefenamic Acid. 
4. Ketorolac (Toradol) – more effective analgesic than aspirin; used for mod to severe pain after 
dental surgery but suggested for no > 5 days;  
→ Side effects of NSAIDS: GI ulcers, ↑bleeding time, impaired renal fct, contra ‐ pregnancy in 3rd trim.  
→ NSAIDS reversibly reduce platelet adhesives; works best for mild to moderate pain; “ceiling effect” 
 Salicylate/Salicylic Acid(Aspirin) – non‐selective COX inhibitor; interferes w/ clotting irreversibly 
reducing platelet adhesives but doesn’t affect coagulation pathway; 
• discontinue 5‐7 days for normal clotting time to reappear. 
• if given w/ ibuprofen, analgesic efficacy < aspirin/ibuprofen alone. 
• Antipyretic action explayed by cutaneous vasodilation leading to increased heat loss.  
• Salicylism – overdoes of aspirin; not for kids w/ viral infection (REYE’S SYNDROME); headache, 
confusion, vertigo, tinnitus, nausea, sweating, vomiting; also contra for pregnancy in 3rd trimester. 
• Low doses of aspirin has cardioprotetive effects b/c reduce thromboxane production in platelets 
causing inhibition of platelet aggregation and can’t form thrombi (clots). 
 
CORTICOSTEROIDS: 
 Corticosteroids: (don’t cure diseases) – produced by ADRENAL CORTEX but don’t CURE any disease. 
1. Glucocorticoids – affect carbs, lipids,& protein metabolism; used as antiinflammatories. 
2. Mineralcorticoids – regulate Na+ (at collecting duct) & K+ metabolism in the COLLECTING 
TUBULES; tx for asthma, arthritis, allergies, stomatitis, erythematosis, & TMJ disorders. 
 Contraindication – any infections (bacterial, viral, fungal), CHF, or ulcers; 
 Adverse rxns – Cushing’s syndrome, Hyperglycemica Osteoporosis, ulcers & increase risk of infection; 
they represent replacement in Addison’s Disease (deficiency in steroids).  
 Addison’s Disease – hyposecretion of aldosterone & cortisol;  tx w/ 2ml of cortisol; corticosteroids 
only REPLACEMENT therapy for addison’s, not treatment; 
 Inhaled Corticosteroids (for asthma) – ↓airway inflammation in asthma enhancing bonchodilating 
effects of β2 adrenergic agonists; ↓ blood levels but can cause candidiasis of mouth & pharynx;  
o Ie‐ Triamcinolone, Beclomethasone, Fluticasone, & Budesonide. 
 Glucocorticoids – act on arachidonic acid metabolism which induces synthesis of protein that 
inhibits phospholipase A2, thus ↓prostaglandin & leukotriene production; may cause ULCERS! 
• creates anti‐inflammatory & immunosuppressive actions.  
• ↑gluconeogenesis, ↓use of glucose,↑protein sythesis,↑protein catabolism, impair wound healing, 
and ↑chance of infections. 
• Ie – Prednisone, Prednisolone, Dexamethasone, & Triamcinolone. 
• Ie – Beclomethasone, Budesonide, & Flunisolide – special glucocorticoids (INHALERS) used to 
tx chronic asthma & bronchial disease.  
• Fluticasone (Flonase/Flovent) – corticosteroid administered by inhalation to treat asthma by 
decreasing inflammation in the airway of asthmatics.   
• Inhaled corticosteroids often cause fungal infections (candidiasis).  
• Nasal spray cortico. used for seasonal allergies: Triamcinolone, Fluticasone, Budesonide. 
• Toxic effects – growth inhibition, hyperglycemia, osteoporosis, psychosis, & salt retention. 
 Prednisone – corticosteroid w/ anti‐inflammatory actions; tx for rheumatoid & osteoarthritis; side 
effects – insomnia, ingestion, arthalgia, edema, peptic ulscers, osteoporosis, muscle weakness.  
 Cortisol – major natural corticosteroid produced by adrenal cortex; mainly glucocorticoid. 
 Mineralcorticoids ‐ ↑ Na retention,↑Potassium depletion (can cause edema & ↑BP if excessive). 
o Ie – Aldosterone (natural), Deoxycorticosterone, Fludrocortisone;  
 Aldsterone – secreted by cells in Zone Glomerulosa of adrenal cortex; regulated by ACTH & renin‐
angiotensin system (regulates blood volume & pressure);  
o promotes reabsorption of Na into blood from glomerular filtrate;  
o so ↑aldosterone = ↑Na & ↓K in blood; so ↓Na in blood causes ↑BP/blood volume.  
o ↓Na = juxtaglomerular cells secrete renin which converts angeiotensinogen to angiotensin 1 
which is converted to angiotensin 2 which stimulates adrenal cortex to release aldosterone.  
 ADH (Vasopressin) ‐ ↓urine by ↑reabsorption of water by tubules; ↑ADH causes arterioles to constrict 
= ↑BP; ↓ADH = ↓water; alcohol inhibits ADH production so extreme loss of water. 
 
CV DRUGS: 
 ANTIARRHYTHMIC AGENTS  (classified via Vaughan‐Williams Classification System) 
1. Group I – Na channel blockers; further classified based on action potential duration.  
1. IA – Prolong action potential: 
a. Procainamide –anti‐A agent; tx of cardiac arrhythmias; derivative of ester LA procaine; 
↓myocardial conduction velocity, excitability, & contractibility by inhibiting influx of Na thru 
myocardial cell membrane so increase recovery period after repolarization.  
b. Similar to Quinidine (atrial fibrillation, tx for supraventricular tachyarrhythmia, PROTOTYPE 
for antiA) & Disopyramide – converts atrial arrhythmias to normal sinus rhythm.  
2. IB – Shorten action potential – Lidocaine(used for emergency ventricular arrythmias & 
decrease cardiac excitability, IV), Mexiletine, & Tocainide. 
3. IC – No action potential – Flecainide, Moricizine, & Propafenone(tx for ventricular 
arrhythmias & supraventricular tachycardias). 
2. Group II – Betablockers – for controlling ventricular rate during atrial tachyarrhythmias.  
1. Propranolol & Esmolo are prototypes! Side effects – bradycardia & hypotension. 
3. Group III – Potassium Blockers ‐ Amiodarone (Cordarone)– most potent & broad spectrum anti‐A 
compound; blocks Na, K, Ca channels & β receptor; tx for suppressing supraventricular & 
ventricular arrhythmias. 
4. Group IV – Ca Channel Blockers ‐ Verampamil –anti‐A agent that inhibits intracellular entry of Ca; 
***drug of choice for suppression of supraventricular tachycardias stemming from AV node.  
→ Ca channel blockers are good antianginal agent, esp. chronic angina;  
→ Cause peripheral arterioles to dilate & total peripheral resistance decrease.  
→ Also cause increase in oxygen delivery to myocardium; nitrates relieve acute angina. 
→ Ie – Verampamil (prototype), Ditiazem, Nifedipine 
 Other Anti‐arrythemics – Adenosine & Digitalis (cardiac glycoside).  
 Cardiac Glycosides: called digitalis b/c from digitalis plant;  
 helps heart beat strongly, slowly, & efficiently; tx of supraventricular arrythmias, shock, & CHF.  
 Inhibits NaKATPase membrane pump by inhbiting adenosine triphosphate enzymes 
(ATPase/Na‐K‐ATPase); inhibiting Na‐K‐ATPase leads to increase CALCIUM ion influx which 
causes ionotropic effect of glycosides.  
 Digoxin (Lanoxin) – anti‐A that directly increases myocardial contraction force; most common & 
versatile; creates positive ionotropic effect (help heart beat stronger); may cause appetite loss & 
diarrhea; contra – ventricular fibrillation & ventricular tachycardia. 
 Most drugs of cardiac arrhythmias act primarily by ↑refractory period of cardiac muscle.  
 ANTICOAGULANTS: 
 Prothrombin Time – detects plasma coagulation defects (factors V, VII, X); thrombin – prothrombin in 
presence of Ca, thromboplastin, or other factors.    
 International Normalized Ratio – prothrombin time expressed in INR values; fibrin=blood clot. 
• INR = PTT/standard PT time X constant (INR = 1, then normal PT time of 12 sec). 
• INR>1 = anticoagulant effect; incr. INR = inc. in anticoagulant effect.  
• No oral surgery if >5; very effective is <4. 
 Wafarin/Coumadin & Dicumarol– anticoagulant; antagonized vit K to prolong clotting time so 
decreasing liver synthesis of factors II, VII, IX, X so cant for fibrin;  
→ used after MI to prevent coronary occlusion, pulmonary embolism, and venous thrombosis. 
 Glycoprotein IIB/IIA Inhibitors – reversible anti‐platelet agents used to prevent acute cardiac 
ischemic complications; the block platelet glycoprotein IIB/IIA receptor (binding site for fibrinogen, 
von Willebrand factor, and other ligands); 
→ Abciximab (Reopro), Eptifibatide (Integrilin), Tirofiban (Aggrastat).  
 Enoxaparin, Dalteparin, Tinzaparin – low molecular weight heparin type anticoagulants that 
prevent deep vein thrombosis; Heparin inhibits rate of clotting proteases by antithrombin III 
imparing normal hemostasis & inhibiting factor Xa. 
 Heparin creates potentiation of antithrombin III inactivating thrombin/prothrombin (factor II) & 
prevents fibrinogen conversion to fibrin; contained in mast cells& basophils;  
→ high MW heterpolysaccharide found in the LUNGS;  
→ neutralizes tissue thromboplastin and blocks thromboplastin generation so affects coagulation 
pathway and prevents fibrin formation.  
→ Small effect on PTT but strongly inhibit factor Xa. 
→ Used for prophy/tx for thromboembolic disorders; administered subcutaneously. 
 Vitamin K – group of fat soluble vitamins for synthesis of factors II, VII, IX, & X & prothrombin in liver. 
 Clopidogrel (Plavix) – inhibits blood clotting by inhibiting platelet aggregation; no ulcer side effect 
like aspirin so antiplatelet drug of choice for pts w/ history of ulcers.  
 Abciximab, Eptifibatide, Tirofiban – glycoprotein IIb/IIa inhibitor type of antiplatelet agent; 
reversible anti‐platelet agents to prevent cardiac ischemic complications; 
 Lepirudin, Argatroban, Danaparoid – thrombin‐inhibitor type anticoagulants; inhibits fibrin 
formation; tx for post‐op deep vein thrombosis.  
 Conditions Managed by Anticoagulants: 
1. Coronary Artery Disease 
2. Angina Pectoris – prevent thrombus from forming. 
3. MI 
4. Stroke – prevents thrombus from forming. 
 ANTICHOLESTEROLS: 
 HMG‐CoA Reductase = hydroxymethyglutaryl coenzyme A reductase, which is key step in synthesizing 
cholesterol; inhibited by “statin” drugs – Atorvastatin (lipitor), Simvastatin (zocor), 
Fluvastatin(lescol), Lovastatin (mevacor), Pravastatin (pravachol), Rosuvastatin (Restor);  
→ When statin drugs inhibit this enzyme, cholesterol isnt produced in liver, so decreases blood 
cholesterol levels. Tx for coronary artery disease; 
→ **do not prescribe statin drugs w/ ERTHROMYCIN drugs, may cause renal failure.  
 Coronary Artery Disease – narrowing of blood vessels of heart restricting O2 flow to heart muscles. 
 Mechanism of Action of ANTIHYPERTENSIVES: 
1. Diuretics: 3 types 
a. Thiazides – inhibit Na reabsorption in DISTAL 
OF RENAL TUBULE causing increased 
excretion of sodium & water;  
i. Hydrochlorothiazide (HCTZ) – most 
widely used diuretic for hypertension but 
may require K+ supplementation;  
ii. Dyazide = Triamterine + HCTZ;  
iii. Metolazone – oral quinazoline & 
sulfonamide diuretic to manage edema & 
hypertension;  
iv. Indapamide ‐ first new class of 
antihypertensives/diuretics;  used in 
advanced renal failure;  
v. Thiazides tx = hypertension, edema of CHF, renal edema, Hypercalciuria, Nephrotic 
diabetes insipidus; adverse effects: Hypokalemia (can predispose pt to digitalis to 
ventricular arrhythmias), Hyperuricemia, Hypercalcemia.  
b. Loop Diuretics – inhibit reabsorption of Cl‐ & Na in ASCENDING LOOP OF HENLE causing ↑ 
secretion of Na, water, & Cl; 
i. ie – Furosemide (Lasix) – prototype, Bemtanide, Torsemide, Ethacrynic Acid. 
ii. MOA – ↑Ca content of urine which cuases ↓renal vascular resistance & ↑renal blood flow.  
iii. Drug of choice with Acute Pulmonary Edema of CHF; adverse effects – ear problems.  
c. PotassiumSparing Diuretics – act in COLLECTING TUBULE & conserve K+; most toxic effect = 
hyperkalemia; ie: 
i. Spironolactone (Aldactone) – competes w/ aldosterone receptor sites causing increased 
secretion of Na, Cl, & water; tx for aldosteronism & CHF.  
ii. Triamterine (Dyrenium) – promotes Na & water excretion but retains K+; blocks Na 
channels; Dyazide = HCTZ + Triamterine.  
iii. Amiloride (Midamore) blocks Na channels in late distal tubule & collecting duct which 
decreases K+ excretion;  
• Osmotic Diuretics – highly filtered by glomerulus; reduce edema from neurosurgery or trauma 
to the CNS; ie – Manitol, Glycerin, Isosorbide, & Urea; given via injection.  
2. β ‐ adrenergic blockers – decrease peripheral pressure by increase cardiac output. 
a. Cardioselective β blockers ‐block β1 receptor; Atenolol (tenormin) & Metoprolol (lopressor). 
b. Nonselective β blockers – Nadolol (Corgard) & Propanolol (Inderal). 
c. Both Atenolol & Propanol good for angina too. 
3. Angiotensin‐converting Enzyme Inhibitors – inhibit conversion of angiotensin 1 to 2 by inhibiting 
angiotensin converting enzyme, causing vasodilation & increased urinary volume excretion 
because Angiotensin II stimulates release of Aldosterone which promotes Na & H20 retention;  
a. Ie – Lisinopril, Ramipril, Enalapril, Captopril, Benazepril, Ramipril, Fosinopril, Quinapril, 
& Perindopril; used to treat hypertension & CHF. 
b. Angiotensin II (stimulate release of ADH – sodium & water retention) receptor blockers – 
Losartan, Valsartan, Candestartan, & Irbesartan.  
c. ACE inhibitors & Angiotensin II receptor blockers indirectly inhibit fluid volume increases.  
d. Renin – proteolytic enzyme of kidney & stored in juxtaglomerular apparatus and converts 
angiotensinogen to angiotensin 1.  
e. Angiotensin II – vasopressor; ↑ peripheral resistance & ADH release causing ↑cardiac ouput.  
4. Ca‐channel Blockers – Nifedipine & Ditiazem – both for angina; **may cause gingival hyperplasia. 
 Other vasodilators (DIRECT VASODILATORS) – Minoxidil (severe ↑BP), Nitroprusside (ER BP), 
Diazoxide (ER BP), Hydralazine (Apresoline); direct vasodilator action on smooth muscle of 
arterioles. 
 Angina – chest pain from occlusion of coronary arteries; Treatment: 
1. Nitroglycerin (Nitrates) – coronary artery vasodilator; administered SUBLINGUALLY w/ onset 2‐
4min; side effects – hypotension & headache; single most effective anti‐anginal agent for acute 
angina episodes.  
2. Non‐nitrate vasodilator = Dipyridamol (persantine) 
3. β blocker – Propanol, Nadolol, Atenolol. 
4. Ca channel blockers – Verapamil, Nifedipine, Diltiazem; they are INDIRECT vasodilators. 
5. Amyl Nitrite – inhalation agent; oxidizes hemoglobin to methemoglobin which binds cyanide 
tightly keeping it in circulation & away from tissues; used for emergency tx for cyanide poisoning; 
o vasodilator & highly volatile & extremely potent so rarely prescribed and not drug of choice for 
angina; side effects – orthostatic hypotension &  
o Most rapid antianginal drug (10sec) w/ DOA = 3‐5 min;  
o Abused to produce euphoria and as sexual stimulant; 
 
ANTIDIABETICS: 
 Insulin: secreted by pancreatic β cells of islets of Langerhans & essential for glucose metabolism; 
subcutaneous injection;  
a. ↑protein synthesis,↓gluconeogenesis, ↑glycogen synthesis, ↑triglyceride storage. 
 Antidibetic/Oral Hypoglycemic agents for Type 2 diabetes;  
1. Glyburide & Chloropropamide – stimulate insulin release from pancreas & reducing glucose out 
from liver.  
2. Metformin & Pioglitazone – increase insulin sensitivity at peripheral taget sites; 
3. Tolbutaminde – sulfonylurea; stimulates synthesis & release of insulin from pancreas and 
increases sensitivity of insulin receptors & utilization of insulin. 
 Humulin 70/30 – brand name for human form of insulin; an insulin mixture of insulin (30%, fast 
onset) & isophane insulin suspension component (70%, long duration). 
 Insulin Zinc Suspension (lente insulin): DOA = 18‐24 hrs & an intermediate acting insulin. 
 Insulin preps mimic endogenous insulin for type 1 & 2 diabetes: 
1. Ultra‐rapid acting insulin – Onset ‐ .25‐.5hrs; DOA = 3‐4 hrs; Insulin Lispro 
2. Short‐acting insulins: onset = .5‐3hrs; DOA = 8‐12 hrs;  
a. Regular Insulin or Prompt Insulin Suspension. 
3. Intermediate‐acting insulin = onset = 8‐12 hrs; DOA= 18‐24 hrs;  
a. Lente insulin & Isophane insulin. 
4. Long‐acting insulins = DOA >36 hrs, Protamine zinc insulin & Ultralente insulin. 
 Insulins differ in their onset & DOA. 
 Hypoglycemia is most serious and most common complication of insulin therapy;  
 
DRUGS: 
 Onset of action (Rate of Absorption) for different drug administration: 
1. Oral – 30 min (safest & easiest route but unpredictable & least effective; many different dosage 
forms); oral route most known for its significant hepatic “first pass” metabolism;  
a. generally absorbed best from duodenum; disadvan‐1st absorbed in intestines & blood from 
intestines then filtered in liver (hepatic filter); emotional stress decreases rate of 
absorption of a drug when given orally.  
2. IM – 5 min; not bicepts; for child = ant. thigh & ¼” of needle; adult = butt/deltoid & 1”of needle; 
never go deeper than 2/3rd of needle length.  
3. Subcutaneous – 15 min; injection under the skin so absorption less rapid.  
4. Inhalation – 5 min; MOST utilized route of administration w/ NO to sedate peds patients.  
5. Patch – 12‐24 hrs; systemic effect. 
6. Intra‐arterial Injection – injected into specific artery; may cause burning. 
7. Intravenous Injection – most rapid onset; allows for titration of individual dosages of drug but 
difficult to reverse; disadv – such rapid onset that overdose is difficult to reverse.  
o Parenteral Administration(not GI) – IV, IA, IM (uniform admin) & Subcutaneous.  
o Enteral Administration (GI) – buccal, sublingual, rectal, or oral  
o Topical – local effect. 
o Transdermal – systemic effect.  
 Drug’s onset of action primarily determined by rate of absorption. 
 Major effect of a drug is determined by how much of the drug is free in plasma. 
 Additive Effect – no greater effects!; when 2 drugs given & result is sum of their individual actions 
when given alone.  
 Synergistic – combine 2 drugs & sum of action > sum of individual actions.  
 Competitive Antagonism – when response achieved by increase dose of agonist in presence of 
antagonist; cant respond in presence of noncompetitive antagonism.  
 Cumulative Action – excessive accumulation effect that occurs if a drug is administered repeated and 
higher conc. of drug is desired may be achieved.  
 Four types of binding to receptors: 
1. Ionic Bonds – electrostatic attraction b/w ions; NOT covalent bonds or nitrogen bonding! 
2. H+ Bonds – b/w polar molecules. 
3. Van der Walls – weak interactions occur b/c close proximity.  
4. Hydrophobic Interactions – b/w drug, receptor & env’t.  
 Four Physiological receptors that drugs bind to: 
1. Receptors as enzymes: phosphorylating proteins in cell which alters cellular biochemical activities. 
2. Ion Channels: bind to ion channels & alter cell permeability. 
3. GProtein Coupled Receptors: when bind to receptor, secondary messengers (cyclic AMP) produce 
to affect cells;  
4. Receptors in cell nucleus: modify transcriptions of specific genes.  
 Drugs transfer across cell membranes through… 
1. Passive transfer – simple diffusion (lipid soluble drugs – only NON‐IONIZED drugs are soluble in 
lipids) & filtration (MV<60,000) & osmosis. 
2. Active trasnfer – lipid insoluble drugs (glucose) shuttled across membranes w/ carrier molecules 
that provide energy for transporting drugs to regions of higher concentration. 
 Facilitated diffusion – carrier‐based transfer; driving force = concentration difference; MOST DRUGS 
absorbed by facilitated diffusion.  
 Osmosis – pure solvent transfers thru semi‐permeable membrane from low to high solute 
concentration; impermeable membrane to solute but permeable to solvent.  
 Drugs that cause Orthostatic Hypotension: (abnormally low BP when pt assumes standing position) 
1. Antihypertensives – Guanethidine (Ismelin) 
2. Phenothiazine – Chlorpromazine & thioridazine (anti‐psychotics) 
3. Tricyclic Antidepressants 
4. Narcotics – Demerol/Morphine 
5. Anti‐parkinson’s drugs – Levodopa, Carbidopa, Levidopa.  
6. NSAIDS.  
 After vasovagal syncope, orthostatic hypotention is 2nd most likely cause of transient unconsciousness 
in dentist office; SnyDrager Syndrome – chronic orthostatic hypotension.  
 Phantom Pain – pain w/ no basis but fixed on some anatomy. 
 Intractable pain – pain resistant/refractory to analgesics. 
 Referred pain – pain in area other than site of origin. 
 Psychologenic pain – pain caused by psychic/mental factors. 
 Pain Threshold – lowest level of pain a pt. can detect.  
 Schedule of drugs criteria based on(Controlled Substance Act of 1970):  
1. Potential for abuse, 2. Medical usefullness, 3. Physiological Dependence, 4. Physical Dependence. 
 Schedule of Drugs: 
I. Not considered legitamate for medicine; no Rx; ie – Marijuana, Crack cocaine, Heroin. 
II. ↑abuse potential but legitamate for medicine; no refills, cant call in; ie – Morphine, Oxycodone, 
Ritalin, Cocaine, straight Codiene.  
III. Less abuse potential; can call in Rx & refills ok; ie – Codiene, Vicodin, Tylenol #3, Hydrocodone. 
IV. Less abuse potential; ie – Diazepam (Valium), Lorazepam (Ativan), Alprazolam (Xanax).  
V. Small abuse; common Rxs, may have small amount of Codeine. . 
 ↑LD50/↓ED50 = ↑therapeutic index = ↑safety. (LD = lethal dose, ED = effective does). 
o Ideal = therapeutic index of 100; ratio measures drug’s SAFETY.  
 Bioavailability of a drug – measurement of rate & amount of therapeutically active drug that reaches 
systemic circulation = 100% when IV; affected by dissolution (GI tract) & distruction (liver). 
 Habituation – acquired tolerance from repeated exposure to drug; 
 For all drugs but IV & IA, drugs absorbed systemically prior to receptors. 
 ***Initial distribution of drug into tissues is determined by rate of blood flow in tissues.  
 Cummulative action – increase concentration of drug desired when administered repeated.  
 Idiosyncrasy – response to drug that is unusual/abnormal.  
 Factors Affecting Hepatic drug Metabolism: 
1. Microsomal enzyme inhibition – drugs inhibit CYP isoforms of P‐450. 
2. Microsomal enzyme induction ‐↑metabolism and↓ drug blood levels. 
3. Plasma protein binding – drugs wont enter liver if highly bound to plasma proteins. 
4. Genetic factors & Pathological factors. 
 Urinary Elimination of Drug: 
1. Glomerular filtration – all drugs filter thru this b/f enter renal tubules.  
2. Tubular reabsorption – reabsorbed back into blood (highly lipid agents). 
3. Active transport.  
 Other excretory pathways for drugs: GI, Lungs, Sweat. 
 Efficacy of drug = intrinsic ability = ceiling effect = maximal; regardless of dose.  
 Potency – conc. of 2/more drugs that produce the same drug effect; the effect that usually is chosen is 
50% of max. effect & dose causing this is EC50; determined by affinity of receptor for the drug.  
 Most important enzyme systems for biotransformation of drugs is in the LIVER! 
 Phase 1 Reactions: in liver microsomal enzyme systems (mixed fct oxidase system or P‐450 system); 3 
patterns of drug metabolism.  
1. Active parent drug converted to inactive metabolite. 
2. Active parent drug → 2nd active compound→ inactive compound 
3. Inactive parent drug converted to active compound. 
 Most common rx in metabolism is OXIDATION RXN of when hydroxyl group attaches to drug 
molecule; 5 cytochromes (drug metabolism familes); ie CYP1A2 (convert to oxidizing product). 
 Phase 2 Reactions: parent drug rendered inactive & excreted in urine thru conjugation rxns – coupling 
drug w/ acid (glucuronic acid) & results in metabolite glucuronide; in liver, kidneys, & other tissues. 
o Conjugation results in polar‐water soluble compounds so excreted in urine.  
 
CHEMOTHERAPY: 
 8 classes of chemotherapy: 
1. Alkylating Agents – form covalent bonds to nucleic acids so alkylate DNA so it doesn’t replicate; 
good for leukemia, lymphoma, myeloma, & carcinoma; common bonding site = N‐7 position of 
Guanine.  
a. Cisplatin ‐ side effects: nausea, alopecia, xerostomic, & mucositis.  
b. Nitrogen Mustards – Mechlorethamine, Cyclophosphamide, Chlorambucil, & Melphalan. 
c. Nitrosureas – Carmustine, Lomustine, Semustine; 
d. Bisulfan – tx for chronic granulocytic leukemia.  
2. Anthracyclines – destroys DNA; Daunarubicin & Doxorubicin; Mucositis is common! 
3. Antibiotics – Dactinomycin 
4. Antimetabolites – interferes w/ biochemical rxn, so interferes w/ S phase of reproduction cycle; 
oldest & most important chemo.; Methotrexate, 5Fluorouracil (5‐FU), 6‐Mercaptopurine.  
a. Folid Acid Analogs – Methotrexate (may cause oral ulcers);  
b. Pyrimidine Analogs– 5FU, Floxuridine, Cystosine Arabinsoide, 6Merpatopurine. 
c. Purine Analogs – Mercaptopurine, Thioguanine;  
5. Antimicrotubular – inhibits cell mitosis; Paclitaxel (taxol). 
6. Antiestrogen – blocks estrogenic tumors, like breast cancer; Tamoxifine (nolvadex) 
7. Vinca Alkaloids – mitotic spindle poisons; Vinblastin & Vincristin.  
8. Gonadotropin HormoneReleasing Antigen – inhibit GDTH; Leuprolide. 
 Asparinigase – deprives tumors of amino acids for protein synthesis; Interferons – boost immune 
system; both don’t fall in chemo category but are used to tx cancers! 
 Interferons – inhibit cell growth, induce gene transcription & alter state of cell differentiation; types: 
o Interferon α2a – hair cell leukemia. 
o Interferon α2b – chronic hepatitis B 
o Interferon αn3 – recurring genital warts 
o Interferon β1a – tx for MS. 
 Mucositis – common rxn to chemotherapy involving inflammation of mucous membranes; use 5‐
fluorouracil, Methotrexate, & Doxorubicin. 
 Alopecia is most common chemo side effect ; occurs 1‐2 weeks after tx; also increase in infections like 
candida and degeneration of lymphatic tissue;  
 Most chemo drugs are teratogenic and need to be avoided in pregnant women. 
 Colony Stimulating Factors: 
1. Darbepoetin Alpha – induces erythropoiesis; tx for anemia from renal failure. 
2. Pegfilgrastim – stimulates neutrophils and decreases infections. 
3. Sargramostin – myeloid reconstitution after bone marrow transplants. 
 Aromatose Inhibitors –  
1. Exemestane – prevents conversion of androgens to estrogen by tying up enzyme aromatous; tx 
for breast cancer. 
2. Letrozole – first line of treatment for hormone receptor positive or metastatic breast cancer in 
post menopausal women.  
 5‐Hydroxytryptamin type 3 Receptor (5‐HT3) – seratonin receptor activated during chemo causing 
emesis(vomiting); antagonist for this receptor: Granisetron & Ondansetron (prophy for chemo). 
 Immunosuppressants: 
1. Pimecrolimus (Elidel) – tx for mild to moderate dermitis.  
2. Sirolimus (Rapamune) – prophy for organ rejection patients.  
3. Tacrolimus – tx for moderate to severe dermatitis. 
 Adalimumab (Humira) – monoclonal antibody binds to human tumor necrosis factor alpha 
receptors; tx for rheumatoid arthritis.  
 Alefacept (Amevive) – monoclonal antibody, tx of moderate to severe psoriasis. 
 Infliximab (Remicade) – monoclonal antibody binds to TNF alpha; tx for ankylosing spondylitis, 
Crohn’s disease, & Rheumatoid arthritis.  
 Trastuzumab – monoclonal antibody binds to human epidermal growth factor receptor 2 protein 
(HER‐2); tx for metastatic breast cancer;  
 Modafinil (Provigil) – CNS stimulant to improve wakefullness in pts w/ excessive daytime sleepines & 
ADHD; decreases GABA mediated neurotransmission.  
 
MISCELLANEOUS: 
 Rx – p.c. = after meals; h.s. = at bedtimes, a.c. = before meals.  
o Superscription = pt’s info; Inscription = drug & drug strength; Subscription = directions to 
pharmacist; Transcription = directions to pt.  
 Glaucoma – increase in intraocular pressure; poor drainage of aqueous humor(fluid in eye) and can 
cause blindness; tx: 
1. Pilocarpine (Isopto‐carpine) – cholinergic agonist; eye drops causing papillary constriction. 
2. Latanoprost (Xalatan) – prostaglandin analog; eye drops reduce intraocular pressure. 
3. Betaxolol (Betoptic) – β‐blocker; eye drops ↓pressure by ↓production of aqueous humor.  
4. Bimatoprost (Lumigan) – same as latanoprost.  
 Drugs that produce REVERSIBLE Xerostomia: 
a. Amitriptyline (elavil) – tricyclic antidepressant; highest incidence of xerostomia! 
b. Diphenhydramine (benadryl) – sedating type anti‐histamine 
c. Atropine – powerful anticholinergic, blocks saliva production. 
d. Diazepam (Valium) – benzodiazepine tranquilizer. 
 Rheumatoid Arthritis(RA) – chronic inflammation of synovium that lines joints causing pain, swelling, 
& destruction; treatment: 
1. Prednisone – decreases inflammatory response. 
2. Gold injection – decreases prostaglandin production. 
3. Methotrexate – affect immune function. 
4. Nabumetone (relafen) – NSAID that inhibits prostaglandin sythensis. 
5. Piroxicam (feldene) – NSAID that inhibits prostaglandin synthesis; may cause gastric irritation, 
heart burn, & nausea.  
 All of these also work for OSTEOARTHRITIS (except gold injections) ‐ the progessive loss of articular 
cartilage due to excessive loads; drugs for OA  provide analgesic & anti‐inflammatory action.  
 Anti‐Rheumatic Agents: 
1. Etanercept (enbrel) – decreases S&S of rheumatoid arthritis; recombinant DNA‐derived protein 
which binds to TNF – which plays important role in RA causing increased inflammation in RA. 
2. Infliximab – treatment for Crohn’s Disease(inflammation of GI tract) & RA; monoclonal antibody 
that binds TNF so decreases inflammation. 
• Parkinson’s Disease – deficiency of neurotransmitter dopamine in brain due to nerve cells in basal 
ganglia degeneration; slow progressing & degenerative disorder; distinguishing features: tremors at 
rest, sluggish initiation of mvmts, & muscle rigidity; Treatment ‐  
• Levodopa – precursor for dopamine. 
• Carbidopa w/ Levodopa (Sinemet) reduces required dose of levodopa by 75% w/o side effects; 
Carbidopa inhibits peripheral decarboxylation of levadopa; Carbidopa doesn’t cross the BBB, so 
levodopa converts into dopamine in the brain.  
• Bromocriptine/Pergolide – dopamine agonists & often given to enhance Levodopa’s action.  
• Selegine –inhibitor of MAO Type B: enzyme causing oxidative deamination of  dopamine in brain.  
• Amantadine – anti‐viral agent that potentiates dopaminergic responses 
• Anticholinergic drugs also tx parkinson’s – like Benztropine & Trihexyphenidyl.  
• Drugs that causes OSTEONECROSIS of the Jaw: temp/perm. loss of blood to bone & bone dies; non‐
healing of extraction socket or exposed jaw bone are symptoms. 
1. Zolendrionic Acid (Zometa), 2. Palmidronate (Aredia), 3. Alendronate (Fosamax) 
 Gastric Antacids – directly neutralized gastric acid (HCl) from stomach; decrease conc. & total load of 
gastric acid; DYSPEPSIA – impairment of the power/function of digestion; antacids: 
1. Sodium Bicarbonate (only systemic antacid) – Alka‐Seltzer. 
2. Calcium Carbonate – Amitone, Tums. 
3. Aluminum Hydroxide (most potent but less neutralizing) – Alterna gel & Amphojel.  
4. Magnesium Hydroxide – milk of magnesia 
5. Bismuth Salts – Pepto‐Bismol. 
6. Magnesium & Aluminum – Maalox & Mylanta.  
 Growth Hormone – Somatotropin – secreted from anterior pituitary gland; ↑protein synthesis rate, 
↓carbohydrate utilization rate, & ↑mobilization of fats for energy; subcutaneous/IM for 3x/week. 
→ Human Growth Hormone‐ prepared commercially as purified polypeptide hormone of 
recombinant DNA origin; used as replacement therapy for pts with HGH deficiency.  
 Gout – elevated levels of uric acid in blood stream; Treatment: 
1. Colchicin – impairs leukocytic migration to inflammation areas & disrupts urate deposition; not 
IM or subcutaneous b/c causes tissue irritation; kidney & liver damage & bone marrow depression 
are side effects; NSAIDS are also used like Indomethacin for acute gouty arthritis. 
2. Allopurinol – ↓uric acid production; inhibits xanthine oxidase which is an enzyme that coverts 
hypoxanthine to xanthine and xanthine to uric acid; drug of choice for CHRONIC GOUT.  
3. Probenecid(benemid) & Sulfinpyrazone(anturane) – enhance uric acid clearance; both in 
kidnesy & inhibit reabsorption of uric acid; slows secretion of PCNS & cephalosporins.  
 Caffeinism – 600‐750 mg of caffeine/day (more than 10 cups/day) w/ >1000mg in the toxic range; 
caffeine stimulates CNS unequally w/ cortex most and spinal cord least. 
 Mercury – prescense in body determined by urine test; average ½ life = 55 days; mercury 
accumulates in brain, liver & kidney. 
• Can cause irritability, excessive saliva, loose teeth, gum disorders, slurred speech, & tremors; 
these symptoms are chronic; higher than avg. accumulations occur in brain, liver, & kidney.. 
• tx – gastric lavage and fluid therapy and British Anti‐Lewisite (BAL)/ Dimercaprol – complex w/ 
mercury & allow to be excreted as inactive compound.  
 Analeptic – not safe/recommended; CNS stimulant that overcome drug‐induced resp. depression & 
hypnosis; ie – Pentylenetetrazol, Nikethamide, Doxapram, Picrotoxin, & Strychnine.  
 Xanthines – for mental allertness, decrease sleep, and increase mood; ie – Caffeine (only OTC), 
Theophylline (for asthma), & Theobromine;  
• Theophylline & Theobromine weaker CNS stimulants than caffeine.  
 Loperamide (Imodium):  1) Anti‐Diarrheal which inhibits perstalsis. 
2) Opoid family but doesn’t penetrate CNS so OTC. 
3) No drug abuse/dependence.  
 Diphenoxylate (Lomatil): antidiarrheal & inhibits GI tract motility & propulsion; Diphenoxylate & 
Atropine together require prescription;  
 Laxatives act in reverse manner of anti‐diarrheals b/c increase GI motility to treat constipation; Ie‐
Magnesium Hydroxide, Caster Oil, Metamucil, & Methylcellulose.  
 Oral Contraceptives block ovulation by inhibiting anterior pituitary hormones FSH & LH; both 
estrogenic & progestational agents; increase risk of thromboembolism and heart disease in smokers.  
→ Contains both estrogenic agent & progestational agent.  
→ Highest risk associated w/ BCP is thromboembolism.   
 Drugs travel thru bloodstream by binding to albumin protein, which is abundant in plasma and 
enables drug to be carried to all tissues and organs.  
 Virtually any drug can cross placenta of pregnant women & enter fetal circulation so check w/ DR.  
 Habituation – acquired tolerance form repeated exposure to particular stimulus but w/o the 
addictive, physiological need to increase dosage.  
 Tolerance – decreased responsiveness to a drug after chronic administration; dosage required to 
produce usual effect is increased.  
 Toxicity is both dose‐depenedent & time‐dependent;  
 Dyesthesia – uncomfortable/painful sensation; in dentistry, manifests as post‐op sequela to regional 
administration to LA.  
PROSTHODONTICS 
FIXED: 
 Gold Crown Preparation = .5 – 1.0 mm;  
 PFM: metal = .5mm, porc. = 1‐1.5mm, total = 1.5‐2mm; labial shoulder = 1.5mm; supporting cusp 
reduction = 2.0mm & opposing walls no more than 10o.  
 Absolute minimum required thickness of porcelain = .7mm & metal coping thickness = .3‐.5mm for 
high noble & .2mm for base metal; 
 Proper thickness need to prevent distortion during firing of porcelain;  
 PFM Alloys ‐   
1. High Noble – 98% Au/Pl/Pt; doesn’t oxidize during casting; BEST! 
2. Noble – 50‐60% Pl & 30‐40% Silver; Palladium‐silver alloy; not nobel metal so oxidizes on casting. 
3. BaseMetal – 70‐80% Ni & 15% Chromium; Nickel‐Chromium alloy; oxidizes & causes PFM 
interface problems; less resistant to corrosion; stronger & lower density than noble metal; 
a. Alloys w/ less than 25% noble elements; 
b. Another example is Chromium Cobalt used for RPDs; 
c. ↑resistance, modulous elasticity, melting temperature; compared to type 4 gold.  
d. ↓density, specific gravity, & yield strength;  all compared to type 4 gold. 
e. The low density makes casting more difficult; 
 ADA Classifies Alloys as follows:  1) Type I – used for small inlays 
2) Type II – larger inlays & onlays 
3) Type III – onlays, crowns, & short‐span FPDs 
4) Type IV – thin veneer crowns, long‐span FPDs & RPDs 
 Porcelain adheres to metal primarily by chemical bond (COVALENT BOND); since true chemical bond, 
failure/fracture will occur in porcelain rather than porcelain‐metal interface;  
 Repeated fracture of PFM is due to INADEQUATE FRAMEWORK DESIGN; 
 AllCeramic Crowns – have low flexural strength and tendency to fracture at minimum deformation; 
 PFM & All cermaic crown require the SAME amount of overall tooth reduction = 1.5‐2.0mm; 
 PFM prep must have all surfaces smooth & rounded in order to prevent fractures;  
 Outer junction of porcelain to metal should be at right angle = 90o;  
 Butt Joint – poorest type of finish line; optimum margin is ACUTE EDGE; main disadvantage is any 
inaccuracies in the crown fit are reproduced at the margin, causing an increased thickness of cement; 
 Best finish margin but least marginal strength = bevel/feather edge; may causes inacurrate 
extension & distortion of wax pattern;  optimum margin for casting b/c easily BURNISHED;  
 Chamfer is preferred finish line on cast gold restorations; a well prepared chamfer combines the 
advantage of easily definable margin on the impression & die, with minimal tooth preparation; 
→ Reduces thickness of cement;  
 Shoulder Margin w/ a Bevel – this margin allows a sliding fit to occur at the margin, thus maybe 
used on proximal box of inlays or occlusal shoulder of mand. ¾ crowns;  
 Margins for different materials:   ‐‐All Ceramic = Shoulder 
‐‐PFM w/ porcelain to margin edge = Shoulder 
‐‐PFM w/ metal collar = Shoulder bevel or Chamfer 
‐‐Full Gold Crown = Bevel or Chamfer; 
 If margins extends into biologic width, constant gingival irritant occurs and crown fails; so crown 
lengthening needs to be performed before FIRST crown preparation; 
 Advantages of Partial Veneer Restorations (¾ or 7/8 crowns): 
→ Great deal of margin is accessible to dentist & patient 
→ Less of restoration margin is in close proximity to gingival crevice (less perio irritation); 
→ More easily seated during cemetation 
→ Portion is accessible if pulp vitality ever needs to be tested;  
 Reverse ¾ crown – common on mandibular molars to perserve LINGUAL area. 
 Standard ¾ crown – preserves buccal area; MOST COMMON type of partial veneer crown;  
 7/8th crown (all metal) is a ¾th crown (all metal) whose vertical distal buccal margin is position 
slightly mesial to middle of buccal surface; advantages: 
→ esthetics, DB finish line easy to access, provides more coverage, excellent abutment for bridge; 
 The path of insertion of anterior ¾ crown should parallel the incisal ½ ‐ 2/3 of labial tooth not tooth’s 
long axis; if parallel to long axis, will cause more gold to be displayed;  
 A pin modified ¾ crown can preserve the facial surface & 1 proimal surface; preferred in cases which 
require repairing of sever lingual abrasion on incisors & canines; 
 Gold Crown Occlusion – check w/ silver plastic shim shock; 
 ALUM – aluminum potassium sulfate; for cords for patients w/ ↑ BP; ZnCl delays healing so don’t 
use; ↑ BP w/ epi cords when applied to severly lacerated gingival sulcus but minimual changes when 
place in an intact gingival sulcus;   
 Mechanical Properties of RESINS influenced by ‐  1) MW of polymer 
2) Degree of cross‐linking 
3) Composition of monomers used to prepare 
polymer 
4) Acrylic resins EXPAND when immersed in 
water & become DISTORTED when dried out; 
 Methyl Methacrylate(MMA) = liquid monomer; hydroquinone inhibitor, cross‐linking agents, & 
chemical activator (dimethylptoluidine) which is only present in self‐cured resins; EXOTHERMIC;  
→ Other monomers – ethyl methacrylate, vinyl ethyl methacrylate, & epimine resins; all less 
irritating to the pulp;  MMA is most frequently used! 
→ Excessive shrinkage may occur if too much monomer is added to the polymer;  
 Polymethyl Methacrylate(PMMA) = powder polymer; benzyol peroxide is initiator; Cross‐linking 
agents contribute greatly to STRENGTH of polymer;  
 Heat Cured Resin – stronger & superior color stability because they contain less residual monomer & 
higher MW than self‐cured resins;  
→ heat (accelerator) decomposes benzoyl peroxide (initiator) into free radicals which initiate 
polymerization of MMA to PMMA;  
 Self Cured Resin – dimethy – p – toluidine (activator – tertiary amine) added to MMA causing 
decomposition of benzoyl peroxide into free radicals which initate polymerization of MMA to PMMA; 
→ Generally used for repairs;  
 Polymerization Range = temp of 60oC – 77oC (140oF – 170oF);  
 Porcelain Veneer Contraindications:  1) severe imbrication (overlapping) of teeth 
2) traumatic occlusal contacts 
3) unfavorable morphology 
4) insufficient tooth structure & enamel 
5) high caries index 
6) short clinical crown 
7) minimal horizontal overlap; 
 Some techniques to remember w/ veneers – should be tried in WET; fit surface is treated w/ silane & 
protected w/ light cured unfilled resin; enamel surface cleaned w/ pumis & water;  
 Most common causes of crown failures – lack of attention to tooth shape, position, & contacts; 
 Greatest potential for wear exists b/w porcelain & tooth b/c porcelain causes accelerated wear of 
opposing dentition – 40x more wear than gold; so gold preferred for bruxism pts;  
 The best measure of the potential clinical performance of a casting alloy is its ADA CERTIFICATION; 
 
PONTICS & FPDs: 
 Portion of pontic approximating ridge should be as convex as possible! 
 6 Types: 
1. Sanitary – nonesthetic zone (convex everywhere); most commonly used where esthetics 
is not important;  
2. Saddle – don’t use due to hygiene, looks most like a tooth; 
3. Modified Ridge Lap – illusion of tooth but all convex; BEST for esthetics; 
4. Conical – rounded; for mandibular thin ridges; 
5. Ovate – sanitary version of saddle; sits in concavity of ridge. 
 Facial lingual dimension of pontic determined by opposing FL contacts; 
 Pontics shouldn’t be in contact during non‐working movement; may be in CO contact & may/may not 
be in working‐side contact;  
 Pontics must have passive pinpoint contact w/ gingiva; excessive tissue contact is one of the major 
causes of failure of fixed bridges; 
 Pontics must not be concave in 2 directions; they should be convex MD & concave FL;  
 Pontic design is more important than pontic material; 
 Multiple adjacent pontics on anterior FPD have reduced FACIAL EMBRASURES to enhance esthetics; 
 Solder joints – connectors of CHOICE when abutment teeth are in normal alignment & good bone 
support; strength of solder connector is ↑ with ↑ height w/ circular form preferred;  
→ solder must have much lower fusion temp. the metal it is joining;  
→ CLEANLINESS is most important prerequisite of soldering since the soldering process depends on 
WETTING the surfaces to achieve bonding;  
→ Flux (often BORAX) displaces gases & removes corrosion products by combining w/ them or 
reducing them; 
 Failed bridge is more detrimental to dental health than failed RPD but fixed restorations are ALWAYS 
the tx of choice, unless contraindicated; Success/Failure of RPD depends mostly on PONTIC DESIGN; 
 Factors that Determine a FPD Design: 
1. Root Configuration – roots that are broader labiolingually than mesiodistally are preferred to 
rooths that have round cross‐section; 
2. Crown to Root Ratio – ideal ratio is 1:2 but 2:3 is more realistic and 1:1 is minimum! 
3. Axial Alignment of teeth – parallelism of abutment preps is best determined by long axis of 
preps;  
4. Length of Lever Arm (span) – replacing 3 teeth is MAXIMUM, more than 2 is high risk;  
a. Edentulous space involving 4 adjacent teeth other than 4 inciros is best treated w/ RPD; 
 The MOST LIKELY indication for splinting is tooth mobility w/ pt discomfort; 
 DO NOT splint natural teeth & implants in a FPD b/c implants lack PDL;  
 Nonrigid Connector – mechanical union of retainer & pontic rather than solder joint (T‐shaped key & 
dovetail); restricted to SHORT‐SPAN bridge that is replacing 1 tooth;  
o Used when retainers CANNOT be prepared to draw together w/o excessive tooth reduction; 
o Path of insertion of key into keyway should be parallel to pathway of retainer; 
 When stress breaker on distal of pontic, occlusion unseats key from key;  
 
PORCELAIN: 
 Porcelain shade in order – value (brightness), chroma (saturation), hue (color). 
 Value – brightness; MOST CRITICAL characteristic that is matched FIRST; relative amount of lightness 
or darkness in a color; intensitiy of a color;  Impossible to increase value; staining reduces value;  
 Chroma – saturation; single most important factor in shade matching; CAN be ↑ using stains; 
 Hue – basic color; drastic changes of hue are often impossible but ORANGE STAIN is most often used 
to change hue;  
 Some Facts for Shade Selection: 1) quick rubber cup/prophy to make shade selection more accurate; 
2) do not gaze for more than 5 seconds 
3) proceed by process of elimination 
4) half‐closed eyes can increase sensitivity of rentinal rods ot better 
select the color’s VALUE;  
 Porcelain ‐ rusts at temp > 2000oF; has good biocompatibility; should be under slight compressive 
stress; Porcelain substrate alloys melt at high temperatures; 
 In all ceramic crown, high strength sintered ceramic is core material; 
 Opaque Porcelain – 1st layer; masks metal color, creates CHEMICAL bonds w/ metal;  
→ it will show thru facial surface of crown if inadequate tooth reduction, too thick metal, too 
thick porcelain, or inadequate thickness of body porcelain;  
 Body Porcelain – bulk of restoration; most of color & shade; 
 Incisal Porcelain – translucent layer;  
 Porcelain bulked out to compensate for it 20% shrinkage; 
 Porcelain stains are Metallic Oxides; 
 Smooth porcelain gives impression of larger size & changes in contour are used to alter the apparent 
long axis inclination of a tooth;  
 Metamerism – different color match under 2 different light sources; staining porcelain decreases 
value and increases metameric responses; ;  
 Flourescence – material reflect UV radiation; teeth fluoresce mainly blue‐white hues (400‐450nm); 
makes a definite contribution to the brightness & vital appearance of natural tooth;   
→ Blue fatigue accelerates yellow sensitivity: means if you look at blue color object while 
selecting the shade, it helps accentuate the ability to discriminate b/w yellow shades;  
 Color of a pigment is determined by selective absorption & selective radiation/scattering;  
 Natural Glace (glaze firing) – when porcelain itself is glazed by separate firing; more permanent than 
overglazes;  
 Glazed porcelain least irritating to gingiva compared to other restorations and resists abrasion; 
 Overglazes (applied glazes) – ceramic powders that maybe added to a porcelain restoration after it 
has been fired; erosion may occur in a month creating rough & porous surface;  
 Classes of Porcelain:  ‐‐Highfusing → denture teeth 
‐‐Mediumfusing → all ceramic crowns 
‐‐Lowfusing → metal ceramic crowns; contains aluminum oxide (↑ its 
resistance to “slumping down” during firing) + calcium oxide + oxides of 
potassium, sodium, & chromium (help reduce cross‐linkage b/w oxygen & 
silicone to lower porcelain’s fusing temperature;  
 Porcelain = feldspar (main) + quartz (strengthener) + metal oxides (impart shade of porcelain); 
amorphous structure (not crystalline);  
→ Kaolin (clay) → binds particles of porcelain together; more in house porcelain;  
→ Compressive strength of porcelain GREATER than tensile strength; 
→ Porcelain is BRITTLE & not capable of plastic deformation;  
→ Constituents of Porcelain:  1) Silicone Dioxide (64‐69%) 
2) Aluminum Oxide (8‐19%) 
3) Potassium Oxide (8%) 
4) Sodium Oxide (2‐5%) 
 Aluminous porcelain uses alumina, not quartz as strengthener; it is considerably stronger than 
conventional porcelains;  
 Degassing – process of heating (980oC) a casting to burn off impurities prior to porcelain adding; 
necessary for all gold‐porcelain systems; degassing metal at too low temp will effect formation of 
oxide layer and it will decrease the bond;  
 Pickling – reduces surface oxides; 50% HCl; frequently the surface of gold casting is dark due to 
formation of surface oxide film;  
 Causes of Porcelain Fracture:  1) Poor metal framework (main cause); 
2) Degas too low temperature 
3) Contaminate metal prior to opaque application 
4) Fusing opaque at too low a temp or too short a time;  
 Sintering – changes powder porcelain to solid; ↑ dentisity; shape maintained.  
 Metal & Ceramic must have closely matched COEFFICIENTS OF THERMAL EXPANSION to avoid 
porcelain fractures;  
 Alloys should have high proportional limit & high modulus of elasticity to reduce stress on porcelain; 
 3 Stages in Firing Porcelain: 1) Low bisque firing, 2) Medium bisque firing, 3) High bisque firing;  
 Porcelain must have:  1) Low Fusing Temperature (if fired too much, it devitrifies/milky);   
2) High Viscosity 
3) Resistance to devitrivation (crystallization); 
 Most common cause of POROSITY in porcelain is inadequate condensation of porcelain;  
 
REMOVABLE PARTIAL DENTURES: 
 Total occlusal load applied to RPD is enhanced by:  1) occlusal surface area 
2) occlusal efficiency 
3) number of existing teeth 
 Kennedy Classification – based on MOST POSTERIOR edentulous area to be restored; periodontal 
damage to abutment teeth is avoided w/ firm tissue support; 4 Classes: 
1. Class I  ‐ bilateral distal extension; 
2. Class II – unilateral distal extension; 
3. Class III – unilateral edentulous space bound by teeth; it is a tooth‐borne RPD b/c it depends 
entirely on abutment teeth for support; 
4. Classs IV – anterior teeth are missing and across the midline; it is a tooth‐borne RPD b/c it 
depends entirely on abutment teeth for support; NO MODIFICATIONS! 
→ Classifications are done after NOT BEFORE extractions are done; 
→ If 3rd molar is present & not to be used as abutment, it’s not considered in the classification; 
→ If 2nd molar is missing & will NOT be relplaced, it’s NOT considered in the classification; 
 Craddock Classification – based on denture type; 3 types:  1) Type I – mucosa borne 
2) Type II – tooth borne 
3) Type III – mucosa & tooth borne 
 Major & Minor connectors MUST BE RIGID for functional stresses applied to RPD to be evenly 
distributed throughout the mouth; 
 Major Connector – the unit of RPD that connects the parts of the prosthesis located on one side of the 
arch to parts on the opposite side of the arch;  
→ should be free of movable tissues & shouldn’t impinge gingival tissues;  
→ most frequently encounter interferences from LINGUALLY INCLINED MAND. PREMOLARS; 
 Maxillary Palatal major connectors may be beaded to produce a positive contact w/ the tissue; 
 Single Palatal Bar – lacks rigidity so for bilateral short span edentulous areas; connected to 1st 
molars;  
 Palatal Horseshoeshaped plate – used when large, inoperable torus prevent using other designs; 
 Anteroposterior palatal bar for RPD – MOST RIGID palatal major connector; used in almost any 
maxillary partial denture;  
→ both ant. & post. connectors cross the midline at RIGHT ANGLES rather than diagonal; 
 Palatal Plate connector – think broad connector that can be used for simple edentulous areas and 
full palatal coverage; 
 Lingual Bar needs 7mm of height = 3mm below gingival margin + 4mm of vertical height; 
 Lingual Plate should cover middle 1/3 of lingual surface of teeth; Indications: 
1. High lingual frenum or when there is NO SPACE in the floor of the mouth 
2. If vestibule is <5mm; 
3. Mandibular tori can’t be removed 
4. To support/stabilize periodontically weakned teeth;  
 Severe anterior crowding is CONTRAINDICATED for using lingual plate; 
 Labial Bar – should be 3mm below gingival margin; used with lingaully inclined mand. anterior teeth 
or w/ large lingual tori; 
 Stress Breaker – device that relieves the abutment teeth to which an FPD/RPD is attached, of all /part 
of the forces generated by occlusal function; 2 types: 
1. WroughWire Retentive Clasp – simplest form of stress relief; Wrought metal is stronger 
w/ greater flexibility than cast metal; 25% greater strength & hardness; 
a. Yield strength can be drastically reduced if exposed to too much heat causing 
recrystallization or gain growth; 
b. Terminal end of retentive arm is placed in middle of gingival 1/3 of crown; 
c. 20‐gauge wrought wire is 2x more flexible than an 18‐gauge wire; 
d. 20‐gauge cast clasp into .010 undercut is alternative to wrought wire; 
2. Splitbar Major connector (“hidden lock”) – flexible connection b/w direct retainer & 
denture base; stress‐breakers with a moveable join;  
 Shorter clasps need finer gauge of wire (higher # = finer) because need optimum flexibility; 
 Round Cross‐section of clasps   = ↑ Flexibility of Clasps  
= ↑ length & taper  
= ↓ cube ratio/thickness & width;  
 Indirect Retainers – RESTS, MINOR CONNECTORS, & PROXIMAL PLATES; function to 
counteract/prevent VERTICAL/UPWARD DISLODGEMENT of the distal extension base;  
→ anti‐rotational device; also prevents DOWNWARD movement so protects soft tissue; 
→ Serves at 3rd reference for seating framework & making altered cast impressions; 
→ Indirect retainer for distal extension are placed as far away from edentulous space while rests are 
placed on abutment teeth next to edentulous areas for max support for tooth borne partials (class 
3 & 4); 
→ The greater distance b/w fulcrum line & IR, the more effective the IR;   
 No indirect retainer for kennedy class 3 – no fulcrum line;  
 As denture base moves upward, the most anterior rest (direct retainer) resists downard movement; 
 Direct retainers must be effect for an indirect retainer to function; 
 Direct retainers – Intracoronal attachment & Clasps;  
 Intracoronal Retainers ‐ MOST ESTHETIC direct retainer for RPD;  built into contour of a crown to 
produce mechanical & frictional retention; not used when RPD depends on edentulous area for 
support (class 1 or 2); 
 Clasps – extracoronal retainers; most common direct retainer for RPD; 2 types: 
1. Suprabulge clasps originate above the height of contour or survey line, usually from occlusal 
rest;  
a. Circumferential Clasp – composed of retentive arm & bracing arm; engages undercut on 
side OPPOSITE of site of rest. 
b. Ring Clasp – engages undercut located on same side of rest;  
c. Embrasure Clasp – when no edentulous space exists 
d. Reverseaction Clasp – hairpin clasp; enagages undercut located on same side as rest or 
on any posterior tooth; 
e. Extended Arm Clasp – circumferential clasp that extends to neighboring teeth; 
f. ½ & ½ Clasp – consists of 1 circumfertial clasp emanating from rest and another amr 
from minor connector on opposite side;  
2. Infrabulge retainers – I, J, U, L, T Bar clasps; approaches crown undercut from BELOW the 
tooth’s height of contour; the provide retions by resistance of metal to deformation; 
a. Must NOT be placed into tissue undercuts nor contact abutment of any places except 
specified undercut;  
b. Advantages – more efficient retention, less distortion, less caries, & greater 
adjustability;  
 Each clasp must be designed to encircle more than 180o (more than ½ the circumference of tooth); 
 Elongation – most important mechanical property of clasps of RPD;  
 Faiure of partial dentures due to poor clasp design is best avoided by altering tooth contours; 
premolars & molars most often need to be altered;  
→ GUIDING PLANES serve to ensure predictable clasp retention;  
 Primary purpose of rests – VERTICAL SUPPORT for RPD & resist VERTICAL FORCES of occlusion;  
 Occlusal Rest ‐ Positive Rest – form acute angles w/ minor connectors that connect them to the major 
connectors; Rest = 2.5mm & < 90o angle to minor connector; reduce marginal ridge by 1.5mm;  
→ the rest occupies the middle 1/3 of the occlusal surface;  
 Cingulum Rest – vertical stop on Anterior tooth; confined to maxillary canines, but sometimes 
maxillary centrals; less torquing stress than incisal rest (not esthetic);  
 Reciprocating arm = lingual arm; Retentive arm = buccal arm; 
 Fuction of reciprocal clasp arm:   1) Reciprocation 
2) Stabilization 
3) Bracing (auxillary indirect retainer) 
 In RPD, stability insured by occlusion; 
 Design characteristics for RPD – 1) Support, 2) Retention, 3) Bracing, 4) Guidance;  
 For RPD, minimal functional stress on abutement teeth; most of stress on residual ridge causing 
resorption;  
 Precision Attachements – Male & female preconstructed parts; little tolerance;  
→ adv – provide retention w/out a lot of metal displayed; excellent bilateral stabilization;  
→ disadv – difficult to repair; never to be used with distal extension RPD w/o stress breaker; 
→ primary indication are when teeth are present on both ends of the edentulous area;  
→ cast crowns must be provided on all abutments;  
 Semiprecision has more tolerance & less retention; it is a cast into the crown & RPD; male portion is 
cast into the RPD;  
 Surverying: 1) Path of Insertion, 2) Position of Survey Lines, 3) Locate Undercut & Nonundercut areas.  
 Dental Surveyer – an instrument used to determine the relative parallelism of oral anatomy; areas 
used for support CANNOT be determined by surveying; 
 When selecting teeth for RPD, the most important factor is available interarch space;  
→ MD width – from distal of lower canine to beginning of slope of ridge; 
→ BL width – narrower than natural teeth b/c decreases stress transferred to denture 
support area during food bolus penetration; also increases tongue space;  
 Chromium Cobalt is inflexible but best for RPDs; adv – corrosion resistance, high strength, & low 
specific gravity; low density and high modulus of elasticity (stiffness); low cost;  
→ Chromium – for corrosion & tarnish resistance due to SURFACE OXIDE LAYER; 
→ Cobalt ‐ ↑rigidity, strength, & hardness; 
→ Nickel ‐ ↑ ductility; measured as percentage of elongation; metallic component of RPD w/ 
the greatest potential for allergic reactions in the mouth; 
 When recording CR for RPD, the occlusal rim is attached to the completed partial denture metal 
framework, instead of record base for complete denture; 
 Most important factor in determining the succes of distal extension RPD is proper COVERAGE over 
residual ridge; 
 If the indirect retainers are not seated as extension base are depressed, the bases need relining; 
 If pt complains of sensitivity to percussion on an abutment tooth of distal extension, most likely 
causes is the occlusion on this abutment;  
 Defective occlusal contacts can also cause a feeling of looseness to the denture;  
 Altered Cast Technique – purpose is to recored the form of the edentulous segment w/o tissue 
displacement & to accrately relate the edentulous segment of the teeth via metal framework; 
→ Helps obtain soft tissue suppor to aide abutments in resisting functional stress; 
→ It is a secondary impression system that uses metal framework to hold customized 
impression trays for the edentulous areas; 
→ Impression records of edentulous ridge tissues in the exact form that they will assume the 
finished RPD is in place on the teeth; 
 Considerations when preparing an RPD abutment to receive a crown: 
1. Path of Draw 
2. Location of rests 
3. Orientation of guiding planes 
4. Placement of porcelain metal finish lines 
 When RPD preferred over FPD: 1) loss of 4 maxillary incisors 
2) distal extension 
3) long span edentulous area 
4) periodontally involved abutment teeth 
5) after recent extractions 
6) economics 
 
COMPLETE DENTURES: 
 If denture falls out when smiling, buccal notch & flange overextended; when yawning, distobuccal 
flange overextended;  
 Sore gums & aching muscles = reduce VDO; generalized soreness after 1st appointment of denture 
insertion is most likely due to improper occlusion;  
→ To identify prematurities, the best method in mouth is to use warm disclosing wax by 
inserting the wax bilaterally & have pt close into CR;  
 Tingling/numbing in corner of mouth/lip, excessive pressure from lower buccal flange near mental 
foramen; 
 Mandibular Denture ‐   ‐‐Distal Buccal Extension = Masseter Muscle 
‐‐Distal Lingual Extension = Superior Constrictor Muscle 
‐‐Lingual Border =  1) Palatoglossus Muscle 
      2) Superior Pharyngeal Constrictor Muscle 
      3) Mylohyoid Muscle 
      4) Genioglossus Muscle 
 Healing of ridge post‐extraction = 4‐6 months (reline at 5 & 10 months); 
 Reline CONTRAINDICATED for decreasing VDO; if decreased VDO, then new dentures are indicated; 
 After relining a denture, if a pt constantly returns for adjustments due to sore spots on ridge, check 
occlusion b/c relining may have changed CR contacts, loss of CR contacts;  
 Recording CR is an essential starting point in design of denture; for complete dentures, MIC of teeth in 
CO is established to coincide w/ pt’s CR, so CO=CR; 
 Flabby Max. anterior ridge when max. complete opposes 6 mand. anterior teeth; 
 Setting denture teeth edge to edge = cheek biting; tx = reduce facial of mandibular molars & create 
proper horizontal overlap; cheek biting also caused by ↓ VDO;  
 Primary reason to use plastic teeth in denture is b/c plastic teeth are retained well in acrylic resin; 
plastic teeth are retained better than porcelain teeth; porcelain teeth also cause denture clicking; 
 Biting corner of the mouth – reset canines & PMs. 
 When Pt has Complete Max. Denture but lacking posterior support, the following occurs: 
1. Excessive amts of hyperplastic tissue on anterior portion of maxilla; 
2. Poor bone structure in anterior maxilla 
3. Fibrous tuberosities 
4. Pt complains of looseness of denture and they can no longer see their upper teeth;  
 Central Incisors should be 8mm anterior to center of incisive papilla; if placed to far superior & 
anterior, effects “F” & “V” sounds; Primary role of anterior teeth on denture is ESTHETICs; 
 Max & Mand. anterior teeth should NOT contact in CR;  
 Most common error that contributes to poor esthetics is placing Max. anterior teeth directly over 
edentulous ridge; Maxillary teeth should be placed FACIAL to the ridge; 
 Max. centrals are most important teeth for esthetics. duh 
 If burning sensation of complete max. denture then pressure on INCISIVE FORAMEN; 
 Position of Lips for Complete Dentures corrected by: 1) Correct VDO 
2) Thickness of anterior border 
3) Teeth position 
 “S” Sound – tip of tongue w/ anterior palate & lingual of Max. ant. teeth; sound that brings the 
mandibule CLOSEST to the maxilla;  
 “Th” Sound – tongue protrude b/w max & mand anterior teeth (2‐4mm). 
 “F” & “V” Sound – incisal edge of maxillary teeth & lower lip; 
 “P” & “B” Sound – formed TOTALLY by lips; 
 Palate too think & incisors are too far palatal if saying “S” but sounds like “Th”;  
 If teeth set too far lingually, the T will sound like a D; if set too far labially, the D will sound like a T; 
 High palatal vault or constricted palate can cause WHISTLING sound; whistling during speech with 
dentures can cause:  1) insufficient vertical overlap 
2) excessive horizontal overlap 
3) area palatal to incisors are improperly contoured; 
 A pt having difficulty swallowing may have insufficient interocclusal space caused by excessive VDO;  
 Learning to chew food satisfactory with new dentures requires at least 68 weeks to establish new 
memory patters; 
 Most effective time to test phonetics → wax try‐in.  
 Longer time pts is edentulous then greater difficulty w/ phonetics than short time pts;  
 Most important factor for retention of completes is PERIPHERAL SEAL;  
 Mucobuccal Fold is most important factor for Maxillary complete RETENTION; 
 Maxillary Complete & Mand. bilatateral Distal extension may show: 
1. Decreased VDO 
2. Prognathic Facial Appearance (associated w/ edentulous state). 
 Maxillary Denture –   Primary Support = Residual Ridge 
Secondary Support = Palatal Rugae 
 Mandibular Denture ‐  Primary Support = Buccal Shelf & Residual Ridge 
Secondary Support = Anterior Lingual Border 
 Coronoid Process interferes w/ denture opening when Max. buccal space filled w/ denture flange; so 
coronoid process can limit the thickness of denture flange;  
 Camper’s Line – parallel to maxillary occlusal rim; line running from inferior border of ala nose to 
superior border of tragus of ear; 
 To determine maxilla occlusal rim vertical length = 2mm below upper lip. 
 Acrylic Resin for denture repairs → pressure = 20‐30 psi; MOST COMMON cause of porosities in 
denture is due to insufficient pressure on flask during processing;  
→ Porosities also occur if packing & processing of power & liquid resin is too plastic 
(stringy/sandy);  
 Palatal Seal –   Posterior Outline → formed by “ah” line or vibrating line (foveal palatini)     
connecting pterygomaxillary notches; hamular notch is on posterior border; 
      Anterior Outline → formed by “blow” line & located at distal extent of hard palate; 
→ Width = 6 mm on left & right & 3 mm at the center; 
→ Depth = 1.5mm on left & right & .5mm at the center;  
→ Outline & depth of seal is different for every pt, determined by palatal form on each pt;  
→ Palatal seal should NEVER be removed; placement of seal ALWAYS done by dentist, not lab! 
→ Excessive depth of seal usually results in unseatin gof denture;  
→ Functions:   1) Completes border seal of max. denture 
2) Prevents food impaction 
3) Improves denture’s physiologic retention 
4) The seal compensates for polymerization & cooling shrinkage of denture 
resin during processing; 
 Vibrating Line – 2mm in front of fovea palatini; extends from 1 hamular notch to the other;  
 Hamulus – superior attachement of pterygomandibular raphe  (tendon) which is b/w buccinator & 
superior constrictor muscles; extension of MEDIAL PTERYGOID PLATE of sphenoid bone; 
 Increased VDO causes clicking of teeth, effects phonetics, & esthetics; need to remount or new CD/CR; 
 Compensating Curve – anteroposterior curvature & mediolateral curvature in the alignment of 
occluding surfaces & incisal edges of artificial teeth used to developed balanced occlusion;  
→ Entirely in DENTIST’s control 
→ Allows dentist to alter the effective cusp angulation w/o changing form of manufactured 
denture teeth; 
 Average Interocclusal Space at REST = 3mm;  
 VDO + Interocclusal Space = VDR; VDR > VDO (always!);  ↓VDO = ↑ interocclusal distance; 
 Correct VDO is evaluated using 4 methods: 
1. Evaluating the overall appearance of facial support; 
2. Visual observation of space b/w occlusal rims at rest 
3. Measurement of dots on face (placed on tip of nose & chin)  
4. Observation when “s” sound is enunciated accurately;  
 Excessive VDO = ↓ freeway space; Decreased VDO = ↑ freeway space;  
 For complete dentures, path of condyle determined by:  1) Shape of fossa 
2) Meniscus 
3) Muscular Influence 
 Submucosal Vestibuloplasty – usually performed on maxillary arch to improve available denture base; 
procedure is favored b/c no raw tissue surface remains to granulate & re‐epithelialize; 
 Underlying BASAL BONE (under the retromolar pad) resists resorption; marked resorption of ridge 
occurs if mandibular complete denture base terminates short of retromolar pad;  
 For the 1st few days after pt receives new dentures, they will have some difficulty eating & EXCESSIVE 
SALIVA due to reflex PARASYMPATHETIC stimulation of salivary glands;  
 Balanced Occlusion is objective of complete dentures; 
 
OVERDENTURE & IMMEDIATE DENTURES: 
 Overdenture – denture whose base is constructed to cover all of an existing residual ridge & selected 
roots; most important is preventing ridge resorption; 
→ retained roots help PREVENT RESORPTION of alveolar ridge, improve denture rentention & allow 
pt some sense of “naturalness” in function of the dentures; 
→ not always necessary to cover root beneath overdenture but if a root is not covered, the exposed 
surfaces are highly susceptible to decay; 
 Immediate Dentures: ideal to fabricate max & mand. dentures at same time; Complete in 2 steps 
1. Extract all posterior teeth EXCEPT max. 1st PM & its opposing tooth so leaves posterior stop to 
maintain VDO; 
2. After healing of posterior area, denture fabrication can begin; Anterior teeth extracted at time 
of denture insertion; 
→ For the 1st 24 hours, do not remove dentures, eat soft foods, & return in 24 hrs to dentist;  
→ Advantage = duplicate position of natural teeth; they are esthetically advantageous in that the pt is 
never w/o either natural or artificial teeth; 
→ Major disadvantage is Anterior teeth try‐in for esthetics;  
→ Prevents tongue enlargement b/c when natural teeth are lost & not replaced, the tongue expands 
into the available space; 
→ Relining/Rebasing the denture is REQUIRED in 8‐12 months! Schedule relines at 5 months & 10 
months post‐extraction; 
 
DENTURE DESIGN CHARACTERISTICS: 
 Stability – the relationship of the denture base to bone that resist dislodgement of the denture in 
HORIZONTAL diretion; involves resistance to horizontal, lateral & torsional forces (most important); 
→ All components of RPD, except retentive clasp tip, contribute to stability; 
 Support – resistance to VERTICAL SEATING forces; provided by rests & denture bases; MOST 
IMPORTANT design characteristic for oral health; for RPD, support given by rests & edentulous areas; 
 Retention  ‐ quality in restoration that resists the force of gravity, sticky foods, & forces associated w/ 
mandibular movement; direct & indirect retainers provide retention;  
→ clasps placed in undercut areas of abutment teeth provide retention;  
 Reciprocation – the means by which one part of the metal framework opposes the action of the 
retainer in function; reciprocating element must be placed OPPOSITE the direct retainer; 
→ Must contact the abutment as the retentive tip passes OVER the tooth’s height of contour; 
→ refers to function of reciprocal clasp arm to counteract forces exerted by retentive clasp arm;  
 Bracing  ‐ horizontal force transmission by placing rigid portions of clasps or other parts of the RPD 
in non‐undercut areas of abutment teeth; 
 Guidance – during insertion & removal obtained by contact of rigid parts of the framework with 
areas on axial tooth surfaces parallel to the path of insertion;  
 
IMPRESSION MATERIALS: 
 Rinse & Disinfect prior to pour of impressions or sending to lab; spray/soak for 10 minutes;  
 Bite Registration Material → Additionreaction silicone impression material; very low flow and 
minimum resistance to the patient’s jaw closure; 
→ Technique – Have pt bite teeth tightly in CO & inject material b/w max. & mand teeth ONLY 
into areas where teeth have been prepared;  
 Ideal Material for Recording CR (not wax!) ‐  1) Rapid setting plaster 
2) ZOE Pastes 
3) Modeling Plaster 
 Best impressurion technique for pt w/ loose hyperplastic tissue is to register tissue in PASSIVE 
position;  
 The primary indicator of accuracy of border molding is the stability & lack of displacement of the tray 
in the mouth; modeling compund has LOW thermal conductivity;  
 Border Molding: 2 stages: 1st stage, the molding should approximate the borders & be slightly 
OVEREXTENDED; excess trimmed & 2nd stage is refining remaining molding by repeating process;  
→ Most critical area on MAX denture = MUCOGINGIVAL FOLD above max. tuberosity area; 
→ For MAND. denture, distofacial extension determined by MASSETER MUSCLE & distolingual 
extension limited by SUPERIOR CONSTRICTOR MUSCLE; 
→ Dislodgement indicates overextension; very common area of overextension is the distobuccal 
corner of mand. denture pushing against Masseter muscle; 
 Ease & Accuracy of Border Molding:  1) Accurate fit of custom tray 
2) Control of bulk & temp of modeling compound 
3) Dried Tray 
 
 Polymerization –  changing elastomeric materials from pastes to rubberlike materials;  
→ Addition Polymerization (no ionic forms) – adding of units on each side of C‐C double bond; 
forms polymer w/o forming any other chemical; 
→ Condensation Polymerization – involves ionic species & produces small molecule by‐products 
of each step of rxn; when other chemical or by‐produces are produced that arent the polymer; 
 Reversible Hydrocolloids, like Agar, are 85% water and can change physical state by adding or 
removing heat; expesive equipment & difficult to disinfect;  
→ dimensionally unstable (single & immediate pour); LONGEST SHELF‐LIFE; 
 Agar – needs special equipement; good for crowns; physical state can be changed from GEL SOL by 
applying heat & reversed back by removing heat;  
→ only elastomeric that doesn’t involve a chemical reaction to set;  
 Alginate  ‐ ↑ temp = ↓ gelation time; too much/little water weakens gel; Reactor = Calcium Sulfate; 
very limited dimensional stability; want 3mm b/w tray & tissue; 
→ Sodium Alginate – tendency to give up water (synerisis  shrinks impression) or gain water 
(imbibition – expands impression); CONTROLS SETTING TIME of alginate b/c it’s the retarder; 
→ ↓ Water/Powder Ratio = ↑ setting of gel; once all the NaPO4 has reacted, the Na Alginate reacts w/ 
remaining calcium ions & forms calcium alginate;   
→ Fast removal of impression from mouth ↑ compressive & tensile strength of impression;  
→ It is a double decomposition reaction b/w sodium alginate + calcium phosphate;  
→ Best method to control gelation time of alginate is to alter water temperature; 
→ If impression is grainy, may be caused by improper mixing, prolonged mixing, or to low 
water:powder ratio; 
→ ALGINATE CONSTITUENTS: 
1. Diatomaceous (silica) = 50% (FILLER) 
2. Potassium Alginate = 20% (forms SOL) 
3. Calcium Sulfate = 16% (REACTOR) 
4. Zinc Oxide = 7% (PLASTICIZER) 
5. Potassium Fluoride = 6% (improves GYPSUM) 
6. Sodium Phosphate = 1% (RETARDER, controls setting time) 
 Polyethers – hydrophilic so unstable if moisture but tolerates moisture better than any other 
elastomer; rubber formed by cationic polymerization – cation but no free radicals;  
→ SHORTEST WORKING & SETTING TIMES (5‐6min); contracts slightly during setting; 
→ Custom trays needed since elastomers are more accurate in uniform thin layers that are            
2‐4mm thick; 
→ excellent dimensional stability; can be poured up to 1 wk; 2 Components: 
1. Base – polyether (polymer), silica filler & plasticizer 
2. Accelerator – crosslinking agent called aromatic sulfonic acid ester which 
produces cross‐linking by cationic polymerization;  
 Hysteresis – when material has melting temperature difference from its gelling temperature;  
 Polysulfide – WATER is by‐product; exothermic & accelerated by temperature; strongest resistance to 
tearing & high flexibility but causes distortion; Longest Setting time = 1214 min. 
→ requires custom tray for impression to control polymerization shrinkage; 2 components: 
1. White BASE – contains low weight polysulfide polymer; 
2. Brown ACCELERATOR – contains LEAD DIOXIDE & sulfur; lead dioxide accelerator 
is responsible for brown color that is difficult to clean off clothes! 
 Silicones – ETHYL ALCOHOL is by‐product (causes shrinkage); for complete dentures/crowns; don’t 
mix initially by hand; less expensive, easy cleanup; 1 year shelf life;  
→ low tear strength & poor moisture tolerance; must be poured immediately;  
→ poor dimensional stability because principal rx occurs during setting time is a condensation 
reaction via elimination/evaporation of ethyl/methyl alchol; 2 components: 
1. Base – liquid silicone polymer (dimethylsiloxane) 
2. Reactor – cross‐linking agent ethyl orthosilicate (metal organic ester) w/ 
activator = tin octoate;  
 Polyvinyl Siloxanes – NO BY‐PRODUCT; Silicone (silane H+ groups) & Vinyl Silicone (vinyl groups, 
catalyst); ↑ temp = ↓ setting time; can be poured up to 1 week;  
→ Excellent dimensional stability & very low permanent deformation;  
→ Poor tear strength, lowest temp rises, stiff, poor wettibility by gypsum;  
→ MOST WIDELY USED & MOST ACCURATE;  
 ZOE Impression Paste – sets as hard, brittle mass; ↑water = ↑setting time; ↓ setting by adding oil; 
→ Chelate – forms in typical acid‐base reactions;  
→ Setting time accelerated by ADDING a drop of WATER to the mix; MESSY & not recommened 
for gagging pt; dimensional stability affected if custom tray is NOT used;  
→ Difference b/w ZOE paste & modeling compound, ZOE must be done in 1 insertion while 
modeling compound is done in 2;  
→ can record soft tissue at rest, sets in 5 min, stable, & less expensive than polysulfides; 
→ Needs no undercuts of ridges; paste need to be uniform in color; 5 Components: 
1. Calcium Chloride – accelerator 
2. Oil of Cloves (70‐85% eugenol) – reduces burning 
3. Vegetable oil – plasticizer 
4. Resinous Balsam – increases flow. 
5. Rosin ‐ ↑ speed of reaction & makes smoother product;  
 SULFER in latex gloves retards PVS setting times; 
 Elastomers are more accurate in uniform → 2‐4mm thick w/ thin layers;  
 Longest to Shortest Working time = Agar > Polysulfide > Silicones > Alginate = Polyether 
 Best to Worst Dimensional Stability = Add’n Silicones > Polyether > Polysulfide > Condition Silicones 
 
DENTAL CASTING & GYPSUM: 
 3 types of Investment Materials: 
1. GypsumBonded – binder is gypson (calcium sulfate HEMIhydrate); for convetional gold 
alloys, Type 1, 2, & 3 gold alloys;  
i. Strength of investment for gold is dependent on amt of GYPSUM; 
2. PhosphateBonded – binder is metallic oxide & phosphate; for base metal alloys for PFMs & 
Type 4 gold; chosen for silver‐palladium, gold‐platinum, & nickel‐chromium alloys; 
i. Any allow w/ casting temp >2100oF/1150oC, should cast with binder OTHER than gypsum; 
3. Silica Bonded – binder is silica gel; for base metals for RPD framework; 
 the expansion of investment provides larger mold to compensate for subsequent contraction of alloy. 
 4 Mechanism Compensate for Solidification Shrinkage of Alloy during Casting: (they play a role in 
producing expanding mold):   1) Setting Expansion of the investment 
2) Hygroscoping expansion of investment (presence of water) 
3) Thermal expansion of investment 
4) Wax pattern expansion 
 Quartz or Cristobalite – refractory materials used for these investments to provide thermal 
expansion for the investment;  
 Potassium fluoride added to flux to dissolve passivating film (supplied by chromium) that may 
prevent wetting of the metal with the solder; Potassium fluoride is most common agent in flux; 
 ↑ strength of solder joint (circular) is increasing height of it; 
 Antiflux – restricts flow of solder; soft graphite pencil. 
 Casting alloys – Type 1 to 4 from weakest to strongest; 
 Gypsum Products – different HEMIHYDRATE particles in each product so different amount of water; 
main constituent = Calcium Sulfate Hemihydrate →all products form this reaction product; 4 Types: 
1. Type 1 – Impression Plaster; β   hemihydrate;  
2. Type 2   Plaster (model); β   hemihydrate; for ortho – 2x of water than stone; 
higher setting expansion than stone;  
a. Heating gypsum in open vessel at 150‐160oC = PLASTER; 
3. Type 3 – Dental Stone; α   hemihydrate; for dentures;  
a. Heating gypsum under pressure at 120‐150oC = STONE; 
4. Type 4 – Dental Stone (die stone); α   hemihydrate; for die‐work; increased 
strength & expansion; 
a. Boiling gypsum in 30% CaCl & MgCl = DIE STONE; 
→ β ‐ hemihydrate  requires more water b/c crystals are sponginess & irregular shaped & more 
porous than α ‐ hemihydrate (more dense crystals); 
→ main differences b/w dental plaster & stone powders is PARTICLE SIZE & SHAPE & POROSITY; 
→ more water used → less expansion & ↓ setting time & ↓ strength; 
→ when water removed, it forms Calcium Sulfate HEMIHYDRATE, but when water is added, it 
forms Calcium Sulfate DIHYDRATE; Starting gypsum is dihydrate;  
→ gypsum + water = heat (exothermic);  
→ All gypsum products are weaker in tensile strength than compressive strength;  
→ Gypsum Accelerators – potassium sulfate, sodium chloride, & aluminum; 
→ Gypsum Retarders – borax, sodium citrate;  
 Gypsum sets faster when →  1) ↑ spatulation 
2) lower water:powder ratio 
3) use mix of water & ground up gypsum particle 
 To prevent air entrapment is to place the proper amount of water in the mixing bowl first then sift the 
model plaster/stone into the bowl; 
 Maxillary sinus appears to ENLARGE throougout life if it is not restricted w/ natural teeth/dentures; 
as the sinus enlarges, the tuberosities move downward;  
 If low tuberosity is not removed, accidentally underextended mand. denture will be made causing 
limited space for teeth;  
 When the casting is COLD‐worked to provide required article/appliance, it is called wrought metal in 
contrast to cast metal; 
 Brittle – material w/ high compressive strength but low tensile strength;  
 Specific Gravity – property of gold alloys that exceeds a base‐metal alloy in numerical value;  
 Sprue – small diameter >1.5mm (10‐12 gauge) PIN made of wax/plastic; sprue should be 
equal/greater than thickest portion of the wax/plastic pattern;  
→ sprue attached to wax pattern at 45o angle;  
→ Spruing at a thin area can produce the same result as usuing a sprue that is too smal causing 
shrink back porosity, causing turbulence in the flow of the molten metal; 
 
CEMENTS: 
 The type of cement used does NOT affect or increase crown retention; 
 Tooth must be WIPED DRY, not air dried or dried w/ alcohol, before cementation; 
 Always apply cement to both restoration & tooth; 
 Composite Resin – luting material of choice to cement a ceramic crown & can provide STRONGEST 
BOND; 
 Zinc‐Phosphate Cement – also can be used to cement ceramic crowns; good compressive strength but 
high pH so need 2 layers of varnish to protect the pulp; 
 Zinc Polycarboxylate or ZOE – biologically compatible cements; used when preps have adequate 
length & retentive features or when prep is deep and pulp vitality is a concern; 
o Zinc Polycarboxylate & GI cements adhere to calcified dental tissue and have SUPERIOR biologic 
compatibility than zinc phosphate cements;  
 
ANATOMY/OCCLUSION: 
 CR = bone to bone relation (no tooth contact) – most unstrained retruded anatomic & functional 
position; cannot be fored into CR from rest position, mand must be relaxed and then guided into CR; 
→ condyle in most SUPEROANTERIOR POSITION w/ the articular disc interposed b/w condyle & 
eminence;  
 Rest Position → Muscle Guided (Freeway space); tonic stretch reflex; average = 26mm; 
 CR → Ligament Guided (retruded position); bone to bone; REPEATABLE reference point; 
 CO → Tooth guided (intercuspal position); determined by cusps of teeth; during “empty mouth 
swallowing”, the mandible is braced in intercuspal position; tooth contacts longer in swallowing than 
chewing;  
 
 1‐7 = Anterior Border Movement – MAX. OPENING;  
 4‐8 = Posterior Border Movement; 
 
 
 Jaw relationship most commonly used in ACTUAL design of restorations is the AQUIRED centric 
occlusion; 
 Nonworking Side Interferences (Balanced Side) – facial cusps of mandibular molars;  
 Working Side Interferences – Lingual cusps (inner aspect) of Maxillary molars; 
 Protrusive Interference – b/w distal inclines of facial cusp of maxillary teeth & mesial inclines of facial 
cusps of mandibular teeth; 
 Protrusive record made to register condylar path; when restoring entire mouth w/ crowns/ 
protrusive condylar path inclination influences mesial inclines of mandibular cusps; 
 Centric Interference (forward slide) – correct by grinding mesial inclines of maxillary teeth & distal 
inclines of mandibular teeth;  
 Mandibular Movements ‐  Protrusive (anteriorly) = 9‐10mm; Laterally = 10mm 
Inferiorly (opening) = 50‐60mm; Posteriorly = 1mm 
 Frankfort Horizontal Plane – outer canthus of eye to tragus of ear; 
 Class II occlusion not good for canine guidance or group function; 
 Mandibular Condylar Movement →  ‐‐Retrusive Mvmt = move back & up 
‐‐Protrusive Mvmt = move down & forward 
‐‐Lateral & Working Mvmt = down, forward, & laterally 
‐‐Lateral & Non‐working Mvmt = down, forward & medially. 
 Masseter Muscle – contracts during swallowing;  
 Functional Cusps: UL & LB; Also called Supporting, Working, Stamp, or Centric Cusps; Contact centric 
stops; they are broader & more rounded cusp ridges; used to CRUSH food; 
 BULL RULE – for Non‐supporting, Balanced, Non‐working, & Guiding Cusps;  
→ inner occlusal incline leading to these cusps are Guiding Inclines – b/c in contact mvmts, they 
guide supporting cusps away from midline;  
→ narrower & sharper cusp ridges to SHEAR food; 
 In posterior crossbite, supporting cusps & guiding cusps are opposite; so BULL RULE for working 
cusps;  
 NonWorking (balancing) Interferences occur on INNER inclines of FACIAL cusps of Mand. molars; 
 Working side(non‐balancing) Interferences occur on inner aspects of LINGUAL cusps of Max. molars; 
 During lateral excursions, the opposing cusps contact on WORKING side; 
 During later excurions, on the balancing/non‐working side, the maxillary lingual cusps contact the 
mandibular facial cusps;  
 Selective Grinding ‐  1) Never Grind Max. Lingual Cusps (Primary centric holding cusps); 
2) Grind Mand. Buccal Cusps if needed (Secondary centric holding cusps); 
→ Only grind cusps if premature contacts; 
→ Purpose of selective grinding is to remove all interferences w/o destroying cusp height; so 
instead of grinding cusps, fossa or marginal ridges opposing premature cusp is deepened; 
 Centric Interferences (forward slide) is corrected by grinding MESIAL inclines of maxillary teeth & 
DISTAL inclines of mandibular teeth;  
 Bennett Movement → aka Lateral Shift/Immediate Side Shift; working side of condyle only; this 
mvment influences MD position of posterior teeth cusps;  
 Bennett Angle → sagittal plane & path of Non‐working condyle during lateral movement; 
 Eccentric Occlusion – a protrusive & right & left lateral contacts of the teeth’s inclined planes when 
the mandible is not moving; 
 Bilateral Eccentric Occlusion – not an objective in RPD construction, unless opposing a complete 
denture; is an objective in complete dentures;  
 Bilateral Balanced Occlusion – dictates a MAXIMUM number of teeth that should contactduring 
mandibular lateral excursive movements; 
 Mutually Protected Occlusion (Canine Guided/Organic Occlusion) – most widely accepted 
arrangement of occlusion; when anterior teeth protect posterior teeth in all mand. excursions; 
→ Canines provide predominant guidance thru full range of mvmt in lateral mand. excursions; 
→ When placing crown on max. canine, if you cange canine guided occlusion to group function, 
you increase the chance of non‐working side interferences to occur;  
 Anterior Guidance ‐ result of horizontal & vertical overlap of anterior teeth; produces disclusion of 
posterior teeth when mand. protrudes & moves in lateral excursion;  
→ the greater the overlap, the longer cusp height;  
 Incisal Guidance – measure of the amount of mvmt & angle at which the lower incisors & mand. must 
move from overlapping position of centric occlusion to an edge to edge relationship w/ max. incisors;  
→ Second end‐controlling factor in articulator mvmt & is to some degree, under the dentist 
control; other end‐controlling factor is RIGHT & LEFT CONDYLAR mechanisms; 
→ Mechanical equivalent of horizontal & vertical overlap; 
 4 Determinants for restoring complete & functional occlusion: 
1. Vertical Overlap of Anterior teeth 
2. Contour of Articular Eminence 
3. Lateral Shift of Working Condyle 
4. Position of Tooth in Arch 
 Determinants of Occlusion – 1) TMJ, 2) Occlusal Surface of teeth, & 3) Neuromuscular System;  
 Group Function Occlusion (Unilateral Balanced Occlusion) – characterized by NO non‐working side 
contacts in a natural dentition;  
→ when ALL posterior teeth on side contact evenly as jaw moves toward WORKING side;  
 End‐Controlling factors of Articular Movement:  1) R & L Condylar Mechanisms 
2) Incisal Guidance 
 Condylar guidance is totally dictated by patient, not by dentist at all; inclination of condylar guidance 
depends on:  1) shape & size of bony contour of TMJ 
2) Muscle actions attached to mandible 
3) limiting effects of ligaments 
4) method used for registration;  
 In complete dentures, the condyle path during free mand. mvmt is governed mainly by shape of fossa 
& meniscus & muscular influence; 
 Inclination of condylar path during protrusive mvmt varies from steep to shallow in different pts, 
which is the most important factor that affects selection of post. teeth w/ appropriate cusp height; 
 Protrusive record is probably the LEAST reproducible maxillomandibular record; 
 Functionally Generated Pathway Technique (FGP) – records movements in wax intra‐orally & 
transferred to articulator in form of a static plastic cast (functional index);  
 TMJ – ginglymoarthrodial joint  ‐ slides/glides & rotates; 2 compartments: 
1. Lower Compartment – Condyle‐Articular Disc; Hinge type or ROTARY movement;  
2. Upper Compartment – Mandibular Fossa‐Articular Disc; SLIDING/TRANSLATORY movment; 
Lateral pterygoid muscle contract so condyle slides FORWARD;  
 Terminal Hinge Position (Transverse Horizontal Axis) – the one relation of the condyles to the 
fossae in which a pure hinging movement is possible;  
 Closes Mandible ‐   1) Masseter 
2) Medial Pterygoid 
3) Temporalis anterior fibers (posterior fibers retract the mandible) 
 Opens Mandible ‐   1) Lateral Pterygoid (also PROTRUDES & LATERAL mvmt) 
2) Anterior Digastric 
3) Omohyoid 
 Lateral Pterygoids are mainly responsible for positioning & translating the condyles; 
 Cusp Inclination  ‐ angle made by slopes of a cusp w/ a perpendicular line bisecting the cusp, 
measured MD or BL; under the DENTIST’s control; 
 Functionally Generated Pathway Technique – prerequisite is optimal occlusion; allows cuspal mvmts 
of the dentition to be recorded in wax intra‐orally then transferred to articulator in form of a static 
plastic cast (functional index); use low‐fusing hi‐fi wax;  
→ all mandibular motion must be directed from an eccentric centric position (never the reverse); 
 When surface to surface contact of flat cusps occur, it should be change to a point to surface contact; 
 When centric occlusion is established, NEVER take the teeth out of centric occlusion; 
 
OCCLUSAL CONTACTS FACTS: 
 DL cusp of mand. 1st molar opposes lingual groove of max. 1st molar (same as mand. 2nd molar); its 
DB cusp opposes max 1st molar central fossa & its D cusp occludes w/ distal triangular fossa of max 1st 
molar. 
 MB & DB cusps of max 1st molar oppose MB & DB grooves of mand. 1st molar; 
 Oblique ridge on Max. 1st molar opposes developmental groove b/w DB & D cusps of mand. 1st molar; 
 Lingual cusps of mandibular 1st PMs don’t occlude anything! 
 Lingual cusps of max PMs occlude the distal triangular fossa of their opposing counterpart; 
 Outer aspects of lingual cusps of mandibular molar don’t contact maxillary teeth; duh. 
 ML cusps of permanent mandibular molars occlude w/ the lingual embrasures b/w their class 
counterpart & tooth mesial to it;  
 Buccal cusp tips of max. PMs oppose facial embrasure b/w their counterpart & tooth distal to it;  
 Max & Mand. canine cusp tips do NOT contact any other tooth;  
 
PATHOLOGY: 
 Palatal Tori – more Females than Males; max size at 30’s or 40’s; may act as fulcrum & causing rocking 
of MAX. denture; post‐op healing slow if removed due to poor blood supply of thin tissues over tori;  
→ Thin mucosa is found over palatal & mandibular tori; 
→ Palatal tori is not usually removed but MAND. tori is usually removed prior to making dentures; 
 Inflammatory Papillary Hyperplasia – denture irritation & food impaction; hard palate; red, firm & 
painless; Candida Albicans may contribute to inflammation; most pts are unaware of lesions; 
 Denture‐Induced Fibrous Hyperplasia – Epulis Fissuratum; vestibular mucosa; trauma from bad 
denture; painless folds of fibrous tissue; often overextension of denture;  
→ Traumatic occlusion of natural teeth opposing an artificial denture may also cause epulis 
fissuratum;  
 Paget’s Disease – Osteitis Deformans; bone disorder in which bone becomes enlarged but weakened 
w/ heavy calcifications; often discovered in dental office b/c pts dentures don’t fit due to widening of 
alveolar ridge;  
 Diabetes – impairs WBC; delays healing, ↑ progress of periodontitis, ↑ calculus, & ↑ PA lesions; not 
associated with mucosal bleeding/bleeding disorders; 
 Denture Stomatitis – localized or generalized chronic inflammation of the denture‐bearing mucosa; 
presents as redness & burning; trauma & secondary fungal infection are most likely causes; 
 Children who wear dentures & acromegaly pts w/ dentures often need their dentures relined or 
remade often to allow for bone growth; 
 Osteoporosis – most common cahnge associated w/ systemic disease;  
 
MISCELLANEOUS: 
 Excessive wear on occluding surfaces of teeth is usually caused by disharmony between CO & CR;  
 Solder must melt at least 150oF below fusion temperature of metals; Gold solder used for FPD & 
Silver solder used for ortho appliances; 
 Horizontal Forces – most destructive to periodontium; 
 Ante’s Law – root surface area of abutement teeth supported by bone must equal/surpass the root 
surface area of teeth being replaced w/ pontics;  
 Strain/Work Hardening – hardening/deformation at room temp; ultimate result is fracture; 
↑hardness, strength, & proportional limit; ↓ ductility & resistance;  
→ ie – bending wire back & forth rapidly between the fingers; 
→ done at room temp in contrast to forging which is working at higher temperatures; 
→ under microscope, elongated grains in microstructure of wrought wire indicated 
worked/strained hardening; 
 Quenching – metal cooled from ↑ temp to room temp; To achieve softened condition for type 3 gold, 
quench in water 30‐40 sec; advtages – maintains the metal’s malleability & ductility and the casting is 
more easily cleaned cuz investment becomes soft & granular; 
 Annealing – softening a metal by controlled cooling of material to ↑ ductility & strength & less brittle; 
→ 3 stages – recovery, recrystallization, & grain growth;  
→ gold foil is annealed to remove volatile surface impuruities prior to placement in prep;  
 Fritting – process for manufacturing low & medium fusing porcelains; creates fine porcelain powder 
(frit) that can be added over by other metallic substances to produce color in porcelain;  
 High Sag Factor(Distortion) – leads to distortion of bridge spans when porcelain is fired; 
 X‐ray Signs of Occlusal Trauma:   1) Hypercementosis 
2) Root Resorption 
3) Alteration of Lamina Dura 
4) Alteration of Periodontal Space 
 Facebow – caliper device records pts. maxilla/hinge axis relationship = open/close axis;  
→ Record used to orient the maxillary cast to the hinge axis on the articulator;  
→ Hinge‐axis face bow transfer enables the dentist to ALTER VDO on articulator; 
→ Hinge‐axis face bow is used to record opening & closing of the mandible; 
 The preferred method to preserve the facebow transfer is TAKING A PLASTIC INDEX; 
 When alter VDO, casts should be mounted on Hinge axis;  
→ Facebow/hinge axis yield error of 2mm or less on most patients;  
 Pantograph – precise tracing of paths followed by the condyle; need 2 facebows & fully adjustable 
articulator;  
 Arcon Articulator – condylar element on LOWER MEMBRANE of articulator; FIXED condyle angle; like 
panadent – for CROWNS & DIAGNOSTIC CASTS; 
 Non‐Arcon Articulator – condylar element on UPPER MEMBRANE of articulator; NON‐FIXED condyle 
angle; for DENTURES;  
 Prolonged sensitivity to heat, cold, & pressure after crown cementation is usually related to 
OCCLUSAL TRAUMA; if CR occlusion is high, pt complains of cold sensitivity & pain on biting hard; 
 Excursive movements must also be checked b/c if pt complains of pain when chewing soft foods, this 
indicates improper balancing or working contacts;  
 Initial sensitivity can be caused by acid irritation accentuated by dehydrated dentin from prolonged 
drying of tooth b/f cementation or incorrect liquid/powder ratio of cement;  
 If marginal ridge is left higher than adjacent marginal ridge, a RETRUSIVE interference movement 
may occur; 
 Advantages of Post & Core:  1) Marginal adaptation & fit of restoration independent of fit of post; 
2) Restoration can be replaced without disturbing post & core; 
3) Can be treated as an independent abutment;  
 A post & core must have roots w/ adequate length, bulk, and straightness; if root configurations not 
favorable, then use pin‐retained amalgma or composite core;  
 Glazed porcelain, polished gold, unglazed porcelain, & polished acrylic are preferred in that order of 
their acceptability to soft tissue; 
 Electrosurgery – passing small current of electricity thru the gingival tissues, causing cells to desiccate 
or scorch; results in some delayed healing b/c lack of proper clot formation;  
→ very good at stopping hemorrhage;  
→ too low a current can be detected by tissue drag;  
→ objectives – coagulation, hemostasis, access to margins, & reduce inner wall of sulcus;  
→ potential serious damage to PDL & surrounding bone, causing loss of attachment; 
 Human Dentition Features the Effect PDL Health & Hard Tissue to resist occlusal Force: 
→ Anterior teeth have slight/no contact in MIP 
→ Occlusal table is <60% of overal FL width of tooth 
→ Occlusal table is at right angles to tooth’s long axis 
→ Mand. molar crowns are inclined 15‐20o toward the lingual 
 
RADIOLOGY 
MISCELLANEOUS: 
 For radiopaque structures, less radiation penetrates the structure & reaches the film so more 
radiation absorbed in structure;  
 For radiolucent structures, less dense materials ALLOW radiation to pass thru by absorbing very little 
radiation;  
 Most benign lesions are unilocular and well‐defined; 
 90% of diffuse radiolucent structures are cancer; if loss of cortical places, the 1st diagnosis is cancer; 
 Osteoradionecrosis is necrosis of bone produced by ionizing radiation; more common in the mandible 
than maxilla due to richer vascular supply in maxilla & b/c mandible is more often irradiated;  
→ Most common precipitating factors are pre & post irradiation & periodontal disease; damage to 
blood vessels predisposes a pt to developing this;  
→ don’t heat bone >116oF/47oC. 
 dental radiographs should be retained indefinitely; legally they are the property of the DENTIST but 
pts have right to reasonable access to radiographs;  
 pts may refuse radiographs but no document can be signed by the pt that releases the dentist from 
liability; 
 Digital Radiography – requires LESS radiationg than traditional x‐rays b/c the sensor is more 
sensitive to xrays; radiation exposure to pt is reduced by 50‐80%; sensor is used in place of film;  
→ Superior gray scale resolution, increase speed of image viewing, decreased cost of 
equipment & film, image enhancement, & superior pt education; 
 Storage Phosphor Imaging System – type of digital imaging system that uses a reversible imaging 
plate rather than a sensor to record image; plates are more flexible thus more comfortable for pt; 
 Direct Digital Imaging System –uses an intraoral sensor attached to a fiberoptic cable; 
 Indirect Digital Imaging System – scans an existing xray and digitizes the image; 
 Charge‐Coupled Device – the MOST COMMON digital image receptor; solid state detector w/ a silicon 
chip embedded in it; used in home video cameras, fax machines, & telescopes; 
 Primary Radiation – radiation generated at the ANODE of the xray tube that is attenuated by the filter 
& object; 
 Scondary Radiation (Scattered Radiation) – arises from interactions of the primary radiation beam 
w/ atoms in the object being imaged; a LEADED RECTANGULAR cone best ↓ amt of scatter radiation; 
→ major source of image degradation in both xray & nucelar medicine imaging techniques;  
→ operator recieves greates hazard from secondary radiation; 
 Collimation – control of size & shape of xray beam using metal plates & slots to confine & direct 
radiation;  
 Radiation beam should be as small as practical; diameter of circular beam of radiation at pt’s skin 
can’t be larger than 2.75 inches; 
 Xray beam composed of rays of different wavelengths & penetrating power (polychromatic) b/c the 
potential across the xray tube constantly changes at the kilovoltage changes; 
→ Short wavelength xrays = high energy; produced at high kVp & penetrates object more readily; 
→ Long wavelength xrays = low energy; produced at lower kVp thus ↓ penetrating power;  
→ Aluminum discs are used to filter out these useless long wave rays to ↑  quality of xray; 
 Filtration – removal of parts of xray spectrum using absorbing materials in the xray beam; reduces pt 
dose, contrast, & film density;  3 types of Filtration: 
1. Inherent Filtration – parts include glass envelope of the xray tube & oil surrounds xray tube to 
cool the tube to dissipate heat; corresponds to ~0.51mm of aluminum; 
2. Added Filtration – obtained by placing thin sheets of aluminum in cone to filter the useful beam 
futher;  
3. Total Filtration – consist of inherent filtration + added filtration; .5mm & 2.5mm of aluminum; 
 Operator should never remain in room holding xray in place for pt; if child needs help, have parent 
hold film with lead vest draped on them; 
 Operator must avoid primary beam by positioning themselves at 90o‐135o angle to the beam; 
 EKTASpeed Film – provides the MOST EFFECTIVE way to REDUCE exposure time, amoutn of 
radiation reaching pt & amount of scatter radiation; 
 Other factors that ↓ Pt Radiation:  1) Lead apron is MOST EFFECTIVE way to stop xrays 
2) ↑ filtration using aluminum disk 
3) lead diaphragms placed w/in cone of xray tubehead 
4) collimating an xray beam 
5) ↑ source‐film distance 
6) intensifying screens (used with pano & ceph) 
 Committee on Radiation Protection of National Bureau of Standards – recommends person who works 
near radiation be exposed in 1 yr to max dose of 5 REM (.1 REM/week);  
→ Maximum Permissible Dose = .5 REM for non‐occupationally exposed persion; 
 Sequence of Radiation Injury: 1. Latent Period, 2. Period of Cell Injury, 3. Recovery Period; 
 Effects of radiation exposure are ADDITIVE, & the damage that remains non‐repaired accumulates in 
tissues; 
 The greater the rate of potential for mitosis & more immature the cells & tissues, the more susceptible 
or sensitive these cells are to radiation;  
→ Radiosensitive cells: immature blood cells (small lymphocytes), bone marrow, reproductive 
cells, & immature bonce cells; Prostate gland is very sensitive to radiation; 
 Hemopoietic tissuse is most sensitive to radiation. 
→ Radioresistant cells: mature bone, muscle, & nerves (pulp); Muscle cells are most radioresistant; 
 Radiation Absorbed Dose – measure of the energy imparted by any type of ionizing radiation to a 
mass of any type of matter; unit of absorbed dose = rad;  
 Equivalent Dose – correct unit of measurement used by 
dentist to compare the biologic‐risk effects/estimates of 
different types of radiation damage to tissue/organ;  
 Effective Dose – used to estimate the risk in humans; 
 Exposure – measure of radiation quantity, the capacity of the radiation to ionize air; Roentgen is 
tranditional unit of radation expsure measured in air; Roetgen only applies to xrays & gamma rays; 
→ Xrays have more energy than line; ~1% of energy released in xray tube is released as xrays; 
 Electromagnetic Radiation – includes microwave, x‐radation, visible light, & gamma radiation; Xrays & 
gamma rays are type of nonparticulate radiation energy; 
 Submandibular gland fossa – large radiolucent space ~5mm below MB rooth of mand. 1st molar;  
 
RADIOGRAPHIC SOLUTION & ERRORS: 
 Developer Solution – solution that converts the invisible image on a film into a visible image 
composed of minute masses of black metallic silver;  
→ Films keep getting lighter & lighter after each development, to correct this problem simply 
replenish the developing solution; so as developing solution gets weaker, film gets lighter; 
→ Function is to reduce silver halide crystals to black metallic silver; 4 Chemicals: 
1. Developing Agent – hydroquinone 
2. Antioxidant preservative – sodium sulfite 
3. Accelerator – sodium carbonate 
4. Restrainer – potassium bromide 
 Fixer Solution – chemical solution whose function is to stop development & remove remaining 
unexposed crystals; fixing time is at least twice as long as developing time; 4 chemicals: 
1. Clearing Agent – sodium/ammonium thiosulfate; commonly called hypo dissolves & 
removes underdeveloped silverhalide crystals from emulsion;  
2. Antioxidant preservative – sodium sulfite 
3. Acidifier – acetic acid 
4. Hardener – potassium alum 
 If a dried xray were processed a 2nd time, there would be no change in contrast/density;  
 Yellowish brown film is caused by insufficient fixing or rinsing; 
 Fogged film may result from improper film storage or outdated films; or due to faulty safelight in 
darkroom with white light leaking; or b/c exposed to radiation other than from primary beam;  
 Low solution levels will appear as developer cut‐off (straight CLEAR border) or fixer cut‐off (straight 
BLACK border); 
 Static Marks (multiple black lines) ‐ due to friction when opening film packets causing static 
electricity; 
 Torn Emulsion – films were allowed to touch or overlap while drying; 
 Clear Films – emulsion washed away b/c film left in water over 24 hrs; or weren’t exposed to 
radiation; 
 Light Films – underexposed/image not dense enough; due to… 
→ Incorrect mA (too low) or exposure (too short) 
→ Incorrect focal‐film distance 
→ Cone too far from pt’s face 
→ Film place backwards;  
 Dark Films – overexposed/image too dense; due to… 
→ Incorrect mA (too high) 
→ Exposure too long 
→ Incorrect kVp (too high) 
 Poor Contrast (very dark/very light areas) – incorrect kVp (too high); 
 Herringbone (Diamond Effect) – a zig zag pattern appears on the processed film when film is placed 
backwards in mouth; 
 
TYPES OF RADIOGRAPHS: 
 Pano is the screening xray for pathology of the jaws; Excellent in Sialography – techniqued used in 
radiology that films the salivary gland after an opaque substance is injected into duct;  
→ Disadv. → ↑ object‐film distance causing image distortion & proximal overlapping; 
→ If Chin tilted too far UPWARD = Reverse Occlusal Plane Curve (frown) – where mand 
structures look narrower & max structures look wider;  
→ If Chin tilted too far DOWNWARD = occlusal place shows excessive upward curve (big 
smile); also severe interproximal overlapping & anterior teeth appear highly distored;  
 Ceph – useful to assess tooth‐to‐tooth, bone‐to‐bone, & tooth‐to‐bone relationships; serial cephs can 
show amount & direction of growth;  
→ Most stable area from which to evaluate craniofacial growth is anterior cranial base due 
to its early cessation of growth; 
 BWs – does NOT show root apices; vertical BW angulation = +8o‐10o; a fuzzy/indistinct image of 
crestal bone is often associated w/ early periodontitis;  
→ Adjust HORIZONTAL ANGULATION to direct the central ray toward center of film; 
→ Child w/ primary teeth, use #0 film. 
→ Child w/ mixed dention, us #1 film 
→ Child with 2nd molars, use 2 to 4 #2 films; sometimes 2 long #3 films but not recommended; 
 Submental‐Vertical (Submentovertex) – xray for diagnosing BASILAR SKULL FRACTURES & provides 
some info about zygoma, zygomatic arches, & mandible; use when suspect fracture of zygomatic arch; 
→ source below mandible & film about the head; 
 Water’s View – standard xray of choice for showing an ANTERIOR view of the paranasal sinuses & 
mid‐face & orbits; face lying against film & x‐ray source behind the pt’s head;  
→ BEST film for radiographic diagnosis of midfacial fractures, sinus infections, & its view 
best demonstrates lesions of the max. sinus; 
 Towne’s View – best film to visualize the CONDYLES & neck of mandible from AP projection; film 
under head & source is from the front & rotated 30o from frankfort plane & directed at condyles; 
→ towne’s view eliminates the superimposition of the mastoid & zygoma over the condylar neck in 
the straight postero‐anterior projection which often makes interpretation difficult;  
→ Reverse Towne’s View ‐ used to identify fractures of the condylar neck & ramus area;  
 
RADIOGRAPHIC TECHNIQUES: 
 Inverse Square Law – the intensity of the film exposure 
decreases as a squared ratio as the distance b/w the object & 
source of xrays increases; meaning intensity ↑ or ↓ exponentially as the source & object are moved 
while the distance b/w object & film remains the same;  
 Half‐Value Layer – amt of material required to reduce the intensity of an xray beam to half; normally 
expressed in aluminum or copper thickness; HVL is indicator of QUALITY of an xray beam; 
→ Strickly defined for different quantities – photon fluence, energy fluence, or absorbed dose; 
→ Not constant!! When measuring mutliple HVLs, the 2nd HVL is greater than the 1st HVL;  
→ The HVL of a beam is ~2mm of aluminum (this means 50% of the xrays exiting the vacumme tube 
are absorbed by 2mm aluminum; doubling the thickness of aluminum will NOT absorb all the 
xrays, but one half of the remaining xrays;  
 Intensifying Screens – used in extra‐oral xrays that convert xray energy into visible light which then 
exposes the screen film; radiation a pt receives is ↓; used for all extra‐oral xrays (pano, ceph); 
 Kilovoltage – quality or penetrating power of the xray beam that controls the speed of electrons;  
→ Suitable ranges are 65‐100 kVp; 
→ Influences the xray beam & radiograph by altering contrast quality (for pts w/ thick jaws, ↑kVp), 
determining the quality of xrays produced, & determining velocity of electrons to anode;  
 Milliamperage ‐ the number of electrons (which determines the quantity of xrays produced) is 
controlled by the TEMPERATURE of the tungsten filament (mA setting); the hotter the filament, the 
electrodes are emitted & available to form the electron stream; suitable range = 7‐15 mA; 
→ Controls the # of xrays produced; 
→ the intesity of xrays produced a particular kVp depends on that number;  
→ setting the xray machine for specific mA means adjusting the former temp to yield the 
current flow indicated;  
→ to ↑ film density = ↑ mA, kVp, & time & ↓ source‐object distance;  
 Exposure Time – length of time xrays are produced & the time the pt is exposed to them;  
 Contrast – only one exposure factor affects contrast → kVp; filtration also plays a role;  
→ ↑kP = more shades of gray = low contrast; so ↑kVp causes the resultant xray to have a LONGER 
SCALE of CONTRAST and ↓kVP causes ↑ subject contrast w/ SHORTER SCALE OF CONTRAST;  
→ high contrast = very dark & very light areas 
→ low contrast = many shades of gray; preferred in dentistry;  
 Density – overall DARKNESS of a xray that ↑ as mA, kVp, or exposure time ↑;  
 Focal Spot – small area of tungsten on the anode (target) from which the xrays emanates & receives 
the impact of the speeding electrons; it is 1 of 3 factors that influence image sharpness;  Size of xray 
tube focal spot influences radigraphic DEFINITION;  
→ Target(tungsten target) – tungsten wafer embedded in anode face at the point of electron 
bombardment;  
→ Target Film distance is determined by length of cone: 
 20cm (8 inches) – short cone that exposes more tissue by producing more divergent beam. 
 41cm (16 inches) – long cone that ↓ amt of exposed tissue by producing a less divergent beam 
& sharper image; 
 Xrays are generated when a stream of electrons (produced by filament) travels from Cathod & is 
suddenly stopped by its impace at tungsten target;   
 Filament located in the cathode and is made of tungsten wire; 
 The small area on the target that the electrons strike is the focal 
spot (the xray source); 
 Dental X‐Ray Tube Parts: 
1. Filament – coiled tungsten wire in cathod that when heated to 
incandescence, emits/produces stream of electrons;  
2. Molybdenum cup – houses the tungsten filament; 
3. Electron Stream – travels from filament in the cathode to the 
tungsten target; 
4. Tungsten Target – located in anode to stop stream of 
electrons; 
5. Focal spot – portion of tungsten target struck by electron 
beam;  
6. Copper Sleeve – located in the cathode; 
7. Vacuum 
8. Xray Beam – produced when electron stream bounces off focal spot on tungsten target; 
9. Leaded glass housing – houses entire xray tube;  
 Vertical Angulation – foreshortening & elongation are produced by incorrect vertical angulation; 
→ Foreshortening – shortened image caused by EXCESSIVE vertical angulation; teeth appear short 
due to too much angulation or poor chair position; 
→ Elongation – elongated image caused by too LITTLE vertical angulation; MOST COMMON error 
when taking xrays where teeth appear too long due to either too little vertical angulation or film 
not being parallel to long axis of teeth of the occlusal plane not being parallel to the floor;  
 Horizontal Angulation – maintaining central ray at 0o; central ray should be perpendicular to mean 
antero‐posterior plane of teeth being xrayed;  
→ Overlapping‐interproximal areas are overlapped due to incorrect horizontal tube angulation; 
 Bisecting Angle Technique – image on the film is equal to length of tooth whne the central ray is 
directed at 90o to the imaginary bisector;  
→ Tooth & radiographic image are equal in length when 2 equal triangles are formed that share a 
common side (imaginary bisector); 
→ Decreases exposure time; xray film may be distored b/c image is not true reproduction of the 
object (due to use of short cone);   
 Paralleling Technique – based on concept of parallelism since film is placed parallel to the long axis of 
tooth being xrayed & central xray beam is directed perpendicular to long axis of teeth & plane of film;  
→ Film holder MUST be used;  
→ Disadv – film placement difficult, ↑ exposure time required b/c use of long cone, & object‐film 
distance is ↑ to keep film parallel so image magnificaiton & loss of definition;  
→ AKA – XCP (extension cone paralleling technique), Right‐Angle technique, & Long‐cone technique; 
 SLOB – if object in question appears to move in SAME direction as xray tube, then it is on the LINGUAL 
aspect; if it appears to move in OPPOSITE direction as xray tube, then it is on BUCCAL aspect;  
 Cervical Burnout – phenomenon caused by relatively low x‐ray absorption on the mesial/distal 
surfaces of teeth, b/w the edges of the enamel & adjacent crest of alveolar ridge; 
 5 Rules to Create Accurate Image on Xray: 
1. Use smallest focal spot that is practical; as focal spot ↓, image sharpness ↑; 
2. Use longest source‐film distance that is practical; 
3. Place film as close as possible to structure being radiographed 
4. Direct central ray at a close to a right angle to the film 
5. Keep film parallel to the structure being radiographed; 
DAY 2 - 11tt April
Case 1: old man , has MI, had adenocarcinoma before, took radiotherapy for that, hepatitis before 24b
yrs, smokers, knee replacement before 6 months,
Medications – aspirin, warfarin, and some other medicines
Oral findings: white patch on floor of mouth, anterior cross bite, missing maxillary molar and exostosis
on the buccal of mandibular premolar /molar area, melanotic macule on the palate
Quest:
1. Reason for dry mouth- medication

2. Reason for the brown lesion on palate- cigarette use
3. Patch on the floor can be all except: stomatis nicotinia
4. Which lab test for the viral infection : HgSab ,/ HgcAb/, Transaminase ,/ no test
5. The patient is at increased risk for all except:
Procedure related bleeding
Hyposalivation
Osteoradionecrosis
SCC
6. Reason for the anterior cross bite : early loss of maxillary molar
7. What is true for his malocclusion
Related only to the anterior region ( on the left side he had a missing canine maxillary and the
posterior bite looked collapsed)
Correction of ant cross bite will improve esthetic and function
The premolar will function for the missing canine(smthg like this)
8. Most important to consider when deciding for the antibiotic prophylaxis : time elapsed since the
surgery
Case 2: 8 yr old girl with many missing teeth due to caries and poor oral hygiene.. anterior cross
bite and a supernumary tooth
Quest:
1. All will be included in the ortho informed consent except
Ortho treatment can bend roots of the teeth
Caries and gums dieses can happen during ortho treatment
Injury to the nerve due to any previous accident can be increased(or somthg like that)
during ortho
During ortho Pt will have to wear mouthguard during sports
2. All are negative sequel of extraction of the supernumary tooth except
Necrosis of 7
Non eruption of 7
Necrosis of 8
Necrosis of 6
3. Correction of the anterior cross bite will result in all except
Increase maxillary arch perimeter
Improve eruption of tooth 11
Stop root development of the central incisor
One more option
4. Correction of cross bite ASAP
Removable appliance with finger springs is one of the ways of correcting cross bite
True/ false question
Case 3:
A 20 years old girl , complains of occasional pain in the back lower jaws, has asthma
Take albuterol
Quest:
1. Reason for her pain
3rd molar
Occlusal trauma
Caries
(in the radiograph and pic there was no clue of 3rd molars or trauma or caries)
2. She starts wheezing on expiration . what will u Not do
Steroid inhaler
B2 agonist inhaler
Put pt is comfortable position
Give oxygen
Case 4: 42 yr old man, many teeth missing, wants denture
Oral finding : mandibular Canine to canine teeth r present, posteriors all edentulous
Maxillary: upper 2nd molar and 2nd premolar present rest all missing
Quest:
1. All are reason for his early tooth loss except

Poor oral care as a child
Lack of fluoridated water
Untreated periodontal disesese
Incomplete tooth development
2. All are risk of extraction of the upper teeth. Which is LEAST excepted
Dry socket
Tuberosity fracture
damage to adjacent tooth
one more option (that was not the least )
3. For denture in the mandible- least preferred

Extracted remaining teeth. Complete denture
Extract all anterior except canines on both sides, crown on the canine and
removable
Extract all teeth, 2 implants and dentures
Extract all, implant and fixed from 27- 25 and 22- 24, remaning removable
Case 5
Another case where the patient had edentulous space in the mandibular teeth
with 18 present. Has radio opacities in that edentulous area.
Quest was smthg like
What is least considered when planning for an implant.
Extraction of 18
Excision of the radioopacity
Proximity to vital structures
One more- don’t remeber( it was important consideration)
Random true/false that remember
1. Smoking is a contributing factor for periodontal disease

Accumulated calculus causes periodontal disease
2. Extraction of 32 causes damage to the lingual nerve

After extraction of 32 the soft tissue should be biopsied
3. Periodontal disease will inevitably cause tooth mortality

And one more regarding tooth mortality. Don’t remember
Dr. $atyam joshi’s Final File Part 2 – 2017-18
Disclaimer: Kindly do not misunderstand these as remembered or leaked
question. If any question or topic happens to appears in exam, it is purely co-
incidental. Any kind of resembelence is completely a coincidence. I have taken
the questions from books and discussions of various forums and tried to find
correct answer with explanation. The sources are mentioned as well. I have also
shortlisted and noted the topics from which I was looking questions. I take no
responsibility of any kind of resembelence, or copyrights issues. This is just a
help done to clear doubts and provide the right answers for all confused
questions and save time.
I have followed all the textbooks, decks, mosby, notes, ASDA, and facebook groups. I have
noted down questions that I found important from many sources. I have added the source with
page number in many repeated or doubtful questions. I will still suggest you to double check
things and study the topic of question because questions are randomly picked as and when
encountered while reading depending on the topics. Once again many questions are
intentionally repeated because I found them important or may be I wanted to add more
information on it. You guys can discuss the files or questions or may be update it like you did for
first file, up to you, but I can say that this is all you need for 2018 prep. All questions from most
of the important topics according to me are covered.
File is in 2 parts: Day 1 and Day 2
Hope this helps.
I believe that Knowledge is priceless, so one more time I will prefer to publish it free rather than
selling it or making money out of it.
NBDE Crash Course:
I would recommend crash courses with Dr. Joshi. Read about it here:
https://www.facebook.com/NBDE-Crash-Course-by-Dr-Satyam-joshi-146130856211047/
I have personally initiated crash courses for NBDE, NO institution or coaching classes or third
party are involved. Its my personal approach towards education. Course is open for 2 months
and space available is 40.
Dr. $ J Final File, Part 2 2017-18

@ Copyrights reserved 1
This course is designed in order to help more people get everything they need to prepare for
the exam in affordable rate so that they do not have to spend money on expensive money
making coaching classes or test taking portals. Over it, Major amount of money from this will be
given in charity to provide education to underprivileged children. If anyone is facing financial
crisis, this coaching is totally free for you.
To ace the exam follow these steps:
1. Before you start, you can see the weight of marks or questions on each subject from
NBDE guide or table I summarized to know your weak and strong areas in order to
schedule your studies.
2. Dental decks as main source (refer text books and videos for tough topics)
Subject Weight of marks (average) Number of cards in decks

acc to nbde guide 2017
endo 31 72
operative 44 124
patient management 51 99
prostho 51 171
orthodontics and 52 63
pedo 94
perio 48 159
oral surgery & pain 47 170
control
pharma 31 234
oral path and 45 183
radio and oral Diagnosis 73
45
Case based 100 16 in booklet
Total number of cards 1442 (approx)
So if you complete 25 cards a day, within 58 or 60 days, you can finish the entire dental decks
for the first time. Try to understand the concepts and try solving as many questions as you can as
and when you read.
3. Mosby for patient management (make sure you understand all the studies etc very well, if
time permits, read it from decks too)
4. Tufts for pharma
5. Kaplan cases
6. Dentin for revision – fantastic book. I strongly recommend. Dentin remains my favourite
till now for part 2.
7. Asda papers

8. Files for revision (my file has almost everything you need, but if you want you can also
go for mango, master files, golden etc. (I have covered them already))
9. Files for pictures called “exam pic” and one in “Master day 2”
10. Work on as many pictures and radiographs as you can
11. Spend an hour at least every day on fb groups or any good discussion forum to solve
questions.
Super important topics
1. Endo or perio diagnosis, pulpitis, periodontitis, abscess, necrosis, granulomas, their tests
etc (I have mentioned a very nice table in the end)
2. Treatment plans
3. Interferences – working non working everything
4. Ortho and pedo cases, malocclusions and treatment plan
5. Flaps, incisions, gingivectomy, grafts, GTR, wall defects, hemisections, root
amputations, etc
6. Studies in pt. management, Cross sectional, observational, case control, clinical trials,
value statistics, errors descriptive studies, etc
7. Implants everything
8. Hue value chroma
9. Pulpectomoy, pulpotomy, apexification, apexogenesis
10. Medical compromised pt management
11. Amalgam class 1, 2, 5
12. Space maintainers and regainers
13. Composites
14. Impression material
15. RPD, designs, RPI, clasps, etc
16. FPD – crowns, preps, bridges
17. CD
18. Sounds
19. Extraction complications, LA complications
20. burs
21. New medicine names
22. treatment plans
23. immunodeficiency cases
24. how to replace cases, by crown or partial or amalgam or what
25. asthma, hypertension, diabetes, thyroid, gardner
26. developmental anomaly, germination, fusion, supernumery etc
27. instruments, files, forceps
28. child behaviour
29. antidotes
30. case study, Which case study tells what.
31. Fluroides: Amount of fluoride in public drink water
32. reinforcement.
33. Bacteria in peridontitis
34. Tooth developement

35. Incisal guidance
36. recent studies
37. LA mechanism
38. erosion, abfraction and attrition cause and treatment
39. antagonist physiologic and competative
40. qns back from pm section in mosby
41. Syndroms
42. Tufts pharma (everything)
43. Cross allergy for anesthetics, know esters and amides
44. Plaque, calculus, pellicle etc
45. kVp, grey scale etc
46. antibiotic prophylaxis new
47. epidemiology/Prevalence of all diseases between different races
48. Pfm and all ceramic preparation
49. cases and tt plan like: decay – tret, don’t tret, observe
50. MOA of drugs
51. patient management about ADHD children
52. drug interactions with epi Bisphosphonates anti hypertensive drugs.
53. Extracting the supernumerary tooth, when, how etc
54. ortho treatment for anterior cross bite, when how etc
55. how to correct patients molar relationship, which were in dental class 2 malocclusion,
class 3
56. ortho – pano, xray, cephalo
57. RCT, bleaching, and crowns
58. Acute chronic periodontitis, anug
59. pulpitis
60. Articulators
61. Cases from board review and kaplan
62. Analgesics, Nsaids
63. H1 blockers
64. la ga, nitrous, everything
65. Sedatives and hypnotics
66. Antibiotics everything
67. Narcotics everything
68. Emergency medications
69. Anti fungal
70. Gerd medications, tb medications,
71. asthma, hypertentions, epi, syncope, shock, pregnant, alcoholic, etc
72. Anti depressants
73. Schedule 2,3, 5 etc
74. Anti diabetic, anti coagulants
75. PT, INR
76. CHF, Angina, arythema, emphysems, laryngeal spasm, syncope, shock, Addison
77. Linea alba, apthous ulcer, candidiasis, Kaposi, Hutchison triad, syphilis, lupus eryth, cav
sinus thrombosis, tracher Collin syndrome, gardner, scarlet fever, ford granule,
pemphigus pemphogoid, scc, bcc, nicotine stomatitis, candidiasis, papilloma, Pyogenic

granuloma, smokers palate, leukoplakia, leukemia, erythroplakia, pulmer Vinson
syndrome, verrucous ca, granuloma, salivary gland tumors, ameloblastic fibroma,
maeloblastoma, AOT, cysts, dentigerous, okc, eruption, nasolabial, nevoid, ecto and
Dentinal dysplasis, Dent. Imperfects, cement osseous, amelo imperfect, osteo imperfects,
neurofibromatosis, neurilemoma peutz jeger, nikolksy sign, steven Johnson,sjrogen,
fissured, geographic tongue, weber syndrome, white lesions etc
78. Le fort fractures,
79. TMJ disorders, MPDS
80. Trigeminal neuralgia, bells palsy
Index (List of sources used to make this file)

Here is the list of books and files that I have referred in order to make this file and important
questions.
1. Textbooks
2. Dental Decks
3. Dentin / Board Busters
4. Mosby
5. Tufts Pharma
6. Kaplan cases
7. ASDA Papers
8. 1000 Q bank
9. Some part of textbooks
10. Files from FB and other sources
11. Golden, mega golden
12. Master files (day 1 and 2)
13. May 2017
14. More recently 04/9/17
15. Recentyrqs 4-11-17
16. More rqs 4/14/16
17. May 11 2017 RQ File covered
18. Reb Ques file
19. questions 072017 | July 2017
20. My… File file | July 2017 | June 9 2017
21. My… File | August 2017
22. August 2017
23. Questions File | September 2017
24. RQ November 2017 File
25. Re… file | November 2017
26. NBDE Pass 2017 RQs November 2017 File
27. nbde pass 2017
28. rqs ( day 1 )
29. Aa’s RQ | December 2017
30. A’s RQ oct 12-13’ 17
31. My Rqs A.. T.. file | November 2017
32. Juz Wish, 8th November 2017
33. N C…’s part 2 File | November 2017

34. 7th December 2017
35. J.. H.. | December 5 at 3:06pm
36. Nb De, RQ's from friend | 8th December 2017 and | Z A. I.. December 4
37. 2016 Continued (imp)
38. 10th December 2017 | Nbde Dental Rq | Rq Dec-2017 file
39. 10th august 2017
40. H… W N…s Rq's. sept 2017
41. U.. S.. rqs
42. 11th August 2017
43. Nbde Aim
44. H… 29 september 2017 | Sept Word
45. RQs 14th Sep 2017.
46. D… s…12th august 2017
47. My rqs
48. T.. RQ – 20 September 2017
49. Z..L.. Rq 19th Sept 2017
50. J.. Nbde October 11 2017
51. NBDE Peri | New RQ |I.. B.. | Doctor RQ | November 18 2017
52. DOCTOR_K RQS | Paris NBDE 10 September
53. 19th October 2017 AJ Mentor | My Qs | AJ questions
54. My RQ's R.. D.. | July 20, 2017
55. Discussion of rq by A G A
56. J.. K.. 20 July 2017
57. R.. H… 20 november 2017
58. R.. C…
59. March 27
60. M.. b.. 14th august 2017 | Marne NBDE July 18 2017
61. S.. V.. Rq 29th August | 25th 26th august RQ
62. Recently-rqs-abril-2017
63. Recently rqs04 /11/17
64. D. H.. – 12th Jan 2018
65. S... December 28 2017
66. R.. G.., 27/28th December 2017
67. S S, 29th December 2017 | Post Xmas file
68. NBDE Goal, 29th December 2017
69. P S Rq (December 22, 2017)
70. P P, December 30, 2017 | My few rem qs
71. J H, December 22, 2017
72. K G 12th January 2018
73. P M 4th Feb 2018,
74. J K, December 23, 2017
75. Y A, 9th February 2018
76. D S 28th December
77. pass nbde 10 feb 2018
78. K F C, 26 Jan 2018
79. H S, 14th February 2018.

80. AT Feb 13th 2018
81. Day 2 cases M 25th August 2017
82. A_s Rq.doc
83. Day two notes.doc
84. Doctor RQ.pdf
85. Mark Goal Qs.pdf
86. May 11 2017 Rq.pdf
87. My file.doc
88. My Qs.doc
89. My s.doc
90. My Rqs A P.doc
91. My questions 072017.doc
92. NBDE 2 Exam Sept WORD.doc
93. Nbde part 2.txt
94. NBDE PASS 2017 RQs NOVEMBER 2017.doc
95. WAY FOR PART 2.doc
96. Questions.doc
97. Recently-rqs-abril-2017.doc
98. Read Ques (1).rtf
99. Read questions ca (1).doc
100. RQ November 2017.doc
101. RQ-Dec 2017.pdf
102. T ques.docx
103. ARROZ CON MANGO.pdf (it’s a really good file, if time permits do go through it)
104. My few rem qs.docx
105. NBDEx2_s RQ.pdf
106. 007.pdf
107. Post Xmas.pdf
108. Money Rqs-Feb.2018.docx
109. S Rq
110. Te Rq
Day 1
1. Stages of AIDS and no. of Leukocyte count. Stage 1: Acute primary infection, Stage 2:
The asymptomatic stage, Stage 3: Symptomatic HIV infection | >150,000
-according to this website CDC classification is below, WHO classification 1) Primary HIV
infection, 2) Clinical Stage 1, 3) Clinical Stage 2, 4) Clinical Stage 3, 5) Clinical Stage 4
According to CDC: Stage 1: Acute HIV infection , Stage 2: Clinical latency (HIV inactivity
or dormancy), Stage 3: Acquired immunodeficiency syndrome (AIDS)
2. Treacher Collin Syndrome ? Deficiency of growth of facial bone and tissues, Small jaw
and chin, Downward slanting eyes, delay development, Malformed ear,mandibular
hypoplasia, hypoplasia zygomatic bone, Defect in all 1st pharyngeal pouch derivatives
Treacher Collins syndrome, autosomal dominant syndrome caused by mutation of
TCOF1. Coloboma is part of a set of characteristic facies that features craniofacial

malformations, such as downslanting eyes, ear anomalies, or hypoplasia of zigomatic
bone and jaw (micrognathia).
3. Ectodermal dysplasia. Cause supernumerary teeth, Anodontia or oligodontia,conical
teeth, slow hair gland growth, Lack of sweat glands, concave nasal bridge, pt. looks older
in age.
4. What is the key factor for a denture to be successful? Stability
5. 4 yrs old child – fluoride supplement? 0.25 to 0.28 ppm
(Very nice chart given about it in master file 1)
6. Infection stage of syphilis? Second stage

7. Optimum treatment for palatal papillary hyperplasia? Electrosurgery
8. What happens when you change from 8’’ to 16’’? ¼
9. 3 canals- which premolar? Maxillary 1st PM
10. Triangular canal central incisor- why? For striaght line access
according to DD 42( 2016-2017) (if not in option then to expose pulp horn)
11. Angles Class II- chances of trauma the most (Class 2 div 1)
12. Most broad spectrum antibiotic? Tetracycline and chloremphenicol
13. Angioedema not caused by which drug? ACE inhibitor (and is Caused by penicilline)
14. Dens in dente? Mostly in maxillary lateral (looks like cingulum on x-ray)
15. One question on SLOB rule? Same lingual opposite buccal
16. Most difficult to floss where? Mesial aspect of max PM1
17. Dental clicking? increased VDO
18. Function of rest? Provide vertical support
19. function of axial guidance? Equals retention on all abutments. Provides reinforcement
and creates a cross-stabilization of the dental arch. Minimize partial denture torsion
forces Allow partial denture to be removed without interference Distributes forces
along the longitudinal axes of teeth. Provides retention by Contact friction between
parallel surfaces on the teeth.
20. Question on horizontal axis of condyle? rotation movement of mandible / Opening and
closing movement
21. As teeth ages, what increases? Hue/chroma? Hue unchanged, chroma increases and
value decreases.
Hue is the individual color of the object, chroma is the intensity of the hue, and valueis
the lightness or darkness of an object. Translucency is the fourth dimension of color
in dentistry
22. Patient wakes up in the morning with sore pain in muscles? Bruxism/Sinusitis? Bruxism

23. Difference between 245 and 330 bur? Length (245-3mm | 330 – 1.5mm, 245 has
sharper angle)
24. Prostaglandin analogue? Misoprostol. (given in open angle glaucoma i.e latanoprost,
and reduce the Intraocular pressure, Bimatoprost)
25. Aspirin and Ginseng? What happens if given together? Bleeding induces
26. Filtration used in X-ray machines? Aluminum. (2.5 mm using 70 Kvp federal norm.
Reduce wavelengths and dose to the patient) (Lead is used for collimination)
27. Compton effect? compton effect increase in wavelength of x rays or gamma rays.
28. Flouride water level? 0.7 to 1.2 ppm (if not in option, 1 ppm)
29. Angioedema? Rapid swelling of dermis,subcutaneous, mucosa and submucosa tissues
Emergency treatment is Intubation and cricothyrodotomy
30. Diphenhydramine- anti motion sickness (Benadryl, also given when pt. is allergic to both
esters and amides. Antihistamin, anti cholinergic, sedation)
31. Difference between snuff dipper and nicotina stomatitis? nicotinic stomatitis lesion
seen on palate due to smoking.....snuf dipper lesion seen on buccal side and it is
mainly due to smokeless tobacco. Snuff--- dysplastic, premalignant, Nicotinic --- non
malignant
32. Pt. sitting with folded arms and legs shaking. What do you say to him? What brought
you here
33. Most commom reason for pt. to have a negative attitude for dental treatment. a) Own
dental experience b) Heard from peer/friends? Own dental experience
34. Clinical test for Rheumatoid arthritis? CCP ( anticyclic citrullinated peptide)
Clinical test - watch toes and fingers - they become crooked, skeletal deformity, The
hallmark feature of rheumatoid arthritis (RA) is persistent symmetric polyarthritis
(synovitis) that affects the hands and feet, although any joint lined by a synovial
membrane may be involved. (wikipedia)
35. Sjogrens syndrome is associated with? Lymphoma
36. Reasons for eruption failure? Ankylosis, primary eruption failure, impaction, down
syndrome, agenisis etc
37. Critical pH for demineralization of dentin? 6.0 - 6.7 for Dentin, 4.5-5.5 for Enamel (6.2-
dentin, 5.5 enamel)
38. Reciprocal anchorage? Stabilization, Reciprocation, Indirect retention, Elastics to close
diastema
39. Diabetes in children can lead to? Blindness
40. B.P. 160/140. Pulse 90. What do you do? Repeat after 15 mins/ call the physician
immediately? Repeat after 15 mins
41. what happens when you increase water in gypsum? Decrease expansion and decrease
setting time.
42. LAP t/t ? Tetracycline 250 mg thrice for 14 days | severe cases- metronidazole and
penicillin (Sc/Rp and antibiotics)
43. Area of least attached gingival? Which tooth? Maxillary canine, mandibular 2nd pm
44. How to check clinically for the prognosis of PDL attachment? Probing
45. Pt. with alcohol abuse? What to check in lab report before extraction? Blood alcohol
level? INR

46. Pain on eating sweet? reversible pulpitis
47. ossifying fibroma? ossifying fibroma encountered in young children often <10
48. Pt receive blow to eye orbital floor less common t/f? True
49. In Facebow transfers relation of arches? In centric/ In occlusion? In centric
50. epinephrine action on which receptor in epinephrine reversal? Epinephrine has effect
on both alpha and beta.. but epinephrine reversal is due to alpha receptor
stimulation. Epinephrine reversal is best demonstrated when it is given after alpha
blocker....which lead to beta mediated vasodilation in peripheral vessels against
vasoconstriction by alpha receptor, so total peripheral resistance is decreased and mean
blood pressure falls.....so epinephrine action on Beta receptor in presence of alpha
blocker causes Epinephrine reversal.
51. initiator in heat cured resin? Benzoyl peroxide
52. cause of brown discoloration of gingival margin of resin restoration? microleakage (still
depends on exact question and options)
53. skewed distribution? Negative and positive.. bimodal distribution. (Positive right peak
and negative left peak)
54. cimentidine function? Cimetidine is a drug that blocks the production of acid by acid-
producing cells in the stomach. Decrease clearance of LA
55. topical antibiotic in perio? Doxycycline
56. child with multiple caries? give GA
57. least congenital missing tooth? Maxillary Canine
58. Gingseng contra with? Aspirin (induced bleeding)
59. Major connector function? Rigidity and stability
60. incisal position during record? Midline of incisal part of upper incisors
61. first pass metabolism? Enterohepatic circulation | Liver - oral drugs
62. Polymerization shrinkage In composite depends upon? Filler content
63. Pulpitis 5 days after class ll composite is due to? Increase occlusal contact, microleakage,
Undercured composite? Increase occlusal contact | Microleakage (if the condition is
after 2-3 weeks, this one goes true)
64. which sound during wax try in? Sibilant | S and Z
65. Least occurrence cyst? Lateral periodontal cyst
66. young female pt with vital tooth canine features with? AOT
67. ortho tipping before of veneering? Before
68. most imp feature of single implant? Anti-rotational (go with osteointigration if in
option)
69. drug biotransformation? Excretion of drug.. by passing through
70. white rough peduncalted lesion on palate? papilloma or fibroma? Papilloma
71. primary and secondary stress bearing areas in maxilla? Primary - Residual alveolar
ridge, Secondary – Rugae
72. primary and secondary stress bearing areas in mandible? Primary- buccal shelf area,
Secondary- residual Alveolar ridge
73. best area for successful implant? ant mandible
74. reason for image distortion? Pt. moved during exposure (Incorrect horizontal and
vertical angulation, technique error)

75. reason for light radiograph? Low Kvp, Ma and exhausted developer and overfixing
76. pedicle graft? When there is recession of single tooth, excellent esthetic, less chance of
failure, good vascularization
77. epi of free gingival graft? Recipient epithelium
78. gingivectomy indication? Gingival hyperplasia, abnormal growth, pseudopockets
present, suprabony pockets
79. gingivectomy contraindication? Infrabony pockets
80. clotrimazole which form torche? Candidiasis
81. topical antifungal? Nystatin and ketoconazole
82. dentist did wrong treatment and didnt tell pt . whats that term? Veracity
83. disc movement first it moves 25 mm click is hear than 5 mm. so what side it goes in 5
mm ? Anterior to normal
84. tooth size and morphology in which stage of tooth development? Bell Stage
85. mandibular denture position in relation to tongue? Below
86. unbunding? dentist seperating treatment charges which actually can be counted as
single procedure whose cumulative is more than actual charge
87. lateral surface of tongue asymptomatic blue lesion in old pt since 5 yrs hemangioma or
varicosities? Varicosities (hemangioma if less than 10 year age)
88. lactating mother sedation drug? Promethazin
89. fever in children drug of choice? Tylenol (acetaminophen)
90. nephrotoxicity by which drug? Aminoglycoside
91. reduced insulin dose in what? IV sedation
92. wheel chair transfer? Sliding
93. desquamative gingivitis? In pemphigus and pemphigoid, lichen planus
94. antibiotic and surgery is treatment for what lap or anug? Antibiotic-lap, Surgery-anug
95. Herpes peak age? 2-5 years
96. difference between affected and infected dentin? affected has discoloration but no
active caries...infected has active progressive caries. Infected always need to be
removed
97. movement for recording buccal frenal area of mandible? Upward and outward

98. opioid allergy? Itching, flushing, hives and dec bp. In Overdose give Naloxone. For
allergic Replace for synthetic opioids. E.g. Tramadol, meperidine. oevrdose causes
resp. depression
99. Pain killer in renal disease? Oxycodone
100. Cocaine? Mydriasis (opioid cause miosis pin point pupil)
101. BDZ antagonist? Flumazenil
102. Neurofibromatosis? Cafe au lauts spots, axillary freckling and lisch nodules
103. Direct retainer uses? Retention/Stability? Retention
104. Which immunoglobulin is concentrated in gingival clevicular fluid? IgG
inferiorly and x-ray direction superiorly which way will the canal appear to move: A)
Apical, B) Mesial, C) Distal, D) Coronal? A) Apical
106. Informed consent can have all of the following EXCEPT: A) Informed consent must be
presented in advance of the treatment. B) Informed consent must contain treatment
options. C) Informed consent must be in written form. D) Informed consent must
contain risks and benefits of the treatment? B) Informed consent must contain
treatment options.
107. Which of the following shows the best way of active listening? A) Rephrasing the
listener’s understanding of speaker’s communication. B) Active eye contact. C) By
sounding listener’s concern? B) Active eye contact.
108. Patient complains, “Why do I have to stay here for so long for you to do this, why can’t
you finish it already?” A) Because that’s how treatment works you idiot. B) That’s how
long it takes to provide quality care. C) It seems like you’re upset, may be we can
reschedule you for another day for longer appointment. D) It seems you are upset,
what are your concerns about the procedure we’re doing today?
109. Question on Type – I error, gave the test result value of 0.01 and the researchers
rejected the null hypothesis, what kind of error? Type – I
effective way to make sure they follow the cleaning regimen? A) Ask the parents to
supervise them. B) Educate them about oral hygiene. C) Give them limited praise with
good progress at each appointment? C) Give them limited praise with good progress at
each appointment
111. Porcelain porosity: Inadequate condensation
112. What do we write the consult for: A) To gain certain information B) To gain clearance C)
To have a better relationship with patient’s physician? B) To gain clearance
113. Child starts throwing fits? Voice control
114. Disabled kid, best measure? Consistency
115. Implant to implant distance? 3mm BL :1.5mm right MD: 1mm
116. Middle-aged male has a fluctuant mass in the midline of neck? A) Thyroglossal duct cyst
B) Brachial cleft cyst? A) Thyroglossal duct cyst
A) mucopolysaccharides B) macros C) levans D) proteins? C) levans
118. Nerve involved in Bell’s palsy? VII
119. 4mm implant, how much do you need buccolingually? 6 mm

120. Mandibular 3rd molar root lost: which space? Submandibular
121. IAN block needle infection where: Pharyngeal, Pterygoid, medial pterygoid muscle?
medial pterygoid muscle
122. Veneer facial reduction? 0.5mm
123. PFM buccal margin depth? 1.5 mm
124. Patient comes back after 1 year of composite restoration with pain and sensitivity?
Microleakage
125. Radiograph to check integrity of Zygomatic arch? Submentovertex
126. TMJ radiograph? MRI for articular disc
127. Behcet’s syndrome associated with: Herpes simplex, Aphthous ulcers, Leukemia?
Aphthous
128. Bradycardia treatment? Atropine, scoplamine
129. Which is NOT used to inhibit salivary secretion? Pilocarpine or Cevimeline
130. Which is contraindicated in nitrous? nasal congestion (if not in option go with copd)
depths of >4mm. B) location of anterior restorations. (because chemotherapy causes
xerostomia which leads to class V lesions) C) location of partial denture flange.? B)
location of anterior restorations. (because chemotherapy causes xerostomia which
leads to class V lesions)
132. Over titration of Amalgam leads to? fast setting so decreased working time, High
contractility, Increase corosion
133. Cavernous thrombosis infection via? lymphatic vessels. as are on the upper lip is
valveless
Prognosis: A) fixed bridge from #10-12. B) RPD with pontic for #11 C) Implants? A) fixed
bridge from #10-12. (in dd it is mentioned that when replacing max or mand canine ,
the central and lateral should be splinted to prevent lateral drifting of fixed bridge)
135. Metalloceramic crown which type of bevel? Chamfer 1mm (in dd for pfm labial
shoulder is 1.5mm Chamfer is 0.5mm)
136. predominant cells in gcf? PMN
137. cleft palate, mand hypoplasia and tonue obstruction? pieree Robin syndrome
138. Neurofibromatosis type 1 features? Cauflet,Lisch nodules,Crowe sign
139. Radiograph with multiple periapical radiolucencies.( cementosseous dysplasia)? Florid
cementoosseous dysplasia
140. Radiograph of cementoblastoma, stafne cyst? stafne cyst is by lingual, angle of mand,
and it is radioluc, and cementobl is radioopaque, at apical of molars, you can see it at
the mandible angle, but it is tilted to lingual of the angle
141. Sequence of using retraction cords? larger first,000 followed by smaller ones 00
142. Gracey curette 13/14 used for- Distal surface of posteriors (11/12 Mesial ,13/14 distal)
143. girl with gingival bleeding and recurrent infection- leukemia
144. 5 mm intrusion of primary tooth? Extract (final answer according to textbooks. Note
that you can check with radiograph if pressure on permanent bud then extract, if not
leave and monitor, then extract)

145. sodium hypochlorite properties? Root canal irrigant, dissolve s organic substance, not a
chelating agent, so irritant to the oral tisues
146. Reason for amalgam fracture at isthmus? Inadequate depth, sharp angles, irregular
surfaces, too shallow
147. they give child’s age and asked for max dosage of lidocaine? 4.4 mg /kg child
148. ledge what to do? bypass it and continue
149. most common area for caries? pit and fissure or apical to contact? pits and fissures
150. pt came back after a month with discolored margins wat could be the reason? Marginal
leakage
151. Function of reciprocal arm? Resists displacement of tooth due to retentive arm,
Stabilization, prevents abutment tooth displacement during removal and insertion
152. function of anti-retraction valve? One way flow check, it prevents the flow of water
back into dental units
153. What dentist cannot increase? value
154. How to manage hearing disable patients? Talk to them slowly and for them to interpret
155. Dentist performing treatment without patients consent? BATTERY
156. Impending doom? panic attack / anxiety
157. majority of fees paid for dental treatment? SELF PAY
158. Antifungal in troche form? CLOTRIMAZOLE
159. Ludwig angina? Ludwig's angina is a fascial space infection with bilateral involvement
of the submandibular, sublingual and submental spaces. The external signs may
include bilateral lower facial edema around the mandible and upper neck. Intraoral
signs may include a raised floor of mouth due to sublingual space involvement and
posterior displacement of the tongue. Symptoms may include dysphagia, pain with
swallowing, difficulty breathing, and pain.
Ludwig's angina should be treated urgently due to the airway being compromised. The
infection may rapidly spread to other fascial spaces of the head and neck, further
compromising the airway.The route of infection in most cases is from infected lower
molars or from pericoronitis.
160. antagonist for benzodiazepines? FLUMAZENIL
161. Closest speaking space sound? S sound
162. Palatal root of max 1st molar appear mesial to MB root, from where does the beam
projected? Mesial side
163. Efficacy of a drug? max ceiling effect
164. Frankfurt horizonal plane? Porion- Orbitale
165. Two questions on fusion and germination? Fusion two tooth bud fused, giving a
apparently a missing tooth. It has independent pulp chambers and canals.
Germination just one tooth bud trying to split in two. Tooth count is normal. One pulp
chamber but two pulp canals
166. Dry socket mainly in which tooth? Mandibular molar
167. Reason for porcelain greening at cervical margin? Silver. (whole crown - silver, at
margins –copper)
168. Antibiotic for Clostridium difficile? Metro, clinda for G+ve( with few G-ve) coci and
staph but it is static not cidal as Penicillin

169. Penumbra? Causes of penumbra - large focal spot size, movement of receptor or
object, To decrease penumbra reduce focal spot size
170. most common emergency in dental setting? SYNCOPE
171. Deviation of mandible on the opposite side of lesion? Condylar hyperplasia, same side
hypoplasia
172. Patient has cold sensitivity and pain on biting? HYPEROCCLUSION
173. Most common impacted tooth? Mandibular 3rd Molar (least common maxillary lateral)
174. most common congenitally missing tooth? 3rd molars - mn 2nd pm- Mx li. (Maxi 3rd
molar, upper jaw have more tendency)
175. Early loss of primary canines, due to? Severe tooth-arch length discrepancy
176. most common type of seizure in young children? absence of seizure / ferbile, then
grand mal
177. Treatment for grand mal seizure? PHENYTOIN
178. For maxillary protrusion? Maxi protrusion is class 2 so we use cervical/ straight pull.
Reverse head gear is for class 3, i.e madibular retrustion.
179. saturation of color? Chroma
180. Patient was standing along a wall, looking at floor in waiting area, what should dentist
say? What brings you here today
181. question on desensitization? slowly increasing anxiety stimuli while using relaxation
skill
182. primary etiological factor of periodontitis? Plaque
183. most common osseous defect? CRATER (3 wall)
184. One wall defect? Hemiseptum
185. effective way for cleaning large proximal areas? Interdental brushes
186. Denture patient difficulty in swallowing? Increased VDO
187. Blue lines seen on ventral tongue and floor of mouth? Varicose veins
188. At what age child develops manual dexterity to brush without any assistance? 6-9 years
189. Galvanic shock? Amalgam opposed gold
190. Galvanic shock? sharp pain electric sensation when two similar surface come in
contact in mouth. occur immediately after new restoration.
191. Chronic periodontitis, frequently seen in? Black male
192. Diabetes mellitus type 2, mostly in? Black male
193. Recent increase in incidence of which type of caries? Root caries
194. Denture becomes tight? Paget disease
195. Treatment for class 2 furcation? GTR

196. What decides formation of new epithelium at receptor site? Connective tissue of donor
site

197. Success rate of non-surgical endodontic therapy? 81-90%
198. High torque handpiece for implant placemen? Low speed high torque
199. Physiologic antagonism? Epinephrine acts as physiologic antagonist to histamine
200. Transient ischemic attack features? Numbness or weakness of one side of the body,
difficult speak, walk and keeping balance. Dizziness
201. Displacement of mand 3rd molar root tip in? submandibular space
202. A young person can give consent for treatment of an old person if he has? Power of
Attorney of Health care
203. What represent the variability about the mean-value of a group of observations?
Standard Deviation
204. Unbundling? dentist charges separate cost for each procedure rather than charging as
a whole
205. Closed panel? Limited providers, HMO
206. Combination syndrome feature? Flabby premaxilla
Combination syndrome commonly occurs in patients with a completely edentulous
maxilla opposed by a bilateral distal-extension removable partial denture. Symptoms of
the syndrome consist of anterior maxillary bone loss, mandibular bone loss, tuberosity
overgrowth, and alveolar ridge canting. It occurs when a total maxillary denture
opposed to anterior natural mandibular teeth. Features: loss of bone on maxillary
anterior alveolar ridge, extrusion of anterior mandibular teeth, development of fibrous
hyperplasia of maxillary tuberosity, When there is a bone loss of anterior maxilla it's
become flabby with most of the tissue is fibrous and no underneath bone support
207. Sulfur in Latex gloves retards setting time of which impression material? Additional
Silicone
208. Function of plaster index? Preserve face bow transfer
209. Indication of lingual plate? Depth of lingual vestibule is less than 7mm
210. Green and orange stain on maxillary incisor, due to? Poor oral hygiene

211. Treatment of ANUG and Alveolar osteitis? ANUG OH instructions, SRP, ab if general
symptoms, gingivectomy. Alveolar osteitis, dressing. No ab needed and do not
curettage
212. Use of lithium? Bipolar Disorder
213. Least reliable test on primary teeth? Electric pulp test
214. In hairy leukoplakia, there is hypertrophy of which papillae? Filiform
215. Case 1- Patient with prosthetic knee replacement 6 month ago, H/O bypass surgery and
radiotherapy for prostate adenocarcinoma. Taking many medications.
Q 1 Reason for dry mouth? Xerostomia due to medication
Q 2 He need antibiotic prophylaxis for what reason? Recent knee replacement
Q 3 Has a white lesion on floor of mouth..It could be anything except SCC. Verrucous
carcinoma, Nicotinic stomatitis
216. Case 2- Girl 8 years..multiple extracted teeth due to caries, anterior cross bite,
supernumerary tooth
Q 1 When should be treated for cross bite? During erupting
Q 2 Preventive approach for caries? Pit and fissure sealants
Q 3 Maxillary 1st molar tilted (due to early loss of E)..what should be the treatment?
Space regaining appliance / Band and loop
217. Which of these not side effect of methotroxate? thrombosis formation
218. which of these will cause the gypsum to set faster? A:borax B:Na citrate C: k sulfide D:
two of them
219. Missing more than two teeth but not all them? Oligodontia
220. enamel loss is not a symptom for dentin dysplasia? True
221. most common supernumerary tooth? Between Maxillary central
222. most common variable tooth is? Maxillary Lateral
223. most common tooth affected by dens in dente? Maxillary Lateral
224. regional odntodysphagia? Ghost teeth
225. most common type of tooth loss in bulimic pt? Lingual Surface
226. tooth loss due to tooth influx? Abfraction
227. bald tongue and dysphagia is in a risk of developing which cancer? SCC (Pulmmer
Vinson syndrome)
228. problem in CL channel which disease? Cystic Fibrosis
229. crowe sign? Neurofibrometosis type 1 (presence of axillary (armpit) freckling in people
with neurofibromatosis type I, Von ricklengston/ Laryngeal spasm)
230. uniform widen in pdl and bilateral resorb of angel what is the disease? Scleroderma
231. condensing ostetits? Chronic pulp inflammation, Non-vital tooth
232. oral sign with achondroplasia? Normal tooth, crowding and class 3
233. dental problem with decrease Alk pho? hypocalcification with enlarged pulp chambers,
hypophsphatasia, Enlarge pulp and incomplete root
234. x linked associated with thin hait and hypodontia? Ectodermal dysplasia
235. supernumerary teeth with cranial bossing which syndrome? CLidocranial
236. warm bone sign of which disease? Pagets
237. early shedding of primary teeth and delay of perm teeth? Cherubism,
Hypophosphatasia, Hyperthyroidism, Papillon-Lefevre Syndrome, EDS

238. dry and rough hair and enlarge tongue and max over grow associated with?
Hypothyrodism
239. bells palsy which nerve? Facial
240. delay healing associated with all except ( Cushing /Addison/-DM/vit c increase )?
Increased Vit C
241. Ig m hetro diagnosis for? infectious mononucleosis by epv
242. simple question about ledwig angina? Submental, submand and sublingial no retro
pharyngeal
243. most common cause of xerostomia? Medication
244. punch out appearance and m spike? Multiple Myeloma
245. wide pdl and paresthesia and tooth loss with? Osteosarcoma
246. sharp pain increase with chewing? Glossopharangyal neuralgia
247. most common non odonto cyst is? Nasopalatine
248. pear shape cyst is? Lateral Periodontal Cyst
249. calcified flax cerbi with which syndrome? Golrin Syndrome
250. most common cyst? Radicular
251. only way to differentiate bw granuloma and radicular cyst? Histology
252. tennis rackets and honeycomb appearance which cancer? Odontogenic myxoma
253. complex odntoma more in? Post. Mandible
254. most common burn in mouth due to? Aspirin
255. geographic necrosis with kidney problem what is the diagnosis? Wegner
256. most common gland affected by salivary gland tumor is? Parotid (depends on what kind
of tumor, also look for minor salivary)
257. question about necrotizing silometaplasia? Hard palate, no treatment needed
258. question about mucocele easy one? On lower lip, change in size
259. warthin tumor effect which gland more? Parotid
260. periapical cemental dysp more in? (Black middle age female in ant mandible.)
261. location for periapical osseus dysplasia (periapical cemento-osseus dysplasia) is? Lower
anteriors. (it is more common in female and more common than cementoblastoma)
Also note
Florid= all quadrants
Focal= in posterior
Periapical= anterior
Bening cementoblastoma= true cementoma
Periapical cementoosseous dysplasia
Focal cementoosseous dysplasia
Florid cemento osseous dysplasia=Gigantiform cementoma
These are all described as Cementoma
Cementomas comprise Periapical cemental dysplasia , Cementifying fibroma,
Cementoblastoma and Gigantiform cementome. They are poorly demarcated non-
specific opacities are sometimes referred to as florid osseous dysplasia by WHO.
Cementoma: RO lesion with a RL RING. associated with tooth. Root outline of tooth can
not be distinguised. Posterior Mandible Area

Focal Cemento Osseous Dysplasia is a COTTON BALL like lesion (RL with RO focal
deposits) in the posterior mandible and NOT associated with a tooth
262. histology of phemphigus and mmp? Pemphigus Suprabasilar split, Infra

263. lumpy jaw and sulfur granule which disease? Actinomycosis
264. most common infectious stage in syphilis? Secondary
265. hand and foot lesion which virus? Coxsaki
266. which of these has pain same to tooth pain (hsv/vzv/max sinusitis)? Shingles (vzv) can
mimic tooth ache
267. how to differentiate ANUG from primary herpetic gingivostomatits? Anug include
inproximal ginigiva, not in primary herpetic
268. lesion in eye has a name subnour? mmp (mucous membrane pemphogoid) - in dd both
penphigus and mmp will have conjunctiva involvment, but with mmp it may lead to
blindness
269. cobblestone appearance - Cobblestone appearance has been reported in:
Crohn's disease: small and large bowel, candida oesophagitis, Hirschsprung disease,
eosinophilic gastritis, duodenitis, Brunner gland hyperplasia of the duodenum, nodular
lymphoid hyperplasia in duodenal cap, Other disease processes can present with a
cobblestone-like imaging characteristics.
intraluminal adhesions of the fallopian tubes on hysterosalpingography, cobblestone
lissencephaly (in the brain)
270. which taste bud affected in geographic tongue ? Filliform
271. not associated with macroglossia? Hyperparathyroidism / Pierre robin syndrome if
below mentioned info does not help
Macroglossia seen in vascular malformations (e.g. lymphangioma or hemangioma) and
muscular hypertrophy (e.g. Beckwith–Wiedemann syndrome or hemihyperplasia).
Enlargement due to lymphangioma gives the tongue a pebbly appearance with multiple
superficial dilated lymphatic channels. Enlargement due to hemihyperplasia is unilateral.
In edentulous persons, a lack of teeth leaves more room for the tongue to expand into

laterally, which can create problems with wearing dentures and may cause
pseudomacroglossia.
Amyloidosis is an accumulation of insoluble proteins in tissues that impedes normal
function. This can be a cause of macroglossia if amyloid is deposited in the tissues of the
tongue, which gives it a nodular appearance.
Beckwith–Wiedemann syndrome is a rare hereditary condition, which may include other
defects such as omphalocele, visceromegaly, gigantism or neonatal hypoglycemia.
Apparent macroglossia can also occur in Down syndrome. hypothyroid disorders.
mucopolysaccharidosis, neurofibromatosis, multiple endocrine neoplasia type 2B,
myxedema, acromegaly, angioedema, tumors (e.g. carcinoma), Glycogen storage
disease type 2, Simpson-Golabi-Behmel syndrome, Triploid Syndrome, trisomy 4p,
fucosidosis, alpha-mannosidosis, Klippel-Trenaunay-Weber syndrome,
cardiofaciocutaneous syndrome, Ras pathway disorders, transient neonatal diabetes,
lingual thyroid.
272. patient allergic to morphine with sever liver problem and he has asthma the best pain
killer for him? a:ibuprofen b:Tylenol c:mepridine d:codine e:non of above? c:mepridine
273. which of these not side effect of cortisone? a:cataracts b:osteoporosis c:increase gastric
mucousal secretion d: Addison disease? d: Addison disease
274. mechanism of action of sulfouria? block k channel
275. mechanism of action of disulfrim ? inhabit aldehyde dehydrogenase enzyme
276. asprin cause? a:metabolic acidosis b:respiratory acidosis c:metabolic
alkalosis d:respiratory alkalosis e:two of them? E: two of them (resp alkalosis and
metabolic acidosis)
277. Which of these not side effect of methotroxate? thrombosis formation
278. which of these will cause the gypsum to set faster? k sulfide
279. light pass through to through (craze line/crack)? Craze line
280. not in the first line of tx of periodontists (antibiotic/surgery)? Surgery
281. not feature of modify Widman flap (displace/no reduce of osseous defect)? no reduce
of osseous defect
282. most common respiratory problem in dental clinic( hyperventilation / no asthma in the
choices )? Hyperventillation
283. most common cause of amalgam failure is? improper/problem with cavity prep
(contamination for fracture. Reference textbooks and decks. 100% confirm about it)
284. doing FMX and u charged the patient for each one is? Unbundling
285. if u reject null hypothesis and p =0.08? type one error
286. wheelchair? sliding
287. child with furcation involve in tooth number E best treatment is? Extraction
288. best test to test tooth with crown? cold test
289. worst media to save avulsion tooth? Water
290. unuion between tow teeth by the mean of cementum is? concrescnase
291. stumilated salivary flow? 1
292. unstimulated ? 0.1 (if 0.2 or 0.3 are not in choice)
293. clediocranial dysplasia? Supernumerary
294. trapezoidal mouth and shovel incisor? Apert

295. baby bottle decay effect mostly? max anterior
296. most common cause of sealant failure? contamination with saliva
297. Naf for how many minutes should be applied? 4 minutes
298. most common congenital missing primary tooth? Maxillary Lateral
299. the smallest primary tooth is? smallest permanant tooth is mandi central incisor but
smallest primary tooth is mandi lat incisor
300. mesial cusp ridge is longer than distal one in? maxi 1st Pm and primary maxi canine
301. which stage abnormality may cause peg shape lateral? Bell stage
302. two canals mostly in which pm? Maxillary 1st Pm
303. edeta? can remove Thin layer of calcification
304. pulp diagnosis (pain on percussion ) not respond to thermal? A: abscess with irreversible
pulpitis B:reverible pulpitis C:periodontitis D: non of above (cant be A bcoz u will not
see abscess with irreversible just with necrotic pulp effect on vitality)
305. no generation after endo for ? dentin
306. remenrlizer enamel is? harder and darker
307. class 2 caries? triangle and the apex to the pulp
308. 245 bur? longer than 330
309. change amalgam to composite? veracity
(FROM ADA WEBSITE ON VERACITY: 5.A.1. Dental Amalgam and Other Restorative
Materials. Based on current scientific data the ADA has determined that the removal of
amalgam restorations from the non-allergic patient for the alleged purpose of removing
toxic substances from the body, when such treatment is performed solely at the
recommendation of the dentist, is improper and unethical. The same principle of
veracity applies to the dentist's recommendation concerning the removal of any dental
restorative material)
310. cusp reduction? resistance form
311. most lab complain from? under prepare
312. about ¾ crown? Less retentive than complete crown
313. wavelength associated with? Hue
314. Facet found on? working side (Buccal of lower cusp)
315. most strain wall? gingival / proximal

316. composite and bleaching? wait 1 week before composite
317. steroid dose need medical consultant? 20 mg for 2 weeks 2 year
318. Repair veneer? miroetch-etch-saline

319. water and temp effect on gypsum you should know it? increase water reduce setting
expansion and incr setting time, Cold water prolong setting time
320. incisal pen? pin lifted up with records
321. baby with streak on palate? Episten nodule , pearl
322. ameloblasoma from okc? light microscope
323. effect on anemia? cold not no2 (No2 will cause anemia crisis – sickle cell anemia)
324. stridor? Larangyospasm
325. sizuer due to? hypo ( Na)
326. Max dose of Tylenol? 4 gm
327. Tylenol which schedule? Schedule 3 (if with codine)
328. First pass metabolism? Liver
329. Advantage of Iv? Allows for titration of drug, Rapid onset
330. Reverse epinephrine by? Alpha blocker
331. Epi works on which receptor? All Alpha 1,2 and Beta 1,2 blockers (source mosby)
332. Not an alpha blocker? Metaprolol
333. First side effect of beta blocker? Tachycardia or Shortness of breath, weakness or
drowsiness (whichever in choice go according to the order mentioned)
334. Which Anesthesia without epi? Mepivicaine
335. Which Anesthesia not with anemia? Nitrous oxide
336. Allergic to both ester and amide what to give? Diphenydrimine (benadryl)
337. EMLA composed of which two type of anesthesia? Lido 2.5 % and 2.5% prilocaine (
mosby)
338. anesthesia not vasodilator? Cocain
339. Why anesthesia not work in inflame area? Decrease in free ion. (Inflamation will reduce
the availability of free bases which is requred to cross the neural membrane , and
become ionized and charged)
340. First nerve affect by LA? Small unmyelinated, (c fibers)
341. Which trimester contraindicate the No2? First
342. Overdose of LA what to give? Diazepam (alpha blocker if diazepam not in choice)
343. Antagonist of dizpam? Flumszenil
344. Problem in liver which benzo to give? lorazepam oxyzepam Trizolam (LOT)
345. Buspiron which receptor works in? Serotonin
346. Best anti epileptic for absence seizure? Ethosuxemide / valporoc
347. LA contra with which drug (MOA)? LA with epi contra with MAO inhibitors, also with
TCA
348. Omprzoel used for ( GERD or zollinger)? GERD
349. Most common side effect of clindmycine is? pseudomem colitis
350. Mech of action of nystatin? Inhibit ergrstrol, Bind ergosterol form pores
351. Which drug increase the effect of amoxicillin? Clavulonic acid (increase with
probenecid ,Peniciline clearance is slow with Probenecid .Peniciline stay more time in
the body .More effect)
352. Drug not with cimtidine? Seldane
353. Drug not with milk? Tetracycline
354. All of these are antipsychotic exept? lorazpam

355. Eps with which drug except? clozapine
356. Aspirin cuz all except ( hyperpnea /tacypenia/hyperkalemia/hyperthermia )?
hyperkalemia
357. Long time pain killer? naproxen
358. Side effect of cholinergic drug? Excessive secretions, meiosis
359. Tx of motion sickness? Atropin, scopolamine
360. Tx of myasthenia gravis? Neostigmine, pyridostigmine, Pencillin, azithromycin.
(endopronium for diagnosis)
361. Tx of xerostomia due to radiation? Pilocarpin. (Ceviemiline use to treat xerostomia
with sjogren syndrome)
362. Edrophonuim all true except? cause dry mouth
363. Overdose of organophosphate cholinesterase inhibitor? Same effect as cholinergic /
Pralidoxime
364. Dont use cortisone in? Peptic ulcer, tb, fungal infection, HIV
365. Mech of action of diltazim? Calcium channel blocker (Diltiazem produces relaxation of
coronary vascular smooth muscle and dilation of both large and small coronary
arteries at drug levels which cause little or no negative inotropic effect.)
366. Contra for use digoxin? Diuretic , will inc digitalis toxicity
367. Mech of action of heparin? Potentiates antithrombin 3 prevents formation of fibrin
368. Aldosterone antagonist? Spironolactone is a nonselective aldosterone antagonist, and
eplerenone is selective
369. Cyp 34A? Inhibitors are antifungals increases triazolam serum conc/ increases serum
level of trizolam (u should know how drug effect on it from dd only, pg 160
miscellaneous)
370. Tx of glucoma by? Pilocarpine (betaxolol,Latanoprost, Bimatoprost)
371. Aledronate use in treat which disease? Osteoporosis
372. ADHA drug? Amphetamine, methymesilate
373. Overdose of lead tx by? EDTA by chelation ( mosby)
374. Modafinil decrease gaba to improve what? Decrease sleep
375. Side effect of opioid ? Misosis, Sedation
376. Overdose of morphine tx by? Naloxone / Methadone
377. Only opioid can be transmucosal is? Febtanyl, available as lollipop type ( brand name
actiq) for transmucosal absorption, and transdermal patch ( duragesic)( dd)
378. Bluish lesion on lateral surface of tongue 5yr painless what is it varicosities or
hemangioma? Varicosities
379. Dry socket irrigation with antibiotics solx or sedative dressing? sedative dressing
380. Warty lesion? papilloma
381. Maxillary 4 teeth rpd? Mac anterior teeth contacting on protrusion only, at CR, balanced
occlusion, canine guided? Mac anterior teeth contacting on protrusion only,
382. benzoyl peroxide decomposition by tertiary amine in chemically activated resin? True
383. Abx in celluitis with draining fistula yes or no? Yes
384. Antibiotic for sinusitis? Augmentin
385. treatment of ANUG? Debridment and antimircobial rins chx or h2o2, Penc v h2o2
debridement

386. Complication of temporal arthritis? Blindness
387. Where do we use 10% chx varnish? P&f caries prevention, white smooth surface caries
prevention, secondary caries prevention? white smooth surface caries prevention
388. Parkinson's disease, all except? is progressive, always require medication, associated
with intentional tremor, associated with dementia? associated with intentional tremor
389. Tx of parkinsons? Levadopa with carbidopa
390. Amount of epithelial regene. Everyday is 0.5-1 mm? True
391. Chronic periodontitis, class 2 diabetes mellitus-- black males? True
392. Gtr best for horizontal augmentation, class 2 furcatin, one wall defect, class 3 furcation?
class 2 furcatin
393. Gtr-- involves coronal movement of pdl? True
394. Reattachment concept? Reunion of tissue to root
395. Radiographic appearance of precornitis? Flames
396. Cracked tooth? Pain on releasing of biting pressure
397. Epinephrine reversal? Pentolamine
398. Achondroplasia dentition feature? Class three, Max small cz cross bite, severe
crowding. normal trunk, short limbs
399. Ameloblastoma? Benign, Localy aggressive, Reverse polarization, Rl post mn, Extreme
facial deformity, teeth vital, painless, honey comb or soap bubble appearnce
400. basal cell carcinoma? Uper face or Lat side of nose
401. Pain medication for alcoholic pt? Oxycodon
402. Fetal alcohol syndrome? Mid facial dyscripancy
403. antibioticis of maythenia g? Penicillin
404. If no enough space what tooth pop out of arch maxi and mand? maxillary arch- canine
and mandibular arch- 2 pm
405. Xyltol? gum
406. FDA. determines which drugs are to be sold by prescription only? Schedule 2
407. Contraindication of RCT? Uncontroll DM , Recent MI, Luekmia
408. Resistance for short crown? Proximal groove
409. Lazer in periodontal disease? gingivectomy
410. Mepridine? Agonist, narcotic Trt mederate to severe pain, Less potent thn morphine,
more thn codiene, shorter duration of action, sintetic opiod
411. fusion germination? Fusion by all enamel, dentin,cementum, Dec no of teeth in arch,
Gemination spliting of crown, Inc no of teeth in arch
412. Erosion.. attrition? Erosion by acid, Attrition teeth to teeth contact
413. Which study can show incidence? Descriptive
414. Objective fear? Due to previous experience
415. theory of stress and how affect immunity? Induce cortisol and reduce immunity
416. Autonomy. Non mal.? autonomy- patients right, non maleficience- know ur ability and
refer to specialist if necessary
417. thyroid crisis symptoms? Exophthalmos , tachycardia, high BP
418. hypoxia sign? Cyanosis
419. what is the most common psych disorder? Depression
420. Occlusal rest clearance? 1.5 mm at marginal ridge

421. How base metal prevent corrosion? Chromium
422. Antibiotic in gingival? Azithromycin, Doxycyclin, Tetracyclin
423. Consent? Autonomy
424. Leakage in amalgam decrease with age? True
425. systemic desensitization? Grafual exposure to fearful stimuli, exposure can be
combined with relaxation exercises
426. 16 kg anasthesia calculation – (16 x 4.4)? 70.4 mg or 1.9 carpules
427. Most common emergency in dental clinic? Syncope
428. Most common respiratory emergency? Asthma...(if hyperventilation is not in the
options)
429. best filling for class 5? RMGIC
430. insluin shock? If conc oral juce,If not iv glucagon when return conc give oral glucose
source
431. Functions of major connector? Rigidity, support, stability
432. Three dentist hired a hygienist - patient injured by hygienist, whose liability? Hygienist
and attending dentist
433. 3 mm crowding in Mandibular ant permanent teeth? No treatment (No treatment if
less than 4 mm, if greater than 4mm then extraction happen or starts with discing and
then extractions up to serial extractions)
434. Class 2 dea prescription? Oxycodeine+ acetaminophen
(CLASS II is Hydrocodeine + acetaminophen / Oxycodeine+ acetaminophen, -
Hydrocodone + ibuprofen = CLASS III, Hydrocodone + acetaminophen = CLASS II,
Codeine+ acetaminophen = CLASS III, Oxycodone + acetaminophen = CLASS II, although
new guide line said hydrocodone and its combinations is class 2 recently,,,, but still in dd
its class 3 , so follow dd which is written for our exam)
435. Tooth extraction ? 1 day after dialysis
436. Which requires elective root canal? Severely tilted (If severely tilted, preparation of the
tooth for a crown is likely to involve hitting the pulp horn, with the possible need for
endodontics on that tooth.)
(Instances in which Elective Endodontic Therapy of an Apparently Vital Tooth may be
Justified: Many of the radiographic signs are subtle and radiographs must be observed
carefully for: Pulpal exposure. Very deep caries or very deep existing restorations (Fig
23-1a), particularly if associated with any of the factors below. Overprepared tooth
stump (Fig 23-1b). Sclerosing pulp canals, if the sclerosis were to continue non-surgical
endodontic treatment might be impossible (Fig 23-1c). Hypercementosis (although this
can be idiopathic) plus: (i) very deep caries; (ii) very deep restoration; (iii) overprepared
tooth stump (Fig 23-1a). Blushing during tooth preparation (Fig 23-1d) which fails to
disappear within one week when dressed immediately with a steroid paste, for
example, Ledermix (Lederle), for 10 minutes and then with zinc oxide eugenol cement.
This recommendation is based upon the clinical records of 35 such teeth observed, on
average, for nine years, with a range of four to 16 years. Only one of the teeth has
developed endodontic problems. This recommendation requires verification by
controlled animal study. Apical root resorption or indistinct root outline and: (i) deep
caries, (ii) deep restoration, or (iii) overpreparation (Fig 23-1e). Radiographic loss of

cortical plate continuity, including any of the indications listed above (Fig 23-1f).
Periapical sclerosis including any of the indications listed above (Figs 23-1c, e).
Internal/external root resorption (Fig 23-1g and Fig 4-27e). Tooth stump with
insufficient retention or resistance form (Fig 23-1b). A post and core may be required for
a mutilated tooth stump. Parallelism problems that cannot be overcome without the
fabrication of a post and core. Furcation problems requiring root resection or division.
Continued pain following tooth preparation.)
437. Clamp no.212 is used for? class 5 restoration
438. Where to punch the hole? facially , lingually? Facially
439. Class 5 - restoration of choice? Rmgi
440. Most common in man? Diabetes
(Hemophilia can be the answer.. because it's genetic and A and B is more common in
males.. but diabetes more common in man with high cholestrol.. depends on exact
question)
441. Caoh success depends on? Providing 2mm of gic base
442. Which material most stable in moisture? Polyvinyl
443. Wat does not aid in restriction and resistance of crown? Less convergence
444. Tooth crown ration fracture most common with? max CI in trauma horizontal fracture,
mand molars - vertical fracture
445. patient allergic to? Nickel
446. Patient I dun have time to quit smoking? Precontemplation
447. Which is trademark name? Registered
448. Patient disoriention? Epinephrine (Atropine can be too, depends on exact question)
449. Dementia? Short term memory loss
450. Most common disease in old age? depression
451. Lingual flange recorded by? genioglossus it effect the length of flange(dd)
(mylohyoid,geniohyoid,genioglossus,superior pharyngeal constricto all records it.
distolingual extension by superior constrictor and distobuccal extension by masseter)
452. Distobuccal by? Masseter
453. Mandibular buccal frenum which muscle? Triangularis
454. Which sinus involved in fracture Le fort 1? Maxillary
455. Which movement of eye restricted in fracture of floor of orbit? Superior
456. wat is leeway space? max--b/w lateral and canine ,mand -canine and mand 1 st molar
457. Scrap amalgam? Sealed
458. Where is the retentive arm placed? Gingival 1/3rd / undercut / below height of contour
(During placement of clasps in the RPD, there are two arms one placed on the facial side
and placed on gingival 1/3 and other reciprocal one goes on palatal side and placed on
junction of occlusal and middle 1/3 . Reciprocal arm counteract retentive arm each and
helps to prevent the rotation of tooth . reciprocal is made of base metal alloy and
retentive is wrought wire)
459. Metal can be used in denture base for the reasons except? Esthetic
460. The retentive arm of clasp features? retentive arm is rigid ant 1/3rd,semirigid--middle
third,flexible treminal 1/3rd

461. Wat does opaquer porcelain help in all except? Translucent (Opaque porcelain mask
the dark oxide color and will provide porcelain metal bond)
462. Why is gold preferred over amalgam? gold thermal expansion near to tooth and gives
ideal contours,better marginal integrity, more biocompatible
463. Which property is imp for burnishing the restoration? Work hardening
464. The inflamed red spots in smokers palate? Nicotine Stomatitis
465. Most common site of caries? pit n fissure
466. Red complex which bacteria? Ptt (prevotella,taneria,treponema)
467. 0mA 1sec and .5secs same effect of the film. What is the ma? 20 (time is reduced by
half so it will double)
468. 1 film- underdeveloped? Reduced time
469. 16kg girl max dosage of lidocaine? 16 x 4.4? 70.4 (36. 4.4 mg/kg for lidocaine without
vasoconstrictor and 7 mg/kg with vasoconstrictor)
470. Buccal root distal to palatal root. Where was d cone placed? Mesial (SLOB Rule)
471. The bur used to polish porcelain? Diamond (Final answer according to textbooks. Do
not confuse with carbide)
472. The bur with more flutes? Does not cut efficiently and polish efficiently (more flutes
better at polishing and less flutes better at cutting)
473. The type of speed for implant site? High torque low speed
474. The margin on cementum. Which material to be placed in gingival third? GIC
475. Repair of porcelain process? micro etch, etch, silane bonding
476. Melanoma location? Hard palate and Gingiva
477. Cause of mucocele? Rupture of minor salivary duct / Mucocele caused by ruptured
salivary duct, usually due to trauma, seen on the lower lip
478. Treatment of ranula? Excision - Sublingual gland removal ( Because marsupialization
results in recurrence and DD says the treatment is surgical and the entire ranula with
the surrounding salivary gland must be removed or it will recur, I think I would go with
ENUCLEATION or gland excision.)
479. Pierre robin was? cleft palate, retrogbathia, and glossoptosis
480. gardener , 3 symptoms wat is 4th that u wud check? Intestinal polyposis,
supernumerary teeth, odontomas, Desmoid tumor, epidermoid cyst or lipoma. (GI

polyps, multiple osteomas, and skin and soft tissue tumors. Cutaneous findings of
Gardner syndrome include epidermoid cysts, desmoid tumors, and other benign
tumor)
481. Ration of cleft lip in Caucasian? 1:700
482. Chronic periodontitis common? Male black
483. Prevelance can be related with which case study? Descriptive
484. Cause and effect which case study? Analytical
485. Osteomas, glossptossis wat wud u check for? Gardner / Pierre robin syndrome
486. Duct of submandibular gland? Whartons
487. Plastic heat sensitive materials sterilisation? Cold/Chemical like gluteraldehyde 2%
488. Does not reoccur? Aot
489. 12 month rct increase in size of radiolucency all the reason except? Apical scar
490. Moa of suphauryl anti diabetic drug? increase insulin production by stimulating b cells
of pancreas
491. Which can be diagnosed only histologically? Radicular cyst from granuloma
492. After 12 months increase in size of lesion in rct treatment teeth? Healing by apical scar
493. Pulp necrosis type of wat resorption? Inflammatory
494. Cellulitis? Lymphocytosis (In cellulitis the number of lymhocytes increase thereby
causing lymphocytosis.)
495. OSHA blood borne pathogens? msds sheet
496. Placement of pfm crown margin ant? At crest of gingival or (not In between crest n epi
coz it will will interrupt with Oral hygiene making it harder to clean)
497. N d wat makes penicillin allergic? Beta lactams ( Penicilin has beta lactam ring and
some people produce IGE n IGG against them causing allergic reaction, However, the
allergy is ang-anb reaction /beta lactamas is pnc resistive not allergic. So depends on
the question)
498. patient has bcc how wud u tell d patient? Good prognosis
499. Wat is best X-ray for detecting bone loss? Bitewing
500. Most common finding of cherubism? Soap bubble appearance
501. potassium sparing drug? spironolactone (if not in option, then Furosemide which is
HIgh ceiling Loop diuretics)
502. Gingivectomy indications contraindications? inadequate attached gingiva,base of
pocket apical to mucogingival junction (Indication - supragingival pocket,
enlargement, Contraindication - infrabony pocket, inadequate width of attached
gingiva.)
503. facial vertical axis divided? 3 parts (according to mosby)
504. cleidocranial wat is absent? Clavicle
505. most common salivary gland Tumor? Pleomorphic Adenoma
506. consent not taken? Which ethic? Autonomy
507. treatment with out consent? Battery
508. liquid in gic? polyacrylic acid
509. statements true reg zinc poly carboxylate? Chelation reaction with Ca ions (adhesion),
chemical adhesion,high film thickness
510. Reason for incisal guide table? Anterior guidance

511. least strength of ceramic crowns - options - pressed leucite ceramic. zirconia, pfm?
Pressed leucite ceramic
512. most important cause of ceramic crown fracture is due to - all lab procedures like firing,
condensation, insufficient temperature or insufficient time? insufficient temperature
or insufficient time (Yes low tempreture in degassing , will affect the bond and more
prone to fracture card 141 pros )
513. Man has problem with dexterity, what will pt have problem with? floss and brushing?
Floss
514. perforation of root canal which is difficult? 3mm apical to gingival sulcus, 3mm coronal
to gingival sulcus, apical 3rd,middle 3rd? 3 mm apical to gingival sulcus
515. behaviour studies by which author? Freud
516. Pt try to hide fear and anxiety,what we look for to understand it? Micro expression
(micro means expressions under skin). (Macroexpression (means crying))
517. More difficult to handle? Anxiety
518. elderly person physically abused whom should u report? Human health Services
519. kid abuse whom should u report? Social Service (In the pt management of dental
decks, it says it depends by the state - "Once abuse is suspected against a child,
elderly, or disabled pt, it must be reported to the appropriate agency (of the state))
520. what is the primary indicator of accuracy of a border molding on a custom impression
tray?stability ,retention? Retention
521. polyether imp comp? sticks to teeth.
522. Ability of impression compound to be adjusted due to which property? Thermoplastic
523. which of the following imp material will distore the least when it store for 24 hrs? silicon
imp material
524. cheek biting in complete denture caused by? Horizontal
525. The most common cause of cheek biting with dentures is? absence of buccal horizontal
overlap
526. null hypothesis in chi test? True
527. p value in null hypothesis above 0.5 means is? statistical insignificant
528. Purpose of statistical tests in clinical trials is? to reject null hypothesis
529. Which if the following has problem in recall bias? Randomised control study
530. WHich case study used in rare disease investigation? Case control
531. The most predictable for treatment of perio disease? Scaling & root planing
(if SRP not in option, Apically positioned flap is predictable in surgeries)
532. whats the problem if you wanna perform apically positioned flap surgery in th mand
second and third molar? external obligue bridge
533. If correct angulation is present when working with a universal curette then? the lower
shank is parallel to the tooth surface
534. ANUG mouth rinse? Hydrogen peroxide
535. Antibiotic for ANUG? Pencillin v (according to DD) Metronidazole (According to
masters and golden, so depends on the options )
536. Anug is usually accompanied by metallic taste...t or F? True
537. patients with pierre-robin syndrome will have? mandibular retrogranthia, Cleft palate,
and glossoptosis, respiratory problem

538. Which disease does not cause cancer: HIV, HPV? HIV
539. Which pair of anesthetics is most likely to cause cross allergy? Lidocaine and
mepivocaine
540. With age, what increases? Chroma increases, value dec and hue unchanged
541. Orange stain? Changes hue, increases chroma (Mosby pg 361)
542. Yellow stain? Changes hue (DD)
543. What should be selected first when picking a shade? hue
(First pick HUE and VALUE is considered THE MOST IMPORT in shade selection. - DD)
544. Which one can human see? Value, chroma , hue? Value with half eye
545. What does staining do for ceramics? Decreases value.
546. erosion due to acidic foods and drinks is usually found on the cervical? facial
(lingual/palatal goes right if erosion is from inside)
547. Free way space? 2-3 mm
548. open bite or increased free way space = decreased bitting force T/F? True
549. When do you check phonetics for a CD? Wax try in
550. During try-in of CD, which phonetics is used? Linguo-alveolar
551. The most radioresistant cells in the body to of radiation are ? Muscle
552. most Radiosensitive cells? Bone marrow lymphocytes/ small lymphocytes
553. What cells are radiosensitive? Bone marrow cells
554. Which are the most radiosensitive cells in the human body? Basal epithelial cell
(In DBM erythroblast followed by lymphocyte, granulocyte, epthelial cell,
spermatozoid )
555. Most important characteristic for choosing major connector? Stability & rigidity
556. Histogram shows? Variance
557. Hazard communication standard was prepared by? OSHA
558. Pedal edema, dyspnea, orthopnea are signs of? CHF
559. A dentist cannot do what to correct the small discrepancies? manipulate the cement-
water ratio.
560. Dexterity comes by what age? 5-6 years
561. Most common complication of N2O? bronchospasm (if following not in option nausea,
vomiting and peripheral neuropathy)
562. Best bone for implant- d1, d2, d3, d4? D1 and type 2

563. A diagnostic test that correctly identifies 20% of screened patients as being dx?
Specificity
564. What does identify persons with the disease? Sensitivity
565. What causes varices on the tongue? Hypertention
(An association between sublingual varices and smoking, age and hypertension was
found. The prevalence of sublingual varices increased with stage of hypertension,
further confirming the connection to increased blood pressure.)
566. Lady presents with blue swelling under tongue? ranula
premolars on R side? pyogenic granuloma
568. Patient with diabetes which finding is not consistent? increase gram negative in
crevicular fluid
569. Most common reason for failure of dental amalgam?Improper cavity prep acc to text
books, (improper prep design- not enough depth, improper titrutration, improper
condensation) (In card 7 opretive said most coz failure is moisture,,, and inproper pre
and not enouh depth is reason o fracture, card 120 oprative)
570. Pt has cranial dysostosis, midface deficiency, hypertelorism and beaten metal
appearnce? Crouzons
571. Automatic defibrillator used in? Cardiac arrest/Arrythimia
572. 8 years old pa ent with nega ve behavior, you use for immobilize? Papoose Board
573. Most convergence in which primary tooth? Mandibular 1st Molar
574. Least antiplatelet NSAID? Colecoxib
575. implants you should know all implant distance
Dist between 2 implants 3 mm, From IAN 2 mm, From mental 5 mm, Tooth and
implants 1.5, buccolingual- 1.5 each side
576. Plaque ph? 5.5
577. Distolingual what is the best filling material? Amalgam
578. The conical shape of pits and fissures caries shows? Two triangles with their bases on
the DEJ

579. Which will show up on transillumination best? Fractured cusp Vertical root fracture
Craze line
580. Patient comes back few months after RCT & Crown with pain upon biting, what
happened? cracked tooth or hypersensitivity? Cracked tooth
581. Neuropraxia: involves both perineurium and epineurium, only perineurium, only
epineurium, none of the above? None of above
Neuropraxia is a disorder of the peripheral nervous system in which there is a
temporary loss of motor and sensory function due to blockage of nerve conduction,
usually lasting an average of six to eight weeks before full recovery.
Neuropraxia is a type of peripheral nerve injury, and is known as the mildest form of
nerve injury. It is classified as a transient conduction block of motor or sensory function
without nerve degeneration, although loss of motor function is the most common
finding. Axonotmesis is a disruption of nerve cell axon, with Wallerian degeneration
occurring below and slightly proximal to the site of injury. If axons and their myelin
sheath are damaged, but Schwann cells, the endoneurium, perineurium and epineurium
remain intact, it is called axonotmesis. Neurotmesis is the most serious nerve injury in
which both the nerve and the nerve sheath are disrupted.
582. Neuropraxia reversible or irreversible? Reversible
583. neuropraxia is permanant nerve loss, in neuropraxia the nerve sheath is damages t/f?
False
584. which salivary gland tumors is associated with neuropraxia (nerve damage): adenoid
cystic carcinoma(ACC)
585. Which of the following glucocorticoids is the strongest? Dexa, Corticoid,
Hydrocortisone? Dexa
586. Disinfectant for dental chair (min)? 10 minutes
587. Le fort 1 fracture? Maxillary sinus (fractures most in le fort 1)
588. Collimation does everything except –reduce pt exposure, reduce operator exposure,
film fog? reduce average energy of x-rays
589. The Dentist completes exam and advises x-rays but the pt refuses. What should the
dentist immediately do? Can decide if treatment can be done without recommended
radiograph but no paper signed by patient can release dentist from liability.
590. Which of the following best explains why the dentist should provide a postpalatal seal
in a complete maxillary denture? The seal will compensate for? polymerization and
cooling shrinkage.
591. damage to the blood vessels as oppose to( nerve , muscles) predisposes a patient to
develop osteoradionecrosis. true or false? True
592. Osteoradionecrosis can be differentiated from osteomyelitis as? Osteoradionecrosis
does not show periosteal reaction
593. The severity of response increases with the amount of X-ray exposure.This effect is
called. Deterministic, Stochastic, Genetic? Deterministic
594. most common recurrent cyst? okc
595. xray for annuerysm cyst? CT Scan (check Picture too)
596. secondary herpes site? Lips (HSV 1 – Lips, HSV 2 - Genital)
597. concentration of apf flouride gel? 1.37

598. Orange stain is important to change chroma or hue? Hue (Value by Violet)
599. Most prevelance? Cleft lip, palate, both? Both
600. Cleft palate prevalence? Palate 1::2000 (lip 1:1000, Both together 1:700)
601. Cleidocranial dysplasia? supernumeraries
602. Retained primary teeth is characteristic for both cleidocranial dysplasia and ectodermal
dysplasia - T/F? True
603. Multiple supernumerary teeth are most commonly found in? cleidocranial dysplasia
604. Hypothyroidism clinical signs? Cold to touch , Thinning of hair, Delayed perm eruption
605. Acromegaly clinical signs? Mandibular Prognathism
606. what is called when u do not take patient consent ?? assault, nonmaleffi, disclosing?
Battery
607. which bur is used for the crown cutting? 245,169,23,7041? 245
608. which forceps is used for mandibular premolar extraction?? 151,150,28? 151
609. Behcets syndrome is associated with ? aphthous ulcers ,herpes zoster, primary herpes?
aphthous ulcers
610. Altered cast technique? Support
611. gracey’s curette no. 13 and 14 used for? Distal Surface
612. After a gingivectomy how does the site heal? endothelium of the blood vessels
613. The gingivectomy approach to pocket elimination results in? retention of all or most of
the attached gingiva.
614. Gingivectomy is used to remove suprabony perio abscess T/F? True
615. Gingivectomy is used to remove suprabony pocket T/F? True
616. Pt. have denture, after 5 years he complains of ulcer and inflammation in lower buccal
vestibule. What is the diagnosis: Hypertrophic frenum or Epulis fissuratum? Epulis
fissuratum
617. Epulis fissuratum should not be removed before the fabrication of new denture T/F?
False
618. what is the cause of epulis fissuratum? over extention (unstable denture correct if c not
in option, DD card 93 prostho)
619. Eosinophillic bone lesion look similar to? Langerhans cell, myeloma? Langerhans cell
620. Two implants difference? 3mm, 5mm, 7mm? 3 mm
621. Angular chelitis caused by vit b deficiency, candidiasis? vit b deficiency,
622. Pregnant sedation – n2o, cholral hydrate, promethazin (N2o contraindicated in 1st
trimester)? promethazin (N2o contraindicated in 1st trimester)
623. Excess interocclusal space – decrease vdo, inc vdo, same vdo? inc vdo
624. Bone morphogeny protein – osteoinductive, osteoconductive? osteoinductive
625. Best graft, autograft + alloplastic graft, allograft, alloplastic? autograft + alloplastic graft
626. Dr says amalgam replace it with diff restoration – beneficience, nommalificience,
veracity, autonomy? veracity
627. Sarcoidiosis similar to – actinic chelitis, fibromatoes gingiva, granulomatous?
granulomatous
628. Multiple procedures cut down to inc reimbursement – unbundling, bundling,
downcoding, upcoding? unbundling

629. r/o diagnosis radioopaque – condensing osteitis, periapical cyst, granuloma, abscess?
condensing osteitis
630. necrotising sialometaplasia ? max hard palate inflammatory lesion
631. table point in child ceph - mand canal, ant ramus, post ramus, inferior border of
mandible? inferior border of mandible (if sella turica in option, select that one)
632. most cardiac collapse in child due to – respiratory collapse, cardiovascular disease?
respiratory collapse
633. crown root fracture most in – mand molar, max incisor, max molar, mand incisor? max
incisor
634. critical ph – 5.5, 7.5 6.0? 5.5
635. ugly duckly space close? distance close by erupting canine
636. platal glands? necrotising ulcer
637. home internal bleach causes mostly – tooth sensitivity, external resorption, internal
resorption? external resorption,
638. Lidweg angina not involv? retropharngeal space, submand, sublingual, submax space?
retropharngeal space,
639. port wine sign? sturge weber syndrome
640. traumatic cyst t/t? aspiration biopsy, excisional biopsy, incisional biopsy? aspiration
biopsy
641. impacted molar which view? PA, waters, lateral skull, ceph? PA
642. find out ACE inhibitor – dicumoral, nsaids, acetaminophen, brufen? dicumoral
643. radiolucent? intermaxillary fissure
644. penetration of electrons depends on? kvp, ma, exposure time, sorce of distance? kvp
645. quality determine by- collimation, ma, half layer curve? collimation
646. carbide bur – less efficient rough, less efficient smooth, more efficient rough, more
efficient smooth? less efficient smooth
647. hypothyroid pt what u seen – cold to touch, seizure, hypotension? cold to touch
648. biotransformation of drug causes – Water soluble, lipid soluble, protein binding,? Water
soluble, threaupetic active (if a not in option)
649. epi in LA causes? inc potency
650. epi nt use in? hyperthyoid, hypothyroid, hypoglycemi? hyperthyoid
651. tmj pain & click 1 week ago and now ok – myofacial pain, subluxation with reduction,
subluxaation without reduction? subluxation with reduction
652. distobuccal muscle? masseter
653. buccal space infection in max with muscle – buccinator, masseter, lateral ptery, medial
ptery? medial ptery
654. condyle side movement with muscle – lateral pterygoid, medial, masseter? lateral
pterygoid
655. cracked tooth – pain on chewing and release, pain on cold, R/D diagnosis? pain on
chewing and release
656. oral wound best treatred with – h2o2, chlx, iodine, alcohol? h2o2
657. new and old cases of smoking is called – incidence, prevelance, relative risk, pupulation
at risk? prevelance
658. dowel is used in restoration used for – retain core, strenghten tooth? retain core

659. max pm1 difficult with mesial concavity best to use- custom wedge, normal wedge,
amaldam recountour? custom wedge
660. implant temp damage for 1-5 min - 55, 47, 30, 50? 47
661. durable amalgam – high copper spherical, high copper spherical admix, conventional
spherical? high copper spherical
662. most hyperplastic alvelor rigde remove for fabricating denture coz – might cause
malignant cancer, good fit of border moulding, disturb denture base nt stable? disturb
denture base nt stable
663. zolvidin? pancreatic
664. thyrotoxic crisis? hyperventilation
665. hyperventilation? tachcardia and tachypnea
666. incisal fracture 3 times veener – inadequate assesement of incisal ridge, lab procedure
wrong? inadequate assesement of incisal ridge
667. fear causes – inc pain tolerance, intensify pain? inc pain tolerance
668. currete mesial of distal root? 11& 12
669. reduce stress hyperglycemia? schedule morning appointment
670. pregnant turn in which position? right hip up, left hip first, supine semirecline? right hip
up
671. crown fell inside the mouth? trendlenberg, supine, recline, semisupine? trendlenberg
672. sealent – deep fissure, cavity, grey discoluration seen inside the enamel, dej? deep
fissure
673. rapid progressive decay- intertubular, dej, enamel? dej
674. no fluoride in water 10 yrs? 1mg per day
675. sterlization resistant – heptatitis B, mycobacterium, streptococcus, staphylococcus?
mycobacterium
676. troch – clotrimazole, fluco, keto, mino? clotrimazole
677. chemical record – mdsh, osha, cde, fda? mdsh
678. penicillin resistant bugs – dicloxacin, ampicillin, cephalosporin? dicloxacin
679. apical abscess & perio abscess difference – percussion, palpation, pulptest? pulptest
680. enamel pearls difficult in perio t/t & it is caused mostly on incisors – both true, both
false, 1st true second false, 1st false second true? 1st true second false
681. which is most rigid – silver palladium, gold platinium palladium, type 3, type 4? type 4
682. difference between primary & secondary trauma – pdl involve, bone support, mobility,
all? all
Secondary trauma from occlusion occurs when the tooth is already periodontally
damaged and mobility was present prior to the supraocclusion.
683. edema in conjuctiva – hypemia, hemmorhage, chemostaxsis? chemostaxsis
684. nt same receptory- physiologic antagonism, competitive antagonist? physiologic
antagonism
685. warfarin potentiate by – saw palmeto, strugwebner? saw palmeto
686. hypodontia affects – alveolar bone, midface, max, mand? alveolar bone
687. petit mall- prevent frm injury, no t/t, phenatoin, diazepam? prevent frm injury
688. perio pblm mostly associated with – cvs, cns? cvs

689. erythromycin mostly sideaffects – g.i disturbance, renal toxicity, hepatotoxicity? g.i
disturbance
690. t/t procedure – definitive evaluation maintainance, definitive maintainance evaluation?
definitive evaluation maintainance
691. cl- 3 restoration? drill large first fill small first
692. Primary untreated? hispanic
693. Oral cancer – white male, black male, Mexicans? white male
694. Apicectomy indication – if convential rct is inadequate, if filling rerct failure inadequate,
almost all rct, if radiolucency exist after rerct failure? if convential rct is inadequate
695. Composite stain t/t –replace, polish, remove upper layer and fill, bleach? remove upper
layer and fill
696. Topical apply? Doxycycline
697. Increase capillary permeability – histamine, dipheamine, histadine? histamine
698. Apexiogenesis success – apex is formed, no pain, no radiolucency? True
699. Chronic abscess t/t 16yrs – endo, pulpotomy, apexification, apexiogenesis? endo
700. Newely erupted teeth? cold
701. Child primary mo do caries t/t – mod amalgam, MO DOL amalgam, mo do composite?
mod amalgam (if Stainless steel crown in option, go with it)
702. Composite compare to gic has better – good translucency, better wear? better wear
703. Composite indirect casting has advantage on direct composite – less polymerization,
more polymers? more polymers
704. Porosity mostly caused by – inadequate condensation, underfiring? inadequate
condensation
705. Cl – 3 bevel – occlusal bevel & gingival butt joint, both occlusal & gingival bevel, gingival
bevel & occlusal 90 degree butt joint, no bevel? both occlusal & gingival bevel
706. Modeling – peer person+positive reinforcement? peer person+giving information
(reinforcement is not modeling, it is operant conditioning )
707. Pt says himself he can cope with dental treatment - Cognitive dissonance, congnitive
restructuring, operant, sensitization? congnitive restructuring
708. Showing Child t/t on other sibling – modeling, sensitization, positive reinforcement,
operant? modeling
709. 10 yrs pt primary mand molar missing which space maintainer – no space maintainer
required, band & loop, distal shoe, removable acrylic? no space maintainer required
710. 5yrs missing second molar missing? Distal shoe
711. Band & loop has nt feature? vertical stop for opposite teeth, causes decalcify after
bands looses cemented, plaque accumulation? vertical stop for opposite teeth
712. Primary incisor 5mm intrude – observation, splint, reposition, splint & reposition?
observation
713. Caries most on primary teeth – distal of first molar, distal of second molar? distal of first
molar
714. Good sugar replace in high caries – xylitol, sorbitol? xylitol
715. Vertical height of face divided into? 3rd
716. Bisphosphanate since 6 months t/t – coronectomy & seal the roots, extn? coronectomy
& seal the roots

717. Bleaching – external resorption, internal, alveolar bone formation, hypercementosis?
external resorption
718. Distance from xray? 6 feet
719. Angle cl – 1 – mesiobuccal cusp of first molar of max in buccal groove of mand? True
720. 4mm exposure – gold foil suture, flap, leave it, antibiotics? gold foil suture
721. Rotation? articular disc & condyle
722. Isolated Expose root surface covered by soft tissuse – fenestration, dehiscence?
dehiscence
723. Immunoglobin in myeloma? m spike
724. Mature plaque? 4-7 days
725. Denture stomatitis nt caused by – allergic denture, medication aminophyline,
candidiasis, inflammatory papillary hyperplasiah? medication aminophyline
726. Papule – small elevation, colour change? True
727. Pain incisor to molar denture flange – traumatic neuroma, neurolemma, neurofibroma?
traumatic neuroma
728. Periapical cemental dysplasia – mand ant, max ant, molars? mand ant
729. Periapical cemental dysplasia? blacks female
730. Lesion om stretch disappear – leukoedema, white neves? leukoedema
731. Most Malignant condition - erythroplakia, leukoplakia? erythroplakia
732. Mucus retention cyst – lower lip, upper lip, gingiva, buccal mucosa? lower lip
733. Chronic inflammation – neutrophilia, neutropenia, lymphopenia, lymphocytosis?
lymphocytosis
734. Chronic inflammation – plasma cell, t-lymphocytes, mast cell, neutrophill? t-
lymphocytes
735. Fda launch drug? random clinical trail
736. Perio related damage? smoking
737. Double blind study nt present –both control group present, minimal bias, pt don’t
known which group he belongs, investigator don’t know which group, All of the above?
All of the above
738. Prophylactic antibiotics with endocarditis – mitral valve prolapse, artrial septa? mitral
valve prolapse
739. Penicillin prescribe causes chills with fever – give erythromycin, add tetracycline? give
erythromycin (if clinda in option, go with it)
740. Least bacteremia – non surgical endo, extraction, srp, implant? non surgical endo
741. Osteoradionecrosis? give pt hyperbaric oxygen before extraction
742. Most stable – pvs, polyether? pvs
743. Periapical radiograph – perio visibility, bone loss, proximal caries? perio visibility
744. Cerebral palsy caused by which nerve – 7, 5, 3, 4? 7
745. Nt used for cast restoration – irreversible hydrocolloid, reversible, pvs, elastomers?
irreversible hydrocolloid
746. Pic like multiple pyogenic granuloma interdental ? ewing sarcoma
747. Lymph node pic in floor of mouth? lymphoepithelial cyst
748. Pic history of new ceramic crown 7 days back two red spots adjacent caused by – herpes
virus, apthus ulcer, chemical burn? apthus ulcer

749. Pic of lesion near lip- recurrent herpes 1, recurrent herpes 2, recurrent apthus,
candidiasis? recurrent apthus
750. Pic of Lesion under denture - irritation fibroma, papilloma, periapical granuloma?
irritation fibroma
751. Target lesion caused by? erythema
752. file number 35 with 21mm length,how much it will be at D16?!! 0.35, 0.67, 0.98? 0.67
753. Centrally muscle faciculation caused by : dantrolene , succynil choline, other unrelated
drugs.? succynil choline
754. Bulemia causes by: erosion, abfraction? erosion
755. sign of "W" on clamp of rubber dam means ? wing clamp, wingless clamp? wingless
clamp
756. laser signature sign? Laser Surgery
757. sliding movmnt of old pat with wheelchair? True
758. which tooth mostly Dense in dent or which tooth mostly has invagination? Maxillary
Lateral
759. least keratinized epithelium seen on ? upper incisor, lower inc,upper pre mplar,lower
premolar? lower premolar
760. pat put aspirin on his teeth and effect on bucal site is? edema, necrotic,
hyperkeratinised? necrotic
761. more than 1/3 of cusp to cusp distance? onlay,inlay,full cr.? onlay
762. pat is very old,need extraction. what pain killer you NOT give for moderate pain relief?
tynelol, ibuprofen,meperidine, aspirin? meperidine
763. midazolam side eff? dry mouth
764. woman came back to do rest of tx. this time you see bruise around her eye.what do you
do? you call policed, you ask ur assistant to ask pat what happened to her, you start
interview pat and document all she says, you ignore and continue the tx? you start
interview pat and document all she says
765. Alkylating agents anticancer drugs? Methotrexate
766. phenytoin for ? grandma
767. ginseng aspirin intraction? Increase the anticoagulant effect
768. emphysema sympt? symptoms of emphysema include shortness of breath, wheezing,
coughing and chest tightness or pain. Other less common symptoms are loss of
appetite, weight loss, depression, poor sleep
769. Blue Sclera Que seen in what? Osteogenisimperfecta
(Blue sclera is seen in OI, marfans syndrome, ehler danlon syndrome, alkaptonuria and
fetal rickets)
770. fluride amount in drinking water ? 0.7 to 1 ppm
771. MUBL? for retrusion
772. DUML? for protrusion
773. nitrous oxide prohibited in : nasal congestion or sickle cell anemia? nasal congestion
774. dry socket tx: curratage, sedative pad inside? sedative pad inside
775. dental lamina formation in uterus at which month? 4, 6 weeks, 8? 6 weeks
776. dental gypsum more water to powder ,what happens? increases setting time, less
expansion

(check DD card 61 opretive of new version , its mentions the same info again in right
way, inc water ratio, will dec setting expansion and retard setting time( long time) also
increase in temp accelerates setting time)
777. unbundling? Separate payment
778. upcoding? Charge more than dentist works
779. difference btw bur 245 vs 330? 245 longer
780. case 1: little girl 9 1/2 yrs old (w/ unerupted canine and pm) .this child has allergy and
taking cetirisine.
wat side effect this drug has: internal staining,ext staining,dry mouth? dry mouth
teeth age of this girl which still is with have not erupted canine? which is older than
8,younger than 8... Below 9 years? Below 9 years
this girl had lots of caries too on occlusal and Mes and distal of posterior teeth.
which tx: amalgam,composite ,ss crown? ss crown (if caries involves more than 1
surface, go with SSC acc to DD)
781. Case 2: woman pat 48 yrs old w bells palsy which happened a month ago: effect of
bells palsy how it recovered. wat do you say to pat? it will healed , self limited,
healed by partially problem, permanent problem..? self limited
782. Case 3: 68yrs old man w/ lots of meds and condition, angina, bis phosphonate.. he
needs extraction. prophylaxis?
time of extraction?(relating to bisphospho)? hyperbaric oxygen Therapy 3 months to
extration
783. Epithelium comes from? the donor site. (blood supply from recipient)
784. Dexterity- to do with flossing? 5 years for brush and 8 years for floss.
785. If lack of dexterity can’t do? interproximal floss
786. Perio v/s endo abscess- pulp testing,lat percussion? Endo abscess - most probably pulp
necrosis EPT. Perio abscess lateral percussion tooth might be vital or non vita
787. Opaque porcelain function? mask dark oxidized color
788. Methotrexate? anti cancer drug folic acid inhibitor
789. What is battery? Treatment without informed consent is battery Autonomy
790. Ectodermal dysplasia? Oligodontia, spairse hair
791. Diabetes commonly found in which ethnicity? Black males
792. What causes cervical discoloration of PFM? copper, ag.plaque.? copper (margin copper,
rest silver according to dd)
793. Flame shaped radiolucency above an unerupted third molar? pericoronaritis
794. Safe drug in pregnancy? acetaminophen
795. Safe drug in breastfeeding? acetaminophen
796. Prolong use of Aspirin can cause? acidosis
797. Pathology? Leuckema, compound odontoma, leucoplakia? leucoplakia
798. Failure of which stage of tooth development affect Number of teeth? initiation (size
and shape in-morphodif)
799. which disease lead to MI? trombosis
800. acute adrenal insufficiency? Hypotention (Because low cortisol)
801. Low contrast? kvp
802. Which doesn’t recur? AOT

803. Antibiotic treatment? LAP
804. Seizures grand mal? Phenytoin
805. petit mal? enthosuximide
806. Overdose cocaine? mydriasis
807. Overdose opioids? miosis
808. Class 5? GIC
809. Short clinical crown, what to do? proxy grooves if lack F-L resistance (prostho decks –
Buccal - retention. Proximal – resistance)
810. Most common emergency? temporal arteritits
811. Pedunucleated leision? SCC
812. Dry socket? sedative dressing
813. benzoyl peroxide decomposition by tertiary amine in chemically activated resin
self cured? True (camparoquinone in light cure)
814. Complication of temporal arteritis? blindness
815. Gtr best for? one wall defect (Class 2 furcation)
816. Gtr? involves coronal movement of pdl
817. Pain medication for alchoholic? Acetaminophen
818. Fetal alcohol syndrome? Cleft lip
819. Contraindication of RCT? vertical root fracture
820. Resistance for short crown? proximal grooves
821. Lazer in periodontal diseases use for? sulcular debridment
822. Erosion? acids
823. Attrition? tooth to tooth
824. Objective fear? after previous painful stimulus
825. thyroid crisis symptoms? hyperT – HR - hypoxia sign - cyanosis
826. value? negative calculation
827. Antibiotic in gingival? tetracyclines
828. Consent? Autonomy
829. Wheelchair? sliding
830. How base metal prevent corrosion? chromium
831. what is the most common psych disorder? Depression
832. Leakage in amalgam? decrease with age
833. systemic desensitization model? hierarchy of slowly increasing anxiety stimulus
834. 16 kg anasthesia calculation? 70.4
835. Most common emergency in dental clinic? syncope
836. Most common respiratory emergency? Asthma
837. function of major connector? stability
838. primary stress bearing areas in mandi dentures? Buccal shelf, residual alveolar ridge
839. In USA most dental pay is? out of pocket
840. Which is more important? Chroma, value? value.(Value is VIP and choosing process is
HUE first then VALUE then CHROMA)
841. Which show saturation of color? chroma
842. Radiation? water lysis
843. Facebow transfer? Centric

844. Acron vs non-acron? One of it performs all the jaw movement the other one is
restricted n limited. It's advantage is that it simulates anatomy over the nonarcon.
AR-CON= AR(ticulator) CON(dyle)
NON AR-CON = you guessed it. (- simple hinge -semi-adjustable (hanau, artex,
panadent etc) (arcon and non-arcon lie here) - fully adjustable)
845. Dental lamina appears at which week? 6th week
846. Distolingual extension of mandi denture which muscle? sup constrictor
847. Incisal edge of anterior teeth touch where? vermilion border
848. Bur for burnishing porcelain? diamond
850. Impresion material moisture tolerant? PVS
851. Behcet's syndrome associated with? Aphthous ulcers
852. High school children have? marginal gingivitis
853. Ginseng contraindicated with? salicyclic acid
854. Erosion? gerd
855. Contraindication for nitrous oxide? nasal congestion
856. Best place for implant? ant mand
857. Solution to keep an avulsed tooth? hanks (worst water)
858. Aplastic anemia? chloramphenicol
859. Pseudomembranous colitis? clindamycin
860. Therapeutic effect? safety
861. Not to do w asthma? Give Oxygen
862. No contraindictation w asthma? Nitrious oxide
863. Gingival graft contraindications? pocket below alveolar crest, thin attached gingiva
865. Bipolar disorder? lithium
866. On which receptors Epi works? a1 a2 b1 b2. (reverse epi on a1)
867. Morphine overdose? naloxone
868. Porcelain porosity? Inadequate condensation
869. Unbundling? Separate prices
870. most commonly used TCA? Amitryptyline
871. cocaine produces vomiting by ? activating CTZ in brain
872. H1 and H2 receptor? H1 - competitive antagonist, H2- blocks receptors
873. H1 blocker (Antihistamine) will increase acid secretion T/F ? False, it decreases
secretion
H1blocker( Antihistamine)--decrease allergic reaction.H2 blockers decrease stomach
acid secrection(Famotidine,Ranitidine) used in peptic ulcer disease or GERD
(gastroesophageal reflex disease
874. Down Syndrome? macroglossia
875. Ectodermal dysplasia? scarce hair
876. Patient smokes pipe and has red bumps on palate? Nicotine stomatitis
877. Arch discrepancy after loss of which tooth? Mandibular canine
878. Space discrepancy after loss of which tooth? Mand 2nd molar
879. Which is NOT used to inhibit salivary secretion? Pilocarpine

880. Osteogenesis imperfecta with? DI
882. Caries not depend on? qnty of carbs
883. Radiograph id? tip of the nose,external auditory meatus
884. Cavernous thrombosis infection via? anterior triangle
885. Tooth mostly involved in perio relapse? Max 1st molar
886. Warfarin test? PTT
887. Why you do not use fovea as indicator? it blocks minor salivary glands
888. Craze lines? Translucent
889. Sausage like appearance on radiograph? sialolithiasis or sialodenitis or
Sialodichitis? sialolithiasis
890. Attached gingival? Enough for gingivectomy
891. Antiretraction valves? prevent crosscontamination
892. composite and bleaching? wait 1 week before composite
893. Ortho treatment? before veener placement
895. Osteosarcoma? PDL widening
896. Most common Impacted tooth? Third molars then maxi canines then lower 2nd pm
897. Ludwig angina spaces? Submandi, sub lingual, sub mental
898. Xerostomia? due to medications
899. Most common cyst? periapical
900. Warthin tumor which gland affects? Parotid
901. Sulfur granules? actinomycosis
902. Multiple myeloma starts? bone pain
903. Not vasodilaltor? cocaine
904. Not a blocker? metoprolol
905. No nitrious oxide? in 1st trimester
906. Liver problem what can you give? Lorazepam (LOT – lora, oxa tema)
907. Cooling? while implant placement
908. Cervicular fluid cells? PMNs (Gingivitis: initial – pmn, middle- lympho, later- plasma)
909. Perio success? establish epithelial attachment
910. Opioid? mu receptors
911. Full dentures clicking? increased VDO
912. Carcinoma vs carcinoma in situ? no invasion
913. Fungal infection? nystatin
914. systemic fungal? fluconazole
915. erythroplakia? carcinoma in situ
916. open bite? le Fort 1
917. Most allergic metal? nickel
918. Frankfort line? Horizontal line Prion to orbitale (occlusal rim – should be parallel to alla
tragus or campers line)
919. labiodental sounds? labioden--f,v,ph --determine position of maxi inci edge,
linguodent--this,that--determine ;labio-lingual posi of anteri,
linguoalv--vertical dimen, vertical length of anter

Labiodental sound(fricative)-f,v,ph
R formed by maxillary incisor contacting the wet/dry line of mandibular lip.
This sounds help determineing the position of incisal edge of maxillary anterior teeth.
Lingudental sounds-this, that,those
Help determineing the labiolingual position of anterior teeth.
Lingualveolar sound (sibilants )-s,z,sh,ch,j
Help determineing the vertical length and overlap of anterior teeth.
920. Open apex tx? Pulpectomy for permanent and caoh / apexification for primary
921. Mouthguard? MPDS
922. Polyether? sticks to teeth
923. RPD connector fracture? do soldering
924. Traumatic neuroma? mental nerve region
925. Secondary herpes? Heals with scar.. vesicles precede, Non keratinized mucosa
926. Primary mand 2nd resembles? Permanent mandi 1st molar
927. Access opening for mand molar? Trapezoid
928. MWF? reduce pocket lining
929. No gingivoectomy? with thin gingiva
930. Drug testing? clinical trials
931. Cohort study,cross -sectional study? Cohort fatal, Prospective follow group of people
over time and see who develops the disease, Retrospective study a population or
community that have ,had exposure
932. where you give GA? When 2 year old kid needs lot of restoration
933. Fearful patient how you respond? tell show do
934. Introduce instruments and tools Desensitization gradually? true
935. Desensitization Smokeless tobacco? verrucous carcinoma
936. Fracture w paresthesia? angle of mandible
937. Space between implants? 3 mm
938. Space loss after loss of which primary tooth? Mand 2nd molar for space loss
(Canine for midline shift)
939. disadvantage of widman flap and know the procedure of widman flap? Does not
eliminate pocket, and does not increase attached gingiva
940. bacteras in red complex? Denticola, p.gingvals, T. Posynyhes

941. predominant cells in gingival cervical fluid? Leukocyte(neutrophils)/ PMN
942. composite is intact but discolored what will u do? Redo (coz Polish and repair will cause
microleakage)
943. cementoosseous dysplasia ? more in ant mand, middle age African females, non
neoplastic radiopaque (Know if You have to choose exception)
944. cleft palate , mand hypoplasia and tonue obstruction? pieree Robin syndrome
945. Gardner syndrome and puetz jeghers both are pigmented lesions? True (and both cause
polyp at different location)
Gardner syndrome consists of adenomatous polyps of the gastrointestinal tract,
desmoid tumours, osteomas, epidermoid cysts, lipomas, dental abnormalities and
periampullary carcinomas. The incidence of the syndrome is 1:14,025 with an equal sex
distribution. It is determined by the autosomal dominant familial polyposis coli gene
(APC) on chromosome 5.
Gardner syndrome can be identified based on oral findings, including multiple impacted
and supernumerary teeth, multiple jaw osteomas which give a "cotton-wool"
appearance to the jaws, as well as multiple odontomas, congenital hypertrophy of the
retinal pigment epithelium (CHRPE), in addition to multiple adenomatous polyps of the
colon. Gardner syndrome is also associated with FAP (Familial Adenomatous Polyposis)
and may manifest as aggressive fibromatosis (desmoid tumors) of the retroperitoneum)
946. neurofibromatosus? Presence of axillary armpit freckling in people with
neurofibrometosis type 1, café on late
947. gardener syndrome? pigmented lesions, cause pulp polyp, delayed eruption
948. multiple periapical radiolucencies? cemebtoosseous dysplasia
949. what make penicillin allergic? Hypersensitivity reaction (not B lactamase coz it is added
in 3rd generation but allergic reaction is present since first generation)
950. montelukast drug moa? blocks the action of luekotrines, Mast cell stabilizer
951. antidepressants ? serotonin
952. girl with gingival bleeding and recurrent infection? leukemia
953. least recurrence? aot,odontogenic myxoma,ameloblastoma,okc? AOT
954. dentist and placebo? A sugar pill often taken by participants in a medical study.
Patients taking a placebo are compared to patients taking actual medications.
955. dentures major connector function? Stability and rigidity (rest is placed on mesial)
956. In what position we measure physiological rest position? upright
957. when you put occlusal rest set of direct reatiner mesial or distal to edentulous area?
Mesial (mesial side if distal to edentulous and distal side if mesial to edentulous)
958. what happen if temp of developing solution is too high? Dark X Ray as it is over
developed
959. 8yr old boy ..crowding in insicors ...canines r yet to erupt ..what to do ??extraction of
primary canines ..stripping ..? place lingual Arch and observe. ( if they ask to select
one, go with just observe, and Lingual arch and observe if crowding is above 4mm, If
crowding less than 4mm we do stripping of ant teeth (only ) we don't strip post teeth)
960. best way to gain max info about pain? tell me about ur past dental experience
961. spontaneous pain at night pt wake up, had lingering pain from cold from a week?
irreversible pulpits or pulp necrosia? Irreversible Pulpitis

962. patient was having diastema, what is that radiolucencies between upper incisors?
intermax suture inciaive canal and follicle of mesiodense? follicle of mesiodense
963. impression material their hydrophobic and phallic properties? (Polyethers are
hydrophilic according to decks, polysulfide pvs condesation siloxanes r hydrophobic,
best material pvs)
964. inc water powder ratio in gypsum does what? Increase setting time, decrease
expansion
965. Patient came in to the office with fingers pressed on his tooth saying it’s painful all
night, you plan to do emergency pulpectomy but right when you start giving anesthesia
patient says i had miocardial infarction 3 months ago and i am taking medicine for that,
what would be your plan then? Give painkillers only
966. which bur is not good for polishing porcelain? Carbide
967. distance between implants? 3 mm
968. adv of implant over fpd? Implant conservative single tooth replace no need for
abutment, conservation of tooth structure and ridge
969. 5 mm intrusion of primary tooth? extraction (because if we do no tt, it will cause
necrosis. If it is less than 3mm intrusion in primary then leave it)
970. sodium hypochlorite properties. Which of the following properties of sodium
hypochlorite is the most undesirable? Toxicity to vital tissue
971. after crown on mand molar mandible gets deflected to working side .. mention cusp and
inclines of mandible involved? Facial cusp, lingual incline
(working side interferences on the lingual incline of buccal cusp of maxillary molar and
on the buccal incilne of lingual cusp of mandibular molar. for working side its bull rule
but remember in non working its its lingual incline of buccal mandibular and rarely
maxillary used)
972. wear facets on lingual incline of maxillary lingual cusp and facial incline of mandibular
facial cusp on left side? right non working side interference best way to dec fear of
child ? sit down to child's level
973. dentist ask a child u want me to help you to sit on the chair, how to define this situation
? perceived, helplessness? Perceived
974. 35 -tooth most involved in vrf (vertical root fracture)? Mandibular 1nd Molar
975. Most probability of vertical root fracture? excessive obturation forces
976. Treatment of VRF(vertical root fracture)? extraction , endo contraindicated
977. What allows tooth to light up under transilluminatuon? Craze
978. Treatment of HRF? 100% oxygen
979. most imp in prognosis of tooth? clinical attachment
980. The base of the incision in the gingivectomy technique is located? apical to the
periodontal pocket
981. pain on biting? cracked tooth
982. adv of stainless steel over ni titanium? Fracture resistance
983. mod amalgam, fracture on occlusal surface but not at isthmus wat to do? polished out
of occlusio..n observe .. take mo do piece separate? Redo

984. differentiate between irreversible pulpits and pulp necrosis? (Necrosis pup is dead pulp
and not respons to pulp test, While irreversable pulpitis is vital inflamed pulp and
response to pulp testing)
Pocket is always associated with Periodontal Abscess, whereas Cavity is always

associated with Periapical Abscess, Periodontal abscess is related to vital tooth, unless
it's an Endo perio lesion. Whereas Periapical Abscess is related to non vital tooth..
985. shape of mand access prep? Trapezoid (max molars- triangular, max premolar - oval)
986. if pt injects la intravs wat will happen? tachycardia
987. childs age - max dosage of lidocaine? multiply it with 4.4
988. drugs that Dec salivation? Atropine
989. ledge wat to do - bypass it and continue with ...use larger file to get rid of it...use bur to
get rid of it? Bypass it and continue
990. what band and loop does provide? vertical stop
991. collagenase and elastase by which bacteria? Porphyromonas gingivalis
992. cervical burnout? vertical boneloss+ furcation involvement, osseous craters
993. Cervical burnout? is a radiographic entity giving cervicalarea a radiolucent appearence
mimicking caries
994. pt had less caries risk ..having stains and catch ..wat to do? observe or gic? gic
995. most common area for caries? pit and fissure or apical to contact? pit and fissure
996. bacteria in 2 day of plaque? Gram positive Cocci (streptococcus mutants and sanguis)

997. angle of instruments in srp? 45-90
998. most common reason for amalgam failure? preparation
999. common reason for failure of composite in posterior? Occlusal wear
1000. venner break down, How to fix back? microetch etch silane bonding
1001. treatment plans on anterior teeth like pfm crown? All ceramic
1002. how water contamination affects amalgam? Delayed/ Hygroscopic expansion
1003. proximal retention of amalgam? Dovetail
1004. probing depth increases in gingival inflammation? true
1005. axial walls on only? Divergent
1006. what can't be used as retainers in fpd inlay only partial crown full crown? Inlay
1007. potassium sparing diuretic? Spirolactone and amiloride | toxic effect it hyperalkemia
1008. Primary tooth with shortest occlusal table? max or mand molar? Maxillary first molar
1009. pt came back after a month with discolored margins wat could be the reason?
Microleakage (if comes in 3 days, reason is amines)
1010. wat opaque porcelain doesn't do? Mask oxide layer or meta bond
1011. cusp involved in non working interference? for working side its bull rule but remember
in non working its its lingual incline of buccal mandibular and rarely maxillary used)
1012. function of post? Retain core

1013. in case history pt is receiving floridated water ...but having plaque ....treatment options
- add more floride ...floride gels ...oral hygiene reinforcement? Sealent
1014. football player use mouth guards ..now he is having pain ..and he is not able to open
jaw in the morning ? myofacial pain syndrome
1015. rubber dam holes, highest chance of leakage? Holes too far
1016. abscess? penicillin vk
1017. composite with stains and pits ..but other wise intact ...wat to do? Redo
1018. liquid in gic? Polyacrylic Acid
1019. color stability? tegdma
1020. irm Zoe with? pmm
1021. what is not used for cast? Irreversible or reversible impression material? Irreversible
1022. safety valve of no? allow 70 percent of nitrous oxide and 30 oxygen
1023. characterstics of autistic child? Unable to focus and follow commands, repetitive,
1024. why v record protusive relationship? to adjust condylar guidance, compensatory curve,
incisal guidance
1025. after dpc (direct pulp capping)? place gic liner over caoh
1026. where to place retentive arm? Retentive terminal alone below ht of contour at
junction of middle and gingival third
1027. hyperactive, sensitive to light
1028. Cardiac arrest in children? Respiratory depression/ fluoride poisoning
1029. minimum anc count for surgery? 15,000
1030. topocal antifungal options fluconazole clotrumazole miconazole griseofulvin?
clotrumazole
1031. does premedications required in cardiac stent murmurs pt had knee replacement within
2 years ? NO
1032. distance for lateral cephalometric? 15 feet
1033. tooth removed socket tissue is examined, they found lymphocyte neutophills and
hemophiillc precursors? leukemia
1034. tooth removed, tissue is examined, they found inflammatory cells granulocyte etc? scar
cyst granuloma? granuloma
1035. pt had fracture and numbness on side on nose cheeks...fracture site? floor of maxillary
sinus roof of orvit ..medial wall of maxillary sinus ...? Medial wall of maxillary sinus
(because its le fort 2)
1036. half radiolucencies line on ramis ..identify ..fracture , air space..? Fracture
1037. quality of x-ray is good or poor? poor
1038. bacteria present in gingiva in anug when tissue is not necrosed ..? rods cocci
spirochetes? Cocci
1039. how to differentiate between Apical and perio abscess? EPT
Pocket is always associated with Periodontal Abscess, whereas Cavity is always
associated with Periapical Abscess, Periodontal abscess is related to vital tooth, unless
it's an Endo perio lesion. Whereas Periapical Abscess is related to non vital tooth.. For

treatment plan of endo perio lesion, here is a very nice image that says everything:
1040. pt is having asymptomatic brwoun macules on buccal mucosa, Melanocyte

proliferation? inc melanin deposition
1041. heat sensitive instruments sterlised by wat? glutaraldehyde
1042. if prostaglandin is not there what will not happen? antipyresis dec blood flow to kidney ,
platelet inhibition? Platelet Inhibition

1043. antiepileptic is used in which condition? Trigeminal neuralgia
1044. from where v can get large piece of graft ilium , ribs? Anterior iliac crest graft
1045. least resistant to fracture? high leucite
1046. how the position of mand foramrn shift relative to occlusal plane in kids? Below
occlusal plain in kids
1047. antiviral for hsv cmv vzv? Acyclovir
1048. bisphosphonates is not used in? Osteomyelitis
Bisphosphonates are currently used in the treatment of osteoporosis
(postmenopausal and steroid-induced), hypercalcemia of malignancy, Paget's disease
of bone, multiple myeloma, and skeletally related events associated with metastatic
bone disease in breast, prostate, lung, and other cancers.
1049. kidney transplant, How to check it's failure initially? Dec renin creatnin uric acid
1050. drug conjugation.? More ionic, polar water soluble
1051. Pt wth lower denture trauma at mental foramen region what disese? Neurofibroma
1052. Pt recive blow to eye, orbital floor less common t/f? False
1053. Tongue blade appliance use for?? Ant cross bite? True
1054. Mouth brether class 2 or 3? Class 2
1055. face bow transfers relation of arches? In centric
1056. Bleeding after tooth extraction? May be from nutrient vessels
1057. Most common site(s) for contact stomatitis? All Side of tongue, Hard palate, and
Gingiva
1058. Is side of tongue involvd??? Yes
1059. Light ortho force can cause?? All Undermining resorption, Root resorption, and PDL
changes
1060. Reduce setting time of amalgam by? Use spherical alloy
1061. Polymerization shrinkage In composite depends upon? Filler content
1062. Which resorption in avulsed tooth? Inflammatory resorption
1063. If superior. post.alv.n block,which procedure can be done? extraction of 2nd Mx molar
1064. complete full moth extraction done,black blue color seen on neck,what is it?
Haematoma
1065. which resorption is due to Implant? NO resorption
1066. Aging pulps show a relative increase in? fibrous elements.
1067. An old patient came with a slowly growing swelling in the angle of the mandible, On
radiograph there is radiopaque lesion with radiolucent border. Whats your diagnosis?
Ossifying fibroma
1068. a patient comes with severe throbbing pain. The tooth is elevated with mobility. The
tooth is compressable in the socket. Diagnosis? Acute exacerbation of chronic
periodontitis
1069. tongue blade appliance is used in? tongue thrusting
1070. carbide bur with more cutting blades produces? smooth at low speed
1071. Burs causes rough surface??? Carbide bur
1072. Pulpitis 5 days after class ll composite is due to? Increase occlusal contact
1073. Marginal linkage of gingival wall of class ll restoration is due to? Buccal nl lingual
1074. Main function of enamel bevel? Increase strength of restroration

1075. Whats the normal response of a inflamed pulp? Hypersensitive painful response
1076. Best radiograph for implant? CT scan.
1077. Malignant tumor invasion by? Lymph node
1078. Early appearance of SqCC? Red plaque.
1079. Early appearnce of herpes / syphilis???? Ulcers
1080. How to dec width of artifical tooth? Facially Line angles
1081. Direct retainer uses? Retention.
1082. Long cone technique? Reduce patient exposure.
1083. Discoloration of loss of translucency of tooth? Pulp death.
1084. Which is not true about amalgam material? Fracture occurs in bulk.
1085. Percussion test is done to? Determine the pain of periodontal origin.
1086. Patient having trauma in incisal 1/3rd of crown, patient complain of cold sensitivity and
roughness of the tooth structure with dentine exposure. What is the 1st
management.??? Smooth the tooth structure, apply CaOH.
1087. on radiograph periapical radiolucency is evident? Focal sclerosis osteomyelitis.
1088. In rct treated tooth which post is used??? Threaded
1089. Over drying after acid etching causes or results in? Marginal shrinkage.
1090. Polymerization shrinkage in composite results of? Due to evaporation of end reaction
product.
1091. An 11yrs old boy had a trauma; the dentin was chipped of minimally. Patient complains
of rough surface sensitivity to cold. What is your emergency treatment? Smoothen the
enamel and apply Ca(OH)2
1092. After seating a crown, the patient come back to the office after 1 week with pain on
mastication on that tooth and bleeding from gingiva. What is the first thing you will
see???? Occlusion.
1093. Failure of RCT is most common in? Mandibular 2nd molar
1094. Glass fiber post compared to custom made post? Less chances of fracture.
1095. Pt comes to you with complete denture that is loose, she wants a new one, and there is
redness under the upper denture with papillary hyperplasia? What is your immediate
management? Excision of lesion
1096. Plaque control ? Initial phase.
1097. K sparing drug? Thiazide, Spironolactone
1098. Virax in oral cavity? Acyclovir
1099. Varicose vein is caused by? hypertension
1100. What procedures you cant do in AIDS? Prophylaxis
1101. Opiods effects? Miosis, constipation, CNS Depression, Respiratory depression (Only
Meperidine causes Mydriasis)
1102. Papoose contraindication? Cooperative child (Long term restraining, Cooperative non
sedated child, Child with a bad previous experience with it, Mentally or physical
abnormal)
1103. Battery? Treatment without concent
1104. Which study doesn’t show cause and effect? Cross Sectional
1105. Drugs those blocks prostaglandins has increased effect on gastric mucosa? Cox inhibitor

1106. Bimaxiallry protrusion? Convex profile, Lip prominence and strain. Both arch procline .
When u see facial profile lip incompetence lips strain n prominence lip profile
1107. Combination syndrome? AKA kelly syndrome, maxilarry CD opposing mand anterior
natural teeth, Cc:- flaby max ant bone resorption, extrusion of mand teeth, posterior
mandibular resorption, maxillary tuberosity enlargement
1108. Chs of band and loop? Doesnt prevent eruption of opposing tooth. Its non functional.
Placed in case of loss of primary 1st molar, perm 1st molar or primary 2nd molar can
be banded
1109. Least fracture resitant ; lithium, feldpathic, zirconia? feldpathic
1110. Pka has effect on what? Onset of action of LA
1111. 16 kg of 3 year old how many mgs LA to give? 70.4
1112. What meds you give in osteomyelitis? Clindamycin
1113. Pt with bizarre behavior and disorientation you give what? ; insulin, glucose, thyroid?
glucose
1114. Initial stages of sedation what pt feels? Tingling of hands
1115. Condensing ostetis? Mild irritation, vital tooth, Abnormal reaction if bone to low grade
infection or in case of high resistant tissue. Radioopacity. Outline of tooth is visible.
1116. Periapical Cemental ossifying? Ant. Mandible, middle age, black womenn
1117. What cyst in roots of mandibular premolar? Traumatic bone cyst
1118. What lesions are not radiopaque? ; AOT, Ameloblastic fibro odontoma? AOT
1119. Least likely to occur, AOT, odontogenic myxoma? AOT
1121. Rg ameloblastic fibro odontoma ? Mixture epithelium and mesenquima, encapsulate.
Mandible area common. Radiolucency with opacity
1122. 9 year old kid swollen gingiva,recureent skin infections? Staph infection, impetigo,
Pemphigus
1123. what is complication of maxillary molar extractions? Sinus perforation (if not in option,
go with fracture of tuberosity)
1124. what is easily curable, macule, hematoma? Hematoma
1125. RPD I bar fractured what you do? Construct new one
1126. What does conjugation do to a drug? Makes it more water soluble to enhance
excretion
1127. Patient with flared maxillary incisors and diasteams, to improve esthetics what you
evaluate first? ; RG, DX wax up, probing depth? Radiographs
1128. Downcoding and upcoding? Down- when insurance company bills your treatment to
the cheaper procedure. Up- when you type your treatment to be more expensive than
actual value to the insurance company
1129. Brown tumors? Hyperparathyroidism
1130. Conditions have macroglossia? Acromegaly, down, hypothyroidism
1131. You don’t do RCT with PA radiolucency in which patients? Diabetes
1132. Systemic antifungal drugs? Amphoteric B, Fluconazole, Ketoconazole
1133. Why you clean tongue? ; esthetic or to prevent odor? to prevent odor
denticolla, forsythia

1135. Nasal obstruction what sedation you cant give? Inhalational
1136. Sulfonamide MOA? COMPETE with PABA to inhibit PABAs actions, which prevents
1137. Traumatic neuroma? Denture irritation, firm nodule, on mental foreman area
Biopsy, or observe? observe
1139. Treatment of concussion? Relief occlusion
1140. Primary maxillary incisors intruded 5mm what you do? Extract
1141. Radiolucency in primary molar furcation area? Irrecersible pulptis
1142. Most common caries location? Pit and fissure
1143. Features of arrested caires? Hard and shiny
1144. Composite characteristics? Rough, glass filler
1145. Opaque porcelain features? Mask the metal and provide chemical bonding
1146. Phelobith location? ; nerve, vein? Vein
1147. Lefort 3 fracture what side gaze is limited to? Laterally, medial or downward?
downward
1148. Lefort 1? Trans maxillary fissure
1149. Axillary freckling seen in? Neurofibrometosis type 1
1150. Too light Rg? Why? Overefixed, underxposed or developer too old
1151. If you take Rg 10 ma with 1 sec exposure and you take another x ray with .5 sec what
MA will you give you want same density rg? 5, 10 or 20? 20 (mAs = mA X time (sec)
10=x. 0.5 x=10/0.5 x=20)
1152. Serpentile lesion on the tongue- feature of? migratory glositis
1153. HIV infection feature? Usually asymptomatic in initial stages | Lymphcytes reduction
1154. Normal skeletal and class 3 dental what could be the reason? Loss of primary
mandibular 1st molar or incisor crowding or thumb sucking? Loss of primary
mandibular 1st molar
1155. 3 mm lack of mandibular arch how you treat? Disk distal of molar, lingual arch and
observe? lingual arch and observe
1156. max 2nd molar less keratinized tissue, which graft you will give? Lateral of pedicle flap
1157. Most common crown root fracture tooth? Maxillary Incisor
1158. Primary mandibular 2nd resembles to? perm 1st molar
1160. Access opening of Mndibular molar? Trapezoidal
1161. Modified widman flap? Full thickness 3 incisions used to expose bone defects
1162. When we don’t do gingivectomy? Attached gingival less than 3 mm
1163. Mouth breather features? Class 2 occlusion, adenoid face, dry mouth, halitosis
1165. behavior shaping question, patient say I don’t wanna quit smoking? Precontemplation
stage
1166. eg of secondary prevention? Treatment before complications, restorations
1167. where you give GA? 2 year old kid needs lot of restoration
1168. most common failure of periodontal failure? Max PM, Max molar, MAnd PM mand
Molars? Max molar

1169. Twisted questions on Mepiridine and MOA read it carefully? Can cause lethal
interaction of malignant hypernemia
1170. What pain killer drug safe in pregnant patien? Tylenol, Acetaminophen
1171. When does dental lamina starts, 2 weeks of uero, 6, 12, 10? 6
1172. What stage supernumery occurs? initiation, histo, apposition? Initiation
1173. What % of community water fluoridation is recieved by US population? 74%
1174. Mechanism of fluoride? chelate calcium, fluoropatite wich is more acid resistance,
Antimicribial at some level, causes stop in glycolysis process of bacteria
1175. Multiple myeloma feature? bone pain, Punch out lesion, M spike
1176. best bone for implant? D1 (for density classification) Type 2 (for quality classification
acc to misch) (According to decks)
1177. what is implant abutment? Connecting element

1178. You making FPD and you see 1 prosthesis in RG is completely seating on implant what
you do? Screw the implant, take anither RG? Section the FPD
1179. Disadvantages of cemented Implant restoration? Need more occlusal and vertical
space
1180. Fearful patient how you respond? Gradual desensitization
1181. Leading question, open ended and reassurance? leading question: you are not affraid,
do you? (not recomendable to use) - open ended: how are you feeling? (let the pt to
communicate and its the best choice -reassurance: what advantages or disadvantages
do you see in tx plan? (making sure pt understood)
1182. After successive trials, child goes thru instruments and hands an instrument to dentist.
What does it show? Desensitization, modeling...? Modeling
1183. Buccal limitation of mandibular denture? Masseter
1184. Lingual limitation of Mandibular denture? Mylohyoid, superior pharingeal constrictor,
buccinator
1185. ANUG resembles to what? herpetic stomatitis
1186. Lefort 1 include what structure? Maxilla, Bilateral Hematoma on hard palate
1187. Smokeless tobacco causes what? SCC, Hyperkeratosis
1188. Max anterior teeth placed too superior and too anterior what sound will affect? F and V
incline, lingual? Marginal Ridge 1.5mm

1190. What not included in the consent? Cost
1191. Epinephrine contraindicate in thyroid? Hyperthyroidism
1192. Dental hygienist and 3 doctors in practice, dental hygienist screwed the case who will be
legally blamed? Dental hyginest and supervising dentist
1193. Abcess include marginal and interproximal gingiva called? Gingival abscess, pericornal,
periapical? Gingival abscess
1194. Whats the indication of half erupted third molar in 18 years old? Pericoronitis and
extraction
1195. Another question on complication of maxillary molar extraction? 1st molar root in sinus
2nd molar related with maxillary tuberosity fracture
1196. You can avoid legde if canal is Small, large, short or curved? Short
1197. External bevel incision? For gingivectomy (For flap- internal bevel)
1198. Ear pain refer to? Mandibular molars
1199. An athlete havin pain and soreness on tmj when he wake up? MPDS
1200. Sublingual varicosities? Elderly (Also Htn, depends on options)
1201. Rg of dentigerous cyst? Around unerupted tooth, symetrycal round RL with RP border,
starting at the CEJ, associated with the crown of an unerupted teeth
1202. Distance bw two implants? 3 mm
1203. # of granulocyte for sugery? 15,000
1204. Periodontitis common in? African American
1205. Nursing bottle caries? Maxillary centrals and molars
1206. Oral infections in what leukemia? CML
1207. TT of ranula? Recurrent removal of gland, enucleation
1208. What is mucocele? extravasaion of fluid, common in lower lip, due to trauma to ducts
of minor salivary glands
1209. Too deep PPS? Gag
1210. Beta 1 selctive actions? Decreaase heart rate, metaprolol if its agonist then inchrease
HR but if antagonist then dec
1211. medicine given in lung patients for better functions and improve asthmatic effects.
Mechanishm of it? B2 agonist (theophilline, albutamol, salbuterol, Montelukast)
(Montelukast - Block the action of leukotrienes) (Lipoygenase path inhibitir act as
bronchodilator) (anti depressents - inhibit Gaba receptore..barbiturates have more
resp. Depression than benzodiazepam)
1212. Exhale wheezing sign of what? Cops, asthma.? COPD
1213. Primary Central incisor eruption date? 7 months
1214. Why pregnant women kept on left lateral? relives pressure of inferior vena cava.
1215. Adverse effect of codiene are all except- somnosolant, constipation, reap. Depression?
constipation
1216. MAO of sulfonamides, macrolides, nystatin? preventing addition PABA into the folic
acid, macrolides: 50s, inhibition of bacterial protein biosynthesis . Nystatin:binds to
ergosterol
1217. Common among aspirin and acetaminophen? Analgesic and antippyretic
1218. Proprietary name of drug is? Brand name

1219. Correct statement on clostridium diff.? Clostridium dificile is treated with
metronidazole. Unless pt is pregnant or breastfeeding, then use vancomycin.
Clindamycin causes clos diff
1220. Red complex bacteria? p.gin, t,forsytia , t.denticola
1221. INR is measure of? Extrinsic, intrinsic or common pathway? Extrinsic
1222. Montelukast MAO? Block the action of leukotrienes
1223. Death of a child having cardiac arrest is due to? Resp. arrest (Acc to dd)
1224. Sensitivity to penicillin is due to? Beta lactamase (if hypersensitivity not in option)
1225. Culture sensitivity test is done for? Antibiotic
1226. HIV, 1st disease or symptom occurring is- no symptom, opportunistic infection?
opportunistic infection
1227. Penicillins are bactericide like or static? Cidal
1228. Cyst occurring inferior to the mandibular canal level? staffer bone cyst.
1229. Ludwigs angina? Sub mental, sub mandi, Sub lingual
1230. can we give chlorhexdine to ADHD child ? NO
1231. Pigeion Chest? Rickets
1232. Bond Strength of Resin more in? Dentin
1233. Rifampin contraindicatedin pregnant? True
1234. Reverse LA? Beta-antagonist (Alpha-Agonist)
1235. Xerostomia treatment? Cevimeline
1236. Russell Body? MM
1237. Ectodermal dysplasia features? Anadontia , conical ant teeth , thin hair , mostly in
male , x link
1238. cleidocranial dysplasia what is missing? clavicle
1239. Identify periapical cemental dysplasia? Cemento-osseous dysplasia (COD) is a benign
condition of the jaws that may arise from the fibroblasts of the periodontal ligaments.
It is most common in African-American females. The three types are periapical
cemental dysplasia(common in those of African descent), focal cemento-osseous
dysplasia (Caucasians), and florid cemento-osseous dysplasia (African descent).
Periapical occurs most commonly in the mandibular anterior teeth while focal appears
predominantly in the mandibular posterior teeth and florid in both maxilla and
mandible in multiple quadrants.
1240. Regional odontodysplasia identify? Ghost teeth
1241. which week does dental lamina appear? 6 week
1242. Piree Robinson syndrome? Cleft palate, retrognathia and glossoptosis
1243. Ranula treatment? Marsupilization or excision with remove sub lingual gland
1244. convergence of buccal and lingual wall which tooth? Primary 1st max molar,2nd molar
all primary? Primary 1st max molar
1245. Distolingual extension of mandibular denture which muscle? Masseter
1246. Which sounds will you look for placing anterior teeth? F and V
1247. Incisal edge of max anterior touch were? On the vermilion border
1248. Major connector function? Stability
1249. In distal extension where do you put rest? Mesial

1250. Most esthetic pontic design? Ovate (decks says modified ridge lap but mosby says
ovate, textbooks say ovate too. it resembles emergency profile of natural teeth)
1251. Where to place margin of anterior crown? Subgingival
1252. Necrotic pulp with open apex what is treatment of choice? Apexification
1253. 1mm exposure what do you do? DPC, pulpotomy, PUlpectomy? DPC
1254. Patient comes after 1 week of composite says he does not like the color what will you
do? Repeat restoration, add composite? Repeat restoration
1255. Which bur do you use for porcelain polishing? Steel,carbide ,diamond? Diamond
1256. Action of beta blocker on smooth muscle? Broncho constrictor
1257. Action of beta blocker on cardiac muscle? Decrease cardiac output, decrease Hr
1258. Which patient requires antibiotic prophylaxis? Prosthetic valve
Cyanotic, Previous endocarditis, Valves problems from recently inplanted heart
1259. MOA of sufonylurea? Inc insuline by stimulation of beta cell in pancreas
1260. immunosuppressive? Methotrexate, Mecaptopurine, Cyclosporine, All are immune
suppression
1261. Antimetabolite for cancer which affects folic acid? METHOTREXATE
1262. Premolar forcep all except? 23 (150-151 are PM forceps)
1263. Bacteria in chronic periodontitis? Echenella and provetella
1264. Bacteria in NUG? Fuso, Spirochete, Provetella
1265. Gingivectomy where to put incision? Base of pocket
1266. What does biologic width comprise of? JE + CT = 2.4
1267. What makes up the periodontium? GIngiva, Alveolar bone, Cementum, PDL
1268. Most common complication of extn of max molar? Sinus perforation, (if not in option,
then go with Alveolar fracture)
1269. Lefort 1 which sinus affected? Maxillary, ethmoid, frontal, mastoid? Maxillary
1270. A boxer wearing mouthgused comes with complain of jaw opening in the morning.
What is your diagnosis? MPDS Unilateral
1271. Light radigraph cause? Underdeveloped, cold developer, insufficient time of exposure
1272. Cold sterilization which chemical used? Gluteraldehyde
1274. Common cause of failure of amalgam restoration? Moisture contamination, improper
design,improper trituration? Improper Design (Although decks say,Failure- water
contamination, Fracture- inadequate design, textbook says improper design)
1275. There is a fracture line on amalgam restoration what is the treatment of choice? Redo
restoration to check the fracture of tooth, Just remove mesial side and check? Redo
restoration to check the fracture of tooth
1276. lot of class 5 what is the material of choice? GIC
1277. Which impression material is moisture tolerant? PVS,polyviny,polyether? PVS
1278. Which material has inherent property of binding with water? PVS,Polyvinyl, polyether?
PVS (if hydrocolloid not in option)
1279. modulus of elasticity which property? Stiffness
1280. Finger spring applied to move the tooth where will be the most force applied? Tooth
dstal, mesial? mesial
1281. Nitrous oxide most common side effect? Nausea and vomiting, orthostatic hpotension

1282. 16kg boy what is the maximum dose of LA? 70.4
1283. A defiant child does not want to cooperate which method to use? GA, voice contol,
HIM? voice contol
1284. Gold standard for behaviour modification? Systemic desensitization, modeling, voice
control? Systemic desensitization (in anxiety and pain control), modeling (less used
according to dd and mosby),
1285. Which one appears on tooth first? Pellicle
1286. Montelukast for asthma. MOA? Leukotrine receptor antagonist (LTRAs) are preventer
tablets
1287. which one in wax try in for complete denture? Esthetic
1288. Deepest part of occlusal rest for RPD? Central fossa
1289. what is Hazard communication? to protect patients and staffs from chemical material
1290. which one related to hazard communication ..? OSHO
1291. FDA is conducting a clinical trial about a new drug on animals and human. What is the
phase 3 of this study? to find the effective dose of the drug
1292. which one not effective in early childhood caries? Bottle of water
1293. 9 years old baby, fever for 3 days, vesicle in oral mucosa, lymphadenopathy? Infectious
mononucleosis
1294. macroglossia not seen? Hyperparathyroidism
1295. early primary teeth lost? papillon-lefevresyndrome
1296. first sign of multiple melanoma? bone pain
1297. the relationship between Treacher Collin and zygoma is the same as cliedocranial
dysplasia and? clavicle
1298. phleboliths in? vein
1299. main feature of cherubism? bilateral jaw expansion
1300. most common in mandibule premolar region? lateral periodontal cyst
1301. submandibular space drainage through which muscle? masseter
1302. which oral pigmented lesion resolve spontaneously? melanotic macule
1303. how many percent have access to fl community water? 80
1304. MOA of sulfanamid ? paba; interfere with folic acid synthesis
1305. MAO of sulfonylurea? stimulate insuline synthesis by pancreatic b- cells
1306. which one is class 2? Percocet
1307. INR? extrinsic pathway
1308. which is correct about conjugation? adding a molecule to the drug
1309. which of these cognitive behavior decrease in a normal process of aging? learning
1310. side effect of nitroglycerine? nausea, headache
1311. which one does not show the dispersing of date? median
1312. DMF shows? caries
1313. fail-safe mechanism part of NO machine does not let the increase of NO flew by what
percent? 70
1314. Pappoos board isn’t used in which situation? Treatment of a 14 years old cooperative
patient
1315. most frequent post extraction complication in maxillary tooth? alveolar ridge fracture
1316. most frequent post extraction complication in mandible tooth? dry socket

1317. where do progenitor cells for new attachment come from? pdl
1318. maximum dose of lidocaine allowed in 4 years old child 16kg? 74
1319. which one is correct about pseudomonas colitis? bcs of clostridium difficile
1320. cleft lip/palatal in Caucasian? 700
1321. primary principle of behavior modification? behavior has consequences
1322. patient manifests sudden bizarre behavior. What will make her feel better? epinephrine
1323. most common salivary gland benign tumor? Pleomorphic adenoma
1324. less reoccurrence? AOT
1325. pt has a chipped veneer, does’t want to remove it. How to fix it? Micro-etch, acid-etch,
silane, resin bond
1326. what does bimaxillary protrusion mean? A Protrusive dentoalveolar position of
maxillary and mandibular arches that produces a convex facial profile.
1327. If the maxillary incisors are placed too far superior and anterior, what is affected? F
sound
1328. pt doesn’t have upper 3rd molars. How many furcation do we have in upper jaw? 8 (
select 6 if in option)
1329. retentive clasp fracture? Work hardening
1330. mild wear facet in primary dentition? No treatment needed
1331. most amount of bone graft from? Iliac
1332. which one has least effect on DURATION of local anesthesia? Systemic absorption of
drug
1333. PKa of local anesthesia has effect on? rate of onset (Pka is onset and protein binding
is duration....lipid solubility is potency)
1334. premedication? (not based on latest AB prophylaxis) Cardiac stent. (Knee replacement,
can be but Not always only first 2 years and if there a hematologic complication after
treatment)
1335. which one is correct about automated external defibrillator (AED)? charges whenever
there is need for that
1336. which one has the least desirable physical properties for a complete denture?
chemically activated resinis
1337. in an appointment for discussing and revealing the result of a BCC lesion biopsy, patient
says ‘’ doctor, tell me straight, do I have a cancer, or not?” what dr should tell him?
Actually this lesion has a better prognosis in comparison to the other lesions
1338. most common crown root fractured tooth? Maxillary anterior
1339. the level of a normal alveolar bone crest in a X-ray can be an indication of? Level of CEJ
1340. what do you see in pathology of osteoporosis? Thin trabecula
1341. which one is the disadvantage of composite? Low thermal coefficient
1342. when a patient who is frighten by endo surgery says by herself “I am strong and I can
handle this situation” what does happen? She manages her stress level because she
activates her Self-reliance.
1343. analog in open tray? For taking same impression
1344. what oil do in X-ray machine? cooling
1345. retention form in cl 5 composite? Groove where? Gingivoaxial and incisoaxial
1346. class 6 composite restoration, too light, what to do? Add composite tint

1347. high caries risk pt, has anterior composite restoration with marginal discoloration. What
to do? Change the whole restoration
1348. what is not the advantage of LED light cure in comparison to halogen? Weight
1349. distance btw film and midsagittal plan in cephalometry? 6 feet
1350. how much bone around implant? 10 mm height, 6mm width
1351. how much granulocyte in blood to do elective surgery? 15,000
1352. first manifestation in HIV? Multiple opportunistic
1353. to be able to burnish a margin of a gold restoration which one should be exceed?
Modulus of elasticity
1354. what impression material has a natural affinity to water? Polyether
1355. Most stable in moisture environment.? Addition Silicone (aka putty or PVS=polyvinyl
siloxane
1356. which one is correct about self-threaded pin? Should be placed on flat surface
1357. which one has the most possibility of getting ORN? Receiving radiation therapy 42.5 GY
(if not in option, go with Bisphosphonates)
1358. patient has history of Bisphosphonates medication. Now need an extraction. What
should we do? no hyperbaric o2 (if not in option, Refer to oral surgeon)
1359. what is seen in cellulite? Lymphocytosis
1360. which one is correct about down syndrome? Affectionate
1361. which one correct about autism? Has repeated questions
1362. which one has more learning problem? Boys
1363. rubber dam placement in a class 5 which extends to the root surface. Hole should be?
More buccally
1364. suprenumary teeth which stage? Initiation
1365. 4 years old kid, trauma to primary incisor, 5 mm intruded. What to do? Extract to not to
interfere with the eruption of permanent tooth
1366. treatment for concussion in primary teeth? no treatment
1367. moisture contamination in amalgam? Increases delayed expansion
1368. What teeth most likely to have crown /root fracture? max anterior
1369. Which tooth is least like to fracture? mand 2 premolar
1370. Where you can find the supernumerary tooth? max anterior
1371. What age is proliferation? 8 weeks
1372. Primary central incisor erupt? 5- 6 month
1373. Bur for porcelain occlusal adjustment? diamond
1374. Which primary tooth is most like any other tooth in the dentition? primary mand 1
molar
1375. Which of the following clinical sign is not characteristic of opioid? dilated pulpitis
1376. Which is not an advantage of ni-ti over stainless steel file? resistance of fracture
1377. What is the shape of access of mandibular 1 molar? Trapezoid
1378. Differential diagnosis of periodontal abscess and periradicular abscess? vitality test
1379. Lateral periodontal abscess is best differentiated from the acute apical abscess by ? pulp
test
1380. What will not regenerate after rct? dentin formation

1381. partner dentist and hygienist hurts patient who involved in a low suit? only dentist
1382. How long after extraction you insert the complete denture? 8 weeks
1383. Which one is more affect in male? hemophilia
1384. Where does the epithelial for a graft come from? donor connective tissue
1385. Kidney dialysis when is appropriate to put the dental appointment? day after dialysis
1386. Tooth extraction, 3 days later starts to hemorrhage what is the cause? fibrinolysis
1387. Periodontal regeneracion involves? shapeysfiber ,cementum and alveolar bone
1388. Which is a periodontal bacteria? staphylococcus
1389. Mot commun cause to cause mobility is? trauma
1390. Why the clasp break in dental appointment while you are adjusting the denture? too
much pression
1391. What cause less allergy? chrome
1392. The space difference between primary canine,second molar and the succedaneous
teeth is called? leeway sace
1393. Lefort 1? maxillary sinus
1394. Where does the epithelial for graft come from after you place it and it is healing?
recipient epithelium of donor
1395. What is the treatment for dry socket? sedative and dressing
1396. What cause pregnant women to sycope? pressure on inferior vena cava
1397. Vicodin schedule? acetaminophen and hydrocone
1398. Best area to place implant? anterior mandibule
1399. Best angle to place curette roots? 45-90
1400. Triad of cheft palate,glossopteris and absent gag reflex is? pierre robin syndrome
1401. What cant the patient not say if upper anterior are too superior and forward for
denture? f and v sound
1402. pt has won denture for 19 years,now he has a sore on buccal with swelling what do u
do? relieve denture in area and re-eveluate in 2 weeks
1403. would relieve a mand denture in the area of the buccal frenun to allow which muscle to
function property? orbicularis oris
1404. what prevent corrosion on a noble metal? chromium
1405. central giant cell granuloma is seen with pts with condicion of ? Hyperparathyroidism
1406. see caries on? x ray .
1407. Café-Au-Lait? Neurofibromatosis
1408. burning sensation on tongue, moves around? geographic tongue
1409. Football player with mouthguard, crepitation of left TMJ, trigger zone tenderness L
temporalis, stiffness upon wakening? Myofacial pain syndrome
1410. What has the highest recurrence rate? Odontogenic keratosis(okc)
1411. If you have lesion of maxillary sinus, what kind of radiograph do you take? Waters
1412. sialilitithiasis is found whew? warton duct (Select submandibular duct if in option)
1413. 3 factor that affect caries initiation ? substrate ,bacteria, hot susceptibility
1414. most common area for caries intiacion ? pit and fissure
1415. dmf index? measure how permanent dentition is affect by caries
1416. 245 carbide burd and 330 carbide what is the different? length distance

1417. more blades on carbide bur is? less efficient and smother surface
1418. Proximal resistance form of amalgam restauration comes from what? retention grooves
in axiobuccal/axiolingual walls.
1419. most commun complication of extraction is? root fracture
1420. the base of the incision in the gingivectomy technique is located? above the
mucogingival junction
1421. which one is true about implant? high torque and slow speed
1422. where perio tx is more difficult? maxillary molar
1423. what is most accurate pulpal test to determine vitally of a tooth with a full gold crown?
thermal test
1424. most common salivary glan being major and minor is? pleomorphic granuloma
1425. ectodermal dysplasia is hereditary. it is not not x linked? true
1426. what percentage of us population on public water supplies lives in fluoridated
community? 74 %
1427. All of the following are hereditary except? regional odontodysplasia
1428. What does hypodontia affect the most? growth of the alveolar bone
1429. blue mass under tongue is? Ranula
1430. Trauma to floor of mouth is? Ranula
1431. which reabsorption is seen is primary teeth? External root reabsorption
1432. why is more color stability in light cure? tegma
1433. X-Ray: Black women, middle aged, anterior radioluceny (can be radio opaque): cemento
osseous dysplasia
1434. Most common place for periapical cemental dysplasia? Lower anteriors
1435. very well defined round radiolucency in panoramic, posterior mandible below inferior
alveolar canal? static bone cyst (stafne defect) see xary in google
1436. first sign of multiple myeloma? bone pain
1437. what is the oil in the x ray tube for? dissipate the heat
1438. Max radiation dose? 50 msv or 5 rem per year
1439. Collimation does everything except? reduce average energy of x rays (energy is
unchanged)
1440. amalgan failure main reason? Improper prep (is fracture – cavity prep would be the
answer)
1441. chronic periodontal is most common in ? black people
1442. what is the correct method of excavation of deep caries? long bur from periphery to
the center
1443. Nitrous oxide is contraindicated in asthma patients. You can put nitrous oxide in anxiety
patient? First is false and second is true
1444. Acute perio abscesses that require drainage are usually? fluctuant localized lesion
management and dental modifications? ASA-2
1446. Failure in morphodifferentiation results in? size and shape abnormality, peg lateral,
macrodontia
1447. 7- yr old boy has vital exposure of tooth 1st perm max molar. What do you do for
treatment.? Pulpotomy

1448. what should be done for quitting??? acupuncture, counseling, smoking cessation drugs?
counseling
1449. What is it called when a patient charges several procedures instead of one? unbundling
1450. Pt. says, “I do not have time to quit smoking.” What stage is s/he in? Precontemplation
1451. What test coumadin? INR
1452. The most prominent psychiatric issue for old people? Depression (Can be Demnitia if
depression not in option coz it is talking about old people)
1453. What happens with horizontal angulation? contact overlap
1454. Class 5 lesion glass isomer; bevel both gingival and occlusal lines? Occlusal - No bevel
(Gingival - Bevel if on enamel/ No bevel if on cementum (root))
1455. What does the hypobaric chamber help? angiogenesis? New formation of collagen as
well as capillary angiogenesis in areas that were resistant to neovascularization - in
both acute and chronic injuries. Regenerating skin cells also function more effectively
in a high-oxygen environment.(hyperbaric oxygen procedure)
1456. Erosion on lingual it's due to bulimiais? true
1457. Which drug gives tardive dyskansia? isphenothiazines
1458. What condition of the tongue involves the foliate papillais? medianremboid glossitis
1459. Diabetic patient before procedure what to do check HbA1C lvl is? true
1460. Vertical root fracture? do not do endo
1461. What isn't in tooth paste like type of fluoride? apf
1462. cheft lip in usa? 1:700
1463. reverse town xray for? condyle
1464. time for surgical hand washing is? 3 min
1465. a patient has a firmnodule underneath the denture what is it? traumatic neuroma
1466. During maintenance therapy pt has recurrent 6mm pocket on M of #4 and D of #20
what is 1st tx option? flap surgery
1467. which of the following has a higher chance of amelogenesis imperfect? dentin dysplasia
1468. Treatment sequence? emergency, disease control, reevaluation, definitive care,
maintenance
1469. Company offers dental insurance to its employees that can go to selected dentist, what
is this example of? Closed planel
1470. Order of bleaching and veneering process? bleach, wait 2 weeks, prep tooth, cement
1471. What is most common periodontitis in school-aged children? marginal gingivitis
1472. Best for interproximal plaque removal in teeth without contacts? interproximal brush
1473. Location apical position flap contraindicated? max palatal
1474. what type of bone with best quality and most suitable for retencion of implant? D1 type
2 (Acc to DD)
1475. which primary tooth is not like any other tooth in the denticion? mand I molar
1476. which is false about na oil? it is a chelating agent
1477. pt comes back few months after rct and crown with pain upon bitting what happened?
crack tooth
1478. crown cement two weeks ago is sensitive to pressure and cold why? occlusal trauma
1479. how long before should you stop baby aspirin before surgery? not necessary to stop it

1480. What is not true regarding patient with diabetes and perio? increase gran negative in
crevicular fluid
1481. The face-bow is used to record? relation of the maxilla to the temporomandibular
joint.
1482. black male with erosive lips, erythematous and blisters on his lips, the description says
that he also have palmar and planta erosion and blisters, what is this syndrome?
erythema multiform
1483. A major difference between light cured and chemical cured composite is that during
setting or in function the light cure material tends to? shrinks rapidly.
1484. When there is no barrier, protection of dentist? 6 feet; 90-135 degrees
1485. Shape of access opening for mand.molar with 4 canals? Trapezoidal
1486. Pt shows reaction to the LA vasoconstrictor so to recover the reactions u will
administer? Alpha 1 antagonist
1487. Which of the following is not good for use in taking impression of a cast restoration?
1488. Which of the following drugs is most effective as an antidepressant? Diazepam
1489. Tricyclic antidepressants have a prominent side effect that most nearly resembles the
usual pharmacological action of? Atropine
1490. According to the theory that agonists and antagonists occupy the same receptor site, an
effective antagonist should exhibit? No intrinsic activity and high affinity
1491. Which of the following drugs has its primary use in the treatment of the manic phase of
depressive psychosis? Lithium
1492. Gastric acid secretion has been shown to be most effectively reduced with the use of?
H2-histamine receptor antagonists
1493. Which of the following drugs is often used to treat trigeminal neuralgia? carbamazepine
1494. The highest risk associated with use of oral contraceptives is? thromboembolic disorder
1495. the various insulin preparations useful in the treatment of diabetes mellitus differ
primarily in? onset and duration of action
1496. Referred pain to EAR IS? MANDIBULAR MOLAR
1497. The maximum amount of nitrous on the machine safety hinge is? 70%
1498. Anterior permanent tooth most commonly erupts in cross-bite? Max laterals
1499. what kind of appliance for posterior cross bite and when? Quad HELIX
1500. Most common cause of anteriocrossbite? lack of interdental arch
1501. What occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st
molar? Class ii
1502. Diatalized occlusion w/ upright cental anterior and deep bite? class II div II
1503. Most common type of occlusion in primary teeth? flush terminal plane
1504. face is vertically divide in? 3 planes
1505. forcep of mand premolar? 151
1506. A patient has pain in her mandibular right 3rd molar and cannot take intra oral x-ray.
Which of the following would you recommend? Lateral oblique
1507. If a patient has crown restoration and you need to type a fluoride for her to use it a
home what kind of fluoride you will type? sodium fluoride
1508. Non-maleficence means? don’t harm

1509. Day 2 case she has 8 years and cross bite , he asked why she had the cross bite due to
early missing of? primary canine
1510. When you let the patient to sign the informed consent that’s called? autonomy
1511. numbers for True positive =81 true negative = X and false Negative = X and false positive
equal number X what is the number for the people that will have a disease or
wherever? TP/ TP+FN.
1512. When you punch the rubber dam in molar teeth there was a leakage or above the high
of contour that’s due to? to close
1513. If you have two distribution that are asymmetrical that’s means? skewed
1514. Dentist treat patient without consent form. What it is called? Battery
1515. When we take a pano for a patient his lower teeth appear elongated and wide what is
the error? chin too far back
1516. What make the reaction on the one that has monomer and activator that was using it
for prepaing the secondary impression on the study cast on the lap . its activated by?
exosermic reaction
1517. Community periodontal index use for some researcher they should contact? CPITN
1518. If the patient has maxillary protrusion and we need to bull the maxillary backward
which we will? reverse pull gear
1519. During xray you find a tooth with RCT it was asymptomatic and the obturation material
beyond the apex what you will do? leave it and watch
1520. If you during extraction of the lower third molar the root tip displaced where will be the
common place to displace on? submandibular space
1521. When the patient open his mouth to the maximum intercauspal position 5-7 you will
here a clicking noise and before he will full closure of the condyle you will hear a second
voice what do you think the cause of the second notice? the disc displaced anteriorly
1522. Gingsing you can use it with all of the following except one which is the exception?
aspirin
1523. Numbeness on the right lower molar area what do you think trauma was? condyle
1524. What is not practical to be done by dentist regarding increasing the fee when? increase
the fee six month without notice to the patient
1525. patient when he open his mouth its deviate away it could be due to? condylar
hyperplasia
1526. for the FDA to approve a new drug to be in the market they have to do some test to
make sure from its effectiveness thats by? randomized clinical trials
1527. Most prevalence number of wall defect? 2 wall
1528. asymptomatic pigmented lesion on the palate 4 mm x 3mm what you will do for it ?
Cone beam and excisional biopsy
1529. what’s the heart rate for a child 3 years I believe ?110
1530. the most prevalence type 2 diabetes will be in? native American
1531. Case in day 2 ANB angle is 5.8 and he in the clinical picture have cross bite anterior what
will be skeletal class ? Class II
1532. If the above patient have SNB 81 what will he have? mandibuilar prognathism
1533. PA of between the trabecula of the bone close to the apex of the teeth? nutrient canal

1534. Patient 3 years old came to your office and his central incisor had a trauma make it
intruded and all the associated tissue was firm what will be the best treatment? no
treatment just watch it
1535. What is Contraindicated for RCT? vertical fracture
1536. Patient stand on the corner looking at the floor and his hand is folded together after you
give his and introducation what you ask him or do next? whats bring you here today
1537. Patient who are having hearing problem what you will do? you will try to talk to the
patient as he can understand your mouth movement easily
1538. Which of these is carcinoma in citu? erthyroplakisis
1539. Whats the most common in the new year increase in? root surface caries
1540. ANUG will be spread to all of these spaces except one? larygois
1541. If patient is taking atenolol do you think it will be least effect on Epinephrine than non
slelective beta blocker? true
1542. Hepatitis A positive can checked by? HBSg
1543. Each of the following devices are effective in removing surface plaque EXCEPT one.
Which is the EXCEPTION? Home water-irrigating device (Water Pik®)
1544. whch tooth is least likely to be missing? canine
1545. trigeninal neuralgia which side? right side
1546. the most permanent psychiatric probelm for people is? depression
1547. Which is a characteristic of a gold inlay? Axial walls converge toward the pulpal floor
1548. Best way to look at alveolar bone loss? bitewing
1549. Most commonly accepted theory of dentinal sensitivity? Hydrodynamic theory
1550. 2 yo kid has 12 cavities on primary teeth, what you going to do? general anesthesia
1551. By having excess amount of monomer in acrylic can create excessive amounts of what?
shrinkage
1552. What is the acid in glass ionomer? Polyacrylic acid
1553. Posterior composite failure mostly due to? shrinkage
1554. Patient has an all veneer on incisal edge, small pice of porcelain came off and wants you
to fix the chip only, what is the sequence of events? microethc, etch, silanate, and
bonding agent
1555. Class III, what kind of surgery? BSSO
1556. For a surgical extraction, what does not contribute to developing post-operative pain?
High-speed drill with water spray
1557. Vasoconstion acts directly on what? duration
1558. WHICH is not ethical to charge more? Without notice every 1 year
1559. what material do you used when you are going to restoring a class V lesion it extends to
the root ? RMGI
1560. After brushing how long until forming mature plaque reappears? 24-36 hrs
1561. survival of a graft depends? on the CT of the recipient
1562. Generalized max denture soreness on the ridge? when pt came for adjustment?
increased occlusion
1563. which one has the worst polymerization shrinkage? class 1
1564. Most neoplasms in what glands? Parotid
1565. chronic perio, found what cells? T cell

1566. Aspirin will inhibit the palate aggregation by inhibit? phospholipase A2
1567. all is true about Periapical Cemental Dysplasia except? anterior max
1568. dementia pt, which one the most challenging? denture
1569. If you have 2 proximal cavities? you will fill smaller, prepare larger first
1570. pin retained - Which statement is not correct? increasing in number of pin strengthen
amalgam
1571. Best biopsy for small bean sized white lesion? excisional
1572. how many canals does 1st max molar has? MB1 MB2 ML P
1573. Anug without systemic manifestation pt, what do u do? Debridement and 12%
clorohexidine
1574. traumatic bone cyst most ass w paget? fibrous dysplasia
1575. Most common crown to root fracture is on what tooth? max ant
1576. Prevalence of caries higher based on? Socioeconomic status
1577. Gingivectomy is performed when? Pockets (if suprabony pocket, yes)

1578. 4 year old loss bilateral primary maxillary 1st molar, what kind of space maintainer?
nance (if it is maxillary)
1579. if you want to do osseous correction? full thickness flap
1580. defect with mesial, distal and lingual missing is called? hemiseptal
1581. morphin binds with? enkalphin
1582. how do u increase retention in short clinical crown? add facial groove
1583. pt with MOD done 1 month ago, complained it hurt when he bits? cracked tooth
1584. the retentive arm in resting position should? passive and does not engage the tooth
1585. Most important about root canal material (guttapercha) EXCEPT? Wall adaptation
1586. which one has the best prognosis? internal root resorption with perforation
1587. irreversible hydrocolloid can lose its dimensional shape even during 100% humidity due
to? syneresis
1588. Lingual flange during impression affected by which muscle? Mylohyoid
1589. Metforim (glucophage) is used to treat diabetics? type II
1590. Most important dimension that ensures the metal connector between abutment and
pontic is sufficient (in 3-unit fpd bridge)? cross section/ occlusal-gingival
1591. Patient presents with blow to face and horizontal fracture of a previously
endodontically treated molar. The fracture is 2mm from the anatomical crown. What
should the dentist do? Ext
1592. cause of allergic gingivitis? flavoring in toothpaste
1593. the most effective way to reduce pulp injury during tooth preparation is to minimize
dehydration of dentin.? True

1594. Rapid palatal expander is used for which of the following? Crossbite
1595. What do you do to camouflage class 2? Ext max first premolar
1596. Lesion with chronic inflammatory cells with epithelial lining and fibrous wall in an endo
treated tooth? Cyst
1597. Which burr is used to smoother the prep? Plain cut fissure bur
1598. Which of the following cements should not be used with all ceramic restorations due to
reports of ceramic fractures? Resin modified GIC (ideal is resin luting)
1599. You did a prep with high speed and diamond bur, tooth is sensitive, what is it about bur
and handpiece that it caused sensitivity? Heat
1600. What is the correct method of excavation of deep caries? large bur from periphery to
center
1601. What age does the mandibular symphisis close? 6-9 months
1602. Zinc eugenol good temp filling? good biological seal
1603. Downssyndrome: trisomy 21, which is a description? Mid Facial discrepancy
1604. Pregnant gingivitis? progesterone
1605. survival of a graft depends? on the CT of the recipient
1606. Indirect sympathomimetic drug? Amphetamine
1607. Side effect of having TCA and epi HTN? Hypotension
1608. side effect of drug that cause altered taste sensation? Cyclobenzaprine
1609. Why is inorganic pyrophosphate in tooth paste? prevent calcium
1610. Diuresis(excessive urine production) after tx of angina w/ a glycoside? b/c of increased
blood flow caused increased blood flow to kidney
1611. Acromegaly not taken care of leads to? Over growth of mandible
1612. Community fluoride: 0.2% / week in underprivileged areas? true
1613. T/F Best way to close 1.5 mm diastmea, which way do you not do it? FULL crown? true
1614. Why don’t put posterior tooth on inclination of ramus? Denture ends before the incline
1615. Diatalized occlusion w/ uprghtcental anterior and deep bite? class II div II
1616. Least associated w/ perio disease? Hypophosphatism, acrodynia true or false? true
1617. Which one would you premedicate? recent MI
1618. Rct, getting post and core and crwonlenghteningin, why do crown lengthing? feral
effect
1619. Best way to find out if the crown is going to seat? die space
1620. Setting condylar inclination on articular using protrusive , what do with the pin?
Remove the pin
1621. The percent of ppl in the US with fluorinated water? 70%
1622. The longest acting analgesic for a pt that got a impacted third molar extracted? Apirin,
Ibuprofin, Naproxen, Acetaminophen ? naproxen
1623. How long you stabilize or splint a mandibular fracture without reduction? 4-6 weeks
1624. Best success for implant location- posterior? anterior mandible
1625. Space between implants? 3mm
1626. Methemoglobinemia is caused by? Prolicaine
1627. palatal root appeared mesial to the MB root of a max first molar – where was the x-ray
beam directed? MOVED MESIAL
1628. virgin premolar with short crown is part of FPD abutment, what do you do? crown

1629. Which is associated w/ burning mouth? candida / Melkerson Rosenthal
1630. What is the best indicator for success of intra-pulpal anesthesia? backward pressure
1631. What trimester is nitrous use contraindicated in? First trimestor
1632. What is stridor characteristic of? Laryngospasm
1633. Patient shows up with kid always bleeds, discomfort? leukemia
1634. T/F, Supragingival alone can eliminate 5mm subgin calc. Supragingival alone is sufficient
for treatment? both false
1635. Pt. allergic to penicillin and has prosthetic heart valve. What pre-med to give? 600 mg
Clindamycin 1hr prior to dental tx
1636. What type of attachment trying to exclude when place barrier after perio surgery? Long
junctional epithelium
1637. Which of the following is FALSE in regards to abuse of the elderly? It is grossly over-
reported and exaggerated
1638. Premolar infection most common in which space? Sublingual
1639. Ear pain which infection? mandibular molar
1640. difference between primary & secondary trauma? pdl involve, bone support, mobility
1641. when rpd continues to break? Occlusal trauma, poor design
1642. least material used in fixed impressions? irreversible hydrocolloid
1643. A patient comes in and you do a MOD composite. He comes in later complaining of
pain, you remove occusal composite replace and pain goes away. What was causing the
pain? Polymerization shrinkage
1644. Dementia is long term memory or short term memory loss? Short term
1645. Trigeminal neuralgia is NOT associated with a spontaneous dull ache? True
1646. Trismus is usual caused by infection in what space? Masseteric
1647. if a patient is taking chantix what else need to be included in his smoking quitting
regimen? Behavioural counseling
1648. how do you identify root caries? Softness
1649. autism patient characerstic? repetitive behavior
1650. Well controlled diabetics, what will you see? Same amount of periodontal disease than
non diabetic
1651. in tooth borne rpd major support for the prosthesis is provided by? occlusal rests
1652. altered caste technique? support
1653. Large filler particles in composite increase the strength of hardness? true
1654. Large filler particles in composite increase polishibility& finishing? False
1655. Light ortho force cause? direct resorption
1656. what type of cells seen in established gingvitis? Plasma cell
1657. Pt is evaluated after periotherapy,what would u check? pocket depth
1658. Loosening and premature loss of deciduous teeth seen in early stage of?
hypophosphatasia
1659. Patient complains of pain due to oral mucositis after radiotherapy, the pain is best
treated with? Benzyl hydrochloride
1660. In constructing upper complete denture against lower natural dentition .when we do
the occlusal adjustment? after constructing study cast and treatment plan

1661. Three weeks after insertion of FPD marked discomfort to heat and cold occurs there are
no other symptoms the most likely cause is? deflective occlusal contact
1662. which study does not tell association between cause and effect? clinical trial
(Descriptive study if in option)
1663. RPD - Clasp functions, what affects flexibility? elongation
1664. S sound Clicking sound of teeth the cause is? insuffieceint freeway space
1665. indirect retainer function? movement of Denture away from tissue.
1666. Major connector? stability and rigidity
1667. FPD - Margins of crown not fitting properly? look for proximal contacts
1668. Patient complaining of pain after a day and cold sensitivity? Occlusal contacts high
1669. In class V amalgam preparation for an incipient lesion, the ideal internal form of the
preparation has which of the following features? Axial wall is uniformly deep into
dentin
1670. in preparing a class I cavity for dental amalgam, the dentist will diverge the mesial and
distal walls toward the occlusal surface. This divergence serve to? Prevent undermining
of marginal ridges
1671. Which of the following has the best prognosis for t/t? Tooth with a small area of
internal resorption
1672. Which is the best way to treat furcation type 2 involvement? GTR
1673. which bur is used to converge axial wall of the crown? No. 169
1674. cause and effect is not seen in? cosssectional
1675. thyiazides is associated with which ion suppliment? potassium
1676. What kind of cement to use to cement a ceramic onlay? resin cement
1677. While viewing a working length radiograph of #5, you discover another root on the
mesial shot (x-ray cone mesial). The second root seems to be distal on the mesial shot.
Which anatomic root is it? Buccal
1678. For a resin-retained FPD (Maryland Bridge) everything is necessary EXCEPT? Bevel
1679. Diabetes pt what is preferred -FPD or RPD? RPD
1680. Palate with swelling and histological feature like peudostatifiedcolumner epithelium
and no effect on underlining cortical bone what is that pleomorphic or exostosis?
pleomorphic
1681. Case of HTN take medication lisinopril what happen? orthostatic hypotension
1682. Aspirin 81mg - needs to stop during extraction if root tip and its easy to extract? No
need to stop
1683. Pt taking HTn drug, aspiring, amytriplin for what u need to consult physician? For
asprine , consult with physician, Avoid NSAIDS with ACE, Beta
1684. Good canine, restored lateral and need rpd for pm and molars on canine one side and
molars on leteral side What u not need? no need to correct canine bcz its not carious
1685. Case of 5 lower incisors and all have PFM and not good perio health. Ask what you have
to prescribe? Mouthwash without alcohol , flossing daily ? Or another mothwash that
prevent hypo-salivation? Mouthwash without alcohol
1686. Amytryplin cause? hyposalivation
1687. vermillion border, damage on lower lip. And lesion >10cm require? incisional biopsy

1688. post and core looking like what? its thick, thin, long, short , normal size? Require 2-3mm
guttapurcha under that.
1689. Amalgam rest fail why? Moisture
1690. RPD qs were about clasps, retention, stabilizing, balance they used different terms for
each...in RPD what is contraindicated with the clasp? Big amalgam, PFM or Composite
rest? Composite rest
1691. initial treatment for the patient? final treatment? most of the time the initial treatment
is SRP or medical history or prophylaxis it depends on exact question
1692. corticosteroids can cause? osteoporosis
1693. TMJ nerve affected by arthritis? Temporal branch of facial nerve
1694. Benzodizapines? GABA Decreases
1695. What is the perfect ratio of KVP and Ma for dental radiography- 65 kvp and 10 Ma, 70
KVP and 20 Ma? 70 KVP and 20 Ma
1696. hair loss? Mercury toxicity, blindness Chelation therapy
1697. What first? bleaching, 1-2week
1698. retention resistance form for Gold? Resistanceform: capping& shoeing.retention :
parallel axial walls,taper of walls
1699. Pain like pulpalgia and its after extraction? traigeminal neuralgia, pulpal pain. Pulpal
neuralgia? trigeminal neuralgia
1700. Which resorption seen in primary tooth? external, internal, replacement, inflammatory?
external
1701. Fluoride chart of which age need how much F? how much NaF need in 3 yrs of age so F?
add .5 for Sodium F (until 3 years:0.25/ 3-6yrs:0.50/above 10)
1702. GIC bond? chemical
1703. Amalgam fracture? Mositure contamination (it says fracture not failure)
1704. Systemic desensitization? exposure
1705. When microleakage in amalgam? 2 to 3 week after
1706. New restoration? apthus ulcer
1707. Which one is not reason of post operative sensitivity- cusp deformation, gap from
microbes, gap leakage and mov of fluid? gap from microbes (Because its treated tooth
so bacteria wont cause). (cusp deformation can cause in hyperocclusin)
1708. Which one is not topical delivery technique in perio- CHz, doxy gel, metro gel,
minocycline powder? minocycline powder
1709. Zoe? good seal
1710. Linear radiopaqur or lucent? Radiopaque
1711. 45 yrs female only stain on pit nd fissure? observe
1712. Damage apically and not respond to EPT? Blood supply intrupted, nerve transmission
stop? nerve transmission stop
1713. Suppuration present and tooth asymptomatic, nacrotic pulp or verticle root fracture?
necrotic pulp
1714. +ve rack angle in files or reamers? Files ( acc to cohen, negative rake in both files and
reamer, positive rake in h files so better cutting)
1715. Child tooth best reliable test- purcussion, cold, heat ,ept? Cold
1716. Necessary for a test to be accurate? validity

1717. Transperent dentin - reminralize or not? Remineralized
1718. Critical yrs for fluorosis? 6-12 (Period of tooth calcification)
1719. Highest F- tooth paste, varnish, water? Varnish (5%)
1720. Which is not cause xerostomia? opioid
1721. Shrinkage due to creep or c factor high? C factor (DD card 45 operative)
1722. Conical caries? smooth surface
1723. Middle reduction for porcelain veneer? 0.5
1724. Ideal biological width after crown lengthening - 2mm interproximal, 3mm, 1mm all
aspect, 3mm all? 3 mm all
1725. Overhange due to improper mateix or improper wedge? Improper Wedge
1726. Why more color stability in light cure? Tegma, PmMA, more nitrite? Tegma
1727. Cone wax technique? putting in sequence (1st functional cusp later nonfunctional)
1728. Apical biopsy? granuloma
1729. Depends on pt posture? VdR
1730. Class 3 Kennedy? no require indirect retainer
1731. For flexibility which clasp use? cast alloy, wroght wire, basemetal? wroght wire
1732. Amentadin for? parkinsons
1733. Palatel tori when should remove - between hard and soft palate, middle of palate,
interfere with pps? interfere with pps
1734. Cross section of mandi incisors? oval
1735. Require tray adhesion? c-sillicon
1736. Phosphate bonded temperature? above 1100c
1737. Upper part of capsule which fibers? capsular or discal? capsular
1738. If pt had difficulty in s, ch what is the problem? linguoalveolar , sibilant sounds effected
by labiolingual placement of teeth or more or less acylic on palatal side of upper
inncisors. increased overjet ot decreased overbite or improperly contoured palate,
teeth forward placed and touvhed, VDO Problem
1739. Major conmector - rigidity, support, stability, retention? Rigidity, stability
1740. Vasoconstrictor? cocaine
1741. relation between MAO and epinephrine? May cause hypertensive crisis not given
together
1742. Gout? probencide
1743. Less plaque in which dz? LAP
1744. Must read implant distances? 3mm
1745. Salio in submandi and warthons duct? True
1746. Establish stage? plasma
1747. Erythromycin and theophyline not given together? cause toxicity in COPD
1748. Which one is schedule 2? Pentobarbital
1749. Apperarances ?
ML- aeur rods
schwannoma- verocay bodies
garre osteomyelitis- onion skin
chronic osteomyelitis- moth eaten
scleroderma- purse string mouth + extrusing teeth

von recklinghausen- Cafe au lait spots; lisch spots on iris; crowe sign= axillary freckles
fibrous dysplasia- ground glass
pagets dis- cotton wool
cherubism- bilateral; soap bubble ; perivascular cuffing
multiple myeloma- punched out
burkitts lymphoma- starry sky; moth eaten
ewings sarcoma- moth eaten; onion skin
histiocytosis x- floating teeth; birbeck granule
odoyogenic myxoma- soap bubble; honeycomb
adenoid cystic ca- swiss cheese; perineural invasion
indborg tumor- leisgang rings
hsv 1 apthae- lipschutz bodies in tzank smear
lichen planus- civette bodies
plummer vinson- iron deficiency anemia; atropic
oral mucus membrane; koilonychia; easophageal web
Basal cell nevus syndr/ gorlin gotz- multiple basal cell nevi; palmar pitting;
hyperkeatosis; bifid ribs; okc in jaws
peuts jeghers- melanin pigments on lips; jejunal
1750. Thiazides if it works for or with K, Cl, Ca, Na? K
1751. After making the crown the lab didn't reduce the lingual cusp the mandible start to
deviate to the left side!! What interferences or cusps caused this movement!? Working
side interference
1752. lower pm which forceps is used? 151
1753. convergence? bur#245
1754. smoke cessation drugs? Chantix, bupropion
1755. Bacteria in healthy mouth? Strep.gorandi
1756. Which type of interleukin in most common after perio disease? IL-1
1757. Interaction of propanolol (B-blocker) with epinephrine is best described by? synergism
1758. Antipsychotic with irreversible side effect? Tradvik
1759. 72 year old women who has Alzheimer's is having a gingivitis and the husband and the
husband is the one who is taken care of her, she needs an instruction about her oral
hygiene? Doctor should go with oral hygiene instructions with her husband
1760. patient swallowed a crown which position? Trendblerg
1761. medications used for all types of epileptic? Phyontin
1762. Ferrule effect? Important for crown lengthening
1763. Classical symptom of asthma is? Wheezing on expiration
1764. Alveolar osteitis, what do you do? Dressing with sedative
1765. when should the child start to speak clearly? 5 years (if speaking problem, 8 years)
1766. overlapping? fix the horizontal angulation
1767. complications of child after taken more then 2g fluouroide? Nausea and vomiting first ,
2 gm lethal dose , lead to cardiac failure , respiratory paralysis ( in acute fl poisining )(
dd pedo )
1768. Side effect of corticosteroids? osteoporosis

1769. Main cause of Alveolar osteitis (another name of Dry Socket)? dislodged clot or
fibrinolysis
1770. how morphine cause nausea ? 1.5-2.5-year child is more prone to injuries because. a.
Due to accidental prone. b. Overprotective parent. c. Abuse. d. No fully coordinated
development? No fully co-ordinated development
1771. Minimum distance between 2 implants? 3mm
1772. Most important when selecting shade? value, translucency, chroma, hue? Value
1773. Well controlled diabetic patient has the same periodontal status as non diabetic? True
1774. Aspirin is contraindicated? asthma patient
1775. Patient is taking propranolol and you give epi and BP rises -why , and which receptor
responsible for that--A1,A2,B1,B2 ? A1
1776. Best test for patient with warfarin. INR, PT time? INR
The clotting test used to measure the effect of warfarin is the prothrombin time (called
pro time, or PT), and INR is a way of expressing the PT in a standardized way by
comparing it to a reference value. INR means PT
BUT
Here is the key to proper understanding:[ A prothrombin time (PT) is a test used to
help detect and diagnose a bleeding disorder or excessive clotting disorder; the
international normalized ratio (INR) is calculated from a PT result and is used to
monitor how well the blood-thinning medication (anticoagulant) warfarin (Coumadin®)
is working to prevent blood clots.] So INR is calculated from PT so ultimately of final
result would be INR. Hence,
For Warfarin...INR is the first choice, Next better option is PT
For Heparin...first better option is PTT ( partial thromboplastin time), Second is INR
Hemophilia, Vwb disease Heparin...PTT
Warfarin/Coumadin, alcohol...INR
Bleeding time...Aspirin
Do not confuse with this picture: Go with PT only if INR is not in option.

1777. Which is the antibiotic prophylaxis for patients with allergic to penicillin? Clindamycin
600mg
1778. What has decreased over time in adults? edentualism
1779. Referred pain to ears? mandibular molars
1780. Heart rate of 4 year old child? 110
1781. If tooth is not responsive to cold next step that u should do? extraction , root canal,
nothing, pulp test ? pulp test
1782. Drug to treat dry mouth? pilocarpine
1783. Patient is asthmatic and has ADHA and takes B2 agonist and amphetamine which drug
causes his insomnia and bad apetite? Amphetamine
1784. Which drug dose not cause gingival hyperplasia? digoxin
1785. Which structure is damaged during free gingival flap surgery taken from palate? Greater
Palatine Artery and nerve
1786. The mesiobuccal incline on the mesiobuccal cusp of mandibular molar (with stainless
steel crown) has wear this is because of movement in which direction(s) 1. working
2.non-working 3.protrusive 4. Retrusive? Working and protrusive
1787. Calcified structure xray behind mand ramus? parotid
1788. If doctor treats without cancen? Battery
1789. To increase the patient's VDO by 4mm? the dentist should make new records of CR
1790. established stage of gin? plasma cell
1791. What causes plasma cell gingivitis? Cinnamon gingivitis
1792. Class 3 on central incisor composite extends to facial. Pt concerned about esthetics.
Heavy marginal discoloration? Veneer (Because if you redo filing, it can cause stains
again)
1793. What do you do when you use calcium hydroxide for pulp capping? add glass ionomer
liner after CaOH2
1794. The reason of high pressure in pregnant women? Preeclampsia (Increase in blood flow)
1795. Premolar has apical infection and it will spread into? sublingual
1796. Most hematoma after what injection? posterior superior
1797. After IAN block patient gets infection of which space? Medial pterygoid
1798. What may lead to osteonecrosis of bone after radiation therapy? X ray mucocel in max
sinus .
1799. Pt has ulcer with inflamed gingiva, histologic exam shows detached epithelial from
basement membrane? BMMP (benign mucous membrane pemphigus)
1800. What is the most common primary occlusion, and what primary occlusion will be class ii
in permanent occlusion? distal step
1801. What may lead to osteonecrosis of bone after radiation therapy? damaged blood
supply
1802. Very short clinical crown, you prep for a metal crown and it is lacking facio-lingual
resistance. You would do? proximal and buccal groove
1803. Which of the following statements is true regarding the radiographic appearance of
furcation Involvements? Bone loss is greater than it appears on a radiograph.
1804. Hep.b surface antibody? not carrier

1805. A lot of translucency on pontic"s gingival 3rd what is the reason- wrong shade selection
or wrong metal thickness Modified pontic ? Wrong metal thickness
1806. Pt wit gag needs to take x ray ? management ? Graded exposure
1807. Fetid odor ? hyperglycemia
1808. Bone drilling tem for implant ; 29, 36, 57 , 70? 36 (Maximum temp is 47)
1809. most common congenital disease in USA? cleft lip and palate
1810. plasma cell gingivitis occur due to? cinnamon flavoring
1811. arrange periodontal treatment phases in order? emegency , initial, evaluation ,
maintainence
1812. prevalence of HSV1 in united states? 20-30% (HSV 2 is more common in USA)
1813. if there is myolohyoid ridge reduction, what changes will be seen? reduction in denture
retention
1814. radiation caries affect? cervical
1815. pit and fissure caries? cone base towards DEJ
1816. a kid bite his lower lip and next day mother noted a blue elevated lesion in lower lip?
mucocele
1817. aspirin affects? irreversably inhibit platelet
1818. asthma? expiratory wheeze
1819. warfarin affects? Inhibits factor 2, 7, 9 10
1820. most appropriate test if patient is on warfarin therapy? INR (For people
taking warfarin, most laboratories report PT results that have been adjusted to the
INR. These people should have an INR of 2.0 to 3.0 for basic "blood-thinning" needs.
For some who have a high risk of a blood clot, the INR needs to be higher - about 2.5
to 3.5)
1821. in tooth borne rpd major support for the prosthesis is provided? occlusal rests
1822. altered caste technique? support
1823. impression material that tear on taking out? polyether
1824. infant has a neonatal teeth got a ulcer in tongue? riga fede disease
1825. a survey was conducted on school children one month ago on dental caries which
study? cross sectional study (Because there was no relation between exposed and non
exposed)
1826. a diagnostic test results are not accurate but 100% consistent? reliability
1827. a 12 year old kid has a deep carious lesion on tooth no. 3, while treating there is pin
point exposure,heamorrhage can be controlled, what serves best long term results?
pulpectomy coz it was deep carious exposure
1828. epiphyseal plate is similar to? synchondrosis
1829. there is a fearful and anxious child how do you proceed the treatment initially? tell
show do
1830. xerostomia patient what is not seen? oral cancer
1831. adding water in gypsum? more expansion less strength
1832. a patient is taking iv bisphosphonates from two years, has non restorable carious tooth ,
what should be the treatment planning? stop the medication three months before
treatment then extract the tooth
1833. a test result is 95% positive, what term we use for this? Sensitivity

1834. color stabilisers for composite? Tegma
1835. funcional cusp bevel? for structural durability
1836. cavernous sinus thrombosis may result from? injury in the upper lip
1837. with age what occur? periodontitis increases
1838. LJP OCCURS? due to bacterial toxin
1839. if an implant placed at a wrong position, what should be the treatment approach? keep
the implant at same place and cover it with soft tissue (coz taking out an implant will
result in lot of bone loss)
1840. adding a complimentary color all of the following increases except? value coz value
never increses
1841. if a child (age not specified) got injury in tooth no. 8 at 2 mm apical to crown cej ( that
means coronal root) what treatment modality u will choose? splint both the parts with
non rigid splints and observe (coz age is not specified and by seeing its coronal root
fracture so may be extraction but again do we extract front tooth)
1842. elimination of drug after its glomerular filtration depends upon? its ionic state
1843. healing after flap procedures is by? long junctional epithelium
1844. how do you identify root caries? softness
1845. best restorative material for posterior tooth root caries? GIC (DD says gic is a best
restorative material for root caries)
1846. a patient is getting recurrent ulcers in mouth that heal spontaneouly , it is aphthous
ulcer? BECHETS SYNDROME
1847. property of a material withstand stress before fracture point? ultimate tensile strength
1848. A patient is taking beta 2 agonist for asthma and his symptoms are not relieving, what is
second choice of drug? corticosteroid
1849. what should be the main concern in placing an implant in maxillary first premolar
region? space available
1850. major source of scattered radiation for dentist is from? patient
1851. trisomy 21 patient have? mid face deficiency
1852. a deaf patient , how do you manage the child? speak and ask everything from care
giver
1853. autism patient characerstic? repetitive behaviour
1854. if a patient is taking chantix what else need to be included in his smoking quitting
regimen? behavioural counselling
1855. medication in GERD? cemitidine
1856. if patient has ketone breath and fainting this is due to? hypoglycemea, (coz patient
might have taken insulin)
1857. EPA regulation of fluoride? 4 ppm
1858. A patient is unable to swallow this is due to paralysis of which nerve? Glossophayngeal
1859. most important aspect in mandibular denture? stability
1860. Which immunoglobulin is concentrated in gingival clevicular fluid? IgG
1861. Which of the following does NOT present itself in the form of Macroglossia?
Hypoparathyroidism
1862. Working interference? which cusps occlude where in working interference? BULL rule

inferiorly and x-ray direction superiorly which way will the canal appear to move? Apical
1864. Informed consent can have all of the following EXCEPT? Informed consent must contain
treatment options
1865. Which of the following shows the best way of active listening? Active eye contact
1866. Patient complains, “Why do I have to stay here for so long for you to do this, why can’t
you finish it already?” It seems you are upset, what are your concerns about the
procedure we’re doing today
1867. Type – I error, gave the test result value of 0.01 and the researchers rejected the null
hypothesis, what kind of error? Type – I
1868. Patient says, “My teeth hurt when I brush them”, what is an appropriate response?
along the lines of oral hygiene instructions
effective way to make sure they follow the cleaning regimen? Give them limited praise
with good progress at each appointment.
1871. Amalgam failure? Cavity prep problem
1872. What do we write the consult for? To gain clearance
1873. Child starts throwing fits? Voice control
1874. Disabled kid, best measure? Consistency
1875. Unstimulated Salivary flow rate in an adult? 0.1ml/ min
1876. Stimulated Salivary flow rate in an adult? 1L/day
1877. Fluoride ppm in community water, average value? 1.0
1878. Fluoride next to tooth? 4 minutes
1879. Implant to implant? 3mm
1880. Best Amalgam? High copper admix & spherical
1881. Most common gland involved in salivary gland tumors? Parotid
1882. Middle-aged male has a fluctuant mass in the midline of neck? Thyroglossal duct cyst
1883. what do you need for caries? Bacteria, supporting carbs and a susceptible tooth
1884. What else do S. mutans produce along with dextran after breaking down sucrose?
levans
1885. Most common TMJ ankyloses caused by? Trauma
1886. Histo differentiation involves which of the following? Amelogenesis and dentinogenesis
1887. Blue sclera? Osteogenesisimperfecta
1888. Cleidocranial dysplasia characteristic? supernumerary teeth
1889. Ectodermal dysplasia? oligodontia
1890. Ectodermal dysplasia? scarce hair
1891. Patient smokes pipe and has red bumps on palate? Nicotine stomatitis
1892. Pseudoepithilomatous hyperplasia a characteristic of? SCC

1893. 85 yr old elderly patient’s son brings the consent form that has name of the legal
guardian, what needs to be done before treatment? Contact the legal guardian who
has the power of attorney to get consent of treatment
1894. Nerve involved in Bell’s palsy? VII
1895. 4 mm implant, how much do you need buccolingually? 6mm (1mm on each side)
1896. Mandibular 3rd molar root lost? submandibular space
1897. IAN block needle infection where? Pterygoid
1898. Arch discrepancy after loss of which tooth? Mand Canine (if not in option, go with
Mandi 2nd molar)
1899. Always requires extractions if Arch space discrepancy is more than? 10 mm (if they ask
quadrant, it would be 5 mm)
1900. Which of the following is clinical sign of Leukemia? Bleeding from gums
1901. The research concludes that patients who use chlorhexidine have better oral health
than those who do not, however, other researchers say there is not much difference in
oral environment of those who use chlorhexidine or not? Double Blind
1902. High school kids have? Marginal gingivitis
1903. Cardiac arrest in children? Respiratory depression
1904. Veneer facial reduction? 0.5mm
1905. PFM buccal margin depth? 1.3-1.5mm
1906. Patient comes back after 1 year of composite restoration with pain and sensitivity?
Microleakage
1907. Kid has occlusal caries on posterior molar which material will you use to restore?
Amalgam
1908. Endo and Perio diff? Pulp vitality test
1909. Endo and Periotx? Endo first followed by Perio
1910. Acromegaly causes? Excessive growth of mandible
1911. Radiograph to check integrity of Zygomatic arch? CT
1912. TMJ radiograph? MRI
1913. MRI is used to view? disc of TMJ
1914. Behcet’s syndrome associated with? Aphthous ulcers
1915. Mechanical damage to teeth? Abfraction
1916. Chemical damage to teeth? Erosion
1917. Bradycardia treatment? Atropine
1918. Which is NOT used to inhibit salivary secretion? Pilocarpine
1919. Which is contraindicated in nitrous? nasal congestion
1920. Target lesions? Erythema multiform
1921. Which of the following confirms the diagnosis of xerostomia? location of anterior
restorations. (A because chemotherapy causes xerostomia which leads to class V
lesions)
1922. Over titration of Amalgam leads to? reduced working time
1923. Buccal limit of mandibular denture? Masseter

1924. Lingual limit of mandibular denture? mylohyoid, genioglossus, palatoglossal and
superiorconstrictor.
1925. mandibular denture case, the efficient way of increasing retention of the denture? this
patient had partial denture with only molars, denture flanges looked pretty short of the
vestibule on both sides and she was tight on money? extending the buccal shelves into
the vestibules a bit more (because the denture flanges looked pretty short of the
vestibule on both sides. There can be option for implant too but patient’s financial
concern.)
1926. Cavernous thrombosis infection? anterior triangle
1927. To anesthetize anterior teeth, which other injection would you have to administer on
top of nasopalatine nerve block? ASA nerve block
1928. Tooth mostly involved in perio relapse? Max 1st molar (due to trifurcation)
1929. Premolar with 3 roots? Max 1st
1930. Which of the following is NOT true about vertical root fracture? Extraction of the tooth
is usually the only treatment for it
1931. What’s the status of pulp when the pain goes away quickly following the removal of
stimulus? normal
1932. Fluoride form for kids under 3yrs of age? drops
1933. Best place for implant? lower anterior
1934. Warfarin and Coumadin test? international normalized ratio
1935. Oral hairy leukoplakia? filiform
1936. Best solution to keep avulsed tooth in? hank’s
1937. Treatment for flared out front teeth of 7yr old? No treatment because of ugly duckling
phase
1938. flared out anteriors. what Class? Class II division I
1939. Opioids affect? Chemotactic center
1940. Alkylating anticancer drug’s side effect? bone marrow suppression
1941. Ginseng contraindicated for? salicyclic acid
1942. Side effect of Zoloft? salivary hypofunction
1943. Pseudomembranous colitis? Clindamycin usage
1944. Therapeutic effect? Safety
1945. Which is False about medications taken parenterally? They are very reliable
1946. Lack of indirect retainer? will result in denture being lifted away from tissue when
pressed on one side
1947. Tuberosity hitting retromolar pad? surgery on tuberosity
1948. Why not use fovea as indicator for posterior limit? because you don’t want to block the
minor salivary glands since fovea represents openings to those minor glands
1949. When to remove the palatal torus? when it covers posterior palatal seal
palatal area. What will be the best course of action? Use horseshoe design to avoid the
torus

1951. Most common gland for sialolith? Submandibular
1952. Most common salivary gland tumor? Pleomorphic
1953. Gingival graft contraindicated when? pocket is below the alveolar crest
1954. Patient swallowed a crown where is it most likely for it to end up? right bronchus
1955. Graft between same species but genetically different individual? Allograft
1956. Anesthetic that is vasoconstrictor? Cocaine
1957. Cross allergy for anesthetics? esters and amides
1958. Which anesthetic is good without vasoconstrictor? Mepvicaine
Prognosis? RPD with pontic for #11
1960. Rifampin used for? tuberculosis
1961. Penicillin moa? transpeptidase
1962. Manic depression? lithium
1963. Parkinson’s? lack of dopamine
1964. Lidocaine? Ventricular arrhythmia
1965. Oral contraceptives failure? Rifampin
1966. Aplastic Anemia? Chloramphenicol
1967. Bone penetration, which drug? Clindamycin
1968. Grand mal seizure? Phenytoin
1969. ADA recognizes as dental specialty? dental public health
1970. Informed consent? Autonomy
1971. Improvement after Endo treatment is most likey after? 1 year
1972. Telling patient about risks and benefits of a treatment is a part of? Autonomy
1973. which antibiotic work on gingiva? azithromycin
1974. automated defibrilator, how does it work? discharge when needed
1975. which bacteria causes elastenase, collagenase? P Gingivalis (select Pseudomonas
aeruginosa if in option)
1976. 15 year old has fever, malaise, vesicles,lymphadenopathy? acute herpetic
gingivostomatis
1977. necrotisizing sialometaplasia? No treatment after biopsy, heals in 6-10 weeks, occurs in
palate
1978. porosity in pfm? Less Condensation
1979. cancer of salivary glands and which one has perineurial invasion? Adenoid cystic
carcinoma
1980. fracture also with paresthesia? angle of mandible
1981. xesrostomia and normal flow rate? 0.5 ml/min
1982. osteoradionecorosis? hyperbaric oxygen
1983. Lateral periodontal abscess is best differentiated from the acute apical abscess by? pulp
test
1984. What will not regenerate after rct? dentin formation
1985. 3 partner dentist and hygienist hurts patient who involved in a low suit? only dentist

1986. How long after extraction you insert the complete denture? 8 weeks
1987. Which one is more affect in male? hemophilia
1988. Where does the epithelial for a graft come from? donor connective tissue
1989. Macroglossia not found in? hyperparathiroidism
1990. painless lesion, bone expansion, ground glass appearance? fibrous displasia
1991. most supernumerary located in the? ant max
1992. Cleidocraniodysplasia? supernumerary
1993. plasma cell disorders? multiple myeloma
1994. Which situation least require insulin? Trauma
1995. Herpangina is caused by? enterovirus
1996. Material least resistant? high leucite
1997. Which anethetic without vasoconstrictor is best to use? mepivacaine
1998. Do not use in myasthenia gravis? imipinem
1999. Broadest spectrum antibiotics? pen g procaine
2000. most common found? odontoma
2001. Smoothest cutting but not efficient? carbide bur
2002. Nitrous oxide side effect? nausea
2003. Pt with many sinus fistula? actinomycosis
2004. Wheezing during expiration? asthma
2007. Anterior guidance? both horizontal and vertical
2008. Wear facet in primary dentition why? Nail Biting
2009. garre osteomyelitis? onion skin
2010. chronic osteomyelitis? moth eaten
2011. scleroderma? purse string mouth + extrusing teeth
2012. von Recklinghausen? Cafe au lait spots; lisch spots on iris; crowe sign= axillary freckles
2013. fibrous dysplasia? ground glass
2014. pagets dis? cotton wool
2015. cherubism? bilateral; soap bubble ; perivascular cuffing
2016. multiple myeloma? punched out
2017. how many percent have access to fl community water? 70
2018. MOA of sulfanamid? Inhibite PABA
2019. MAO of sulfonylurea? Stimulate beta celss and increase insulin sensitivity
2020. which one is class 2? Percocet
2022. which is correct about conjugation? adding a molecule to the drug
2023. which of these cognitive behavior decrease in a normal process of aging? learning
2024. Analog (definition)? Replica of implant for lab purpose
2025. Distance between implants? 3mm
2026. Taurodentism? Bullous tooth, large pulp horn (its also a type of hipomature and
hypoplastic autosomal dominant amelogenesis imperfect as per first aid)
2027. Clinical trial? Experimental study done after etiology is found to test possible
treatment

2028. Hazard communication paper identify which institutions created it? (OSHA)
2029. identify what materials are named hazardous? EPA for outside hazards and OSHA for
inside
2030. Chemical sterilization? Gluteraldehyde
2031. Informedconsent? autonomy
2032. Veracity? To be truthful
2033. Radio resistant cells? Muscle and nerve cell | Post mitotic cell
2034. Cherubism? Moon face bilateral jaw expansion
2035. Ectodermal dysplasia, anhidrosis (no sweat glands) and Hypothricosis (decrease in hair)?
X linked male more affected, oligodontia or hypodontia, conical shaped teeth
2036. Most common side effect of nitrous oxide? Nausea
2038. A child 16 kg how much LA? 72
2039. Ludwing angina? Sub mandi, sub lingual, sub menal, Penicillin, metronidazole,
clindamycin, and ciprofloxacin are often the antibiotics of choice. Streph and staph
causes it
2040. Patient in dialysis do dental treatment? ( day after, day before, day of dialysis)? Day
after
2041. Suppression of cortisol (20mg, 200 mg, 10mg, 1mg for 2 weeks in 2 years)? 20mg for 2
weeks in 2 years
2042. The more common site of caries? Pit and fissure
2043. Arthroscopy? steroid injections, disc manipulations
2044. Gardner syndrome? Intestinal polyp, supernumery
2045. Indirect rest instead amalgam to get better? For ideal contour
2046. More common PSICHIATRIC pathology in older? depression
2047. Vertically face divided? 3
2048. Penumbra? Penumbra is lack of sharpness of the film. It is a fuzzy, unclear area that
surrounds a radiographic image and is affected by focal spot size(smaller the better),
film composition(larger the size of crystals less sharp the image), and movement
during the exposure.
2049. Osteomyelitis? Staph -- infection from in to out -- radiolucent--- pain after ext -- pen v
I. V
2050. Patient said “I don’t have time to quick smoking? precontempation
2051. Most crucial in replantation after avulsion? time
2052. Harder area to floss? mesial of first pm
2053. Pka has effect on? Onset
2054. Which is not radiopaque? AOT
2055. Least likely to recur? AOT (Most-okc)
2056. Anticancer drug with effect in acid folic? Methotrexate
2057. RPI I bar fracture what do you do? Splint
2058. Brown tumors? Hyperparathyroidism
2059. Macroglosia is not common in? Hyperparathyroidism
2060. Clean tongue to prevent? Odor

2061. neurofromatosis What do you not see? Café au lait, lisch nodules of the iris, super
numerary are SEEN
2062. Retentive claps? Infrabulge
2063. Initial treatment of LAP? antibiotics+ SRP
2064. Lefort 1? maxillary sinus
2065. Apexogenesis? Vital tooth
2066. Apexification? Nonvital tooth
2067. Treatment of ranula? Excise
2068. Liquid in Glass ionomer? Polyacrylic acid
2069. Source of epithelium for grafts? iliac
2070. Half erupted third molar in a 18 years old patient, WHY do you extract that molar? to
avoid chronic pericoronaritis, because thirds molars can produce crowding in anterior
2071. Tooth with crown best pulpal test? Cold
2072. Nsaid who does not affect palettes? Celecoxib/acetaminophen
2073. Multiple Myeloma first sign? Bone pain
2074. Melanoma common localization? Palate and gingiva
2075. Reciprocal anchorage? Cross elastic, used for closure of midline diastema
2076. PM with 3 canals? Maxillary 1st PM
2077. Disadvantage of partial thickness flap? Thin flap so can be teared easily
2078. Most stable in moisture? PVS
2079. More common reason of amalgam fracture? Water contamination
2080. Antibiotic seen in GCF? Azithromycine
2081. Gingivectomywhere to do incision? Base of the pocket, external bevel
2082. Perio maintenance interval? 3 months
2083. True about Niti over stainless steel? Flexible, cannot stand in canal , memory , less
breakage, curved canals , shows wear signs before breaking Intrapulpal anesthesia
2084. Supernumerary teeth seen in? Gardner, down, cledocranial dysplasia
2085. Treatment without consent? Battary
2086. Least probable canal ledges ( short, small, large, curved)? Short
2087. Med who increase cardiac output (beta blockers, alpha, ace)? Beta blocker
2088. Wheezing seen in ( asthma, COPD)? Asthma
2089. Common between Aspirin and acetaminophen? Antipyretic, analgesic
2090. Montelukast Moa? Bronchodilator
2091. Culture of sensitivity used to? Describe antibiotic, bact resistant
2092. 3 years old with 5 mm intrusion? Let it erupt (here age and exact question has to be
focused. Because extraction can also go right with it)
2093. Ignoring a patient bad behavior? Extinction
2094. #8 with radiolucency increase in size for all of the following except? apical scar
2095. More common cells in cellulitis? Leukocytosis
2096. Most common tooth lost due to periodontitis? Max 1st molar
2097. Pathology with early teeth lost? Papillion-Lefevre syndrome, Chediak-Higashi
syndrome, hypophosphatasia, neutropenia, leukemia and in some cases Langerhans
cell histiocytosis
2098. Epinephrine avoid in? multiple sclerosis, hypertension

2099. Side effect of albuterol? Xerostomia
2100. Dental lamina (2, 6, 8, 12 weeks)? 6th week
2101. Best bone to implant located in? D1, type 1
2102. Repair of veneer? Micro etch etch salinate bond
2103. Cause of mucocele? Trauma
2104. Pulp necrosis what type of resorption? inflammatory
2105. K sparing drugs? Eplerenone (Inspra), Spironolactone (Aldactone), Triamterene
(Dyrenium)
2106. Patient with SCC and he said something like “Are you saying that I have cancer? How do
you respond? This has better prognosis than others cancers.
2107. Common salivary gland tumor? pleomorphic adenoma or mixed
2108. Properties of Zinzpolycarboxilate, and other with GIC? Polyacrylic acid with GIC
2109. Staffne cyst? Deperssion of mandible on lingual side, Static, pseudo
2110. Nystatin Moa? Bind to ergosterol
2111. Primary teeth who resemble mandibular first molar? Perm Mandi molar 2
2112. What to use with disable kid? consistency
2113. Patient with bradycardia what to give him? atropine
2114. more cost effective fluoride treatment? Community fluoridation
2115. Incisal guidance? Vertical and horizontal overlap
2116. Nsaid preferred for kids? Acetaminophen
2117. Nsaid who does not affect platelets? Difluzole
2118. Index of caries? DMFT
2119. Allograft concept? Freezed, dried, osteoconductive. from cadaver of same species in
form of DFBDA (osteogenic because of Bone Morphogenic Proteins) or FDBA
(osteoconductive) Mosby pg 277
2120. Which is not used in cast restauration? Irreversible impression material
2121. Anug? punched out papilla, Tx: antibiotic (metro), ohi, sc
2122. Belladone alkaloids ( contraindications)? Anticholinergic MI
2123. Stridor seen in? Laryngeospasm
2124. Efficacy concept? Intrinsic effect
2125. More common in men? hemophilia
2126. What is not a benefit of ¾ crown one a Full crown? Placement time
2127. Alveolar osteitis treatment? Anelgesic, sedative dressing, no antibiotic
2128. Treatment contraindicated in trough trough furcation? GTR
2129. Least effective reducing interproximal plaque? Water pick
2130. Morphine side effects? respiratory depression, constipation, dysphoria, miosis, coma
2131. Most common reason of cardiac arrests in children? Respiratory failure
2132. Bur used to polish porcelain? Diamond (Carbide for cutting)
2133. After scaling and root planning, pockets still persist? go ahead with perio surgery
2134. Low contrast? exposure time
2135. Disadvantages of split thickness flap- know the advantages and disadv of all flaps? Split
thickness flap- comprises of C.T. and epithelium without the periosteum
2136. Epithelium comes from? the donor site
2137. Vertical Releasing Incisions use? Displaced flap

2138. Retentive clasps? junction of the cervical and middle third
2139. Allergic to penicillin, antibiotic of choice? Tetracycline 500mg (Pay attention to the
drug and the dosage. Clindamycin is usually the drug of choice in penicillin allergy
cases but the dosage for clinda is 600 mg not 500.)
2140. Dexterity? flossing problem
2141. Lower incisor eruption time? 5 to 7 months
2142. Everything is true about Cross-sectional studies except? ‘no cause and effect’
2143. External oblique ridge- Mandibular molars? interferes with FGG
2144. Which causes GI bleeding/ all cause GI bleeding except? celecoxib, naproxen, ketorolac
2145. Distraction osteogenesis v/s BSSO? Injury to IAN is the disadvantage of BSSA
2146. FDA phase 3? to find the effective dose of the drug
2147. Perio v/s endo abscess? pulp testing
2148. Night pain is characteristic of- pulp necrosis, symp? symp.irr. pulpitis
2149. Fluconazole? mucocutaneous and systemic
2150. Drugs causing xeristomia causes? Parasympathetic cholinergic
2151. Opaque porcelain function? to decrease contamination of additional porcelain with
metal in ensuing firing and baking procedures
2152. Methotrexate? anti cancer drug
2153. 3mm crowding- what would you do? Nothing
2154. Human subjects research? always take permission and signature
2155. Gunshot wounds? Bone grafts/ Secondary healing
2156. Crouzon syndrome? Class 3 (Underdevelpped maxilla)
2157. Ectodermal dysplasia? Conical tooth, anodontia or hypodontia, nail and sweat gland
affected
2158. Treacher Collins syndrome? Hearing loss. (It is an autosomal dominant congenital
disorder characterized by craniofacial deformities, involving ears, eyes and
cheekbones and goes along with normal intelligence.The typical physical features
include downward-slanting eyes, micrognathia (a small lower jaw), conductive hearing
loss, underdeveloped zygoma, drooping part of the lateral lower eyelids, and
malformed or absent ears)
2159. If hit below the eye? inability to look upward
2160. Lefort 1? Maxillary sinus
2161. Common complication of maxillary extractions? sinus opening
2162. Interproximal caries seen on? PA, pano, bitewing, occlusal? bitewing
2163. The spacer in wax pattern should be placed at? Right angle
2164. CD and RPD in same patient for wax rim why would u bevel anterior part of wax rim?
not enough interocclusal space but enough for esthetic
2165. Verrucous CA? smokeless tobacco
2166. Melasma most commonly seen in? pregnancy
2167. Most commonly associated with trisomy 21? down
2168. Flame shaped radiolucency above an unerupted third molar? chronic pericoronitis
2169. Bradycardia seen in? hypothyroidism
2170. Thomas and chess- classification of kids? easy, difficult and slow to warm up kids
2171. Nitroglycerin adverse effects? Tachycardia

2172. Leukemia? bleeding gums
2173. Low contrast? kvp
2174. Which doesn’t recur? AOT
2175. Radiolucency? Ameloblastic fibroma
2176. HIV? not to give antifungal therpy
2177. Composite? radiopaque
2178. Class 5? GIC
2179. Pain on buccal cusp not palatal? vertical root fracture
2180. Vertical root fracture most commonly seen on which teeth? mandibular molars
2181. Trephination? pus is trapped within bone
drainage through bone as emergency when theres acute pain of abscess and couldn’t
do drainage thru canal or soft tissue ( not soft tissue swelling) And there is also
apical trephination when u insert a file beyond working length to attempt draining an
abscess thru the canal Usually if apical trephination fails and no soft tissue swelling the
next option would be trephination thru bone.
2182. Purpose of Hex in implants? antirotation
2183. Most common type of caries seen in kids? Anterior facial and posterior interproximal
2184. non working side interference? LUBL
2185. Beclomethasone uses? is inhalational steriod used as inhaler in asthma prevention
2186. Doxycyline read its uses? Doxycycline: in Dentistry: prevent further breakdown of
periodontal tissues by blocking collagenase Other uses: sinusitis, acne, anti malaria, its
broad spectrum so i guess there are a lot of infections to treat
2187. reverse smile? pt chin upward
2188. Antidot for benzo is? flumazinel
2189. Cocaine? vasoconstrictor
2190. Most common type of caries in primary first molar is? Proximal surface below the
contact point
2191. beclomethasone: popular inhaled corticosteroid used for the treatment of asthma can
cause? candidiasis.
2192. Opiod side effect? Miosis
2193. Ch perio most common in? African American
2194. Mepivacaine indication? any condition where epi is contraindicated and if pt is allergic
to metabisulfate
2195. percussion used for? sypmptomatic apical periodontitis
2196. Benzoyl peroxide initiator? self cure
2197. Caoh indications? Primary, direct pulp caping
2198. patient had electric pain after restoration? galvanic shock
2199. Recession? apical positioning flap

2200. Interaction between nitroglycerin and epinephrine is what type of antagonism?
Physiologic
2201. Color stability in light cure? tegdma
2202. Composite class 2 restoration maintained by? extent till caries
2203. Rubber dam leakage? holes placed too close
2204. Rest thickness at margin-0.5/1.5 or 1mm? 1.5 mm
2205. What distunguish myocardial infarction from angina? thrombosis
2206. Occlusal adjustments after composite restoration or amalgam green stone, diamond
bur, steel bur or carbide bur? Diamond
2207. Sodium hypochlorite doesn't? chelates
2208. Sodium hypo? dissolves necrotic tissues
2209. Pt. wd radiation therapy effects? carcinogenisis
2210. Pt. has white spot on cervical area of tooth, what is the treatment? no treatment
2211. reverse smile? pt chin upward
2212. Lithium? bipolar
2213. Elongation of which papillae? hairy tongue
behaviour into routine check ups instead of emergency visits only by dentist Except?

positive reinforcement, operant conditioning, educate the patient, give him knowledge
regarding oral hygiene maintaince? positive reinforcement
2215. Lithium? physicotic stage of Bipolar (maniac phase)
2216. 8 years old, cross bite. Lateral incisors did not erupt. When tx? Immediatle (springs)
2217. Flumazenil ? Benzo
2218. Most ankylosis? Primary mand SECOND molar
2219. Most dry socket (alveolar osteitis)? Not associated with infection. 3-4 days after exo.
MOST COMMOM is on Mand molar (usually third). DO NOT curate to induce bleeding.
PVS and latex interaction – The SULFUR in latex glove will RETARD the setting time
(THE FERRIC and ALLIMINIUM SULFATE retraction solution cord) . Also temperature
sensitivy (increased temp, shorten working time).
2220. Scavengers? hydrogen gas release
2221. Major connector function? RIDIDITY and support (distribute vertical forces)
2222. Reciprocal arm? direct retainer, located suprabulge(STABILIZATION, resistance to
horizontal forces)
2223. Primary areas for support MAXILLA? Horizontal portion of hard palate; Max tuberosity.
Second would be residual alveolar ridge.
2224. MANDIBLE? Buccal shelf and residual ridge
2225. Width of palatal strap? should not be less than 8mm
2226. Anterior table of articulator? ‘’incisal guide table’’, maintain incisal guide angle (fixed
and not customized). Upper surface is concave.
2227. Pointer in facabow? orient the facebow assembly to a anatomical reference point
(lowest margimofORBITAL rim and Nasion). Facebow records the SPATIAL relationship
of Max arch to some anatomic reference point and then transfer it to the articulator.
2228. How to compensate PROTUSION in articulator? slide forward 5-8 mm. Record the
interocclusal relationship in protrusive (slide 6mm from CR), On the articulator set it at
0 inclination and place the record on MAND post teeth and after that seat the max
cast into record and adjust the condylar guidance.
2229. Lesion on tongue? ECTOPIC THYROID (from thyroid dysgenesis). Base of the tongue
(posterior to foramen Cecum)
2230. Albuterol? tx of asthma. b2 agonist.
2231. cross sectional? observational, non experimental.evatualte 2 groups at the same time.
different from longitudinal study that evaluate one group over a extended period of
time
2232. not give in asthma? nsaid (ibuprofen, aspirn); beta blockers
2233. how to treat asthma? the emergency drug is salbutamol, oxygen (in acute asthma
attack). if the patient is unresponsive (and tried 3x salbutamol – epinephrine) we can
assess the stage by history: mild, use beta agonist inhalors / moderate, beta inhalors
and corticosteroid inhalors / severe-oral cortico, or has been hospitalized.
2234. heart rate in child? 110
0 to 3 months: 143 beats/min (ranging from 107 to 181 beats/min)
3 to 6 months: 140 beats/min (104 to 175 beats/min)

18 months to 24 months: 116 beats/min (82 to 149 beats/min)
2 to 3 years: 110 beats/min (76 to 142 beats/min)
15 to 18 years: 73 beats/min (43 to 104 beats/min
2235. pain med in patient with apnea? cannot give opiod. may be nsaid
2236. disadvantage of no2? nitrous oxide is expensive to buy and to transport. it must be
used in conjunction with more potent anaesthetics and muscle relaxants to produce a
state of full surgical anaesthesia.
2237. unilateral class 2? early exo of a
2238. 0.1% chlorexidine, what for? prevent interproximal caries
2239. Gtr? rgenerate the periodontum, used in 3 wall infrabony defect, ckass 2 furcation.
promotes growth of endthelial cells, osteoblast, cementoblast. not epithelial cells.
coronal movement of pdl.
2240. anxyolitic for pregnant/ breast feeding? promethazine (first generation anti histaminic)
2241. don’t give benzo but? serotonin agonist (buspirone)
2242. chronic perio prevalence? african american
2243. most commom anomaly ? black
2244. dmft for what study? community trials
2245. pain med for liver toxicity? oxycodone / bleeding problems - acetaminophen
2246. ginseng not with aspirin? bleeding
2247. alcoholic patient med? naproxen / hydrcodone
2248. mode? most frequent measurement in a set of data
2249. prevalence? cross sectional
2250. when use laser in perio? sulculardebridment
2251. internal part of implant? the extention is part of abutment that fits in the implant.
cointain the antirotatioanal element
2252. short molar, how to get extra retention? grooves on b and l
2253. to increase retention in short crown? ¾ crown with grooves on proximal
2254. x ray for max sinus? waters
2255. filters for? absorb not useful xray (long length), reducing the patient dosage
2256. ian accessory nerve, causing pain? mylohyoid nerve
2257. target? tungstain
2258. green stain on gingival margin pfm? cooper turn the cervical 1/3 greeen. silver would
be the entire crown.
2259. fluoride to use to prevent veneer staining? naf
2260. tx for localized aggressive periodontitis ? non-surgical therapy with systemic antibiotics
2261. tx for perion with calculus in smoker patient? debridment, oral hygiene, tabacco
cessation

2262. mand 32, irreversible pulpitis, what is the least important? canal calcification, curved
roots, difficulty with anesthesia, inclination of tooth? Canal Calcification
2263. white lesion floor of the mouth, could be all except? scc, verrucous carcinoma,
leukoplakia, nicotitis stomatitis? nicotitis stomatitis
2264. how to treat? the diagnosis is normally made based upon the clinical appearance and
history. tissue biopsy is not usually indicated unless there are areas of ulceration or
localized erythroplakia (red patches)
2265. rpd clasp breakage due to what? Work hardnening
2266. which is more hydrophillic pvs or poly ether? Polyether
2267. face division (vertical2/3rd)? 3
2268. disease more common in men ? haemophilia
2269. relation between incisal guidace and condylar guidance? incisal guidace is equal and
condylar guidance
2270. which has poorest prognosis? adenoid cystic or plga salivary gland or mucoepi? plga
salivary gland tumor
2271. what comes before plaque or pellicle or biofilm? Pellicle
2272. deepest part of occlusal rest for rpd? Central fossa (its asking for deepest point which
is central foss acc to decks)
2273. which one in wax try in for complete denture? Esthetic
2274. cleidocranial as to what it affects? clavicles
2275. questions on modellling technique in pt mngmt? pt made to observe his cousins or
friends behaviour to improve his own
2276. slob ( if the buccal root of the maxi first pm is distal to its palatal root what direction has
the tube head moved to )? Mesial
2277. distal extension of mandi cd lateral limit influenced by? masseter
2278. key feature of the custo tray during final impression is? its under extension
2279. class two drug? percocet
2280. cognitive behaviour that decreases with aging? learning
2281. absolute contra of papoose straps? a co-operative patient
2282. common complication of maxi extractions and with mandi extractions? infection
2283. what sound is affected if incisors are placed too far superiorly and ant? F and v
2284. best ( conservative ) method to close a 1 MM non patho diastema in a young adult is?
composite
2285. if a patient doesn’t have 3rd molars how many furcations will he have in mxi arch? to
make the calculation simple there are three furcations for maxi teeth mesial distal and
buccal rest is simple calculation
2286. most common site for mandi fracture? Condyle (Lease common - Coronoid Process)
2287. complication with distraction osteogenesis nerve damage? Damage to IAN
2288. implant anologue used to replicate the position of implant on the implant platform? if
its used for impressions? nope that’s impression copings
2289. distance from the ant loop and the implant which is? 5mm
2290. during ianb bleeding is caused due to puncture into which artery? IAN
2291. the incision for int bevel in which directio is it directed? Reverse bevel (internal) – axial
towards bone. (Cl – 3 bevel – occlusal bevel & gingival butt joint)

2292. for gingivectomy where is the incision directed? In gingivectomy, you do not do
internal bevel incision
2293. why do we remove bone during modified widman flap? Used to expose root (It Doesn’t
remove perio pocket it just removes pocket lining)
2294. which type of comp are used for posterior comp and for repairing small occlusal defects
(micro, mid, macro, etc )? Macro filled - Posterior composite, Midi -small occlusal
deffects
2295. why don’t we do posterior comp? Coz it is technique sensitive. Other reasons include,
Contamination and Shrinkage
2296. dentist does a comp but shade is too light what is the most conservative mngmt? tint
and not redo the entire restoration because they have used the wor conservative and
margins are sealed
2297. chisel cuts what? Enamel
2298. mucormycosis is seen with? uncontrolled diabetes
2299. what drug for mild cases, what drug for sever cases or htn emergency? Chlorothiazide
as a diuretics for mild cases and Guanethidine for severe cases. (Mild- b blockers and
thiazides, Moderate ace inhibitors and alpha blockers, Severe- neuronal depletion
agents)
2300. what not to give in copd emergency mnmgt? Oxygen or a potent bronchodilator along
whith o2? oxygen
2301. montelukast and zakirlucast what type of drugs? Blocks the effect of leukotriene. It’s a
mast cell stabilizer
2302. effect of age on biotransformation of the drug. during drug Biotransformation, what is
drug mostly fate? become more ionized and less lipid soluble
2303. what property of a cement is not affected by water to powder ratio options were
solubility, consistency, thickness, etc? Solubility
Solubility unaffected as it is wetting of powder particles which initiates chemical
polymerization
2304. what would one prefer distal rest or mesial rest? always go for mesial rest
2305. sulcular depth req for lingual bar? 7mm is the depth of sulcus u need. (4mm is vertical
height as per DD 147)
2306. most rigid type of maxi major connector? Anterior post palatal bar and least rigid is
horshoe type design
2307. migrane with how the triptans work? it is the most commonly used migraine
medications, It called as seotonin 1 receptor agonists. 5HT1B and 5HT1D receptors
located on extracerebral and in cranial blood vessels. tiptans will cause cranial vessels
constriction and reduced transmission in trigeminal nerve
2308. Prevention of migraine the following drugs are used except? Succinyl choline
2309. To control the migraine attack which of the following drugs will be given? Ergotamine
2310. pt with symptoms of headache fatigue, fever and vison loss? temporal arteritis
2311. supernumerary teeth with intestinal polps and osteomas? gardners syndrome
2312. unstimulated flow from? submandibular salivary gland
If its stimulated, answer would be Paritod. In the clinic, the saliva secreted at rest is
often called ‘‘unstimulated secretion,’’despite the involvement of nervous activity. With

respect to stimulated secretion, the parotid contribution becomes more dominant: in
response to strong stimuli, such as citric acid, the flow rate is about equal to that from
the submandibular gland, whereas in response to chewing, the flow rate is twice as high
as that from the submandibular gland.
2313. ant flabby tissue under maxi cd and mandi ant natural teeth? combination syndrome
2314. sign of kidney failure which will levels will shoot the earliest blood uric acid, creatinine,
creatinine phosphokinase, urea, etc? Creatinine
2315. commonly used nsaid in kids is? Ibuprofen (best is acetaminophen)
2316. acetaminophen acts on temp centre in hypothalamus thus causing its? anti pyretic
effect (Do not confuse with prostaglandins)
2317. advantage of led light cure with respect to halogen? Curing depth
2318. what is the first stage of hiv infection? asymptomatic phase
2319. denture considerations in patients with diabetes? Arch shape
use porcelain teeth, arch shape should be narrow, imp with non pressure tech rest of
the points are given in deck
2320. opg with a radio lucency extending from post mand to ant? okc (confusing option can
be ameloblastoma , but ameloblastoma spreads labiolingually rather than ant post)
2321. pano with radiolucency seen with unerrupted tooth? dentigerous cyst
2322. cause of orn (osteoradionecrosis)? bisphos and 42 gy? bisphos (as 42 gy is susceptible
and more than 60 gy means he has high chances but bisphos is like the principal cause
that’s y it was called bronj but now they have changed it to mronj which is medically
induced orn)
2323. base value for good patient relation is? communication should be good
2324. judge or never judge a patient? judge
2325. dist between casette/grid and the collimator for a lateral ceph? 15cm, 60 cm, 5 inch, 6
inch? 5 feet = 60 inch. (and is distance between casette /film and midsagital plane is
15cm)
2326. supernumerary teeth occurs due to problem in what stage of tooth development?
Initiation (table in mosby)
2327. space maintainers - loss of uni first primary molar what does one give? Nance for
maxilla and lingual arch for mandible
2328. class v cavity punch the hole on rubber dam? more bucally
2329. gold restoration use? 212 ivory clmap
2330. teeth who bear clamps? the hole should be bigger than the rest
2331. bur to polish porcelain is? diamond
2332. what type of dentin shouldn’t be removed during prep? eburnated dentin
2333. never do pulpo on closed apex? True
2334. one thing we cant see clearly on 2d image is? missed canal or extra canal which
requires cbct
2335. porcelain has tooth matching color by? Glaze firing (tegma)
2336. Dentist choice by metamerism? Different colors under different light sources
2337. Lab add stains inside the porceline to? Decrease the value
2338. Lab glazes and polishes the porcelain in the end of the design? More compatible to
gingiva

2339. Medicines contraindicated in a cystic fibrosis pt? B2 antagonist, Nitrous Oxide
anticholinergic is indicated with cystic fibrosis since it reduce the mucous secretion
which blocks the airway... b2 antagonist is contraindicated since it cause
bronchospasm
General anesthesia is avoided too in dd, they will have Copd , like chronic bronchitis ,
sinusitis , so beta 2 agonist will help
2340. least likely periapical pathology in children? Odentogenic
2341. BBB (blood-brain barrier) know the meds that pass through? Levadopa/Carbidopa
2342. Meds in multiple myeloma? Biphosphonate, Corticosteroid
(alkylating agents,immunomodulators,monoclonal antibodies protease inhibitors,
Cyclophosphamide ( alkylating agent) is uesd in dd,,bisphosphonate)
2343. Conscious sedation? Nitrous oxide
2344. Pt on sulfonamides, what will be the most likely side effect that being a dentist you can
say? presence of mucositis or RAS due to Def of folic acid
2345. Meds not given to peptic ulcer pts? Corticosteriod (NSAID and Steroids
contraindicated)
2346. Meds not given to pt on anti cholinergic tx? Opioids
2347. Meds not given to a pt who has epinephrine? Moa, Tricyclic, antidepressents, Non
selective Beta blocler
2348. Meds not given to one on BDZ? Antifungal, barbiturates
2349. Meds contraindicated in pt on barbiturates? MAO Inhibitors
2350. Except sweat changes, pt will also show what changes in cystic fibrosis: lung, saliva,
urine and some other options? Saliva
2351. COPD pt, what is contraindicated? Oxygen
2352. Asthma pt, what is not contraindicated? N2O
2353. Max amount of N2O that can you flow into the tube at a time? 70% for adult and 50%
for kids
2354. Epinephrine given with LA, vasodilation with which receptors, all alpha and beta in
option? Vasoconstriction with alpha 1, vasodialation with beta 2
2355. Tetraycline works by: no 30s or protein synthesis ,interference with collagenase, 50s
unit, plasma proteins and dna gyrase? 30’s protein synthesis
Terta will affect protein synthesis at 30 subunit, while doxycycline in 20 mg will be
subantibacterial that inhibit collagenase and Mmp 13, 8 ,, there is diffrence betweem
them
2356. Pt on sulfonamides, what will be the most likely side effect that being a dentist you can
say? Steven Johnson Syndrome, can also cause Skin rash, dizziness, diarrhea.
Trombocitopenia maybe careful with medication like NSAID. Side effect:
Hypersensitivity, Stevens-Johnson Syndrome,Photosensitvity, aplastic anemia,
thrombocytopenia, hyperkalemia, kerniterus, nephrotoxicity (crystalluria, allergy,
psychosis)
2357. Pt on seldane what can u not give? Erythromycin, any macrolide
The interactions were first identified in 1990 and involve many drugs. Among the
drugs known to interact with SELDANE are ketoconazole (NIZORAL), erythromycin (E-

MYCIN), nefazodone (SERZONE), itraconazole (SPORANOX), clarithromycin (BIAXIN),
mibefradil (POSICOR) as well as grapefruit juice.
2358. Pt on your chair, presents with insulin shock, what will you do next? Orange juice,
glucose, epinephrine, O2, etc? Orange juice if conscious and 50% IV Dextrose if
unconscious
2359. Pt on hep B meds, what will you do? Call physician, order regular CBC etc. blood reports,
were some fancy names of tests later? Blood reports
2360. Mandi tori removal, most frequent complication? loss of cortical border bone, injury to
mental n, lingual n, or IAN injury? Lingual nerve
2361. During maxillary tori removal, you accidentally perforate a part of the palate with the
tori, what structure will you see? Nasal cavity, inferior concha, pharynx? Nasal Cavity
2362. During 3M removal, which mand part is most likely to get fractured? Lingual cortical
bone in mandible and buccal in maxilla
2363. Which nerve damaged while distally inclined mand 3M disimpaction? Lingual nerve
2364. Closed mandi fracture, which is most likely to interfere with the closed reduction? Pull
of muscle, 3 different combinations of muscles, or improper access? 3 combination of
muscle
2365. Best radiograph to view zygoma? waters, PA, CT, MRI? CT (if submentovertex in option,
go with it)
2366. Pregnant pt, When is the best time to treat her? 2nd trimester
2367. What meds can u give her or not? Acetaminophen
2368. What is most likely to lead her present with a syncope? Pressure on IVC
2369. Old pt, 84 yo, what is your primary concern? Talk to him as politely and simple language
as u can, involve him in his decisions for tx plan, involve a guardian in his tx plans?
involve a guardian in his tx plans
2370. Stubborn pt, comes in coz of dissatisfaction of his previous several dentists. Despite of
so many changes he still seeks for better prosthesis, what makes u determine if he will
be satisfied by your tx or not? Several verbal communications in options, the most
affirmative and agreeing to what the pt was saying, to build rapport and form of trust is
most imp? to build rapport and form of trust
2371. Pt with a nodule on the middle of the neck, what is most likely dx? Thyroglossal duct
cyst
2372. Pt on anti hypertensive drugs, anti diabetic drugs, numerical readings, looked normal?
proceed with the tx
2373. Pt on no significant med history, past history of some surgeries, blood pressure comes
out to be a little high, what will you do next? Call his physician, ask him if he is okay,
schedule him for a recall, measure BP after 15 mins and see what comes up? measure
BP after 15 mins and see what comes up
2374. Pt has AIDS, his viral load is 100,000, t cell count is 30, what will be your inference? His
viral load is too high and he is on no condition to get tx, he has no problems taking any
tx, his t cell count is too low and that might put him at a risk of infection? t cell count is
too low and that might put him at a risk of infection

2375. AIDS pt in first stage. Which of the following will you notice? He is highly infectious, he is
moderately infectious, he is symptomless in this stage, he will show up with
opportunistic infections? he will show up with opportunistic infections
2376. Which lesion resolves by itself? Hematoma or hamartoma? Hematoma
2377. Bone marrow depression by what drug? Chloromphenicol
2378. Tx of osteromyelitis? surgical, no meds? Sequestrectomy, sauceraisation, curettage
2380. Malignancies to the oral cavity from the rest of the body are most likey to end up in
which region? floor of the mouth, bony landmarks and side of tongue and corner of lip?
Floor of the mouth
2381. Pt has no caries on abutment of FPd, but opposing tooth is in poor occlusion, what will
be your abutment prep selection? FCC
2382. occlusal caries premolar for FPD abutment, good OH, good occlusion. what will be your
abutment plan? Onlay
2383. tooth prep on anterior teeth? reduction on middle and incisal third for PFM
2384. Which equipments in the dental health clinic will need a signed something? UV light,
halogen light, lasers, high speed hand pieces? lasers
2385. Pt comes in with signs of physical assault, whom shall u contact first? Police or
concerned local committees or, talk to pts guardian or do nothing? Child Protective
Services
2386. Metal most likely to show allergies in the pts from the alloys we use? Chromium, nickel,
cobalt, indium, some other metals? Nickel
2387. When can you not place a temporary restoration in the pt? he came in as an emergency
appt, your time to close the office and he comes in, he needs a RCT in that tooth, he has
several large lesions that need to be treated ASAP? your time to close the office and he
comes in
2388. Pt came in for a 3 month recall, initial therapy doesn’t show any changes, pocket depths
not exceeding 3-4 mm, what tx step will u do? srp and wait for 3 more months ,surgery
only if pockets greater than 4 mm
2389. Pt comes in for a 6 month maintenance appt, little improvement in pdl status and
plaque control is efficient, though u can see infra gingival calculus, what was the
reason? You didn’t do SRP properly, pt has no good access to the deep pockets, pt only
concerns about looks, etc? You didn’t do SRP properly
2390. Calculating the specificity for disease containing and non containing pts in a study was
asked, options in %, simple math? Specificity means those who dont have so, TN/TN +
FP *100
2391. Angry child, shows this behavior on the second but was cooperative on the first appt,
what is the best method to control this behavior? N2O tx, GA, papoose board, voice
control? Voice control
2392. Denture wearing pt has pink raised lesions on the palate, what can it be? Epulis,
fibroma, papillary hyperplasia, etc? Papillary Hyperplasia
2393. Tori on upper palate, extending to the post palatal seal, what decides whether you
remove it or not? Tori extension affecting the stability of the denture, undercuts

affecting the retention of the denture, size of tori? undercuts affecting the retention of
the denture
2394. Pano to identify FD? FD Fracture
chemical influences in the pdl, zones of oxygen tension and oxygen deficit are created,
changes in pdl blood supply, changes in pulpal response? changes in pulpal response
2396. Pt comes to you with a catheter, which of the following will facilitate your tx? Ask the pt
to remove the cath, you remove the cath, leave it as it is and take detailed history
again? leave it as it is and take detailed history again
2397. LA without epinephrine? Mepivacaine, bupivacaine, articaine, lidocaine, benzocaine?
Mepivacaine
2398. Macroglossia is not seen in which of the following conditions? hyperparathyroidism
2399. Pt with mid face ill developed, no ear pinna, which syndrome? Eagle’s, tracher Collin’s,
apert, crouzon? Tracher Collin’s
2400. cause of angular chelitis: immune, speech therapy, poor home care? Immune
2401. Epinephrine is not given in patient with which drug in med history? Diphenhydramine
2402. AED is not used in? children, old patients, etc? Children
automated external defibrillator (AED) is a portable device that checks the heart rhythm
and can send an electric shock to the heart to try to restore a normal rhythm. AEDs are
used to treat sudden cardiac arrest (SCA).
2403. Aspirin patch is histologically? Necrosis, hyperkeratosis? Necrosis
2404. Phlebolith seen in? nerves veins, etc? Veins
2405. Folic acid inhibited in? methotrexate, fluorouracil
2406. Bisphosphanates are not given in? metastasis of breast ca to bone, metastasis of
prostate to bone, osteolyelitis, multiple myeloma? Osteomylitis
2407. Early loss of teeth associated with which syndrome? Down syndrome, Cleidocranial,
Ectodermal, Cherubism
2408. traumatic neuroma? Trauma from denture to metal and most
2409. bone Grafting, which one shows worst prognosis? Max ant, mand ant, max post, mand
post? Maxillary posterior
2410. On left side max 1 M MB cusp touch man 1 M DB cusp, on right side no max 1M, there is
max PM2 touch central fossa on man 1M, and max 2M MB cusp behind man 1M DB
cusp. Which class Angle on each side? Class 2
2411. If overjet 14 mm, which kind of surgery you do? BSSO
2413. Osteoradionecrosis what true? More in mandible/ more in maxilla/ more of 42 gray?
More in mandible
2414. Which micro organism in rhomboid glossitis? Candidiasis
2415. Dental lamina. Week utero? 6 week
2416. Age of calcification ant max teeth? all the anterior permanent teeth begin calcification
during first 6 months, except for maxillary lateral incisors. The maxillary lateral incisor
may be used as a key to timing; if this tooth is affected, the causative event is likely to
have occured at 1 year of age or older.
2417. Least reduced? intraproximal plaque

2418. Bleeding few days after extraction. Why? Fibrinolysis
2419. Pain in tmj area? Osteoarthritis
2420. Bone marrow suppression, effect from which drug? Mustagen
2421. Gingival graft contra? Thin attached gingival or wide defects
(Maxillary canine is contraindicated coz for palatal graft as there is no
unattached gingival)
2422. Contra N2O2? nasal disease, in 1st trimestr
2423. Drug that increases salivation ? Pilocarpine, methacholine, neostigmine
2424. Decr. Salivation? propranolol, atropine, scopolamine
2425. Antiviral drug works on all of them? herpes simplex, zoster and CMV
2426. which xray you do for tmj? MRI
2427. panoramic? auditory meatus
2428. PA xray of ant max teeth? soft tissue of nose
2429. What is the 02 taper on hand K-files? 0.02-mm increase in diameter per 1-mm increase
in length
2430. Alcoholic pt. which test to do? INR
2431. Test for diabetic pt? HbA1c
2432. Which tooth LEAST common missing? Caniane
2433. In which perio disease you give systemic AB? Can be indicated in anug but initial is OHI
and peroxide mouthwash) (if there is No option of generally aggressive perio)
2434. Status epilepticus – treatment? Diazepam (Dilatin, Valium)
2435. Grand mal seizure – treatment? Phenytoin
(PE tit mal .... Ethosuximide .. PE.. Grand mal ..Phenytoin.. GP ....last
one Status epileptics so –Diazepam)
2436. Tobacco chewing not associated with? Abrasion
2437. H2O2 for wound? True
2438. Diazepam for peripheral realxant or lower seizure threads hold? Peripheral muscle
relaxant
2439. No IV Dizepam for old patient? Shorter half life
(with IV diazepam risk of thrombophlebits and CI narrow angle glaucoma and
physchoses)
2440. First pass? Liver
2441. Alv Ostetis? Sedative dressing
2442. Pulp Necrosis for? Heat (doesn’t respond to ept or cold)
2443. Replace restoration? Ankylosis
2444. Inflammatory response? Pulp necrosis (external inflammatory resorption)
2445. Normal Salivary flow? 0.5 ml/min (closest 1 ml/min) (unstimulated is 0.3 ml/min )
2446. Pilocarpine? 400 mg excess methyl globunuria (5 mg – 3 to 4 times daily) (for
xerostomia and also cevimeline..recommended dosage for pilocarpine is 5 mg 4 times
per day . cevimeline 300 mg 3 times per day)
2447. Antipsychotic drug? Tardicasive (phenothiazines: block dopaimnergic site of brain,
depress CTZ, sedation, antiemetic, alpha adrenergic receptor blockage, potentiate
action of narcotics. CAUSES extrapyrimidal syndrome and tardive dyskinesia. caution
with patients taking sedative drugs and with liver diseases

2448. Vancyclovir? HSV and CMV
valaciclovir tx : HSV1&2, genital herpes, cold sores &VZV(shingles) .. Ganciclovir tx: CMV
retinitis and CMV prophylaxis in transplant patients
2449. Bechet Syndrome? Apthous Ulcer
2450. Epi and Levo act on? Alpha 1
2451. Disabled child? Clorhexidine
2452. If acromegaly untreated? Mandi growth will be more for class 3
2453. Which one has Least strength? Leituce
2454. Dentist plan to Bleaching and veneer ? bleach 2 week prep and bond
2455. Mg can give? Penicilline (no erythromycin)
2456. N2o2 CI in? nasal congestion (also in psychosis)
2457. Nystatin for? Candidiassis
2458. Clindamycine SE? Pseudo colitis
2459. PA not seen in? Mental foreman
2460. HIV 100000 virus T cells 30 ? low T cells
2461. TMJ Disc? MRI
2462. Dentist mount max cast no facebow . Wanna increase VDO? record new CR (Coz it is
not possible to change in articulator)
2463. Record protrusion for? horizontal condylor inclination in articulator
2464. X-ray? Tip of the nose
2465. Oral pigmentation can be done? Hematoma
2466. Pano X-ray 14 yr old pano 30 is rct. Pt complained just enlarge and hyper occlusion?
fibrous dysphasia
2467. Primary tooth bud can intrude permenant tooth bud? Extraction
2468. Which one is least post op complaint after tm? pulp death with asymp periodontitis
2469. Pulpitis and Periodontitis? Pulp vitality
2470. 4-6 years? Fear of unknown
2471. Primary tooth bud? 4 month inutero
2472. For max perm incisor? 1-6 moths for calcification (3-4 closest one)
2473. Max dose of acetaminophen within 24 hours? 4 m
2474. NSAID CI in? Asthma
2475. Oxycodone itch and hypotension ? allergy (release histamine)
2476. Abfraction? flextural
2477. MI and angina? depend on artheroscelerosis lesion (can also be thrombosis)
2478. Thyrotoxicosis? Tachycardia
2479. Cross allergy lido? Mepi
2480. Extodermal dysplasia? Oligo, sparse hair
2481. Hemophilia A? Prolonged or increased PTT and normal PT, platelet count , and normal
bleeding time
2482. Alcohol? INR
2483. Coumarin? INR
2484. Marginal break after amalgam restoration? Edge strength (High mercury content,
result from time of trituration, condensation , copper and mercury ratio)
2485. 2 weeks after restoration feel cold and bite on hard? Hyperocclusion

2486. Xerostomia, But no medicine, pocket depth >4mm, ant caries? Ant. Caries
2487. Osteonecrosis can be found in except smoking, Bisphonate, Active perio, Lumpectomy?
smoking
2488. Cetricine SE, Options are, Xero, Ext staining, Int staining, Ging hyperplasia? Xero (it has
anticholinergic effect)
2489. Syphilic infectius stage? Most infectious is 2nd stage
2490. Type 2 error for pt. management? Accept null hypothesis
2491. GTR to prevent? CT (GTR blocks junctional epithelium and gingival ct with use of
membranes, it prevents the long junct epithelium by preventing the coronal
movement of cells ad allow the pdl cells to proliferate. To make a new attachment)
2492. Rubella embryopathy? In 1 trimester eye ear heart blood problem
2493. Pt is 82. Her son sign as a guardian . What will dentist do with consent ? Consult pt too
and guardian, Pt can sign consent? Consult pt too and guardian
2494. What’s for palpation, To know something happen in cortical bone, To know what’s
going on the pdl? To know what’s going on the pdl (inflammation detection)
2495. Isthmus more than one third? MOD Onlay
2496. Older patient? Cervical darker (GIC given)
2497. How do you decide incisor edge? Lower lip during smile (macillary 2 mm from upper
lip)
2498. 20 mm crepitus and 5 mm tooat tmj? Internal dearrangement (can be trismus too,
depends on exact quesiton)
2499. Dentist studied 3 mths ago for disease. What study. Case control or cross sectional?
Case control
2500. NaoCl except? Chelation
2501. NaoCl removes? Necrotic debries
2502. digital X-ray is? Spatical
2503. Most resistant? Nerve
2504. Pt is hand fold and shaking his leg waiting area? Anxiety
2505. Gingivectomy CI? Below Free gingival groove
2506. Nasopalatine injection? not enough ant sup alv inj
2507. During prep pulp can damage because of? Heat
2508. Cleft palate hard to talk cuz can’t close air soft palate? true
2509. Buccal-lingual bone width necessary for 4 mm implant? 7mm.
2510. If open bite 8 mm, which kind of treatment do you do? Surgical procedure
2511. Pigmentation, Neurofibromatosis and Preuz-Jeghers? cafe-au-late spots
2512. Osteoradionecrosis? More in mandible
2513. How treat root caries? Rmgic
2514. Mucocele where most common? lower lip
2515. Ginco Biloba contraindication? Blood-thinning medications -- Ginkgo has blood-
thinning properties and therefore should not be used if you are taking anticoagulant
(blood-thinning) medications, such as aspirin, clopidogrel (Plavix), dipyridamole
(Persantine), heparin, ticlopidine (Ticlid), or warfarin (Coumadin).
2516. Bleeding few days after extraction? fibrinolysis.

2517. When gingiva inflammation is least expected? Xerostomia or Lack of keratinized
gingival? Lack of keratinized gingiva
2518. What is not true about Xerostomia? it is extremely difficult to treat it with Saliva
substitutes and inducers. Because, it can be improved with the right medication.
2519. V-form caries? tip towards the DEJ.
2520. Burn mouth syndrome due to? Xerostomia
Melkerson has fissured tongue- fissured tongue associated with burning sensation
2521. Best topical Antibiotic agent? Chlorhexidine
2522. Most secure indicator for future caries? Bacteria, something else, salivary flow? Salivary
flow
2523. Most common congenitally missing primary tooth? Maxillary lateral
2524. Drug after conjugation? Becomes more ionic
2525. The conjugation of glucuronic acid to a drug by the liver is an example of a? Phase II
inactivation reaction
2526. Wrought wire, around 0.2 mm to the abutment tooth if minimal wire length is 4,6 or 8
mm? 6 mm
2527. Most common to see in a teenage girl with buccal errupted canine? Anterior deep bite,
recession, 2 others? Recession
2528. Abutment height in implant restorations selected according to? At the height of
alveolar crest
2529. Cocain effect? contraction of dilator pupillae, contraction of sphincter papillae?
contraction of dilator papillae (Mydriasis)
2530. Used as topical LA? Cocain, Benzo, Lido, Bupivacaine? Benzocaine (If in option, select
Both Lido and Bezo are used)
2531. Face rash, defect on heart, kidney and blood vessels? Systemic lupus erythematosus
2532. Most difficult to maintain space? 6 y.o missing primary MD M2, (Since first perm molar
may try to close the space left in between, in that case we will
have to use space regaining appliance
2533. After RCT on a tooth with sinus tract, what is the tx for the sinus tract itself? NO therapy
is needed
2534. Disease with excessive bone production, but less bone resorption? Osteopetrosis
2535. Mouth breather have? Open bite, long face, deep bite etc.? Open bite
2536. Typical face feature for muscle weakness? Long upper face
2537. Kid with ADHD what tx? Continue treatment (note that N20 can be given in child with
ADHD and chlorhexidene cannot be given as it may cause discoloration)
2538. You want to give anesthesia. Kid is taking Adderall, what should you do? Continue med
(adderall is combi of amphetamine and dextroamphetamine.. used for ADHD usually)
(in decks it is said that you don't any special treatment considerations for these kids
and in the following para, they mention about the stimulants which they may need to
use !)
2539. Incision for palate tori? for palatal tori the incision is over it as a shape of
Y...for mandible tori, incision is similar to rainsing a flap, at the gingival crevice and if
required vertical incision given but never on tori.
2540. Pain drug for the night? Naproxene

2541. Side effect of opioids, all except question? Mydriasis (side effects are Constipation,
nasea, vomiting, Respiratory depression)
2542. Lateral positioned flap? Indication- for single tooth gingival recession,
contraindications:adjacent tooth have fenestrations or dehiscense
2543. What is the strongest point of statistics? Selectivity / Sensitivity in clinical trials
2544. In a dental research report, the term "statistically significant" means? Results are not
likely to occur, purely by chance
2545. Which of the following statements regarding the association of coronary artery disease
and periodontal disease can NOT be supported by scientific evidence? There is a strong
statistical association.
2546. In USA most dental payment? Cash for service
2547. Restoration in anterior teeth done weeks ago, filling too light. What is the most
conservative tx.? Apply composite tint (Keyword here is conservative)
2548. Which shows saturation of color? Chroma
2549. In English the s/ch/sh sounds, how is anterior teeth position?
Labiodental sound(fricative)-f,v,ph are formed by maxillary incisor contacting the
wet/dry line of mandibular lip. This sounds help determineing the position of incisal
edge of maxillary anterior teeth.
Lingudental sounds-“this, that,those”: Help determineing the labiolingual position of
anterior teeth. Lingualveolar sound (sibilants )-“s,z,sh,ch,j”:Help determineing the
vertical length and overlap of anterior teeth. S sound help to determine vertical
dimension and known as closet speaking space around 1 mm. TH sound helps to
determine if anterior teeth was set too far labially , lingually, or in right position
2550. Why do we do apexification? Open apices (If vital-- apexogenesis, necrosed--
apexification) (CaOH for multiple visits and MTA for single visit apexifications)
2551. Tx. for atypicaly errupting permanent tooth, with gingival margin above CEJ.
Gingivectomy, Apical positioned flap? Apical positioned flap
2552. All can be Dif. Diagnosis of Leukoplakia except.
Differential diagnosis are Candidiasis, Condyloma Acuminatum, Morsicatio buccarum,
labiorum, and linguarum Cheek, lip, and tongue biting Oral Frictional Hyperkeratosis,
Oral Leukoplakia, Proliferative Verrucous Leukoplakia, White sponge nevus
2553. Collimation purpose.? Reduce diameter of primary beam and increase the average
energy of x rays
2554. Calculation of incidence index. The incidence of caries in your office this year is 300 out
of 1000 teeth and last year it was 200; so what is it for this year? 0.1 ( Incidence is
occurrence of new cases only so it's 300-200/1000= 0.1 or 10%)
2555. Kid with bad OH what ortho tx? Fixed, removable, no tx? Removable
2556. Veneer facial reduction? 1.5 mm ( 0.3 gingival middle 0.5 n incisal 0.7-1)
2557. If a Porcelain to metal fused anterior crown too opaque, what”s the reason? The tooth
was prepare in single facial plane
2558. A patient is unhappy with the esthetics of an anterior metal-ceramic crown, complaining
that it looks too opaque in the incisal third. The reason for this is most likely? The tooth
was prepared in a single facial plane

(When you prepare the tooth in a single plane there will be insufficient reduction at
incisal edge. So in the lab the technician can not add enough layers to mask the
opaque layer or the crown would look very bulky)
2559. Perio-Endo lesion tx? First Endo then perio
2560. MRI how does that work? radiowave
2561. MRI works via what scale of electromagnetic spectrum? radiowave
Acetaminophen
Masseter
2564. If upper complete denture overextended? Gagging
palatal area, and in need of complete denture. What to do? Remove torus
2566. Ignoring the pt bad behavior? extinsion
2567. High kV? Long wave lenght low energy; Short wave length high energy;? Short scale
contrast due to lower KV, long scale contrast due to higher KV
(Kvp 70 and higher) (higher Kv, lower the patient dose)
2568. ACE-blockers? All that ends with -PRIL And they inhibit bradykinine metabolism
2569. Actinomycosis? Draining sulfur granules, side of the neck
2570. Perforation of anterior maxillary incisors during RCT accessnin general most common on
which surface? Mesial (Dental Board Busters: Maxillary Incisors &Canines: ALL have 1
root, 1 canal, &a distal axial inclination. Thus, when penetrating along the long axis of
the tooth, the bur must be slightly angled toward the distal surface to avoid
perforation of the mesial portion of the root.)
2571. Cast impression least acurate? Reversible Hydrocolloids, Irreversible Hydrocolloids,
Polyether? Irreversible Hydrocolloids
2572. Q on Chronic Heart Failure? Bupivicane should be avoided
2573. Neuropraxia? Heals in 4 weeks. Perioneum is intact
Neurapraxia is a disorder of the peripheral nervous system in which there is a
temporary loss of motor and sensory function due to blockage of nerve conduction.
Neurometsis is permenant
2574. Pat. With xerostomia. All is true for the indications to manufacture a complete denture
with METAL basis except? More acuracity, More wetability, Low cost, More durability?
More wetability
2575. Pat. comes back after two weeks with discolored margins. Cause? Marginal
leakage/cooper (depends on type of discoloration and crown)
2576. Antifungal that can be topical and systemic? clotrimazole
2577. preparation before grafting? remove all granular tissue completely.
2578. Carbamacepin used in? nerve pain.
2579. Which postion is patient related? VDO, CR, VRP, ICP? CR
2580. What will most likely cause the odontoblastic processe to retract in the dentinal
tubules? Trauma

2581. All is correct about sclerotic dentin except? extremely low permeability or better bond
with restorative materials compared to normal dentin? better bond with restorative
materials compared to normal dentin
2582. Which study doesn’t show cause and effect? Clinical trial
2583. What is true about remineralized enamel? Remineralized enamel is darker than
surrounding enamel
2584. Sialolithiasis? Surgical extirpation (submandibular gland and duct)
2585. Elective RCT contraindication.? Myocardial Infraction pt. if contraindicated
2586. Gagging patient, what's the tx in a long term? Desensitization
2587. Exhaling wheezing? Asthma
2588. Adverse effect of codeine? somneloscent
drowsiness, lightheadedness, dizziness, sedation, shortness ofbreath, nausea,
vomiting, sweating, and constipation. Other adverse reactions include allergic
reactions, euphoria, dysphoria, abdominal pain, and pruritis
2589. Culture sensitivity test.? determine the antibiotic tt
2590. pontic design.? Acc to DD, Most esthetic is – modified ridge but go with ovate if both
in option, most common – ovate (reference from DD however, final answer from
textbooks which says ovate)
2591. Action of beta blocker on smooth muscle? Bronchodilator
(decreases cardiac output in cardiac muscle)
2592. What is true about if a general dentist decides to perform a treatment which is normally
done by specialist? non-malficence violation
2593. orthostatic hypotension? orthostatic hypotenssion caused by antihypertensives,
phenothiazines TCA, narcotics and antiparkinson's drugs
2594. Middle aged guy with kindney failure due to Lithium overdose. What pain drug is less
expected to be nephrotoxic? Aspirin, Ibuprophen, Oxycodone? Acetaminophen (if not
in option, ibuprofen) (also in kidney failure we can give tramadol, if not in option,
oxycodon)
2595. Why do we need ruler in lateral cephalogram? For magnification (if not in option, go
with measurement, reference carranza)
2596. In removal of palatine tori which structure can be damaged? Greater palatine nerve
and artery
2597. 10 y.o girl, with good OH, no caries but a child of divorced parents. How would you rate
her caries risk? Low, Middle, High? Low (child knows to take care of her OH)
2598. Hispanic guy, no insurance, needs tx. If you extract tooth 14, what is the most expected
complication? The tooth had RCT and a very big amalgam fllg. Sinus perforation, Ridge
fracture, Tooth fracture, Bleeding? Tooth fracture
2599. 10 y.o child case, where upper canines were closely to errupt, but primary canines were
still there. the radiolucency that surrounded the errupting teeth? cysts or tumors?
Dentigerous cyst (if not in option, go for eruption cyst)
2600. Pat. Allergic to sulfa, which meds. Are contraindicated? Sulfonamides, bactrim
2601. Middle aged Pat. With one-tooth gap. If you want to close it orthodontically, what will
you expect? No bodily movement of the teeth, Rotation mesio-facially, Rotation mesio-
lingually? Mesiofacially

2602. two small radioopacities in the bone where MD M1 was missing? Odontogenic tumors,
Root rests, Focal idiopathic osteosclerosis? Focal idiopathic osteosclerosis
2603. Test for kidney failure? Creatinin
2604. RCT of a central maxillary incisor. What is true? it will be difficult compared to a normal
case, because canal was really obliterated.
2605. Pat. Bites down on his maxillary M1, which already had a super big amalgam fllg, and
breaks off one of the cusps supragingivally. What tx? PFM Crown (not onlay in this
case)
2606. On xray, opacity apical of a RC treated tooth. What could it be? sealer.
2607. Pat. Has very strange bite, posterior crossbite, Class 2 relationship on the molars, but
almost perfect overbite. What is the most likely cause? Canine
2608. How to treat his posterior cross bite? Quad helix expander
2609. Female pat. Wants all her teeth extracted, although they don't look as bad, what tx. Is
appropriate? Patient education
2610. That 10 y.o girl had a very strange bite, with a skeletal midline deviation to the left what
can be the cause? Can be TMJ, condylar hyperplasia or bone tumor
2611. On a lateral cephalogramm of the 10 y.o girl what is the radiolopacity that crosses her
posterior teeth? Maxillary sinus, Orbita, Zygomatic arch, Palatine process of maxilla?
Zygomatic arch
2612. Hispanic Pat, without insurance. Missing teeth, needs tx. What is the least tx indicated?
sinus lift
2613. 10 y.o girl who was asmathic. Meds.? Albetrol
2614. Old pat, heavy smoker with white patch on lip? Hyperkeratosis due to smoking. (Can be
leukoplakia too coz patient is smoker. Depends on exact case)
2615. How to biopsy that hyperkeratosis? Incisional
2616. Pat. With leukoplakia on lower side of the tongue. How to biopsy that? Exfoliative
cytology
2617. What structure can be damaged while biopsying the lower side of the tongue? Lingual
nerve, mylohyoid muscle
2618. Pat. With HTN. Taking various meds. Lisinopril, Beta-bloker among those. Which ones
lowers his BP? Lisinopril
2619. Elderly pat. With a super old bridge on lower back teeth. Has sensitivity when drinking
cold drinks. Which tooth most likely to be the reason? The bridge had 3 abutment teeth.
On the x-ray one tooth had a post, another one had a big radiolucency. Both teeth are
non vital, Only tooth with calculus is vital (coz considering x-ray, it was the only molar,
which looked normal with a little subgingival calculus)
2620. Pat. Taking antidepresants. Having heavy bruxism. What is least likely to do to treat him,
except? lower his medication
2621. Pat. With pigmentation above maxillary lateral incisor. What could that be and how
would you biopsy that? Incisional biopsy (is small lesion)
2622. elderly pt. taking various med. Including Aspirin 81mg. Would you stop Aspirin before
SRP? No, doesn’t need too stop baby aspirin
2623. Middle aged woman who wanted all her teeth pulled out, had a radiolucency in the
canal of an endo treated upper canine. What could that be? Can be fracture gp

condensation or inflammation from coronal pulp (not internal resorption because
tooth is endodontically treated)
2624. She had multiple fractured teeth, which were all previously endo treated. Why does her
oral situation looks like that. All except? external tooth trauma
2625. depressed guy? Amitriptyline med
2626. Cleft lip which embryo week? 4-6 week
2627. When do you use Laser or Electrocoagulation surgery intraorally? Laser for
gingivectomy
2628. Forceps for upper PM? 150
2629. Burn mouth syndrome due to? Multifactorial etiology and cause taste disorder
2630. Best topical Antibiotic agent? Bacitracin
2631. TAD (=Temporary Anchorage Device). Where it gets its stability from? TAD gets stabilty
from cortical bone as well as from its perpendicular placement.
2632. Tx for Status Epilepticus. ? midazolam or oxazolam (if NO Diazepam in option) (coz its
same or rather better than diazepam or valium)
2633. 2 y.o. uncooperative child. What to do to examine? GA, Papoose board, Restrict by
dental assistant, Restrict by the parent? restricted by parent.
2634. Fluoride function on Enamel? displacement of calcium ion to fluoride ion during the
mineralization of the enamel.
2635. Most secure indicator for future caries? Bacteria, salivary flow? salivary flow
2636. How to avoid cheek bites? by reducing the buccal surfaces of the lowers molars
2637. Xerostomia causing drugs work on which receptor? chlolinergic muscarinic receptor
blockers.
2638. Most common to see in a teenage girl with buccal erupted canine? Anterior deep
bite, recession? recession
2639. Cocaine effect? contraction of dilator pupillae, contraction of sphincter pupillae?
contraction of dilator papillae
2640. Cause for Hairy Leukoplakia? HIV, EBV, HSV, Candida? EBV
2641. Disease with excessive bone production, but less bone resorption? pagets disease
2642. Mouth breather have? Open bite, long face, deep bite? long face and open bite also
caused by muscle dystrophy
2643. Typical face feature for muscle weakness? Long face and open bite
2644. Incision for palate tori? Y shaped incision
2645. Pain drug for the night? Naproxen
2646. Side effect of opioids, all except? can be diarrhea and dieresis
2647. Lateral positioned flap? Denudated roots with adecuated depth tissue, dehisecence
,fenestration and single tooth recession
2648. Most common seizure in children? febrile seizure and treatment is ethosuximide
Acetaminophen
Masseter (can also be coronoid process)
2651. Pseudomembranous colitis? Clindamycine (caused by clostridium dificlie and
treatment is carbenicillin)

2652. Which tooth more prone to caries? Manndibular 1st molar
2653. ACE-blockers? All that ends with -PRIL And they inhibit bradykinine metabolism
2654. Actinomycosis? Draining sulfur granules, side of the neck
2655. Vertical root fracture most commonly seen? Mandibular molar
2656. Crown to root fracture most commonly seen? Max central
2657. Perforation of anterior maxillary incisors during RCT access in general most common on
which surface? Mesial
2658. Cast impression least accurate? Reversible Hydrocolloids, Irreversible Hydrocolloids,
Polyether? Irreversible hydrocolloid
2659. Chroma, Hue, Value.? Chroma is the saturation, increase with orange.Value is the
single most imp factor, u can’t increase it, it has 1-100 numbers. Hue is the actual
color.
2660. Chronic Heart Failure? Digitalis
2661. Neuropraxia? Gradient/transient nerve damage
2662. If a patient has had a car accident and an assumption of a broken cervical spine, which
xray is contraindicated? Waters, SMV, Pano, CT? Waters
2663. Carbamacepin used in? nerve pain. Trigeminal neuralgia (anticonvulsant also goes
true)
2664. Which study doesn’t show cause and effect? Clinical trial
2665. What is true about remineralized enamel? Rough and dark, Remineralized enamel is
harder and more resistant to demineralization
2666. Sialolithiasis.? in children transillumination, blockage in the salivary
2667. Elective RCT contraindication? Leukemia .
2668. Gagging patient, what's the tx in a long term? Gradual Desensitization
2669. Adverse effect of codiene.? CNS Depression
2670. pontic design.? Pontic MD Convex and BL CONCAVE should not touch the ridge
2671. Action of beta blocker on smooth muscle? Vasodilation
2672. What is true about if a general dentist decides to perform a treatment which is normally
done by specialist.? Veracity if dentist thinks it is beyond control
2673. orthostatic hypotension? orthostatic hypotenssion caused by antihypertensives,
phenothiazines TCA, narcotics and antiparkinson's drugs
2674. Least affected by inhalation of NO2? Dentist or patient or Hyginest? Patient (Because
Dentist have to do same in more than one patient)
2675. % of auto accident in USA? 90-95
2676. Patient with transient ischemic attack , what is contraindicated.? Anticholinergic
2677. Epinephrine and nitroglycerin what kind of reaction together.? Physiological
2678. Study that does not deoend on sample? Longitudinal (can be case report too, depends
on options)
2679. Management of Van willbrande? Factor 8
Local haemostatic agents before surgery, rubber dam is recommended to minimize soft
tissue injury, same bleeding control protocol as in oral surgery should be applied.
Aspirin and NSAIDSs should be avoided. 1- Avoid Asprin and NSAIDS. 2-use Tylenol with
or without codeine or COX-2 inhibitor( Celeccoxibe, Rofecoxib.3- screen prolong
bleeding time, PFA-100, or prolong partial prothrombine time.)

2680. Step to take impression to record masseter? tongue movements as it has to record
disto lingual border, During border molding the masseter muscle can be activated by
pushing downward on the patient’s chin while the patient attempts to close the
mouth against this pressure.
2681. Side effect of adrenal insufficiency? Hyperpigmentation, orthostatic hypotension,
weakness, weight loss
2682. Two non collinear and equal opposite forces are called? Reciprocal force (couple)
2683. Treatment of GAP? Surgical intervention and antibiotics (Mosby) (debridement and
abs)
2684. Treatment of LAP? SRP and Antibiotics
2685. Transillumination in kids for? Kaposi and sialolith
2686. Contrindication of gingivectomy? infra bony pocket, not enough width of attached
gingiva
2687. Success rate of nonsurgical endo? Good
2688. Kennedy class 3 support? Tooth
2689. Space between occusal rest and opposite teeth? 2-4 mm (we make rest seat about 1.5
mm deep at marginal ridge)
2690. Reason for frequent urination in 3 trimester? Pressure on bladder
2691. Medicine locally used nowdays for periodontitis? Minocycline / doxycycline
2692. Ludwig’s Angina Tx? Succycolin (open airway) (I and D, if systemic antibiotics should be
given, if breathing problem, opening of airway in emergency (tracheostomy))
2693. Intrapulpal injection? Back pressure (30 sec)
2694. Impacted canine tumor? AOT
2695. Forceps slips and causes the puncture wound. How it closes? Secondary intention
2696. Which stage of tooth results in form and shape of teeth? Morphodifferentiation (Bell
stage)
2697. Pagets disease of bone? Cotton woll, bilateral expansion
2698. Cementoblastoma? Sunray
2699. Odontoma? Most common
2700. 1st Molor calcification? Calcification begins at birth and completes after 2-3 yrs after
eruption
2701. Which bone of facial skeleton formed by intramembranous? Maxilla, Mandible and
cranial vault. (symphysis menti if in option)
2702. Patient complains the dentures are becoming too tight and not fitting anymore. What
is the diagnosis? pagets
2703. not feature of modify Widman flap (displace/no reduce of osseous defect)? no reduce
of osseous defect
2704. Advantage of osteogenesis distraction is? Large movements, less relapse
2705. An investigation that is not accurate but consistent is? Reliability
2706. Remineralized enamel is rough and cavitation? Darker than surrounding
2707. endplate potential is terminated by? Acetylecholine
2708. S,z,che sounds : Teeth barely touching ? true
2709. Herpes population in USA? 80%
2710. Steps of plaque formation? pellicle,biofilm,materia alba,plaque

2711. Beclamethazone? Topical corticosteroid for treatment of asthma
2712. Why use antiretraction valve? To prevent infection between dentist and patient
2713. Dose of hydrocortisone taken per year that will indicate have adrenal insufficiency and
need supplement dose for surgery? 20 mg 2 weeks 2 years
2714. impending doom? anxiety, panic attack? panic attack
2715. Most impacted tooth? Maxillary canine (if 3rd molar not in option.)
its maxillary canine which is impacted after 3rd molars... DD are wrong in some many
places. Manibilar 2nd premolar is the most common missing tooth as it can start
calcification as late as 8 years of age . So this this the only exception where 8-9 yearsof
age and tooth bud its determined missing.
2716. Least common survival of lip cancer? White females
2717. How to distinguish dx for ANUG? Involves interdental papilla
2718. Which type of periodontitis need antibiotics? Acute and agreesive (LAP) (antibiotic for
periodontitis is metronidazole)
2719. Ranitidine? decreases gastric acid secreation,h2 antihistamine
2720. Which is prevelant? 2 wall defects (if in option, choose craters first)
2721. Zygomatic process on X Ray? U shaped
2722. Opiod addict? Methadone (overdose-naloxone)
2723. NUG etiology and treatment? Spirochet and SRP (Debriment rinse and ab if systemic
involved) (Pevotela intermedia , spirochete , fusibactetuim)
2724. PMN present in healthy sulcus? True
2725. Difference between chronic and agreesive periodontitis? Presence of plaque (chronic
develop slowly and aggressive develop fast) (low level or no plaque with agreesive)
2726. Free gingival graft aggressive around 2nd and 3rd molar because ridge T/F? If oblique
ridge lower, its true
2727. you have a 8 months old pregnant that you extracted 2 teeth, which required flap and
sectioning of tooth, what medication would be MOST appropriate to prescribe - aspirin,
ibuprofen, acetaminophen, tylenol 3? Acetaminophen
2728. guidelines for antibiotic prophylaxis? given in recent MI, prosthetic valves, shunts (not
given in joint replacement, also not given during impressions, restorations and RCT(
which I doubt) source TUFTS)
2729. there was a lady who had widened PDL and bilateral resorption of angles of mandible,
wat is the cause?- osteosarcoma, Marfan syndrome? Osteosarcoma
2730. congenital abnormalities are associated with which stage of development of the tooth?
Histodifferentiation
2731. Mechanism of action for drugs in diabetes and asthma? Diabetes meds action - either
to produce insulin from beta cells of islets or reduce glucose production from liver
Asthma meds beta agonist- bronchodilation (Diabetes meds action - either to produce
insulin from beta cells of islets or reduce glucose production from liver, Asthma meds
beta agonist- bronchodilation)
2732. how much you have to reduce for veneer, in a 1/3 incisal, and anterior PFM crown?
veneer incisal 1/3 = 0.7 to 1mm, anterior Pfm crown - Gingival and middle third =
1.5mm
and incisal third= 2mm

2733. Diagnosis of ANUG is based on punctuate interdental papillae (not biopsy) t/f? True
2734. ANB (-) angle means class III? true
2735. Pregnant lady – notice HTN – why? Preeclampsia
2736. given : HCt – 25 , BUN- 20 glucose 80, what should be your concern? bleeding
(The definition of normal red-blood cell percentage also varies from one medical
practice to another. Generally, a normal range is considered to be: For men, 38.8 to 50
percent. For women, 34.9 to 44.5 percent.May 26, 2016)
2737. why some people have secondary herpes virus without primary?subclinical T/F? True
2738. the arch length in mandible decreases most from - loss of primary 1st or second molar?
Primary 2nd molar (source DD)
2739. Down syndrome? Macroglossia
2740. 2mm opening to sinus after extraction - what to do? Nothing
2741. Pemphigoid? deep layer, pacantholysis absent, Intraepidermal ..no acantolysis,
Interepithelial split not INTRA
2742. Von Recklinghausen’s neurofibromatosis? Pigmentation, Single or multiple nodules,
Crowes sign and Lisch sign
2743. in asthmatic patient albuterol doesn't work, whats next? Theophylline 0.3 mg 1:1000
2744. Angioedema? Due to deficiency of c1 estrase inhibitor
2745. If filling has marginal ditching of <.5mm do you redo restoration? Do nothing (In mosby
it is given if amalgam ditch less than 0.5 not an indication for replacement)
2746. what makes nuclei of dentinal tubules displace? Mechanical irritation, chemical
irritation, etching, DRY? Mechanical irritation
2747. how are root surface caries detected? Softness, (With tactile sensitivity – explorer is
used)
2748. Treatment planning sequence? emergency, control, reeval, definitive, maintenance
2749. If expoased pulp, calcium hydroxide (how thick? 0.5mm) and then liner on top? rmgic
2750. If put amalgam in triturater too long, It hardens quicker? True
2751. Orange and green stains on teeth is from what? Poor oral hygiene
2752. Cavernous sinus thrombosis? one involving infection (upper lip, headache first sign,
blurred vision)
2753. first sign of cavernous sinus thrombosis. vision changes? Periorbital edema, headache,
blurring
2754. Methemoglobinemia? Prilocaine
2755. What anesthetizes posterior soft palate? Lesser palatine
2756. Gorlin – OKC? nevoid basal cell carcinoma
2757. Ulcer on a tongue- what is it associated with, it happens every so often and goes away?
Cancer sores or apthous ulcer
2758. Which disease gets arthritis associated? Sjorgran
2759. Mucocele formed by? Salivary duct trauma
2760. Most common salivary gland tumor? Pleomorphic adenoma
2761. Ameloblastoma x ray? Soap bubble apprearance
2762. Downsyndrome kid does not hav which? CARIES (they don’t get multiple caries but
they have pdl widening)
2763. Biggest fear of 4-6 years old? Unknown (Treated by TSD)

2764. Degrees to hold instrument? 45-90
2765. Point of hex in implant? Anti rotational
2766. Collection of mucin surrounded by epithelium? Mucocele retention cyst
2767. Implant should be placed more apical or more coronal to surrounding teeth gingival
margin? More apical
2768. Best tooth brush method? Sulcular
2769. What causes tardive dyskinesia? Anti-psychotic (long term use of neuroleptic
medication)
2770. better retention/resistance for short crown crown? Retention - facial groove,
Resistance - boxes and grooves (proximal)
2771. prep= grooves, boxes, decrease convergence angle? True
2772. S sound question? Excess vertical dimension
2773. Clasp on RPD should be passive and not put pressure on tooth? True for retentive clasp
2774. Hardest impression material to take off? Polyether
2775. incisal edge has opaque look to it? What caused this? Reduction of tooth in single plane
(Biplanar reduction of crown not done properly)
2776. Resin modified glass ionomer cement advantage? Better strength than GIC, stronger
and less soluble (according to DD)
2777. Guy from Ethiopia had Hep B positive surface antibody? What does this mean?, he is
fine, he has it and needs vaccine, he has it and needs some medication? He is fine
(previous exposure with hep B / must be vaccinated and he is not a carrier)
2778. a scenario with a young girl who had a trauma tooth with a “bubble on the gums”, she
also drank a ton of soda? Bubble on gum is related to absess
2779. some man who was very fat, had HT, - what else can he have? Diabetes (can also be
Thyroid coz Htn never affects Thyroid whereas a thyroid disorder causes Htn)
2780. which organ would be least effected knowing his condition? kidney, pancreas, thyroid
or colon? Colon
2781. what was least likely to cause his high caries rate? dry mouth(could be cariogenic food)
2782. Anxiety def by frued and ericsson? Silver Lining (According to Freud, a feeling of
impending danger that can be based on objective, neurotic, or moral threat)
2783. Varience? In varience greater the range of data wider the distribution
2784. Preloading of implant whats the major concern? Torque
2785. 4mm sinus opening to sinus after extraction no option of suture? Flap from buccal
if <2mm leave it alone, if 2-6mm a figure 8 suture should be placed over tooth socket ,
if larger than 7mm the opening should be closed with flap procedure
2786. What will do some tooth mobility prior to periodontal surgery? We will splint some
mobile tooth (depends on exact question)

2787. Folic acid intake in pat for? methotreate inhibit folic acid
but if pt is taking folic acid - then its for vit b deficiency
2788. Concussion in child what to do? Observe
2789. Pat, asks abot sterilization what did you say? Show him sterilization room
2790. Altered cast technique is for? Support
2791. An altered cast impression technique for free-end extension mandibular partial denture
cases is done primarily to? capture soft tissue in a supporting form and prevent
displacement of the retromolar pad.
2792. Class 3 occlusion seen in which ethnicity? Native americans
Highest prevalence of caries = Hispanics
Highest DMFT = White (cuacasion) (highest amount of restored teeth)
Highest untreated primary teeth = Hispanic
Highest untreated perm teeth = Black (African American)
Moderate periodontitis = Black males ( African American)
Class II caries = Whites (cuacasion)
Class III caries = Blacks (African American)
Cleft lip/palate w/ Class III occlusion = Native American
Cleft lip alone = Asian
Cleft lip and palate in USA = 1:700 to 1:800
US population - Class 1 - 70%, class 2 - 25%, Class 3 - 5%
2793. Highest unfilled caries seen in? Black
caries in children Hispanics, most restored cavity in adult is white, most decayed teeth
in adults is blacks
2794. Hazard communication standards? Protection against chemical ...it’s written by MSDS
but regulated by OSHA

2795. Which model is currently in use? Specific plaque theory or NON-specific plaque theory?
Specific plaque theory
2796. Most prevelant type two diabetes? Black male (DD reference)
2797. Best test to test tooth with crown? Cold
2798. Trapezoid mouth and shovel incisor? Apert Syndrome
2799. Baby bottle decay affects mostly? Maxillary central incisors
2800. Common cause of sealent failure? Contamination
2801. NaF applied for how many minutes? 4 minutes
2802. Mesial cusp ridge longer than distal in? Primary canine and max 1st pm
2803. Stage forming peg lateral? Morpho (Bell)
2804. Smallest primary tooth? Mandi lateral
2805. EDTA can remove thin calcification not any calcification? True
2806. pulp diagnosis (pain on percussion ) not respond to thermal? abcess, necrotic pulp
2807. No regeneration after endo? Dentin
2808. Change amalgam to composite? Veracity
2809. class 2 caries triangle and the apex to the pulp? Base at DEJ, apex at pulp
2810. cusp reduction? Resistance form
2811. Most lab complain from? Under prepared (insufficient reduction)
2812. Facet found on? Working side
2813. Most strain wall? Gingival, proximal
2814. Way to Differentiate between Ameloblastoma from OKC? Histologically
2815. Way to Differentiate between Granuloma and radicular cyst? Histologically
2816. Effect on anemia? Cold (not No2 – 100% confirmed)
2817. Seizures due to? Hypoantremia
2818. Crowe Sign? Neurofibromatosis Type 1 aka Von Recklinghausen
2819. Warm born disease? Pagets
2820. Early shedding of Primary teeth and delay of permanent teeth? Cherubism
2821. IgM hetro diagnosis? Infectious Mononucleosis by EPV
2822. Clacified Flax Ceribri w/ which syndrome? Gorlin Syndrome
2823. Most common cyst? Periapical
2824. Most commo burn in mouth? Aspirin burn
2825. Edrophonium all true except? cause dry mouth
2826. True cyst (aneurysmal, traumatic, etc)? Aneurysmal bone cyst (traumatic bone is true
cyst according to DD)
2827. Trauma in young kids? Lack of motor coordination
2828. Percent of kids with trauma? around 24%
2829. Plaque index used to? Patient motivation
2830. Measure arch length? mesial surfaces of the first permanent molars
2831. For dentist to avoid a lawsuit he needs? Competence
2832. Dermatologist refer a pt to you suspecting intra-oral cyst, which disease? One of the
pigmented lesions (Gorlin Syndrome - nbcc)
2833. Acron and non-acron articluator? Acron for tmj disease diagnosis, Non acron is semi
adjustable for fdp rpd. Arcon is true condyle in lowermember and fossae in upper

member exactly like us were as non arcon is reverse e.g. Ofnon arcon is 3 point
articulator e.g. Of arcon is hanau semiadjustable articulator.
According to dental decks.. Both( acron and non acron) are semiadjustable which
allow orientation of casts in relative to tmj.. Acron used for fabricatingfixed
restoration while nonacron for complete and partial denture
2834. Infra-orbital pointer of articulator? Three point reference
2835. Protrusive movement on articulator how to set it? Remove the incisive pin
2836. Frequent urination in pregnant women? Pressure on bladder
2837. Antifungal torche? clotrimazole
2838. Ttt without consent? Battery
2839. Charging full mouth xray as separate? Unbundling
2840. 3 mm subging composite? Need crown lengthening. 0.3 mm composie sub gingivally
cavity and it was bleed what is the reason of pot operative senstivity
2841. circumferential opposite force? Couple or anchorage? Couple
2842. pt with pulp capping failed? Do RCT
2843. demarcation line in ismuths? Redo the filling
2844. <0.5 marginal defect in amalgam? Observe
2845. Epinephrine and histamine? physiologic
2846. Fluoride in 1.1 or 5%? 0.5 mg 1.1 NaF
2847. Unethical of dentist to increase fees? Pt had difficult procedures
2848. Not included in the consent? payment
2849. Pic of generalized inflamed gingiva in upper teeth of child pt was treated for skin disease
for 2 month? multiple pyogenic in child
2850. Pt with controlled systemic? ASA 3
2851. how the partial agonist works in relation to full agonist? Partial opioid agonist = Mixed
agonist-antagonist
Buspirone (BuSpar) is a partial agonist at a specific. Its dopamine agonist and
serotonin partial agonist
Agonists have intrinsic activity (maximal effect of a drug); efficacy of 1
- Pure antagonists have no intrinsic activity; efficacy of 0
- Partial agonist has an intrinsic value between 0-1
2852. According to the theory that agonists and antagonists occupy the same receptor site, an
effective antagonist should exhibit? No intrinsic activity and high affinity
2853. Thyroid crisis? hypertension
2854. Cocaine doesn’t do? Doesnt do Vasoconstriction (does mydriasis)
2855. Intra canal anesthesia? 30 sec onset? Intra pulpal back pressure takes 30 min
2856. Accurately filled root canal but over extended gutta percha? observe
2857. Xray of Paget? Cotton woll
2858. epidemiology/Prevalence of all diseases between different races? Most Periodontal + 5
yr survival cancer
2859. Handicap on wheel chair? Ask him
2860. 2 proximal cavities? clean bigger restore smaller
2861. rubber dam leak? too close
2862. doom? panic attack

2863. dementia? Short term memory loss
2864. most common dental emergency? Hyperventilation or syncope? Syncope
2865. most common elderly disease? depression
2866. most common molar relation in ped? Flush terminal plane
2867. most common resp emergency? hyperventilation
2868. perio disease is recently connected to? Cardiovascular
2869. oral cancer is connected to Alcohol, OH, smoking? Smoking
2870. gingival disease in kids? Marginal
2871. HIV +ve pt needs extraction, what test? Cd4 or viral or platelet or hematocrit? Cd4
2872. how to arrange the lower teeth of denture? it should be in relation to the ascending
ridge of the mand
2873. missing upper incisor? lateral
2874. record distobuccal extension or denture by? press on mandible (masseter)
2875. pregnant pt, Nitrous Oxide which trimester or avoid? 1st Trimester
2876. Pregnant and breastfeeding must give sedation? chloral hydrate
2877. Alcohol fetal syndrome? Mid face deficiency (mid face discrepancy)
2878. Most common Congenital anomaly? Cleft lip
2879. Mucous retention etiology? Trauma to salivary gland
2880. When to remove tourus palatines? When it removes with torus palatines
2881. finding as Sausage-like in radiograph of salivary gland? Sailolithiasis (sialodentitis if
sailolithiasis not in option) (Sialodichitis)
2882. Transillumination in kids? Sialolithis (koplik spots too of in option)
2883. Factors contributing to perimplantities? Bacteria and poor health
2884. Wide embrasure after perio surgery, how to clean? Interdental brush
2885. Factors considered in tt planning for implant all except? age or region of mandible?
Region of mandible
2886. Success of flap depends on? after the surgery or before surgery or location or type of
incision? location or type of incision (select oral hygiene if location and type of incision
not in choice)
2887. Surface characterization of porcelain? Value/Chroma? Value
2888. Orange stains? Poor oral hygiene
2889. Heart rate 4 years? 110
2890. Chroma? Saturation of hue
2891. proximal cavities? Clean bigger, restore smaller
2892. Painful in premolar area? Traumatic neuroma (trauma to mental nerve)
2893. Caries in radiation pt where? Cervical, pit and fissure, proximal, all? All
2894. Spread of caries? Dej
2895. Sensitivity most? dej
2896. ¾ and full crown? Benefit of ¾ crown over full crown is retention
2897. Small mandibular first premolar needed as an abutment, what will you do? Full crown
2898. short clinical crown, how to increase retention? Buccal groove for resistance (Proximal
groove for retention)
2899. Not shown in xray? Nasolabial cyst
2900. Most common emergency in children? Febrile

2901. Traumatic bone cyst? scalloping
2902. X ray teeth white, which Error? Poor developed or old developed or over fixed
2903. Contraindicated endo? Vertical root fracture
2904. At what age is complete Calcification of first molar? 2-3 yr
2905. Tooth/arch discrepancy in size in upper arch, which tooth blocked out? canine
2906. Non-working interference which incline in which cusp upper and lower? Upper buccal
incline of lingual cusp, Lower lingual incline of buccal cusp. (Maxillary Lingual Cusp?
Lingual incline)
2907. Intensifying screen function? Reduce exposure
2908. Radiographs for impacted tooth? Occlusal+periapical or occ + panorama or periapicals
at different angulations? Occlusal + panorama
2909. which of the following will appear in bitewing radiograph of 1st PM? Mesial of lateral,
distal of canine
2910. Wall not present in class v? distal wall? Facial
2911. Most common bone defect? 1 or 2 or 3 wall? 2 wall
2912. Multiple exposure of low dose? Skin erythema
2913. other name for Dry socket? common where + ttt? alveolar OSTITIS, TT:sedation inside
socket
2914. Reciprocal arm function? Stabilization (alter the force of retentive arm, alter horizontal
force)
2915. Clearance from occ rest 0.5, 1, 2? 0.5
2916. Rate of formation of dentin? 1mm/6 moth
2917. Rate of epithelium formation? /6 month? 5-21 days
2918. High risk pt:? emergency, control, re-evaluation
2919. Maintenance phase in perio tt? Prevents the recurrence of disease
Phase 1 is Scaling and RP phase 2 PDL suger, Phase 3 restorative, phase 4 maintenance
2920. Caries bacteria, which initiate? strpt mutans (and which has role? Lacto)
2921. Ludwig angina? Which space not involved? Submental, submandi, sublingual involved
2922. Lost root in man molar extraction? Which space? Submandibular
2923. Space related to lingual cortex of lower? Submandibular (In acute cellulitis, infection
from lower teeth perforates the lingual cortical plate of bone and moves into
superficial lingual spaces and from there track backward. Infection from lower molar
teeth, after penetrating lingual cortical plate reaches the junction of facial spaces of
posterior border of mylohyoid muscle. From there the infection may spread forward
to reach the sublingual and submandibular spaces and backward into parapharyngeal
spaces )
2924. IAN anesthesia failed? Accessory innervation from which nerve? Auricoltemporal,
mylohyoid? Auriculotemporal
2925. Hepatitis A mode of transmission? Oral and rectal
2926. Irreversible pulpitis diagnosis? Thermal hot
2927. Differentiate between perio and endo cases? Ept
2928. Down has? relative macroglossia
2929. OI associated with? DI

2930. Body in Herpes? Lipschultz bodies or Tzank?? Lipschultz bodies (Tzank is for
pemphigus)
2931. Most common dental payment type in USA, self-pay? self-pay
2932. Side effect of an anticancerous medication? Methomoglobiniemia
2933. Long acting LA: 2% lidocaine 1:100,000 or Bupivcaine 1:100,000? Bupivcaine 1:100,000
2934. strongest LA, same options but this time? 0.5% Bupivacaine
2935. Max anesthetic dose in 16 Kg child? 70.4
2936. Child with bad OH just finished orth? Fixed retainer, removable retainer or no retainer?
Removable
2937. Major connector? Rigidity and support
2938. Stress bearing areas in lower? buccal shelf
2939. Detrimental forces on implant? Oblique or horizontal? Horizontal
2940. CT around implant? Implant failure (Connective tissue fibers present parallel
to implant. But they don't insert in implant. Ref DD on one card it says and on other
card # 59 perio dd it says that no CT around implant)
2941. Bench mark of sterilization? For autoclave its bacillus
N for disinfectiob its myobacterium tuberculosis
2942. Gracey curette? 90 degree, pointed tip or triangular cross section? Gracy- 70 (universal
– 90)
2943. Xylitol gum? Bacteriocidal, Prevents caries
2944. Temporal arteritis? jaw claudication
2945. Ant triangle of the face? cavernous sinus
2946. Dexterity? problem with flossing and brush
2947. How do you differentiate between acute peri apical abscess & acute apical periodontitis
? Lat percussion. (Vertical percussion in AA n later percussion in PA)
2948. test to differentiate chronic apical abscess and chronic apical periodontitis? Lat
percussion (vitality)

2949. Diagnosis of Chronic apical abscess vs Chronic periodontal abscess? EPT (Some may
debate here saying answer can be thermal coz ept might show false results and is not
reliable but still it remains first choice of test)
-Acute apical periodontitis: pain to percussion
-Chronic apical periodontitis: Radiolucency
-Acute apical abscess :pain to palpation
Chronic apical abscess drainage and sinus tract
All apical periodontitis and abscess have radiographic RL except acute apical
periodontitis- it doesn’t.
2950. Methotrexate? anti cancer drug folic acid inhibitor
2951. What causes cervical discoloration of PFM? copper
2952. Flame shaped radiolucency above an unerupted third molar? pericoronaritis
2953. adrenal crisis? hypotention
2954. Overdose cocaine? Mydriasis
2955. Class 5? GIC
2956. Pedunucleated leision? Fibroma
2957. Fetal alcohol syndrome? Mid face discripency

2958. Contraindication of elective RCT? Myocardial Infraction, Leukemia
2959. Lazer in periodontal diseases? Sulcular debriment
2960. thyroid crisis symptoms? Exophthalmos , tachycardia, high BP Thyroid crisis treatment:
Inorganic iodide (which may be administered in the form of potassium iodide or
Lugol's iodine and antithyroid drugs (propylthiouracil or methimazole) are used to
reduce the release of thyroid hormone from the gland. Beta-1-selective Beta blockers
are also used to reduce the effect of circulating thyroid hormone on end organs.(e.g.,
propranolol) Corticosteroids (e.g., dexamethasone) are used to prevent peripheral
conversion of T4 to T3. In high fever, temperature control is achieved with
paracetamol/acetaminophen, frequent fluid replacement, mechanical ventilation and
corticosteroids.
2961. value negative calculation? true negative correction then --TN/TN+FP * 100
TP/TP+FP is a formula to calculate positive predict value
2962. How base metal prevent corrosion? Metal oxide layer
2963. Low Sag in FPD cause? Less deformation of bridge spans when fired
2964. Leakage in amalgam? decrease with age
2965. systemic desensitization? Gold standard in behavior modification (for anxiety)
(Gradual exposure to fearful stimuli, exposure can be combined with relaxation
exercises)
2966. Radiation? water lysis
2968. Irrevrsible hydrocolloid? imbibition
2969. Ginseng contraindicated with? salicyclic acid
2970. Best place for implant? ant mand
2971. Pseudomembranous colitis? clindamycin
2972. Nitrous has no contraindictation? with asthma
2974. Bipolar disorder? Lithium
2975. H1 and H2 receptor? h1 benadryl ,h2 cimetidine, H1 - competitive antagonist, H2-
blocks receptors
2976. H1 blocker (Antihistamine) will increase acid secretion ... T/F ? False, it decreases
secretion. (H1blocker( Antihistamine)--decrease allergic reaction.H2 blockers decrease
stomach acid secrection(Famotidine,Ranitidine) used in peptic ulcer disease or GERD
(gastroesophageal reflex disease)
1st-Generation (Classic) Hl Blockers: Diphenhydramine (Benadryl), Chlorpheniramine
(Chlor-Trimeton), & Tripelennamine (Pelamine
2nd Generation Hl Blockers: Cetirizine (Zyrtec), Fexofenadine (Allegra), Loratidine
(Claratin), & Desloratidine (Clarinex).
2977. Down Syndrome? Relative macroglossia
2978. Osteogenesis imperfecta with? DI type 1
2980. Caries not depend on? quantity of carbs
2981. Antiretraction valves? prevent cross contamination

2983. Liver problem what can you give? (LOT – lora, oxa tema) (Mepi if asking about LA)
2984. Cooling while implant placement? High Torque low speed
2985. Carcinoma vs carcinoma in situ? No invasion (does not cross basement membrane)
2986. Headgear? Straight Headgear we use for extruded molar, Cervical we use for intruded
molar. Wear for – 14 hours, Growth hormone released in the early evening so ideal to
placeheadgear after dinner not before bedtime - Ref. DD. (also Combination headgear
is a combination of Cervical and high pull headgear) (for mandible is chin cup..for mx
is high pull,cervical, straight HG) (for class 2 correction u use-cervical ,high pull or
combinatn and for class 3 correction - reverse pull headgear and chin cup.)
2987. Erythroplakia? carcinoma in situ
2988. 8mm open bit? le Fort 1
2989. Frankfort line? orbital portion
2990. Impression material setting interference with? Latex
2991. 2 year old kid needs lot of restoration? GA
2992. progressive paresthesia in mandible? Tumor
2993. fracture with parasthesia? Angle of mandible
2994. Smokeless tobacco? Verrucous carcinoma
2995. Drug testing? Clinical trials
2996. MWF reduce pocket lining? True
2997. RPD connector fracture? Do soldering
2998. Traumatic neuroma? Mandibular premolar region
2999. Most allergic metal? Nickel
3000. Frankfort linelabiodental sounds? Fricative sounds (line – p to o)
3001. Open bite? Le fort 1 osteotomy
3002. Full denture clicking? Increased VDO
3003. cocaine produces vomiting by? activating CTZ in brain
3004. No to do w asthma? Give Oxygen
3005. Therapeutic effect (safety)? LD50/ED50
3006. Aplastic anemia? chloramphenicol
3007. Pseudomembranous colitis? Clindamycin
3008. Erosion? Gerd
3009. what is the LEAST factor that would make you refer a tooth that needs endo to a
specialist? Mesial angualtion
3010. Radiograph of a remaining root with an apical radiolucency. Remaining root was
extracted and the lesion was taken biopsy, results came back with many neutropils.
What is the lesion? Cyst? Abscess
3011. When u do an endo for lower molar with bad perio condition and a cusp breaks, what
do? Place a ceramo-metallic crown
3012. Which condition has osteomas? Gardners
3013. 40 year old pt with Class 2 mobility and furnation of 7 in posterior molars. which has the
worst prognosis? Furcation
3014. Which causes pseudomonas colitis? Clostridium difficile (also Clinda)
3015. Battle injury is caused on? fracture of mastoid

3016. Which motor nerve injury causes paralysis of lateral rectus muscle of eye? Occulomotor
(CN6)
For superior oblique, answer will be trochlear
3017. Patient is considering partial denture of acrylic or base metal which will cause excess
salivation? Base metal
3018. Which bur is good for finishing axial walls in crown prep? Straight fissure
3019. Best finish line for porcelain crown? Shoulder
3020. Pt has shared an personnel tragedy with you what do you do 1) reflection 2) restating 3)
ignore him? Reflecting
3021. Pt. with down syndrome has abusive and dominating mom, what do you do? Consult
social service dept. (for adult, it should be human service dept.)
3022. CHIP insurance? For Kids who parents r not eligible for medicaid whose income is
above their Medicaid brackets
3023. Osteoclast has increase in which chemical mediator during its half life? IL 1
3024. During opaque bone condition, which interleukin is high? IL 1
3025. buccal mucosa whith yellow tiny eruptions a) fordyce granules 2) SCC 3) papilloma?
Fordyce granule (buccal mucosa - fat)
3026. Which is the differential dx for DI 1) AI 2) ectodermal dysplasia 3) dentinal dysplasia?
dentinal dysplasia
3027. Pt is walking who is suffering from angina takes nitroglycerine and suffers from
breathlessness,chest pain and sweating which of these conditions he is having 1)
Myocardial infarction 2) syncope 3) hypglecemia? Myocardial infarction
3028. what anatomical condition in Max lateral incisors is present in 5% that makes the tooth
loose its attachment? Palatogingival groove
3029. Which condition of existing amalgam filling should make you take immediate action 1)
tarnish and corrosion 2) fracture 3) marginal ditching? Fracture
3030. One distinguish feature of patient with down syndrome? Class 2, macroglosia or
pigmentations? Macroglossia
3031. The prepared tooth for PFM crown has one of the following occlusal features 1) flat
occlusal surface and rounded sises 2) Sharp and angular 3) conical? Flat occlusal surface
and rounded sises.
3032. aspirin causes all except one 1) prolonged bleeding time 2) delayed platelet aggregation
3) alkalosis 4) hypothermia? Hypothermia
3033. 4 year old has her max central intruded 5 mm. which of the following do u do 1) Ortho
repositioning to use as space maintainer 2) extract 3) leave it? Leave it (need not to
extract coz of age)
3034. Pt develops an psychotic episode in your office which of the following do you do 1) Give
IV lithium 2) call his physician and make sure nobody is hurt 3) ask him to leave? Call his
physician and make sure nobody is hurt
3035. Drug used in diazepam overdose? Flumazenil
3036. Patient had lower anteriors retained but max a denture and was a diabetic?
Combination or Kellys syndrome
3037. child 9 year old whose mandibular teeth have moved left from the midline.water with
fluoridation of 2 which has caused fluorosis? Functional shift in occlusion

3038. Another bipolar patient with multiple fractured amalgam fillings and gingivitis? Lithium
for bipolar (never nitrous for such patients as they have psychoses)
3039. 40 year old pt with Class 2 mobility and furnation of 7 in posterior molars, which has the
worst prognosis? Furcation
3040. What causes pseudomonas colitis? Clostridium difficile (also Clinda)
3041. Battle injury is caused on? fracture of mastoid
3042. Which motor nerve injury causes paralysis of lateral rectus muscle of eye? Occulomotor
(CN6)
For superior oblique, answer will be trochlear
3043. 8 yrs girl, 3mm anterior crowding what is the Rx? A. canine extraction b. disc distal of
the canine c. lingual wire d. extraction of canine with lingual space maintainer? Lingual
wire.
Space regaining (localized space loss)—indicated when space loss is minor (< 3 mm).
a. Removable appliance with nger springs to tip
teeth distally.
b. Headgear (for the maxillary arch).
c. Activated lingual arch (for the mandibular arch).
d. Lip bumper (for the mandibular arch).
e. Limited xed appliances.
(1) Followed by placement of a space maintainer a er space is regained.
3. Moderate crowding (<4 mm).
a. Arch expansion (this is a controversial topic).
B.
excess space. Anterior spacing.
4. Severe crowding (>4 mm).
a. Arch expansion (this is a controversial topic).
b.Serial extraction.)
3044. 3 unit fix prosthesis including canine as pontic which type and why? simple, complex?
Complex
(Lateral is not a good abutment. Mosbys pg 317when replacing the canine, the central
and lateral should be splinted to prevent lateral drifting if fixed bridge"
Mosbys pg 334 Pontic is ovate- very high esthetics! or modified ridge lap? These are
mucosal Pontiac that should be concave and passively contact the ridge)
3045. Working interference? for interference remember LUBL( lingual upper buccal lower)
and for grinding means to remove those interferences remember BULL(buccal upper
and lingual lower)
3046. Schedule 2? Schedule 2 drugs have high potential for abuse! Eg: hydromorphone,
methadone, cocaine, codeine, amphetamine, oxycodone, percocet, methadone,
phenobarbitol, morphine
3047. Membrabe separation? Pemphigoid
(Pemphigoid: autoimmune disease of mucous membranes. Antibodies directed against
basement membrane antigens v/s Pemphigus autoimmune of mucocutaneous disease
(more superficial) )

3048. Oral lesion caused by sexually transmited disease? HPV Condyloma
(Squamous papilloma-hpv 6 or 11 Verruca Bulgaria- HPV 2 or 4. Oral condyloma HPV 2,
6, or 11 Focal epithelial hyperplasia HPV 14 and 32. Herpes, syphillis, and gonorrhea can
also cause oral lesions.)
3049. Stability of mandibular denture? Buccal shelf
3050. Disposal of amalgam? High vacume suction (for storage, amalgam scrap should be
stored in a tightly-sealed container and covered with Sulfide solution)
3051. Voice control? Aversive conditioning
3052. Aspirin? Used as Blood thinner: reduces clumping action of platelets most common
dose to prevent heart attack or stoke: 81 mg (Can range to 325mg)
Used as NSAIDs 300-650 every 4-6 hrs
Max daily dose 4 g analgesic, anti inflammatory, anti pyretic and anti rhuematiod. Cause
G.I.t disturbances and should be avoided in feverish children, can cause reyes syndrome
in kids, It is a irreversible cox 1 and 2 inhibitor Side effects- Chronic: salicylism (ringing of
ears, nausea, and vomitting, bleeding, cns effects, gi disturbences. Acute: Acid base
problems, dehydration, hypokalemia. Can also cause respiratory alkylosis or metabolic
acidosis
3053. Oil function in X-ray tube? Dissipiate heat
3054. Difference between idopathic osteonecrosis and condensing osteitis? condensing
osteitis first of all is non vital and it's radiooapque no radioluscent rim. idiopathic
osteosclerosis is vital. IO is not associated with any type of inflammation! CO is
associated with chronic inflammation! CO is invariably associated with a tooth with
deep caries or large restorations!
3055. Cellulitis? Lymphocytosis (lingual and sublingual spaces involved and can cause
laryngeal edema, elevation of tongue, trismus, rx is drainage and antibiotic)
3056. Rx for child pain? Tylenol
3057. Crown cementation? Contraindicated with mrgic, check for proximal contacts first
3058. Moisture effect of amalgam? Delayed expansion
3059. Best type of bone for implabt? D1 (according to DD)
3060. 15 year old patient has narrow maxilla due to cleft palate, why? late in Rx of palate
during childhood ( can also be by not using obturatior).
3061. Leeway space? Difference in M-D between primary canine and molars and permanent
canines and premolars. (max 2-2.5 mand 3-4 mm)
3062. Primate space? Between lateral and canine in mx and between canine and 1st molar in
mandible. Seen in primary dentition (1.7 mm in Mx and 1.5 mm in mm)
3063. If mandibular canine erupt facially what may happen? Recession
3064. Child not Co-operative . dentist ignore him and stay calm and finish the work. what
method he is following? Extiction
3065. apart syndrome? Micrognathia, bulging eye (genetic disorder characterized by the
premature fusion of certain skull bones (craniosynostosis). This early fusion prevents
the skull from growing normally and affects the shape of the head and face. In
addition, a varied number of fingers and toes are fused together (syndactyly))
3066. which side of blade of cureete touch tooth first? Lower edge
3067. maximum dose of acetaminophene in 24 hrs? 6 tab 500 mg (4 gm)

3068. sensitivity and specificity calculation? sensitivity = tp/tp+ fn* 100, specificity Tn/ TN+
fp*100
3069. drugs for osteoporosis.. choose exception? Antichoolinergic
biophosphonate, etidronate, reclast+ fosmax
3070. dentinogenesis imperfecta in radiograph? Obliteration of pulp chamber, constricted
cervical portion of enamel, conical crown
3071. osteoredionecrosis, which is most associated? a) bisphosphonate b)maxilla c) mandible
d) 40 gy? Mandible (radiation above 65 gy)
3072. in u.s which is most commonly asso with osteoporosis..1.estrogen level2 steroid
use3.bisphosphonate. and other? Estrogen level (biophosphonate is used for the
treatment of osteoporosis)
3073. ortho single tooth crossbite.. which spring will you use for correction? z spring for
crossbite and finger spring for diastema
3074. cleidocranial dysplasia? Multiple supernumery tooth, hypohydrosis, hypotrichosis and
hypodontia
3075. Veneer reduction in the middle third of crown? 0.5 mm
3076. Glass post advantage? Opacity
3077. bur no 245 and 330 difference? 245 – longer – 3 mm, 330 - shorter – 1.5 mm
3078. #30 h file which has 0.16 mm diametere at taper so its diameter at 5 mm? file is
tappered in decreased at 1 mm 0.1 mm.. added 0.5 mm..in 0.16 mm
3079. Perimplantitis causative bacteria? Gm negative rods and anaerobic
3080. Macroglossia not seen in? Hyperparathyroidism
3081. Battle sign? it's fracture of middle cranial fossa
3082. Type 1 error, P value is 0.05 and result is 0.01? False
3083. Epi reversal? Phentolamine
3084. Avulsed tooth? 7-14 days
3085. Elective ends CI? A) leukemia B) Recent Cardiac procedure or something C)
Chemo/radio therapy ? Recent MI of <6 months and angina
3086. What is not covered in ethics? Fees
3087. Which line angle is missing in DO Cavity? Mesioicclusal
3088. Cusp reduction? Resistance form
3089. Common respiratory condition in dental office? Hyperventillation
3090. Muscle paralysis, lower face? Long face
3091. Crown reduction how? Just as the natural shape of tooth
3092. Asthma? Leukotrines
3093. DD of DI, exclude? Ectodermal dysplasia
3094. Smooth surface? Straight cut fissure
3095. Fluoride limit? 0.7-1.2
3096. Motion sickness? Scopolamine
3097. BDZ? Flumazelin
3098. Bells plays also asso with? Herpes
3099. Oral finding of TB? ulcer on tonsils and enlarged
3100. One old person lots of class 5, may be in 6-7 teeth, which one to use? Composite or
GIC? GIC

3101. 40 yrs old, excellent oral condition but has. Deep groove? Observe
3102. What you will not use for sterilization? Cloth
3103. Sialolithiasis ? Warthins duct (no gland name)
3104. Immature tooth what is best? Cold
3105. Cleft palate? Multifactorial
3106. After wearing denture, saliva increase.. what is it? Parasympathetic of saliva
3107. Common lymphoma of jaw? Burkitts
3108. Increase keratinization which flap? Lateral pedicle
3109. LA dose on child based on what? Weight
3110. Status epileptics? if diazepam not in option, picke midazolam
3111. Which is not tooth related? Nasolabial
3112. Fluoride which ion replace? Hydroxyl
3113. SJogrens syndrome effects? xerostomia, keratoconjunctivitis sicca, rheumatoid
arthritis
3114. Xerostomia drug? Antipsycotic
3115. Working side interference and protrusive interfernce1 question? Working BULL,
Protrusive- DUML
3116. Prostho case which clasp to use? Ibar clasp
3117. denturebase :Support or stability or retention? Stability and support
3118. damage to nerve during Inf alveolar injection? Lingual nerve
3119. Radiograph of fibrous dysplasia of jaw? Ground glass appearance
3120. Antibiotic prophylaxis do we need or not? antibiotic prophylaxis for prosthetic heart
valves, bacterial endocarditis, congenital heart disease, pulmonary shunts! other than
these not required
Patient Selection: The current infective endocarditis/valvular heart disease guidelines
state that use of preventive antibiotics before certain dental procedures is reasonable
for patients with:prosthetic cardiac valves, including transcatheter-implanted
prostheses and homografts; prosthetic material used for cardiac valve repair, such as
annuloplasty rings and chords; a history of infective endocarditis;
a cardiac transplanta with valve regurgitation due to a structurally abnormal valve;
the following congenital (present from birth) heart disease:b unrepaired cyanotic
congenital heart disease, including palliative shunts and conduits any repaired
congenital heart defect with residual shunts or valvular regurgitation at the site of or
adjacent to the site of a prosthetic patch or a prosthetic device
3121. Pain to ears, which teeth? Mandibular molars
3122. Longer bur 245 or 169? 245
3123. Girl with many caries teeth?Amlgam,Rmgic,Gic,composite? GIC
3124. Cervical caries which filling?? GIC
3125. Most radiosensitive ??Muscle,bone marrow,nerve cells? Bone marrow
3126. Which drug is antianginal? Nitrates
3127. Trendelberg position? For hypovolemic shock
3128. Ectodermal dysplasia feautres? hypo/anodontia, hypotrichosis, hypohidrosis
3129. Creidocranial dysplasia features?? absence of clavicle, supernumerary teeth
3130. Which tooth loss causes arch length deficency?? Primary Canine

3131. Elderly people ?? Medicaire
3132. Asked about Dry heat process what happens?? Protein Coagulation
3133. Which drugs are not used with gingiko? Aspirin
3134. Alcoholic patient which test?? INR
3135. Which antibiotics is not cellwall?? pencillin,cephalosporin
3136. Tetracyclines?? protein synthesis
3137. Where to put rest ?? towards or away from edentulous? away from edentulous
3138. Antifungal drug systematic?? Fluc
3139. What causes osteoradionecrosi? radiotaion therapy
3140. Drug for gingival hyperplasia? dilantin, phenytoin, calcium channel block
3141. Drugs for xerostemia? atropin, scopalamine, propantheline
3142. Crepitus while opening and closing which disorder? Osteoarthritis or rheumatoid
arthritis? Osteoarthritis
3143. Venner middle reduction how much? 0.5 mm
3144. Cocain side effect? Mydriasis
3145. Diazepam side effect? Teratogenic, cleftlip/palate
3146. Negative value calculation? Tn/tn + fn
3147. If vdo increases what you will do? Redo bite rim registration
3148. Patients has caries at gumline and have to make rpd what will you do with that tooth?
Inlay, Onlay, Full ceramic crown, 3/4 crown? Full ceramic crown
3149. Joint and margin for all ceramic crown and metal crowns? Shoulder with butt joint 90
degree, Reduction at margin 1mm
3150. more mercury in amalgam what will happen? Marginal fracture and increased
corrosion, increase in setting expansion and decrease in strength
3151. Which wall is not present in class 5? Pulpal
3152. Retention groove class 2 amalgam? Axiobuccal and Axiolingual
3153. Making rpd wat you consider first? Frame design
3154. Xray tube changed to 8 to 16 how time will change? it decreases to 1/4 so its 0.25
second
3155. Md dimension for implant? The minimum mesiodistal dimension for two standard 4
mm implant is 1.5 mm (space between implant and tooth) + 4 mm (diameter of
implant 1) + 3 mm (space between 2 implants) + 4 mm (diameter of implant 2) + 1.5
mm (space between implant and tooth) = 14 mm
Note= if thay ask for 1 implant, answer will be 7mm or 6 mm if 7 is not in the options.
3156. Space between 2 implants? 3 mm
3157. long junctional epithelium? lanina dura and hemidesmosom
3158. Aspirin effect on what? thromboxane a2
3159. Dentist doing treatment without conset? Battery
3160. NO2 contraindication? copd,sinusinf, 1st trim of pregncy, ear infection
3161. Steriod drug when to test? 20 mg more than 2 yrs
3162. Bells palsy, which nerve? Facial nerve
3163. What to first check in crown? Proximal contacts

3164. Surface suseptible to carries? Pit and fissures
3165. What you check first in reevaluation first? BOP
3166. Dizapem mild effect, do what? thrombophlebitis
3167. Pt is 4 year , 0.25 taking fluoride how much additional fl will you give? 0.5 mg/dl
3168. To see mandible condyle which x-ray? CT (if there is no reverse tome or mri in option)
3169. Intraepithelium and nikolsky’s sign in which? Pemphigus vulgaris
3170. which tooth has low copper amalgam filling? One with discoloration near margin
3171. How to differentate between endo and perio lesion? Tooth Vitality test
3172. Fissured tongue syndrome? Merkelson roestheal syndrome
3173. Naloxone poisoning? To treat opioid poisoning
3174. Comparison between inlay and onlay? Cusp involvement
3175. Onlay and direct comp? just one appointment for composite About which grooves to
prevent buccolingual? Small crown. Faciointerproximal groove for 3/4, facial grooves
for retention and proximal grooves for stability
3176. Pregnant pt? left side, right hip up
3177. Hemorrhage in mn after extraction due to /fragidity, fibrinolysis? fibrinolysis
3178. Function of mid palatine suture in set of denture? give support, retention,both? give
support
3179. child when cry become blue ? inc in heart rate or dec? inc in heart rate
3180. Correction of an inadequate zone of attached gingiva on several adjacent teeth is best
accomplished with a/an? a) apically repositioned flap, b) laterally positioned sliding
flap. c) double? apically repositioned flap (We use apf to correct attached gingiva. It’s
distal wedge that is ci with inadequate gingiva)
3181. Smoker patient what don’t u see: a) Increased BOP b) decreased gingival inflammation?
Increased BOP
3182. Pt takes too much opioid, what do you see? a) Insomnia b) Irritability c) Headache d)
cold? Irritability
3183. child come to u bec her upper teeth set behinf the lower but in the radiograph the child
look like cl 2? What type of profile ? convex or concave? concave
3184. An uncooperative 5 year old child has a carious lesion in her primary mandibular second
molar. There is no tooth mobility, but the practitioner notes a small, draining sinus tract
adjacent to the tooth. Which of the following is t/t of choice? a) Extraction b)
Pulpectomy c) Indirect pulp therapy d) Calcium hydroxide pulpotomy e) Formocresol
pulpotomy? Pulpectomy
3185. pt positive ept ,sensitive to cold and linger pain,pain to specific tooth?irreversible
pulpitis, symptomatic irrive with periodontal, symptomatic irr with apical absucss?
irreversible pulpitis
3186. what do you see when your max is constricted by 3mm? a) bilateral cross bite b) shift
midline towards the effected side c) shift midline towards the unaffected side? bilateral
cross bite

3187. moth eaten appearance seen in? Acute osteomyelitis, Ameloblastoma, Ewing sarcoma,
Burkitt lympona
3188. which of following is not radicular cyst? apical ,lateral, residual and paradental?
paradental cyst
3189. sialo odontogenic cyst other name? Glandular Odontogenic Cyst
3190. Stafne Bone cyst? Near mylohyoid ridge, Shows submandibular gland lesion in
hystopatho, pseudo cyst, Below inferior alveolar canal
3191. reactive arthritis: tmj inflammation conjunctivitis? The three most common symptoms
of reactive arthritis are arthritis, conjunctivitis, and urethritis. The onset of symptoms
typically occurs one to four weeks following the initial infection and may present
acutely or develop slowly over time. It can occasionally occur years after the initial
infection.
Type of reiter s syndrome. Urination conjunctivitis joint pain, Discomfort pain occurs
in area away from the source . Usually due bacterial infection in genitals. Pain or
disconfort during urination. localized area of inflammation with erosion of condyle
and fossa
3192. Blue sclera? Di type 1 and hypophophatasia include osteogenesis imperfecta hence
they can be the answers too
3193. mandibular retrognathia? teacher Collin
3194. fluoridation dose required for 6 months old? No
3195. complete epithilzation occur after how many days after surgery? and when complete
maturation? 7-10 days and maturation 21-28 days
(epitheliazation = 10 to 14 days
maturation = 40 to 45 days
maturation of scar = 12-15 months)
3196. correct sequence of plaque.. signaling, biofilm, plaque acc, one is maturation n
colonization? Pellicle biofilm materia alba plaue (association- adhesion- proliferation-
micocolonies- biofilm formation- Growth or maturation)
3197. Bacteria seen in pericoronitis? Streptococci and Anaerobic like prevotella and
bacteroids
3198. drug need folic acid to taken with? sulfonamides
3199. phenobarbiturate? Long acting, Anticonvulsant in epilepsy (Moderate acting is - Seco
and Amobarbital)
3200. if its less than 0.3 no bw 0.3-06 still no and above? 0.25
3201. Sequence of shade selection? Hue Chroma Value (source- Mosby)
3202. organism in rct? e fecalis killed by mta
3203. Okc? Most recurrent and present in Gorlin synd
3204. 1:50000? 0.036 mg adrenalin
3205. cartige vol in north America? 1.8 ml
3206. Flame shaped bur? To reduce lingual tooth preparation in veneer (however in
textbook sturdvent it says flame shaped burs can be any carbide or diamond and it is
used for removing excess composite mainly on facial surface)
3207. Inverse square law? If radius increases twice then intensity decrease to 1/4th

3208. Nsaid, antipyretic? effect on hypothalamus ( by inhibition of PG synthesis in
hypothalamic temperature center)
3209. Coumodulin? Anticoagulant, PT/INR
3210. Demerol? Meperidine or synthetic opiod, narcotic treat moderate to severe pain
3211. Naproxen? Agonist antagonist of receptor Opioid, 8hrs effect strong analgesic, Long
acting Nsaid (non selective COX)
3212. Cholinergic? increase salivation- miosis- bronchoconstriction- vasodilation-
bradycardia, also Increase laceimationa and sweating
3213. Potassium sparing? A milo ride, Trimmers, Spironolactone, Eplorenon (1- aldosterone
antagonists - spirinlactone,eplerenone 2)Na channel blocker - amiloride , Triamterene)
3214. Ortho fix appliances? Bracket and arch wire, quad helix
3215. Referral not given to oral surgeon/endodontist: a) Proximity to Inferior alveolar, B)
Mesial angulation, C) Inability to produce profound anesthesia? inability to produce
profound anesthesia
3216. Removal of bone for improvising the bony contour: a) Ostectomy, B) Osteoplasty?
Ostectomy
3217. Plaque removal for large embrasures: a) water pik, b) inter proximal brush, c) wooden
stimulator, d) tooth pik? inter proximal brush
3218. Root tips that were associated with a radiolucent lesion. Upon biopsy, there was a sheet
of neutrophils seen. What is the diagnosis? A) Periapical cyst, b) Abscess, c) cemento
osseous? Abscess
3219. Discoloration of veneer after two weeks. Cause? Amines
3220. lateral ceph given, f the profile was concave or not. SNA=87, SNB=81? Convex
3221. SNA=87, SNB=82. Diagnosis? Maxillary Protrusion, Mandibular retrusion, Maxillary
retrusion? Maxillary Protrusion
3222. Study that is used for incidence. A) cross sectional, b) RCT, c) longitudinal, d) case
control? Longitudinal (cohort shows incidence)
3223. Ginseng contraindicated with? Aspirin
3224. While making alginate impression, there was a swelling associated with the upper and
lower lips? Angioedema
3225. Gracey curettes: a) have one edge on the lateral surface, b) blade angulated at 90
degree, c) triangular cross section? have one edge on the lateral surface. (Gracey-one
cutting edge, Blade angleg 60 degree to shank, Semicircular crosection)
3226. Black triangle disease? Gum recession
3227. Quorum sensing? it is an interaction b/w bacterial cells in plaque matrix
3228. Cause of diuresis in pregnancy? Pressure on bladder
3229. Measloma seen with? SLE
3230. Malignant tumor cause? Parenthesis
3231. Acron record the centric? True
3232. Cervical lymphadenopathy multiple myeloma? not shown on pano only on Lateral
oblique

3233. 14 mm crowding- ortho and surgery, ortho only, surgery only? Ortho and surgery
3234. how to treat a patient. give an order ex: perio, endo, operative? Perio then endo then
operative then ortho last
3235. Currete for mesial and distal? 11 and 12 for Mesial and 13 and 14 for distal
3236. most common organism in implant failure; same as regular dentition? Gram negative
anaerobics
3237. how to treat a patient with implant supoorted dentures: fluouride? Neutral sodium
fluoride
3238. Battle sign? Mastoid fracture
3239. Rate limiting step in tooth movement? Enamel, Cementom, Dentin, Bone? Bone
3240. X-ray sensor resolution? Special resolution, Chemical resolution, Detector resolution?
Spatial resolution (Phosphorus crystals)
3241. Salivary gland tumor with perineurial invasion? Adenoid cystic carcinoma
3242. Women with enlarged periodontal ligament and involvement of ramus or condyle?
Osteosarcoma (because condyle is involved, if just angle was involved, it would be
syctemic sclerosis)
3243. What is the reason of salivation of patient wearing new denture? Parasympathetic
reflex activated
3244. Reason of pt with cleft palate can’t swallow? soft palate can close the pharynx (acc to
DD)
3245. Click sounds when you closing the mouth? Condyle lies posteriorly to the disk (
Reduction upon closing)
3246. Subgingival caries? Crown lengthing according to DD
3247. Short crown what to use? Full crown, PFM according to DD
3248. Aspirin what is not true? 1) Increase gastric acid or 2) low blood flow to kidneys? low
blood flow to kidneys
3249. Pinkham precooporative child notion? Pre-cooperative child is less than 3 yrs...
potentially cooperative is 3-8 yrs.. and cooperative is above 8 yrs..
3250. Gardner syndrome? Intestinal polyps, multiple osteoma and skin and soft tissue
tumor, supernumery tooth
3251. Underdeveloped zygoma and ears? Treacher choline
3252. Best type of amalgam? admixed high copper
3253. Why one condyle is small one is normal? Pano error or Previous fracture or Facial
deformities? Pano error
3254. First stage of BRONJ? CHx rinses to be ensued
3255. retention and resistance form of short crown , very long options.? Proximal boxes and
vertical grooves
3256. If junctional epi is formed after periosurgery or flap , how to confirm it ? A) clinically b)
histology c ) substraction d ) ct? Clinically
3257. what muscle will impinge and cause sore throat in complete denture: options was
masseter , buccinator , superior constrictor? Superior constrictor
3258. how to protect root under overdenture, fluoride or metal coping? metal coping.

3259. pt come , had a cardiac arrest and you did cpr , pt is not responding , what dentist will
do in dental office, 1) leave the pt , 2) give epi intravenously ,3) increase the rate ? Give
epinephrine
3260. For optimum esthetic while settting maxillary denture, the incisal edge of maxillary
teeth should follow? Lower lip while smiling
3261. if we cover mid palatal suture by denture , what its consider? Resitance form only,
Retention only, Both retention and resitance? Retention form only
3262. Laser wavelength? Infrared
3263. cancer spread form other body part to mouth by? tongue, or floor of mouth or posterior
manbible? Posterior mandible
3264. What is the best outcome obtained when giving intrapulpal anesthesia? Back pressure
or Fast onset in 30 sec? Back pressure (the way to have best result is back pressure and
the result is fast onset in 30 seconds)
3265. which bacteria causes elastenase, collagenase? (Choose Pseudomonas aeruginosa if in
option)
3266. Lateral periodontal abscess is best differentiated from the acute apical abscess by? pulp
test
3267. plasma cell disorders? A) multiple myeloma B)lymphoma hodguin? multiple myeloma
3268. Which situation least require insulin? A) trauma B)stress C)corticoid reposition? Trauma
3269. Herpangina is caused by? A) epsteinbar virus B) enterovirus? Enterovirus
3270. Material least resistant? A)lithium dissilicate B)high leucite? high leucite
3271. Which anethetic without vasoconstrictor is best to use? A)lidocaine B)articaine C)
mepivacaine? Mepivacaine
3272. Do not use in myasthenia gravis? A)erythromicine B)peniciline C) imipinem? imipinem
3273. Broadest spectrum antibiotics? A)ampicilim B)pen v potassic C)pen g procaine D)pen g
potassica? pen g procaine
3274. most common found? A) odontoma B)ameloblastoma C)ameloblastic fibroma?
Odontoma
3275. Smoothest cutting but not efficient? carbide bur
3276. Nitrous oxide side effect? nausea
3277. Pt with many sinus fistula? actinomycosis
3280. Anterior guidance? both horizontal and vertical
3281. garre osteomyelitis? onion skin
3282. chronic osteomyelitis? moth eaten
3283. scleroderma? purse string mouth + extrusing teeth
3284. von Recklinghausen? Cafe au lait spots; lisch spots on iris; crowe sign= axillary freckles
3285. fibrous dysplasia? ground glass
3286. pagets dis? cotton wool
3287. cherubism? bilateral; soap bubble ; perivascular cuffing
3288. multiple myeloma? punched out
3289. how many percent have access to fl community water? a.90 b.20 c.40 d.80? 80
3290. which one is class 2? a.Vicodin b.Percocet? Percocet

3291. INR? a.intrinsic pathway b.extrinsic pathway c.prothrombin? extrinsic pathway
3292. which is correct about conjugation? a.adding a molecule to the drug b.making the drug
more lipid soluble c.increase in the effect of drug? adding a molecule to the drug
3293. which of these cognitive behavior decrease in a normal process of aging? a.learning b.
attention c.reaction time? Learning
3294. Deepest part of the occulsal rest for RPD? marginal ridge
3295. Disease most common in men? hemophilia
3296. Absolute contra of papoose strap? a cooperative child
3297. Most common complication of maxilla extraction? Hemorrhage (go with infection if
hemorrhage not in option)
3298. what sound is affected if incisors too far superiorly n anteriorly? F and V (Fricative)
3299. Best (conservative) method to close a 1 mm non patho diastema in a young adult is?
composite
3300. If a patient doesn’t have 3rd molars how many furcations will he have in mxi arch? 16
(to make the calculation simple there are three furcations for maxi teeth mesial distal
and Buccal so (4 molars * 3 furcations = 12), 1st pm is bifurcated, that means it has 2
furcations (2*2=4). We have 16 furcations.
3301. Most common site for mandi fracture? Condyle
3302. Implant analogue used to? replicate the position of implant on the implant
platform
An implant analogue is an implant replica and is inserted into the set impression
material before the cast is poured. Impression coping is attached directly to the
implant fixture head. Impression copings facilitate transfer of the intraoral location
of the implant to the same position on the laboratory cast. Impression copings can
be either screwed into the implant body or screwed or snapped onto an implant
abutment.
3303. distance from adjacent tooth and the implant? 1.5mm
3304. most common site for graft? Iliac
3305. Complication with distraction osteogenesis? Nerve damage

3306. During IANB bleeding is caused due to puncture into which artery? inferior alveolar
artery

3307. the incision for int bevel in which direction is it directed? the internal bevel incision
(reverse bevel) starts at a distance from the gingival margin and is aimed at the
bone crest.
3308. For gingivectomy where is the incision directed? above mucogingival junction
3309. Why do we remove bone during modified widman flap? to achieve a good tissue
adaptation to the neck of the teeth.
3310. Montelukast and zakirlucast what type of drugs in relation to their effect on
leukotriene? Block leukotriene (cys-LT1) receptors
3311. What would one prefer distal rest or mesial rest? always go for mesial rest (mesial to
edentulous area)
3312. Gardner’s syndrome u will also expect to see? Intestinal polys
3313. Where to punch the hole for a class 5? Facially
3314. Which movement of the eye is restricted in fracture of the floor of the orbit? Sup
(remember SO4 LR6)
3315. which category does chronic periodontics primary bacterias has? Red complex bacteria
(also learn about orange complex)
3316. where to store scrap amalgam? Plastic sealed container
3317. Primary tooth intrudes 5mm on a 3 year old? Observe
3318. Analog (definition)? Is a replica of the actual implant, for lab purpose
3319. Distance between implants? 3mm (between mental nerve 5mm - between vital tissue
2mm - buccal, lingual, maxillary sinus, nasal cavity and inferior border all are 1mm -
between adjacent natural teeth 1.5 - 2-3mm below cej of the adjacent tooth)
3320. Taurodentism (definition)? apical enlargement of pulp
3321. Cross sectional study? descriptive study, used for prevalence and incidence, there is no
correlation in these studies, no cause and effect relation.
Cross-sectional study—study in which the health conditions in a group of people who
are, or are assumed to be, a sample of a particular population (a cross section) is
assessed at one time. Consider the hypothesis that drinking alcohol increases the risk of
developing oral cancer. If researchers chose to conduct a cross-sectional study to
compare the occurrence of oral cancer among men who are not alcohol drinkers. The
researchers could then determine whether there is an association between the
cannot determine whether the outcome (in this case, oral cancer) occurred before the
men started drinking or if it developed as a result of some other cause (e.g., metastasis).
3322. Hazard communication? (OSHA) and one to identify what materials are named
hazardous) – chemical hazard MSDS, For general hazard OSHA. MSDS regulated by
OSHA through Hazard Communication Standard.
Hazardous chemicals—the OSHA hazard communication standard requires employees
to receive training about the risks of using hazardous chemicals and the safety
precautions required when handling them. Employees must be trained in identification
of hazardous chemicals and PPE to be used for each chemical. This training must occur
within 30 days of employment or before the employee uses any chemicals and annually

thereafter. Just as with the blood-borne pathogen standard, a written plan identifying
employee training and detailing specific control measures used in the work- place must
be compiled for hazardous chemicals. Penalties can be imposed on the employer if the
office is not in compliance
3323. Clinical trials? Clinical trials attempt to evaluate the effects of a treatment. A clinical
investigation.
3324. Community trials? in a community trial, the group as a whole is studied rather than the
3325. Radio resistant cells? Nerve
3326. Ectodermal dysplasia? anhidrosis (no sweat glands) and Hypothricosis (decrease in
hair) Hereditary ectodermal dysplasia.(1. X-linked recessive condition that results in
partial or complete anodontia. 2. Patients also have hypoplasia of other ectodermal
structures,including hair, sweat glands, and nails. Microdontia.)
3327. INR, What it measure? extrinsic pathway, intrinsic pathway? 0.8 -1.3 normal – for
surgery on patients taking anticoagulants 2-2.5
3328. Patient in dialysis? do dental treatment day after dialysis
3329. The more common site of caries? pit and fissures
3330. Arthroscopy? Steroid injections, disc manipulations, have a look in joint space. Surgical
treatments for temporomandibular disorder . 1. Overview—surgical treatments of the
TMJ include arthrocentesis, arthroscopy, disc repositioning, disc repair or removal,
condylotomy, and total joint replacement. Arthroscopy involves the placement of two
cannulas to allow access for intracapsular instrumentation of the superior joint space.
Disc manipulation, disc release, posterior band cautery, and disc repositioning and
stabilization techniques all have been described. Arthroscopy appears to be an effective
modality in a select group of surgical patients and offers a potentially less morbid access
to the joint.
3331. More common psichiatric pathology in older? Depression (Mania as secondary choice)
3332. Patient said “I don’t have time to quick smoking? Precontempation
Precontemplation — an individual is not considering a behavior change. Contemplation
— an individual begins to consider a behavior change. Preparation — preparing to take
steps to change (o en expresses a desire to change a behavior). Action — an individual is

engaged in taking action toward behavior change (o en requires support for his or her e
orts). Maintenance — an individual attempts to maintain a changed behavior.
3333. Least likely to recur? AOT
3334. RPI I bar fracture what do you do? Soldering
3335. Macroglosia is not common in? Hyperthyroidism
3336. Clean tongue to prevent? odor
3337. Geographic tongue? benign migratory glossitis, erythema migrans, Common (2% of
population) benign condition of the tongue of unknown cause. Appears as white
annular lesions surrounding atrophic red central zones that migrate with time.
Occasionally symptomatic (mild pain or burning). No treatment necessary
3338. Nsaid who does not affect palettes? Celecoxib, selective cox 2 inhibitors
3339. Multiple Myeloma first sign? bone pain
3340. Cause of mucocele? trauma
3341. Incisal guidance? Vertical and horizontal overlap
3342. Nsaid preferred for kids? preferred nsaid for kids is Ibuprofen, if not NSAID then
acetaminophen.
3343. Bur used to polish porcelain? diamond
3344. Downcoding? insurance only paid for 1 out of 2 procedure.
3345. K sparing drug? Spironolactone, amiloride, triamterene - K+-sparing diuretics qreduce
the driving force for K+ movement into the lumen.
3346. Virax in oral cavity? Virax (acyclovir) - Acyclovir is an antiviral agent with activity
against Herpes simplex virus types 1 and 2, (HSV-1 and HSV-2) and varicella zoster
virus (VZV).
3347. What procedures you cant do in AIDS patient? No prophylaxsis, because candida
3348. Opiods effects? Miosis, constipation, cns depression, also respiratory depression, and
ONLY MEPERIDINE mydriasis
3349. Characteristics of band and loop? Doesnt prevent sobre-eruption of opposing tooth. Its
non functional
3350. Least fracture resistant? lithium, feldpathic, zirconia - The order of chipping resistance
(from least to greatest) was: feldspathic porcelain and a leucite glass ceramic (which
were similar), followed by the lithium disilicate glass ceramic and the two resin
composites (which were similar), and finally the zirconia which had the greatest
resistance to chipping.
3352. Patient with bizarre behavior and disorientation you give what? glucose
asymptomatic VITAL TOOTH. Radiopacity may be caused by low-grade pulp irritation.
This process is asymptomatic and benign. It does not require endodontic therapy.
3354. 9 year old kid swollen gingiva, recurrent skin infections? Pemphigus (can be impetigo
too)
3355. What is easily curable? Hematoma
denticolla, forsythia.

3357. Sulfonamide MOA? COMPETE with PABA to inhibit PABAs actions, which prevents
Observe (Any lesion red or white doesn't go away for 2 weeks we should do biopsy)
3359. Radiolucency in primary molar furcation area? Pulpectomy - If 1st molar extraction
3360. Opaque porcelain features? Mask the metal and provide chemical bonding with metal
3361. If you take radiograph 10 Ma with 1 sec exposure and you take another x ray with 0.5
sec what mA will you give to get same density radiograph? 20 (qmAs = mA X time (sec)
10= x. 0.5 x=10/0.5 x = 20)
3362. 3mm lack of mandibular arch how you treat? lingual arch and observe
3363. Primary mandibular 2nd resembles to? Permanent first
3365. Mouth breather features? class 2 occlusion, adenoid facies, open bite, dry perioral
tissues.
3366. Where you give General A.? 2 year old kid needs lot of restoration
3367. When does dental lamina starts? 6 weeks
3368. What stage supernumerary occurs? Initiation
3369. What % of community water fluoridation? 74% - Mosby
3370. Multiple myeloma feature? bone pain? Yes, first sign, Punch out lesion, Bence jhon
proteins
3371. Lefort 1 includes what structure? Maxilla, hard palate, there is a sign of bilateral
hematoma on palate = guerin sign
3372. Smokeless tobacco causes what? Leukoplakia - verrucus carcinoma
3373. When you make rest on molar you make rest deep enough in? marginal ridge 1.5mm
3374. Abcess include marginal and interproximal gingiva called? Gingival abscess
3375. External bevel incision? Gingivectomy
3376. Pulpal anesthesia? Back pressure
3377. Primary teeth with occlusal convergence? Max first molar
3378. Short crown resistance and retention? Buccal groove
3379. White lesion on 75 yr old pt, from 19 years, what to do? Biopsy or cytology? Relining
and Observe
3380. Bur for porcelin cutting? Carbide burs
3381. Occlusal rest? On marginal ridge for support
3382. Systemic desensitization? teaches the person to replace the feelings of anxiety with
feelings of relaxation when the object or behavior is present
3383. What procedures cant be done on patients with AIDS? Many extractions together
cannot be done
3384. Characteristic of band and loop, does all EXCEPT? Prevent sobre eruption
3385. #9 about the 9y/o kid with swollen gingiva, taking meds for? recurrent skin infection
3386. Pic of a Xray, What is wrong with it? It was SUPER light
3387. what will be the reason for extraction, on an 18 y/o? to prevent pericoronitis
3388. A guy that had a bike accident, what can be the diagnosis? Myofacial Pain
3389. Epinephrine interferes with? hyperthyroidism
3390. Main cause of alveolar osteitis (dry socket)? fibrinolysis clot

3391. Frequent of cleft lip in Caucasian? 1:700
3392. Facial height divided into? vertical 3rds
3393. Most common impact tooth? upper canine (If 3rd molars are not in option)
3394. Schedule 2? Percocet
3395. Coil spring for uprighting? open coil spring to upright a molar. Coil spring tends to
"spin" premolars unless precautions are taken.
3396. A coil spring used over an arch wire segment to regain space should deliver a force of?
90 to 120gms
3397. A buccal coil spring is used to regain space between 1st premolar & 1st molar. The most
common post treatment complication is? Tendency for the 1st premolar to rotate
3398. Automated defibrilator, how does it work? discharge when needed
3399. Which bacteria causes collangenase? “Clostridium perfringens” secretes collagenase, a
proteinase of “Bacteroides gingivalis” has been reported to induce secretion of tissue
collagenase, this is suggested to be involved in the etiology of periodontal disease.
“Porphyromonas gingivalis” belongs to the phylum Bacteroidetes and is a nonmotile,
Gram-negative, rod-shaped, anaerobic, pathogenic bacterium.
3400. 15 year old has fever, malaise vesicle and lymphadenopathy? Primary herpetic
gingivostomatitis: Initial infections of HSVI, in some patients, the initial infection with
these viruses produces no noticeable clinical signs and can go undetected clinically. In
other patients, however, the symptoms resulting from this initial infection can be quite
severe, and it is these severe symptoms that are know as primary herpetic
Gingivostomatitis. Primary herpetic gingivostomatitis is contagious and requires careful
attention to prevent its spread. The initial infection with HSVI usually occurs in childen
or in young adults, but it can occur at any age. Primary herpetic gingivostomatitis signs:
Oral pain, difficulty in eating and drinking, swollen, red, bleeding gingiva, painful oral
ulcers, in the more severe clinical manifestation, this infection is associated with
symptoms such as pain, elevated temperature, a vague feeling of discomfort (malaise),
headache, and swollen lymph nodes (lymphadenopathy).
3401. Gingival cord disadvantages? Technique sensitive as the instrument offers poor tactile
sensation. It can potentially damage the periodontium.
3402. Somnolence? OPIOIDS
3403. Sequestrum seen in? A sequestrum is usually a complication of osteomyelitis and
represents devascularisation of a portion of bone with necrosis and resorption of
surrounding bone leaving a 'floating' piece. The sequestrum acts as a reservoir for
infection and as it is avascular is not penetrated by antibiotics. It usually requires
excision if cure is to be achieved. This is not seen only in osteomyelits, but also in
eosinophilic granuloma, fibrosarcoma and lymphoma.
3404. 3mm crowding in year old? observe
3405. Anterior teeth finish line? Subgingival
3406. Arch discrepancy? after the loss of mand 2nd molar
3407. Battery? no consent
3408. Autism in kid? repetition and consistency
3409. Which position is patient relations? Centric relation

3410. MOD amalgam fracture on occlusal surface but not at isthmus what to do? take mo
redo piece separate
Fracture of a Class II amalgam restoration at the junction between the occlusal and
proximal portions is the result of inadequate resistance form. When placing a Class II
amalgam in a primary tooth, with isthmus width should be 1/3 of the intercuspal
width. If an amalgam fracture occurs, it is most likely to occur here. An amalgam
restoration needs a minimum 1-mm thickness in nonstress areas and 1.5- to 2-mm
thickness in areas that may be under load. Except for class V amalgams, the prepared
walls generally converge to the exterior.
3411. Shape of mand access prep? Mandibular central incisors and canines – OVAL,
mandibular PMs – OVAL, mandibular molars – TRAPEZOIDAL.
3412. If pt injects LA intravs wat will happen? tachycardia
(LIDOCAINE is the local anesthetic that may manifest its toxicity clinically by initial
depression and drowsiness (rather than stimulation and convulsion). The initia effect on
the brain for local anesthetics is usually stimulation, then depression. However, it is
possible that the excitatory phase of the reaction may be extremely brief, or may not
occur (this is true especially with lidocaine and mepivacaine) causing patients to feel
drowsiness. *lidocaine & Mepivacaine can also show crossallergenicity. Usually, the
FIRST clinical sign of mild lidocaine toxicity is NERVOUSNESS. Mild toxicity can be caused
by an intravascular injection, unusually rapid absorption, or too large a total dose of the
local anesthetic. Clinical manifestations of a mild lidocaine toxicity related to CNS
excitation. Nervousness (increased anxiety), talkativeness, muscular twitching, perioral
numbness, increased HR, BP, RR. Lidocaine can skip the excitatory phase and go straight
to the depression phase drowsiness). If the clinical manifestations do not progress
beyond these signs with retention of consciousness, no definitive therapy is needed. The
lidocaine will undergo redistribution and biotransformation, and the blood level will fall
below the toxic level in a short time. Treatment of a sustained convulsive reaction to a
local anesthetic includes oxygen and Diazepam IV. If proper equipment and adequately
trained staff are unavailable, do not attempt injections. Possible side effects of lidocaine
systemic absorption (not necessarily toxic levels) are tonic-clonic convulsions,
respiratory depression, and decreased CO. EPI treats bronchospasm associated with
hypotension (i.e. anaphylaxis). EPI is the agent of choice to treat/reverse anaphylactic
reactions (given sublingually or subcutaneously) because it has desirable vasopressor
activity, bronchodilator properties, and has a rapid onset of action. EPI has stimulatory
effects on a & b adrenergic receptors. EPI treats hypersensitivity reactions. Common EPI
side effects: headaches, agitation (anxiety), and tachycardia. EPI is used with caution in
patients with high BP and hyperthyroidism. These patients may have an increased
sensitivity to EPI.
3413. Collagenase and elastase by which bacteria? Porphyromonas gingivalis – Plaque
bacteria produces ENZYMES (hyaluronidase, collagenase, chondroitin sulfatase elastase,
andproteases) that may initiate periodontal disease. • Collagenaseenzyme produced by
Bacteroides species that catalyzes collagen degradation (hydrolysis). • Hyaluronidase-
enzyme produced by Streptococcus mitans & salivarius that destroys the amorphous

ground substance. • Chondroitin Sulfatase-enzyme produced by Diptheroids that also
destroys amorphous ground substance.
3414. Bacteria in 2 day of plaque? Bacterial Colonization: Gram + rods and cocci - DD: Cocci
still dominate but there are increasing numbers of filamentous forms and slender rods.
Gradually the filamentous forms replace many of cocci. Within a short time after
cleaning a tooth, the pellicle coated tooth surface is colonized by gram (+) bacteria (i.e.
Streptococcus sanguis, Streptococcus mutans, & Actinomyces viscosus - rods). These are
the primary colonizers. 1. Primary Plaque Colonizers: DAY 1- GRAM (+) facultative
bacteria that are the constituents of EARLY (YOUNG) plaque, appearing within a short
time after cleaning a tooth. Streptococcus sanquis, Streptococcus mutans, &
Actinomyces viscosus. 2. Secondary Plaque Colonizers: are GRAM (-) bacteria
(Fusobacterium nucleatum, Prevotella intermedia,& Capnocytophaga species). Tertiary
Plaque Colonizers: consists of GRAM (-), ANAEROBIC RODS that appear 1 week after
plaque accumulation (Porphyromonas gingivalis, Campylobacter rectus, Eikenella
corrodens, Actinobacillus actinomycetemcomitans/AA, and oral spirochetes (Treponema
species).
3415. cervical burnout? CERVICAL BURNOUT (due to decreased X-ray absorption) - a
phenomenon caused by relatively low x-ray absorption on the mesial or distal surfaces
of teeth, between the edges of the enamel and adjacent crest of the alveolar ridge.
Because of this diminished x-ray absorption, these areas appear relatively radiolucent
will ill-defined margins. It is caused by the normal configuration of the affected teeth
(CEJ) which results in decreased x-ray absorption in those areas. These radiolucencies
should be anticipated when viewing x-rays of almost any tooth, and must not be
mistaken for a carious lesion.
3416. When sharpening instruments, the ________ of the blade should be placed at a ______
angle to the sharpening? Bevel, 45° (OPERATORY When sharpening an instrument, the
bevel of the blade is placed at an angle of 45 degrees to the sharpening stone. This
ensures maximum efficiency of the blade to sharpen the instrument.)
3417. The two MOST critical parameters for the prognosis of a periodontally involved tooth
are? ATTACHMENT LOSS (most critical) and tooth mobility
3418. Axial walls on onlay? For a cast onlay or inlay, ALL axial walls must be convergent or
there will be an undercut (DD). For an MOD onlay preparation, axial walls must
slightly converge from the gingival walls to the pulpal wall (for the same reason the
onlay would not seat if the axial walls diverged).
3419. The function of the direct retainer? is to retain the removable partial denture by means
of the abutments. Stabilization is provided by the minor connector. Support is
provided by the rest. The indirect retainers improve the efficiency of the direct
retainers. Direct retainers do not add strength to the major connector.
3420. Potassium sparing diuretic? Spironolactone, a potassium-sparing diuretic useful in
treating edema and heart failure, is a competitive antagonist at the aldosterone
receptor.
3421. Primary tooth with shortest occlusal table? Greater convergence of the buccal and
lingual walls results in a proportionately narrower occlusal table. This is more
pronounced in the MAXILLARY FIRST PRIMARY MOLAR than second primary molar.

3422. What opaque porcelain doesn't do? Opaque porcelain must mask the dark oxide color
and provide the porcelain-metal bond. Bond strength depends on good wetting of the
metal surface. Masking must be accomplished with the minimum thickness of
opaque—about 0.1 mm— leaving maximum space to develop a natural appearance
with body and incisal porcelains. DD: The opaque is applied first to mask the metal
and to give the restoration its basic shade.
3423. What is function of opaque porcelain EXCEPT? to help come up with a base/stump
shade
3424. Function of post? the primary purpose of the post is to retain a core in a tooth with
extensive loss of coronal structure. Posts do not reinforce the tooth, but rather weaken
it further by additional removal of dentin and by creating stress that predisposes to root
fracture. Post preparation. The primary purpose of the post is to retain a core in a tooth
with extensive loss of coronal structure. The need for a post is dictated by the amount
of remaining coronal tooth structure. Posts do not reinforce the tooth but further
weaken it by additional removal of dentin and by creating stress that predisposes to
root fracture. At least 5 to 7 mm of remaining gutta-percha is Recommended
3425. Why v record protusive relationship? A protrusive record registers the anteriorinferior
condyle path at one particular point in the translatory movement of the condyles.
Some clinicians use this type of record to determine the amount of space between
maxillary and mandibular teeth or occlusal rims to maintain balanced occlusion
throughout the mandibular functional range of movement when articulating teeth.
Christensen’s phenomenon refers to the distal space created between the maxillary and
mandibular occlusal surfaces of the occlusion rims of dentures when the mandible is
protruded. It is caused by the downward and forward movement of the condyles. BB -
The purpose of making a record of protrusive relation is to register the condylar path
and to adjust the condylar guides of the articulator so they equal the patient's condylar
paths. The mandible can protrude -10 mm. The protrusive record is probably the LEAST
reproducible maxillomandibular record.
3426. What is the purpose of making a record of protrusive relation and what function does it
serve after it is made? To register the condylar path and to adjust the condylar guides
of the articulator so that they are equivalent to the condylar paths of the patient.
3427. Marginal stain on class 3 composite, how would u treat? REPAIR ?? or replace? Replace
because marginal stain caused by microleakage.
3428. Color stability tegdma: tegdma inc color stability and dec viscosity produced by? bisgma
(BisGma has questionable color stability)
3429. IRM (Zinc Oxide Eugenol Cement) with PMM? Type III ZOE (Reinforced ZOE): a
temporary filling material (lRM) and thermal insulating base. The powder is composed
of zinc oxide and finely divided polymer particles (polymethyl- methacrylate) in the
amount of 20-40% by weight. The zinc oxide powder is surface treated by an aliphatic
monocarboxylic acid like propionic. Eugenol is the liquid. This combination of surface
treatment + polymer reinforcement results in a material that has good strength and
toughness which markedly improves abrasion resistance. Good for basing large and
complex cavities as it withstands the pressure of amalgam condensation, with minimal
effect on the pulp.

3430. Chelation? a chemical phenomena common to zinc oxide-eugenol and polycarboxylate
cements.
3431. The cement which has antibacterial property is? Zinc oxide Eugenol cement.
3432. Not used for cast rest? irreversible impression material
3433. Safety valve of no allow? 70 percent of nitrous oxide and 30 oxygen
3434. Most common reason for cardiac arrest in children? respiratory depression
3435. Minimum granulocyte count? Generally accepted reference range for absolute
neutrophil count (ANC) in adults is 1500 to 8000 cells per microliter (μl) of blood.
3436. Topical antifungal? Clotrimazole and miconazole used topically to treat candidiasis.
3437. Does premedications required? pt had knee replacement within 2years (ALL patients
during the first 2 years after joint replacement require antibiotic premedication. If
more than 2 years after prosthetic joint replacement pass with no complications, then
premedication is NOT required.
3438. MI within 6 months? Antibiotic prophylaxis given or not? DD: YES
3439. Distance for lateral cephalometric? 60 inches - The distance b/n x ray source and the
mid-sagittal plane of patient is fixed at 5 feet(60 inches), 6 feet is the distance
between operator and patient.
3440. Tooth removed socket tissue is examined found lymphocyte neutophills, (granulocytes),
and hemophiillc precursors? leukemia
3441. Tooth removed ..tissue is examined found inflammatory cells granulocyte? granuloma
3442. Pt had fracture and numbness on side on nose cheeks...fracture site? roof of orbit
3443. A patient experiences numbness of the left upper lip, cheek, and the left side of the
nose following a fracture of his midface. This symptom follows a fracture through?
infraorbital rim.
3444. Lower lip numbness is seen in what kind of mandibular fracture, ANGLE T/F (angle and
body)? True
3445. If prostaglandin is not there what will not happen? reduced platelet aggregation.
3446. Bisphosphonates is not used in? Osteomyelitis
3447. Drug conjugation? more ionic - Conjugation of drugs results in polar, water-soluble
compounds that are rapidly excreted in urine. Thus, the parent drug is effectively
rendered inactive and transported out of the body by this process.
3448. Middle aged guy with kidney failure due to Lithium overdose. What pain drug is less
expected to be nephrotoxic? Oxycodone
3449. Why do we need ruler in lateral cephalogram? For magnification – scale Calibration
ruler for magnification correction. Ruler to standardize the magnification rate of
radiographs.
3450. In removal of palatine tori which structure can be damaged? Greater palatine artery
her caries risk? Middle
still there. the radiolucency that surrounded the erupting teeth? Eruption cyst.
complication? The tooth had RCT and a very big amalgam fllg? Tooth fracture

pneumonia
3455. Middle aged Pat. With an one-tooth gap. If you want to close it orthodontically, what
will you expect? No bodily movement of the teeth, Rotation mesio-facially? Rotation
mesio-facially
3456. two small radioopacities in the bone where MD M1 was missing? Focal idiopathic
osteosclerosis.
3457. diagnostics of teeth on x-ray, if it is a proximal caries or burnout? If it is on every tooth,
it is most likely to be burnout!
3458. Test for kidney failure? creatinine
3459. RCT of a central maxillary incisor. What is true? it will be difficult compared to a normal
case, because canal was really obliterated.
3460. Pat. Bites down on his maxillary M1, which already had a super big amalgam filling, and
breaks off one of the cusps supragingivally. What tx? PFM
3462. How to treat his posterior cross bite? Hyrax appliance (banded type)—for skeletal
expansion, this is the most commonly used type of rapid palatal expansion/rapid
maxillary expansion appliance. Haas appliance: However, difficulty in maintaining
hygiene and possible inflammation of the palate are considered disadvantages by some
clinicians. Hawley-type removable appliance with a jackscrew— for skeletal or dental
expansion, this appliance may be used to correct mild posterior crossbites in children
and young adolescents. Quadhelix and W-arch—generally for dental expansion, these
appliances consist of heavy stainless steel wire with four (quad-helix) or three (W-arch)
helices that are incorporated to increase the range and flexibility.
posterior teeth? Palatine process of maxilla.
sinus lift
3467. Pat. With leukoplakia on lower side of the tongue. How to biopsy that? - In all cases,
leukoplakia must be completely excised since diagnosis cannot be made clinically (DD)
3468. What structure can be damaged while biopsying the lower side of the tongue? lingual
artery
3469. Pat. With HTN. Taking various meds. Long list, Beta-bloker among those. Which ones
lowers his BP? Lisinopril Lisinopril: ACE inhibitors, "inhibit" the conversion of inactive
Angiotensin I Angiotensin II (a vasoconstrictor). This causes peripheral vasodilation
and secondarily increases urinary volume excretion. Both actions cause reduced BP.
3470. Pat. Taking antidepresants. Having heavy bruxism. What is least likely to do to treat
him? except the one saying to lower his medication

would you biopsy that? excisional, because it was small
3472. lderly apt. taking various med. Including Aspirin 81mg. Would you stop Aspirin before
SRP? NO
3473. Middle aged woman who wanted all her teeth pulled out, had a radiolucency in the
canal of an endo treated upper canine. What could that be? Radiolucency in the canal
oral situation looks like that. All except? external tooth trauma.
3475. depressed guy, and his Amitriptyline med.? Tricyclic antidepressants are very likely to
cause xerostomia. Amitriptyline is especially potent in this regard. (Mosby) The most
common CNS adverse reaction is DROWSINESS. Anti-cholinergic adverse effects are dry
mouth (xerostomia), constipation, blurred vision, and tachycardia. Drug-induced
xerostomia must be treated palliatively with artificial salivary substitutes. – BB EPI
(vasoconstrictor) in local anesthetic injections must be used cautiously in patients taking
tricyclic antidepressants (Le. Elavil), Serotonin & NE reuptake inhibitors (Le. Effexor) to
avoid transient and significant increases in blood pressure. These antidepressants
greatly increase NE levels in tissues. In the presence of a vasoconstrictor administered
via a local anesthetic injection, the patient can experience a significant elevation of
blood pressure due to the vasopressor actions of the combination. – BB
3476. on picture it is obvious Class I relationship of 1st molars (MB cusp of upper 1st molar
occludes mesial buccal groove of 1st mand molar) but later there was on cephalometrics
pt has ANB=6.? SKELETAL CLASS 2 with dental class 1 (teeth may compensate for
dental disharmony) - SKELETAL CLASS 2, DENTAL CLASS 1
3477. on picture there is a very deep overbite (upper incisors covered 2/3 of lower incisors),
but canines position look Class I (cusp of upper canine occludes in between lower canine
and premolar) , and looking at anterior teeth what Class this pt has? Class ll. if anterior
looks like cls 2 div 2 along with deep bite +class 1 molar or canine relation termed as
DECKBISS
3478. On x-ray, there is max lat incisor with RCT done and crown, periapical RL (looks like old
RL 4 mm) and within RL RO in the middle... what is that? Hypercementosis
3479. Same Pt had this max upper lat inc and 1 st molar only left on that side. Pt Decided to do
RPD. 1) Because of the absence of canine it affects this lat inc long prognosis? True 2)
Because this upper denture has no vertical stop with mandible on that side it affects this
upper lat inc long prognosis.True
3480. pt has mild crowding in lower ant teeth, narrow arch, no crowding in maxilla, but
narrow arch, very little overbite (like 1mm), long face. she expected to have all, except?
Obtuse nasolabial angle (it can’t be obtuse angle because of the flarring of teeth)
restoring the space? distal rest with a buccal retentive clasp
3482. You are doing a wheel chair transfer, which of the following will you not do? not to use
the belt of the pt.
3483. Pregnant pt, When is the best time to treat her? Best time 2 nd trimester during
pregnancy.
3484. What meds can u give her or not? acetaminophen you can.

3485. What is most likely to lead her present with a syncope? pressure on IVC
3486. Old pt, 84 yo, what is your primary concern? involve a guardian in his tx plans
3487. Stubborn pt, comes in coz of dissatisfaction of his previous several dentists. Despite of
so many changes he still seeks for better prosthesis, what makes u determine if he will
be satisfied by your tx or not? the most affirmative and agreeing to what the pt was
saying, to build rapport and form of trust is most imp
3488. Pt on anti hypertensive drugs, anti diabetic drugs, some numerical readings, looked
normal? proceed with the tx
3489. Pt on no significant med history, past history of some surgeries, blood pressure comes
out to be a little high, what will you do next? measure BP after 15 mins and see what
comes up
3490. Pt has AIDS, his viral load is 1,000, T-cell count is 30, what will be your inference? his T-
cell count is too low and that might put him at a risk of infection
3491. AIDS pt in first stage. Which of the following will you notice? he is symptomless in this
stage
3493. Malignancies to the oral cavity from the rest of the body are most likey to end up in
which region? floor of the mouth
3494. Which equipments in the dental health clinic will need a signed something? Lasers
3495. Pt comes in with signs of physical assault, whom shall u contact first? talk to pts
guardian
3496. Denture wearing pt has pink raised lesions on the palate, what can it be? papillary
hyperplasia
remove it or not? Undercuts affecting the retention of the denture
chemical influences in the pdl (Application of orthodontic forces will provoke a
haemodynamic response in the pulp).
3499. Pt comes to you with a catheter, which fo the following will facilitate your tx? leave it as
it is and take detailed history again
3500. Drugs not to give to a pregnant lady? NO
behaviour into routine check ups instead of emergency visits only by dentist? Except
positive reinforcement (Reinforcement means behavior increases, we don’t want
that.)
3502. Patient had lateral crossbite, why? maxilla to small and lateral shift to the right side
3503. What to do with teeth S – teeth was ok? don’t treat but observe
3504. Profile of this child in cephalo How many teeth are missing. Had also some
supranumerary? count them.
3505. Tooth is painful? mand first molar. What to do? Extract
3506. What do you suspect? diabetes type II
3507. What is the first think you will do to treat this patient? Refer to the physicans
3508. What contribute to the future risk of caries in this patient, exept one, which one? many
sweets and bad diet (AMOUNT)

3509. Child with ADHD, What is he taking? amphetamine.
3510. He can’t sleep and eat? because of the treatment.
3511. He had insomnia, why? amphetamine (indirect acting symphatomimetic) Not to many
things during one appointment.
3512. Don’t use tell show do? False, we use it.
3513. ADHD is most common with: males or female? males
3514. if you can give child with ampfo Or should you lower the dose of amphetamine? No
need to adjust dose
3515. 8yr 7 months child with supernumerary anterior teeth. Patient had class 2 skeletal and
class dental malocclusion due to? missing canine teeth.
3516. SNA was 87 and SNB 82- what will we call? Maxillary protrusion
3517. patient had Hep A 20 years ago what lab test you need? Nothing. We don't care about
his hep A 20 years ago
3518. Probing depth is 5 and prob pass 2 mm apical from CNJ how much is the attachment
loss? 7 (5 +2 – remember here it says apical loss over probing depth so we add
otherwise we substract)
3519. most common cause of amalgam failure is? improper/problem with cavity prep
(contamination for fracture. Reference textbooks and decks. 100% confirm about it)
3520. High water/powder ratio results in? decrease in thermal expansion, decrease in setting
expansion, Decrease strength, Increase setting time.
- Dr. $atyam Joshi
Day 2
Pictures
1. pic of amelogenesis imperfecta

2. Radiograph showing odontoma
3. Hemangioma of tongue
4. Silolith
5. Odntoma
6. max sinus after extraction get enlarge
7. picture of rpd I bar
8. melanocytic macule
9. pyogenic granuloma
10. epulis fissuratum pic
11. Pic of inferior border of maxillary sinus
12. Pic of Nicotine stomatitis
13. Pic of papule
14. amelogenesis imperfect
15. dentinogenesis imperfect

16. hyperthyroidism condition of teeth in patho
17. Fusion,Gemination
18. Pictures Ranula
19. Dentigerous cyst
20. Periapical cemental dysplasia
21. condyles on panoramic
22. Rg imageof lateral wall of nasal fossa
23. Dentigerous cyst radigraph
24. Amalgam Tatooo
25. Dentinogenesis imperfecta
26. Coronoid process
27. Ameloblastoma
28. AOT
29. nutrients canals pic
30. maxillary process
31. Pyogenic granuloma pic
32. Xray tip of the nose
33. Pic. Of hyperkeratosis
34. fissured tongue
35. hemangioma
36. epulis fissuratum
37. ranula
38. opg to count supernumerary teeth
39. opg and clinical picture, identify gemination or fusion
40. Picture of vermillion border damage on lower lip
41. Picture to identify Fluorosis
42. leukemia
43. amelobrastic fibroma
44. Overdevelopment film
45. Picture-Hyoid bone( both sides)
46. pano- inferior border of mandible
47. pano of a pedo patient and dental age
48. DD of Nevus on palate (pic)
49. Panoramic of 9 year old kid.
50. Pic of geographic tongue
51. X-ray identification: - Median Palatal Suture, Zygomatic process of maxilla, Dorsal
Surface of tongue, Odontoma
52. PA x ray with max molars. R-O line under the filling
53. X ray for zygomatic process
54. x ray about R-O lesion b/w 24,25
55. x ray about R-L lesion b/w 20,21
56. recognize plaque in radiographs
57. recognize class 123 relationship
58. Panoramic xray.# 30 after RCT 3 year ago. Now has pain and positive percussion. There
is RL in the area. What can be the disease?
59. Picture: Amalgam Tatooo

60. xray about intermaxillary suture
61. xray of jaw fracture
62. pano of zxygomatic process of the maxilla .same can be found xray found in dd
63. X-rays/pictures: Dentinogenesis imperfect, Coronoid process, Ameloblastoma, AOT
64. Pic of geographic tongue on lateral view of tongue
65. Pano of ear lob
66. radiograph on aot , zygomatic process of maxilla, soft tissue of nose, hyoid bone, tongue,
stafne bone cyst, fibrous dysplasia
67. Picture-Hyoid bone( both sides) pano- inferior border of mandible
68. Mesial, distal, flush terminal plane picture
69. Picture of epulis fisrratum
70. Smokers palate picture
71. Leukoplakia tongue pic
72. dentinogenesis imperfecta x ray
73. Chronic pericoronitis in x ray
74. Lateral ceph with an arrow point on Mastoid process, coronoid process, ear lobe
75. Pic of decay in the rvg or pic
76. Orthokeratinised, Parakeratinised, Nonkeratinised
77. Gingival tattoo
78. arrow in the pano of hyoid bone
79. hyoid bone on the cephalo
80. Radiograph with multiple periapical radiolucencies
81. cementosseous dysplasia
82. Florid cementoosseous dysplasia
83. Radiograph of cementoblastoma, stafne cyst
84. Panoramic molar with amalgam filling.
Cases
Case 1- Patient with prosthetic knee replacement 6 month ago, H/O bypass surgery and
radiotherapy for prostate adenocarcinoma. Taking many medications.
Q 1 Reason for dry mouth? Xerostomia due to medication
Q 2 He need antibiotic prophylaxis for what reason? Recent knee replacement
Q 3 Has a white lesion on floor of mouth..It could be anything except SCC. Verrucous
carcinoma, Nicotinic stomatitis? Nicotinic stomatitis
Case 2- Girl 8 years..multiple extracted teeth due to caries, anterior cross bite, supernumerary
tooth
Q 1 When should be treated for cross bite? During erupting
Q 2 Preventive approach for caries? Pit and fissure sealants
Q 3 Maxillary 1st molar tilted (due to early loss of E)..what should be the treatment? Space
regaining appliance / Band and loop

Case 3: little girl 9 1/2 yrs old (w/ unerupted canine and pm).this child has allergy and
taking cetirisine.,
Q1. wat side effect this drug has?: internal staining,ext staining, dry mouth? dry mouth
Q2. teeth age of this girl which still have not erupted canine? which is older than 8,younger than
8, Below 9 years...? Below 9 years
Q3. this girl had lots of caries too on occlusal and Mes and distal of posterior teeth.
which tx: amalgam,composite, ss crown? ss crown (if caries involves more than 1 surface, go
with SSC acc to DD)
Case 4: woman pat 48 yrs old w bells palsy which happened a month ago:
Q1. effect of bells palsy how it recovered?
Q2. wat do you say to pt.? options: it will healed , self limited, healed by partially problem,
permanent problem.? self limited
Case 5: 68yrs old man w/ lots of meds and condition,angina,bis phosphonate.. he needs
extraction.
Q1. about prophylaxis?
Q2. about time of extraction?(relating to bisphospho? hyperbaric oxygen Therapy 3 months to
extraction
Case 6: case on asthmatic pt, picture of condyles on panoramic and

Q1. pt have osteoarthritis or rheumatoid arthritis? Rheumatoid (its asthma related)
Case 7: ANB angle is 5.8 and he in the clinical picture have cross bite anterior what will be
skeletal class? Class II
Case 8: Pedo, one was routine examination but found caries and what is tx for each tooth, about
his behavior and patient management, space maintenance, number of permanent teeth seen on
pano. She had a shunt placed some years ago. His pano had a oval radiolucency near the condyle
on both the sides
Q1. for what it was? all anatomical landmarks like external meatus or transverse canal etc?
Case 9: Pedo, was a girl with class 3 in primary teeth, although intraoral pics didn’t show
primary 2Ms, but anterior were edge to edge. She lost a lot of space
Q1. the cause of space loss, and space management, not space maintenance (look for small
words in the questions to answer wisely)
Q2. her facial profile?
Q3. her oral hygiene practices were poor, how to motivate her? Voice control, negative or
positive reinforcement? positive reinforcement
Case 10: Adult, a man with mand tori identification on pano, with no significant med history but
takes bisphosphonates.
Q1. how would you modify your plans?

Case 11: Adult, lady, had ortho done when she was teenager, now has upper front teeth lost, she
is about 40’s now.
Q1. reason for spaces
Q2. she had chelitis angularis, reason to that? Fungal/ vit B def
Q3. she had facia palsy, what would you tell the pt about the prognosis of this long term disease?
Q3. prostho management, placement of clasps, materials to be used, some teeth look like their
restorations are old, what will you treat these teeth with? (don’t get if her radiographs and no. of
teeth seen on x rays don’t match her clinical teeth)
Case 12: Adult, 50 yr up pt, she had trauma some time ago and lower 3 teeth were discplored,
upper right CI was RCt, apicectomy treated and she also had tori, but almost all teeth present.
Q1. what will you do about the tori?
Q2. what about the fractured crown, redo or repair?
Q3. the upper CI periapical lesion did not heal in 2 years what can it be? And how to treat it?
Q4. RCT bleaching and crowns ?
Case 13: Adult, young lady with regular dental tx, on OCP
Q1. what meds not to prescribe? Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol),
Felbamate (Felbatol), Oxcarbazepine (Trileptal), Phenobarbital (Luminal), Phenytoin
(Dilantin, Phenytek), Primidone (Mysoline), Topiramate (Topamax)
Q2. she had a palatal lesion, differentials?
Q3. she had unknown swellings in mand right post, vital teeth, differentials?
Q4. extracted the third molar but cant resolve the lesion? OKC (coz microscopy said they
found epithelial cells and inflammatory cells)
Q5. pdl management phases?
Q6. Hep a treated previously, what should u keep in mind? it is not a blood borne disease
Q7. if any special care or precautions needed?
Case 14: Adult, 90 year old man comes with his son as guardian, he has had tube ligation done,
some anti hypertensive tx, several teeth missing, mand psot ridge knife edge, he thinks his
dentures doesn’t fit any more.
Q1. his prostho tx?
Q2. had one radiopacity between two teeth, what can be dx? idiopathic osteosclerosis
Case 15: Adult, pt with very very poor OH, and retained root pieces, 3M present but no first or
second molars in some places, lower both 3M were semi-impacted and mesioangulated, he had
ameloblastoma, he had this drug for depression, for allergies, etc, and his treatment was based on
early, and late treatment plans, kinds of prostho tx, clasps, crowns, materials of choice, etc
Case 16: Restorations

Q1. height copper and low copper restoration? check X-ray and it has to be same, So look at
the photos and choose the different color. high copper content of amalgam are superior to
conventional amalgam because less likely to corrode and have less marginal breakdown, main
purpose of adding copper to amalgam is to decrease gamma 2 phase(tin mercury)

Case 17: ortho patient
Q1. has canine class 1 but ob and oj is minimal? mand crowding cuz tooth size are normal
Q2. Dental and chronical age
Q3. about RPI?
Case 18: Guy from Ethiopia had Hep B positive surface antibody-
Q1. what does this mean? he is fine, he has it and needs vaccine, he has it and needs some
medication? He is fine (previous exposure with hep B / must be vaccinated and he is not a
carrier)
Case 19: a scenario with a young girl

Q1. who had a trauma tooth with a “bubble on the gums”, she also drank a ton of soda? Bubble
on gum is related to absess
Case 20: some man who was very fat, had HT, -
Q1. what else can he have? Diabetes
Q2. which organ would be least effected knowing his condition… kidney, pancreas, thyroid or
colon-? Colon
Q3. what was least likely to cause his high caries rate? dry mouth (could be cariogenic food,
because in the case didn't say anything about what he is eating or if he drinks a lot of water)
Q4. Thyroid ? Htn never affects Thyroid whereas a thyroid disorder causes Htn
Case 21: A man who is smoker with knee replacement 6 month ago, White lesion under the
tongue. Brown pigment near midline of palate. Hypertensive, took many meds and he had weird
occlusion of post class II and anterior cross bite. Missing upper canine (premolar took place and
function as a canine, noticed it was missing when asked history) and the other side, he was
missing 1M.
Q1. The decision to give prophylactic antibiotic is based on: According to the patient AND
physician recommendation or preference?
Location of knee surgery
Extend of knee surgery
The years elapsed from the surgery
Q2. The cause for this pt occlusion is:
Class II molar and canine relationship
Class III molar and Canine relationship
Early loss of a maxillary tooth
Q3. What to do with the lesion, cytology or bio psy? Biopsy
Q4. if you would do emergency surgery to this pt, the MOST you would concern is Prolonged
bleeding or Cardiovascular issues? CVS (because of profound bleeding not prolonged, he was
not on aspirin)
Q5. Lesion could be any of these except: SSC, verrucous carcinoma, keratosis, actinic
stomatitis? Nicotine Stomatitis (reverse smoking to be exact cause smokers keratosis..
somekeless wont appear on palate.. they cause Verrucous Carcinoma. Nicotine melanosis
and stomatitis both by smoking)
Q6. The pigment is most likely caused by? smoking

Q7. The biopsy of the lesion came back with increase melanin in epithelial layer so the lesion is?
nicotine stomatitis-increased production of melanin by the normal number of
melanocytes(melanin 1q) A benign lesion on the hard palate typically associated with pipe
and cigar smoking.(smoke 2q)
Q8. RO body in upper 1PM socket? remaining root tip
Case 22: the case for young child, chephalometry, SNA and SNB no are given, and diagnosis of
skeletal class. Know them.
Case 23: A case about an 8 yr girl, early loss of upper M1 and M2, canine tilted distaly and perm
1M tipped mesial making the occlusion Class II posterior and cross bite anterior. Impacted
upper lateral with superneumary tooth blocking it.
Q1. effect of Orthodontic movement
Q2. When to correct ANT cross-bite: as soon as possible or wait till complete root formation of
upper incisors. As soon as possible
Q3. Will ant cross-bite cause movement of lower incisors? Yes
Q4. Gingival recession in lower incisors? True
Case 24: A case about a 22 yr old female with bad OH,

Q1. Pt needed to extract 2 lower impacted 3rd molars, do we do soft tissue biopsy BEFORE
extraction? No (done after extraciton)
Q2. Extraction of lower third molar has risk of? lingual nerve ingury
Q3. When you do an endo for lower molar with bad perio condition and a cusp breaks, what to
do?
Place a full ceramic crown
Place a ceramo-metallic crown
Place a temporary crown until the perio is ttted
Q4. How to motivate the pt for proper OH you do all except
Positive reinforcing
Pt something
Operanet conditioning
Motivational intervirwing
Carrot stick
Case 25: Diabetes case

Q1. Diabetes pt what is preferred -FPD or RPD? RPD
Q2. Palate with swelling and histological feature like peudostatifiedcolumner epithelium and no
effect on underlining cortical bone what is that pleomorphic or exostosis? pleomorphic
Q3. Case of HTN take medication lisinopril what happen? orthostatic hypotension
Q4. Aspirin 81mg - needs to stop during extraction if root tip and its easy to extract ? No need to
stop
Q5. Pt taking HTn drug, aspiring, amytriplin for what u need to consult physician? For asprine ,
consult with physician, Avoid NSAIDS with ACE, Beta
Q6. Good canine, restored lateral and need rpd for pm and molars on canine one side and molars
on lateral side, What do u not need? no need to correct canine bcz its not carious

Case 26: of 5 lower incisors and all have PFM and not good perio health. What you have to
prescribe? Mouthwash without alcohol , flossing daily ? Or another mothwasht?
Q1. hypo-salivation.? Mouthwash without alcohol
Q2. Amytryplin cause? hyposalivation
Case 27: 11 years old, kidney dialysis for 10 years and got transplant 1 year ago. He had
Hodgkin lymphoma 5 years ago, mitral valve and regurgitation. He is taking lot of complex
medicines
RG and clinical pictures shows that he has amelogenisis imperfecta
Q1. all are immunocompromised drugs except? know all immunocompromised names and
corticosteroids : Glucocorticoid , hydrocortisone, methylprednisolone, prednisone , (
triamcinolone , beclomethasone, budesonide, flunisolide) these are inhaled corticosetetiod
for astham treat. Other immunosuppresive, cyclosporin, azathioprine, methotrexate,
cyclophosamide
Q2. what drug can cause amelogenisis imperfecta? tetracycline cause amelogensis imperfecta
Q3. why his third molars are missing? Third molars do not erupt by 11 yrs age
Q4. bilateral radioopacity in mandible whats the dx? Cherubism
Q5. in a Rg canine was short in length whats the dx? AI, DI, Dentin dysplasia? DD
Q6. does he need Ab before procedures? No
According to new guide line mitral valve or without regurgrition dont need AB , check this
in dentin
Q7. why he has gingival enlargement? He was taking cyclosporine too
Case 28.: 14 years old, all 4 canines erupted buccally and has pigmented macules on her cheek,
asthmatic taking albuterol
Q1. albuterol can cause all except? increased salivary secretion
Q2. small white lesions on palate? Cause of inhaler its candidiasis
Q3. is nitrous oxide is contraindicated? Not contraindicated for Asthma
Q4. Will you explain the whole ortho tx to her parents and post complications like she may need
gingival grafts? Yes
Q5. The reason of pigmentation on her cheek? Proliferation of melanocites, proli of basement
cells, deposition of melanin or foreign body? Deposition of Melanin (According to DD)
Q6. will ectopically canine resorb #7 roots? True
Q7. Anb 6, class 1, 2, 3? Class 2
Q8. Clinicall picture what class, it was? class 1
Q9. Features of her face has everything except? incompetent lips
Q10. If she decided to extract premolars what forceps not to used? 150 upper 151 lower
Q11. In this case there the best treatment can be? a) extract all canines b) expansion of upper and
lower arch? expansion of upper and lower arch

Q12. the profile? convex depending in the photograph
Q13. what is the preventive treatment for this patient? a) sealant for #3,14, 19, 30 b) encourage
the patient to use brushing and dental floss c) use mouth wash? sealant for #3,14, 19, 30
Q14. what is the treatment of choice for tooth #19 if it is already catch the prob during
examination? a) compsite filling b) sealant c) no treatment? Composite filling (sealent is best
for age 6-12 according to DD)
Q15. What is the most costly to do to prevent declassification around the braces? a) varnish
every 6 month b) scaling every 3 month c) daily systemic supplement d) using mouthwash?
Varnish every 6 months
Case 29:, 45 years male, 2 pack smoke a day, dry mouth, lot of carious teeth, went successful
rehab for bad alcohol habits, seems he doesn’t drink now
Q1. will you prescribe Acetaminophen/oxycodone in this patient? no
Q2. missing canine will make max rpd compromised? True
Q3. If you use #7 in rpd will it compromise the tooth? Yes cause no posterior teeth and no
canine
Q4. Rg picture shows tori in maxilla and mandible both
Q5. 2*3 radioopacity on LI which has RCT on it, what is it? It is hypercementosis and will you
biopsy it
Q6. photo showing the patient has preparation about 0.5 from facial and incisal, what type of
restoration the patient lost? a) crown b) Veneer c) composite? Veneer
Q7. why not prescribe acetaminophen/ oxycodone on this pt?? pt. is alcoholic and cause
hepatotoxicity
Case 30: middle age female, smokes daily and she is fed up from falling restorations every time
and she wants to extract her all teeth, psoriasis in hands and feet
Q1. by doing what patient want, is conflict bw what two, autonomy, justice, nonm, bene?
Autonomy and nonmal
Q2. treatment options for her? Crowns
Q3. what clasp will you give in max RPD if you class II kennedy? RPI
Q4. why you can see condyles in PAN, bilateral fracture, osteoarthritis, rheumatoid arthritis?
Rheumetoid arthritis
Q5. radiolunceny in bw 8 and 9 it was? incisive foramen
Q6. if you want her to quit smoking the day of extraction would be the quit date and you give
Chantix 1 week beore the quit date? True
Q7. consent
Case 31: An Old woman with Parkinson Disease came to the clinic with her hus-
band. She had distal caries on maxillary molar.
Q1. Out of all the symptoms of Parkinson's disease which symptom is not important to dental

treatment?
A. Rapid Eye blinking
B. Tremor
C. Muscle rigidity
D. Loss of Automatic Movements
Q2. While working, the patient moved, and the dentist injured her near the cheek. Which artery
was injured and caused bleeding?
A. Buccal artery of maxillary artery
B. Labial artery of ECA
C. Facial artery of ECA
Q3. What is the first important thing to do after the patient starts to bleed?
A. Stop bleeding
B. Call an oral surgeon
C. Call her husband.
D. Inform patient
Case 32: A 32 years old lady with cervical neoplasia comes to your clinic for ulcers
on one side of her palate. Drug history of taking oral contraceptives.
Q1. Action of Oral contraceptives?
A. Dec. Lh
B. Inc Lh
C. Inc Fsh
D. Dec. Fsh
Q2.What could be the cause of the ulcer
A. CMV
B. EBV
C. HPV
Q3. Patient is most likely to have which neoplasia
A. HIV
B. Cervical cancer (can also be true, depends on details)
C. Rubeola
Q4. What can be done for diagnosis of this viral disease except?
A. Saliva examination
B. Examination of fluid from vesicles
C. Oral examination (can also be true, depends on details)
Q5. Epithelium of this ulcer
A. Orthokeratinised
B. Parakeratinised
C. Nonkeratinised

Case 33: Pedo, routine examination but found caries and what can be tx for each tooth, his
behavior and patient management, space maintenance, number of permanent teeth seen on
pano.? She had a shunt placed some years ago His pano had a oval radiolucency near the condyle
on both the sides, what it was? external auditory meatus
Case 34: Pedo, a girl with class 3 in primary teeth, intraoral pics didn’t show primary 2Ms, but
anterior were edge to edge (look for stuff like that to answer such questions).
She lost a lot of space, the cause of space loss and space management? (not space maintenance,
so look for small words in the questions to answer wisely)
her facial profile, her oral hygiene practices were poor, how to motivate her? Voice control,
negative or positive reinforcement? Positive reinforcement
Case 35: Adult, a man with mand tori identification on pano, with no significant med history but
takes bisphosphonates, how would you modify your plans? Take a note that he takes
bisphosphonates, so answers will go accordingly
Case 36: Adult, lady, had ortho done when she was teenager, now has upper front teeth lost, she
is about 40’s now, reason for spaces, she had chelitis angularis, reason to that, and she had facia
palsy, what would you tell the pt about the prognosis of this long term disease?
Simple prostho management, placement of clasps, materials to be used, some teeth look like their
restorations are old, what will you treat these teeth with? don’t get confused if clinical and
radiographic count of teeth do not match. Sometimes questions from that quadrant having
doubtful count might not come.
Case 37: Adult, 50 up pt, she had trauma some time ago and lower 3 teeth were discolored,
upper right CI was RCT, apicectomy treated and she also had tori, but almost all teeth present,
what will you do about the tori?
Q1. what about the fractured crown? redo or repair
Q2. the upper CI periapical lesion did not heal in 2 years what can it be? And how to treat it?
Q3. simple RCT bleaching and crowns?
Case 38: Adult, young lady with regular dental tx, on OCP, what meds not to prescribe, and she
had a palatal lesion, differentials? she had unknown swellings in mand right post, vital teeth,
differentials?
Q1. extracted the third molar but cant resolve the lesion, was? OKC, coz microscopy said they
found epithelial cells and inflammatory cells
Q2. pdl management phases?
Q3. she had Hep A treated previously, what should u keep in mind? it is not a blood borne
disease

Case 39: Adult, 90 something year old man comes with his son as guardian, he has had tube
ligation done, some anti hypertensive tx, several teeth missing, mand psot ridge knife edge, he
thinks his dentures doesn’t fit any more, t his prostho tx?
Q1. he had this one radiopacity between two teeth, dx? idiopathic osteosclerosis
Case 40: Adult, pt with very very poot OH, and retained root pieces, 3M present but no first or
second molars in some places, lower both 3M were semi-impacted and mesioangulated, he had
ameloblastoma, he had this drug for depression, for allergies, etc, and his treatment was based on
early, and late treatment plans, kinds of prostho tx, clasps, crowns, materials of choice?
Case 41: A lady of 50s..black pigment on palate.

Q1. which black pigment is not present in oral cavity? Lentigo (LENTIGO MALIGNA à
usually occurs in the elderly. It is most common in sun damaged skin on the face, neck, and
arms (Hutchinson freckle).
Q2. Pt has some non- painful, hard, movable swelling in the floor of the mouth (pic shown) pt is
not aware about it? Lymphoepithelial cyst
Q3. Pt has some non-painful lesion in 2nd molar region. Pt is not aware of the lesion. which of
the following can be D/D but NOT? Lateral periodontal cyst
Q4.O Keratocyst - Multiple lesions found in children may be a component of the? nevoid basal
cell carcinoma syndrome (gorlin syndrome). the chief site of involvement is the mandible in
the posterior body and ascending ramus. often associated with impacted tooth. tendency to
grow in an anterior-posterior direction without bony expansion
Case 42: A child with missing lower right 2nd primary molar...
Q1. Space loss is due to? mesial & distal drifting of both ant & post teeth
Q2. what kind of occlusion? class 1 on left class 3 on right
Q3. Where does the chronic abscess seen in primary teeth? Furcation
Q4. How to maintain the space for the missing 2nd primary molar with drifting of two adjacent
teeth? we cannot as space is lost, we need space regainer its an ASDA ques
Case 43: child case

Q1. pt has multiple class 1 caries what filling? Amalgam as amalgam is preferred by the
boards other reason composite has C factor and GiC has less strength
Case 44: elderly male 40 pack year cigarette smoking history with multiple drugs, gastric
bypass, hypertension?
Q1. What can change this pt to stop the habbit? Self motivation through behavior education
Q2. Behaviour of the society can be modified by? a) Surveying b) Study conduction?
conduction

Case 45: pt with upper and lower few teeth. Pt has financial restriction
Q1. How to raise his occlusion? by fabrication of upper complete denture
Case 46: Case on Management of transient ischemic attack- read the drugs? – antiplatelet
agents are recommended over anticoagulants to reduce risk. Combining aspirin with
dipyridamole is suggested over aspirin alone. Clopidogrel is a reasonable substitute for people
allergic to aspirin. A transient ischemic attack (TIA) is a brief episode of neurologic dysfunction
caused by ischemia (loss of blood flow) – either focal brain, spinal cord, or retinal – without
infarction (tissue death). TIAs have the same underlying cause as strokes: a disruption of
cerebral blood flow (CBF). Symptoms caused by a TIA resolve in 24 hours or less. Antiplatelet
medications such as aspirin are generally recommended. They reduce the overall risk of
recurrence by 13% with greater benefit early on. The initial treatment is aspirin, second-line is
clopidogrel (Plavix), third-line is ticlopidine. If TIAs recur after aspirin treatment, the
combination of aspirin and dipyridamole may be recommended. Some people may also be given
modifiedrelease dipyridamole or clopidogrel. An electrocardiogram (ECG) may show atrial
fibrillation, a common cause of TIAs, or other abnormal heart rhythms that may cause
embolization to the brain. An echocardiogram is useful in detecting a blood clot within the heart
chambers. Such people may benefit from anticoagulation medications such as heparin and
warfarin.
Case 47: 11 years old, kidney dialysis for 10 years and got transplant 1 year ago. He had
Hodgkin lymphoma 5 years ago, mitral valve and regurgitation. He is taking lot of complex
medicines. RG and clinical pictures show he has? amelogenisis imperfect
Q1. All are immunocompromised drugs except? know all immunocompromised names and
corticosteroids: Glucocorticoid, hydrocortisone, methylprednisolone, prednisone,
(triamcinolone, beclomethasone, budesonide, flunisolide) these are inhaled corticosetetiod
for astham treat. Other immunosuppresive, cyclosporin, azathioprine, methotrexate,
cyclophosamide
Q2. What drug can cause amelogenisis imperfecta? Tetracycline
Q3. why his third molars are missing? he is 11 year still third molar not erupted
Q4. Bilateral radioopacity in mandible whats the dx?
Q5. in a Rg canine was short in length whats the dx? AI, DI, DD? Dentin dysplasia
Q6. does he need Ab before procedures? no need to antibiotic
Q7. why he has gingival enlargement? He was taking cyclosporine too, cyclisporine lead to
gingival enlargement
Case 48: 14 years old, all 4 canines erupted buccally and has pigmented macules on her cheek,
asthmatic taking albuterol
Q1. albuterol can cause all except? increased salivary secretion
Q2. small white lesions on palate? Cause of inhaler it is? candidiasis
Q3. is nitrous oxide is contraindicated? NO

Q4. Will you explain the whole ortho tx to her parents and post complications like she may need
gingival grafts? YES
Q5. The reason of pigmentation on her cheek? Deposition of melanin
Q6. will ectopically canine resorb #7 roots? YES
Q7. Anb 6, class 1, 2, 3? 2
Q8. Clinical picture what class? class 1
Q9. Features of her face has everything except? incompetent lips, her lips looked fine
Case 49: 45 years male, 2 pack smoke a day, dry mouth, lot of carious teeth, went successful
rehab for bad alcohol habits, seems he doesn’t drink now
Q1. will you prescribe Acetaminophen/oxycodone in this patient? no
Q2. missing canine will make max rpd compromised? YES
Q3. If you use #7 in rpd will it compromise the tooth? Yes cause no posterior teeth and no
canine
Q4. Rg picture shows tori in maxilla and mandible both
Q5. 2*3 radioopacity on LI which has RCT on it, it is? hypercementosis and will you biopsy it
Case 50: middle age female, smokes daily and she is fed up from falling restorations every time
and she wants to extract her all teeth, psoriasis in hands and feet
Q1. by doing what patient want, is conflict bw what two, autonomy, justice, nonm, bene?
autonomy, nonmalficiency
Q2. treatment options for her?
Q3. what clasp will you give in max RPD if you class II kennedy? RPI
Q4. why you can see condyles in PAN? Rheumatoid arthritis
Q5. radiolunceny in bw 8 and 9 it is? incisive foramen
Q6. if you want her to quit smoking the day of extraction would be the quit date and you give
Chantix 1 week beore the quit date? True
Q7. consent
Case 51: An Old woman with Parkinson Disease came to the clinic with her hus-band. She had
distal caries on maxillary molar.
Q1. Out of all the symptoms of Parkinson's disease which symptom is not important to dental
treatment? Rapid Eye blinking
Q2. While working, the patient moved, and the dentist injured her near the cheek. Which artery
was injured and caused bleeding? Buccal artery of maxillary artery
Q3. What is the first important thing to do after the patient starts to bleed? Stop bleeding
Case 52: A 32 years old lady with cervical neoplasia comes to your clinic for ulcers on one side
of her palate. Drug history of taking oral contraceptives.
Q1. Action of Oral contraceptives? Oral Contraceptives: Ovulation is inhibited by suppression of
FSH and LH.? Dec. Lh and Dec. Fsh

Q2.What could be the cause of the ulcer? HPV
Q3. Patient is most likely to have which neoplasia? Cervical cancer
Q4. What can be done for diagnosis of this viral disease except? Oral examination
Case 53: Cases with asthma women. She takes albuterol.

Q1. What can she has? xerostomia.
Q2. She had an attack what can you give her, choose three? b.oxygen c.steroids d. beta2
agonist
Q3. Reason of asthma? constriction of brionchole. And inflammation of brionchole. Read it
Q4. What happens in asthmatic bronchiole? constrict
Case 54: some man who was very fat, had HT, -
Q1. what else can he have? Diabetes (can also be Thyroid coz Htn never affects
Thyroid whereas a thyroid disorder causes Htn)
Q2. which organ would be least effected knowing his condition? kidney, pancreas, thyroid or
colon? Colon
Q3. what was least likely to cause his high caries rate? dry mouth(could be cariogenic food)
Case 55: F/28 years old/ healthy just taking antihistamines…everything else was fine.
Q1. Crown on #4 with recession…u can see a little metal on the gingival. She wants to cover it
what to do? A whole new crown
Q2. Amalgam on the buccal groove of tooth #19, she wants that “black dot” off because of
esthetics, what to do? Composite
Q3. Missing tooth #20, if she gets a coil spring on #19 how will the moment work…will it push
the molar distal only, push the PM mesial…make force on BOTH tooth?
Q4. A nevus on her cheeks on the external examination pics. Is it Melanin proliferation, melanin
deposition?
Case 56: case of the 10 y/o who had kidney transplant and hodkins. Taking Cellcept, prednisone,
cyclosporin
Q1. Which drug of the long list he had is immunosuppressive? mycophenolic acid- CellCept
Q2. Why does he have amelogenesis? genetic
Q3. Why does he have gingival enlargement? Cyclosporine
Q4. On his xray, he had a vertical radiolucent line, bilateral on his molars. In the middle of the
body of the mandible what was it?
Q5. why doesn't he have 3rd molars? genetics (if age is not in option)
Random case and pic questions
1. Picture: “erythematous, bleeding swelling” mandibular swelling right next to premolars

on R side? pyogenic granuloma

2. Picture of vermillion border damage on lower lip. And lesion >10cm require? incisional
biopsy
3. opg and clinical picture, identify gemination or fusion. gemination there is single pulp
canal
4. pano of zxygomatic process of the maxilla .same xray found in dd
5. Radiograph with multiple periapical radiolucencies.( cementosseous dysplasia)? Florid
cementoosseous dysplasia
6. Radiograph of cementoblastoma, stafne cyst? stafne cyst is by lingual, angle of mand,
and it is radioluc, and cementobl is radioopaque, at apical of molars, you can see it
at the mandible angle, but it is tilted to lingual if the angle
7. Panoramic. all mandibular molar with amalgam filling. Which one is low copper?? Deep
filling
8. photo showing the patient has preparation about 0.5 from facial and incisal, what type of
restoration the patient lost? Veneer
premolars on R side? pyogenic granuloma
10. Pic like multiple pyogenic granuloma interdental ? ewing sarcoma
11. Lymph node pic in floor of mouth? lymphoepithelial cyst
12. Pic history of new ceramic crown 7 days back two red spots adjacent caused by – herpes
virus, apthus ulcer, chemical burn? apthus ulcer
13. Pic of lesion near lip- recurrent herpes 1, recurrent herpes 2, recurrent apthus,
candidiasis? recurrent apthus
14. Pic of Lesion under denture - irritation fibroma, papilloma, periapical granuloma?
irritation fibroma
15. MUBL? for retrusion
16. DUML? for protrusion
17. dis advantage of widman flap and the procedure of widman flap? Does not eliminate
pocket, and does not increase attached gingiva
18. composite is intact but discolored what will u do? Polish and repair
19. picture with multiple periapical radiolucencies ? cemebtoosseous dysplasia
20. differentiate between irreversible pulpits and pulp necrosis? (Necrosis pup is dead pulp
and not respons to pulp test, While irreversable pulpitis is vital inflamed pulp and
response to pulp testing)
21. half radiolucencies line on ramis ..identify ..fracture , air space ,two options were more
...? Fracture
22. An old patient came with a slowly growing swelling in the angle of the mandible, On
radiograph there is radiopaque lesion with radiolucent border. Whats your diagnosis?
Ossifying fibroma
23. on radiograph periapical radiolucency is evident? Focal sclerosis osteomyelitis.
24. RG pictures Rg ameloblastic fibro odontoma ? Mixture epithelium and mesenquima,
encapsulate. Mandible area common. Radiolucency with opacity
25. Rg of dentigerous cyst? Around unerupted tooth, symetrycal round RL with RP
border, starting at the CEJ, associated with the crown of an unerupted teeth
26. very well defined round radiolucency in panoramic, posterior mandible below inferior
alveolar canal? static bone cyst (stafne defect) see xary in google

27. X-Ray: Black women, middle aged, anterior radioluceny (can be radio opaque)? cemento
osseous dysplasia
28. picture PA of between the trabecula of the bone close to the apex of the teeth? nutrient
canal
29. Picture of vermillion border damage on lower lip. And lesion >10cm require? incisional
biopsy
30. Probing depth is 5 and prob pass 2 mm apical from CNJ how much is the attachment
loss? 7 (5 +2 – remember here it says apical loss over probing depth so we add
otherwise we substract)
31. a patient is getting recurrent ulcers in mouth that heal spontaneouly accompanied by a
picture, so by seeing a pic one thing you can confirm is that it is aphthous ulcer? bechets
syndrome
32. Radiograph to identify the soft tissue? tip of nose along the root tips of centrals
33. Radiograph to identify? external auditory meatus
34. Picture of flared out anteriors asking Class? Class II division I
35. Cross allergy for anesthetics? Know esters and amides
36. radiographic image of (painless lesion, bone expansion)? fibrous displasia (ground
glass appearance to identify)
37. Cross sectional studies, Observational study which studies both exposure and disease
at the same point of time
38. Clinical trial, Experimental study done after etiology is found to test possible
treatment
39. Leukemia picture? bleeding gums
40. management of hypertension? Chlorothiazide as a diuretics for mild cases and
Guanethidine for severe cases. (Mild- b blockers and thiazides, Moderate ace
inhibitors and alpha blockers, Severe- neuronal depletion agents)
41. opg with a radio lucency extending from post mand to ant? okc (confusing option can
be ameloblastoma , but ameloblastoma spreads labiolingually rather than ant post)
42. pano with radiolucency seen with unerrupted tooth? dentigerous cyst
43. On left side max 1 M MB cusp touch man 1 M DB cusp, on right side no max 1M, there
is max PM2 touch central fossa on man 1M, and max 2M MB cusp behind man 1M DB
cusp (pic). Which class Angle on each side? Class 2
44. Which micro organism in rhomboid glossitis? Pic? Candidiasis
45. Tmj x rays, which xray you do for tmj? MRI
46. X ray - disc of TMJ.
47. Panoramic - auditory meatus
48. PA xray of ant max teeth - soft tissue of nose
49. Pano X-ray 14 yr old pano 30 is rct. Pt complained just enlarge and hyper occlusion?
fibrous dysphasia
51. Elderly pat. With a super old bridge on lower back teeth. Has sensitivity when drinking
cold drinks. Which tooth most likely to be the reason? The bridge had 3 abutment teeth.
On the x-ray one tooth had a post, another one had a big radiolucency, So, there is only
molar, which look normal with a little subgingival calculus? True, Both teeth are non
vital, Only tooth with calculus is vital

52. Middle aged woman who wanted all her teeth pulled out, had a radiolucency in the canal
of an endo treated upper canine. What could that be? Can be fracture gp condensation
or inflammation from coronal pulp (not internal resorption because tooth is
endodontically treated)
oral situation looks like that. All except? external tooth trauma
54. Ameloblastoma x ray? Soap bubble apprearance
55. Guy from Ethiopia had Hep B positive surface antibody- what does this mean? he is fine,
he has it and needs vaccine, he has it and needs some medication? He is fine (previous
exposure with hep B / must be vaccinated and he is not a carrier)
56. a scenario with a young girl who had a trauma tooth with a “bubble on the gums”, she
also drank a ton of soda? Bubble on gum is related to abscess
57. Pic of generalized inflamed gingiva in upper teeth (can be a child) pt was treated for skin
disease for 2 month? multiple pyogenic in child
58. Xray of Paget? Cotton woll
59. Radiograph of a remaining root with an apical radiolucency. Remaining root was
extracted and the lesion was taken biopsy, results came back with many neutropils. What
is the lesion? Cyst? Abscess
60. Lateral ceph with an arrow point on? Mastoid process, coronoid process, ear lobe
61. a pic of buccal mucosa with yellow tiny eruptions a) fordyce granules 2) SCC 3)
papilloma? Fordyce granule (buccal mucosa - fat)
62. Radiograph of fibrous dysplasia of jaw day2? Ground glass appearance
63. a pic of teeth, what does the patient has? dentegenous imperfect
64. photo of the teeth, which tooth has low copper amalgam filling? One with discoloration
near margin
65. Picture of mucosa in lower lip? Hyperthrofia
66. Picture of this child 11 years old, Maxilary central ok but lateral in crossbite. Sth like?
How to treat? maxillary expander
67. Middle aged guy with kidney failure due to Lithium overdose. What pain drug is less
expected to be nephrotoxic? Oxycodone
68. Why do we need ruler in lateral cephalogram? For magnification – scale Calibration
ruler for magnification correction. Ruler to standardize the magnification rate of
radiographs.
69. In removal of palatine tori which structure can be damaged? Greater palatine artery
her caries risk? Middle
still there. the radiolucency that surrounded the erupting teeth? Eruption cyst.
complication? The tooth had RCT and a very big amalgam fllg? Tooth fracture
pneumonia

74. Middle aged Pat. With an one-tooth gap. If you want to close it orthodontically, what will
you expect? No bodily movement of the teeth, Rotation mesio-facially? Rotation mesio-
facially
75. two small radioopacities in the bone where MD M1 was missing? Focal idiopathic
osteosclerosis.
76. diagnostics of teeth on x-ray, if it is a proximal caries or burnout? If it is on every tooth,
it is most likely to be burnout!
77. Test for kidney failure? creatinine
78. RCT of a central maxillary incisor. What is true? it will be difficult compared to a
normal case, because canal was really obliterated.
79. Pat. Bites down on his maxillary M1, which already had a super big amalgam filling, and
breaks off one of the cusps supragingivally. What tx? PFM
81. How to treat his posterior cross bite? Hyrax appliance (banded type)—for skeletal
expansion, this is the most commonly used type of rapid palatal expansion/rapid
maxillary expansion appliance. Haas appliance: However, difficulty in maintaining
hygiene and possible inflammation of the palate are considered disadvantages by some
clinicians. Hawley-type removable appliance with a jackscrew— for skeletal or
dental expansion, this appliance may be used to correct mild posterior crossbites in
children and young adolescents. Quadhelix and W-arch—generally for dental
expansion, these appliances consist of heavy stainless steel wire with four (quad-helix) or
three (W-arch) helices that are incorporated to increase the range and flexibility.
posterior teeth? Palatine process of maxilla.
sinus lift
86. Pat. With leukoplakia on lower side of the tongue. How to biopsy that? - In all cases,
leukoplakia must be completely excised since diagnosis cannot be made clinically
(DD)
87. What structure can be damaged while biopsying the lower side of the tongue? lingual
artery
88. Pat. With HTN. Taking various meds. Long list, Beta-bloker among those. Which ones
lowers his BP? Lisinopril Lisinopril: ACE inhibitors, "inhibit" the conversion of
inactive Angiotensin I Angiotensin II (a vasoconstrictor). This causes peripheral
vasodilation and secondarily increases urinary volume excretion. Both actions cause
reduced BP.
89. Pat. Taking antidepresants. Having heavy bruxism. What is least likely to do to treat him?
except the one saying to lower his medication
would you biopsy that? excisional, because it was small
91. lderly apt. taking various med. Including Aspirin 81mg. Would you stop Aspirin before
SRP? NO
92. Middle aged woman who wanted all her teeth pulled out, had a radiolucency in the canal
of an endo treated upper canine. What could that be? Radiolucency in the canal

oral situation looks like that. All except? external tooth trauma.
94. depressed guy, and his Amitriptyline med.? Tricyclic antidepressants are very likely to
cause xerostomia. Amitriptyline is especially potent in this regard. (Mosby) The most
common CNS adverse reaction is DROWSINESS. Anti-cholinergic adverse effects are
dry mouth (xerostomia), constipation, blurred vision, and tachycardia. Drug-induced
xerostomia must be treated palliatively with artificial salivary substitutes. – BB EPI
(vasoconstrictor) in local anesthetic injections must be used cautiously in patients taking
tricyclic antidepressants (Le. Elavil), Serotonin & NE reuptake inhibitors (Le. Effexor) to
avoid transient and significant increases in blood pressure. These antidepressants greatly
increase NE levels in tissues. In the presence of a vasoconstrictor administered via a local
anesthetic injection, the patient can experience a significant elevation of blood pressure
due to the vasopressor actions of the combination. – BB
95. on picture it is obvious Class I relationship of 1st molars (MB cusp of upper 1st molar
occludes mesial buccal groove of 1st mand molar) but later there was on cephalometrics
pt has ANB=6.? SKELETAL CLASS 2 with dental class 1 (teeth may compensate for
dental disharmony) - SKELETAL CLASS 2, DENTAL CLASS 1
96. on picture there is a very deep overbite (upper incisors covered 2/3 of lower incisors), but
canines position look Class I (cusp of upper canine occludes in between lower canine and
premolar) , and looking at anterior teeth what Class this pt has? Class ll. if anterior looks
like cls 2 div 2 along with deep bite +class 1 molar or canine relation termed as
DECKBISS
97. On x-ray, there is max lat incisor with RCT done and crown, periapical RL (looks like
old RL 4 mm) and within RL RO in the middle... what is that? Hypercementosis
98. Same Pt had this max upper lat inc and 1 st molar only left on that side. Pt Decided to do
RPD. 1) Because of the absence of canine it affects this lat inc long prognosis? True 2)
Because this upper denture has no vertical stop with mandible on that side it affects this
upper lat inc long prognosis.True
99. pt has mild crowding in lower ant teeth, narrow arch, no crowding in maxilla, but narrow
arch, very little overbite (like 1mm), long face. she expected to have all, except? Obtuse
nasolabial angle (it can’t be obtuse angle because of the flarring of teeth)
restoring the space? distal rest with a buccal retentive clasp
101. You are doing a wheel chair transfer, which of the following will you not do? not
to use the belt of the pt.
102. Pregnant pt, When is the best time to treat her? Best time 2 nd trimester during
pregnancy.
103. What meds can u give her or not? acetaminophen you can.
104. What is most likely to lead her present with a syncope? pressure on IVC
105. Old pt, 84 yo, what is your primary concern? involve a guardian in his tx plans
106. Stubborn pt, comes in coz of dissatisfaction of his previous several dentists.
Despite of so many changes he still seeks for better prosthesis, what makes u determine if
he will be satisfied by your tx or not? the most affirmative and agreeing to what the pt
was saying, to build rapport and form of trust is most imp
107. Pt on anti hypertensive drugs, anti diabetic drugs, some numerical readings,
looked normal? proceed with the tx

108. Pt on no significant med history, past history of some surgeries, blood pressure
comes out to be a little high, what will you do next? measure BP after 15 mins and see
what comes up
109. Pt has AIDS, his viral load is 1,000, T-cell count is 30, what will be your
inference? his T-cell count is too low and that might put him at a risk of infection
110. AIDS pt in first stage. Which of the following will you notice? he is symptomless
in this stage
112. Malignancies to the oral cavity from the rest of the body are most likey to end up
in which region? floor of the mouth
113. Which equipments in the dental health clinic will need a signed something?
Lasers
114. Pt comes in with signs of physical assault, whom shall u contact first? talk to pts
guardian
115. Denture wearing pt has pink raised lesions on the palate, what can it be?
papillary hyperplasia
remove it or not? Undercuts affecting the retention of the denture
117. Ortho forces applied, what is least likely to happen? Differentiation of cells due
to chemical influences in the pdl (Application of orthodontic forces will provoke a
haemodynamic response in the pulp).
118. Pt comes to you with a catheter, which fo the following will facilitate your tx?
leave it as it is and take detailed history again
119. Drugs not to give to a pregnant lady? NO
behaviour into routine check ups instead of emergency visits only by dentist? Except
positive reinforcement (Reinforcement means behavior increases, we don’t want
that.)
121. Middle aged guy with kindney failure due to Lithium overdose. What pain drug is
less expected to be nephrotoxic? Aspirin, Ibuprophen, Oxycodone, one more?
Acetaminophen (if not in option, ibuprofen) (also in kidney failure we can give
tramadol, if not in option, oxycodon)
122. Why do we need ruler in lateral cephalogram? For magnification (if not in
option, go with measurement, reference carranza)
123. In removal of palatine tori which structure can be damaged? Greater palatine
nerve and artery
124. 10 y.o girl, with good OH, no caries but a child of divorced parents. How would
you rate her caries risk? Low, Middle, High? Low (child knows to take care of her OH)
(Debbatable with middle)
125. Hispanic guy, no insurance, needs tx. If you extract tooth 14, what is the most
expected complication? The tooth had RCT and a very big amalgam fllg. Sinus
perforation, Ridge fracture, Tooth fracture, Bleeding? Tooth fracture
126. Q. about that 10 y.o child case, where upper canines were closely to errupt, but
primary canines were still there. They asked about the radiolucency that surrounded the

errupting teeth. Options were different kinds of cysts and tumors.? Dentigerous cyst (if
not in option, go for eruption cyst)
127. Pat. Allergic to sulfa, which meds. Are contraindicated? Sulfonamides, bactrim
128. Middle aged Pat. With an one-tooth gap. If you want to close it orthodontically,
what will you expect? No bodily movement of the teeth, Rotation mesio-facially,
Rotation mesio-lingually, one more? Mesiofacially
129. A Q. about two small radioopacities in the bone where MD M1 was missing.
There were options about Odontogenic tumors, Root rests, Focal idiopathic
osteosclerosis.? Focal idiopathic osteosclerosis.
130. Q on that child case which bite relationship it has. Distal, Mesial, End-to-end
131. Test for kidney failure. Creatinin
132. Q on except for the 3rd molard, how many teeth was the child missing.
133. Q on RCT of a central maxillary incisor. What is true? it will be difficult
compared to a normal case, because canal was really obliterated.
134. Pat. Bites down on his maxillary M1, which already had a super big amalgam fllg,
and breaks off one of the cusps supragingivally. What tx. ? PFM Crown (not onlay in
this case)
135. On xray, opacity apical of a RC treated tooth. What could it be? Looked like
sealer.
136. Pat. Has very strange bite, posterior crossbite, Class 2 relationship on the molars,
but almost perfect overbite. What is the most likely cause? chose something with the
Canine
137. How to treat his posterior cross bite? Quad helix expander
138. Female pat. Wants all her teeth extracted, although they don't look as bad. Qs.
About what tx. Is appropriate.? Patient education
139. That 10 y.o girl had a very strange bite, with a skeletal midline deviation to the
left. They ask about the cause. Can be TMJ, condylar hyperplasia or bone tumor
140. On a lateral cephalogramm of the 10 y.o girl what is the radiolopacity that crosses
her posterior teeth? Maxillary sinus, Orbita, Zygomatic arch, Palatine process of maxilla?
Zygomatic arch
141. Hispanic Pat, without insurance. Missing teeth, needs tx. What is the least tx
indicated? sinus lift
142. Qs about that 10 y.o girl who was asmathic. Meds.? Albetrol
143. Old pat., heavy smoker with white patch on lip? Hyperkeratosis due to
smoking. (Can be leukoplakia too coz patient is smoker. Depends on exact case)
145. Pat. With leukoplakia on lower side of the tongue. How to biopsy that?
Exfoliative cytology
146. What structure can be damaged while biopsying the lower side of the tongue?
Lingual nerve, mylohyoid muscle
147. Pat. With HTN. Taking various meds. Long list. Lisinopril, Beta-bloker among
those. Which ones lowers his BP.? Lisinopril
148. Easy Q on tx. Of a RCT tooth with a big amalgam fllg.
149. Elderly pat. With a super old bridge on lower back teeth. Has sensitivity when
drinking cold drinks. Whisch tooth most likely to be the reason? The bridge had 3
abutment teeth. On the x-ray one toothe had a post, another one had a big radiolucency

and to me it looked dead! :-D So, it was the only molar, which looked normal to me with
a little subgingival calculus. So, I picked that!? True, Both teeth are non vital, Only
tooth with calcilus is vital
150. Pat. Taking antidepresants. Having heavy bruxism. What is least likely to do to
treat him. All options were correct, except the one saying to lower his medication!? lower
his medication
151. Pat. With pigmentation above maxillary lateral incisor. What could that be and
how would you biopsy that? Incisional biopsy (is small lesion)
152. A Q. about that elderly apt. taking various med. Including Aspirin 81mg. Would
you stop Aspirin before SRP? No, doesn’t need too stop baby aspirin
153. Middle aged woman who wanted all her teeth pulled out, had a radiolucency in
the canal of an endo treated upper canine. What could that be? Can be fracture gp
condensation or inflammation from coronal pulp (not internal resorption because
tooth is endodontically treated)
154. Another Q about her, showing a lateral upper incisor with post and crown, asking
how that post looks on the x-ray. Too narrow, too long, too wide, too short
155. Another Q about her. She had multiple fractured teeth, which were all previously
endo treated. Why does her oral situation looks like that. All except question. I took
external tooth trauma? external tooth trauma
156. Q. about that depressed guy? Amitriptyline med
157. Pt has all canines erupted ectopic, but the rest of occlusion looks fine, what should
be done? extract premolars and with fixed ortho move canines on their place
158. If she decided to extract premolars what forceps not to used? 23
159. q about the profile? It was convex depending in the photograph
160. what is the preventive treatment for this patient? encourage the patient to use
brushing and dental floss
161. What is the most costly to do to prevent declassification around the braces?
varnish every 6 month
162. what is the treatment of choice for tooth #19 if it is already catch the prob during
examination? compsite filling
163. a patient broke his tooth – max 1 pm. He had excellent hygiene. Tooth broke 2
mm under the gingiva. It has big amalgam filling. What you do? RCT and post and
crown.
164. Case with the man with allergy to penicyline and clindamycine..He had a joint
Replacement? He doesn’t need prophy for that
165. if he need prophy for treatment what you give him? Azitomycin
166. He has terrible pain in the face. During the night too. It lasts 5 sec. It comes and
go away. What is it? Neuralgia
167. Case with 5 years old girl She had all first molars and erupting max central.
Second central incisors – had accident and was avulsed. What you do with concussion?
observe and control max central
168. her age. Is her dental age? the same as bone age
169. She had dark changes in her gingival? racial changes sth like this
170. on her gingiva above her central incisor.? It was sinus tract Because of her
accident 3 mouth earlier.
171. She has lateral crossbite – how to treat it.? maxillary expansion

172. Can you give her for daily use CHX – T/F? True
173. You should show her and her parent how to brush T/F? True
174. Man with hyperlipidemia. Triglyceride is high. What do you suspect? Metabolic
syndrome.
175. Metabolic syndrome can cause cancer of all except one? Thyroid
176. Treatment of this patient? Initial therapy (OHIs – SRP – Caries control – crown
lengthening)
177. Man smoking. He had also rheumatoid disease. He has hypertension. Tekes
Propranolol. Is taking Chantix. What he can have? Xerostomia
178. Which drug causes dry mouth? Chantix
179. You give him LA with epi, what happened? blood pressure elevated
180. It doesn’t work – what else can you give him? a. bupropion Zyban b. nasal spray
c. nicotine gum? Nicotine gum
181. Which ASA classification he is? class II. RA (ASA classification)
182. Sequence of tx plan? (emergency – caries control – reevalute – definitive
treatment – maintenance ) ECRDM
183. Children with cleft palte? Pano and cephalo. Given SNB - 73 and ANB -2 what
angle class is it.? class III malocclusion.
184. Patient had lateral crossbite – why? maxilla to small and lateral shift to the
right side.
185. What to do with teeth S – teeth was ok? don’t treat but observe
186. Profile of this child in cephalo How many teeth is missing, Had also some
supranumerary? count them.
187. Can’t implant in? cleft palate
188. Tooth is painful, mand first molar. What to do? Extract
189. Obese man with hypertension - 190/110 Didn’t treat it. Haven’t been in doctor 10
years. No medicaments. He is going to the restroom 2 per night, What do you suspect?
diabetes type II
190. What is the first think you will do to treat this patient? Refer to the physicans
191. What contribute to the future risk of caries in this patient, exept one, which one?
many sweets and bad diet (AMOUNT)
192. Child with ADHD, What is he taking? amphetamine
193. He can’t sleep and eat? because of this treatment
194. He had insomnia, why? amphetamine (indirect acting symphatomimetic) Not
to many things during one appointment.
195. Don’t use tell show do? False, we use it.
196. ADHD is most common with? males
197. if you can give child with ampfo Or should you lower the dose of amphetamine?
No need to adjust dose
198. case about 8yr 7 months child with supernumerary anterior teeth. Patient had class
2 skeletal and class dental malocclusion due to? missing canine teeth.
199. SNA was 87 and SNB 82- what will we call? Maxillary protrusiom
200. patient had Hep A 20 years ago what lab test you need? Nothing. We don't care
about his hep A 20 years ago
- Dr. $atyam Joshi

Special thanks to the people who participated in all group discussions and gave the best share
of their knowledge.
EXTRA INFO REGARDING TIME AND BREAKS :

Day 1 exam has 2 session of 3:30 min..100 ques 15 min break 100 ques 30 min break...100
ques 15 min break ...100 ques and done
Day 2 exam has 57-67 ques 15 min break.....47 ques done...
You cannot go back to any of ques once you finish those ques...
Credit of the below mentioned information goes to anonymous author/s, it is

just copied and pasted:

Decidious forcep: 101 for all teeth

Most common impacted anterior tooth--- maxillary canine
Most common impacted tooth --- lower 3rd molar then upper 3rd molar and maxillary
canine then mnd 2nd pm
Most common supernumerary tooth — mesiodens
Most common ectopically erupted tooth — maxillary permanent first molar followed by
canines- Man: canine & 2 pm
Most common malignancy of oral cavity—squamous cell carcinoma
Most common benign tumour of oral cavity — fibroma

Most common retained tooth – primary mandibular second molar
Most common recurring cyst— odontogenic keratocyst
Most common cyst in oral cavity— periapical cyst
Most common lichen planus- reticular lichen planus
Most common dermatosis to affect oral cavity- lichen planus
Most common chemical burn in oral cavity –aspirin burn
Most common topical fluoride in adults – stannous fluoride
Most common topical fluoride in children—1.23 APF gel.
Most common burshing technique- scrub technique
Most common developments cyst- nasopalati ne cyst
Most common complication of GA (op)-nausea
Most common used drug for petitmal epilepsy- no treatment
Most common used drug for grand mal – phenytoil
Most common drug used for temporal epilepsy- carbomezepine
Most common treatment for cyst – enucleation
Most common used clasp-simple circlet clasp
Most common used face bow in fpd- kinematic
Most common complication of RA involves TMJ-fibrous ankylosis
Most common salivary malignancy in children – mucoepidermoid carcinoma.
Most common salivary malignancy in palate area- ACC
Most common type of haemophilia--- haemophilia A
Most common type of gingivitis in children--- eruption gingivitis
Most common type of cerebral palsy is – athetoid/ spastic
Most common nerve involved in C sinus thrombosis – abducent nerve
Most common type of impaction ---mesoangular
Most common benign epithelial tumour---- papilloma
Most common complication of surgical extraction of lower third molar — loss of blood clot
Most common used instrument grasp — pen grasp
Most common susceptible tooth for caries— mandibular first molar
Most common contrast media - iodine in oil
Most common cause of light radiographs — exhausted developer
Most common cause of failure of RCT— inadequate cleaning and shaping – debridement
Most common isolated yeast strain from RCT— Candida
Most common bacteria found in root canals --- gram positive
Most common part of oral cavity affected by L planus –buccal mucosa.
Management of Medically compromised patients
1) HYPERTENSION
i. Preoperative
1. Measure blood pressure and review health status to include all medications. 2.
Refer/encourage patient to see physician if BP is elevated.
3. Minimize stress; might consider oral sedative premedication.
4. For patients with BP less than 180/110, and no evidence of target organ involvement (i.e.
encephalopathy, MI, unstable angina) any dental treatment may be provided)

5. For patients with BP greater than 180/110, defer elective dental care, ONLY EMERGENCY T/T
ii. • During Treatment 1. Provide local anesthesia of excellent quality. 2. For patients on
nonselective beta blocker, limit epinephrine to no more than 2 cartridges of 1:100,000
epinephrine. 3. Avoid epinephrine-containing gingival retraction cord. 4. For patients with
upper level stage 2 hypertension (160/100), consider intraoperative monitoring of BP, and
terminate appointment if BP reaches 180/110.
iii. • Postoperative 1. Make slow changes in chair position to avoid orthostatic hypotension. 2.
Ensure patient’s vitals are stable prior to dismissal. 3. Record pre- and post-operative vitals in
Axium. 4. Use caution when prescribing post-operative antibiotics as some can interact with
antihypertensive medications and enhance hypotension.
2) OSTEOARTHIRITIS
DENTAL MANAGEMENT AND TREATMENT PLANNING MODIFICATIONS: • Ensure patient
comfort while in chair • Be aware of potential for increased bleeding in patients on aspirin
products or NSAIDs (not clinically significant) • Antibiotic prophylaxis may be indicated for
some patients with joint prostheses.
• Technical modifications determined by patient disabilities: • OH: may need special techniques
(electrical toothbrush, modified handles, elbow support) • Ability to insert/remove appliances •
TMJ involvement: monitor and treat appropriately
3) MYOCARDIAL INFARCTION
Use vasoconstrictors with caution, due to increased risk for adverse outcomes1.Increased risk
of cardiac arrhythmias in patients taking digitalis (e.g., digoxin).2.Increased risk of a
hypertensive episode followed by bradycardia in patients taking nonselective beta-blockers
(e.g., propranolol).3. Risk of complications increases with high doses of vasoconstrictors
Prescribe with caution
1. NSAIDs and ASA with Digoxin, Captopril, Propranolol: limit prescribing to 4 days or less.
2. Antibiotics (e.g., erythromycin, tetracycline) with Digoxin, Propranolol.
3. Barbiturates, benzodiazepines with Digoxin, Verapamil, Lovastatin.
Epinephrine-containing local anesthetic can be used with minimal risk if the dose is limited to
0.036 mg epinephrine (2 cartridges containing 1:100,000 epi) or 0.20 mg levonordefrin (2
cartridges containing 1:20,000 levo)2. AVOID the use of epinephrine-impregnated retraction
cord and epinephrine 1:50,000 concentrations.
Increased risk, monitor patient
Low-dose ASA (75–325 mg/day), antiplatelet agents (e.g. clopidogrel), and oral anticoagulants
(e.g., warfarin) can increase the risk of surgical and postoperative bleedin
Delay routine dental treatment for 6 weeks if patient has had a revascularization procedure
(i.e. coronary artery bypass graft or stent placement).
Short, morning appointments for stress and anxiety reduction.
1. Prior to dental treatment, ask the patient about unstable angina and exercise tolerance.2.
Prescribe adequate analgesia during the appointments to minimize pain, discomfort, and
anxiety. 1. Consider semisupine chair position for patients with cardiovascular
disease.2.Discharge patient slowly to avoid orthostatic hypotension.

4) STROKE
a. Morning appointments and short appts
b. Only do emergency t/t if stroke occurred 6 mths ago
c. anticoagulant drugs like heparin should be stopped at least 6-12 hours before treatment. Six
hours after bleeding, when blood clots are built up, heparin systemic treatment can be
resumed. If there is some other anticoagulant medication involved, it should be stopped
several hours or days before bleeding dental treatment, after determining the International
Clotting Rate (ICR) and decision depends on neurologist’s advice
d. blood pressure should be monitored and oxygen therapy device is needed in dental office.
e. The minimal amount of anaesthetic solutions should be injected, concentration of added
epinephrine should be very low (1:100.000 or 1:200.000). Use of gingival retraction cord soaked
with epinephrine should be avoided.
f. - Metronidazolum and tetracycline should be avoided, since they may affect blood clotting. -
If the patient shows symptoms of stroke, he should get oxygen therapy immediately and should
be referred to a hospital as soon as possible.
g. advise the use of electric toothbrushes, easier to handle, use of dental floss, oral irrigation
and prophylaxis using chlorhexydine and fluoride.
h. Advice FPDs as its more manageable for them
5) EMERGENCY TRAINING
1. Call 911 or ask someone else to do so. 2. Try to get the person to respond; if he doesn’t, roll
the person on his or her back. 3. Start chest compressions. Place the heel of your hand on the
center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.
4. Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches
in infants. “One hundred times a minute or even a little faster is optimal,” Sayre says. (That’s
about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive.”) 5. If you’ve been
trained in CPR, you can now open the airway with a head tilt and chin lift. 6. Pinch closed the
nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an
airtight seal, and then give two, one-second breaths as you watch for the chest to rise. 7.
Continue compressions and breaths – 30 compressions, two breaths – until help arrives
2. ORDER
a. Check airway b. check breathing c.extend neck and tilt chin 4. Protrude tongue and mandible
6. ASTHMA
1. Suspend the dental procedure and raise the patient to a comfortable position.
2. Establish and keep the airways free, and administer an inhalatory β2 agonist.
3. Administer oxygen with a mask. If no improvement is observed or the symptoms worsen,
administer subcutaneous epinephrine (1:1000 in solution, 0.01 mg/kg body weight, with a
maximum dose of 0.3 mg).
4. Notify the emergency medical service. 5. Maintain adequate oxygen levels until the patient
breathes regularly and/or medical help arrives (8)7. XEROSTOMIA
7) Medications causing xerostomia:

antihistamines : antidepressants, anticholinergics, anorexiants, antihypertensives,
antipsychotics, anti-Parkinson agents, diuretics and sedatives.antiemetics, antianxiety agents,

decongestants, analgesics, antidiarrheals, bronchodilators and skeletal muscle relaxants
1)TCA and SSRIs
2)diphynhydramine benadryl: sedative antihistaminic has anticholinergic effect
3)diazepam valium: benzodiazipine tranquilizer, anticholinergic effect
4)atropine: potent anticholinergic drug
5)hydroxyzine: anxiolytic, antihistamine, tranquilizer, has antimuscarinic effect
6) CCBs
7) Levodopa
8) Metformin
9) Hydrochlorthiazides
Anti sialologues (to obtain dry field)

1)atropine sulfate, glycopyrolate(robnul), belladona derviatives, propantheline bromide (pro-
banthine)
2)any anticholinergics as they block post ganglionic cholinergic fibers
*contraind. in pts w glucoma, CV prob, GI obstruction, asthma
*they block vagal impulses, constric sphincters in bronchi, bladder & intestine.
relax iris sphincter, dec. gastric, bronchial & slaivary secretions, and perspiration
Conditions causing xerostomia:

Sjögren's syndrome
Sarcoidosis and amyloidosis, rheumatoid arthritis, systemic lupus erythematosus, scleroderma,
diabetes mellitus, hypertension, cystic fibrosis, bone marrow transplantation, endocrine
disorders, nutritional deficiencies, nephritis, thyroid dysfunction and neurological diseases such
as Bell's palsy and cerebral palsy.
Hyposecretory conditions, such as primary biliary cirrhosis, atrophic gastritis and pancreatic
insufficiency, may also cause xerostomia. Dehydration resulting from impaired water intake,
emesis, diarrhea or polyuria can result in xerostomia.
Psychogenic causes, such as depression, anxiety, stress or fear, can also result in xerostomia.
Alzheimer's disease or stroke may alter the ability to perceive oral sensations.
Hyperventilation, breathing through the mouth, smoking or drinking alcohol. Trauma to the
head and neck area can damage the nerves supplying sensation to the mouth, impairing the
normal function of the salivary glands
Acute xerostomia from radiation is due to an inflammatory reaction, while late xerostomia,
which can occur up to one year after radiation therapy, results from fibrosis of the salivary
gland and is usually permanent. Radiation causes changes in the serous secretory cells,
resulting in a reduction in salivary output and increased viscosity of the saliva
8)DIABETES
Dental management
In patients with controlled diabetes, no special treatment is required for routine dentistry
including prophylaxis and dental restorative care. The patient should be told to continue with
their normal eating and injection regimen. Morning appointments are recommended because

cortisol levels are highest at this time and will provide the best blood glucose level. The
morning meal should not be skipped.[4]
Likewise, the type 1 patient should not be scheduled immediately after an insulin injection
because this may result in a hypoglycemic episode. No more than 2 carpules of lidocaine
1:100,000, prilocaine HCL (1:200,000), or bupivacaine with 1:200,000 epinephrine should be
delivered for anesthesia.
In the moderately-controlled diabetic patient, a maximum of 2 carpules of bupivacaine or
prilocaine should be used and, if a major procedure is planned (eg, multiple extractions,
periodontal surgery), an antibiotic should be prescribed following therapy. Following surgery
the patient’s food intake should include the proper caloric content and
protein/carbohydrate/fat ratio to maintain glucose balance.
In the uncontrolled or brittle diabetic patient, only acute dental infection should be treated on
an outpatient basis. Delivered anesthetic should not include epinephrine. Antibiotics should be
prescribed following treatment and monitored carefully for sensitivity and efficacy. In-patient
intervention is recommended for more complicated dental treatment because precise insulin
management and post treatment care with respect to infection and electrolyte balance may be
needed.[5]
Complications/management/prevention
If hypoglycemia appears to be developing, dental treatment should be terminated and glucose
administered. Loss of consciousness is the most serious complication of hypoglycemia. Medical
assistance should be quickly sought and, if the dentist is knowledgeable with IV procedure, an
IV should be placed with immediate delivery of 25-30 mL of a 50% dextrose solution or 1 mg of
glycogen. Glycogen can also be provided by intramuscular or subcutaneous delivery.
Post-treatment problems can include delayed healing and infection. In uncontrolled diabetics,
electrolyte imbalance can also present a problem following dental treatment.
9) ANGINA
• short morning appointments,
• premedication with anxiolytics or prophylactic nitroglycerin,
• nitrous oxide-oxygen sedation, and slow delivery of an anesthetic with epinephrine
(1:100,000) coupled with aspiration.
• The patient with mild or moderate angina should be reminded to have with them their
nitroglycerin tablets in case of an attack during treatment.
• Anxiolytic night before (triazolam, etc)
• oxygen deprivation in the patient with severe ischemic disease and angina can be avoided by
delivery of oxygen via nasal cannula at 3L/min during dental treatment. Administer .4 mg
Sublingually every 5 mins.
10) SYNCOPE
- lay patient in a supine position, elevate extremities (trendelbrg position)
- administer oxygen
- avoid rapid changes in posture

11) COPD
• No NITROUS
• No rubber dam usage
• Anxiety reduction protocol
• Afternoon appts so secretions can clear out a bit
List of Common Drugs & Their Antidotes
Agent/Drug Antidote
Acetaminophen/Tylenol/Paracetamol acetylcysteine (Mucomyst)

Antcholinesterase atrophine sulfate or pralidoxime
Anticholinergics physostigmine
Benzodiazepines flumazenil
Beta blockers glucagon
Calcium channel blockers glucagon
Coumadin/Warfarin phytonadione (Vitamin K.)
Cyanide amyl nitrate, sodium nitrate, sodium thiosulfate
Cyclophosphamide mesna
Digoxin digibind
digoxine immune fab
Dopamine phentolamie (Regitine)
Extrapyramidal symptoms (EPS) diphenhydramine (Benadryl)
Ethylene glycol fomepizole
Fluorouracil leucoverin calcium
Heparin protamine sulfate
Insulin reaction Glucose (Dextrose 50%)
Iron deferoxamine
Lead dimercapol, edetate calcium, disodium,
Methotrexate leucovorin calcium
Narcotics naloxone (Narcan)

Neuromuscular blockade (paralytics) anticholinesterase agents
Opioid analgesics nalmefene or naloxone
Potassium albuterol inhaler, insulin & glucose, NaHCO3,
kayexalate
Tricyclic antidepressants phyostigmine or NaHCO3
lefort1 -floating palate  guerin sign  cracked pot sound
 lefort 2-moon face ,paresthesia of check  bilateral ecchymosis  cracked pot and
CSF rhinnioria 
lefort 3-racoons eyes  panda facies  battles sign Sunken eyes (also seen in blow out
fractures - fractures of orbit)
GENERAL RESORPTION PATTERN the maxillary teeth generally flare downward and outward so
resorption takes place as upward and inward ,the outer cortical plate is thinner than the inner
cortical plate so resorption is rapid in outer ,as resorption takes place in maxilla it becomes
smaller
IN MANDIBLE the anterior teeth generally incline upward and forward to the occlusal plane so
resorptionin ,the outer cortex is thicker than the lingual cortex and width of the mand is
greatest in inferior border so it will resorb lingually (inward) and inferiorly (downward )ans as a
result the mand becomes wider posteriorly
The alpha particle is the heaviest. It is produced when the heaviest elements decay. Alpha and
beta rays are not waves. They are high-energy particles that are expelled from unstable nuclei.
In the case of alpha radiation, the energy The particles leave the nucleus .
The Stephan Curve is something we learnt about at dental school- it shows the effect of eating
and drinking in your mouth clearly in a graphical form and is crucial in helping you understand
dental decay.
red complex-last colonizers,associated with chronic periodontitis with deep pokects and
recession
purple,green,yellow-primary colonizers of sub gingival sulcus
orange-secondary colonizers -gingivitis n presence of bleeding

Fatal disease - cohort study Rare disease - case control study Cohort study measures incidence
and exposure Can find out history of the disease Cross-sectional for prevalence and rate can
study multiple exposures or multiple outcomes
By most common odontogenic cyst is radicular most common non odontogenic cyst is

nasopalatine cyst Most common epithelial odontogenictumour is ameloblastoma most
common odontogenic tumor is odontoma non odontogenic tumors is osteosarcoma and
metastatic carcinoma
1.Most common impacted anterior tooth--- maxillary canine 
2. Most common supernumerary tooth—mesiodens 
3. Most common ectopically erupted tooth—maxillary permanent first molar 
4. Most common malignancy of oral cavity—squamous cell carcinoma 
5. Most common benign tumour of oral cavity—fibroma 
6. Most common retained tooth – primary mandibular second molar 
7. Most common recurring cyst— odontogenickeratocyst 
8. Most common cyst in oral cavity— periapical cyst 9. Most common lichen planus- reticular
lichen planus. 
10. Most common dermatosis to affect oral cavity- lichen planus 
11. Most common chemical burn in oral cavity –aspirin burn 
12. Most common topical fluoride in adults – stannous fluoride 
13. Most common topical fluoride in children—1.23 APF gel. 
14. Most common burshing technique-scrub technique 
15. Most common developments cyst-nasopalati ne cyst 
16. Most common S/E of GA (op)-nausea 
17. Most common used drug for petitmal epilepsy-ethosuximide 

18. Most common used drug for grand mal-phenytoil 
19. Most common drug used for temporal epilepsy- carbomezepine 
20. Most common treatment for cyst – enucleation
 21. Most common used clasp-simple circlet clasp 
22. Most common used face bow in fpd- kinematic 
23. Most common complication of RA involves TMJ-fibrous ankylosis 
24. Most common salivary malignancy in children – mucoepidermoid carcinoma. 
25. Most common salivary malignancy in palate area-ACC 
26. Most common type of haemophilia--- haemophilia A 
27. Most common type of gingivitis in children--- eruption gingivitis 
28. Most common type of cerebral palsy is –athetoid/ spastic. 
29. Most common nerve involved in C sinus thrombosis – abducent nerve 
30. Most common type of impaction ---mesoangular
 31. Most common benign epithelial tumour---- papilloma 
32. Most common complication of surgical extraction of lower third molar—loss of blood clot  
33. Most common used instrument grasp—pen grasp 
34. Most common susceptible tooth for caries—mandibular first molar 
35. Most common contrast media - iodine in oil 
36. Most common cause of light radiographs — exhausted developer
 37. Most common cause of failure of RCT— incomplete debridement 
38. Most common isolated yeast strain from RCT— Candida 
40. Most common part of oral cavity affected by L planus –buccal mucosa.

Periapical and radicualr cyst r one and the same thing
1-Ground Glass appearance--> Fibrous dysplasia 2-Punched out radiolucencies-->Multiple

Myeloma 3-Cotton Wool Appearance-->Paget's Dz 4-Tooth Floating in Air-->Eiosinophilic
Granuloma 5-Snow Appearance--> Calcifying Epithelial OdontogenicTumor(CEOT) 6-Honey
Comb Appearance-->OdontogenticMyxoma 7-Soap Bubble Appearance--> Aneurysmal Bone
Cyst, Cherubism 8-Scooped out radiolucencies at mid root level-->Histiocytosis X 9-Scalloped
radiolucencies around the roots of teeth--> Simple bone cyst aka traumatic bone cyst 10-
Beaten Metal appearance on the skull-->Crouzon Syndrome 11-Enlarged marrow spaces-->
Sickle cell Anemia 13-Widened PDL with dissolving bone--> Non-Hodgkin lymphoma 14-Moth-
Eaten radiolucency--> external resorption salt and pepper appearance radio-graphically-COC
1. cemento-osseous dysplasia---lower anterior
2. traumatic bone cyst--- mandiular.. between canine and molar region
3.primordial cyst--- mandiular 3rd 4th molar region
4. dentigerous --- mostly mandibular 3rd molar and maxi canine region
5.stafne bone cyst--- below mandibular canal
6. latealperiodaontal cyst--- mandiular canine premolar area
7.bohn nodule---- newborn gingiva
8.epstein pearl--- midline of palate of newborn
9.cementoblastoma--- mandible molar area,grows on roots
10. OKC--- mandiular molar and ramus
11. nasopalatine duct cyst-- between roots of maxi central incisors
12. globulomaxi cyst--- between maxi lateral and canine
13.thyroglossal duct cyst-- midline of neck
14.demoid cyst--- FOM or upper neck
15.brachial cyst--- anterior to sternocleidomastoid

16.ossyfiying fibroma--- premolar area
Highest DMFT = White (caucasian) (highest amount of restored teeth) Highest untreated

primary teeth = Hispanic Highest untreated perm teeth = Black (African American) Moderate
periodontitis = Black males ( African American) Class II caries = Whites (caucasian) Class III
caries = Blacks (African American) Cleft lip/palate w/ Class III occlusion = Native American Cleft
lip alone = Asian Cleft lip in USA = 1:700 to 1:800 class 2 malocclusion : whites of northern
European descent class 3 malocclusion : Asian Caucasians have more lip cancer while African
american have more oropharyngeal carcinoma. Anterior open bite: African American(blacks) 
Deep bite: cuacasian( whites) , cemento osseous dysplasia - black middle aged women
* reverseoverjet.....>Cl III MO *reverse polarity....>ameloblastoma *reverse bevel.....>Cl II gold

inlay *reverse bevel incision.....> in undisplaced flap when the incision is done coronal to the
sulcus *reverse occlusal plane.....> in panoramic radiograph when pt chin is tipped upward
Waters view--->Maxillary sinus Bite wing------>Interproximally caries Periapical----->Periapical

tissue&Periodontal disease Submentovertex--->Zygomatic fracture Lateral Cephalometric---
>Face growth Posterior-Anterior of skull--->Skull vault Reveres Towns---->Condylar necks 
MRI------->TMJ CBCT----->Implant&Endo
Drug overdoses Diazepam treats Lidocaine overdose .Flumanzil treats Diazepam overdose 

.Neostigmine treats cholinestrase inhibitors overdose .Nalaxone treats opoid overdose .Milk &
Calcium for fluoride overdose .Antidotes for different drug overdose...1.Heparin- protamine
sulfate .TCA overdose- Physostigmine . Warfarin- Vit K .Opioids - Naloxane/Naltrexone .Beta
blocker- glucagon . Benzodiazepene- Flumazenil . Theophylline- beta blocker .organohosphate
poisoning- atropine, pralidoxime .Acetaminophen- N acetylcysteine  .aspirin- Potassium salt
and sodium bicarbonate calcium sodium ( EDTA) -lead poisng Dimercaprol,Penicillamine, edta-
mercury poising
Types of studies: 1)Case Series:study some clinical cases of jaw necrosis. 2)Cross

Sectional:Interview All patients at the school for jaw necrosis and use of biophosphate at one
time. 3)Case Control Study:Identify patients with and without jaw necrosis,follow them for use
of biophospate. 4)Cohort Study:Enroll all patients at the school and follow them for years to
see who develops jaw necrosis.
Important Diseases according to "Age":
*Fibrous Dysplasia---->Children *Paget's Disease------>Adults over 50 *Aneursmal Bone Cyst----

>Teenagers *Cherubism----->Children *Periapical Cemeno osseous Dsysplasia---->Middle aged
black women *Capillary Hemangioma---->1st week after Birth till 9 years old *Cavernous
Hemangioma---->Old Adults
Deterministic: dosage dependent, in deterministic there a limit only after it reaches that limit
effect will occur. It will increase with increase in dose.
Stochastic: it is not dose dependent any amount will cause effect
o UNBUNDLING: "the separating of a dental procedure into component parts with each part
having a charge so that the cumulative charge of the components is greater than the total
charge to patients who are not beneficiaries of a dental benefit plan for the same procedure."
o BUNDLING "the systematic combining of distinct dental procedures by third-party payers that
results in a reduced benefit for the patient/beneficiary."
o UPCODING or overcoding: "reporting a more complex and/or higher cost procedure than was
actually performed."
o DOWNCODING: "a practice of third-party payers in which the benefit code has been changed
to a less complex and/or lower cost procedure than was reported except where delineated in
contract agreements."
In Epidemiology a confounder is: not part of the real association between exposure and disease
 o predicts disease unequally distributed between exposure groups o A researcher can only
control a study or analysis for confounders that are: known, measurable Example: Grey hair
predicts heart disease if it is put into a multiple regression model because it is unequally
distributed between people who do have heart disease (the elderly) and those who don't (the
young). Grey hair confounds thinking about heart disease because it is not a cause of heart
disease. Strategies to reduce confounding are: o randomization (aim is random distribution of
confounders between study groups) o restriction (restrict entry to study of individuals with
confounding factors - risks bias in itself) o matching (of individuals or groups, aim for equal
distribution of confounders) o stratification (confounders are distributed evenly within each
stratum) o adjustment (usually distorted by choice of standard) o multivariate analysis (only
works if you can identify and measure the confounders)
Primary Teeth : Largest : Mandibular 2nd Molar Smallest: Mandibular Lateral incisor
Permanent tooth: Largest: Maxillary 2nd Molar Smallest: Mandibular Central Inc

Pulpal and Periradicular/Periapical Conditions Pulpal Conditions: Normal Pulp - A normal pulp
is symptom free and will normally be responsive to the electric pulp tester (EPT). When
evaluated by thermal testing, the normal pulp produces a positive response that is mild and
subsides immediately when the stimulus is removed. Reversible Pulpitis - Caries, cracks,
restorative procedures or trauma may cause a pulp to become inflamed. The patient’s chief
complaint is usually of an exaggerated response to thermal stimulus but once the stimulus is
removed, the discomfort does not linger. EPT results are responsive. Irreversible Pulpitis - If
the inflammatory process progresses, irreversible pulpitis can develop. Patients may have a
history of spontaneous pain and complain of an exaggerated response to hot or cold that
lingers after the stimulus is removed. EPT results are usually responsive. The involved tooth
will often present with a history of an extensive restoration and/or caries. In certain cases of
irreversible pulpitis, the patient may arrive at the dental clinic sipping a glass of ice water or
applying ice to the affected area. In these cases, cold actually alleviates the patient’s pain as
the dental pulp has developed allodynia and is hyperalgesic. Normal body temperature is now
causing the nociceptors in the pulp to discharge.10 Removal of the cold causes return of
symptoms and can be used as a diagnostic test. Irreversible pulpitis can also present as an
asymptomatic condition. Internal resorption and hyperplastic pulpitis (pulp polyp) are
examples of asymptomatic irreversible pulpitis. Pulpal Necrosis - Necrosis is a histologic term
that denotes death of the pulp. Teeth with total pulpal necrosis are usually asymptomatic
unless inflammation has progressed to the periradicular tissues. The pulp will not respond to
the EPT and if using a digital EPT, this result should be reported as no response (NR) over 80.
The pulp will not respond to thermal tests. The dental record entry for this pulpal diagnosis
should be pulpal necrosis. Pulpless Tooth - A tooth from which the pulp has been
removed. For example, a tooth with previous pulpotomy/pulpectomy/root canal debridement
or previous root canal therapy should be recorded as a pulpless tooth for the pulpal diagnosis. 
Previously Treated - A clinical diagnostic category indicating that the tooth has been
endodontically treated and the canals are obturated with various filling materials, other that
intracanal medicaments. Previously Initiated Therapy - A clinical diagnostic category indicating
that the tooth has been previously treated by partial endodontic therapy (e.g. pulpotomy,
pulpectomy). Periradicular/Periapical Conditions: Normal Periradicular Tissues - Normal
periradicular tissues will be non-sensitive to percussion and palpation testing. Radiographically,
periradicular tissues are normal with an intact lamina dura and a uniform periodontal ligament
(PDL) space. Acute Periradicular Periodontitis - Acute periradicular periodontitis occurs when
pulpal disease extends into the surrounding periradicular tissues and causes
inflammation. However, acute periradicular periodontitis may also occur as the result of
occlusal traumatism. The patient will generally complain of discomfort to biting or
chewing. Sensitivity to percussion is a hallmark diagnostic test result of acute periradicular

periodontitis. Palpation testing may or may not produce a sensitive response. The PDL space
may appear normal, widened, or there may be a distinct radiolucency. Acute Periradicular
Abscess - In this situation, bacteria have progressed into the periradicular tissues and the
patient’s immune response cannot defend against the invasion. It is characterized by rapid
onset, spontaneous pain, pus formation, and often swelling of the associated
tissues. Depending upon the location of the apices of the tooth and muscle attachments, a
swelling will usually develop in the buccal vestibule, on the lingual/palatal, or as a fascial space
infection. Percussion testing produces a response that is usually exquisitely sensitive. This
exaggerated response can help differentiate between acute periradicular periodontitis and the
early stages of acute periradicular abscess. Palpation testing produces a sensitive
response. Radiographically, the PDL space may be normal, slightly widened, or demonstrate a
distinct radiolucency. This periradicularpathosis can occur with a necrotic pulp or a pulpless
tooth that has been partially or definitely endodontically treated if continued bacterial
contamination and/or leakage occurs. Chronic Periradicular Periodontitis - When bacteria or
bacterial products from a necrotic pulp or pulpless tooth slowly ingress into the periradicular
tissues, the patient’s immune system may become involved in a chronic conflict. The resultant
inflammatory process causes periradicular bone resorption that manifests as a periradicular
radiolucency on the radiograph. Clinically, the patient is asymptomatic. Percussion and
palpation testing produce non-sensitive responses. SubacutePeriradicular Periodontitis - The
patient will present with mild to moderate symptoms that may include spontaneous pain or
discomfort on biting or chewing. The tooth may present with any pulpal diagnosis. Percussion
testing produces a mild sensitive response and palpation testing may or may not be
sensitive. Clinical symptoms are not as severe as acute periradicular
periodontitis. Radiographically, the tooth will present anywhere from a normal periradicular
appearance to a distinct radiolucency. These patients must receive endodontic treatment in a
timely manner because the condition can quickly progress into acute periradicular periodontitis
or an acute periradicular abscess. Chronic Periradicular Abscess - An inflammatory reaction to
pulpal infection and necrosis characterized by gradual onset, little or no discomfort and
intermittent discharge of pus through an associated sinus tract. Clinically, the patient is usually
asymptomatic because the sinus tract allows drainage of any exudate from the periradicular
tissues. EPT and thermal testing are non-responsive. Percussion and palpation testing usually
produce non-sensitive responses. Radiographically, a periradicular lesion is associated with the
involved tooth. This entity can also occur with a pulpless tooth that has been partially or
definitely endodontically treated if continued bacterial contamination and/or leakage occurs. 
Focal SclerosingOsteomeylitis (condensing osteitis) - This entity may be considered a true lesion
of endodontic origin (LEO). The involved tooth will have an etiologic factor for low-grade,
chronic inflammation such as a necrotic pulp, extensive restorative history or a crack. The
patient may be asymptomatic or demonstrate a wide range of pulpal symptoms. EPT and

thermal tests may or may not be responsive. Percussion and palpation testing may or may not
be sensitive. Radiographically, the involved tooth will present with increased radiodensity and
opacity around one or more of the roots. Evidence supporting consideration as a LEO is that
85% of these periradicularradiodensities resolve after endodontic therapy if they have a pulpal
diagnosis of irreversible pulpitis. Focal Osteopetrosis - This entity is not a LEO. The patient will
be asymptomatic. EPT and thermal testing are responsive and normal. Percussion and
palpation testing will typically be non-sensitive. The involved tooth is usually a virgin tooth or
has a normal pulp. Radiographically, the tooth will present with increased radiodensity and
opacity around one or more of the roots. No treatment is necessary and the tooth should
simply be monitored at periodic recall.
Classification of benign fibro-osseous lesions of the craniofacial complex
I. Bone dysplasias  a. Fibrous dysplasia  i. Monostotic  ii. Polyostotic  iii.

Polyostotic with endocrinopathy (McCune-Albright)  ivOsteofibrousdysplasiaa  b. Osteitis
deformans  c. Pagetoid heritable bone dysplasias of childhood  d. Segmental
odontomaxillary dysplasia II. Cemento-osseous dysplasias  a. Focal cemento-osseous
dysplasia  b. Florid cemento-osseous dysplasia III. Inflammatory/reactive processes  a.
Focal sclerosing osteomyelitis  b. Diffuse sclerosing osteomyelitis  c. Proliferative periostitis
 IV. Metabolic Disease: hyperparathyroidism V. Neoplastic lesions (Ossifying fibromas)  a.
Ossifying fibroma NOS  b. Hyperparathyroidism jaw lesion syndrome  c. Juvenile ossifying
fibroma  i. Trabecular type  ii. Psammomatoid type  c. Gigantiformcementomas
Immune granulomas can have a few different appearances, depending on their cause. Here’s a
summary: 1. Tuberculosis. Granulomas in TB are sometimes called tubercles. They are
caseating, meaning they are “cheesy” in gross appearance. Histologically, there is a bunch of
amorphous, granular, necrotic debris in the center of the granuloma. You should see some acid-
fast bacilli in there too.
2. Leprosy. These granulomas are non-caseating, and an acid-fast stain should reveal bacilli.
3. Syphilis. Granulomas in syphilis are called gummas; they have central necrosis (but not really
caseating, because you can still see cell outlines) and a plasma cell infiltrate.
4. Cat-scratch disease. These granulomas may be stellate in appearance. They contain

neutrophils and some granular debris, but giant cells are rare.
5. Sarcoidosis. Granulomas in sarcoidosis are non-caseating, with a lot of activated

macrophages.

6. Crohn disease. Sometimes you see non-caseating granulomas in the intestinal wall in patients
with Crohn disease.
Age at which children develop dexterity and speech.(5 yrs speech 8 yrs dexterity).
Skirt preparation in gold only - it is a surface extention feature for secondary retention. the
preparation is extended over to facial/lingual external wall of tooth in cases of short axial walls
or tilted teeth (there r few other indications as well). the finish line over the external
facial/lingual surafce extends at the mid third of surface n doesnt extend all the way down as in
crown preps.
iseally INR should be between 2 and 3.5 it should not be higher than 4 and lower than 3 before
extractions which mat indicate or fuse bleeding for simple extractions ptshoi=uld be lower
than 4 moderate bleeding, included and impacted third molar surgeries or multiple
extractions- it should be less than 3 if over 5 no surgical treatment
adult periodontitis-P.gingivalis ANUG-spirochetes juvinile periodontitis-A.A

More information can be found on
http://studylib.net/doc/5830907/formulation-of-pulpal-and-periradicular-diagnoses#

1. All are signs of opioid toxicity except
2. Tt of ranula- masupialization (option had excision of
submandibular gland …that’s wrong)
3. Feature of muscle weakness disorders- long lower facial
height
4. Lots of nsaids and cardio drugs and their interactions
5. Aspirin does not increase what?- bleeding time,
prothrombin time, acidosis, renal prostaglandins
6. New behavior management q which is not there is mosby
7. How to obtain confidence of child- positive reinforcement,
tell show do
8. Biotransformation of drugs
9. Coumarin effects decreased by?
10. Cleft lip at what age- 2-3 weeks, 6-7weeks
11. 5-6 q on glaps and gingivectomy which were easy- they
play around with indications
12. q about 22 yr old girl with fever , malaise,
lymphadenopathy, multiple ulcers on tongue, palate with
swollen gingiva- anug, acute herpetic gingivostomatitis,
marginal gingivitis, herpangina
13. Kaposi sarcoma caused by hiv- t/f
14. Hairy leukoplakia- caused by hhv, hiv, ebv
15. Lymphoma in jaws- hodgkins, non –hodgkins
16. Q about not a topical drug delivery sytem in perio- I
discussed it with someone I remember, ans was
metronidazole gel
17. Symptoms of pedal edema, persistent cough, obese,
raises end diastolic pressure, guess disease- I marked chf
18. Which antihistamine for peptic ulcer- diphenhydramine,
citrezine, ranitidine
19. Periodontitis- seen in black males
20. Average fluoride in community water system- 0.6-1.2ppm
21. Q about man with good oral hygiene and stained buccal
groove- observe
22. Collimation purpose
23. How to prevent gonadal exposure during mand iopa- e
films, lead apron, thyroid collar
24. Antibiotics not helpful in which perio- chronic perio
25. Which impression material gives off h2 gas
26. Which impression material not for cast impressions
27. Connector in fpd should be greatest in which dimension-
mesio-distal, buccolingual, occluso-gingival
28. P<0.01 , reject null hypothesis- option had both correct
decision and type 1 error
29. Incisal table angulations depends on
30. Q on cleidocranial dysplasia about open sutures
31. Neurogenic sarcoma?
32. Calcified falk cerebri-?
33. DistobuccAL flange extended in max denture and mand
denture which structures obstructed
34. While recording pps what is kept in mind except- fovea
palatine, vibrating line, pterygoid notch, throat form and
tuberosity
35. Kid was taking Ritalin- which disease
36. Local vasoconstrictor which la- cocaine, benzocaine,
lignocaine, procaine
37. Lithium toxicity affecting renal function, which analgesic to
be given
38. Recovering from alchoholism, which analgesic to be given
except- ibuprofen, Percocet, vocodin, tylenol3
39. Child in pre something stage of cognitive behavior- what is
problem- establishing communivation
40. Child is uncooperative is 2 yrs old, retrain by- parents,
papoose, assistant, sedate
41. Fail proof mechanism of nitrous oxide cylinder
42. Conscious sedation- verbal response, pain response, eye
response, touch response
43. Pregnant woman in syncope due to which structure
44. Short crown premolar as abutment in fpd- inlay,onlay, pfm,
all ceramic crown
45. Why wait for 1 week between bleaching and veneering
46. Porcelain veneers frequently changed due to- chipping or
discolouration ?
47. 3 q on hue, value , chroma each asking known rqs
48. sealants bond to teeth by?
49. 2 statements about ethics.. q like which are true or false-
individuals can discuss about ethics and come to different
conclusions something like that
50. 2 q on sibilant sounds- how are teeth touching or
contacting…are they supposed to be different?!!!
51. Implant template what for?
52. 3 q asking me about distance btw 2 implants!
53. Apf impossible in mand lingual or max palatal
54. Max 3rd molar root displaced into which space?
55. 3rd molar extraction may cause-
(a) paresthesia, fracture , alveolar osteitis
(b) paraethesia, bleeding, infection,
(c) alveolar osteitis, paresthesia, infection
56. old man had a lot of carious class v lesions, ideal material
for restoration- amalgam, direct gold, gic, composite
57. for gingivectomy incision directed where?
58. In tooth supported rpd, which part prevents movement of
abutment?
59. Which is poorest form of temporary restoration- zoe,
composite with zn phosphate, cold cure set in mouth
cemented with zoe, cold cure set in cast cemented with
zoe
60. Bruxer had old mod amalgam with sec caries, which
material to be replaced with- composite, amalgam, all
ceramic
61. Effect of norepi prolonged by- moa , neuronal uptake
inhibitor
62. Cholinesterase inhibitors- sympatholytic, sympathomimetic,
parasympatholytic, parasympathomimetic
63. Doesn Lisinopril cause k+ depletion?
64. Lots of q on antidepressants and their interaction
65. Pic of geographic tongue staright out of op decks
66. 1 pathetic rf of fibrous dysplasia m guessing because I saw
no boundaries of the lesion
67. one opg to identify ear lobe
68. filteration in xrays?
69. High voltage kvp resultant xrays will have?
70. Palatal tori reaching pps, how to construct cd
71. Features of dementia
72. Elderly patients have lesser effect to cns drugs, t/f
73. Which tumor has enamel, dentin, pulp, cementum?
74. Defining rapport in fancy terms …sounded like an English
exam
75. Gracey curette for mesial surface
76. Angulation of scaler tip
77. Efficacy of ultrasound scaler depends on?
78. 2 q on cross cut fissure bur
79. organism which can produce metabolic products from
estradiol
80. interocclusal record of 1mm was taken with facebow,
options asking whether its possible or not
81. 3 q on arbitrary and arcon articulators
82. hyperpyrexia, tachycardia, nervousness, diarrhea,
tachypnea- pheochromocytoma, thyroid storm
83. primary side effect of albuterol- xerostomia, candidiasis,
caries, dysguesia
84. if pt had gum boil, you do rct, what tt for gum boil-
curettage, excision, local antibiotics, no tt
85. q on ept in various scenarios with tough language
86. q on pulp pathologies
87. movement during extraction of mand molars
88. forceps for fractured tooth at level of furcation- 23
89. vital tooth radiolucency at mand premolar roots
90. periapical radiopacity not related to inflammation,
neoplasm, fibro-osseous lesion or systemic disease-
idiopathic osteosclerosis
91. which tooth not suitable for occlusal seat placement-
canine, lateral incisor, premolar, molar
92. patient taking amytrptilline, what happens when
administered la with epi
93. epi reversal by which drug
94. about proscar- option did not have bph had prostatic
cancer something about inhibiting 5 alpha reductase
95. emphysema pt- what considerations in dental set up- I
had options regarding nitrous oxide, reclining in supine
position, administration of epi
96. transillumination helps identify what by illuminating tooth-
craze line, vertical tooth fracture, microleakage and
another option
97. a weird q about in pa radiograph, bone defect of osseous
crater is underestimated, overestimated, undiagnosed,
remains the same something like that…find out
98. q on unbundling, bundling and up and down coding
where they confuse you with similar sounding terms
99. iopa shows patent coronal pulp chamber which changes
appearance in the middle of root indicates what?-
calcification, internal resorption, canal bifurcation, pulp
stones
100. clearance btw occlusal seat on marginal ridge and
opposing cusp
101. chronic burning mouth in- merkelson Rosenthal,
candidiasis, lichen planus, pemphigus
102. in chronic perio all are risk factors except- smoking, age,
diet and saliva
103. What will not set off an event in a child with sickle
disease: Trauma, Cold, Infection, Nitrous oxide
104. Which antihypertensive causes orthostatic hypotension
105. Pt had asymptomatic apical periodontitis, histopath
shows plasma cell, macrophages, mast cells- apical
granuloma, cyst, abscess, neoplasm
106. Which mediator produced by plaque bacteria induces
bone loss- endotoxin
107. Which mediator found in areas of bone loss- IL-
1,IL3,IL2,IL8
108. Angulation of incisal table depends on?
109. Antifungal used both in topical and systemic forms-
options had fluconazole and miconazole
110. Test correctly identifies 95 diseased individuals of 100,
characteristic of test- 95% sensitivity, 95%specificity, 95%
ppv, 5%npv
111. Q on calculation of attachment loss
112. Young woman with shiny cervical lesions on cervical
third on palatal surfaces of maxillary anterior- erosion,
abrasion, attrition, abfraction
113. Intensive drug therapy of diabetes mellitus has following
objectives- 1. Home blood sugar eval
2. type 1 and 2 dm control
3. home urine glucose analysis
something else
114. Size and shape which stage of dental development
http://forums.studentdoctor.net/threads/official-nbde-part-2-study-q-a-thread.814471/page-4
Endo Diagnosis:
QUESTION: which teeth do you perform pulp eval on?

a. tooth only
b. tooth and neighboring teeth---?
c. tooth, neighboring teeth, contralateral tooth
d. tooth, neighboring teeth, opposing tooth
QUESTION: When testing tooth for cold; test adjacent teeth and opposing teeth & contralater
teeth)
QUESTION: Is an apical radiolucency present for a long time with no symptoms and no sinus tract
associated with necrotic pulp or asymptomatic apical periodontitis? Asymp chronic periodontits
QUESTION: You have a tooth, no pulp, but periapical radiolucency, you do access and find no canal,
what do you do? - I said don’t try to be a hero, refer to an endodontist
QUESTION (DAY 2): A molar is super-erupted, but has irreversible pulpitis, what do you do? – RCT
and Crown (other choices were EXT, just do crown – this was tricky because to answer the
question, you have to look at the patient dental chart and findings)
QUESTION: 5yrs old patient, he fell down 2 months ago, and hit his #E when he fell down, the tooth
is now discolored, what do you suspect? – Necrotic pulp.
1
QUESTION: Same patient as above, there is a red swollen lesion on the gingival of tooth #E, what is
most likely be? – Sinus tract (other choices, periapical cyst, periapical granuloma, etc)
QUESTION: Same kid from above, What do you recommend for this tooth? – EXT!
QUESTION: What does radiolucency at furcation of primary M1 in 5yo usually indicate: erupting
permanent PM1, necrotic pulp, normal anatomy
a. Necrotic pulp – it is in a 5yo so man PM1 shouldn’t be causing resorption yet
QUESTION (DAY 2): A case of a patient with tooth that has sensitivity that lingers with thermal test,
and positive to percussion, what does the patient have? – Irreversible pulpitis with acute
periapical abcess (other choices were Irreversible puplitis with no acute peripical abcess, and 2
other choice with reversible pulpitis in them).
QUESTION: Prolonged, unstimulated night pain suggests which of the following conditions of the
pulp?
A. Pulp necrosis
B. Mild hyperemia
C. Reversible pulpitis
D. No specific condition
QUESTION: Chronic periradicular abscess indicates: necrotic pulp
QUESTION: X-ray of PA R/L of a primary teeth: Normal R/L because perm tooth is erupting
underneath
QUESTION: Lucency is seen in PA, it’s under the furcation of primary molar, what could this be due to? –
Necrotic pulp (other options were roots are resorbing, permanent tooth caused it, some other stuff)
QUESTION: Little girl had ALL, had radiolucency in furcation of primary 2nd molar. What is the
treatment?
• Extraction
• Pulpotomy
• Pulpectomy
QUESTION: primary tooth got necrosis, and the inflammation went down through furcation and
affects permanent tooth. What is it gonna cause to permanent tooth? Can disturb ameloblastic
layer of permenant successor or spread infection
QUESTION: Radiolucency in furcation of primary tooth? Necrotic, extract

QUESTION: In a primary tooth apical infection the first radigrapoh sign is where?- in the furcation.
QUESTION: Most common medication for pulpectomy/pulpotomy? FOROMCRESOL
QUESTION: calcium hydroxide is contraindicated in pulpotomy in a child because it causes

irritation leading to resorption in primary teeth
QUESTION: 5.38 picture: know when to extract
If it’s a primary 1st with furcation involvement: EXT
2
If it's a primary 2nd, furcation, but restorable: PE
If its any other primary tooth no furcation: PO
QUESTION: The best method to test newly erupted primary teeth – percussion
QUESTION: Which is incorrect? Do EPT for traumatic tooth
QUESTION: Least reliable test on primary teeth

• Electric pulp test
• Percussion (MOST RELIABLE)
QUESTION: If you have pain, what would be the hardest to anesthetize?
a. Irreversible pulpitis and maxillary

b. Irreversible pulpitis and mandibular
c. Necrotic pulp and maxillary
d. Necrotic pulp and mandibular
“When irreversible pulpitis is a factor, the teeth that are most difficult to anesthetize are the
mandibular molars, followed by the mandibular premolars, the maxillary molars and premolars,
and the mandibular anterior teeth. The fewest problems arise in the maxillary anterior teeth.”
Hargreaves, Cohen. Cohen's Pathways of the Pulp, 10th Edition. Mosby, 052010.
QUESTION: pulpal pain that only occur at night with no stimulation: pulpal necrosis
QUESTION: when the heat apply to tooth, lingering pain for several minutes: irreversible pulpitis
QUESTION: what is diagnosis: lingering pain to cold and sensitivity to percussion?Irreversible pulpitis
and acute periapical abscess
Usually periodontal abscess is sensitive to percussion…irreversible is usually percussion
positive
QUESTION: A tooth is not responsive to cold, not to percussion, and palpation is tender: necrotic pulp
and chronic apical periodontitis. – irreversible pulpitis and normal apex) there was not an item saying
necrotic pulp and normal apex)
QUESTION: Which of the following least important factor in referring an endo case to specialist?
Dilacerations, calcifications, inability to obtain adequate anesthesia? Lease import is mesial inclination
of a molar*** correct answer
QUESTION: 7 yr old boy has vital exposure of tooth 1st perm max molar. What do you do for
treatment. Pulpotomy carious? Pulpotomy.
3
QUESTION: Child had carries exposure on primary 1st molar….what to do pulpotomy
QUESTION: A 7-year-old patient fractured the right central incisor three hours ago. A clinical
examination reveals a 2-mm exposure of a "bleeding pulp." The treatment-of-choice is
A. pulpectomy and apexification.
B. pulpotomy with calcium hydroxide.
C. direct pulp cap with calcium hydroxide.
D. one-appointment root canal treatment.
QUESTION: Did pulpotomy in a 7 yr old’s pulp exposed decayed tooth #30 why? To allow
completion of root formation (apexogenesis)
QUESTION: Why would you do a pulpotomy in a mandibular first molar of a 7 year old? To continue
physiologic root development
Apexification: Create an apical barrier in a necrotic tooth with an open apex.

 Induce a calcified apical barrier by placing dense calcium hydroxide paste after the
instrumentation. Canals are obturated when barrier is formed in 3–6 months.
 Placement of an artificial apical barrier, such as MTA, prior to obturation. This method, can
be completed in a day or two, appropriate when patient compliance or long-term follow-up
care is questionable.
Apexogenesis: Vital pulp therapy performed to allow continued physiologic development and
formation of the root.
 Place calcium hydroxide over the radicular pulp stump. Recall every 3 months to check for
the pulpal status.
 RCT is indicated when the root development is completed.
apexogenesis & apexification on primary vital & non vital teeth

• apexogenesis: tx of VITAL tooth w/ an OPEN apex & pulp exposure using calcium hydroxide to
preserve vitality & encourages the continued development of the root
• apexification: tx of NONVITAL tooth w/ incomplete apex formation & pulp exposure using
calcium hydroxide to achieve apical closure
Apicoectomy: (Root-end resection): Prep of flat surface by excision of apical portion of root.
QUESTION: Know when to do indirect pulp cap, pulpotomy, apexification (non vital teeth with MTA),
and pulpectomy (ZOE if apex is not closed in primary teeth) in pedo patients.
QUESTION: Indications for apicoectomy: RCT can’t be done by conventional means, failed existing
RCT and can’t re-treat
4
QUESTION: why you do apico surgery except : When an apical portion of canal cannot be cleaned,
persistent apical pathology after RCT, apical fracture, overextension of material interferes with
healing.
QUESTION: When do you use an apicoectomy? failing RCT and can’t do retreat also w/ post and
cant get to area
QUESTION: If a tooth with previous endodontic treatment becomes reinfected, it is best to retreat it
conventionally by removing the filling material, debride the canals, and refill. However, if the tooth has
been restored with a post, core, and crown, then apical curettage, then an apicoectomy and retrofill
should be performed.
QUESTION: PEriapical lesion biopsied after apicoectomy of RCT treated tooth, tooth still sensitive
tooth, with neutrophils, plasma cells, nonkeratanized stratified epithelieum (islands of), and
fibrous connective tissue→ abcess, granuloma, cyst,
QUESTION: There is a study that shows there is extraradicular plaque in an infected tooth what
does this mean the Dentist might need to do: I was deciding between mechanochemical irrigation
and debridement of the canal vs doing surgical endo (apicoectomy)
QUESTION: Extraradicular biofilm theory recommends endo with: Crown down, debridgement, Ca(OH)2
therapy? (irrigate and debride)
QUESTION: Why you perform apexification: When you have necrosis on an open apice tooth.
QUESTION: why you do apico surgery : When an apical portion of canal cannot be cleaned,
healing.
QUESTION: Why you do apico surgery: When an apical portion of canal cannot be cleaned, persistent
apical pathology after RCT, apical fracture, overextension.
QUESTION: Patient (6 yo), the treatment of choice for a necrotic pulp on permanent first molar would be:
1. Apexification (Non vital) 2. Apexogenesis, (vital) 3. Root Canal Treatment
QUESTION: why you perform apexification(non-vital) :When you have necrosis on an open
apex tooth
QUESTION: Definition of apexification:The process of induced root development or apical closure of the
root by hard tissue deposition NONVITAL
QUESTION: Tx for Traumatic pulp exposure on max incisor that root has not completed formation?
Apexogenesis
QUESTION: pt comes to you and theres non vital tooth with open apex-apexification NONVITAL
QUESTION: irreversible pulpitis with open apex apexification
QUESTION: Six months ago you did a RCT on central with an open apex (the pt was young, but can’t
remember the exact age). You place calcium hydroxide in canal and waited the 6 months. You open the
canal but can still pass #70 file through the apex. What would you do?
- *calcium hydroxide
- Zinc oxide eugenol
- gutta percha
QUESTION: Pt is 13 years old and has a non-vital maxillary central. The apex is still open what do you
do.
A. Apexogenesis
B. Apexification** I think this is right I put A.
5
C. Pulpectomy
D. Nothing
QUESTION: Pulp is vital, pt’s a 8 year old. Apex is open. What do you do.
A. Apexification
B. Apicoectomy
C. Pulpectomy
D. calcium hydroxide pulpotomy.**
Tooth Avulsion: complete dislodgment of a tooth out of its socket by traumatic injury. Short extra-
oral dry time and proper storage medium are key factors in offering favorable treatment outcome.
 Indications for treatment: Treatment is indicated when a tooth is completely dislodged from
its alveolus.
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QUESTION: Reason for failure of replantation of avulsed tooth: external resorption, internal
resorption
QUESTION: Most important factor about avulsed tooth – Time (other options were like what you store it
in, etc)
QUESTION: why an implanted avulsed tooth fails: outside of mouth too long: too much extra oral
time
QUESTION: Before 15 min what is success rate of avulsed tooth? 90 percent success rate, by 30
min success rate decreases to 50%
QUESTION: why an implanted avulsed tooth fail : a) the dentist curettage the socket b) too much
extra oral time c)the dentist clean the root surface d)failure to place the tooth in the solution ( Fl )
QUESTION: Which is incorrect: should rinse with water if tooth is taken out
QUESTION: Splinting Avulsed tooth – 1-2 weeks **yes..mosbys says splint for 7-10 days
QUESTION: How long do you splint after tooth has been avulsed? 1-2 weeks
QUESTION: Splinting avulsed teeth – for how many days? 7-10 days
QUESTION: Best substance to place avulsed tooth.? hanks solution(na, K,calcium plus glucose) if not
milk.
QUESTION: What is best storage media for avulsed tooth? HANK(HBSS: Hank’s balanced salt
solution) Best solution
QUESTION: If tooth has closed apex, immerse tooth in 2.4% sodium fluoride solution with what pH
for how many minutes? pH of 5.5 (changed the pH) for 5 min…
QUESTION: Avulsed tooth should be treated with what to reduce root resorption? 2% Sodium
fluoride for 20 minutes.
QUESTION: Avulsed tooth, extraoral time was less than 60 mins, primary tooth, what you do? Don’t put
it back.
QUESTION: If tooth has open apex, and it gets avulsed, how you close it? You use MTA.
QUESTION: Which material is least cytotoxic for perforation repair? MTA
QUESTION: CaOH tx for an avulsed tooth????? Yes or no?
QUESTION: Splint tooth for pt comfort
Avulsion – 7-10 days non rigid splint, antibiotics
Rigid splint for horizontal root fractures 3 months
Extrusion is a splint for 2-3 weeks
QUESTION: Intrusion tx of permanent teeth? Reposition and splint

QUESTION: Patient intrudes mature maxillary incisor. Trauma causing deep intrusion to a
permanent tooth causes PULP NECROSIS and conventional RCT is necessary.
QUESTION: Tooth with closed apex gets intruded, what is most likely to occur? Necrosis
QUESTION: Intrusive trauma pulp necrosis, what percent is rate of pulp necrosis? 96 %
RCT related:
Endo tests?
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Percussion- presence of inflammation in PDL or not.
Palpation- spread of inflammation to perodotium from PDL or not.
EPT- Pulp vitality (necrosis or not).
Thermal test (hot & cold)-pulp vitality. Hot (irrev), cold (rev)
QUESTION: Primary purpose of sodium hypochlorite? Dissolve necrotic tissue
***Sodium hypochlorite NaOCl is NOT a chelator, (it dissolves organic tissue)
QUESTION: Bleach is not a chelating agent
QUESTION: Sodium hypochlorite is used for everything except? Chelation
QUESTION: Sodium hypochlorite is not a chelating agent. **It is an 5.25% irrigation solution—
germicidal. It is also vital to tissue. Other irrigation solutions include urea peroxide (glycerol based) and
3% hydrogen peroxide. Chelating agents are good for sclerotic canals. Substitute sodium ions and soften
canal walls.
QUESTION: What is the job of Ca(OH)2 during a root canal procedure: Intracanal medicament
QUESTION: which is a chelator for endo? EDTA, sodium hypochlorite, etc.

EDTA is chelator, removes SMEAR LAYER and inorganic material.
(NaOCl = sodium hypochlorite only dissolves organic material, only disinfects and is most
common irrigant.)
QUESTION: EDTA: **Percentage of EDTA: 17%
QUESTION: What is the function of EDTA: remove inorganic material and smear layer
QUESTION: Which one is false about NaOH? – It’s a chelating agent.
QUESTION: Which one is correct about EDTA? – It’s a chelating agent.

QUESTION: Chelating agent: EDTA
QUESTION: contraidication for CaOH: Pulp symptomatic for last month..
QUESTION: PAR seen on asymptomatic tooth, when opened the canal is calcified what do you do: do
nothing, refer to endodontist, place EDTA
QUESTION: Internal resorption left untreated can lead to? I think Pink tooth
QUESTION: Similar question: What causes Pink Tooth Mummery? Trauma and infection internal
resorption
QUESTION: treatment for internal resorption (endo): RCT
QUESTION: How to treat internal root resorption : Endo
QUESTION: Internal resorption shows all BUT – radiography is symmetrical with the pulp space, can
resorb all the way to the PDL, a treatment option is observe until resorption stops, resorb to create
pink tooth
QUESTION: when a tooth is ankylosed what type of resorption : replacement resorption
QUESTION When you replant teeth, what will happen
a. Ankylosis (will not say that) – replacement bone formation ANS
QUESTION: Inflammatory external root resorption? What do you do? Extraction ENDO!
QUESTION: The treatment-of-choice for an external inflammatory root resorption on a non-vital tooth is
8
A. Extraction  
B. Surgical curettage of the affected tissue  
C. Pulpectomy and obturation with gutta-percha and sealer  
D. Removal of the necrotic pulp and placement of calcium hydroxide  
E.Observation since it is a self-limiting process
QUESTION: when a reimplanted tooth presents external resorption what is the Tx : a) RCT with
gutta percha JUST OBTURATE AND PLACE CaOH
QUESTION: How you manage tooth with external root resorption
b. Instrument and put CaOH
QUESTION: when a reinplanted tooth presents external resorption what is the Tx : a) RCT with
gutta percha b) obturation with CaOH c) extraction
(do CaOH every 3 months until PDL is healthy then complete RCT)
QUESTION: which has the best prognosis
• perforation in extneral resorption
• perforation in internal resorption??
• extruded gutta percha
QUESTION: least likely to result in endo failure? overfilling with gutta percha, inadequate either
obturation or cleaning and shaping (can't remember), lateral root resorption, perforating
internal resorption
QUESTION: cause of grey tooth
• blood products in the dentinal tubules (what I put, I think this is correct)
• internal resorption
• external resorption
• calcified canal
(hyperbilirubinemia: grayish-blue: Xtina)
QUESTION: Why are traumatized primary incisors discolored? Pulpal Necrosis and Pulpal
Bleeding
QUESTION: elective endo
• pulp exposure
• unrestorable tooth…
• endo contraindicated in: non restorable tooth
QUESTION: Most common cell in necrotic pulp? PMN cells
QUESTION: Biggest reason for failure of RCT – cleaning of the canals, proper obturation …
QUESTION: root canal failed on upper canine - due to cleaning and shaping
QUESTION: root canal failed on upper canine - (lack of seal)
QUESTION: RCT done 1.5 yrs ago, now radiolucency and fistula - incomplete RCT
9
QUESTION: Pt comes in for a RCT on a non-vital tooth with 1mm apical lucency. 5mo later comes back
with 5mm lucency, why?- Improperly done endo, retx. Others another canal, osteosarcoma, carcinoma.
Most common cause of RCT failure is inadequate disinfected RC, 2nd most common cause is poorly
filled canals.
QUESTION: Incomplete removal of bacteria, pulp debris, and dentinal shavings is commonly caused
by failure to irrigate thoroughly. Another reason is failure to
A. use broaches.
B. use a chelating agent.
C. obtain a straight line access.
D. use Gates-Glidden burs.
QUESTION: least likely cause for failed RCT

a. GP beyond apex---causes of failure 1) insufficient canal debridement 2) insufficient
obuturation/leakage.
b. clean & shaping no good
c. obturation no good
QUESTION: Gutta percha, all except – adapts to tooth (needs sealer)
QUESTION: Which of the following is not a property of gutta-percha . radiopacity, Biocompatibility,
Antibacterial, Adaptation
QUESTION: Gutta percha has the following advantages EXCEPT: 1.easy manipulation, 2. Adapts to
tooth surface, 3.Anti- microbial,4. Biocompatible 
QUESTION: Patient comes back few months after RCT & Crown with pain upon biting, what
happened…cracked tooth, hypersensitivity
QUESTION: Pt has pain in tooth after crown and root canal: vertical root fracture, a lot of these type of
questions, know wehter it’s vertical, or occlusion problems (sensitive to cold, hot and all that).
QUESTION: Similar questions: Crown cemented two weeks ago is sensitive to pressure and cold, why?
Occlusal trauma
QUESTION: Pain on tooth 2 weeks after crown placement? I put root fracture
***No why would it be root fracture after a crown placement?? it would make more sense that it’s a root
fracture after RCT not crown placement. I think answer should be hyperocclusion, if the option was there
****
QUESTION: Tooth with endo treated and post with crown have pain after several days esp during biting
and cold: vertical root fracture
QUESTION: Patient has pain 1 month after cemented crown and post and rct, pain on biting, why?
Vertical root fracture
QUESTION: You did endo on patient, weeks later you did CPC after that? Patient has post-op pain on
tooth? Vertical fracture
QUESTION: RCT is contraindicated for a vertical root fracture
QUESTION: Vertical root fracture – non restorable after
QUESTION: Most common cause of vertical rt fracture?
• In endo tx’d teeth: excessive lateral condensation of GP
• In vital teeth: physical trauma
QUESTION: Vertical Root Fracture is most likely found? Mand posteriors
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QUESTION: Which teeth do vertical fractures more common? – Lower posterior teeth.
QUESTION: What causes most vertical root fractures? Condensation of gutta percha
QUESTION: most probability of vertical root fracture- isolated pocket depth
QUESTION: isolated pocket . What condition? Vertical root fracture
QUESTION: Patient get paid every now and then on a tooth when he eats meal? – Cracked tooth
syndrome
QUESTION: Which one has a different transillumination? I said cracked tooth (other choice were crown-
and-root fracture, have no idea!)
QUESTION: which allows the enitre tooth tooth to light up under transillumination? I said
cracked tooth (other choice were crown-and-root fracture, separated tooth, have no idea!) I said
ccraze lines? ? CRAZE LINE (WHOLE TOOTH)
QUESTION: When does transillumiator show evenly through tooth: craze line, crack, fracture from
crown to root: Craze line
QUESTION: when does translumination shows the whole crown : a) fracture cusp b) cracked tooth
c) craze lines
TRANSILLUMINATION: shows cracks. Whole tooth = craze line
QUESTION: Type of fracture that lets light pass completely through…
a. crazed CRAZE LINE
b. split tooth
QUESTION: Which will show up on transillumination best?
Cracked tooth
Fractured cusp
Craze line
QUESTION: Vertical root fractures are also called cracked teeth. The prognosis of cracked teeth varies
with extent and depth of crack.
b. Both statements are false.
c. First statement is true, second is false.
d. First statement is false, second is true.
QUESTION: If two cavities were thought to be two separate fillings but upon exam it was a crack through
the isthmus. What do we tx this symptomless crack with?- observe
QUESTION: most common tooth associated w/ cracked tooth syndrome: Mandibular second molars,
followed by mandibular first molars and maxillary premolars, are the most commonly affected teeth.
QUESTION: Crack tooth syndrome is most likely found? Mandibular Molars
QUESTION: Most common to have cracked tooth = mand 1st molar (mand 2nd first) MD
direction
QUESTION: horiz root fracture
a. reduce & immobilize
QUESTION: How do you first tx a horizontal root fracture?
Immobilize the segments
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Rct
Splint
CaOH
QUESTION: Apical horoziontla root fracture: no pain, what do you do? Rct, scaling, rct if tested
nonvital, monitor 1 year
QUESTION: Horizontal Root Fracture more common in anteriors, the success and healing of
horizontal root fractures is the immediate reduction of the fractured segments and the
immobilization of the coronal segment 12 weeks
QUESTION: Horizontal rooth fracture: take multiple vertical angulated xrays
QUESTION: What teeth most likely to have crown/root fracture … max anteriors, mand anterior, max
posteriors, mand posteriors- a strong majority are lower molars (1st)
QUESTION: Most common teeth with crown to root fracture? Mand molars
QUESTION: which tooth is least likely to fracture: mx premolar, mx molar, md premolar, md
molar
QUESTION: which tooth is most commonly fractured? mx incisors, md incisors, etc.
QUESTION: Chronic endo lesion, what type of bacteria? Anerobes ANS (multiple anerobes)
QUESTION: Reason for failed endo?

Seal 2mm away from apex
Bacterial infection
RCT sealer beyond apex
Forgot other one
QUESTION: Endo file breaks when you at 15 file. refer to endodontist.(retrieving it was not an option)
QUESTION: If file breaks tooth asx:
• Leave and monitor
QUESTION: You being the best doctor in the world, you broke a 5mm dental instrument in a canal during
RCT procedure, what’s the best thing to do? – Tell the patient what happened, and refer her to an
endodontist. (Other choices were, take a picture and only tell patient if you see the instrument in there, re-
schedule patient to continue with RCT, Put a watch on it)
QUESTION: Endo on a molar.
Break a file on apical level, what should you do?
-write on med history and continue?
-refer patient to specialist?- if it was in middle third you would continue treatment.
QUESTION: what file was the endodontist using?
Stainless steel
Ni Ti
QUESTION: What is not an advantage of NiTi over stainless steel

Ability to stay centered in canal
Something aided depth penetration into canal
My bad don't remember this question very well
12
QUESTION: all are advantages of using nickel titanium endo files over regular steel files except?
a. flexibility (yes)
b. bending memory (yes)
c. direction of the flutes (no)?
QUESTION: What is the weakness of Ni files vs regular- strength, flexibility... and some other choices ( I
wrote strength)
QUESTION: What is the NOT an advantage of stainless steel files? 1. More flexible.., 2. Less chance for
breaking, 3. Allows the file to be centered in canal, 
NiTi rotary files remain better centered, produce less transportation, and instrument faster than stainless
steel files due to their superior flexibility and resistance to torsional fracture. They have 10x the stress
resistances of stainless steel (stronger).
QUESTION: Which of the following is not an advantage of Ni-Ti over stainless steel file?
a. Maintains the shape of canal,
b. flexibility,
c. resistance to fracture.
QUESTION: you separate an endo file 3mm from the apex and obturate above it... which case will
show the best prognosis?
a. vital pulp w/ no periapical lesion(yes)
b. vital pulp wI periapical lesion
c. necrotic pulp wI no periapical lesion
d. necrotic pulp wI periapical lesion
QUESTION: Best prognoses for a broken instrument at apical third?

Vital pulp with no PA abscess
Necrotic pulp with no PA abscess
Vital pulp with PA abscess
Necrotic pulp with PA abscess
QUESTION: which has worst prognosis? File fracture, transportation, I put perf through furcation
QUESTION: How many canals do you expect in primary M2: four
QUESTION: Access design –mandibular is trapezoid

QUESTION: What is the shape of the access of mandibular 1st molar?
A. Square
B. Trapezoid**
QUESTION: maxillary 1st molar access opening: triangular
QUESTION: Pulpal anatomy dictates a triangular-access cavity preparation in the MAXILLARY

CENTRAL INCISOR.
13
QUESTION: why do you do triangular access on incisors (max central inccisor?)
a. to help with straight line access
b. help expose pulp horn
c. to follow the shape of the crown
QUESTION: Ept tests whether its responsive or nonresponsive that’s it (not tell level of
necrosis/how vital the tooth is, etc.): Nerve
QUESTION: EPT – responsiveness (not health)

QUESTION: How does a tooth covered with crown react to pulp testing--- cold is better test (thermal)
QUESTION: what can you diagnose with the EPT test : pulpal necrosis
QUESTION: How do you differentiate between an endo/perio lesion? EPT
QUESTION: EPT: to differentiate if perio (some response to ept) or endo(necrotic, no response to EPT)
involvement
QUESTION: Vitality test used to distinguish periodontal from endo lesion – vitality and probing
depths
QUESTION: know best way to diagnose irreversible pulpitis ? heat. Cold/ thermal test
QUESTION: EPT is more accurate than cold test for pulp necrosis? FALSE
QUESTION: What is untrue about EPT?

It is more reliable than cold testing for necrotic teeth (false!!!)
It gives relative health status of pulp (true)
Tells if there are vital nerve fibers (true)
QUESTION: EPT does NOT indicate health of the pulp
QUESTION: EPT- compared to cold test it is superior (False)….

QUESTION: What is not true regarding electric pulp test: Doesn’t tell you about vascular or
something like that (doesn’t tell you about vascularity of pulp which is true pulpal diagnosis)
QUESTION: Did not respond thermal and ept but response to palpation and percussion? Necrotic pulp
QUESTION: Most reliable way to test vitality of a tooth? EPT (I think Thermal was more correct, damn I
was tired at this point, and I was low on RedBull) **Mosbys states that thermal tests must be done before
a final diagnosis, because EPT can have may false readings
QUESTION: Luxated tooth, negative EPT - disruption of nerves to tooth
QUESTION: Best prognosis of perio endo lesion
• Endo with rct – perform first
• Perio scaling and root planning
QUESTION: what is initial treatment of combination perio and endo lesion: do rct first or perio first,
etc: RCT first
QUESTION: Pulp vitality testing. Difference between perio and endo periapical lesions. Best
prognosis – perio started from endo, or endo started from perio?
QUESTION: test performed to differentiate endo vs. perio lesions : Percussion
QUESTION: Percussion: can identify perio involvement
QUESTION: Difference b/w acute apical abscess and lateral periodontal abscess: Vitality test
14
QUESTION: lateral periodontal abscess is best differentiated from the acute apical abscess by?
a-pulp testing
b.radiographic appearance
c.probing patterns
QUESTION: how do you distinguish acute apical absess and periodontal absess : vitality
QUESTION: differential diagnosis of periodontal abscess and periradiculal abscess?
a.percussion
b. vitality test
c.palpation
QUESTION: on primary teeth you dont want to use ept  thin enamel false results and after
trauma you don't want to use electronic pulp tester.
QUESTION: What is test to diagnose acute periradicular periodontitis – sensitive to percussion
QUESTION: Good way to diagnose acute periradicular periodontitis – sensitive to percussion
QUESTION: acute apical periodontitis is best diagnosed with: percussion

QUESTION: acute periradicular periodontitis sensitive to what? Cold, Percussion
QUESTION: radiographically the acute apical abscess
a. is generally of larger size than other lesions
b.may not be evident
c.has more diffuse margins than other lesion
QUESTION: What is test to diagnose chronic periradicular periodontitis? Percussion (palpation?)
QUESTION: How do u test a tooth to differentiate between chronic perio and supperative perio?
a. cold test
b. percussion (and lateral percution of course)
c. EPT
QUESTION: Indications of perio lesion vs endo lesion: apical radiolucency and pain upon lateral
pain pressure (not apical)
QUESTION: Which of following is not endodontic in origin: tooth with wide sulcular pocket not
extending to apex
QUESTION: What is feature that makes it a perio lesion that’s not seen on an endo lesion: I said it
was there is pain on lateral percussion of tooth and wide space of pocket against tooth
QUESTION: Which of the following conditions indicates that a periodontal, rather than an
endodontic problem, exists?
A. Acute pain to percussion with no swelling
B. Pain to lateral percussion with a wide sulcular pocket
C. A deep narrow sulcular pocket to the apex with exudate
D. Pain to palpation of the buccal mucosa near the tooth ape
15
(true perio-endo lesion) Evaluate strategic value of the tooth. If tx is warranted, initiate endo
therapy first. Perio treatment may be combined with periapical surgery, if needed. Prognosis is
poorest.
If Endo lesion is draining through periodontal ligament space, Complete endodontic treatment and
wait several months to evaluate healing of periodontal lesion
If Perio Lesion has spread to the periapical region, Evaluate vitality of the pulp, institute
periodontal treatment alone if vital (treatment may devitalize pulp).
Endo-perio: pulpal necrosis leading to a perio problem as pus drains from PDL.
Perio-endo: infection from pocket spreads to pulp causing pulpal necrosis.
QUESTION: Endo abscess but no sinus tract, can pus drain through the PDL: True
QUESTION: endo lesion with sinus tract. Do RCT and leave the sinus tract alone, will heal
QUESTION: What treatment is required with tooth with draining sinus tract has been treated via RCT:
no further treatment
QUESTION: when do you puncture? An abcess.
Localized chronic fluctuant in palpation.
Localized chronic hard in palpation (if hard there is no pus)
QUESTION: A patient has a non vital tooth and a fistula is draining around gingival sulcus. What to
do
endo and perio at same time
perio and then endo
only endo
only perio
QUESTION: There usually is no lesion apparent radiographically in acute apical periodontitis. However,
histologically bone destruction has been noted.
QUESTION: Based solely on the sharp transient response of pulp to hot stimuli, what is the periradicular
diagnosis?
a. Acute apical periodontitis
b. Cannot diagnose based on information provided.
c. Acute Apical abscess
QUESTION: What is the clinical ‘hallmark’ of a chronic periradicular abscess?

a. Large periradicular lesion
b. Sinus tract drainage
c. Granulation tissue in the periapex.
d. Cyst formation.
QUESTION: Hallmark of periradicular abscess - sinus tract
16
QUESTION: A periradicular radiolucent lesion of endodontic origin on the radiograph may be any of these
histological diagnoses except one. Mark this exception.
a. A cyst
b. A granuloma
c. An Abscess
d. Dentigerous cyst
QUESTION: What complete endodontic diagnosis could be completely asymptomatic but should require
endodontic therapy?
a. Pulpal necrosis and acute periradicular periodontitis
b. Normal pulp and acute periradicular periodontitis.
c. Pulpal necrosis and chronic periradicular periodontitis.
d. Normal pulp and normal periapex
QUESTION: A lesion of non-endodontic origin remains at the apex of the suspected tooth regardless of X-
ray cone angulations.
a. True
b. False
QUESTION: Periapical abscess, what do you do? DO NOT DO RCT FIRST, YOU ARE SUPPOSE TO
INCSION AND DRAINAGE AND PRESCRIBE ANTIOBIOTCS AND WAIT TO DO RCT AT A
LATER DATE
QUESTION: How do you treat perio abscess? I put ENDO first, then possible perio tx later
QUESTION: Acute perio abscess – you must drain lesion
QUESTION: Acute perio abscesses that require drainage are usual firm, localized lesion (other
options are fluctuant, local lesion; generalized firm lesion)
QUESTION: First thing do with periapical abscess? Incise and drain,

Use gutta percha to find it
QUESTION: number one thing for acute apical abscess is drainage and cleaning the canal (multiple
questions reformatted that ask about this)
QUESTION: after an endo in maxillary molar what Tx would you for sinus track : no tx
QUESTION: Most critical for pulpal protection ANS.  Remaining dentin thickness (2mm)
QUESTION: What will not regenerate after RCT: dentin formation, cementum, PDL, alveolar bone
QUESTION: Each of the following can occur as a result of successful rct tx except which one? - formation
of reparative dentin
QUESTION: Boy has horizontal root fracture in apical 3rd, no symptoms or mobility, what tx? Monitor,
RCT, extract, pulpotomy, splint
QUESTION: A maxillary central incisor of an adult patient is traumatized in an accident. The tooth is
slightly tender to percussion, is in good alignment, and responds normally to pulp vitality tests.
Radiographic examination shows a horizontal fracture of the apical third of the root. The best treatment is
A. Root canal treatment
B. Splint and re-evaluate the tooth for pulpal vitality at a later time
C. Apexification
17
D. Apicoectomy to remove the fractured apical section of the root followed by root
canal treatment
QUESTION: Worst prognosis for RCT – ledge formation, vertical fracture during obturation,
instrument gets stuck in apical 1/3 …
QUESTION: Fracture at apical 1/3, how long do you splint – 7-10 days, 2-3 weeks, 4-6 weeks
QUESTION: Nonvital after a fracture? Reevaluate at a later time
QUESTION: a Pt with an endo in a molar tooth, after one year a cyst form, the tooth was extracted,
after another year the cyst was bigger what happened : bad endo, the dentist did not curettage
well when the extraction was done
QUESTION: during root canal you notice you left debris in the canal most likely due to lack of use of
which? Gates burs, broaches, chelating agents? Others? Irrigant??
QUESTION: Taurodontism has enlarged pulp chamber in which direction? apical, occlusal or apical
AND occlusal **** know what tauradontism looks like on x-ray****
QUESTION: Taurodontism pulp bigger: apically
Operative:
QUESTION: Critical pH of developing cavity? pH 5.5*
QUESTION: pH that enamel starts to demineralize – 5.5
QUESTION What can tell best thing about caries: past caries history
QUESTION Which is least likely to predict future caries?
Amount of sugar intake
Frequency of sugar intake
Amount of caries and restorations
(I would have prob put amount of caries and restorations b/c this is known to be an indicatior of
past caries not future caries.)
QUESTION: 3 factors that affect caries initiation? substrate, bacteria, host susceptibity
QUESTION: Which of the following is the earliest clinical sign of a carious lesion?
A. Radiolucency
B. Patient sensitivity
C. Change in enamel opacity
D. Rough surface texture
E.Cavitation of enamel
QUESTION: What is true of Strep. mutans?
• Can live in plaque,
• Can live on gingival
• Can live in a child with no teeth
• Has to live on a non-shedding surface
QUESTION: Most Cariogenic? Sucrose... S.mutans adheres to the biofilm on the tooth by
converting sucrose into an extremely adhesive substance called dextran polysaccharid.
QUESTION: How do cells first attach- dextran or lextran? **I think its dextran. S. Mutans is involved in
converting sucrose  dextran like long chain polysaccharides (glucans/fructans) using enzyme
Glucosyltransferase. This is the main way caries develop.
QUESTION: Caries progression – lactobacillus
QUESTION: what contributes to caries formation – Lactobacillus
18
QUESTION: What helps in carious process but it is not the primary inititator for caries:
Lactobacillus
QUESTION: Lactobacillus: does not initiate caries but is part of the progression of caries
QUESTION What is the most important etiologic factor in getting caries?

Saliva ph
Refined sugar
fluoride tx
saliva flow
QUESTION: Which race has most caries in kid population?
• Hispanics
QUESTION: What race for children has highest caries incidence? HISPANIC
QUESTION: early childhood caries- centrals and molars
QUESTION: Which population has the most number of UNRESTORED caries: black
QUESTION: White females have the most caries in permanent teeth
QUESTION: Know how to determine if a patient is a high caries risk? Assessment
QUESTION: most recent increase in caries is seen in: roots
QUESTION: What one of the following increasing in the US? – Root caries
QUESTION: New data regarding caries shows: more smooth surface caries, more pit-fissure caries,
same, more root caries
a. More root caries
QUESTION: Recent survey, what kind of stats on caries?

• inc in smooth surf caries - wrong
• inc in pit/fissure caries - wrong
• smooth surf caries and pit/fissure caries is same - wrong
• inc in root caries****
QUESTION: How do you diagnose root caries? Soft
QUESTION: Best indicator of root caries is a soft spot
QUESTION: best clinical determinant of root caries  ?
sensitivity to cold
sensitivity to sweets
soft spot on tooth - visual and tactile methods are used for detect caries
QUESTION: Remineralized teeth are they stronger than regular enamel?
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QUESTION: For a lesion in enamel that has remineralized, what most likely is true? 1. The enamel has
smaller hydroxyapatite crystals than the surrounding enamel, 2. The remineralized enamel is softer than
the surrounding enamel, 3. The remineralized enamel is darker than the surrounding enamel, 4. The
remineralized enamel is rough and cavitated
QUESTION: Sign of remineralization: I put rougher than tooth structure and darker, but not sure
QUESTION: What’s the characteristic of a remineralized tooth? Darker, harder, more resistant to acid
QUESTION: Remineralized lesion is shiny and more resistant to future decay
QUESTION: Characteristic of a lesion that is remineralized:
black, dark, bright
black, dark, opaque
black, dark, cavitated
QUESTION: remineralized lesions, yellow: -more resistant to future caries
QUESTION: Remineralization? Harder than normal. (Pit and fissure are most prevalent caries)
QUESTION: What does arrested caries look like? Black dark
QUESTION: Leathery brownwhite lesion? arrested, acute, chronic
QUESTION: Scleoritc dentin: harder, better to bond to?
QUESTION: Which of these is NOT an important reason for a clinician to be able to distinguish
remineralization? I put color. I have no idea what this was asking.
QUESTION: Most common area for caries initiation? I put cervical to contact, Pit and Fissure
QUESTION: What is the most common site of enamel caries?
• pit and fissure*
• at the contact point
• slightly incisor to contact
• slightly cervical to contact
QUESTION: Where does caries start? Apical to proximal contact.
QUESTION: location of interproximal caries lesion : below the contact
QUESTION: Most interproximal decay happens where? – Just under the contact.
QUESTION: A class II caries is: Apical to contact
QUESTION: When do you restore a lesion? – When there is cavitation (others were when it’s half
through enamel, when it passes CEJ, when you see it on xray).
QUESTION: When do you tx caries: half way to the enamel, through enamel, when you can see it
on xray (NO) Answer: cavitation
QUESTION: In which of these cases do you start restoration: can see on x-ray, cavitation present,
lesion ½ into enamel, cross CEJ (not DEJ)
QUESTION: when you start to do a caries : a) more than half way into enamel b) in the DEJ c) in CEJ
d) when you see it in the xray
QUESTION: When do you restore a tooth?
a. Either when its CAVITATED or when its ½ in enamel (but this can remineralize..)?
b. Nothing about dentin involvement.
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QUESTION: Tx of root surface caries (pg 40): what kind of dentin should not be restored?
Eburnated dentin(Sclerotic dentin)
QUESTION: Fluoride is used for? Smooth interproximal surfaces.

QUESTION: Smooth surface caries most likely due to? Plaque
QUESTION: Where does fluoride work the best?
A. interproximal**
B. Pit and fissure (I saw this somewhere and it said smooth surfaces, pit and fissure is
prr/sealant)
**WORKS BEST ON SMOOTH SURFACES***
QUESTION: What caries lesion has a V shape pointing to pulp- occlusal, smooth, root caries
QUESTION: Which of the following is a factor for smooth caries and sugar in-take? – Consistency (others
were volume, and other option. Consistency I thought would be like if you keep taking a lot sugar diet on
daily basis)
QUESTION: Which of the following is a factor for smooth caries and sugar in-take? – Consistency–
consistency b/c if it’s the sticky type it stays on the tooth longer allowing bacteria to keep pH lower
longer
QUESTION: Caries in children depend most on: amount, consistency, time
QUESTION: occlusal caries where is base and cone? Triangle point at enamel and base to dentin,
dentin base to tip at pulp
QUESTION: Pit and Fissure caries is described as two cones:
a. Two bases are pointing toward the pulp

  b. Two apexes are pointing toward pulp>>>> in smooth surface (proximal caries)
c. One apex toward the pulp and one base toward DEJ
d. Both bases facing DEJ
QUESTION: Pit and fissures caries have the base of both triangles lie along the DEJ
QUESTION: pit and fissure caries, base is at dej

QUESTION: DEJ- diff btw smooth caries(conical), occlusal (apex at occlusal), interprox (apex at
DEJ)
QUESTION: conical shaped caries w/ broad base with apex towards pulp is commonly seen in?
a. root caries
  b. smooth caries
  c. pit/fissure caries
QUESTION: Dx of pit and fissure caries, explorer catch, or dark stained grooves? Others? Inverted V on
x-ray
QUESTION: Most likely dx indicator of pit and fissure carries is what?- explorer catch. Others, xray,
adjacent tooth decalcify, contralateral tooth thingy
QUESTION: enamel caries best detected by explorer catch, pit and fissure stain.
21
QUESTION: 40 y pt w/ all 32 teeth. No cavities. Has stain & catch in pit of molar. what do you do?
QUESTION: Pt 32 year old, none of the teeth has restoration, pits and fissure stain? What do you do?
Observe, Fluoride
QUESTION: if you inadvertently seal over caries what happens? Arrested caries.
QUESTION: Fill over a caries – arrested caries
QUESTION: If a dentist seals a caries lesion on tooth, what would be the most likely result? 1. Arrest
caries (answer), 2. Extension caries, 3. Discoloration of tooth, 4. Micro-leakage
QUESTION: If you feed a person through a tube, then you decrease risk of caries
QUESTION: mechanism of caries indicator: enters the dentin and binds to the denatured collagen
QUESTION: Caries die- marks denatured collagen
QUESTION: How does caries indicator dye work. Bind to surface collagen of caries
QUESTION: How does caries indicator work? (p.17)
• A colored dye in an organic base adheres to the denatured collagen which distinguishes between
infected dentin and affected dentin
QUESTION: What does caries indicator do – I put it only stains affected dentin, not infected dentin
QUESTION: What type of caries detection is the Dyfoti used for? Class I Class II, Class III
•detection of incipient, frank and recurrent caries, demineralization
QUESTION: DaignoDent is Class I – ONLY OCCLUSAL CARIES (pit and fissure)
QUESTION: Incidence of caries in your office this year is 300 out of 1000, last year it was 200, so what is
it for this year? 300/1000
QUESTION: Number of people with caries or other stat your looking for in your office this year is
300 out of 1000, last year it was 200, so what is it for this year? 300/1000 im pretty sure incidence
is NEW cases. And the answer is 100/1000. DESCRIPTIVE STUDY
it for this year? 300-200/1000= 100/1000= 0.1
QUESTION: dentist has 300/1000 patients with periodontitis; last year only 200 had periodontitis
what is the incidence for this year: 10%
QUESTION: Radiographic decay most closely resemble which zone of carious enamel? Body zone*, dark
zone, translucent zone, surface zone
QUESTION: When looking at a radiograph, what zone of caries are you looking at? Body zone
Demineralization.
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QUESTION: Know what DMFS stands for decay missing filling surface
QUESTION: Know DMFS : Decayed, missing, filled, surfaces
QUESTION: DMFS is for surfaces including 3rd molars 0-160, for primary use def index
QUESTION: what is DMFS : Decayed, missing, filled surfaces…It is a dental epidemiologic
indice
QUESTION: in DMFS “ s” stand for ----------- surface DECAY MISSING FILLED SURFACE
QUESTION: In the DFMS system whats the S stand for?- Surfaces
QUESTION: DMFS stands for? – Decayed Missing Fillings and Surfaces
QUESTION: DMF index measures how permenant dentition is affected by caries
QUESTION: Dmf-measures the amount tooth decay
QUESTION: DMFT is for permanent teeth ( no 3rd molars nor primary teeth ) 0-28
QUESTION: DMFT- who has the most F- white, blacks, Hispanic, Indians
QUESTION: Which race has a higher F in DMFT index: White
QUESTION: For adults, black males for untreated decay…DMFT
QUESTION: Which population has the most number of unrestored caries: Black
QUESTION: deft= for primary (e=extraction)
QUESTION: which of the following acronyms is only used for kids? PI, def, DMF, OHI-S, another weird
acronym
QUESTION: DEFT for kids
QUESTION: Whats the D__ the one that’s only three letter system of tooth carries tracking, what can it
not do?- Track how teeth were lost.
QUESTION: Differences between 245 and 330 burs- 245 bur is 3mm in length, 330 is 1.5mm. All
other dimensions the same except for length.
QUESTION: Difference between but 225 and bur 330: ive never seen 225 before, deciding between
longer bur length for 225 and sharper line angles made with 225 (old exams say 245/255 burs
have longer head so im assuming it was the same, I went with this)
QUESTION: 245 carbide and 330 carbide have what difference? Length distance
QUESTION: 245 bur vs 330 bur - 245 is longer (3mm) 330 (1.5mm) inverted cone
23
QUESTION: burs 245 vs 330 question = 245 is longer!!! (3mm) 330 is 1.5mm in length.
QUESTION: difference between 330 bur and 245 bur: how is the shape, what angle they form,
length and 245 has sharper angle
QUESTION: Example pear shape bur- 56 or 699? (Isn’t pear shaped…more like a 330?)
Pear = 329, 330, 245 (330L)
QUESTION: Bur used that converges F and L walls? # 169, 245, 7901,
QUESTION: Bur used that converges F and L walls? #245, 7901, 169 if 169 is not there pick 245
245 = 330L = pear and elongated bur, 169 = tapered bur, .9 diameter
QUESTION: What bur do you use to shape convergent walls for amalgam
The bur # that aids in wall convergence!! They had 169 and 245 not 254!!!
QUESTION: Which bur do you use for peds? A.245 B.18 C.51
QUESTION: which is best for occlusal convergence in a prep, 245 (169 is better for occlusal)
QUESTION: Diameter of 245 bur ? 0.8
QUESTION: What bur use for Amalagam retenetion in class II- 245 or 330
QUESTION: Burs and smoothing out preps? More flutes and shallow, more flutes and deeper, less flutes
and shallow, less flutes and deeper
QUESTION: more Blade? less efficient more smooth,
QUESTION: More blades on bur: SMOOTHER, DECREASED CUTTING EFFICIENCY
QUESTION: More blades on carbide bur = less efficient cutting, smoother surface
QUESTION: More blades on bur = smoother! But poor cutters Less blades = cut better but less
smooth.
QUESTION: increase # blades = increase smoothness, decrease cutting. Decrease blades of bur =
better cut of decrease smoothness.
QUESTION: Which burr is used to smoothe the prep? diamond, carbides with flutes??????
QUESTION: Which high speed bur gives a smoother surface? Plain cut fissure bur = best
cross cut fissure have a higher cutting efficiency
QUESTION: Bur used for polishing – Carbide more threads STEEL FOR POLISH
QUESTION: Use a large bur and start in the middle of a cavity

QUESTION: What is the correct method of excavation of deep caries. Long bur from periphery to the
center, large bur from center to periphery, small bur from periphery to center, small bur from center to
the periphery
QUESTION: How to excavate if think might be close to pulp- small or large bur, take out first in deepest
or periphery first **I would think you would use the largest bur that fits, and go around the periphery
and then towards the deepest
QUESTION: Rotary hand instruments: high speed how many round per min? 200,000 rpm
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QUESTION: know applications of chisel and spoon
Chisels are intended primarily to cut enamels, but spoons remove caries and carve
amalgams
QUESTION: whats difference btwn an enamel hatchet and gingival marginal trimmer (both chisels)
GMT has curved blade and angled cutting edge. Enamel HA: cutting edge in plane of handle
QUESTION: main difference and advantage of using GMT instead of Enamel hatchet?
a. bi-angled cutting surface
b. angle of the blade
c. push/pull action instead of
QUESTION: what can't you use to bevel inlay prep? a. enamel hatchel b. ging marg trimmer c. flame
diamond d. carbide.
QUESTION: What do u not use when beveling gingival margins? Tapered diamond
QUESTION: Instrument to plane gingival margin on a class II?

• 2 with 3 number and 2 with 4 numbers
• Answer has 4 numbers – last number is different.
QUESTION: How do you bevel occlusal floor (gave list of instruments)
• 13,8
• 15,80
• 15,95
QUESTION: How do you bevel occlusal floor (gave list of instruments): 15,80
QUESTION: What instrument would not be used to bevel the gingival margin of an MOD prep?
Enamel Hatchet
QUESTION: Proper pulpal floor depth using Bur 245?
is 3mm, so half of it is 1.5 mm which is proper pulpal floor depth

QUESTION: Hydrodynamic theory?
Definition: Postulates that the pain results from indirect innervation caused by
dentinal fluid movement in the tubule that stimulates mechanoreceptors near the
predentin
QUESTION: Sensitivity theory – hydrodynamic theory
QUESTION: Most commonly accepted theory of dentinal sensitivity?

A: Hydrodynamic theory
QUESTION: Best theory to explain dentin hypersensitivity. ANS Hydrodynamic theory
QUESTION: You did a prep with high speed and diamond bur, tooth is sensitive, what is it about bur
and handpiece that it caused sensitivity?
A) Desiccation b) traumatized dentin? Heat

QUESTION: Most common pulpal damage from cavity prep – heat, dentin dessication
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QUESTION: What would cause displacement of odontoblastic processes? Thermal, “dessication”
/mechanical/chemical/
QUESTION: Displacement of odontoblastic nuclei caused by: mechanical, thermal, chemical
QUESTION: What causes the displacement of nuclei in the dental tubules?
Thermal? Chemical?mecanical?dessication???
QUESTION: Displacement of odontoblasts in tubules: Thermal, mechanical, chemical, caries:
related to hydrodynamic theory I think so I put thermal
QUESTION: Wat doesn’t cause corrosion of burs? Dry heat

QUESTION: Which method of sterilization does not corrode instruments – Dry Heat, Ethylene oxide
QUESTION: Which method of sterilization does not dull carbide instruments – Dry heat
QUESTION: Sterilization most destructive to burs: steam heat

QUESTION: What is best to sterlize carbide burs? Autoclave…? DRY HEAT or unsaturated chemical
vapor->no corrode or dull
Ethylene oxide is for heat-sensitive instruments.
Amalgam:
QUESTION: Symptom of amalgam toxicity for dentists
QUESTION: Acute mercury toxicity for dentists, first signs – nausea, muscle weakness (hypotonia)?, …
QUESTION: Acute mercury toxicity for dentists, first signs – nausea, muscle weakness?, …
Paresthesia = first sign or tremors
QUESTION: Subacute mercury poisoning symptoms – hair loss and muscle weakness
QUESTION: Subacute mercury poisoning: Hypotonia- muscle weakness
QUESTION: Mercury poisoning effects? Loss of hair was a choice (I looked it up, and I think that is the
answer)
QUESTION: Most likely for amalgam to fail? Outline cavity design, poor condensation
QUESTION: MOD amalgam with hole why? -poor condensation
QUESTION: Most common reason for Amalgam fracture occuring in a primary tooth: Inadequate
cavity prep (especially the isthmus area)
QUESTION: Most common fracture of Class II amalgam: isthmus
QUESTION: Most common reason for failed amalgam= depth
QUESTION: Most likely reason for fracture line in amalgam? Inadequate depth on prep
QUESTION: Similar question: Most common reason for failed amalgam = depth (prep design)
QUESTION: Most common reason for failure of dental amalgam:
moisture contamination
improper prep design- not enough depth
improper titrutration,
improper condensation
QUESTION: Failure of amalgam - poor condensation (water or saliva contamination during
condensation) –
QUESTION: Patient had occlusal amalgam on tooth #30 few weeks ago, one day the dude went to China-
town and was having lunch with his hommies. He bit down on something and the amalgam broke off. He
came back to your office demanding how could this happen with a new filling. What should be crossing
your mind? – The prep was not deep enough.
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QUESTION: Page 48. Table 2-3….Prepped the amalgam, which is incorrect?: Cavo surfaces is
greater than 90 degree
QUESTION: Axial pulp should be ? 0.2-0.5 into DEJ
QUESTION: how far extend pulpal floor in class I amlgam cavity on primary dentition
a. 1mm into dentin **
b. Just into dentin
QUESTION: Greatest wear on teeth enamel? Enamel, hybrid composite, amalgam

QUESTION: Greatest wear on opposing tooth: amalgam, porcelain, microfill, hybrid composite?
Porcelain
QUESTION: Causes greatest wear on enamel? I chose zirconia … porcelain, amalgam, enamel, hybrid
composite
QUESTION: Picture of deep amalgam with overhang but it looks really bad why does it look like
that? Corrosion
QUESTION: What is wrong with marginal ridge of DO amalgam of #29? All of the following (except
maybe)? Occlusal wear, over carving, wedge not placed right, i put OVER CARVED
 Pic of deep amalgam w/overhand but it looks really bad why does it look like that ?
o corrosion
 What is wrong with marginal ridge of DO amalgam of #29? All of the following?
o overcarve
QUESTION: Which tooth will the matrix band be a problem with when placing a two surface amalgam?
to give an idea of the anatomy of the region: mesial on maxillary first molar b/c of the cusp of
carabelli also Mesial Of max 1st premolar (MOST DIFFICULT) > Distal of max molar
QUESTION: worse restorative material for ID canine? gold, glass ionmer, composite,
amalgum? worst will be Composite > GIC> Amalgam> Gold( according to dental
decks composite not given for class 3 DL in canines)
QUESTION: class 3 on a canine, all are appropriate except: gold inlay, composite, amalgam,
glass ionomer
QUESTION: More corrosion in which phase? Tin-mercury phase
QUESTION: What causes corrosion? Silver and tin k[ .....according to first aid pg 76 noble metals
(gold, pd, platinum) are CORROSION RESISTANT, Tin and gold, Gold and silver
QUESTION: What is the corrosive phase of amalgam? Tin/Copper phase, Gamma2 – tin/mercury
QUESTION: What causes corrosion in amalgam? Tin
- The most common corrosion products found with conventional amalgam alloys are oxides
and chlorides of tin.
- The chief function of zinc in an amalgam alloy is to act as a deoxidizer, which is an oxygen
scavenger that minimizes the formation of oxides of other elements in the amalgam alloys
during melting.
QUESTION: Zinc in Amalgam, what is used for? **Decreases oxidation of other elements, deoxidizer
QUESTION: What type of Mercury is in the dental office? Inorganic, elemental
QUESTION: Amalgam- most toxic mercury- Elementary murcery, ethyl murcey, methyl mercury
QUESTION: most toxic mercury - methyl mercury (organic mercury)
27
QUESTION: Type of mercury most hazardous to dentist health: methylmercury, ethylmercury,
inorganic mercury, elemental mercury
QUESTION: Amalgam large condenser with lateral condensation is used in: Spherical
QUESTION: What type of amalgam needs to be condensed more? Spherical.

QUESTION: MC amalgam: Irregular cut last cut.
QUESTION: Material to use for best interprox contact of a CLASS II is Admix Amalgam (others
Spherical amalg., Composite w/ and w/o filler)
QUESTION: Over triturating amalgam? sets too fast, decreases setting expansion (increase compressive
strength)
QUESTION: Similar question: Over titrate amalgam?? Decrease setting expansion, (increases strength)
QUESTION: Overtrituation of amalgam causes? Decreased setting time and decreased expansion and
makes it stronger
QUESTION: Huge MOD in posterior  restore with amalgam
QUESTION: MOD amalgam with tooth pain? – fractured
QUESTION: Tooth #30 has huge MOD amalgam and is deep. Hurts pt when he eats french bread. what
is the cause? a. root fracture
QUESTION: Patient has a line of separation coronoapical (the wont say vertical fracture on the test),
the tooth is asymptomatic and it only hurts when patient eats French bread. What should you do?
Ext only if moveable pieces. If asymptomatic & not moveable fair prognosis RCT
QUESTION: days after placed an MOD amalgam pt present pain in biting and cold : check occlusion.
QUESTION: Placing pin in amalgam restoration, only choices I remember are 1mm pin or 1.5mm
pin. Others didn’t make sense. 2mm into amalgam
QUESTION: Threaded pin- Amt in tooth/restoration/angulation

The optimal depth of the pinhole into dentin is 2mm.
Threaded pins used in a dental amalgam restoration should be placed -2mm in depth at
a position axial to the DEJ and parallel to the external surface between the pulp and
tooth surface. Pins should be 2mm into dentin, 2mm within amalgam, and Imm from the
DEJ (to be safe) with no bends in the pins.
QUESTION: What happens to amalgam if it is contaminated with water? Loss of strength
QUESTION: Moisture contamination during amalgam restoration? Decreased strength
QUESTION: If there is water while you are condensing amalgam, what happens? I put decrease
in strength
QUESTION: If there is water while you are condensing amalgam, what happens? Delayed explansion
(severe expansion, corrosion and decreased compressive strength)
QUESTION: What is true of amalgam within a year after placement

Marginal leakage increases as restoration ages
Marginal leakage decreases as restoration ages
No marginal leakage
QUESTION: Marginal leakage in an amalgam after 1 year, then what happens? I put that it
decreases.
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QUESTION: You have an amalgam that is ditched at the margin by .5mm and no signs of recurrent
decay what do you do: observe/monitor, remove and replace
QUESTION: Amalgam restoration is good, margin is .5 mm open, what do you do? Repair with
amalgam, repair with comp, don't touch it
QUESTION: Know the ideal preps of Amalgam Class I and V. (can leave unsupported enamel in class V)
both into dentin.
QUESTION: Where is it acceptable to leave unsupported enamel? Occlusal of class V amalgam
QUESTION: What do class I & class V Ag ideal prep have in common
a. both slightly extend into dentin
b. both have flat axial & pulpal wall
QUESTION: Indirect restoration over amalgam: in order to get ideal contours
QUESTION: What is the reason you would do MOD onlay vs Amalgam: Better facial contour &
Microleakage
QUESTION: Class 2 amalgam vs class 2 gold inlay except:

QUESTION: Advantage of inlay over amalgam? Esthetics, less tooth reduction
QUESTION: Is the isthmus the same for inlay and amalgam YES
QUESTION: Proximal retention in class II box for amalgam? Retentive grooves, convergence of facial
lingual walls, bevel on axiopulpal line angle, all of the above, none of the above
QUESTION: Resistance form for amalgam prep : bevel in the axiopulpal line angle to reduce stress
and increase RESISTANCE form- “ways to resist stress”. Flat walls are right angles of tooths long
axis
QUESTION: resistance form for amalgam prep : bevel in the axiopulpal line angle to reduce stress
and increase RESISTANCE form.
QUESTION: how to prevent proximal displacement of Cl II filling -  retention grooves
QUESTION: What’s the best way to prevent proximal dislodgement/fracture of class II amalgam filling?
• Retentive grooves* I put this, but not 100% sure
• converging axial walls (B&L walls)
• depth of prep
QUESTION: Proximal resistance form of amalgam restoration comes from what?

a. convergence of buccal/lingual wall
b. retention grooves in axiobuccal/axiolingual walls - for proximal resistance
c. Dovetail - provides retention form
QUESTION: Mesial and distal walls of class I amalgam must be divergent not to undermine
marginal ridges
RETENTION: 1st = BL walls converge, 2nd = Retention grooves/Occlusal dovetail

RESISTANCE: 1st = Flat floors, rounded angles (bevel in axiopulpal line angles)
29
QUESTION: How to account for mesial concavity on maxillary 1st premolar when restoring with
amalgam: custom wedge? Other options, acrylic within matrix, normal matrix create overhang and
recontour
QUESTION: BWX, Tooth #18 has mesial amalgram restoration with overhang and very light contact.
What lead to this Doctor? – A wedge was not used! (or poor adaptation of matrix band)
QUESTION: premolar restored with open contact, why?

Wedge not placed right-I think ive seen this question before
Matrix band was not well adapted
QUESTION: Put wedge after matrix
QUESTION: From pt images, Which amalgam filling has the lowest Copper content? One that looks
corroded.
QUESTION: a pt presents with amalgams restorations in good shape, the dentist suggest to change
them for composites due to systemic toxicity of the amalgam what ethic principle is there or the
dentist is violating what principle:,
veracity,
QUESTION: Dentist tells patient they need to replace all amalgams because mercury is toxic to body.
Which principle of ethics does it violate? Veracity? Beneficence
QUESTION: Definition of Veracity - doctor lied to patient about amalgam should be replaced with
composite, because amalgam causes toxicity
Gold:
Malleability – deform (without fracture) under compressive strength; ability to form a thin
sheet; gold is malleable
Greatest malleability to least: gold, silver, lead, copper, aluminium, tin, platinum, zinc, iron, and
nickel
Ductilty – deform (without fracture) under tensile strength; ability to stretch into wire
greatest ductility to least: gold, silver, platinum, iron,nickel, copper, aluminium, zinc, tin, and lead.
Gold inlay/onlay – divergent walls (2-5 degrees per wall), 30 degree bevel margins for better
fit, skirt – extend beyond line angle
QUESTION: onlay resistance/retention: 2 to 5 degrees of taper per wall, as long a wall as possible, .
primary retention is from wall height and taper. Secondary retention is from retention grooves,
skirts, and groove extensions.
QUESTION: most rigid: type 4 gold

QUESTION: What is the hardest metal? Gold Type IV
QUESTION: When do use base metal apposed to gold…. Long span bridges
QUESTION: Ductility –Golds ability to be worked into different shapes
QUESTION: only advantage of porcelain over gold : esthetics.
QUESTION: advantage of gold on occlusal surface, porcelain in facial surface----conserve tooth

structure, minimal reduction...???? Gold is compatable in wear with natural tooth, porcelain gives
esthetics. Gold crown is more conservative.
QUESTION: Reduction dimension for functional/non-functional cusps in gold and PFM
30
Gold: functional = 1.5, non-function = 1. PFM = 1.5-2mm
QUESTION: Why bevel edge of gold- marginal stability

QUESTION: why bevel gold inlay
answer was obvious…had to do with better adaptation. Other choices were not right
QUESTION: Effects burnishability in gold- yield
QUESTION: What is the reason the burnish gold to the margin: Acute angle of gold margin
QUESTION: Weakest part of the gold mod inlay is its??- cement layer (cement = weakest part of cast
gold restoration)
QUESTION: Gold crown being cemented, which is wrong? Zinc phosphate is not an option. DOES
NOT REMEMBER WHAT THE QUESTION IS ASKING
QUESTION: Zinc phosphate can be used for gold.
QUESTION: Which is not correct? resin ionomer used to cement crown
QUESTION: When is base metal indicated over gold alloy: fpd
QUESTION: What is the most accurate pulpal test to determine vitality of a tooth with a full-gold
crown? Electric testing, 2. Percussion test, 3. Palpation test, 4. Thermal test
QUESTION: Recently placed gold inlay; what is the most common reason for pain afterwards?
Fracture of the tooth has to be suspected
Galvanic shock Sensitivity - choose this if only question says opposing dissimilar metal
QUESTION: gold on upper tooth, lower amalgam, patient has severe pain? Galvanic shock.
QUESTION: Gold casting --? Due to hygroscopic expansion or setting expansion

QUESTION: Isthmus of MOD prep extend over 1/3 of cusp to cusp, how to treat? amalgam, onlay,
inlay crown
>1/3 intercuspal dimension
QUESTION: Which indicated for MOD with intercuspal dimension > 1/3? MOD amalgam, MOD
onlay, MOD inlay, full coverage
QUESTION: Preparation with isthmus more than 1/3 wide between cusps-inlay or onlay
QUESTION: Best indication for onlay? Low caries index, dentin not supporting cusps.
Want atleast 1mm of dentin supporting cusps.
QUESTION: When is onlay indicated: when cuspal coverage is needed or when cusp undermined by
not enough dentin,
QUESTION: 14 year old with MOD restoration, decay interproximally and undermined enamel in all
cusps.
-onlay(maybe)
-inlay
31
-crown
QUESTION: Why bevel for a gold onlay? Resistance; percent elongation for burnishing and remove
unsupported enamel

c. better adaptation
QUESTION: What is the reason the burnish gold to the margin
• Acute angle of gold margin
QUESTION: which is the only surface not beveled for an onlay (pulpal)
QUESTION: Dentist has to reduce a weak cusp during onlay preparation is to : a) outline form b)
resistance form c) retention form
QUESTION: what form are you taking into account to involve the cusp during the prep of a tooth (I
said resistance, could be outline but I doubt it)
QUESTION: when you include cusp into preparation, what is it called? Is it convenience or retention
form?
Removing cusp affects retention form
Increasing intercuspal space affects resistance form
Marginal ridges help with resistance form
Loss of marginal ridge affects both resistance and retention
QUESTION: Cuspal coverage – retention form

QUESTION: Pt w/ onlay, 3yrs later sensitivity- cement wash out?
QUESTION: Reason for using porcelain for posterior onlay (bond to dentin, to correct occlusion,
etc)
QUESTION: use of indium (tin & iron) with alloy is mainly to provide chemical bond with porcelein 
QUESTION: Purpose of addition of tin and iron to metal ceramic allows: Chemical bond, covalent
bond with porcelain
QUESTION: Cut onlay…find out margin of crown w/in 1 mm of interseptal bone

a. pack cord, take imp
b. crown length surgery----impinges biologic width…
c. use amalgam
QUESTION: In a gold MOD onlay, how are the axial pulpal walls? Converging
QUESTION: Pulpal axial walls converge
QUESTION: Which are incorrect? Inlay and onlay are divergent. They are convergent. ONLY
WALL TO CONVERGE IN INLAY ONLAY = AXIAL WALL
QUESTION: Axial walls converge in inlay preps.
QUESTION: Which is a characteristic of a gold inlay?
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A: Axial walls converge toward the pulpal floor
QUESTION: From facial to lingual, the axiopulpal line angle of an onlay preparation is longer than the
axiogingival line angle (if it were not, the preparation would be undercut and the onlay would not seat).
For an MOD onlay prep, the axial walls must converge from the  gingival walls to the pulpal wall (for
the same reason, the onlay would not seat if they diverged).
QUESTION: Indication for inlay?  low caries risk
QUESTION: When is the best case to use an inlay? – Patient with low caries index.
QUESTION: all of the following u can use inlay except (high caries risk)
QUESTION: Where is the MOD inlay hitting when it contacts early?- interprox
QUESTION: What causes most post op sensitivity in direct inlay: Polymerization shrinkage
QUESTION: Patient receives a blow to the chin who has a MOD inlay placed on the maxillary molar 3
months earlier. Now the patient has a vague pain on biting, there are no other symptoms. why? maxillary
sinusitis, m-d fracture,
QUESTION: Reason of reduction of tooth for MOD inlay except- amt of enamal on teeth
QUESTION: Disadvantage of gold inlays. Lack of resistance to wear??
QUESTION: main disadv of gold inlay
a. deform under load- since it is high noble gold and softer, it may have higher creep
b. wear opposing
c. cement is soluble
d. possible attrition
QUESTION: How to remove a gold inlay? Section isthmus and remove in 2 pieces
QUESTION: Cement for porcelain onlay HAS TO BE RESIN
QUESTION: Cement onlay and see black lines few months later MICROLIKAGE
QUESTION: Coefficient of thermal expansion
is most for which material - tooth<gold (most) <amalgam<filled resin<unfilled resin
QUESTION: Linear thermal coefficient is most for tooth- gold- amalgam- composite (most)
QUESTION: What has the largest thermal expansion? Composite? Unfilled resin = 8x. highest
Prosthodontics:
QUESTION: only advantage of resin over porcelain : done in one appointment
QUESTION: Common feature between porcelain veneer and all-ceramic crown preparation – rounded
internal
QUESTION: What is the most important thing for retention? surface area
QUESTION: Most lab complain? tooth is under reduced
QUESTION: Porcelain greatest in compression
QUESTION: Porcelain is stronger under compression forces
QUESTION: Porosity in PFM – inadequate condensation
QUESTION: Reason for porcelain porosity - inadequate condensation
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QUESTION: What is the weakest porcelain? I put Feldspathic
QUESTION: What is the weakest porcelain? pressed leucite, unless feldspathic dental porcelain was an
answer
… Feldspathic porcelain <Leucite-reinforced ceramic< Castable glass <Glass-infiltrated
alumina
QUESTION: Best material to oppose a porcelain crown? Porcelain
QUESTION: Best way to see if a crown seats: die spacer
QUESTION: Silver turns porcelain what color? Green
QUESTION: What turns a PFM green? Silver
According to Mosbys, silver (Ag) is not considered noble; it is reactive and improves
castability but can cause porcelain “greening.”
QUESTION: what component makes a PFM green in the cervical 1/3 copper at the margin its
copper, other places its silver
QUESTION: Dentist has most control in success of PFM: parallelism
QUESTION: What parts of tooth prep can be managed by operator: parallelism, surface area, length,
circumference
QUESTION: Wear of enamel due to porcelain on opposing
QUESTION: What is function of opaque porcelain EXCEPT
mask metal framework

to help come up with a base/stump shade
for initial bond to metal
to decrease contamination of additional porcelain with metal in ensuing firing and baking
procedures
QUESTION: When you receive a crown back and want to seat it what is the first thing you check for?
a. Shade (Aesthetics) or internal
b. Proximal contacts
c. Margins
QUESTION: for a crown try in what would check first : interproximal contacts. (remember check
shade first!)
QUESTION: First thing to check when trying in metal-porcelain FPD? Contacts… true if esthetic is not
an option
QUESTION: First thing to check when trying in metal-porcelain FPD? I put contacts, esthetics
Porcelain veneer measurements:
QUESTION: Most technique sensitive part of placing veneers? Preparation, color match, impressing
QUESTION: Pt had veneers cemented with light cured resin. Now comes back few weeks later with
brown staining at gingival margins. Why?
Chromogenic bacteria **
Breakdown of light cured resin cement released some chromogenic substance
Pretty much all the choices other than a had to do with the cement. I didn’t know the
answer. They all seemed right. The only think we were taught in Hewlett’s lecture
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was you get brown/black precipitate when you mix viscostat and nephrostat cus of
the action when alum chloride and ferric sulfate mix. But that wasn’t an answer
choice.
QUESTION: There is a veneer which is bonded with resin and the patient comes back after a month or so
with a dark stain near margin,reason? Microleakage
QUESTION: The dentist cements the porcelain veneer with light cured resin and the patient returns with
brownish discoloration at the margins.why? not enough cement or microleakage(depends on duration
of pt return)
QUESTION: How much tooth structure needs to removed on the facial for a porcelain veneer? .5
mm
QUESTION: Mid facial reduction of a porcelain veneer? .5mm

QUESTION: when preparing for a porcelain veneer how much would you reduce in the facial 1/3 :
Gingival third:0.3 mm veneer reduction

Facial third: 0.5 mm veneer reduction
QUESTION: Veneer fractures, what do you do? Pumice, etch, microetch, etch, microabrasion,
silane…know what to do and the order, application of etch to the prep, bonding resin to prep, etch the
inside of veneer, silane the inside of the veneer, luting agent
QUESTION: Patient has an all veneer on incisal edge, small piece of porcelain came off and wants
you to fix the chip only, what is the sequence of events: microethc, etch, silanate, and bonding
agent
QUESTION: What do you use to cement a veneer?

• Resin cement
• Polyacrylic
QUESTION: Opaque coming through on veneer whats the problem? Veneer under prepped
QUESTION: Advantage of a direct composite vs. a veneer? --direct composit-only 1 appointment vs.
veneer is at least 2
QUESTION: Order of bleaching and veneering process: bleach, wait 2 weeks, prep tooth, cement
QUESTION: When will you bleach teeth in anterior veneer prep- before veneer prep, wait for 2-3
weeks, after preping veneer and then bleach, after cementing veneer and bleach 
QUESTION: Pt has veneers from 6-11, which fluoride do you use to not stain?
A. Stannous Flouride
B. Sodium Flouride**
C. Acid Flouride
QUESTION: where will you place the margins in a anterior PFM prep: Subgingivally
QUESTION: minimum incisal reduction in anterior PFM : 2 mm
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QUESTION: The necessary thickness of metal substructure is 0.5mm . The minimal porcelain
thickness is 1-1.5mm. Thus, the tooth reduction required for a PFM crown is -1.5-2.0mm. The labial
shoulder width is ideally 1.5mm.
QUESTION: Facial reduction for PFM at gingival 3rd is 1.5mm
QUESTION: Reduction for functional cusp bevel on porcelain? 1.5-2mm
 minimum metal thickness of 1.5 mm for functional cusp & 1 mm for nonfunctional
 2 mm for porcelain
QUESTION: How much reduction would you do for a PFM crown on anterior- 1.5mm on facial
incisal plane not incisal angle
QUESTION: How do you make sure your all ceramic restoration does not fracture? I put you must
have NOT LESS than 1.5mm porcelain @ occlusal
QUESTION: What to do to increase retention of the crown . (All are possible options, EXCEPT!)-
options were- proximal boxes, buccal grooves, functional cusp bevel?
QUESTION: When you have a short crown for pfm: place proximal boxes and vertical grooves to
increase retention
QUESTION: Reason for functional cusp bevel = resistance

QUESTION: Functional cusp bevel: structural durability
QUESTION: Why do a functional cusp bevel on a crown prep? To prevent fracture of the cusp and for
proper casting/fabrication of the crown
QUESTION: Reason for functional cusp bevel: Prevent cusp fracture
QUESTION: In PFM, Porcelain fractures because the junction should be? right angle, not round
QUESTION: When you want to cement crown, what is the sequence?, look inside the
crown(internal fit), contact, then margin Interna;contact margin
QUESTION: Which of the following do you not do in cementation of a porcelain crown: etch enamel
with hydrofluoric acid
QUESTION: With resin cement on all porcelain what is NOT the reason why you use it: for added
retention …cements shouldn’t be used for added retention, to fill small openings at margin
QUESTION: With resin cement on all porcelain what is NOT the reason why you use it: I put down
for added retention bc I thought cements shouldn’t be used for added retention (other choices,
was to fill small openings at margin and something else)
QUESTION: You have a patient who wants an all porcelain on number 8 – the incisal edge keeps
breaking off and u have to come in to repair, why does it keep breaking off? Because the anterior
guidance and the protrusive movements/clearance space was not properly
calculated/maintained
QUESTION: Porcelain is strongest under compression or right after being processed and cooled???
QUESTION: #10 crown on a patient is PFM. It looks longer than #7. All of the following maybe the
reason why the crown looks like this, except? – Incorrect shade. (Other choices; insufficient tooth prep
(yes), too think metal (yes), too thick porcelain (yes) – all of these could have caused it).
QUESTION: what didn’t cause the unesthetic opacity of crown: shade selection; other choices were
under-prepared tooth, too thick metal, too thick base porcelain or something like that
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QUESTION: What could the reason be if you see opaque porcelain in the incisal third of the facial of
the PFM crown: inadequate reduction of the inciso facial part of the tooth
QUESTION: Incisal 1/3 of pfm is opaque white why? Too little reduction
QUESTION: Incisal 1/3 of pfm is opaque white why? Isa id because of too much base porcelain
placed
QUESTION: Anterio pFM, incisal 3rd was radioopague? Improper second plane of reduction**
QUESTION: If incisal edge of PFM is opaque it is because they didn’t do a second plane of reduction
QUESTION: Lab overbulks porcelain…why? Not enough reduction on tooth, compensate for 20%
shrinkage
QUESTION: All porcelain crown on 8 that is too light but it is a good crown what would u do and I
put to whiten the other teeth. (vital tooth bleaching)
QUESTION: crown of inferior molar has a wear facet in porcelain on the mb inclination of MB cusp.
Most likely associated with?
Interference in protrusion? & working interference
Dotn know the other choices
QUESTION: Where do you attach a non-rigid retainder from a FPD? Don’t know and don’t remember
choices, they were medial and distal of and to somethings.
QUESTION: For a stress breaker on a FPD to be effective it must be- don’t know and don’t remember but
something mesial of the distal abut and so on and so forth.
isnt that the one with the key and u place on mesial of pontic.??????
QUESTION: A fixed partial denture…keeps breaking. POOR FRAMEWORK.
QUESTION: Most common reason for PFM bridge breakage? Firing schedule, high contact,
inadequate design
QUESTION: FPD is seated during framework try in but when come back for final cementation holds up:
interproximal porcelain overcontoured
QUESTION: All ceramic FPD should cover how much of abutment? I put 270 degrees
QUESTION: ¾ crown advantageous except for? I put it has LESS retention than full crown
QUESTION: Resistance to lingual movement of ¾ crown? Lingual wall of groove, facial wall of
groove, facial aspect of prep
QUESTION: What prevents lingual displacement of a ¾ crown? Lingual wall ( of grooves)
QUESTION: What is the basis for classification of different F P D pontics: Relation of the pontic to
the supporting tissue
QUESTION: Modified ridge lap pontic: Minimal ridge contact
QUESTION: Modified ridge lap has what kind of contact? Minimal contact with residual ridge
QUESTION: The modified pontic how should it touch the gum?

Barely touch it
Impinge on it
QUESTION: pontics : should not blanch tissues
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QUESTION: pontics : should not blanch tissues
QUESTION: Pontic of 3-unit fpd should rest gently on the soft tissue
QUESTION: Anterior teeth, which pontic is best? ovate or modified ridge, read the case and see
if ext or not, if you can do the ext prior, you can do ovate which is best aesthetic
QUESTION: Pontic length on a bridge, whats most important AP dimension, MD dimension**

QUESTION: Strength of Abutment connection to pontic which is more important? occlusogingival
width
QUESTION: Most important dimension that ensures the metal connector between abutment and
pontic is sufficient (in 3-unit fpd bridge)? occlusal-gingival,
pontic is sufficient (in 3-unit fpd bridge), I said cross section (idk if that makes sense); other options
are buccal-lingual, occlusal-gingival and mesial-distal (I would think its all three but it wasn’t an
option)
QUESTION: a pontic in the bridge shows the metal, why?

Underreduction
Framework was not done well( since is a pontic this is probably the answer)
QUESTION: if patient has ging 1/3 translucent of a pontic: prob because of poor shade selection
QUESTION: Edentulous space is wider than adjacent anterior tooth, how to match them? Make
pontic line angles farther apart and deeper interproximal embrasures, make pontic line angles
closer and deeper interproximal embrasures, make pontic line angles farther and shallower
interproximal embrasure, make pontic line angles closer and shallow interproximal embrasures
QUESTION: How do you decrease the width of an artificial tooth? Deepen the facial line angle
proximally and increase the interproximal embrasure, Deepen the facial line angle proximally and
decrease interproximal embrasure, take the facial line angle labially and increase the
interproximal embrasure, take the facial line angle labially and decrease the interproximal
embrasure.
QUESTION: How do you make a crown narrower?   move line angles more facially
QUESTION: Anti’s law; 3 abutments, one being lateral, with 2 pontics, prognosis good, poor, excellent?
Poor? (root surface of abutment teeth have to be greater than root surface of pontic)
QUESTION: Which of the following is not ideal abutment-pontic connection? – Lateral Incisor-Central
Incisor (other choices, Central Incisor-Lateral Incisor, Canine-Lateral Incisor, etc)
QUESTION: What is most damaging in canteliever: it was between mand molar pontic-premolar
abutment
QUESTION: Which canteliever bridge would be most destructed of abutment tooth: lateral incisor as
abutment with central incisor as pontic (larger root surface of pontic than abutment)
QUESTION: worst cantilever  lateral abutment with central pontic

QUESTION: The strength of soldered connector of FPD in enhanced? 1. Using higher carat solder, 2.
Increasing height (answer), 3. Increasing width, 4. Increasing gap
QUESTION: When soldering, what is the most important factor?
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• width
• height**
• etc..
QUESTION: Fixed -do preparation and design.Ex type of margin for ceramic (shoulder). What should be
placed against porcelain bridge. What is a "key"
**NONRIGID CONNECTOR: Key and keyway—for pontics and shortspan bridges where you can’t get
proper draw without a lot of tooth reduction. POI is parallel to pathway of retainer.
QUESTION: Keyhole for post and core to prevent rotation

QUESTION: What is an active screw (post) vs. inactive post?
An active post is one that engages (screws into) the dentin in the canal space. Traditionally, the major
concern about active posts has been the potential for vertical fracture of the tooth during placement of the
post. active posts are indicated when the canal length is insufficient to gain adequate retention with a
passive post
QUESTION: What is the advantage of a fiber post over a cast post? Forgot the options but the one I
put was the fiber post is stronger and causes less fracture of the tooth… Not sure one other option
was it was fiber post is more radiopaque and another saying that fiber post has the same modulus
of elasticity as dentin.
QUESTION: How does a dowel post and core help prevent vertical fracture? Ferrule, Ventilating groove,
bevel, vertical stop
QUESTION: Dowel core = vertical stop FURREL
QUESTION: What is the point of putting a post on an endo treated tooth? retain the build-up and
restoration (not sure about the restoration part). Retain core
QUESTION: Purpose of placing a post after RCT = retain core
QUESTION: Function of a post?

A: Retain the core
QUESTION: Dowel after endo for: Retention of core (Dowel=post Im guessing)
QUESTION: cast post and core - you put extra slit - what is that for? prevent rotation
QUESTION: how should prep for cast post? Etc. Need at least 4 mm of GP to preserve apical seal
QUESTION: Most important when selecting shade? VALUE. value, transluceny, chroma,
concentration, and hue, color . Value is the most critical of the three parameters when attempting
to match an adjacent natural tooth; hue is the least important
QUESTION: Most important is value when selecting a shade

QUESTION: What is chroma- saturation
QUESTION: What is value- black and white
QUESTION: Hue, Value, Chroma (which one is color?)
QUESTION: Most important color: value
QUESTION: Least importatnt: fluorescence, hue, etc?
QUESTION: When you have color index of 100, which of the following is effected? Value
39
QUESTION: When you have color index of 100, which of the following is effected? I said Chroma.
(others were value, hue, etc)
QUESTION: When you have color index of 100, which of the following is effected? I said Chroma.
(others were value, hue, etc)
QUESTION: Scale of 100
a. Chroma
b. Value
c. Or Hue?
QUESTION: Color value : 0 black 100 : white

QUESTION: Staining a porcelain restoration: Decrease the value
QUESTION: What does staining do for ceramics? Alters hue. Decreases value. Alters chroma.
QUESTION: Crown #9 and #10. One of the crowns looks very light(white). What did the dentist pick
wrong?
Hue
Chroma
Value
QUESTION: When you add a different color to a resin, you increase what? Hue? Value? Chroma
QUESTION: Dentist changes shade with complementary color what does he do: increase chroma?
QUESTION: Add complement color: Decrease Value
QUESTION: A dentist adjusts the shade of a restoration using a complementary color. This
procedure will result in
A. increased value.
B. decreased value.
C. intensified color.
D. increased translucency.
QUESTION: complementary color that changes ? Old TQ A. Value
QUESTION: Complimentary color decreases value

QUESTION: Which can you not do: increase value
QUESTION: brightness is equal to: Value ( you can decrease but not increase it )
QUESTION: What can’t occur with the addition of stain? Increase value, decrease value, increase
chroma, increase hue, decrease chroma
QUESTION: What cant you change: hue, increase value, decrease value, change chroma
QUESTION: how to change hue: add orange to it
QUESTION: How do you lower value in a restoration? STAIN, Complement color or orange
QUESTION: Value least, due to lack of variation in mouth=Hue
QUESTION: What complement color to darken porc? gray, orange, ochre, violet. Add gray to
decrease value.
QUESTION: Use complimentary color to change/stain crown to decrease the value most common is:
40
Violet Orange, gray, yellow
QUESTION: complementary color used to change-orange

QUESTION: If you add a complementary color yellow, what happens to the hue? Dec red content of
yellow red shade Side note: adding yellow stain=Inc chroma of basic yellow shade
Pink purple makes yellow  yellow red
QUESTION: Which represents position on the spectral wavelength? hue
QUESTION: Wavelength assoc with hue
QUESTION: which color characteristic is dependent on spectral wavelength: hue
QUESTION: what is best way to determine value: open eye as wide as you can, arrange the shade
guide in increasing value (chose the latter)
QUESTION: Value? Most important, Lightness. Put shade guide from light to dark. Half close eyes to
increase sensitivity to better select value.
QUESTION: How pick shade - place values in order, Squint for chroma
QUESTION: Which one can human eye see, hue vs value, vs chroma? Value. (more rods than cones, and
eyes are more sensitive to value)
QUESTION: Avoid metamarism Want consistant look in light

QUESTION: How to prevent metamerism – shade under multiple light sources
FUNCTIONAL/NON FUNCTIONAL MOVEMENTS:

 Balancing LUBL
 Working BULL
 Protrusive DUML
Centric Relation: Man to Max

Centric Occlusion: teeth
QUESTION: Non-working movement, which one is true? – Lingual cusps of upper molars hit lingual
inclines of facial cusps of mandibular molars.
QUESTION: Non-working contacts… mand buccal cusp lingual incline
QUESTION: Contact on lingual portion of buccal cusp of mandibular molar = what kind of
interference? Non-working, working, protrusive
QUESTION: questions on nonworking interference. wear facets on lingual incline of mx lingual
cusp and facial incline of md facial cusp on left side. pt has : left nonworking interference,
protrusive interference, right nonworking interference, etc
QUESTION: Working side interferences are seen on what surfaces? palatal inclines of buccal
cusp of upper and buccal incline of lingual cusp of lower; (the nonworking cusps on the fxnal
side are interfering)
In MIP or CO, the buccal incline of palatal cusp of upper and lingual incline of buccal cusp of
lower. Balanced side interferences are buccal incline of palatal cusp of upper and lingual incline
of buccal cusp of lower (it‟s the working cusps interfering)
41
QUESTION: Wear on buccal of maxillary premolars due to, due to mandibular movement working
or nonworking?
QUESTION: When will the bull rule be utilized with selective grinding? Working side
QUESTION: The mesiobuccal incline on the mesiobuccal cusp of mand molar (with stainless steel
crown) has wear: this is because of movement in which direction(s): I said working and
protrusive movement
QUESTION: #30 gold crown has wear located on the MB cusp of the MB incline, cause – protrusive and
working side movement
QUESTION: Max molar on mesial slope of mesial lngula cusp wher do you have wear on lower
teeth? Mesial or diatal incline of either mesial facial aor mid facial cusp? Distal incline of midfacial
cusp
QUESTION: The mesial angle of the ML of max 2nd molar occludes with what on the man 2nd molar
a. Mesial MB cusp
b. Distal MB cusp
c. Mesial DB cusp
d. Distal DB cusp
QUESTION: mesial angle of the L of maxillary second molar occludes with what on the mand 2nd
molar.? Distal of MB CUSP
QUESTION: Pt bites down after cementing down and deviates to the right #30
• Lingual incline of the buccal cusp
QUESTION: Crown on number 30, pt tries to close, contact interference deviates to left, lingual incline of
buccal cusp needs to be altered buccal incline of the lingual cusp
QUESTION: #30 hyperoccluded, deviated – incline most effected is max/mand balancing cusp?
QUESTION: In restoring a canine protected occlusion, with anterior overbite of about 2mm. The buccal
cusps of posterior teeth should be flat, BECAUSE they will guide the protrusion.
a. both are true
b. only the second statement is true
c. both are false
QUESTION: what kind of occlusion is if in right lateral movement all posterior teeth are not in
occlusion : canine guidance
QUESTION: which of the following would result in inaccurate terminal hinge record? acutely
apprehensive patient, severe skeletal cl III, tooth contact, muscle pain, etc
QUESTION: IF you are making a crown but before you begin, when you do equilibration, what are
you trying to achieve to get rid of the non-working interference?
a. Posterior dissocculusion??
42
Bimaxillary protrusions, Refers to a protrusive dentoalveolar position of maxillary and

mandibular dental arches and flare teeth.
QUESTION: Where to the condyles go in CR?-Superio-anterio-Medial

QUESTION: Which anatomical components are responsible for rotation of the mandible? Disc
and condyle
QUESTION: If you both condyle break, what you get? Posterior open bite!
QUESTION: Dislocation of condyle- mandible deviates opposite
QUESTION: What is Bennett angle?

a. it is the angle that is formed by the non-working condyle and the sagittal plane during lateral
movement
b. it is the angle that is formed by the condyle and the horizontal plane during protrusive movements.
c. It is an difference in condylar inclination between protrusive and lateral movements
d. It is the difference between in the condylar and incisal inclinations.
QUESTION: bennett shift mainly on: lateral movement or working side
Composite:
QUESTION: what type of bond is composite on tooth structure?
a. chemical bond
b. mechanical bond (micromechanical)
c. organic coupling
d. adhesion
QUESTION: Two things that account for a successful posterior composite restoration? type of resin
and type of prep
QUESTION: Postoperative MOD composite pain, most likely due to? hyperOcclusion
QUESTION: Few days after placement of composite restoration complains of pain especially with biting
but relieved by cold: check occlusion
QUESTION: What determine class 1 composite prep? - The depth of decay!

QUESTION: What indicates the design of composite class I preparation
Only incorporates pits of lesion - this one
2mm pulpal floor depth
45 degree bevel cavosurface
Ortho
QUESTION: When doing a class 1 with composite what is the requirement: contain to only pit and
fissure caries
QUESTION: consideration for a class I posterior composite restoration :

Case, selection, isolation
QUESTION: What determines composite class 2 prep? Caries, Access
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QUESTION: prep shape for composite is determined by caries extent
QUESTION: 2 things that account for successful post composite restoration – type of resin and
type of prep
QUESTION: When do you replace class 2 composite? - When you have recurrent decay!
QUESTION: When do you replace class 2 composite? – When you have ditching at the margin (other
choices were discoloration, and roughness)
QUESTION: You are doing a composite slot on mesial and distal of 1st molar, dds decided to connect
by crossing the oblique ridge, why? Only answer that made sense was that when oblique ridge is
less than 1.5mm you involve it
QUESTION: Restoration of class 2 for posterior with heavy occlusion – amalgam, composite, microfill …
QUESTION: Class II prep into cementum, how should you restore? GI, Hybrid , non-restorable
QUESTION: What is the main problem with class 2 composite- water or constructions of material
QUESTION: Small occlusal fillings need to be done on posterior, what do you use – amalgam,
composite? (small lesion so don’t want to take away too much with amalgam), GI
QUESTION: Large MOD composite, what’s disadvantage? Occlusal wear  
QUESTION: What is not a class I cavity preparation? gingival 1/3 of #19, Lingual pit of #7, Lingual pit of
#18
amount of stress for composite depends on c factor
QUESTION: C factor in class 1 composites, which one is correct? – less walls is lower C factor (you
need less walls) for ex, class I composite: 5 bonded/1 unbonded: 5
QUESTION: C factor in class 1 composites, which one is correct? –More walls, higher C Factor
QUESTION: which has the highest C factor- class 1 & class 5
QUESTION: What has most stress on it? ( c factor) class IV, CLASS 1
QUESTION: C factor question. Asked which is correct—class 5 is worst, bonded/unbonded,
QUESTION: Which part of composite stains the most- gingival proximal, facial proximal, lingual
proximal, or occlusal
QUESTION: 2ndary caries is most likely at gingival mrgin
QUESTION: Transillumination is useful in the diagnosis of .Class 1, class 2, class5, class 3
44
QUESTION: What do u place on a 75 yo patient with like 8 class v carious lesions? I put GI just
because there a lot of caries but the other options were composite, amalgam and something else.
QUESTION: Class V lesions? Composite or GI?
QUESTION: Pt w/ a lot of cervical caries – Resin composite best material to use – false. Best would
be GI
QUESTION: Patient had a lot of cervical caries in posterior-resin would be the best to use FALSE GI
QUESTION: pt. comes in and has a lot of class 5 caries- RMGI
QUESTION: 65 y/o pt shows several new caries in molars and pre molars class V what material
would you use : a) amalgam b) composites c) glass ionomer
QUESTION: #5 cervical lesion Class V what do you need to consider? Isolation
QUESTION: Class V onto root: Bevel enamel, 90 butt margin on cementum

QUESTION: What is not an indication for restoring class V abrafaction?
a. sensitivity,
b. esthetics,
c. prevention of decay,
d. prevention of further structure loss,
e. restoring physiological contour
QUESTION: Too light on class v composite, how would u treat?

QUESTION: if a class IV is too light what to do? Add more composite
QUESTION: what to do if Class IV is too light? Stain composite, or veneer ? Or replacement?
QUESTION: Class IV composite, notice it is too light 2 weeks later. Add composite tint or do direct
facial composite in new color
QUESTION: If a dentist notices that a large but acceptable composite is too light a few weeks
after placing it, what should he do? I put nothing
QUESTION: Class 4 stained. Veneered with composite

QUESTION: class 3 extends to facial. The restoration is pigmented but margins are perfectly sealed,
however they have bad color. What should you do? -remove 1mm prep and add more composite
QUESTION: If a patient has a stained but acceptable composite and wants it fixed, what do you
do? I put remove 1mm and replace
QUESTION: Class 3 stained ? Removed? Veneered with composite
QUESTION: Marginal stain on class 3 composite, how would u treat? REPAIR ?? or replace? I would
guess repair I dunno
QUESTION: Patient has class 3 on facial with marginal staining what do you do to fix it: I said
replace with composite
QUESTION: Recently placed a class 3 comp, pt isn’t happy with it and has a huge staining on margins
what to do? Replace, remove on margins and place composite, extract/implant, etc
QUESTION: After caries removal sound tissue is on cementum. How do you restore? Build up with GI
and place composite
QUESTION: Prep you did went down to cementum , what d you do to fill it: pdf old exam question
answer says put rmgi then composite on top
QUESTION: Class 3 prep subgingival, restore with GI, followed by composite
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QUESTION: Subgingival composite where cementum is exposed- what type should u place? Dual cure or
fluoride releaseing composite?
QUESTION: Class 3 composite w/ radiolucency under it  this cud result from all the following
except: liner, recurrent caries, contraction from shrinkage of curing, etc. (agu’s answer:
contraction…)
QUESTION: MOD amalgam that passes the 1/3 distance of cusp height, do what – MOD amalgam, MOD
composite, MOD onlay, MOD inlay
QUESTION: All are advantages of indirect composite over direct except: better marginal
adaption/seal
QUESTION: Direct composite vs inlay- what is better about the direct composite- I wrote seal
QUESTION: main advantage of doing direct composite over composite onlay?
a. less shrinkage-Ive seen this in other tests
b. better marginal adaptation - best answer among the options
c. greater hardness and wear resistance
QUESTION: Most important factor when placing a composite in post teeth. Case selection
QUESTION: Posterior composite fails because usually… water degradation or shrinkage?
QUESTION: Main reasons for failure of posterior composites? I put case selection and technique.
QUESTION: Composite for back molar: technique and case selection
QUESTION: Main reasons for failure of posterior composites? I put case selection and
technique.
QUESTION: Posterior composite failure mostly due to – shrinkage
QUESTION: sensitivity following composite restoration in post most common cause---???due to
resin,polymerization shrinkage in margin,shrinkage floor...???
QUESTION: You place a conservative composite on a posterior tooth and the patient returns due
to sensitivity. What is the most likely reason? I put trauma to dentin during preparation, as in
they didn’t use bonding agent? But I read in the questions that a lot of people put
“microleakage.”
Failure decay, microleakage
Sensitivity occlusion, debonding
QUESTION: You place a conservative composite on a posterior tooth and the patient returns due to
sensitivity. What is the most likely reason? Putting large amount of comp while filling, microleakage,
trauma to dentin during preparation, Etch causing pulpal pain, bacteria, gap, cuspal
QUESTION: Post op composite: sensitive

QUESTION: Cause for post-operative sensitivity of composites –  shrinkage
QUESTION: reason for replacing posterior composite, and factors that affect success
QUESTION: Most common reason for replacing posterior composites: RECURENT caries, inadequate
margins, fracture of composite (ONLINE SAYS: The two main causes of posterior composite
restoration failure are secondary caries and fracture (restoration or tooth)
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QUESTION: What is the most common reason that posterior composites need replacement? I put
recurrent decay
QUESTION: After placing a crown with composite resin, after six month around the porceline
gingiva there is a discoloration ( brown color) what is the cause: ? Amin discoloration of resin
QUESTION: an anterior composite placed 10 years ago without caries what is the most common
reason to make a new one : color change
QUESTION: How long should you wait after bleaching to do a composite on an anterior tooth? I
put 1 week at least
QUESTION: How long after vialt tooth bleaching can you bond resin to it? 24 hours, 3 days, 1 week
QUESTION: Why do you replace anterior composites- staining
QUESTION: Why do you bevel when placing anterior composite?

Beveling does everything except strong margin in composite
QUESTION: beveling in acid etching composite for.... more surface area.
QUESTION: why do we bevel cavosurface of comp? A: more surface area
QUESTION: Which one is not reason for post-op sensitivity Class I comp? cusp deformation due to
shrinkage force,
QUESTION: You have a pt. with a composite filling that complains of pain to cold a chewing, you ditch it
out with a bur, no more pain. What was the cause of the pain? Polymerization Shrinkage.
QUESTION: Post op sensitivity on MOD so removed a portion of the occlusal and placed more
composite what was cause: fracture, microleakage, inadequate margins and water coming out of the
tubules, acid etch, compression pulling on cusps
QUESTION: Which of the following Is not the reason for postop hypersensitivity of a composite:
options are toxic effect of aci etch on the pulp (I said this one), polymerization shrinkage on the
margins so that bact can come in, poly shrinkage on the occlusal floor (idk what answer is)
QUESTION: Restore tooth with MOD comp. then pt. comes back 2 days later with sensitivity. Then
you put composite over it and relieves the pain.
QUESTION: What is the least likely cause of sensitivity after composite placement? Fluid
movement in pulp caused by open margin
QUESTION: Composite recently placed. all could be a reason for sensitivity. EXCEPT:-polymerization
shrinkage, pulpal irritation from etch, shrinkage created gap for bacteria to go in
1 etchant causes sensitivity
2 gap causing microleakage of bacteria
3 gap causing movement of fluid out of pulp
4 polymerization shrinkage that causes cuspal shrinkage
QUESTION: When do you see microleakage with composite restoration done without rubber dam?
Same amount of time as if done with rubber dam?
2 weeks later
2 months later
QUESTION: Class 2 done without rubber dam, how long until you see microleakage – 2-4 weeks, 4-6
weeks, same time as with rubber dam on
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QUESTION: When do u start to see lines if u do class 2 without rubberdam? 4-6 Weeks? when not
applied under rubber dam isolation 4-6 weeks you see leakage compared to RDI
QUESTION: You did class II composite without rubber dam. When do you start having marginal
leakage?
4-6wks, 6mo-1yr (something like that), same time as the one you did with rubber dam on, ??
QUESTION: Highest chance of leakage under rubber dam? Holes too wide, Holes too far apart, Too
close
QUESTION: What is not an advantage of rubber dam when compared to not using it: Improved properties
of materials, shortens operative time, facilitates the use of water spray
QUESTION: Placement of rubber dam affect the colour selection by dehydration of tooth gives
inaccurate tooth shade  
QUESTION: Placement of rubber dam affect the colour selection by black background
QUESTION: W on the rubber dam clamp means it is? wingless
QUESTION: repairing porcelain veneer with composite  microetch, etch, silane, resin
QUESTION: How to fix porcelain chip on PFM with composite? Microetch, etch, silane, bonding
QUESTION: Steps for adding to porcelain? Microetch, etch, silane, bonding agent
QUESTION: Veneer replacement: microetch, etch, silane, bond

QUESTION: Similar question Patient has an all veneer on incisal edge, small piece of porcelain came off
and wants you to fix the chip only, what is the sequence of events: microetch, etch, silanate, and
bonding agent
QUESTION: Patient has an all veneer on incisal edge, small pice of porcelain came off and wants you
to fix the chip only, what is the sequence of events: microethc, etch, silanate, and bonding agent
(there was another option that has silanate involved so not sure)
QUESTION: pt has composite restoration with severe pain with localized swelling---- Incision & Drainage
QUESTION: Pt had #8 & had a bunch of little pits in #8; how would you fix it? Composite over pits,
or over entire tooth, or veneer w/ porcelain, etc. (agu put: composite over pits only)
QUESTION: pt complains of a marginal stain on #8, what do you do? i said polish it
QUESTION: Similar question: Patient’s chief complaint is #8 and #9 don’t look right. Picture shows
nothing is wrong with #9, #8 has extra enamel at the incisal-distal aspect. What do you do? – Shave the
inciso-distal aspect of #8. (Other choices were stupid; like put composite on both teeth, put a crown on
#9, etc)
QUESTION: Advantage of a direct composite vs. a veneer? direct composite- 1 appointment vs. veneer
=atleast 2
QUESTION: You place a CaOH on the tooth for a direct pulp cap what is needed: placement of a
liner
Cement & Materials:
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QUESTION: Beveling in acid etching composite Increase surface area
QUESTION: beveling in acid etching composite use more surface area.
QUESTION: Etch cleans the tooth and creates micropores for micromechanical retention.
QUESTION: Etchant does all except- provide chemical bond

QUESTION: Etchant does all except? Increase surface area, remove debris, Increase wettability of
enamel, or decrease irregularities at cavosurface margin.
QUESTION: What does acid etching NOT do: Cleans surface debris, Roughens enamel surface, Gives
more surface area, Helps in wetting the enamel
QUESTION: Etch dissolves smear (does not)- dry out collagen

Etch removes the smear layer, exposed collagen fibers can form hybrid layer with resin
QUESTION: Hybrid layer. ANS primer within intertubular dentin
QUESTION: Acid-etching does not cause. Reduced leakage, better esthetics, increased strength of
composites.
Acid etch technique: conserves tooth structure, reduces microleakage, improves esthetics and provides
micromechanical retention.
Etch does improve marginal seal, helps in wetting enamel, cleans surface debris, created micropores
(roughness of surface)
QUESTION: if contamination after etch : re etch
QUESTION: Pg 62, current dentin bonding system: know the difference of total etch and self etch
QUESTION: The most unreliable? self etch
QUESTION: Function of filler in resin—strength (reduces polymerized shrinkage and increases hardness)
QUESTION: Filler composites: Larger fillers have more strength, but do not polish as well
QUESTION: denstist who work with HEMA( composite) can have what kinda complication.? contact
dermatitis
QUESTION: HEMA can give dentist what health problems HEMA causes  contact dermatitis
QUESTION: HEMA used by dentist, what phenomenom happens – anaphylaxis, contact dermatitis,
immune mediated reaction, arthus phenomema?
QUESTION: What acid is in GI cement > silicate glass powder & polyacrylic acid.
Components of GI CEMENT – alumina silicate and polycarboxylate
QUESTION: Asked about use of glass ionomer what is liquid made of? ***P= fluoroaluminosilicate glass
L=polyacrylic acid
QUESTION: What is the acid in glass ionomer? Phosphoric acid, Polyacrylic acid-in durelon
QUESTION: conditioner in glass ionomer : polyacrylic acid- = liquid
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QUESTION: Cool glass slab why? More powder incorporated, less powder incorporated, decrease
working time
QUESTION: purpose of a cool glass slab when mixing cement is to incorporate the most powder into
liquid as possible.
QUESTION: Veneer after a month time has some brown stain: not enough cement at margin,
Microleakage
QUESTION: Which indicated for high caries risk or multiple class Vs? GI
QUESTION: Check proximal contacts first when cast that fits on die cannot be seated on the tooth in the
mouth
QUESTION: When you seat a crown, it isn’t seating. What is the first thing you do?
Check contacts?
Look for nodules on casting?
QUESTION: What is the most practical way to seat a casting at the time of cementation? grind the inside
away since the other answer choices would be either impractical or not done at cementation
QUESTION: Make sure casting seats do the following EXCEPT:
• Increase thermal expansion of investment
• Mix cement thin
• Remove internal nodule with occlude
QUESTION: if you have a bubble in an impression for a crown that is not visible what is going to
happen with the crown when comes from the lab and you try to seated in the mouth  does not
seat
QUESTION: Void in die, crown was processed, what will happen? – crown will seat in die, but not on
tooth
QUESTION: What won’t affect metal casting seated on master cast? Impression inaccuracies
 It wonr fit tooth, it WILL fit cast
QUESTION: You notice void on occlusal of cast. Crown will
a. Fit on die and not on tooth
b. Fit on tooth and not on die
c. Fit on both
d. Not fit on either
QUESTION: What do you not do if your crown doesn't fit? - can't change the cement ratio mixture
QUESTION: Why do we lute all ceramic crowns with composite: increase strength, color stability,
sealing of margins, enhance retention
- Composite Resin-the luting material of choice to cement a ceramic crown and can provide the
STRONGEST BOND
QUESTION: Why don't you use GI resin cement in cementation of all ceramic restoration? its expansion
could cause cracking of porclain
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QUESTION: Sensitivity of pulp in regards to cement, which is correct? resin ionomer and glass
ionomer cause highest pulp sensitivity
QUESTION: which cement is the easiest to remover after procedure? Zinc Phosphat
QUESTION: Zinc phosphate pH is is 3.5, what is the significance of that? this might also cause
pulp sensitivity
QUESTION: what component of cement contributes to adhesion? Polycarboxylic acid, benzoyle

peroxide, others, Polyacrylic side group chelation between carboxyl groups and calcium in tooth.
QUESTION: Photo initiator of composite? Camphoroquinone
QUESTION: resin activator: camophoroquinone
QUESTION: Diketones activate by ? visible light, blue light to produce slow reactions. Amines are
added to accelerate curing time. Cross link reaction.
QUESTION: the most radiopaque in composite is: Barium ( it is a metal)
QUESTION: most radioopaque in porcelain
a. barium and zirconium glass
b. silica
c. quartz
QUESTION: Heat cured indirect composite (increase strength )vs direct composite. Which is
incorrect?
a. Heat composite is harder
b. Heat composite is more resistant to abrasion
c. Heat = Less irritation to tooth due to less shrinkage
d. Heat indirect has better bonding to the dentin and enamel **
QUESTION: Which composites have more color stability? I put light cure due to TEGDMA
HEAT CURED (light cured) RESINS HAVE SUPERIOR COLOR STABILITY
QUESTION: Which composites have more color stability? light cure due to Triethylene glycol
dimethacrylate TEGDMA
QUESTION: with tegdma and hema: light cure to maintain proper shade
Microfill composites are more color stable than hybrid. Microfill have the
smoothest finish compared to hybrids which are rougher. Rougher will pick up stain
easier.
QUESTION: What is importance of light cured vs autocured in terms of shade balance (question
didn’t make sense): I said it was the less number of nitrates when you lightcure; other option is
light cure
QUESTION: What is importance of light cured vs autocured in terms of shade balance; the less
number of nitrates when you lightcure;
QUESTION: curing light intensity: 400
QUESTION: What is false about LED vs halogen curing lights:
a. blue light is 340-370 450-750
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b. battery powered/cordless LED is acceptable
c. LED lasts longer than halogen
d. something about a photoinitiator
e. Blue light is not 340-370
QUESTION: Lasers and LED lights don’t cure all resins b/c some resins photoinitiatiors have require
light sources is out of range: true and correct logic
QUESTION: Which of the following will be not be good against enamel? – Hybrid resins (other
choices, enamel, amalgam and unfilled resins – Hybrids have silica filler, which increase
hardness wear resistance) mine also had porclelain though. porcleain
QUESTION: Which of the following will be not be good against enamel? – Hybrid resins (other choices,
enamel, amalgam and unfilled resins – Hybrids have silica filler, which increase hardness wear resistance)
--hybrid is the most abrasive
QUESTION: Which one is true about Glass Ionomers – It has good tensile strength (others choice
were compressive strength, or something that’s for more stronger material like amalgam) there was
one more option that seemed to be a better attribute than tensile – don’t remember. ?
QUESTION: GI non benefit- good tensile (not compression)

GI is brittle = high compressive, low tensile strength
QUESTION: *** VRMGI? Advantage beside fluoride release? Ionic bond btwn enamel and dentin,
QUESTION: Something about glass ionomer: forms ionic bond.

QUESTION: GI forms ionic bonds
QUESTION: Direct Pulp cap w/ CaOH; wuts most important thing to do? Put 2mm of it, put 3mm of
it, put a hard liner/base above CaOH, etc. (agu’s answer: put hard liner/base above CaOH)
QUESTION: direct pulp cap- do you put 2mm of calcium hydroxide or calcium hydroxide liner and
a glass ionomer base
QUESTION: How do you improve the success of calcium hydroxide on a direct pulp cap? Place GI liner
over calcium hydroxide,
QUESTION: 1 mm away from pulp horn, large carious lesion what do you do? Pulp cap, with liner etc…
Other options too
QUESTION: Pulp Capping use calcium hydroxide, in order to protect the pulp put 2mm
thickness base
QUESTION: What is the composition of Glass Ionomers? Silica glass and polyacrylic acid.
Know GI cement/GI restorative--**think GI joe! He leads a double life and can be both a cement and
restorative material! As a cement---low pH can cause sensitivity, pulp irritation, least erosive (because GI
joe is super strong you can’t beat him up). As a restorative material---releases F, low solubility, thermal
ins, sim therm exp to tooth, chemical adhesion, biocompatible. However, GI has less surface hardness,
compressive strength, and tensile compared to COMmander COMposite!
QUESTION: What is a compomer? (p. 26) GI and Composite modified with polyacid groups, used in
low-stress-bearing areas (Less wear resistant than composite, Releases fluoride)Root caries and Class V.
RMGI is better.
QUESTION: What is compomer combined benefits of composites (the “comp” in their name) and glass
52
ionomers (“omer”).
QUESTION: Reinforced Zinc Phosphate Eugenol: Best luting agent? (This statement does not make
sense…reinforced ZOE is biocompatible but has very low strength and is only used for very retentive
restorations…nowadays only used as a temporary cement…Xtina)
QUESTION: The strength of Zinc Oxide Eugenol can be increased by adding what? Methylmethacrylate
QUESTION: Methyl methacrelate (reinforced ZOE)
QUESTION: *Zinc oxide eugenol is IRM but theres an extra component that makes it IRM which is the
methylmethacrylate which is an inactive ingredient.
QUESTION: zinc oxide-eugenol with polymer reinforcement.
QUESTION: IRM is ZOE mixed with what? Titanium, MMA
QUESTION What has been added to IRM: ZOE + PMMA beads added to poweder to increase strength
QUESTION: pH of ZOE (near 7), zinc phosphate: **pH of 3.5—acidic irritates pulp.
QUESTION: Zinc eugenol good temp filling: gives a good bacterial seal, high compressive strength,
high tensile strength, good biological seal
QUESTION: the main component of any root sealers is? Zinc oxide
QUESTION: when you used ZOE in a primary what kind? ZnOE without catalyst., Lack of catalyst
gives adequate working time filling the canals
QUESTION: what do you fill a root canal with on a primary tooth

 ZOE without catalyst
 Gutta percha
 Sealer alone
 ZOE with accelerator
 ZOE without accelerator
QUESTION: What is the material in reinforced IRM that give it strength

A. amalgam powder
B. Zinc phosphate
C. Poly methyl methacrylate**
D. Titanium powder
QUESTION: Zinc phosphate cement is used as luting agent : the initial acidity may elicit a traumatic
response if…
a. Only a thin layer of dentin is left btwn cement and pulp
b. very thin mix of cement is used
c. tooth has already a previous traumatic injury
d. No cavity varnish is used
A. a, c, & d
B. a or d
53
C. b only
D. all of the above
QUESTION: If you add BIS-GMA to PMMA increases strength or results in the doughy texture to
have more working time
QUESTION: PMMA resin? bis-GMA

QUESTION: Crosslinking factor of P-MMA? bis-gma, benzoyl peroxide
QUESTION: Crosslinker in pmma: bisgmma, benzoyl peroxide
QUESTION: Bis-GMMA- provides the CROSS LINK
QUESTION: Cross-linking in polymers leads to what? – Better Strength.
QUESTION: PMMA and what crosslinking does? I put strength but not sure
QUESTION: Addition of long chains in PMM is for what reason: increase strength, allow doughy
consistency before set, allow for addition of more powder without crazing, prevent shrinkage
QUESTION: If too much monomer is added to polymer: Causes excessive shrinkage
QUESTION: Increase monomer causes shrinkage
QUESTION: By having excess amount of monomer in acrylic can create excessive amounts of what:
shrinkage, expansion, thermal conduction are 3 of the 4 options
QUESTION: Adding more monomer increases

a. Expansion
b. Shrinkage?
c. Brittleness
d. Harness
QUESTION: KNOW WHAT INCREASES AND DECREASES SETTING TIME:
increased water:powder ratio increases setting time, decreases expansion,
mix faster, increase water temp  decreases setting time
QUESTION: If you decrease water temp (make it colder), you have more working time for an
QUESTION: Increase set time with Alginate (Irreversible Hydrocolloid)? Cold water and more water
QUESTION: If you increase water to powder ratio, you have decrease expansion
QUESTION: IF you have decrease spatula/mixing, you decrease expansion
QUESTION: IF you have increase spatula/mixing, you increase expansion
QUESTION: Increased trituration time will increase compressive strength/decrease setting

expansion;
QUESTION: Increasing trituration timeReduced the setting expansion
54
QUESTION: Know what increases and decreases setting time for gypsum
(slurry/temperature/spatulation) – longer spatulation time, greater expansion (shorter time) ----
***Gypsum bonded investments. Type I, II, III gold. Gold shrinks, so mold must expand to compensate.
Older invst—decrease expansion; Increased time between mixing in water bath immersion---dec exp;
Increase water:powder ration—dec exp; Increase spatulation time—increase expansion
QUESTION: What decreases setting time of Gypsum: Decrease water:powder ratio
QUESTION: What happens if you increase water in gypsum stone? Less expansion and strength (b/c
particles are farther apart)
QUESTION: How to decrease setting time (increase spatulation time, increase water temperature,
use of slurry water, decreases water:powder ratio)
QUESTION: How to increase setting time? Hot water, increase water/powder ratio, decrease
water/powder ratio
QUESTION: Same thing but with increase/decrease in setting expansion-more water, less
expansion, less strength
QUESTION: what happens when you increase w/p ratio of an investment: increase thermal
expansion, decrease thermal expansion, increase setting expansion...?
QUESTION: Similar question with how to increase setting time of alginate
QUESTION: take an impression and lip immediately swells? Angioedema

QUESTION: C1 inhibitors are used in angioedema to inhibit the complement system
QUESTION: C1 esterase inhibitor – angioedema
QUESTION: C1 Esterase Ihibitor question-hereditary angioedema
QUESTION: Which of the following systems is thought to malfunction in the hereditary form of
angioneurotic edema?
A. C-1 esterase
B. C-1q inhibitor
C. CH50 consumption
D. Serine phosphatase
E.Complement synthetase
QUESTION: Alginate 100% humidity: Shrinks due to syneresis.

QUESTION: Alginate impresssion shrinks due to - syneresis.
QUESTION: Alginate imp 100% humidity will shrink: syneresis= extraction or expulsion of a liquid
from a gel shrinkage
QUESTION: With alginate in 100% humidity, why will shrinkange still occur? Imbibemnt,
syneresis, historgysm
QUESTION: Most inaccurate? Irreversible hydrocolloid
QUESTION: Synerisis imbibition applies to which impression mat? Reversible hydrocolloid. Irreversible
is not an option
55
QUESTION: when pouring gypsum material into an impression which material will cause the least amount
of bubbles? Polysulfide, polyether, silicone, irreversible hydrocolloid
QUESTION: Dimensionally stable impression- additional silicone (polyvinylxsiloxane?...Xtina)
QUESTION: Most stability:
hydrocolloid reversible
hydrocolloid irreversible
polysulfide
*PVS and polyether were not option
QUESTION: Most stable impression material: additional silicones ( aka PVS ) they just used
QUESTION: which provides best dimensional quality (PVS)
QUESTION: polyvinyl siloxanes gets affected by latex (handle with latex gets messed up the sulfer
in latex gloves that retards the setting of PVS addistion silicone))
QUESTION: PVS➡Polyether-Most!
QUESTION: Polyether – wuts bad about it? Hard to take out cuz it sticks to teeth
QUESTION: Polyether disadvantage compared to other elastomerics?choices: sticks to teeth,

longer working time, less accuracy
QUESTION: Biggest disadvantage of polyether? I put hard to remove from teeth
QUESTION: Which one most likely to get stuck in mouth? Polyether??***
QUESTION: Impressions: whats wrong with polyether- its hard engages undercuts
QUESTION: When compared to other materials, which of the following is the main disadvantage of using
polyether elastomeric impression materials: Are much stiffer
QUESTION: Most rigid impression material, Polyether
QUESTION: Most rigid impression material – polyether
QUESTION: which is hardest one to remove from the oral cavity (STIFFEST) (polyether)
QUESTION: what material you would not use for a single crown : a) polyether b) polysulfide c) PVS
etc
QUESTION: Which of the following is the best for tear strength – polysulfide / polyether
QUESTION: Polysulfide gives out ? water
QUESTION: Catalyst of polysulphide POLYSULFIDE impression material- lead dioxide
QUESTION: Condensation silicone – ethyl alcohol as by product

QUESTION: Condensation silicone releases? Alcohol
QUESTION: Don’t use for casting impression? Reversible Hydrocolloid.

QUESTION: Acceptable impression material for a casting?
• Irreversible hydrocolloid
• Reversible hydrocolloid
QUESTION: Which of the following is not good for use in taking impression of a cast restoration – I
said irreversible hydrocolloid (other option was reversible hydrocolloid, and addition silicone)
56
QUESTION: Which is not recommended for final FPD impression?
• irreversible hydrocolloid*
• reversible hydrocolloid
• PVS
• Polyether
QUESTION: Which material cannot be used to get cast impression?
o Reversible hydrocolloid
o Irreversible hydrocolloid
o Polysulfide
o PVS
QUESTION: All of the following are good impression materials for crowns except: irreversible
hydrocolloid,
QUESTION: addition silicone is the most stable elastic impression material in a moist environment
QUESTION: Addition silicon(PVS) releases? H2 (as secondary reaction)
QUESTION: The most stable elastic impression in moisture environment?
a. polyether
b. additional silicon
c. condensation silicon
d. polysulfide
QUESTION: Which impression least distorted by water? Addition silicone (Condensation silicone
better ans if available
QUESTION: imbibition and syneresis affect which one the most

a. reversible hydrocolloid----
b. impression compound
c. polysulfide
d. silicone
FLUORIDE:
QUESTION: how many mg of fluoride in 1 liter of water at 1 ppm : 1 mg
QUESTION: Patient has 1ppm fluoride in water-what is that equal to in mg/L?- 1mg/L = 1ppm
QUESTION: What does floried replace in hydroxyl appetite: hydroxyl
QUESTION: What ion is replaced to get hydroxyfluoroapatite? HYDROXYL

Hydroxyapetite + Flouride ------> Flourapetite + Hydroxy
The incorporation of fluoride into the enamel hydroxyapatite crystal: Fluoride ions replace the hydroxyl
radicals of the hydroxyapatite crystals in the enamel, producing fluorapatite. This form of enamel is less
soluble in catabolic acids produced by oral bacteria.
QUESTION: least soluble
a. fluorapatite
QUESTION: Fluoride becomes fluoroapetite which is insoluable
QUESTION: ***Fluoride works in all these ways except: Increases strength of collagen**
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Fluoride BREAKSDOWN collagen, is bacteriocidal, fluoroapetite is more resistant to acid
attack, decreases solubility of enamel, excreted by kidneys, helps remineralize
QUESTION: Fluoride helps prevent caries in all ways except? lower pH of the oral cavity
QUESTION: Fluoride helps prevent caries in all ways except? I put lower pH of the oral cavity,
since it does not do that! Fluorapetite has a lower critical pH of 4.5
QUESTION: Flouride accumulated most- away from DEJ (surface of tooth)
QUESTION: Where does fluoride localize? Outer enamel**
QUESTION: Fluoride spot makes enamel more resistant to future caries
QUESTION: Fluoride does all the following, except? – Direct action on plaque
QUESTION: What does floride do? Floroapitate that’s acid resistance.
QUESTION: How do you determine the severity of fluorosis? Look at the two worst teeth?
• Higher the fluoride level, greater degree of enamel change
QUESTION: Flouride in acidualted flouride. 1.23 %
QUESTION: What conc of acidulated phosp fluoride is used in the dental office? 1.23
QUESTION: ADA recommends to apply in-office floride foam for how long?- 4 MIN
QUESTION: How many minutes do you place Neutral sodium fluoride tray on teeth? 4 minutes
QUESTION: Floride supplementation is effective in: everybondy, only kids, anyone but most
beneficial to children.
QUESTION: Supplemental fluoride when can you give it? 6 mos
QUESTION: what age should fluoride supplements be started? 6 months
QUESTION: Minimum fluoride age? 6 months

QUESTION: What age does fluoride incorporate into primary dentition? 4 months in utero
QUESTION: At what age does florousis of teeth anterior permanent teeth occur?- 4-6mo (others 0-4mo,
1year, 2years and 6 years)
QUESTION: Fluoride – toxic dose 5-10 mg/kg
QUESTION: Usual water flouridation- 1.0 ppm
QUESTION: 1ppm for average fluoride in water (FYI in January of 2011 this statement was
issued: “The Department of Health and Human Services today announced that it will revise the
recommended levels for optimally fluoridating community water systems. Historically, the
recommended optimal level for community water fluoridation has been 0.7 to 1.2 parts per million.
The new recommended level is 0.7 ppm.”)
QUESTION: What is the EPA highest conc of natural fluoride in drinking water? 4 or 1ppm????
QUESTION: Maximum allowed fluoride in the water by EPA (environmental protection agency)?
4.0mg/liter
QUESTION: Maximum fluoride according to some agency is ? 4ppm (options were 1,2 ,3, 4mm)
QUESTION: Community fluoride: 0.2% / week in udnerprivelaged areas
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QUESTION: Flouride is given to children in schools usually by what method: .05 daily, .2 daily,
.05 weekly, .2 weekly ( I guessed this, I have no idea because this question is a total waste of my
time and I cant think of any situation where knowing this would be useful)
QUESTION: How do they administer Fluoride in schools? 0.2% Fluoride rinse 1x week
QUESTION: What happens when a kid with primary teeth ingests fluoride? - It affects their
permanent teeth.
QUESTION: Fluoride table, 5yrs old with .75ppm intake - I said don't give more (answer said 0ppm)
QUESTION: Floridation supplement for a 5 year old drinking .75ppm h2o?- 0mg
QUESTION: 4 yrs old patient, 0.25ppm fluoride intake, what do you? – Give her systemic Fluoride
(other were apply fluoride, change diet to more fluoride intake).
QUESTION: 4 yr old lives in community with .28 ppm: systemic fluoride supplement, prescription
fluoride rinse
QUESTION: 4 yo with .4ppm fluoride. Supplement? 0.25PPM or 0.25mg/L
fluoride rinse
QUESTION: 2 yo takes 20mg fluoride pill – coma, nausea, renal failure, cardiac arrest
QUESTION: a child has injested 20 mg of fluoride. What will likely happen? Nausea
QUESTION: 7 year old patient has no fluoride in drinking water. What do you give them systemically…
5 mg, 1 mg, .25 mg
6 months-3 year = 0.25mg
3 -6 years = 0.5mg
7 – 16 y.o. = 1mg
QUESTION: IF PATIENT GETS 0.3-0.6mg from water then half supplement from 3-16years
QUESTION: 4.5 years old child with .75ppm fluoride in their water req. how much fluoride
supplement? 0 mg. optimal range of fluoride in water lies between 0.7 and 1.2 ppm
QUESTION: The appropriate amount of fluoride in the community water: 0.75-1.2
QUESTION: Supplementation for 10 year old with no other fluoride source? 1 mg every day or 1 mg
every week?!?
QUESTION: 2.5 year old with 0.4 ppm fluoride in water… normally I would say rx nothing but that
wasn’t a choice – I put 0.25 mg supplement
QUESTION: The drinking water supply of a community has a natural F level of .6ppm. The F level is
raised by .4ppm. Tooth decay is expected to decrease by what % after 7 years?
40%
QUESTION: 3 year old patient lives in area with 0.4ppm fluoride. How much do you
supplement? 0.25 mg
QUESTION: 7 year old child living in area with .2 ppm fluoridated water-supplement 1.0
QUESTION: what type of Fl in water: include fluorosilicic acid (hydrofluorosilicate) – most

commonly used, sodium fluorosilicate, and sodium fluoride
QUESTION: Types of Fluoride used in toothpaste: sodium fluoride, Stannous fluoride(most

effective), Sodium monofluorophosphate
QUESTION: Which type of fluoride not in toothpaste: acidic fluoride
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QUESTION: Which fluoride is not found in toothpaste? Acidulated (???)
QUESTION: what toothpaste should not be used in a patient with multiple porcelain crowns?
acidulated
QUESTION: Best thing for child to rinse with? Sodium fluoride
QUESTION: What mouthwash is good for children with caries? NaF
QUESTION: What rinse is used at home for developmental disabled child to reduce of plaque: NaF,
stannous fluoride, chlorhexidine
QUESTION: the usual metabolic path of ingested fluoride primarly involves urinary excretion
with remaining portion in? skeletal tissue
QUESTION: where is the biggest store of fluoride in tissues? Skeletal tissues

A. interproximal**
prr/sealant)
QUESTION: In history of dentistry, which of the following has decreased?
• Interprox-due to fluoride
• Pit and fissure
QUESTION: What is least likely to cause baby bottle caries?

a. Breast milk at night
b. Formula made with fluoridated water
c. water with no fluoride
d. juice
QUESTION: ECC cause by all at night except – bottle feeding with formula with fluoridated water, breast
feeding, sippy cup with OJ, bottle feeding with processed water with no fluoride
QUESTION: ECC which location?
a. Max incisors and molars?
b. Max incisor and molars?
c. Max canine
d. Man canine and molars?
Primary max incisors (B&L), then primary molars, mandibular unaffected bc
tongue blocks
QUESTION: ECC early childhood caries. Question asked which teeth specfically affected. 1) Max and
mand incisors 2) max central and 1st molar 3) man central and 1st molar Max anterior and primary
molars
QUESTION: What teeth are assoc with ECC? primary incisors, incisor and canine, incisor and molar
QUESTION: Question about what determines fluoride supplementation for a city - temperature
QUESTION: percentage of fluoride water in US - 85% (should be about 65-70%)**ADA site talks about
percentage of people receiving fluoridated water.. couldn’t find percentage of fluoridated water itself.
Percentage went up from about 65% to 74%.
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QUESTION: What percentage of americans have public fluoride in water: 66%, 85%, other lower
numbers Update: CDC 2010 reports Americans have 79.6% water fluoridation
QUESTION: porcentage of cities in U.S with fluoridate water : 69or 75%???
QUESTION: water fluoridation in what percentage of towns/cities? 30%, 70%, 85%

QUESTION: What is percentage of communities that are fluoridated in America? 60, 85%...
QUESTION: What is percentage of community water fluoridation- 67, 85, 35
QUESTION: Fluoridation for water: effectiveness: early studies showed that it prevents 50%-70%
of caries in permanent teeth, Howerver currently the effectiveness is 20%-40%
QUESTION: Effectiveness of Water fluoridation in the U.S. is 20%-40% (40%)
QUESTION: Fluoridation: daily use of tablet cause 30% reduction in new carious lesions
QUESTION: Fluoridation: know the primary/secondary/tertiary prevention differences.
Primary: aims to prevent the disease before it occurs. Health education, community fluoridated water,
sealants.
Secondary: Elimates or reduces disease after they occur. Composite filling
Tertiary prevention: Rehabilitates an individual in later stages to restore tissues after the failure of
secondary prevention. Examples include dentures and crown and bridge.
QUESTION: Fluorosis does what – inhibits remineralization (irreversible)

QUESTION: Fluorosis does what – inhibits remineralization, however fluoride induced enamel
hypoplasia or hypocalcification which is characteristic of fluorosis is caries resistant
•Higher the fluoride level, greater degree of enamel change
QUESTION: Which fluoride do you give and why? Do certain fluorides stain? Stannous fluoride
may stain. Better to recharge GI? APF
QUESTION: Dentist places sodium fluoride on patient with GI fillings rather than acidulated fluoride
because – acid of fluoride will wear away at GI. TRUE
because – acidulated fluoride will wear away at GI?
QUESTION: Applying Fluoride (APF) on GI cement what happens? A. dissolves it b. stains it
(decks says loos glace) roughens it
C. Acid Flouride
QUESTION: What fluoride tx used in a pt with amalgams, pfm’s , composite restorations, implants? NaF
more profound= acidulated
QUESTION: Pt has fillings and full porc. Crowns, but has decalcification on class V? 1.1 % NaF,
QUESTION: Caries in elderly, which one is not useful in managing: use of 1.1% fluoride as a standard
of care
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QUESTION: what is her dental age based on xrays  advanced, chronological lags behind dental, Tx for
#D  TE, c. what to do with lesion on distal of #S (look incipient, resorbed)  apply fluoride varnish
every week, do DO comp or amalgam, observe and reassess next visit, disc the distal surface, d. both
child and guardian should receive oral health instructions, oral health care should include daily fluoride
rinses  both statements are true.
QUESTION: Sealants- mechanical microretention binding to tooth

QUESTION: Contradiction of sealant: when you have rampant or gross caries
QUESTION: a child with no decay but deep pits and fissures what is the Tx plan : sealants
QUESTION: Patient has deep grooves but no decay on permanent molars, what do you suggest? –
Sealants
QUESTION: Patient has deep grooves but no decay on permanent molars, what do you suggest? - Sealants
QUESTION: Ortho pt: has never had a restoration? Wut wud you do?  sealants, do nothing, etc.
(agu put: do nothing)
QUESTION: High caries risk patient, when is he indicated for sealants? Obvious clinical cavitation on the
occlusal, deep fissures without caries
QUESTION: Pt at high caries risk? Place sealants in deep fissures
QUESTION: pictures of molars in 16 y/o – does it need sealants, no treatment, Class I. Book says do
sealant age 6-12, so no treatment most likely unless caries visualized.
Bleach:
QUESTION: In-home bleaching percentage - 10% carbamide
QUESTION: 25% carbamide peroxide for home bleaching: False, its 10% carbamide peroxide
QUESTION: H2O2 – 35% used in in-office bleaching
QUESTION Material used for mouth guard vital bleaching: 10% carbamide peroxide.
QUESTION: Home bleaching kit. Maximum dosage? Carbamide peroxide 10%

QUESTION: home bleaching what causes : sensitivity
QUESTION: Most successful teeth for bleaching? Aged yellow staining
QUESTION: What is the most effective way of bleaching teeth? In-home vital bleaching.
QUESTION: Non vital bleaching is with? hydrogen peroxide 35%, carbamide peroxide, and
sodium perborate.
QUESTION: Bleach most often used in internal bleaching: sodium perborate

QUESTION: Difference b/t dentist and home bleaching.. strength of peroxide
QUESTION: Bleaching tray at home? Make sure custom fit
QUESTION: best way to decrease gingival irritation w/ home bleaching? well fitting trays
QUESTION: Bleach used to dissolve organic tissue
QUESTION: Purpose of bleach except- getting past foramen to treat bone
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QUESTION: most common complication of internal bleaching  cervical external root
resorption
QUESTION: How do you treat it? Scale the area
QUESTION: What is worse outcome of nonvital bleaching (internal bleach for endo)…external root
resorption, internal root resorpotion /CERVICAL RESORPTION. Non vital bleaching
consequence: internal resorption /cervical resorption
QUESTION: You are about to prep a tooth for PFM crown, patient also needs teeth bleached, how do
you go about it? – Bleach first, wait 2 weeks, prep tooth, then restoration.
QUESTION: You are about to prep a tooth for PFM crown, patient also needs teeth bleached, how do you
go about it? – Bleach first, wait 2 weeks, prep tooth, then restoration. (Other choices, Bleach and prep 1st,
then wait 2 weeks, Bleach last after prep and crown).
QUESTION: How long after vital tooth bleaching can you bond resin to it? 24 hours, 3 days, 1 week
QUESTION: Anterior crown lighter than rest of teeth  bleach rest of teeth
QUESTION: Patient is complaining about a very light colored anterior PFM crown she had done
sometime ago, there is nothing clinically wrong with the crown. What do you do Doctor? – Bleach
natural teeth (other choices, re-do the crown, put a darker shade composite on crown, some other
stupid answers).
QUESTION: #8 PFM is too light but good margins and been there for 10 years – vital night guard
bleaching
QUESTION: Anterior crown placed 10 years ago, 45 yr old woman, color doesn’t match natural teeth
now, appears clinically acceptable, what will you do?
a. vital bleaching
b. new crown
c. microetch and composite bond
QUESTION: The prognosis for bleaching is favorable when the discoloration is caused by
a. necrotic pulp tissue
b. amalgam restoration
c. precipitation of metallic salts
d. silver-containing root canal sealers
QUESTION: The office bleaching changes the shade through all except…
a. dehydration
b. etching tooth
c. oxidation of colorant
d. surface deminearalization
QUESTION: No obvious clinical caries in a child. Radiographically, interproximal caries on primary tooth
T. Best tx: MO and DO composites, MOD amalgam, stainless steel crown
Oral Pathology:
http://www.aapd.org/media/Policies_Guidelines/RS_LabValues.pdf
QUESTION: Hairy tongue – hypertrophy filly form papilla
QUESTION: What is usually seen with affected hypertrophic filiform pappilae: Hairy tongue
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QUESTION: Causes ofHairy tongue ? antibiotic , corticosteroid, hydrogen peroxide
Many people with BHT are heavy smokers.[4] Other possible associated factors are poor
oral hygiene,[4] general debilitation,[4] hyposalivation (decreased salivary flow rate),[5]
radiotherapy,[4] overgrowth of fungal or bacterial organisms,[4] and a soft diet.[5]
Occasionally, BHT may be caused by the use of antimicrobial medications e.g.
tetracyclines,[5] or oxidizing mouthwashes or antacids
QUESTION: Which of the following is seen with hyperplastic(or was it associated with) foliate
papilla: hairy tongue, Lingual tonsil hyperplasia
QUESTION: Which of the following is seen with (or was it associated with) hyperplastic foliate
papilla: I put hairy tongue, other option was median rhomboid glossitis, also lyphadenopathy)
a. Lingual tonsil hyperplasia
QUESTION: Hyperplastic lingual tonsils may resemble which of the following?

a. Epulis fissuratum.
b. Lingual varicosities.
c. Squamous cell carcinoma
d. Median rhomboid glossitis.
e. Prominent fungiform papillae.
QUESTION: Loss of filliform papilla- vitamin def- vit b

QUESTION: Bilateral swelling of parotid cannot be caused by: Anorexia,
QUESTION: Patient has bilateral white lines @ occlusal plane, what is primary microscopic finding?
Epithelial hyperkeratosis
QUESTION: Pt has hyperkeratosis around occlusal? linea alba
QUESTION: What is white and bilateral on buccal mucosa (leukoedema not choice), Linea Alba
QUESTION: Ulcer on tongue repeated every 4 months- apthous ulcer
QUESTION: why brush tongue - to reduce odor
QUESTION: Pic: had a red thing on tongue where is it from (candidiasis, Kaposi, syphilis, gonnaria)
QUESTION: Behçet's disease Pic of something on tongue: aphthous ulcer – related to bechet’s disease
QUESTION: Behcet’s syndrome? Oral lesions similar to apthous ulcers?
QUESTION: Bechets syndrome produces what type of mouth lesion: Apthous Ulcers , apthous stomatitis,
recurrent. herpes
Behçet disease sometimes called Behçet's syndrome,Morbus Behçet, Behçet-Adamantiades syndrome, or
Silk Road disease, is a rare immune-mediated small-vessel systemic vasculitis that often presents with
mucous membrane ulceration and ocular problems. Triple-symptom complex of recurrent oral aphthous
ulcers, genital ulcers, and uveitis. As a systemic disease, it can also involve visceral organs such as the
gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems. This
syndrome can be fatal due to ruptured vascularaneurysms or severe neurological complications.
QUESTION: Pathognomonic for measles? Koplik’s spots
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QUESTION: koplick spot? buccal muscosa ulcerated, related to measle
*Koplick—ulcerated buccal mucosa…MEASLES
QUESTION: Transillumination in children – Koplik? (Koplik’s spots are associated with

measles)
QUESTION: Syphilis: hutchinson triad (presentation for congenital syphilis, and consists of three
phenomena: interstitial keratitis, Hutchinson incisors, and eighth nerve deafness.)
QUESTION: indents on incisal edge with narrowing at mesial and distal? I guessed congenital
syphilis (Hutchinson’s tooth?)
QUESTION: A chanker due to Syphilis mostly resembles: Aphthous ulcers.
QUESTION: stages of syphilis is most infectious: primary and secondary, primary, secondary, tertiary,
primary secondary and tertiary
QUESTION: Heck disease: 13 and 32
(also known as focal epithelial hyperplasia) is a cutaneous condition characterized by

white to pinkish papules that occur diffusely in the oral cavity.[1]:411 It is caused by the
human papilloma virus types 13 and 32.
QUESTION: baby with streaks on palate

• bone nodulus
• Epstein pearls
• congenital epulus
QUESTION: Kid has nodule on palatal suture-what is it
• Ebstein pearl
• Bohn nodule hard/soft palate+ B/L of ridge
QUESTION: neonate with a bunch of nodules on alveolar ridge. What is it?

a. Bohn’s nodule
- keratin-filled cysts of salivary gland origin on palate of newborn
 Eruption cyst
 Congenital cyst of newborn
Oral Pathology:
Systemic Lupus Erythematosus:
Lupus Erythematosus –collagen/CT multisystem disease. Unknown cause. Women 10x more
frequently. Avg age =31yo. Malar rash, kidney problems 50% of time &lead to organ failure.
Pericarditis also frequent complication; warty vegetations on valves =Libman-Sacks endocarditis.
Oral lesions if evident- palate, B mucosa, gingiva.
QUESTION: Xerostomia, complication of :Sjö gren's syndrome, dry moth dry eye PAROTID
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SWELLING LUPUS RHEUMATIOD ARTHRITS poorly controlled diabetes,
QUESTION: Which syndrome has rash on cheeks, ulcers, kidney, etc? lupus
QUESTION: Which skin condition has endocaditis and glom- lupus
Cavernous Sinus Thrombosis:
QUESTION: cavernous sinus problem - due to infection of upper lip / canine space infxn / max ant
teeth
QUESTION: Most likely to cause cavernous sinus thrombosis: valve infected by endocarditis, soft tissue
abscess in upper lip (veins of face don’t have valves)
QUESTION: a cavernous sinus infection would most likely come from, maxillary sinus, paranasal sinus,
frontal sinus, ant. Max. teeth
QUESTION: Site of infection most likely to enter cavernous sinus? Anterior triangle, naso-labial
cyst
QUESTION: Danger triangle of the face – cavernous sinus (no valves in the veins)
QUESTION: Why are you afraid of having infection in anterior triangle (i.e. upper lip) because there
are valve-less veins that can send infection back to the brain
QUESTION: Which of the following causes Cavernous sinus thrombosis: A)Subcutaneous Abscess of
upper lip b)Subcutaneous abscess of lower anterior region
Infections in upper front teeth are within the area of the face known as the "dangerous triangle". The
dangerous triangle is visualized by imagining a triangle with the top point about at the bridge of the
nose and the two lower points on either corner of the mouth
QUESTION: Danger zone of Cavernous Sinus: Signs and symptoms. What is the first one? Blurred
vision
QUESTION: first sign of cavernous sinus:

bulging eye??
loss vision
***HEADACHE***
QUESTION: Pathognomonic sign of CST? Ptosis, bulging eye, headaches(1st one)
QUESTION: Cavernous sinus thrombosis early indication? Peri-orbital swelling, blurry vision
QUESTION: Cavernus sinus has : ptosis, decreased vision, opthalplagia
vision
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Cavernous sinus thrombosis (CST) is the formation of a blood clot within the CS at the base of the
brain which drains deoxygenated blood from the brain back to the heart. usually from a infection
from nose, sinuses, ears, teeth or Forunculo. Staphylococcus aureus and Streptococcus are often
the associated. symptoms include: decrease or loss of vision, chemosis, exophthalmos (bulging
eyes), ptosis, headaches(1st one) and paralysis of the cranial nerves which course through the
cavernous sinus. This infection is life-threatening and requires immediate TX.
Ludwigs Angina:
QUESTION: Which space is not involved in ludwig’s angina? (sublingual, submandibular,
retropharyngeal, or submental)
QUESTION: What space is not associated with ludwigs angina? Associated with sublingual,
submental, submandibular
QUESTION: Ludwig’s angina seen in all spaces except: Retropharyngeal
QUESTION: Cellulitis most of the time involves unilateral, ludwigs angina is bilateral and complication is
edema of GLOTTIS
QUESTION: patient has bilateral submand infection, tongue is raised due infection - Ludwig's
QUESTION Bilateral submandibular infection, tongue was elevated due to infection - Ludwig's
Notes: Ludwig angina is the bilateral cellulitis of submandibular and sublingual spaces.
QUESTION: What u need to worry most abt ludwigs? swelling of glottis
QUESTION: Ludwigs: edema of glossitis
QUESTION: complication of lugwig’s angina:edema of glottis
QUESTION: Ludwig’s Angina symptoms? Swelling, pain and raising of the tongue, swelling of the neck
and the tissues of the submandibular and sublingual spaces, malaise, fever, dysphagia (difficulty
swallowing) and, in severe cases, stridor or difficulty breathing.
QUESTION: What is the main danger in Ludwig’s angina? closing of the airway
QUESTION: Mandibular 2nd molar infection spreads to what space? Submandibular space.
QUESTION: What space is mand 2nd molar below buccinators? Submandibular, submenal, sublingual, or
Buccal ???
QUESTION: Infection on the mand buccal side of premolars is most likely to go where? Submand space.
QUESTION: Infxn of mnd 2nd pm goes into submandibular space
QUESTION: Mand premolar infection can go to submandibular space
QUESTION: Premolars and molars infection –submandibular space
QUESTION: Which muscle separates 2 potential infection spaces from a maxillary 2nd molar?
Buccinator or Masseter
QUESTION: if you have an infection in the lateral pharyngeal space what muscle is involved? Medial
pterygoid
The lateral aspect is more involved, and is bordered by the ramus of the mandible, the deep lobe of
the parotid gland, the medial pterygoid muscle, and below the level of the mandible, the lateral
aspect is bordered by the fascia of the posterior belly of digastric muscle.
QUESTION: You are extracting a mandibular 3rd molar and the distal root disappears into which
67
space? submandibular space
QUESTION: Root of Mand molar displaced into what space? submandibular
QUESTION: If you extrad madibular molar where to goes, submandibular space.
QUESTION: IAN tract infection, '-[involves what space? Pterymandibular space
Treacher Collins Syndrome:
Downw=ard facing eyes
QUESTION: Which disorder least developmental delay-trecher collins syndrome

QUESTION: Treacher Collins-loss (hypoplasia) of zygomatic bone, what do patients with cleidocranial
dysplasia have? Loss of clavicle
QUESTION: Malformed ear, mandibular hypoplasia – Treacher Collins
QUESTION: Describes patient saying they have mandibular hypoplasia, Malformed ear
eyelids, ear pinna-- Treacher Collins
Scarlet Fever:
QUESTION: Strawberry tongue seen in scarlet fever, Also in Kawasaki disease and toxic shock syndrome
QUESTION: Picture of strawberry tongue (scarlet fever)
QUESTION: Strawberry tongue seen in scarlet fever
Fordyce Granules:
QUESTION: Fordyce granules – ectopic sebaceous gland
QUESTION: Fordyce granule is what?

• salivary gland
• sebaceous gland*
• sweat gland
Turner Tooth:
68
QUESTION: Turners teeth is assoc with?
QUESTION: Most probable reason for a Turner Tooth? Syphilis? Trauma
QUESTION: Most probable reason for a Turner Tooth? Trauma at birth, trauma when young
QUESTION: turners tooth – single tooth affected
QUESTION: Turner’s tooth is caused by: I put “trauma or local infection”
QUESTION: What gives you Turners incisors
• syphilis
• trauma during delivery
• *trauma during pregnancy (occurs when developing permanent tooth is damaged
by periapical infection in overlying deciduous tooth. This causes defect in enamel)
Recurrent Aphthous Stomatitis:

aphtous ulcers in non keratinized tissue – herpes in keratinized tissue
aphthous stomatitis: recurrent discrete areas of ulceration that are almost always painful. occurs
on freely movable mucosa that does not overlie bone,Aphthous can be differentiated since it
usually does not occur over bone, does not form vesicles and is not accompanied by fever or
gingivitis.
QUESTION: Patient has ulcer at mucolabial fold, it goes away and comes back, what could it be? –
Apthous!
QUESTION: Pt has occasional sores on mucolabial fold on mandibular arch that healed without scarring:
minor aphthous
QUESTION: Ulcer that appears often on buccal vestibule that goes away without scarring after a week or
so? Minor Apthous ulcer.
QUESTION: Ulcer healing with scar tissue: major
QUESTION: A chancre due to Syphilis mostly resembles: Aphthous ulcers.
QUESTION: History of lesions that go away after 1 week – recurrent aphthous ulcers
QUESTION: What don’t u treat aphthous ulcers with – acyclovir
Benign Mucous Membrane Pemphigoid (cicatricial):
Pemphigoid = D = DEEPER (subepithelial separation) than pemphigus S = SURFACE (epithelial
separation)
69
Know Pemphigoid--**autoimmune disorder where antibodies attack epidermis. Blisters and vesicles
develop—BMMP—benign mucous membrane pemphigoid. This is DIFFERENT than Pemphigus
vulgaris because—less severe and HISTO: vesicles are SUBepidermal and NO acanthylosis.
QUESTION: Pemphigoid – separation of basement membrane

QUESTION: Subepithelial separation on immunofluorescence indicates? benign mucous membrane
pemphygoid
QUESTION: Another name for chronic desquamative gingivitis? Cicatricial pemphigoid
QUESTION: Most likely to cause desquamative gingivitis:
lichen planus-
Pemphidus vulgaris
Pemphigoid- I would think this one!
Disease with Desquamative gingivitis: lichen planus, mucous membrane pemphigoid (95%),
and pemphigus
A band of red atrophic or eroded mucosa affecting the attached gingiva is known as dequamative
gingivitis. Unlike plaque-induced inflammation it is a dusky red colour and extends beyond the
marginal gingiva, often to the full width of the attached gingiva and sometimes onto the alveolar
mucosa
QUESTION: Desquamative gingivitis is associated with which 2 conditions. Lichen planus and
pemphigoid
QUESTION: Desquamative gingivitis? Answers are in pairs: Pemphigoid and lichen planus
QUESTION: basic question of pemphigus…asked which was a vesicular disease. BUT classmate did
get question on which layer it effects. Lichen Planus and pemphigoid =subepithelial, and
pemphigus is suprabasilar vesicle.
QUESTION: Sloughing of gingiva epithelium in max and mand arches: pemphigus or pemphigoid
QUESTION: Which pemphigoid like lesion most often in infants? Bullous Pemphigoid , Pemphigus
Vulgaris, Pemphigoid etc don’t remember.
QUESTION: A child is most likely to have which of these: pemphigus, pemphioid, erythema
multiform, epidermolysis bullosa
QUESTION: Child formed blisters with minor lip irritation? Epidermolysis bullosa
QUESTION: Which pemphigoid like lesion most often in infants? Pemphagus Vulgaris, pemphigoid etc
don’t remember. Epidermolysis bullosa—small blisters that develop from mild provocation over areas of
stress—ie elbows and knees****
QUESTION: Young child/infant exhibits ulcerations of mouth: epidermalysis bulosa
QUESTION: Said something about a kid who formed blisters with minor irritation to the lips
a. EPIDERMOLYSIS BULLOSA
Condyloma Acuminatum:
QUESTION: Condyloma accuminatum (genital wart) is caused by which virus? HPV*

QUESTION: Condyloma acumulatum- caused by HPV (venereal warts)
70
QUESTION: Which of the following does not have cauliflower like , pebbly appearance? Verrucous
carcinoma, fibroma , condyloma accuminata, papilloma.
QUESTION: HPV: know the subtypes, 6 and 11 for condyloma acumintam
 HPV types 6 and 11 are most frequently the cause of genital warts
Candidiasis:
Candida forms – ulcer, Erythema, white hyperplastic, white/curd
QUESTION: Hiv patient with oropharyngeal candidiasis, what would u prescribe- fluconzole ????
QUESTION: Systemic antifungal in HIV patient?? Fluconazole
QUESTION: Patient with HIV has candidiasis- bec it is HIV related, increased CD 4... ( I wrote increase
CD4...?)
QUESTION: which oral medication would you give to tx vaginal candidiasis? Nystatin, griseofulvin,
monistat, Diflucan (fluconazole)
QUESTION: If pt undergoes radiotherapy for cancer, the most common oral infection that necessitates
drug tx in this stage is? 1. Candida albicans (answer)
QUESTION: Candidasis in cancer patients due to- chemotherapy, radionecrosis
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QUESTION: Inhaled methacholine (steroid) produce oral candidiasis
QUESTION: Pt has multiple white patches that can be scraped off  candidiasis
QUESTION: Oral cytology smears are MOST appropriately used for the diagnosis of which of the
following? Pseudomembraneous candidiasis
QUESTION: What oral manifestation is seen in children with HIV? Candidiasis #1
QUESTION: Patient is 4yrs old on lots of AB what is most likely? Candidiasis
QUESTION: Candida- can wipe away: Nysatatin

QUESTION: systemic med for candida: amphotericin B
QUESTION: broad spectrum antibiotics : increase superinfection (infxn by candidiasis) and
resistance.
QUESTION: Which is associated w/ burning mouth? Candida
QUESTION: Lesion in the middle of tongue also pt had it on palate before and pt is healthy?
Karposi, candidiasis, Syphilis
QUESTION: Rhomboid tongue thought to be- a type of candidiasis

QUESTION: Median rhomboid glossitis—***smooth red area of tongue that lacks the papillae
QUESTION: Healthy 36 year old, red patch on palate, redness in middle of tongue:
-kaposi sarcoma,
-syphilis
-median rhomboid glossitis
-gonorrhea
Primary Herpes:
Gingivostomatitis Herpetica: initial presentation during the first ("primary") herpes simplex
infection. of greater severity than herpes labialis (cold sores) which is often the subsequent
presentations. is the most common viral infection of the mouth,affects both the free and attached
mucosa. Tx Acyclovir, valacyclovir, Penciclovir Famciclovir.
QUESTION: 85% of people have herpes
a. 65-90% worldwide; 80-85% uSA
QUESTION: Kid with herpes. What is the age of infection?

2 years
QUESTION: Age of primary infection of herpes? 2 yo, 4 yo, 6 yo, 8 yo, 10 yo (added info below)
QUESTION: Age of primary infection of herpes? 2 months, 4 yr , 6 yr, 8 yr

From oral path book under viral infections; “acute herpetic gingivostomatitis arise between 6
months and 5 years, with peak prevalence btwn 2-3 years of age. Development before 6 months is
rare due to protection of maternal anti-HSV antibodies.
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QUESTION: Young person w/ fever & vesicles: FEVER = PRIMARY herpes stomatitis
QUESTION: Primary herpatic gingivostomatitis- fever, ulcer in mouth. No symptoms
QUESTION: Primary herpatic gingivostomatitis- child 2 yrs , fever, not ant to eat
QUESTION: After orthodontic tx, pt with no other systemic disease develop high fever? due to
canker sores by newly placed brackets.
QUESTION: ways to treat kid w/ herpetic gingivostomatitis EXCEPT
a. antibiotics
b. give numbing anesthetic before eating
c. have pt rest and drink lots of water
Recurrent Herpes Simplex:
QUESTION: Herpes can be diagnosed by exfoliative cytology. A characteristic multinucleated cell

appears in the smear of herpes infections.
QUESTION: Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone.
The hard palate is the most common site, alveolar mucosa
QUESTION: 2ndary herpes ? lip, gingival, and palate pg 106, table 4-1
QUESTION: Herpes simplex is most common cause for Bell’s palsy

QUESTION: Herpetic withlow? Herpes on finger
DRUG OF CHOICE:
acyclovir: herpes I, II, VZV,EBV
ganciclovir (IV): CMV or (valancyclovir – oral)
Primary HSV: PALLATIVE
recurrent herpes medication: docosanol (abreva), acyclovir (zovirax)

Know drugs that are used for Herpes: Acyclovir, valtrex (valacyclovir), docosanol (abreva), and
PENCICLOVIR
QUESTION: Acyclovir given for herpetic lesions. Also, phosphorylated and activated in infected
viral cells.
QUESTION: herpes, zoster – Valacyclovir treats herpes labialis
QUESTION: Patient gets recurrent herpetic lesions very often with gingivostomatitis. What should
be done?
Acyclovir.
Palliative trt
QUESTION: Hiv pt with oral herpes, what would u prescribe- vir
QUESTION: Tx for herpatic gingivostomatitis?
• palliative tx**
• acyclovir
• systemic antibiotic
• steroids
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QUESTION: Patient has all clinical signs of Herpes (with lesion on corner of mouth that comes and goes)
which medication do you recommend? – The one that ended with a vir. (no acyclovir in the answer
choices)
QUESTION: best med for herpes, CMV…acyclovir.
QUESTION: Valcyclovir (Valtrex): Tx for herpes simplex/herpes zoster
QUESTION: Tx for herpes simplex and herpes zoster : Valtrax
QUESTION: Which most closely mimics dental pain: herpes zoster, CMV, herpangina
QUESTION: Pain lesion - Herpes Zoster
QUESTION: Patient comes with recurrent herpetic stomatitis on the lips and history shows no signs
of primary herpetic gingivostomatitis. Why? Most primary infections are subclinical
QUESTION: 2nd recurrent herpes, supposed to have a primary phase but no sign? It is subclinical
QUESTION: pt presents at 3 days with secondary herpes lesion? What the treatment of choice?
Antiviral?
Palative treatment****
Acyclovir was an answer choice (but acyclovir works best before you get the lesion)
QUESTION: Herpetic gingivostomatitis – within 3 days of onset: treat with Acyclovir 15mg/kg 5 times
per day for 7 days
All patients: palliative care: plaque removal, systemic NSAIDS, and topical anesthetics
Contagious when vesicles are present
QUESTION: Primary herpretic stomatitis? Reactivation of the primary can cause recurrent herpes
infection
QUESTION: Which dz is caused by the virus that causes acute herpetic gingivostomatitis?
A: herpes simplex 1
QUESTION: Herpes lesion intra orally how do u treat? Palliative, acyclovir?? *Tx is supportive—topical
before eating, analgesics, maintain fluid/electrolyte balance, anti-viral agents. DO NOT GIVE
CORTICOSTEROIDS.
QUESTION: acyclovir inhibits mrna. How does it have selective toxicity MOA? Only
phosphorylated in infected cells and inhibits viral mRNA…does not work on dna
QUESTION: Acyclovir-inhib mRNA?-phosphorylated-. nucleoside analogues--can’t make RNA
The mechanisms of antiviral action of acyclovir are well known (Figure 40-9). The nucleoside
analogue is phosphorylated to form acyclovir monophosphate by herpesvirus-encoded
thymidine kinase and phosphorylated further by other enzymes to acyclovir diphosphate and
triphosphate. Acyclovir triphosphate acts to inhibit viral DNA polymerase and to terminate
elongation of the viral DNA chain as spurious nucleotide is incorporated into DNA. In the
noninfected host cell, phosphorylation of acyclovir occurs to a limited extent. Acyclovir
triphosphate inhibits HSV DNA polymerase 10 to 30 times more effectively than it does
mammalian cell DNA polymerase.
QUESTION: how is Acyclovir selective toxicity mechanism of action?
1. only phosphorylated in infected cells and inhibits viral mRNA
2. does NOT work on DNA
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QUESTION: Post herpetic neuralgia cause by: (VZV)herpes zoster, HSV 1, HSV 2, CMV
QUESTION: What does histoplasmosis oral lesion look like? I put recurrent herpes
Painful, ulcer with irregular borders, similar to cancer
QUESTION: Same patient as #49, has upper denture, when he removes it, there is unilateral lesion on the
palate. What could it be? – Herpes (other choices were more serious pathological lesions).
QUESTION: Pic with half the tongue (left side) that looks like herpes lesion and other nothing on it- I
wrote zoster
QUESTION: Pic of tongue one side with messed up: herpes zoster
QUESTION: Antivirals(wrong match)- azt with herpes zoster

QUESTION: Herpetic neuralgia seen after Herpes Zoster (complication of longer shingles) (hh3,
VZV)
QUESTION: Syphilis Chancre resembles 1) Cancer 2)Herpes: 3)Herpangina 4) Apthous Ulcer
QUESTION: Kaposi sarcoma by herpes 8
QUESTION: Kaposi sarcoma most likely on hard palate
Traumatic Neuroma:
QUESTION: A patient has a denture and a firm, swelling under the buccal flange midway
between incisors and molars. What is it? traumatic neuroma
QUESTION: Mandibular Denture: Lump hurts: Anterior to posterior areas cause is: traumatic neuroma
Pyogenic Granuloma:
QUESTION: Picture said: “erythematous, bleeding swelling” mandibular swelling right next to
premolars on R side? I put pyogenic granuloma
QUESTION: Pyogenic granuloma develops RAPIDLY
QUESTION: Pink growth on palatal between canine and 1st pre? Papilloma, pyogenic granuloma,
peripheral ossifying, irritation fibroma?
QUESTION: Which lesion shows the most rapid change in size?
• fibroma
• *pyogenic granuloma
QUESTION: fastest growing tumor????
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a. oncocytoma
b. pyogenic granuloma
c. pleomorphic adenoma
QUESTION: Which one is common in pregnancy and in normal condition--pyogenic granuloma
QUESTION: Patient is female and pregnant and is said to have this enlargement and picture has it
on the corner of her mouth (vermillion border) and she said it just developed; the picture had it
shown as a boil and very red, said it bled, and was no painful – I went with pyogenic Granuloma
other option that could have made sense bc I didn’t know what it was a varix (dilated vein)
QUESTION: Picture... Lesion near labial comissure? Canditits Pyogenic Granuloma???
QUESTION: Lesion on gingival – if you press, it blanches and it bleeds easily – dx = pyogenic
granuloma
Giant Cell Granuloma:

QUESTION: Where do u find giant cells? Hyperthyroidism, Hypothyroidism, Hyperparathyroid,
Hypoparathyroid
QUESTION: Giant cell lesion found in bone what test would you run to help with diagnosis? Bence
Jones(from multiple myeloma, this is what I put), calcium levels, Complete blood count
QUESTION: Giant cell lesion is most like histology of congenital epulis of the newborn. NO!—
Granular cell Myoloma
Squamous Papilloma:
QUESTION: Lesion on the palate verrucous and pedunculated: Papilloma
QUESTION: The causes of Verrucus xanthoma? Human papilloma virus

QUESTION: Cauliflower looking lesion, no picture given - Papilloma
QUESTION: lesion in lip with cauliflower shape : PAPILLOMA - the most common benign
neoplasm of EPITHELIAL TISSUE ORIGIN. It appears as apedunculated (foot-shaped), or sessile
whitish cauliflower-like mass on the tongue (posterior border), lips, gingiva, or soft palate.
QUESTION: pedunculated lesion on palate what is it? Papilloma
QUESTION: The most common between five? 1-Papilloma 2-Rhabdomyoma 3-Leiomyoma 4-

Lymphangioma 5-Neurofibroma
Fibroma:
QUESTION: Which one resembles Epilus Fissuratum – Fibroma (both share trauma as etiology)
QUESTION: Epulis fissuratum is most similar cellularly to: fibroma, granulomar cell tumor, etc
a. Fibroma (and a question about how to treat a patient with old denture and epulis –
usually make new denture or modify; don’t just wear same denture)
QUESTION: there was a picture of Fibroma but the term fibroma was not used instead they used
another name: Focal Fibrous Hyperplasia
QUESTION: Fibromas are a result of what dysfunction? Neoplaisa, dysplaia, hyperplasia
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QUESTION: In most of the cases, localized fibromas are often: Dysplasias, metaplasia, anaplasia,
hyperplasia``
QUESTION: Which of the following does not have cauliflower like , pebbly appearance: Verrucous
carcinoma , fibroma, condyloma accuminata, papilloma.
Granular Cell Tumor:
pseudoepitheliomatus hyperplasia: resembles SCC. It is seen in inflamm papillary hyperplasia, chronic

hyperplastic candida, Granular Cell Tumor, blastomycosis.
QUESTION: Congential epulis histological similar to: hemangioma, lymphangioma, granular cell
myoblastoma
QUESTION: Patient has congenital epulis. What is the histology most similar to? Granular cell tumor
Leukoplakia:
QUESTION: If you have leukoplakia for biopsy, do you incise or excise for biopsy? 1. Incision (answer)
QUESTION: Leukoplakia all over- incise multiple areas w incisional.

Erythroplakia:
QUESTION: In smoker’s soft palate, theres red points, wut could it be?  erythroplakia, initial
stages of SCC, nicotinic stomatitis (hard palate), etc.
QUESTION: what presents with severe dysplasia? Erythroplakia, white sponge nevus
QUESTION: Lesion commonly with dysplasia and carcinoma in situ-- Erythroplakia
Squamous Cell Carcinoma:
QUESTION: White ppl have least oral carcinoma: or asian, Indian, blacks
QUESTION: Worse rate of SCC is in? I put Black men
QUESTION: Etiology of Squamous Cell Carcinoma, external factors and stress.
(alcohol, tobacco, UV radiation, certain HPV types, vitamin deficiency, immunocompromised, iron
deficiency anemia – plummer Vinson syndrome…etiologies added from First Aid)
QUESTION: Xerostomia increases risk of SCC
QUESTION: lateral boarder of the tongue picture looked like squamous cell carcinoma
QUESTION: Lesion that resembles SCC…16wks and then disappers

a. papilloma
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b. keratoacanthoma
c. papillary hyperplasia
QUESTION: Which of the following has the best survival rate?
a. squamous cell carcinoma
b. adenocarcinoma
c. osteosarcoma
QUESTION: SCC on tongue, What you do? Incisional
QUESTION: #1 risk factor for oral cancer Tobacco
QUESTION: Most likely site for SCC? Ventrolateral tongue (other choices were weird…palate
(least)…)
QUESTION: Beetle nut case SCC, xerostomia ? gingival recession ?

QUESTION: Pt has been a smoker (60 pack yr history); ulcer in lower lip, non-indurated; wuts most
probable diagnosis? SCC
QUESTION: Most common malignancy in the oral cavity?

a. metastatic ca (most common malignancy found in bone)
b. basal cell ca (most common type of skin cancer)
c. epidermoid ca (aka SCC…I’m pretty sure this is the right answer…Xtina)
d. mucoepidermoid ca (most common salivary gland carcinoma)
e. adenoid cystic ca (second most cmoon salivary gland carcinoma)
QUESTION: Most malignant cancer in oral cavity? Epidermoid carcinoma ***SCC! (look it up)
QUESTION: Which of these is the most likely to become malignant? low grade mucoepidermoid
carcinoma;
QUESTION: Radiographic Picture: image was upside down, had pink tissue-two teeth on bottom, bump
on palate-what is the lesion? ---SCC?
Leukoedema:
QUESTION: Leukoedema – blanches, no treatment

QUESTION: Leukoedema: Stretch and it disappears
QUESTION: dr stretches buccal mucosa, white, and spreads out thinner: leukoedema
QUESTION: Similar question: Which white lesion disappears upon stretching? Leukoedema
QUESTION: White on mucosa-no information-hyperkeratosis? Gauri put leukoedema; white sponge
nevus other option, lichen planus
QUESTION: Lesion that blanches -Leukoedema- it disappears on streching, it is always bilateral
QUESTION: A patient presents with a bilateral, grayish-white lesion of the buccal mucosa. This lesion
disappears when the mucosa is stretched. Which of the following is the MOST likely condition?
A. Leukoedema
B. Leukoplakia
C. Lichen planus
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D. White sponge nevus
Leukemia:
lymphocytic leukemia-involves Iymphocytes.

• Chronic lymphocytic leukemia runs a variable course (older patients may survive years
even without treatment). lymph node enlargement is the main pathologic finding. May
be complicated by autoimmune hemolytic anemia.
CML – Philadelphia chromosome (chromosomal translocation)**Chronic myelogenous leukemia
QUESTION: Leukemia picture
o Says bleeding gums

o 20 yr old patient
o Been bruising easily
QUESTION: Patient shows up with kid always bleeds, discomfort – leukemia
QUESTION: Leukemia Picture: young person that is fatigued and has a jacked-up mouth
QUESTION: Pic of kid with bleeding gums problem healing- leukemia

QUESTION: Most common type of leukemia in children? 1. ALL (answer) (lymphoblastic)
QUESTION: Pt had erythematous and gingival enlargement over past 5 weeks. And increased report
of bruising on body – cause is acute leukemia: Specifically, AML
QUESTION: A 6 years old patient has acute lymphatic leukemia. Her deciduous molar has a large carious
lesion and furcation lucency. How will you treat this person?
a. pulpotomy
b. pulpectomy
c. extraction
d. nothing
QUESTION: An 18 year old man complains of tingling in his lower lip. an examination discloses a
painless, hard swelling of his mandibular premolar region. the patient first noticed this swelling three
weeks ago. radiograph indicate a loss of cortex and a diffuse radiating pattern of trabeculae in the mass.
which of the following is the MOST likely diagnosis?
a. leukemia
b. dentigerous cyst
c. ossifying fibroma
d. osetosarcoma
e. hyperparathyroidism
Verrucous Carcinoma:
QUESTION: Best prognosis? Verrucous carcinoma in vestibule, verrucous carcinoma floor of mouth,
SCC floor of mouth, SCC in other areas
QUESTION: smokeless tobacco : verrucous carcinoma
QUESTION: Verricus leukoplakia, HPV 16 and 18
QUESTION: Most common most pathogenic location verrucus carcinoma-floor mouth buccal vestibule
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QUESTION: Verrucous carcinoma presents with
• warty lesion
• white ulcerated patch (that’s what it looks like on google images)
• smooth pedunculated lesion
• I put large warty mass- variant of SCC
(large broad based exophytic papillary leukoplakic lesion: Xtina, First aid)
Salivary Gland Tumors:
Most common salivary gland benign major or minor : Pleomorphic adenoma  
Most common malignant minor: Adenoid cystic carcinoma  
Most common malignant major: Mucoepidermoid carcinoma  
QUESTION: Most common salivary gland tumor: Pleomorphic adenoma
QUESTION: Most common gland in Pleomorphic adenoma:
MOST COMMON SITE = MINOR GLANDS OF PALATE
*MOST COMMON TUMOR OF PAROTID GLAND*
QUESTION: Pleomorphic adenoma – most common benign tumor of salivary glands
QUESTION: which s most common salivary gland tumor pleomorphic adenoma and
mucoepidermoid
**Pleomorphic adenoma-most common belign
Mucoepidermoid: Most common malignant
QUESTION: Which of the salivary tumor glands has the best prognosis: Mixed Tumor, Adenoid
cystic carcinoma (perineural spread), Mucoepidormoid Carcinoma (most common)
Acinar Cell Carcinoma (better answer if there)
QUESTION: Which of the salivary tumor glands has the best prognosis: Mixed Tumor (plemomorphic
adenoma), Adenoid cystic carcinoma (perineural spread), Mucoepidormoid Carcinoma (most common)
Acinar Cell Carcinoma (better answer if thereI put polymorphous low grade adenoma but I think the
answer is adenoid cystic…
QUESTION: Best prognosis for oral cancers: Adenomatoid od. Tumor, low-grade --, malig. Mixed tumor
Benign Mixed tumor (pleomorphic adenoma) = best prognosis
Low grad mucoepidermoid is also good
Malig Mixed tumor & adenomatoid = worst
QUESTION: Perineural invasion is seen in: adenoid cystic carcinoma, Pleomorphic adenoma or low
grade mucoepidermoid carcinoma. This tumor has a marked tendency to invade nerves. Perineural
invasion is seen in about 80% of all specimens.
QUESTION: Adeno cystic carcinoma : neurotrophic factor and perineral invasion
80
QUESTION: perineural invasion—ACC (adenoid cystic carcinoma) other choices were OKC, etc
QUESTION: Table 4. 3: swish cheese? adenoid cystic carcinoma
  Adenoid cystic carcinoma

o High grade salivary malignancy
o Palate most common
o Most common malignant
o “swiss cheese” microscopic pattern
o spreads through perinueral spaces*****
Ameloblastoma:
Most common EPITHELIAL ODONTOGENIC TUMOR...mand molar area
QUESTION: Ameloblastoma histology : stellate reticulum in bell stage, epithelium in net flex
pattern
QUESTION: Which one can leads to ameloblastoma? – Dentigerous Cyst.
QUESTION: What cyst is ameloblastoma most likely to stem from? Dentigerous cyst
QUESTION: Which describes ameloblastoma best? I put local invasion
QUESTION: What is the most definite way to distinguish ameloblastoma from OK?
a.smear cytology
b.reactive light microscopy
c.reflective microscopy
QUESTION: Ameloblastoma case Q. You get a picture, slow progessing, other false choices included
dentigirous cyst.
QUESTION: Multiluncency in bone and ramus: ameloblastoma
  ameloblastoma
o benign, aggressive odontogenic tumor w/recurrence
o most common tumor
- Ameloblastoma – consists entirely of odontogenic epithelium. MOST AGGRESSIVE odontogenic tumor.
MOST COMMON epithelial odontogenic tumor.
Solid (multicystic or polycystic) – most aggressive kind and requires surgical excision
Ameloblastic Fibroma: compared to ameloblastoma - younger age, slower growth, does not infiltrate
QUESTION: A painless, well-circumscribed radiolucency and radioopacity in the posterior mandible of

11yrs old boy. what is the differential diagnosis? Ameloblastic fibro –odontoma
QUESTION: Xray - Ameloblastic fibro odontoma/odontoma?
Odontoma:
QUESTION: pic of compound odontoma
81
QUESTION: x-ray of odontoma ( anterior lots of little tooth in the x-ray around the canine)
QUESTION: recognize odontoma--- **compound odotoma—looks like a tooth more defined; complex
odontoma—giant mass that is also radiopaque, but does not look like a tooth—
QUESTION: Syndrome with multiple odontomas-gardners syndrome
QUESTION: Picture of multiple small teeth within a radiolucency: compound odontoma, pindborg
tumor, calcifying odontogenic
- The other tumor of mixed, (epithelial and mesenchynal) origin is the odontoma. These
calcilied iesions take one or two general configurations. They may appear as multiple
miniature or rudimentary teeth, in which case they are known as compound odontomas,
Adenomatoid Odontogenic Tumor (AOT):

QUESTION: AOT (Adenomatoid odontogenic tumor) radiograph picture
o Exact picture used
QUESTION: Max canine surrounded by lesion: AOT

QUESTION: 2/3 tumor: adenomatoid odontogenic tumor: 2/3rd in maxilla, 2/3 in female, 2/3rd
in anterior jaw
QUESTION: Radiolucency at the end of a tooth that looks like there might be an AOT but the patient is
having symptoms (I wrote pericapical cyst)
QUESTION: Radiolucent lesion Between canine -lateral with radiopacity inside: adenomatoid
tumor
QUESTION: mixed density young child: AOT
QUESTION: AOT on xray- REMEMBER lesion goes to apex
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QUESTION: A 16 year old boy. Xray showed maxillary anterior tooth with a radiolucency with
“SPECKS” in it (yes that’s the word that was used). Adenomatoid Odontogenic Tumor
Amelogenesis Imperfecta:
QUESTION: amelogenesis imperfecta is autosomal dominant.
QUESTION: Amelogenesis imperfect: X-ray: open contacts
QUESTION: Pictures of teeth, premolars just erupted. Thick dentin thin enamel, pulps not
obliterated, no contact – AI
QUESTION: Radiographic picture with large decay and radiolucency. In addition to periapical
radiolucency what other thing do you see? amelogenesis imperfecta (tooth lacks enamel)
QUESTION: Know the Imperfectas Amelogenisis: Hypoplastic pitting enamel
QUESTION: All of the following are congenital except…

a. dentinal dysplasia
b. amelogenesis imperfecta
c. regional odontodysplasia
d. ectodermal dysplasia
QUESTION: Question describing regional odontodysplasia: ghost teeth. (enamel, dentin and pulp
are all affected. Non hereditary)
QUESTION: when does enamel hypoplasia occur: Altered matrix formation. (BELL STAGE)
DI vs Dentinal Dysplasia:
DI: Crowns are short & bulbous, narrow roots, obliterated pulp
DD: Short roots (sometimes rootless), obliterated pulp, sometimes PA RL, mobile teeth
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QUESTION: Dentingenesis imperfecta related to osteogenesis imperfect
QUESTION: What is seen with Osteogenesis Imperfecta: Dentinogenesis Imperfecta
QUESTION: osteogenesis imperfecta usually assoc w/

a. DI
b. AI
c. hypercementosis
d. cleidocranial dysplasia
QUESTION: pulp is gone: DI Dentinogenesis imperfect
QUESTION: Dentinogenesis Imperfecta: Obilterated pulp chambers
QUESTION: all of the following are differential for Dentinogensis imperfecta except?
ectodermal dysplasia,
amelogenesis imperfecta,
enamel dysplasia,
dentinal dysplasia
QUESTION: Which is not associated with dentogenesis imperfecta? Ectodermal dysplasia because
the enamel is the ectoderm, dentin is mesoderm I think
QUESTION: Differential diagnosis of Dentingenesis imperfect includes all except:

-OI
-ECTODERMAL DYSPLASIA
-enamel hypoplasia (AI)
-dentin dysplasia
QUESTION: Dentinogenesis Imperfecta poorly mineralized dentin, enamel frequently fractures

from the teeth leading to rapid wear and attrition of the teeth.
QUESTION: Dentinogenesis imperfect type I when? part of osteogenesis imperfect BLUE
SCLERA..... or it can be a separate inherited dominant trait without OI (DI type II)
QUESTION: Which one is associated with dentinogenesis imperfecta?

• blue sclera (this is from osteogenesis imperfecta)
• hypodontia
• Other characteristics of this condition: opalescent teeth, affects both primary and
permanent, teeth are bluish-brown and translucent, enamel is lost early, type 1 is with osteogenic
imperfecta, type 2 is not with OI, type 3 is the bradywine type which occurs in absence of OI and is
isolated to Maryland. Type 3 also exhibits multiple periapical radiolucencies and large pulp chambers.
QUESTION: Dentin dysplasia looks like dentinogenesis imperfect, WITH ONE DIFFERENCE?
dysplasia has radiolucency.
QUESTION: Radiograph what is it: Aentinogenesis Imperfecta pulpless tooth 1 and 2…Type 3 are shell
teeth
dentinal dysplasia (coronal type II) –no/short roots, large pulp chamber-looks like dental
imperferca radicular is type-1-complete pulpal obliteration, short roots, PA RL
QUESTION: Dentinal dysplasia type 1 is pulpless
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QUESTION: Dentinal Dysplasia Clinically the dental crowns appear normal while radiographically,
the teeth are characterized by pulpal obliteration and short blunted roots. The teeth are generally
mobile, frequently abscess and can be lost prematurely.
QUESTION: KID x ray cant see shit on xray however you can tell the roots are short. Sister also has
same condition. What condition is this?
DI-autosomal dominant!!
AI-autosomal recessive
Detin dysplasia – autosomsal dominant
QUESTION: A picture of dentin dysplasia – Short rooted teeth with periapical lucencies
QUESTION: Teeth with very large pulp chambers and open apex, 12 yo boy, sister also effected:
Dentinal dysplasia
QUESTION: Some teeth appear to be clinically normal, but exhibit (1 ) globular dentin, (2) very
early pulpal obliteration, (3) defective root formation, (4) periapical granulomas and cysts, and (5)
premature exfoliation. The condition is known as which of the following?
A. Shell teeth B. Dentin dysplasia C. Regional odontodysplasia D. Amelogenesis imperfect

E.Dentinogenesis imperfecta
QUESTION: Ectodermal dysplasia expressed as? anodontia or hypodontia, with or without a cleft
lip and palate. Anodontia also manifests itself by a lack of alveolar ridge development; as a result,
the vertical dimension of the lower face is reduced, the vermilion border disappears, existing
teeth are malformed, the oral mucosa becomes dry, and the lips become prominent. The face of an
affected child usually has the appearance of old age.
QUESTION: Ectodermal dysplasia definition

QUESTION: Ectodermal dysplasia? Abnormality of 2 or more ectodermal structures. Hair loss, thick nails,
light skin, no sweat glands, missing teeth.
QUESTION: Congenitally missing teeth often seen in? Ectodermal dysplasia
QUESTION: Ectodermal dysplasia: which of the following is correct? It is xlinked, not autosomal
dominant
-  Ectodermal dysplasia – hereditary, abnormal skin, hair, nails, teeth, sweat glands. Teeth develop
abnormally causing anodontia or oligodontia (partial). Retained primary teeth. CONICAL shaped anterior
teeth.
QUESTION: Characteristic of Ectodermal Dysplasia is? – Oligodontia (some missing teeth, not all)
QUESTION: Ectodermal dysplasia: Oligodontia
QUESTION: ectoderman dysplasia : partial or complete anodontia

QUESTION: hypohidrotic child --> ectodermal dysplasia
QUESTION: Ectodermal dysplasia – sparse hair
QUESTION: Ectodermal dysplasia- sparse hair
QUESTION: ectodermal dysplasia…oligodontia and lack of sweat glands
QUESTION: what characterizes ectodermal dysplasia? Skin, hair, nails, SWEAT GLANDS?
QUESTION: What does hypodontia affect the most? I put growth of the alveolar bone?
85
QUESTION: Having hypodontia/anodontia will prevent/undermine formation of what? I said
alveolus (others were maxillary and mandibular arch but not together)
QUESTION: What do you see when you have hypodontia: maxillary deficiency, mandibular
deficiency, atrophic ridge, midface deficiency
QUESTION: Hypodontia affects maxillary constriction
QUESTION: Hypodontia- FEWER number of teeth
1. max deficiency
2. man deficiency
3. mid-face deficiency
4. cortical bone deficiency
5. alveolar bone deficiency
QUESTION: Radiographs of a patient's teeth reveal that the crowns are bulbous; the pulps,
obliterated; and the roots, shortened. These findings are associated with which of the following?
A. Osteogenesis imperfecta
obliterated; and the roots, shortened. These findings are associated with which of the
following?
Porphyria
Pierre Robin syndrome
Amelogenesis imperfecta
Osteogenesis imperfecta
Erythroblastosis fetalis
QUESTION: Blue sclera seen in? osteogenesis imperfect
QUESTION: Blue sclera? Ectodermal dysplasia or OI
QUESTION: What is the most common? Dentinal dysplasia, amelogenesis imperfecta, dentinogenesis
imperfecta, cleft lip (Cleft Lip/palate)
Cherubism:
QUESTION: Cherubism: Bilateral jaw expansion
QUESTION: A kid presents for bilateral enlargement, painless, etc (they are implying Cherubism, what is
the Tx? No Tx required!
Fibrous Dysplasia:
QUESTION: Fibrous Dysplasia – ground glass appearance**Mccune-Albright Syndrome—polyostotic

fibrous dysplasia—areas of radiolucent/radiopaque---potential for malignant transformation
QUESTION: fibrous dysplasia on xray: lucency w/ no opacity, no tooth involved
QUESTION: Panoramic with big radiopacity?

-fibrous dysplacia: it is diffuse radiopacity-vital tooth
-osseous fibroma:radiolucent vital tooth
-cementous dysplacia
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QUESTION: Fibrous dys (diffuse expansion of the mandible)
QUESTION: Picture of couple radiolucency lateral to lateral incisors, asymptomatic, 35 yo female:
fibrous dysplasia- Monostotic fibrous dysplasia may be completely asymptomatic and is often an
incidental finding on x-ray
QUESTION: Which of the following is frequently accompanied by melanin pigmentation (cafe-au-

lait spots)?
A. Osteomalacia
B. Hyperparathyroidism
C. Osteogenesis imperfecta
D. Polyostotic fibrous dysplasia
QUESTION: McCune Albright’s Syndrome – Café au lait spots (coast of Maine)—bone and skin
disorder—brown spots! Coast of maine hahaha
Condensing Osteitis:
QUESTION: Cause of radio opacity of infected tooth- condensing osteitis

QUESTION: Xray – condensing osteitis
Traumatic Bone Cyst:
QUESTION: Scalloped and vital : traumatic bone cyst

QUESTION: Traumatic bone cyst (simple bone cyst) – nothing inside
QUESTION: Traumatic bone cyst pic-
QUESTION: Picture said: “scalloped border, patient is asymptomatic” I put traumatic bone
cyst- Psuedocyst, heals by itself
QUESTION: question about traumatic bone cyst—not a true cyst b/c not epithelial lined
d. scallops around the roots of teeth
QUESTION: Young patient with traumatic bone cyst, what tx? None, spontaneous healing
Pagets Disease of Bone:
QUESTION: Paget’s Disease – cotton wool appearance of skull
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QUESTION: picture of paget disease : cotton wool in skull
QUESTION: Pagets disease : increase alkaline phosphatase
QUESTION: Pagets disease : increase alkaline phosphatase
QUESTION: Which one most likely has potential for malignant transformation: osteomas, paget’s,
QUESTION: what has high incidence of becoming malignant? Cant remember options but I put
Paget’s disease
QUESTION: Which of the following has the potential for undergoing spontaneous malignant
transformation?
A. Osteomalacia
B. Albright's syndrome
C. Paget's disease of bone
D. Osteogenesis imperfecta
E. von Recklinghausen disease of bone
QUESTION: Which has the highest potential for malignant transformation? Pagets disease->
Osteosarcoma
QUESTION: Pagets can lead to osteosarcoma

QUESTION: Denture does not fit anymore as a result of? paget disease aka osteitis deformans! –
cotton wool
- -->Paget’s Disease – aka Osteitis Deformans – chronic bone disorder where bones become enlarged and
deformed – dense but fragile. Seen in pts OLDER pts. Dentures stop fitting. Develops slowly. COTTON
WOOL appearance, hypercementosis, and loss of lamina dura. Labs – INCREASE serum ALKALINE
phosphatase but normal serum phosphate and calcium. Risk of osteosarcomas.
Langerhans, Histocytosis X:
QUESTION: Langerhans x- floating teeth in air.

QUESTION: Radiographic Picture: Floating tooth-not in bone, opacities in lesion-what is it?
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• Whole jaw cyst
• Ameloblastoma
• Keratocyst
• Dentigerous cyst
QUESTION: Hand-Schuller-Christian triad
o Diabetes insipidus
o Exophthalmos
o Bone lesions (Langerhans dis)
Oral signs of hand-schuler-christ. = bad breath, sore mouth, loose teeth
lesion are sharply punched out radiolucency and teeth appear as FLOATING IN AIR
Nasolabial Cyst:
QUESTION: Not a bone cyst? Nasolabial cyst, occurs outside of bone

QUESTION: Which one is soft tissue involvement, not bone - Nasolabial Cyst
QUESTION: Soft tissue cyst- nasopalatanine duce, nasolabial,
QUESTION: A patient has a swelling under the upper lip that is by her lateral incisor and raises
the ala of the nose from the outside. What is it? I put nasolabial cyst
QUESTION: Radiolucency radiating from root of central incisor toward midline, could be all of the below
except … lateral periodontal cyst, nasopalatine cyst, some sort of fibrous dysplasia, nasolabial cyst
- Because this cyst is extraosseous, it is not likely to be seen on a radiograph.
QUESTION: Which one not seen radiographically? Naoslabial cyst
QUESTION: Nasolabial angle: angle b/w base of nose and lip; should be perpendicular, if its acute,
that means patient has big lips
QUESTION: Lining of nasolabial cyst- pseudo stratified squamous
QUESTION: What is the rarest cyst? Lateral Periodontal Cyst
• Nasolabial cyst?
Lymphoepithelial Cyst:
QUESTION: Round yellow-white bump underneath tongue? Lymphoepithilial cyst? Yellowish cyst on
floor of mouth? Oral lymphoepithelial cyst
QUESTION: Round yellow-white bump underneath tongue? Lymphoepithalial cyst?
QUESTION: Patient (young child) w/ nodules on right side of tongue that are fluid filled the rest of
the mouth is WNL no other systemic signs
a. Neurofibromatosis
b. Lymphangioma *
c. Granular cell tumor
Odontogenic Keratocyst:
OKC
• High recurrence
• Intrabony, post mandible;
• basal cell nevus syndrome (a.k.a. Gorlin’s syndrome, multiple OKC’s seen:
Xtina)
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QUESTION: Which is most likely to recur? I put OKC
High recurrence!
– Intrabony, posterior mandible but anywhere; BCNS association
QUESTION: Largest incidence of recurrence? OKC
QUESTION: Most reccuring :okc

QUESTION: What has the highest recurrence rate?
• *Odontogenic keratocyst
QUESTION: initial treatment for OKC is enucleate or resect?? (Usually therapy is enucleation and
cryosurgery…not sure…Xtina)
Nevoid Basal Cell Carcinoma:
QUESTION: Gorlin syndrome = nevoid basal cell carcinoma. Commonly seen OKCs and palmar
pitting, plantar keratosis (odontogenic keratin cyst)
QUESTION: which disease has multiple OKC’s? nevoid basal cell carcinoma. Is answer.
QUESTION: What else most often seen with bifid rib, nevoid basal cell? Odontogenic keratocyst
QUESTION: Basal cell nevus syndrome (a.k.a. Gorlin’s syndrome, multiple OKC’s seen Nevoid basal cell
carcinoma: lots of cyts OKC or NEW NAME ---keratocystic odontogenic tumor (KCOT) multiple OKC
- nevoid basal cell carcinoma
QUESTION: Has Lots of odontogenic keratocysts (OKC): Nevoid Basal Cell Carcinoma Syndrome
(Gorlin Syndrome; Basal cell nevous syndrome)
QUESTION: What else most often seen w bifid rib, nevoid basal cell? Odontogenic keratocyst.
QUESTION: What does multiple OKC tell you? Gorlin syndrome! **also called basal cell nevus
syndrome
QUESTION: multiple OKC=GOrlin gotz
QUESTION: Basal cell nevus bifid rib syndrome (gorlin-goltz syndrome)
QUESTION: Nevoid basal cell carcinoma causes – cyst in the jaws?
QUESTION: nevoid BCC and palmer melatonin indicative of: OKC
OKC – from remnants of dental lamina
QUESTION: Gorlin’s- calcified falx cerebri
QUESTION: Which syndrome Pt has calcified falx cerebri, multiple okcs, bifid ribs? - Gorlin Goltz
syndrome aka Basal cell bifid rib syndrome.
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Gardner Syndrome:
QUESTION: Which syndrome includes osteoma? Gardners
QUESTION: multiple osteomas are found in--> garderners
QUESTION: Which condition presents w/ many osteomas? Gardner’s Syndrome (Multiple

facial osteomas & skin nodules)
QUESTION: Gardner multiple osteomas and intestinal polyps
QUESTION: In which syndrome Pt has ? Gardner's syndrome and esophageal stenosis syndrome
QUESTION: Colon polyps and some kind of oral lesion? Gardners syndrome
QUESTION: gardners syndrome with multiple osteoma and intesbtinal polyps
QUESTION: What do Gardners and Peutz-Jeghers syndrome have in common? GI polyps?
QUESTION: What has polyps…Gardners , Peutz-Jegher, and Crohn’s

QUESTION: In Gardners Syndrome there may be cancerous transform of what?- polyps in intestine.
Bells Palsy:
QUESTION: unilateral eye and lip, unable to close (picture of black chick) - bells palsy photo of a
person to identify the condition : bell palsy ( see mosbys photo )
QUESTION: Know bell’s palsy: unilateral facial paralysis

QUESTION: What causes bells palsy? I chose idiopathic.
Decks: Bell's palsy: involves unilateral facial paralysis with no known cause, except that there is a loss of
excitability of the involved facial nerve. The onset oft his paralysis is abrupt, and most symptoms reach
their peak in 2 days. One theory of its cause is that the facial nerve becomes inflamed within the temporal
bone, possibly with a viral etiology.
QUESTION: Which cranial nerve affected bells palsy? Facial nerve (7th )
Temporomandibular Dysfunction:
QUESTION: Clicking in tmj: internal derangement with reduction
QUESTION: Which artery supplies the TMJ? Deep auricular, maxillary, superficial temporal…MADS
Middle meningeal from maxillary, ascending pharyngeal, Deep auricular, superficial temporal
QUESTION: Best imaging for TMD: MRI
QUESTION: Best way for soft tissue ( disc of TMJ ) : MRI

QUESTION: Mri is best way to look at condyle/tmj
QUESTION: best diagnostic eval for TMJ disc? MRI, CT, PA radiograph
QUESTION: Which radiograph will give you a direct view of the TMJ? (TMJ Tomography?)
QUESTION: Scanning disk tmj- mri best view
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QUESTION: Part of the TMJ that purely rotates : Articular eminence of condyle
QUESTION: Rotation involves what structures? condyle, glenoid fossa, disc, TMJ
Condyle and articular fossa
QUESTION: Which anatomical components are responsible for rotation of the mandible? Condyle and
articulating disk
QUESTION: When TMJ is in rotational movement, rotation is in lower compartment
QUESTION: Lower compartment of TMJ is for? Rotation, upper compartment – translation
QUESTION: what causes tmj ankylosis? Trauma?? Rheumatoid arthritis

QUESTION: Patient can’t speak English well, she doesn’t work, she has TMJ problems, she is on meds.
Which one will not affect her oral hygiene prognosis? - TMJ problems. (Rationale here is; she may not
be able to afford hygiene procedure, she might not understand doctor’s recommendations, and her meds
can contribute to hygiene issues. TMJ problem was not serious enough, as in she can open her mouth to
clean her teeth)
QUESTION: Man comes in after years of tmjd with reduction and is now only able to open 25mm and
that’s it with muscle pain. Whats his disorder?- Myofacial pain syndrome.
QUESTION: Pt is clicking in the jaw suddenly cannot open 25 mm: myofacial pain syndrome (can
cause clicking, limited opening, pain), internal derangement without reduction has no noises or
clicking but limited opening to <30mm
QUESTION: Patient always had internal derangement with clicking all of a sudden no noise and
open max 30 mm what happened? Myofascial pain
QUESTION: Football player with mouthguard, crepitation of left TMJ, trigger zone tenderness L
temporalis, stiffness upon wakening: Myofacial pain syndrome
QUESTION: Highschool football player wears a mouthguard, very tender to palpation of temporal
area, muscle soreness..? question never said about noises: Myofacial pain disorder (possibly
osteoarthritis)
QUESTION: Football player with a mouthguard tenderness to temporalis and hard to open mouth in
morning
• myofacial pain
• tmj dislodgement
QUESTION: Most immediate sign after high occlusion bridge? Myofacial pain
QUESTION: symptoms of pain and tenderness upon palpation of the TMJ are usually associated with
which of the following
a. impacted mandibular third molars
b. flaccid paralysis of the painful side of the face
c. flaccid paralysis of the non painful side of the face
d. excitability of the second division of the fifth nerve
e.deviation of the jaw to the painful side upon opening the mouth.
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QUESTION: TMJ pain are mostly related to: 1- VII, 2-V3, 3-V2, 4-V111
QUESTION: What branch off facial nerve gets damaged the most during TMJ surgey?   Temporal
QUESTION: Nerve most damaged in tmj surgery- FACIAL
QUESTION: TMJ ligaments purpose – limit the movement of mandible, helps open mandible, helps
closes mandible
QUESTION: Which muscle mainly responsible for positioning and translating condyles? Lateral
pterygoids
QUESTION: Stress causes immune weakness which leads to disease and bruxism
QUESTION: How do you treat bruxism? Mouthguard
QUESTION: Occlusal guard-distribute occlusal force
QUESTION: Main function of the occusal guard:
• Distribute forces more evenly
• To relax the musculature
• Bruxism
Erythema Multiforme:
QUESTION: Target lesions? Erythema Multiforme (also has positive nikolsky sign)
QUESTION: Steven-Johnson syndrome? conjuctiva, and genital problems
Pemphigus:
QUESTION: A patient has painful lesions on her buccal mucosa. A biopsy reveals acantholysis and a
suprabasilar vesicle. Which of the following represents the MOST likely diagnosis?
A. Pemphigus
B. Psoriasis
C. Erythema multiforme
D. Bullous lichen planus
E.Systemic lupus erythematosus
QUESTION: intraepithelial-pemphigus
QUESTION: immunofluorescence of antibodies , Pemphigus intraepithelial , demosomas.

Pemhigoid and pemphigus: which one comes apart from Connective Tissue
Actinolysys is present in pemphigus
If antibody is linear… pemphigoid
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If antibody is fishnet… pemphigus
QUESTION: immunofluoresence used for dx of

a. pemphigus
b. LP
vulgaris because—less severe and HISTO: vesicales are SUBepidermal and NO acanthylosis.
Pemphigus--**autoimmune disorder where there is acanthylosis, tzanck cells. Antibodies are directed
against the epithelium. Target the desmosomal Dsg3 and cause sloughing. Nikolsky’s sign is when the
epithelium can just be rubbed off of an unaffected area—HISTO: vesicles are suprabasilar and there is
presence of acanthylosis
QUESTION: Pic that looked like herpangia in back of palate- qusion stated there are nikoski signs what
is it- I wrote herpangia... but pemphigus was also a choice (Erythema multiform and pemphigus vulgaris
both show Nikolsky sign
QUESTION: White film w/ pos nikolsky-pemphigus tx w incisional biopsy
QUESTION: Blow cold air on mucosa causing a positive Nikosky sign a) erythema multiformb) herpes
c) phemphigoid NO PEMPHIGUS AS ANS CHOICE. eipdermolysis bullosa IS THE ANSW (maybe
erythema mutiforme)
INFO: In Pemphigus this disease, patients have autoantibodies against desmogleins, which are part of
the spot desmosomes
Types: Most commonly Vulgaris
INFO: In Pemphigoid, the antibodies are directed against hemidesmosomes
Types of Pemphigoid (Bullous -Rarely affect mouth), Blisters of skin
Cicatrical-- Affects mucous lining, MOUTH
1. nikolski sign: pemphigus
2. basement separation between ET: pemphigus
Scleroderma:
QUESTION: Widening of PDL and loss of ramus of mandible: Scleroderma
QUESTION: scleroderma: symmetrical widening of PDL and deposition of collogen in organs leads
to failure
QUESTION: CREST Syndrome=SCLERODERMA . connective tissue disease of skin, blood vessels,

muscles, and internal organs. autoimmune disorder. Blue fingers, Hair loss Skin hardness Skin that
is abnormally dark or light
Geographic tongue:
QUESTION: Picture of fissured tongue

QUESTION: Description of geographic tongue
QUESTION: Guy with lesions on his tongue that seem to move locations --> erythema migrans
(geographic tongue)
QUESTION: burning sensation on tongue,, moves around: geographic tongue
QUESTION: cause of geographic tongue: unk
a. ulceration of mucosa
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QUESTION: Xray – Erythema migrans
QUESTION: Migratory glossitis picture

QUESTION: red whiteborder path-migratory glossitis.
QUESTION: Lesion hurts after eating spicy food, has white lesions with red borders that move
Geographic tongue
Aspirin Burn:
QUESTION: aspirin burn is due to:  coagulation necrosis.

Basal Cell Carcinoma:
QUESTION: Oral path picture of Basal Cell carcinoma. – round bluish lesion on side of lip
QUESTION: Painless ulcer, upper lip, it grew bigger after 2 weeks - Basal cell carcinoma
QUESTION: Picture of basal cell carcinoma on patient’s face
QUESTION: a picture of basal cell or kerato ancathoma ......on the face crater like with a crust in the
middle **remember keratoacanthoma has a bump with a crusty crater in the middle, but BCC can be
pink, waxy/pearly, or skin colored or brownish. BCC is more reddish/can be flat while keratoacanthoma
has a crust and looks really gross
Mucocele:
Mucocele: Caused by ruptured salivary duct, Usually due to trauma, Seen on the lower lip
NEVER ON GINGIVA
QUESTION: Most common location for mucocele? Lower lip

QUESTION: Mucocele most likely is on the Lower lip!
QUESTION: Patient had SSC removed and now has a mucocele looking lesion on the lower lip what is it?
I wrote mucocele, other choices fibroma, SSC
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QUESTION: You get mucocele due to? - rupture of salivary ducts (trauma related)
QUESTION: Mucocele, what causes it clinical term that refers to two related phenomena: mucus
extravasation phenomenon, and mucus retention cyst. The former is a swelling of connective
tissue consisting of collected mucin due to a ruptured salivary gland duct usually caused by local
trauma, in the case of mucus extravasation phenomenon, and an obstructed or ruptured salivary
duct (Parotid duct) in the case of a mucus retention cyst
QUESTION: most common site for mucous retention cyst? Lip
Ranula:
QUESTION: Ranula: blue mass under tongue
Blue nodule floor of mouth, fluctuant..ranula
QUESTION: Lady presents w/ blue swelling under tongue? I put ranula
QUESTION: ranula due to –mucus plug
sialolith
mucus plug
trauma
fibrous plug
QUESTION: Trauma to floor of mouth
• Mucocele
• Submandibular hemangioma
• Ranula
QUESTION: How do you treat a ranula? excise (all of it)
QUESTION: ranula treatment: excision of sublingual gland
QUESTION: Ranula txt…Excisional, incisional, or aspiration
Texture/consistency of dermoid cyst vs ranula

dermoid is doughy/rubbery consistency
ranula is more fluctuant, bluish
QUESTION: Sialolithiasis is found where? - submand duct (wharton’s)
QUESTION: Sialolithiasis (calcified salivary stone) is found where? REPEAT question - submand duct
QUESTION: Sialoliths most commonly associated with submandibular gland

QUESTION: Sialoliths most common in what gland: Submandibular gland and duct
QUESTION: Some histology question about the paratoid gland. Mentions “SAUSAGE LINKS”: Answer
is Sialodochitis
QUESTION: Gland most frequently involved in Sialolithiasis? Parotid? Small glands? SM? SL?
QUESTION: Parotid gland – chronic sialodochitosis

QUESTION: Most probable cause of swelling of the upper lip? Sialolithiasis? Mucous plug?
QUESTION: Pt with sialadenitis (actini enlarge) caused by sialith in the duct
• Procedure: No removal of the gland
• Non sx therapy
• Attempt removal non sx (supposed to give moist heat, or citrus foods to encourage
dislodgment…wiki…Xtina)
• Intra oral sx
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QUESTION: How do u tx painful Sialolith in whartons duct….. initially?
Moist heat
Dilation of duct
Surgically remove sublingual gland
Surgically remove submand gland (cannulate the duct and remove stone)
(massage or lemon drops not an option)
(If it is a smaller stone…moist heat is the first option…wiki…Xtina)
QUESTION: tx for large sialolith near orifice of Wharton’s duct
a. transoral to unblock duct
b. extraoral to remove gland
c. cannulation & dilation---***?? Canulate the duct (sialotomy) to remove stone
QUESTION: mucous retention cyst
Antral Pseudocyst (mucous retention pseudocyst):
QUESTION: something in maxilla - muco-retention cyst?? Antral pseudocyst?

QUESTION: Pic of inverted Y xray (antral y??)
QUESTION: Antral Y (they also called it an “inverted Y”)
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QUESTION: Radiograph 6 arrows - inverted Y – floor of nasal fossa
QUESTION: What is the inverted Y made up of? Maxillary sinus/floor of nasal cavity
QUESTION: what is the isthmus of Y (where nasal floor (straight radiopaque line) and maxillary sinus
(curved radiopaque line) start and meet). What are the two anatomical factors that border this?
Floor of nasal cavity and maxillary sinus
QUESTION: radiograph of earlobe and turbinate: inferior nasal turbinate or mucous retention cyst
or antral pseudocyst
QUESTION: Radiographs of the ear lube, mucous retention cyst aka antral pseudocyst in maxillary
sinus
QUESTION: Huge PA radioopacity in maxillary sinus – mucus retention cyst
QUESTION: diffuse but distinct radiopacities in max sinus: mucous retention pseudocyst made
sense, others were sinusitis and something else
QUESTION: something radiolucent in the entire sinus with was sinusitis. was not Mucous retention
cyst
QUESTION: What is this lesion seen in patient’s right maxilla (pano picture)? – Mucoretention cyst.
QUESTION: photo of maxillary sinus with radiopacity in one of the sinus and you have to identify
the condition: mucous retention cyst- antral cyst
QUESTION: antral pseydocyst
Ankyloglossia:
QUESTION: Ankylglossitis- tongue tied!!
Dentigerous Cyst:
QUESTION: which can become ameloblastomic ?? dentigerous cyst, lymphedema, epidermoid,
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QUESTION: Radiographic picture: upside down molar with lucency around crown-what is it? Dentigerous
cyst
STARTS AT CEJ
QUESTION: Which cyst is most likely to become neoplastic?
a. dentigerous
b. residual
c. radicular
Varicies:
QUESTION: Varicosities in ventral tongue in – elderly
QUESTION: What causes varices on the tongue? I put hyperthyroidism HYPERTENSION

QUESTION: bilateral asymptomatic blue stuff under tongue
a. hemangioma
b. varices
Parulis (gum boil):
QUESTION: picture #30 endo txed…parulis….
QUESTION: Photo ID: Parulis
QUESTION: Reason for parilis- incomplete root canal (redue root canal)
Tuberculosis:
QUESTION: Oral signs of tuberculosis- cervical lymph nodes, larynx, and middle ear. Oral lesions of
TB are uncommon- usually chronic painless ulcers. Secondary lesions on tongue, palate and lip.
Primary lesions usually enlarged lymph nodes. Rare is leukoplakic areas.
QUESTION: What does tuberculosis lesion in the oral cavity look like? large ulcer
The most frequently affected sites were the tongue base and gingiva. The oral lesions took the
form of an irregular ulceration or a discrete granular mass.
QUESTION: What does tuberculosis lesion in the oral cavity look like? large ulcer (Painful nonhealing
indurated often multiple ulcers)
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Extravasated Blood:
QUESTION: Hemangioma excised from tongue. Which is it? Choristoma, hamartoma, teratoma
QUESTION: 4 yr old kid has hemangioma on his tongue from when he grew. It grew at the same rate he
did. chroistoma, hamartoma, teratoma
HAMARTOMA- Normal tissue overgrowth
CHORISTOMA- TISSUE overgrowth in Wrong location
QUESTION: patient has had a hemangioma on tongue since birth, it grows at the same rate as the tongue.
Hamartoma, teratoma, etc….hamartoma grows at the same rate as the surrounding tissues
QUESTION: What goes away from mouth by itself- eccymosis
Allergic Mucositis:
QUESTION: Allergic Stomatitis of the mouth is commonly seen because of the: flavors in a
toothpaste: Cinnamon
QUESTION: Allergic gingivitis caused most by- toothpaste flavor(cinnamon)

QUESTION: cause of allergic gingivitis
a. flavoring in toothpaste---?
b. food coloring in foods
c. Fluoride in toothpaste
QUESTION: Patient has red gums and is told she has “plasma cell gingivitis”. Common cuase is?
I put cinnamon flavoring in the dentrifice
QUESTION: Plasma cell gingivitis- cinnamon!!
Crohn’s Disease:
QUESTION: Child with granulomatous gingiva and bleeding rectal-anus has what?
•Crohn’s
QUESTION: Oral granulomas, apthous ulcer, rectal bleeding is seen in…
a. Wegeners granulomatosis
b. ulcerative colitis
c. crohn’s disease
QUESTION: Crohns – granulomatous gingival hypertrophy
QUESTION: Couple questions on crohns disease and mouth- I think one of the questions mentioned
something about ulcerations in the rectum (that’s right we are going to be dentist and checking peoples
buttholes out for our differential diagnosis!)mouth ulcers and swollen gums!!
Dermoid Cyst:
QUESTION: Which would be located in the floor of the mouth and be “doughy”?
A Ranula, this is what I put but could be B or C not sure
B. Dermoid cyst DOUGHY
C Lymphoepithelial cyst **
Multiple Endocrine Neoplasia Syndrome
QUESTION: MEN- adrenal over production
Nasopalatine Cyst:
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QUESTION: most common nonodontogenic cyst
nasopalatine duct cyst
a. dermoid
b. thyroglossal
c. lymphoepithelial
QUESTION: Nasopalatine X-ray- heart shaped central
QUESTION: Nasopalatine cyst tx- enucleation

QUESTION: Pic of nasopalatine canal
Intraoral picture of nasopalatine cyst by incisive papilla on backside of 7 and 8. The foramen and
nasopalatine canal is where the incisive papilla is and if theres a cyst there then what does it look
like clinically? Soft tissue is swelling and discolored.
QUESTION: The clinical radiograph and picture didn’t match up. The clinical pictures were taken after
the radiographs so it could have developed afterwards and there was fineprint that this was written and
not for other cases so it was a trick and it was a nasopalatine cyst probably…
White sponge nevus:
QUESTION: leukoplakia that you can’t wipe off…I put white sponge nevus.
QUESTION: White on movable mucosa- leukoplakia or white sponge nevus
QUESTION: Patient has bilateral white lines @ occlusal plane, what is primary microscopic
finding? White Spongy Nevus
QUESTION: White stuff under tongue what is it not? White sponge nevus
Picture of something white. Said it was not wipeable/stretchable.
a. Lichen planus or
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b. White sponge nevus.
QUESTION: White lesion, cannot be scaped away, picture: leukoplakia is not there in the options
QUESTION: Pic- white sponge nevus *white sponge nevus usually presents bilaterally/symmetrically. It
usually appears before puberty. Often mistaken for Leukoplakia. /// Leukoplakia differs in that it presents
later on in life.
It presents itself in the mouth, most frequently as a thick bilateral white plaque with a spongy
texture, usually on the buccal mucosa, but sometimes on the labial mucosa, alveolar ridge or floor of
the mouth. The gingival margin and dorsum of the tongue are almost never affected.
QUESTION: Buccal cheek of 60 yrs man, not wipe-able? leukoplakia( more on floor 50%,
tounge25%), candida, white spongy nevous bilatral- autosomal dominant
Trigeminal Neuralgia:
QUESTION: Patient feels pain on biting and feeling of fullness in maxillary posterior teeth, why?
sinusitis, atypical trigeminal neuralgia,
QUESTION: ***Maxillary sinusitis bacteria: Strep pnuemoniae
 Drug for max sinusitis: Amox with clavulnic acid (for b-lactamase strep)
QUESTION: Which of the following is most likely to be interpreted as toothache by Pt?
maxillary sinusitis can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache)
tmj dysfunction
otitis media
QUESTION: lady, pain, hurts at night, can’t find pain:

-trigeminal neuralgia
-something about mandibular teeth intruded
QUESTION: A fews qs on trigeminal neuralgia. Affects what age group? What type of pain?
Age: The average age of pain onset in trigeminal neuralgia typically is sixth decade of life, but
it may occur at any age. Symptomatic or secondary trigeminal neuralgia tends to occur in
younger patients. >35 years
Nature of pain: Pain is stabbing or electric shock like sensation and is typically quite
severe. Pain is brief (few seconds to one to two minutes) and paroxysmal, but it may
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occur in volleys of multiple attacks. Pain may occur several times a day; patients typically
experience no pain between episodes.
Distribution of pain: Pain is one-sided (unilateral, rarely bilateral). One or more

branches of the trigeminal nerve (usually lower or midface) are involved.
QUESTION: Carbamazapine - Tx trigeminal neuralgia

QUESTION: Carbamazepine:used for Trigeminal Neuralgia, Do not use to treat constant, fascial pain.
Use NSAIDS
Actinic Cheilitis:
QUESTION: Actinic chelitis---> SCC
QUESTION: Symptoms of actinic cheilitis? Loss of vermillion border
QUESTION: How do you treat actinic cheilitis? According to wiki, its 5-fluorouracil or imquimide,
but im not sure if those were even answer choices
QUESTION: Actinic Chelitis: lower lip shows epithelial atriohy and focal keratosis  same as
Actinic Keratosis
QUESTION: Which of the following lesions has the greatest malignant potential?
A. Leukoedema
B. Lichen planus
C. Actinic cheilitis
Post-Development Loss of Tooth Structure:

Attrition is wearing away from natural dentition
QUESTION: All of the following cause xerostomia except?

a. caries,
b. candidiasis
c. dental attrition
QUESTION: Xerostoma causes the following except:
o Caries
o …
o Attrition
QUESTION: Most attrition of an enamel against what? (porcelain not an option in the answer)
a) Enamel
b) Amalgam
c) Hybrid resin
d) Microfill resin
QUESTION: attrition or bruxing on mand anteriors (posterior looked fine)
QUESTION: All of the following reasons to restore erosion lesion except one, which one?
a. prevent future erosion
b. reduced sensitivity
c. esthetic
QUESTION: Erosion? Chemical & Bulimia.
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QUESTION: Bulimia and gastric reflux cause...erosion
QUESTION: Type of wear from gastric acids: erosion
QUESTION: Erosion- chemical wearing of tooth (gerd)

QUESTION: Which one is chemical cause of tooth destruction: Erosion
QUESTION: chemical wear of tooth : erosion
QUESTION: Abfraction: if not too deep don’t touch it. If deeper, fill with glass ionomer cement?
Compomers
QUESTION: Abfraction: flexure of tooth
CEMENTO-OSSEOUS DYSPLASIA:
Know Cemento-osseous dysplasia aka CEMENTOMA:
• Usually 30-50 years old, African-American Female
• Mandibular anterior VITAL teeth
• Asymptomatic periapical radiolucencies which transform to radiopacities
• No treatment required
QUESTION: Cementoma (periapical cemental dysplasia)-usually occurs in the anterior region of
the mandible, starting as a radiolucent lesion that eventually calcifies. Cementoma DOES NOT
affect pulp vitality. Asymptomatic= no bone expansion. Periapical cemental dysplasia; periapical
osseous dysplasia)
QUESTION: Periapical cemento-osseous dysplasia….on a radiograph, anterior mandible, black women
***REACTIVE; vital teeth, radiolucencies around apices of mand incisors—usually!!!! Ck
QUESTION: X-Ray: Black women, middle aged , anterior radioluceny (can be radio opaque):
cemento osseous dysplasia, periapical cemental dysplasia
QUESTION: Radiographic Picture: lower mand incisors, slight radiolucency-kind of smeared together-
what is the lesion—cemento-osseous dysplasia
QUESTION: Most common place for periapical cemental dysplasia : Lower anteriors
QUESTION: Black woman, middle aged, case Q’: osseous cemental dysplasia.
QUESTION: Most common site for cementoosseous dysplasiamand ant vital teeth, no pain or
expansion, multifocal periapical lucencies which mature over time and become mixed then finally
opaque.
anterior mandible
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Periapical cemento-osseous dysplasia
QUESTION: Tooth with normal PDL, totally vital, tissues normal, but radio-opaque lesion @
apex? periapical cemento-osseous dysplasia
QUESTION: cemento-osseous dysplasia – pic, but don’t forget lower anterior, black female.
Florid Cemento-osseous Dysplasia:

Florid Black females vital all four Quads: Florid Cemento-Osseous Dysplasia
Focal White females vital edentoulous one lesion: Focal Cemento-Osseous Dysplasia
• 30-50 white female
• Posterior mand / asymptomatic solitary lesion
Lichen Planus:
QUESTION: Histologically, the loss of the rete peg often is a sign of?
a. pemphigus
b. lichen planus
c. pemphigoid
d. syphills
pemphigoid
QUESTION: Lichen planus discription
QUESTION: Lichen plannus: Target T lymphocyte
1. Lichen planus
a. Mucocutaneous disease
b. T lymphocytes target (destroy) basal keratinocytes, (reason unknown)
c. Hyperkeratosis, lymphocyte infiltrate at the epithelial CT interface
d. Basal zone vacuolation due to basal keratinocyte destruction
e. Epithelium may exhibit a “saw tooth” pattern
f. Bilateral on buccal mucosa***
g. Reticular type: interlacing lines (wickhams striae)
h. Tx: corticosteroids
QUESTION: Pic of 55 yo woman with erosion: lichen planus
QUESTION: Lichen planus most commonly found on buccal mucosa

QUESTION: Lichen planus more common in women
QUESTION: Erosive lichen planus – gingival is magenta to bright red

QUESTION: Lichen planus, what do you treat with? Choices (don’t remember the specific names)
were antifungal, antiviral, etc. so know the etiology of each pathology, many pharm questions are
simple, but it’s just that I couldn’t remember etiology of certain diseases. TOPICAL
CORTICOSTEROIDS OR ANTIHISTIMINE
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Peripheral Ossifying Fibroma:
QUESTION: Which of the following reactive lesions of the gingival tissue reveals bone formation
microscopically? Peripheral ossifying fibroma
Cleidocranial Dysplasia:
QUESTION: What is the most significant finding in cleidocranial dysplasias: odontomas, supernumery
teeth, sparse hair, multiple impacted teeth
QUESTION: Cleidocrainal dysplasis - supernumerary tooth
QUESTION: Cleidocrainal dysplasis – retained teeth, REPEATED AGAIN

QUESTION: Cleidocranial dysplasia- over retained primary teeth
QUESTION: Cleidocranial: can your shoulders touch? Absence of teeth, also has supernumerary
QUESTION: Cleidocranial dysplasia? Disease of the bones of the skull and clavicles. Short, big head,
shoulders move in, high palate, retention of primary teeth, and supernumerary teeth.
QUESTION: Cleidocranial dysplasia- no clavicals
QUESTION: Cleidocranial syndrome: x ray with absence of clavicle
QUESTION: Heridatary / hypoplastic clavicle? cleidocranial dysplasia
  Cleidocranial dysplasia
o Autosomal dominant
o Delayed tooth eruption, supernumerary teeth, hypoplastic or aplastic clavicles,
cranial bossing, hypertelorism
QUESTION: Which will give you very narrow facial structures and delayed eruption of permanent teeth?
• *cleidocranial syndrome
• downs syndrome
QUESTION: questions on cleidocranial dysplasia : Multiple supernumerary teeth, prognathic jaw-
class III, delayed eruption, fontanelle failed to close
QUESTION: Many questions (5) on Cleidocranial dysplasia: Multiple unerupted supernumerary

teeth, Retention of primary teeth, delayed eruption of permanent teeth, Missing clavicle
QUESTION: Head distortion at birth? Fontanelles

QUESTION: What allows for compression of skull during birth? Fontanelles -_-
QUESTION: What is the part of the infants head that allows it to change shape?
• Fontanelles (enable the bony plates of the skull to flex…according to wiki…not sure if it would be
the correct answer but I guess…Xtina)
a. Fontanelles
QUESTION: Which structures in a baby allow the head to deform in the birth canal? I put
fontanelles
QUESTION: Fontanelas close anterior-12-18months, posterior 3-4 months
QUESTION: Fontanelles, child skull, close by age 2
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Neurofibromatosis (Von Recklinghausen):
QUESTION: Clinical picture with nodules & café laut spots: neurofibromatosis
QUESTION: Neurofibromatosis ? café au lait spots.
QUESTION: Café-Au-Lait – Neurofibromatosis **Von Recklinh..disease—neural tumors… all these
bumps all over it’s disgusting. (Remember that McCune Albright Syndrome – Polyostoic FIBROUS
DYSPLASIA also has café au lait spots---fibrous bone replaces normal bone…Liche nodules, café aulet
spots-Neurofibromatosis
QUESTION: An adult patient presents with multiple, soft nodules and with macular pigmentation of the
skin. Which of the following BEST represents this condition?
lipomatosis
b. neurofibromatosis
c. metastatic malignant melanoma
d. polyostotic fibrous dysplasia
e. bifid rib-basal cell carcinoma syndrome
QUESTION: which of these have supernumerary teeth, lisch nodule on iris, ____
• neurofibromatosis
QUESTION: Neurofibromatosis clinical presentations: Café au lait, lisch nodules, neurofibromas
Calcifying Odontogenic Cyst/Gorlin Cyst:

QUESTION: “Ghost cells”: keratinized calcifycing odontogenic cyst
Auriculotemporal Syndrome/Frey’s Syndrome:

QUESTION: Pt has problems on one side of their face when they eat, they recently had parotid surgery,
also had to do with something with their nerve
A. Papillon Leferve
B. Frey’s Syndrome* --strong salivation
QUESTION: Freys syndrome**symptom where you sweat near cheek area when eating. Usually after
parotid surgery.
QUESTION: Patient had portid surgery now sweats before he eats only on one side this is due to what? I
wrote Freys syndrome (whatever it is the guy needs serious help and should not be in my office!)
QUESTION: Injure arteritemporal nerve-sweating out of parotid (auriculotemporal syndrome)
QUESTION: frey’s syndrome – parotid gland
QUESTION: Auriculotemporal nerve is severed, what are symptoms? gustatory sweating,
Actinomycosis:
QUESTION: Actinomycosis of jaw presents how? Lumpy Jaw
QUESTION: Actinomycosis has pus, antibiotics
• Abscess, Draining fistula, contains yellow sulfur granules
• I&D + antibiotics
QUESTION: Which dz is most likely to cause suppuration?
A: Actinomycosis
Condylar Hyperplasia:
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QUESTION: A patient presents with malocclusion and a unilateral, slowly progressing elongation of her
face. This elongation has caused her chin to deviate away from the affected side. The MOST probable
diagnosis is which of the following?
A. Ankylosis
B. Osteoarthritis
C. Myofascial pain
D. Condylar hyperplasia
Dens Invaginatus:
QUESTION: Dens in dente: Most common seen in max lateral incisor
QUESTION: Talon cusp is for? dent evagenatus, NOT invagenalis
 Evangelicals believe in Eagles ( Talons)
Epulis Fissuratum:
Keratoacanthoma:
QUESTION: Lesion looks like squamous cells: Keratoacanthoma
QUESTION: Keratosis happen where in the mouth?
a. palate
b. buccal mucosa
c. floor of mouth
d. upper lip
Warthin Tumor:
QUESTION: Warthin tumor most common in what gland: Parotid (don’t get mixed up with whartons
duct)
Stafne Defect (salivary gland depression defect)

QUESTION: Radiograph of mandibular gland depression. 1. Stafne defect (answer)
QUESTION: A picture of stafne's defect, but there was no stafne answer - submandibular fossa defect
(this is what I wrote)
QUESTION: very well defined round radiolucency in panoramic, posterior mandible below inferior
alveolar canal – static bone cyst (stafne defect)
QUESTION: ID salivary bone cyst (another name for stafne bone cyst) on PAN
QUESTION: Pan of jaw…lucent lesion…salivary gland inclusion…

QUESTION: Xray of Stafne defect (only option was salivary inclusion defect)
QUESTION: Stafne defect: salivary inclusion
SjÖgren’s Syndrome:
QUESTION: Complications of Sjogrens syndrome –features of (Stevenson sth) Answer was with
keratoconjunctivitis it involes the genitalia too.
QUESTION: Sjogrens – autoimmune destroy glands
QUESTION: Sjogren’s syndrome: destruction of salivary and tear ducts dry mouth
QUESTION: Sjogrens Synd associated with all EXCEPT
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Herpes
Keratoconjunctivitis
SLE
QUESTION: what is most common with sjogrens? lymphoma (or maybe lipoma or some other
growth)pleomorphic adenoma, increased sweating and osteoarthritis.
QUESTION: Which articular disease most often accompanies Sjö gren’s syndrome?
A. Suppurative arthritis.
B. Rheumatoid arthritis.
C. Degenerative arthrosis.
D. Psoriatic arthritis.
E. Lupus arthritis.
QUESTION: xerostomia is present in all of the following except? Options were : Sjogrens syndrome, Vit
C. Defenciency (Other parotid problems) Xerostomia is rarely due to a vitamin deficiency
QUESTION: Sjogren syndrome? Laboratory test: SS-A / SS-B (also ANA or Rheumatoid factor)
QUESTION: Secondary Sjogren Syndrome: dry eye, dry mouth, Rheumatoid Arthritis
QUESTION: Which of these are used in lab test for sjogren,? ANA
 Typical Sjögren's syndrome ANA patterns are SSA/Ro and SSB/La
Sarcoidosis:
abnormal collections of inflammatory cells (granulomas) that can form as nodules
QUESTION: Treatment of sarcoidosis? Corticosteroids, antibiotics...
QUESTION: TB is similar to? Sarcoidosis
QUESTION: question on sarcoidosis? Know that it is granulomatous
QUESTION: Sarcoidsis commonly involved organ: lungs
QUESTION: Sarcoidosis is mainly related to which organ? predominately a pulmonary disease
QUESTION: ***Girl with caries into the pulp on tooth #3 – radiograph shows alternating RL/path at
inferior border of mandible (a.k.a “onion skin”, bacterial)Garre’s Osteomyelitis aka chronic
osteomyelitis
QUESTION: Garre's (prolifrative periostitis) and Ewing sarcoma are both onion skin
Peutz-Jeghers Syndrome:
QUESTION: Peutz Jeghers and Pierre showed up on my exam. They gave only description and you
had to diagnose.
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QUESTION: Peutz Jeger syndrome ? Not cafe au lait, but freckles on lips.
QUESTION: Peutz-Jeghers syndrome – multiple menanotic macules and gastrointestinal polyposis
QUESTION: Peut-jeghers syndrome : intra oral melanin pigmentation also intestinal polyps
Osteosarcoma:
QUESTION: Widening of pdl is early sign of what? Osteosarcoma!
QUESTION: most common primary malignant tumor of young people-osteosarcoma
QUESTION: osteosarcoma in x ray : sun burst and simetrical widening of pdl.
QUESTION: Enlarge PDL and radiolucency at mandibular angle? A. Osteosarcoma sunburst
QUESTION: Osteosarcoma: causes early lesion of PDL widening (Symmetric widening of the
periodontal ligament space is an early radiographic sign of osteosarcoma)
QUESTION: Uniform wdining of PDL and there is resorbtion in the bone : osteosarcoma, fibrous
dysplasia
QUESTION: osteosarcoma in x ray : SYMMETRICALLY WIDENED PDL SPACE, SUN-
RAYAPPEARANCE
QUESTION: Patient has paresthesia and grows in mandible: is going to be osteosarcoma (young
patient)
Osteoporosis/Osteopetrosis:
QUESTION: Which one is NOT RO? (choice: osteopetrosis – marble bone, extremely rare; osteoporosis,
pagets – cotton wool)
Multple Myeloma:
QUESTION: Multiple Myeloma: Punched out lesions.
QUESTION: Considerations for multiple myeloma
QUESTION: first sign of multiple myeloma : bone pain ( in limbs and thoracic region)
QUESTION: first sign of multiple myeloma: bone pain ( in limbs and thoracic region)
QUESTION: multiple myeloma -> plasma cell
QUESTION: Multiple myeloma appearance? punched out lesion
  multiple myeloma/plasma cell myeloma

o monoclonal neoplastic expansion of immunoglobulin secreting B cells
o multiple punched out bone lucencies
o high M protein in serum
o bence jones protein in urine (light chains)
o tx: chemo poor prognosis
Necrotizing Sialometaplasia
QUESTION: Know necrotizing sialometaplasia….painless ulcer on hard palate…goes away on its own.
Heals without scarring
Odontongenic Myxoma:
QUESTION: Pic of Myxoma pt. Usually in post. mandible, no symptoms, moves teeth, **cortical
explansion and root displacement, always radiolucent and honeycombed pattern!!!!!
QUESTION: soap bubble lesion in xray , what is it, there was no cherubisum ????? Giant cell
Odontogenic Myxoma , often seen with impacted tooth
*Soap bubble lesion= odontogenic myxoma
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QUESTION: Picture of Odontogenic Myxoma: Soups bubbles.
QUESTION: Odontogenic myxoma
Radiology:
QUESTION: When there is no barrier, protection of dentist: 6 feet, 90-135 degrees
QUESTION: most of the x-ray is converted to? heat
QUESTION: most of the x-ray is converted to: heat
QUESTION: what is the oil in the x ray tube for : dissipate the heat ( cooling)
QUESTION: why oil in x-ray tube: heat: cools off the anode
QUESTION: purpose of oil in x-ray tube housing: prevent rust, reduce radiation, dissipate heat
to the target, lubricate
QUESTION: Something about what is best x-ray: short wavelength, high energy
QUESTION: What is primary source of radiation to the operator when taking xrays: I said it was
radiation left in the air, other options were scatter from the patient, scatter from the walls,
leakage from the xray head.
QUESTION: In performing normal dental diagnostic procedures, the operator receives the greatest
hazard from which type of radiation?
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A. Direct primary-beam
B. Secondary and scatter
C. Gamma
QUESTION: Radiology-sievert dosage allowed in a year for dentist – 50msv
QUESTION: Max dose for dental personnel for radiation is? I put 50 Msv per year
QUESTION: Max radiation dose: 50 msv or 5 rem per year

Per month = 4msv, Per week = 1 msv
QUESTION: Collimation and what it does: reduces xray beam size and volume of irradiated
tissue, usually with circle diameter of 2.75 in
QUESTION: What does collimation do? Reduce area of exposure, remove scatter
QUESTION: Collimater function is all but- increase penetratability

QUESTION: collimnation in xrays - reduces low energy radiation
QUESTION: Collimation = block (lead)
QUESTION: collumnation in xrays – decreases the diameter of the beam
QUESTION: Collimator: reduces size of xray beam to reduce patient radiation
QUESTION: what the collimator does : reduce the 1)volume of tissue being irradiated and
2)reduce the amount of scatter radiation by 60%
QUESTION: what the collimator does : reduce the volume of tissue being irradiated and reduce the
amount of scatter radiation.
QUESTION: Collimation does everything except: reduce pt exposure, reduce operator exposure, film fog,
reduce average energy of xrays (energy is unchanged)
Scatter radiation decreases with change to rectangular collimator, film fog(scattered radiation that reaches
the film, unwanted darkness  decreased by collimation) decreases and image quality increases.
QUESTION: Collimating device on the x ray

• Except: prevents fogging
QUESTION: Collimation is?
The accurate adjustment of the line of sight of a telescope.
Control of size and shape of xray beam
QUESTION: By what % do you decrease radiation when you use a square collimator vs.
rectangular? 80%
QUESTION: How do you minimize exposure radiation – I remember one answer choice that I took
into account was minimizing the amount of tissue being radiated but that’s not what I selected
QUESTION: the use of intensifying screens --> reduce the radiation
QUESTION: Xray filters are used for? Reduces intensity of electron beam, selectively absorbs low
energy photons. LONG WAVELENGTH Inherent filtration=glass, oil. Total filtration=aluminum and
inherent filtration (from Gohel’s lecture)
QUESTION: filter absorbs….
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a. Long wavelength
b. “Filtration is a mechanism where the low quality, long wavelength xrays are
absorbed from the exiting beam. Alumnium disks absorb lower penetrating xrays.”
241 First Aide
QUESTION: X-ray tube target made out of: tungsten, lead copper
QUESTION: Target metal in xray: tungsten
QUESTION: Filament produces heat in the xray
QUESTION: which material is used as a filter in xray machines? Lead, aluminum, others
QUESTION: filtration = filter (aluminum)
QUESTION: Digital image: which is digital detector? Charge coupled device (pg132)
QUESTION: The greatest decrease in radiation to the patient/gonads can be achieved by…
a. change from D to F speed
b. thyroid collar
c. filtration
d. collimation
e. high doses low frequency
QUESTION: Which of the following safety techniques provides the GREATEST DECREASE in overall
radiation-risk to patients?
A. Changing from Group D to Group E film
B. Switching from round to rectangular collimation
C. Using an automatic rather than manual processing switch
D. Adding a cervical collar to a leaded apron
QUESTION: What happens when you don’t have proper vertical angulation when taking xrays – I
said it was elongation of the object other options were fuzzy pic (either resolution or contrast)
QUESTION: Change vertical angulation when taking a PA will cause what? Distortion?
Magnification? ELONGATION OR FORESHORTENING
QUESTION: Change in vertical angulation of the xray what happens—
o Distortion
o Increase- shorten if decrease- elongates
QUESTION: Vertical angulation  distortions

QUESTION: Excessive vertical angulation, distort (xrays)
QUESTION: change in vertical angulation in xray what happens? Distortion
QUESTION: xray with shortened teeth. Whats wrong? I put vertical angulation
QUESTION: If you take a PA and the tooth is foreshortened, why did it happen? I put because
the vertical angulation was too large
QUESTION: Foreshortening of roots caused by...excess vertical angulation
QUESTION: xray beam is perpendicular to the film, not to the tooth, = forshortening
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***Elongation & foreshortening occurs when there is excessive vertical angulation
Central ray needs to be perpendicular to film and object
Perpendicular to object but not film: elongation
Perpendicular to film but not object: foreshortening
QUESTION: Overlap on bitewings  horizontal angulation

QUESTION: BW Overlap? Horizontal angulation off.
QUESTION: horizontal movement of xray - leads to overlapping
QUESTION: if you horizontally angle in BW, you can get- overlap
QUESTION: xray with cone cut. Whats wrong? I put PID, other choices are horizontal, vertical, etc
MISALIGNED of XRAY TUBE HEAD, incorrect beam centering
QUESTION: Pano – max centrals look abnormally wide – has to do with position of pt head either too
back, forward
the patient is positioned too far backward, (Figure 2, position 3) the skin anterior to the tragus can
be felt immediately posterior to the head support. The further the patient is positioned backward in
the focal trough, the wider the images of the anterior teeth will become until they are so wide that
the outlines of the crowns of the teeth can hardly be discerned.
QUESTION: Something that causes teeth to look longer has to do with angulation – how much tilt up and
down
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If the head/chin position is too low the images of maxillary anterior teeth will appear elongated and the
mandibular anterior teeth will appear foreshortened.
If the head/chin position is too high (a lack of negative vertical angulation On the radiograph, the occlusal
plane of the teeth will then appear horizontal or, with a positive occlusal plane, as a "frown line."
QUESTION: Reversed occlusal plane on pano – chin raised too high

QUESTION: Pan has a reverse occlusal plane – patient head tilted too far upward
QUESTION: Know the positioning of panoramic films (why is there an error? ex: chin tilted to high/low,
etc.)
• CHIN UP = frown
• Chin down = steeper smile
QUESTION: Pano, with short upper roots? 1. Patient’s didn’t put tongue on the top of their mouth (correct
answer)
QUESTION: Fuzziness on outside of radiograph due to:

• Umbra
• Pneumbra
QUESTION: Pneumbra affected by all except:
• Moving x-ray tube
• Moving film
• X-ray dimensions/field/scatter
• Film-object distance (decrease)
• Reduction of film target distance
QUESTION: How does penumbra affect the contrast of an x-ray? Decrease in contrast
 Larger Penumbra—DECREASE contrast

 Larger penumbra = more unsharpness
QUESTION: Penumbra – how to prevent this in x-rays: decrease size of focal spot, increase
source-object distance, and reducing object-film distance (should be parallel), central ray
must be perpendicular to tooth, object and film, no movement.
QUESTION: how to reduce penumbra? Choices were moving object, decrease object/source
distance, decrease object/film distance
QUESTION: How do you prevent prenumbra?
o Should be produced from a point source to blurring of the edges of the image
o Strong beam to penetrate
o Xray should be parallel
QUESTION: What is pneumbra. it was in a qs and i had no idea what it was talking about pneumbra
 The area on the film that represents the image of a tooth is called the umbra, or complete
shadow. The area around the umbra is called the penumbra or partial shadow. The
penumbra is the zone of unsharpness along the edge of the image; the larger it is, the less
sharp the image will be. The diagram at right shows how the penumbra is formed. X-rays
from either extreme of the target, and from many points in between, pass through the edge
of the object and contribute to the penumbra.
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QUESTION: PA distortion answer according to an article online is 14% , there was answer choices
3-5% , 11-15%
QUESTION: Margin of error of PA daiograph - 3-5% (this is what I wrote)??
QUESTION: Pano distortion is : 25% but could range 10-30%
QUESTION: What does it look like on a pano when your patient moves during the pano? A vertical blur
line vs horizontal defect.
QUESTION: Big artifact in pano which was a ghost of a necklace.
QUESTION: tear drop shaped in max sinus - pterygomaxillary fissure
QUESTION: Earlobe on the pano was asked from yesterday.
QUESTION: MRI uses what electromagnetic wave? RADIOWAVES
QUESTION: BW placed vertically why? More alveolar bone

QUESTION: Vertical BWX are better than horizontal BWX because of what Doctor? – You see more
bone.
QUESTION: What cannot be seen with a PA? pterygoid hamulus, coronoid notch, mental foramen,
mand. Canal
QUESTION: What structure can you not see on a PA radiograph
-Hamular process Visible
-Mental Foramen Visible
-Coronoid process Visible
-Mandibular foramen
QUESTION: If you have lesion of maxillary sinus, what kind of radiograph do you take? 1. Waters
(answer)
QUESTION: Which is most important for diagnosis of maxillary sinus xray: occlusal, panaromic,
Waters- Water's view is best to evaluate orbital rim areas.
QUESTION: Which is most important to see the maxillary sinus xray: CT, occlusal, panaromic, MRI,
Waters
QUESTION: Best imaging for sinusitis or sinus infection: I put CT, but had occlusal radiograph, PA
radiograph, Panoramic. Know that sinuses are best viewed with Waters technique, but this was not
in answer choice neither was none of the above as a choice.
QUESTION: Source/object distance for lateral ceph: 5 feet, 6 feet, 15 cm, 60 cm

QUESTION: Xray taken from mesial of max 1st premolar, buccal root will be where? mesial, distal,
occlusal
QUESTION: Max sinus diagnostic tool: waters, towne, ap, pano
QUESTION: best way to diagnosis sinus problems: CBCT
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QUESTION: Same question but answer for that one was waters x-ray
QUESTION: best radiograph for max sinus problem – waters
QUESTION: Which picture is best for max sinus lesions? CT (no waters in the choices)
QUESTION: Which picture is best for max sinus AGAIN? Waters!
QUESTION: best radiograph for max sinus problem – waters (CT)
QUESTION: Which picture is best for max sinus lesions? Pano (no waters in the choices) (NO)-- CT
QUESTION: Which picture is best for max sinus AGAIN? Waters! (NO)—CT
QUESTION: Best diagnostic image for pathology in max sinus: waters, CT, MRI, periapical, pan?
a. CT
QUESTION: all types of x rays to diagnose or to see maxillary sinus ? Waters, panoramic, CT scan
QUESTION: Which radiograph would you use to view a fracture of the mandibular symphisis? Posterio-
Anterior also Mand occlusal works too. Lateral oblique for fractures in angle, body and ramus
QUESTION: They liked to ask intermaxillary suture a lot which comes up clear on radiograph and it looks
like a fracture (which is an answer choice), but its not. The decks are good enough.
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median palatal suture/intermaxillary suture
Nose vs lip line in radiograph
LIP LINE
QUESTION: best view for zygomatic arches: Pano
Zygomatic arch on radiograph
1. Coronoid process of the mandible. Begin at the right coronoid process. Examine for
coronoid hyperplasia. Tip of coronoid should not be more than 1cm above superior
border of zygomatic arch.
2. Sigmoid notch. Do not mistake a rarefied medial sigmoid depression for pathosis.
118
3. Mandibular condyle. Evaluate for erosions, remodeling, eburnation, subchondral cysts,
osteophyte formation which may signal arthritis.Less commonly, erosions may be
caused by neoplastic disease.
4. Subcondylar (condylar neck) region. Evaluate.
5. Ramus of the mandible. Evaluate.
6. Angle of the mandible. Evaluate.
7. Inferior border of the mandible. Evaluate #4 - 7 for cortical integrity. Rule out fractures.
Repeat steps 1 - 6 on the patient's left side.
8. Lingula. Evaluating the precise location in any individual patient assists in determination
of where to give inferior alveolar nerve block.
9. Inferior alveolar neurovascular bundle (mandibular canal). Follow from lingula to mental
foramen. In some patients the anterior extension which exits out the lingual foramen will
be visible. Evaluate relationship of impacted teeth to the canal. Evaluate general bone
quality and check for focal osseous defects.
10. Mastoid process. Evaluate structures on the left side of the maxilla first.
11. External auditory meatus. Evaluate.12 Glenoid fossa (temporal component of the TMJ).
Check for erosions, sclerosis, and other signs of arthritis.
12. Glenoid fossa (temporal component of the TMJ). Check for erosions, sclerosis, and
other signs of arthritis.
13. Articular eminence. Look for zygomatic air cell defect (ZACD).
14. Zygomatic arch. Do not mistake a wide zygomatico-temporal suture for a fracture. May
also contain ZACD in the posterior half of the arch.
15. Pterygoid plates. Evaluate.
16. Pterygomaxillary fissure. Check for cortical integrity to rule out neoplasia.
17. Orbit. Evaluate.
18. Inferior orbital rim. Check for cortical integrity to rule out fracture.
19. Infraorbital canal. The infra-orbital foramen should not be viewed if the patient was
properly positioned.
20. Nasal septum. Evaluate for septal deviation or perforation. Evaluate the nasal fossa for
polyps.
21. Inferior turbinate/soft tissue concha covering. Evaluate.
22. Medial wall of the maxillary sinus. Evaluate.
23. Inferior border of the maxillary sinus. Evaluate.
24. Posterolateral wall of the maxillary sinus. Evaluate the integrity of the sinus walls to rule
out developmental, inflammatory, traumatic or neoplastic processes. Examine the
content of the sinus for the degree of pneumatization. Check for antral pseudocysts,
chronic mucosal hypertrophy, polyposis, mucocele or neoplasia.
25. Malar process. Repeat 10 - 25 on the right side of the patient.
26. Hyoid bone. Evaluate.
27. Cervical vertebrae 1 - 4. Observe for osteophyte formation, loose bodies or other
evidence of osteoarthrosis. Remember the circular radiolucency in C2 is the transverse
foramen.
28. Epiglottis. Evaluate.
29. Soft tissues of the neck. Evaluate for a wide range of soft tissue calcifications.
30. Auricle (earlobe). Evaluate.
31. Styloid process. If elongated/ calcified stylo-hyoid ligament, rule out Eagle's syndrome.
32. Oropharyngeal airspace. Evaluate.
33. Nasal air. Evaluate.
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QUESTION: Look at pano picture on mosbys pg 141. I messed up on it but it was an arrow pointing
b/w posterior wall of maxilla and posterior wall of zygomatic process of maxilla: ans. Is
pterygomaxillary fissure
QUESTION: Identify the following on xray :External oblique ridge, genial tubricle, Stylo hyoid
ligament on xray
 External oblique: running down roots on mandibular molars
Genial Tubricle: radiopaque line under mandibular abteriors
Stylohyoid ligament:
QUESTION: Showed a pan, what is the round opacity under #24 and #25 … genial tubercles
120
nutrient canal, zygomatic process of maxilla, normal anatomy (I had lateral canal and I put that.
Other choices were all pathological findings)
QUESTION: Nutrient canals seen radiographically most common where? Mandibular incisors
121
Nutrient Canal
X-ray of nutrient canals in mandibular anterior
There was a x-ray pointing with arrow to the lower lingual anterior. The answer was nutritional
canal.
MAND. TORI
122
know the SLOB rule. Also know Vertical rule, which is same as SLOB but in a vertical dimension.
QUESTION: Digital X-rays less exposure from d-films to digital films. digital 50% less radiation
exposure (75% less radiation exposure)
QUESTION: Digital xray vs D speed film, numbers: 10, 30, 60 , I put 60. I forget what it was asking
QUESTION: Going from a d speed film to digital film whats the speed diference (speed increases)
Film Speed Group Speed Range (reciprocal

roentgens)
C 6-12
D (Kodak Ultraspeed) 12-24
E (Kodak Ektaspeed Plus) 24-48
F (Kodak Insight) 48-96
1. (is Digital speed equal or similar to F film?)
QUESTION: going from d speed film to digital film, speed is increased

QUESTION: By reducing film speed from D to E and still keeping film density the same what would you
need to change? Decrease Exposure time
D to E will reduce radiation by 30-40%
D to F will reduce radiation by 60%
F to digital reduce radiation by 40%
QUESTION: Latent period of xrays is time btw when you exposed patient and clinical reaction to
xray
QUESTION: In radiobiology, the "latent period" represents the period of time between
A. cell rest and cell mitosis.
B. the first and last dose in radiation therapy.
C. film exposure and image development.
D. radiation exposure and onset of symptoms.
QUESTION: Which electron shell has highest power? (f/d...outermost shell)
QUESTION: which electron level has the highest binding energy? N K L OR M

K is located closest to the nucleus highest energy
QUESTION: Radiographic Picture: looked washed out, no contrast, what was adjusted?
• Decrease kvp
• Increase kvp
• Increase time
• Less developing solution
QUESTION: what was the problem of x ray that appears too white: incorrect distance from target to
film distance, low mA and low density.
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QUESTION: what was the problem of x ray that appears to white : incorrect distance from target to
QUESTION: light films (underexposed/image not dense enough): due to incorrect milliamperage
(too low) or exposure (too short), incorrect focal-film distance, or cone too far from the patient's
face, or film is placed backwards.
QUESTION: If xray is too dark : It was too long in developer solution
QUESTION: Dark films (overexposed/image too dense): due to incorrect milliamperage (too high),
exposure (too long), incorrect kVp (too high).
QUESTION: You take an xray at a certain mA, KvP and exposure time is 8 seconds when the
beam is 10 inches away. What if everything were the same except the beam was 20 inches
away? I put quadruple the exposure time
QUESTION: You increase the distance of the tube by 2 times the length, how much does the xray
exposure decrease – I said by 4
QUESTION: I aka intensity inversely proportional to 1/D2: -if increase distance by 2- intensity is
decreased by 4
QUESTION: If change from 8mm cone to 16mm how much exposure time do u need to increase by?
2.4.6.8? **inverse square law—going from 8  16 = double distance 2r  1/22 = ¼ radiation exiting so
increase exposure by 4!!!! Another example, if you go from 8  24 = triple distance 3r  1/9 radiation
leaks so increase exposure by 9!!! Remember that going from an 8 mm to 16 mm cone means the
cone/target is LONGER. This is the PID (target to film distance). If the PID is increased there is LESS
magnification. If the PID is shorter there is MORE magnification. Also density increases when kA, mA
and exposure are increased. That means the xray looks darker
QUESTION: By what factor would you increase kVp if the doctor doubles the distance. It’s a factor of 4
since its squared distance.
QUESTION: Increase BID distance from 8 to 16, exposure time change from 0.5sec to? .25, 1, 2, 3......
with parallaling technique ….....
QUESTION: The x-ray of an interproximal underestimates the size of the actual crater (other is
overestimates and is same size)
QUESTION: How do you increase the average energy of the beam – kvp versus ma
QUESTION: If developer is used up, what will happen?—lighter picture

QUESTION: Deterministic radiology effects: increases effect with dosage-direct effect
QUESTION: The severity of response increases with the amount of X-ray exposure. This effect is called:
�Deterministic, Stochastic, Genetic
QUESTION: Radiation injury from – free radical formation from indirect, free radical from direct
QUESTION: How do you minimize exposure radiation? minimizing the amount of tissue being
radiated
QUESTION: which type of radiation is constantly in effect: Inhaled radon radiation, not terrestrial or
cosmic
QUESTION: Most radiation from nature – inhaling radon internal, terrestial, cosmic
QUESTION: Radiation that is stochastic, with non threshold effects would a clinician notice first –
leukemia, skin burn, hair loss, bone marrow effect
124
Stochastic effects are associated with long-term, low-level (chronic) exposure to radiation.
("Stochastic" refers to the likelihood that something will happen.) Increased levels of exposure make
these health effects more likely to occur, but do not influence the type or severity of the effect.
QUESTION: Thermionic emission where? Filament Cathode

QUESTION: Therm-ionic emission of x-ray comes from – filament
Emission of electrons from heated cathode. Cathode has a filament circuit.
QUESTION: Irradiation cause saliva to have lower- sodium content
QUESTION: know how xrays interact with matter: photoelectric effect
In the photoelectric effect, electrons are emitted from matter (metals and non-metallic solids, liquids
or gases) as a consequence of their absorption of energy from electromagnetic radiation of very short
wavelength and high frequency, such as ultraviolet radiation. Electrons emitted in this manner may be
referred to as photoelectrons.
X ray photon interacts with an orbital electron, all of the energy of the photo is absorbed by the
displaced electron in the form of kinetic energy
QUESTION: if something is a structure in mouth thick – it absorbs more radiation, appears more radio-
opaque on xray
QUESTION: Dentist is more exposed to what type of radiation besides machine?

Scatter tube
Scatter patient
Scatter wall
QUESTION: how does x-rays primarily damage cells: Hydrolysis of water molecules
QUESTION: Radiation induced mutation is the result of? 1. Hydrolysis of water molecules.
QUESTION: which kind of radiation causes most cancer? Hydrolysis of water, etc
QUESTION: Radiation affects the body by: LYSIS of H20
QUESTION: Which structure is most radio sensitve: hemopoitic bone marrow
QUESTION: What cells are radiosensitive? Bone marrow cells, reproductive cells lymphoid cells,
immature cells, intestine. **REMEMBER radioRESISTANT – salivary glands, kidney, liver
QUESTION: What is most radio-resistant cell: Muscle (also nerve and mature bone)
QUESTION: Which one of the following tissues is least sensitive to ionizing radiation: muscle,
lymphocytes, squamous epithelium
QUESTION: radiation least likely to cause damage: muscle cells
QUESTION: Tissue least affected by radiation- muscle

QUESTION: Radiation of 4(Gy) to the skin will cause? Erythema
QUESTION: basic osteoradionecrosis question…bisphos with radiation
QUESTION: To get osteoradionecrosis radiation dose must be: Above 50 gys (above 60)
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QUESTION: Which is greater risk for ORN? IV bis for a year, radiation 65 grays
QUESTION: 69 Gray= osteoradionecrosis
QUESTION: Bisphosphonates used for all except: multiple myeloma, osteomyelitis, metastasis to
bones from breast cancer, metastasis to bones from prostate cancer
QUESTION: Bisphosphonates used to treat everything except? multiple myeloma, osteomyelitis
QUESTION: What conditions not to use bisphosphonates: Metastatic disease to bone, Multiple myeloma,
Metastatic breast cancer, Metastatic prostate cancer?
QUESTION: Indication for bisphosphonates: osteoporosis

QUESTION: Does bisphosphonate add calcium to bone (know this so you can answer one question)
No, It inhibits osteoclast via apoptosis
QUESTION: What is the mechanism of action of bisphosphonates? Inhibit osteoclasts,
QUESTION: Osteonecrosis is more common with IV drugs like zolmeda(zoledronic acid) and
aredia(palmidronate) (NOT fosamax or boniva)
Zolendronic acid- IV bispho

Aredia (is a bisphophosate)- Its IV
Boniva is- oral bisph
QUESTION: Which one these IV bisph would be contraindicated for orthro? Aredia
QUESTION: Why is orth contraindicated: pt is taking bisphosphonates (Aredia)
QUESTION: What is Aredia: IV Bisphosphonate
QUESTION: Why one is not true about a patient who takes Fosamax and will need an invasive procedure?
– Discontinue Fosamax 1 week before procedure (that stuff stays in the system longer than that)
QUESTION: pt taking bisphosphonates for 1yr IV, highest risk during dental tx? Osteonecrosis
QUESTION: Pt doesn’t like her bridge didn’t like her smile. Can you do bone graph in
bisphosphonate and would last?  NO BONE GRAFTING
QUESTION: A scenario about a patient who is taking bisphosphonates and gets osteonecrosis of the
jaw.
a. Osteonecrosis without radiation

b. Osteonecrosis with radiation
c. Answer is the first one bc it did not say anything about osteoRADIOnecrosis. You get
necrosis due to the bisphosphonates.
QUESTION: Osteonecrosis of jaw (2 questions): more common in mandibular; nothing to do with

radiation
QUESTION: How does Osteoradionecrosis negatively effect dental healing?

(well causes presence of non vital bone and loss of circulation to the area…would have to see answer
choices…Xtina)
QUESTION: Osteoradionecrosis most associated w/ what?
A: Mandible
QUESTION: Cause of ORN: Loss of vascular supply
QUESTION: osteoradionecrosis:
underdeveloped film
QUESTION: If need to extract teeth after patient had radionecrosis- I think refer to OS
126
QUESTION: Osteoradionecrosis scenarios..pre extract questionable teeth, hyperbaric oxygen pre
and post if doing invasive procedures
QUESTION: Kvp – energy
QUESTION: A higher kilovoltage produces x-rays with:Greater energy levels More penetrating
ability Shorter wavelenghts , increase in density
QUESTION: KVp inc more penetrating , high energy
QUESTION: Increasing milli amperage results in an increase in: Temperature of the filament &
Number of x-rays produced MA increase
QUESTION: Increasing mA alone results in a film with: High contrast
QUESTION: If you increase distance,then u need to increase mA
QUESTION: What does ma and kvp do? Longer KVP, shorter Wavelenght, Higher energy
QUESTION: how do you change from a low contrast (longer scale of contrast) to a high contrast
(shorter scale) without changing density: increase mA and kvp, decrease mA and kvp, increase
kvp decrease mA, decrease kvp increase mA
Anemia:
QUESTION: sickle cell anemia - nitrous oxide,
QUESTION: Which is not Contraindication for sickle cell anemia or something like that ? Nitrous,
infection, trauma, cold
QUESTION: All increase risk of sickle cell crisis except: cold, infection, trauma (of these 3)
QUESTION: sickle cell anemia in children’s : risk factor for nitrous and cold
QUESTION: which hemoglobin is affected- S
QUESTION: sickle cell anemia what is trigering it
QUESTION: A question about sickle cell anemia and you have a thromolytic crisis…what could
precipitate this?
a. Nitrous oxide / oxygen use – used for treatment?

b. A cold
c. Trauma
d. Something else
QUESTION: **Infection (cold) can trigger a crisis bc decrease of o2***
Sickle cell anemia is seen exclusively in black patients. Periods of unusual stress or of O2
deficiency (hypoxia) can precipitate a sickle cell crisis.
QUESTION: Chloramphenicol-aplastic anemia

QUESTION: hemolytic anemia – RBC are destroyed but bone marrow cant produce fast enough
QUESTION: which happens more in males? Mandibular dysostosis, hypothyrodisim, diabetes, sickle
127
cell anemia
QUESTION: Macrocytic anemia which vitamin deficient? A, B, C, D, E
QUESTION: which one is microcytic anemia? iron deficiency anemia.
QUESTION: ***Difference between aplastic, pernicious, sickle cell anemia

Aplastic anemia: bone marrow doesn't make enough new blood cells.
Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S.
Pernicious anemia: body can't make enough healthy red blood cells because lacks vitamin B12
because they lack intrinsic factor, a protein made in the stomach. A lack of this protein leads to
vitamin B12 deficiency.
Microcytic hypochromic anemia- iron def anemia (most common)
Oral Surgery:
QUESTION: Warfarin(Coumadin) what test? INR
QUESTION: warfarin pt. what test do you run prior to extraction or surgery: INR/PT
QUESTION: how does warfarin work on anticoagulation: decrease K+ needed to synthesize

factors II, VII, IX, X
QUESTION: The most important anticoagulant effect of heparin is to interfere with the conversion of
A. PTA to PTC.  B. PTC to Factor VIII.  C. fibrinogen to fibrin.  D. prothrombin to thrombin. E.

proaccelerin to accelerin.
QUESTION: pt taking dicumorol (vit K antagonist) is probably treated for? coronary infarct
QUESTION: Pt is taking dicumarol what are they being treated for? This was an old board repeat
A. Myocardial infarction (dicumarol is similar to warfarin)
QUESTION: Patient is on Coumadin, what do you need…INR, ptt
QUESTION: Pt using Warfarin, what lab test would help determine if pt is treatable? INR, PTT, PT
QUESTION: INR of patient on Coumadin….2-3
QUESTION: warfarin patient and when should you do treatment: INR = 2.0-3.0
QUESTION: Coumadin - INR
QUESTION: What is the best way to test clotting function on a patient taking Warfarin? INR
QUESTION: Patient is taking warfarin, what could u do? proceed with treatment because his INR is <2.5
QUESTION: Patient is taking Coumadin and you wan to know the coagulation status of patient
before surgery, what do you order?
INR
QUESTION: INR deals with PT
QUESTION: INR – value of 1 is normal (12 sec)
The higher the INR, the greater the anticoagulant effect.
QUESTION: question that was testing INR numbers .....i forgot the details **normal INR =1, higher
INR more bleeding, PT value,
128
QUESTION: suspend warfarin 3 days prior to extraction (stop drug 5 days before, and resume the
day after surgery)
QUESTION: suspend warfarin 5 days prior to extraction
QUESTION: Patient comes in and is on Coumadin, what do you do?
a. Stop for 1 day
b. Stop medication of 3 days
c. Do not need to stop medication
QUESTION: what INR is ok to place implant? 2.5, 3.5, etc I believe u can place implant in patient who
has INR less than 2.5
bleeading measuments : PTT 25-36 sec PT 5-7 sec platelets 150K-450K minimum platelets 50 k
bleeding time : less than 9 min INR : 1 do not treat with more than 3.5
QUESTION: Coumadin (warfarin): give vitamin KKKKKKKKK
QUESTION: alcoholic patient, order:

PT/INR
QUESTION: severe alcoholic now recovering need 24 tooth extraction which test needed----INR,CBC
QUESTION: Alcoholic patient come for extractions: INR?
QUESTION: Alcoholic patient, is about to undergo surgery. Which blood work test is most
important?
-creatinine
-PT extrinsic system (Vit. K coagulation factors-2,7,9,10); used to test warfarin/coumadin
effectiveness, for liver damage, and Vit. K status
-PTT intrinsic system; used to test Heparin
-Bleeding time
QUESTION: accurate way to detect blood alcohol in the body except
liver glucouronidation
weight
amount of food in stomach **amt of food in stomach dictates how fast your blood alcohol level
will increase
percentage of alcohol in drink
how fast you drank it
QUESTION: best way to determine platelet fxn

a. platelet count
b. bleeding time
c. PTT
d. INR
QUESTION: What aspirin affects? Extrinsic, intrinsic, bleeding time, common pathway?
QUESTION: What determines the bleeding time? Intrinsic, extrinsic, platelet adherence, common
pathway
QUESTION: Aspirin: platelet count
QUESTION: aspirin decrease platelet fxn
129
QUESTION: Bleeding time has to do with platelet count - Bleeding time = time required for blood
to stop (2-6min normal) Bleeding time is increased in disorders of platelet count, uremia, and
ingestion of aspirin and other antiinflammatory medication
QUESTION: asprin has no affect on PT or PTT or INR... it affects platelets..

QUESTION Aspirin is CONTRAINDICATED with which of the following drugs?
A. Coumarin (Coumadin®)
B. Triazolam (Halcion®)
C. Barbiturates (Phenobarbital®)
D. Pentobarbital (Nembutal®)
E.Methylprednisolone (Medrol®)
QUESTION: Patient taking aspirin for hypertension: Consultation with physician
QUESTION: prostaglandin inhibitor cause all expect: increase gastric mucous
PG:decrease gastric acid and increase gastric mucous ..... Inhibiting PG will increase gastric acid and
decrease mucosa.  That's why people taking too much aspirin can get stomach bleeding cause more
acidic and no protection
QUESTION: What makes prostaglandin: Arachidonic acid
QUESTION: ginseng- antiplatelet ( interferes with coagulation – not given with aspirin).  pt on warfarin,
aspirin
QUESTION: Before doing extraction you look at a patient’s CBC report. What causes to contact
patient’s physician? Hematocrit was given as 25. While in males it is 45% and females 40%
QUESTION: Anticoagulants act antagonize Vitamin K to work, prolong bleeding.

QUESTION: Anticoagulants – antagonize vit. K, INR used for Coumadin patients
QUESTION: INR 1.75 what do you do after extraction to control bleeding? Keep stuffing shit in it, bite
on normal gauze, squeeze b/l plate to collect bone fragments,
QUESTION: Warfarin = INR. Know numbers! I got pt with INR of 12.5, then asks what to do next.
Classmate had same questions with INR of 2.
QUESTION: extractions for a pt with an INR of 2. what should you do? Nothing
QUESTION: Safe INR is 2 for coumadin pt

QUESTION: pt on coumadin, INR 2--- I think it is okay to continue tx. Mosby’s states that normal INR of
people on anticoagulants is 2.5-3.0.
a. extract, use sutures, hemostatic agents
b. get pt off coumadin for 2 days before extraction
QUESTION: Patient had extraction and socket is still bleeding 5 hours later? refer for INR
QUESTION: Tooth extraction, 3 days later starts to hemorrhage what is the cause? Fibrinolysis
130
QUESTION: PT (12-14 secs, Factors 2, 7, 9, 10) and INR are extrinsic pathway
QUESTION: PTT – intrinsic factor 8.9.11.12 test for detecting coagulation defects of the intrinsic
system - hemophiliac
QUESTION: Factor VIII is hemophila A
QUESTION The drug contra indicated in pt taking gingko biloba: HEPARIN
Diabetes:
QUESTION: Glucocorticoides are contraindicated in: Diabetes
QUESTION: Glucocorticoids side effects? Infection, reduce inflammation, hyperglycemia.
QUESTION: Negative effect of chronic use glucocorticoids? Pg. 303 mosby section D adverse effect
QUESTION: Overweight patient that has to piss 2wice at night? Diabetes
QUESTION: Oral hypoglycemic drug for diabetes --?sulfonylurea and metformin (MOA)
QUESTION: Why don’t you give Sulfonylureas to Type I diabetic patients? They do not have beta cells
for insulin & Sulfonylureas MoA is to stim those cells
QUESTION: Sulfonyl ureas – diabetes drugs: They act by increasing insulin release from the beta cells in
the pancreas.
QUESTION: MOA of sulfonylureas: release of insulin
QUESTION: How do Sulfoneureas work? Stimulate insulin release from Beta cells, stimulate
binding, decrease glucagon levels.
QUESTION: MOA of sulfonylurea- increase insulin PRODUCTION and SENSITIVITY by Beta cells
stimulation
receptor name?binds to ATP-dependet K channels
QUESTION: Metformin suppresses glucose production in liver (decreasing hepatic gluconeogenesis
decreases glucagon levels) – bind to AMP protein kinase receptors
QUESTION: Proposed modes of action for the oral antidiabetic agents include each of the following
EXCEPT one. Which one is the EXCEPTION?
A. Blockade of glucagon release from pancreas

B. Blockade of catecholamine release from adrenal medulla
C. Stimulation of insulin release from pancreatic beta cells
D. Action as direct receptor agonists for the insulin receptor
E. Increase affinity of tissues for utilization of available plasma glucose
QUESTION: Diabetes – more in men?
QUESTION: Hb1AC: Measuring glucose level over extended period
QUESTION: Pt who took too much insulin will have all except- Hyperglycemia
QUESTION: decrease in ⬇ glycogenolysis in the liver would be expected with insulin
QUESTION: Which one of the following effects males almost exclusively?

• *hemophilia (it is carried by the female but only effects the male)
• downs
• diabetes
131
QUESTION: which happens more in males? Mandibular dysostosis , hypothyrodisim, diabetes, sickle cell
anemia
QUESTION: Sign of hypoglycemia- I put bradycardia but later checked I think answer is mydriasis
…other options were diaphoresis (sweating),
Signs of hypoglycemia: headache, mental confusion, somnolence, sweating, tachychardia,
tremors, nervousness
QUESTION: Which is risk factor for hypoglycemia? Age, alcohol, hypertension
Well-known risk factors for the development of hypoglycemia include exercise, alcohol, older age,
renal dysfunction, infection, decreased intake of energy, and mental health issues, including
dementia, depression, and psychiatric illnesses. In the ADVANCE trial, cognitive dysfunction
increased the risk of hypoglycemia
QUESTION: Controlled diabetes has same perio problems as those who don’t have diabetes TRUE
QUESTION: Controlled diabetic patients do not get more perio disease than non-diabetic
QUESTION: What is not true regarding patient with diabetes and perio: either increase of
crevicular fluid or increase of sugar in crevicular fluid (of these two choices, 1st is better cuz there
is sugar in the fluid)
QUESTION: Patient with diabetes which finding is not consistent … increase collegenase in crevicular
fluid, increase glucose in crevicular fluid, increase gram negative in crevicular fluid, decrease in
thickness of basilar lamina of blood vessels in periodontium.
QUESTION: Diabetic patients have more of the following except: higher glucose levels in gingiva,
increased anaerobic bacteria in pockets, …
QUESTION: increases in diabetics except? IL1, collagenase, glucose, bacteria
QUESTION: Diabetics are more prone to perio and are less resistant to the effects of bact.- both statements
are true.
QUESTION: By recent studies, which one has a correlation with periodontitis? Diabetes -
diabetics are 15 times at risk
QUESTION: pt presents with aggressive bone loss, bleeding gums, mobile teeth…. Etc
• uncontrolled diabetes
• non hodgkins lymphoma
QUESTION: ASA III: uncontrolled diabetes
QUESTION: Diabetes you get infections more likely, not bleed easier
QUESTION: diabetes most common: black men
QUESTION: What diabetes patient should be monitoring daily except for what? NOT glucose in urine
QUESTION: Endo surgery contraindicated when… diabetes? HTN
QUESTION: When would elective endo treatment be contraindicated? diabetes, hiv, etc
QUESTION: What disease will alter healing after root canal treatment? HIV or diabetes?think its diabetes
since they have altered wound healing..
QUESTION: Periodontal disease is associated with what systemic diseases? Diabtes and HIV
QUESTION: Diabetes can you place implant if HbA1c is 8: refer to physician, and no cant place implants
132
QUESTION: Pt with hemoglobin A1C of 12%. Pt just visited the MD, what kind of TX we can do?
Consult with an MD prior to tx
In most labs, the normal range is 4-5.9 %.
In poorly controlled diabetes, its 8.0% or above
In well controlled patients it's less than 7.0
QUESTION: LA with epinephrine contraindicated in? Uncontrolled Diabetes, hypothyroidism,

hyperthyroidism
QUESTION: LA with epinephrine contraindicated in? Diabetes, hypothyroidism, hyperthyroidism

QUESTION: epinephrine is contraindicated in what disease? Cardiac patients hyperthyroidism,
diabetes mellitus...sorry can't remember the rest
QUESTION: Type I Diabetes leads: a) Aphasia b) Ataxia c) Blindness d) Deafness
QUESTION: Common complication of Type 1 diabetes: I wrote as blindness assuming retinopathy!!
QUESTION: Treat diabetic patient 2 hours after eating and taking insulin
QUESTION: Kidney dialysis: best to do tx when, I put day after dialysis, or inbtwn days of dialysis
QUESTION: Insulin shock, what do u give?- give insulin, give OJ, give oral sucrose **glucagon shot?
Do NOT give more insulin, blood sugar is already low enough. Give OJ or oral sucrose maybe.. depends
on the answer choices.
QUESTION: what would you give to a patient who goes into a diabetic shock (hypoglycemia)?
QUESTION: Pt is a child and is diabetic undergoes hypoglycemia in the chair if conscious give him
orange juice (unconscious give him 50% dextrose IV)
QUESTION: child goes into insulin shock in the chair (hypoglycemia)

a. give OJ----?
b. ask parent to give kid insulin shot
QUESTION: Unconscious diabetic is treated with: 50 % dextrose in water I V.
QUESTION: HgbA1c is 12 for a patient in your office? – Get him out of there, haha! , refer him to
physician for diabetic/sugar management. (I believe normal A1c levels are 4.0-6.0…Xtina) HbA1c stands
for Glycosylated hemoglobin. Measures blood glucose in past 2-3 months. NORMAL = 4-6%. Increased
is above 7%
QUESTION: Diabetic for IV sedation. If insulin dependant, have them not eat, not take short acting
insulin and take half dose of long acting insulin. If not dependant, no food and no meds
QUESTION: Patient is non-insulin dependent diabetic and needs minor oral surgery w/ IV
sedation. What should he do? I put clear-liquids and regular dose of diabetes meds. Minor
surgery: normal as long as procedure occurs within 2 hours of eating and taking
meds.
133
QUESTION: Day of surgery- diabetic what do u tell him- no food no insulin, food and insulin, clear liquid
and ½ insulin, clear liquid and normal insulin
QUESTION: You have a diabetic patient, you can manage him all the following ways except? – Tell him
to eat light breakfast on the day of the appointment (the other choices were, schedule the dude a morning
appointment, tell him not to take his hypoglycemia meds for his appointments, monitor his blood sugar
level on the day of the procedure)
QUESTION: pt with diabetic having sedation IV and LA---ask the pt to take high calorie food with
insulin, low calorie food with insulin (reduce dose of insulin and no food)
QUESTION: DM pt. What to instruct before conscious sedation procedure?

A: Low calorie meal and reduce insulin dose
QUESTION: IV sedation Diabetic patient comes for surgery. What are the instructions? dependent-
don’t eat, remove short duration insulin, half dose of long, type II not dependent- no eating no
medication.
QUESTION: how are the diabetic drugs classified- by duration
QUESTION: Various preparations for diabetes are differneces in what? Duration of action,
mechanism of action?
QUESTION: Patient has ketone breath and is confused. Why? I put HYPerglycemia.
QUESTION: Ketone breath: Diabetes type 1
QUESTION: Ketone breath and alter state of consciousness? Hyperglycemia
Congestive Heart Failure/Heart:

QUESTION: Patient with orthopnea(shortness of breath-dyspnea-while laying flat), dyspnea,
pedal edema
a. Emphysema
b. Pulmonary edema
c. COPD
d. Congestive heart failure
QUESTION: Dypspnea, orthopnea seen in? CHF

QUESTION: What is common symptom of CHF? Orthopnea* (other symptoms: dyspnea, fatigue,
paroxysmal nocturnal dyspnea, edema)
QUESTION: Common s and s of ChF
QUESTION: Dyspnea, orthopnea seen in? CHF What is common symptom of CHF? Orthopnea*
QUESTION: Tx of CHF pt? early morning appts?
QUESTION: Most common reason for cardiac arrest of kid – respiratory distress
QUESTION: what is the most common heart problems in children: c) Ventricular septal defects
QUESTION: Most common cause of heart failure in kids: congestive heart failure, cyanotic heart
disease,…didn’t know answer, according to google, its respiratory failure
QUESTION: heart failure in kids - due to defect in heart respiratory distress
134
QUESTION: what is the most common heart problems in childrens : a)congestive heart failure b)
septical Atrial. Etc…. ventricular septal defects or communications between the bottom
chambers(structural heart defects)
QUESTION: Peripheral edema : congestive heart failure.
QUESTION: Patient has distended jugulars, pitting edema and dyspnea? I put
congestive heart failure
QUESTION: Pt edematous pitted, shortness of breath? Congenital heart failure,
QUESTION: why is pt taking ACE inhibitor (hypertension / CHF)

QUESTION: pt taking cardiac glycosides. what is it used for? (choices: hypertension,
congestive heart failure, etc...can't remember)
QUESTION: what do cardiac glycosides(Digitalis) do? Inhibit NA/K atpase and Increase Na and ca in
cell and increases the refractory period.
QUESTION: how does digitalis works : blocks Na/K/ATP ase = influx more Ca
QUESTION: how does digitalis works : blocks Na/K/ATPase = increase influx more Ca
QUESTION: Digitalis -Increase Ionotropic (contractions) effect of the heart, know the mechanism as well
QUESTION: Use of digitalis: Post myocardial infarction, Supraventricular arrhythmia, (digitalis...cardiac
glycoside…common indications for use is for atrial fib)
QUESTION: Action of Cardiac glycosides,(Digoxin ) binds and inhibits Na+/K+ ATPase for atrial
fibrillation
QUESTION: How does Digoxin work? Inhibits Na/K ATPase of cardiac cell membranes resulting in
increase of Na concentration intracellularly. cardiac glycoside. ALSO increases intracellular Ca++
QUESTION: mechanism of Digoxin – blocks Na/K+ pump increase intracellular sodium promote
calcium influx contractility
QUESTION: Ginseng question! – pt takes for energy, but it will interfere with…digitalis, can’t
remember the rest. ASPIRIN. Ginseng = antiplatelet
QUESTION: Ginseng: CI with aspirin or digoxin??
QUESTION: Pt. on ginsing what do u want to avoid? Warfarin/nsaids and Aspirin
QUESTION: Pt taking ginseng. Which med should be avoided?

• Penicillin
• Aspirin*
• Digitoxin
QUESTION: Peripheral edema : increase systole : congestive heart failure.
QUESTION: Peripheral edema : congestive heart failure.
QUESTION: Patient has distended jugulars, pitting edema and dyspnea? I put congestive heart
failure
QUESTION: Pt has history of cardiovascular disease and now pt is taking aspirin. Pt needs ext. What
should dentist do?
• Med consult with physician*
• Normal extraction
• Stop aspirin 3 days before and 2 days after surgery
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QUESTION: Mechanism of most drugs that tx arrhythmias? Decreases repolarization rate, Prolongs
refractory period.
QUESTION: Cardiac referred pain not consistent with? Pain goes away with LA
QUESTION: MI and arrhythmia difference? Thrombosis, arthrosclerosis
QUESTION: When you have artial arrythimia….whats the mech of action for the drug for it?
a. Well, I know you can give Quinidine, Verapamil, and Digitalis for atrial…and the side
mechanism of Quinidine is it increases the refractory period..thats the only
answer that made sense
QUESTION: general question about arrhythmias. They increase calcium inotropic effect, decrease SA
node transmission, increase refractory period…
QUESTION: If a patient has chest pain while at rest, what kind of angina is it? Unstable
QUESTION: Angina at rest?
a. Pseudo-angina
b. Unstable angina
c. Infarction
QUESTION: patient has pain in heart when sleeping-unstable angina.
QUESTION: side effect of nitroglycerin : orthostatic hypotention and headache.
QUESTION: side effect of nitroglycerin : orthostatic hypotension and headache.
QUESTION: nitrites /nitrates : Vasodilation
QUESTION: nitrates and nitriles have what systematic effect? Vasodilation of arteries  decreased
BP  tachycardia
QUESTION: Nitrates/Nitriles, how do they respond to Angina? –blood vessels.

QUESTION: Nitrates/Nitriles, how do they respond to Angina? – I said they act on muscle cells, correct
answer was through blood vessels. (dilate blood vessels)
QUESTION: How do nitrates work on the heart- relaxing and widening the blood vessels in the
body, allowing more blood and oxygen to flow to the heart. Since the arteries are wider, it is easier
for the heart to pump blood, so it does not require as much blood and oxygen.
QUESTION: You give the nitroglycerin to the pt with angina and heart rate goes up what's the
reason? natural reflex to the decrease in blood pressure
QUESTION: Nitrates and how they affect the heart: something with relaxation of smooth muscle
QUESTION: Nitrates effect in blood vessel? . Nitroglycerin is a nitrovasodilator. It produces nitric

oxide, which activates guanylyl cyclase which, in turn, catalyzes the production of ⬆ cGMP.
QUESTION: Amilnitrate & Nitroglycerine? Vasodialate coronary arteries **for angina pectoris—chest
pain caused by occlusion of coronary arteries!!!
QUESTION: *** For Angina drug, which drugs can’t you take: some type of hydrothiazide med
QUESTION: Diuresis(excessive urine production) after tx of angina w/ a glycoside ? b/c of
increased blood flow caused increased blood flow to kidney
QUESTION: Epi and Nitroglycerine : ....antagonist,

QUESTION: Transient Ischemic Attack what is false
o More prone to heart attack
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o Should take nitroglycerin
QUESTION: TIA-transient inschemic attack; what is false? Better chance to get stroke-true, patient
should take nitroglycerin FALSE-give for angina to prevent heart attacks.
Lungs:
QUESTION: Asthma causes constriction on bronchioles and inflammation true: Beta 2 receptors for
the lungs
QUESTION: asthma causes constriction of bronchioles and inflammation, constriction of smooth

muscle
QUESTION: What does asthma do? Causes constriction of smooth muscle T and inflammation of
bronchioles? T
BETA 2 RECEPTOR FOR LUNGS
BETA 1 FOR HEART
QUESTION: What do asthmatic patients have problem with? – Wheezing Exhalation

QUESTION: Child makes a wheezing sound before injection? Asthma (induced by stress)
QUESTION: Wheezing  exhale with high pitch
QUESTION: Wheezing sound: insp or exp
QUESTION: COPD vs Asthma? Asthma have problem breathing in,(but wheeze when exhaling), COPD
has problem exhaling
QUESTION: Most breathing problem in dental setting? – Asthma (other were hyperventilation, COPD,
etc)
QUESTION: Most common respiratory problem in dental office: COPD/asthma
QUESTION: most common respiratory condition you will encounter in office? COPD 
hyperventilation
QUESTION: Most common respiratory emergency in dental office: hyperventilation
QUESTION: Hyperventilation causes – tachycardia and tachypnea
QUESTION: What is the most common cause for breathing difficulty in the dental chair? asthma
QUESTION: Patient has palmar pits, something and something when he presents: either CHF or
emphysema
QUESTION: Soft tissue emphysema: endo

QUESTION: face swelling after air spray in perio pocket: soft tissue emphysema (sudden painless
swelling)
QUESTION: Perio surgery, air into sulcus. What occurs?- subcutaneous emphysema
QUESTION: Emphysema: constriction of air sacks
QUESTION: Pt has emphysema. What are his symptoms? Dyspnea, wheezing, cough, chest tightness. Air
sacks are all destroyed (narrowing of distal airways)
QUESTION: Crowing sound when breathing? Stridor??
• asthma attack
• COPD* I put this but I didn’t know what crowing sound means.. so not sure
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• Pneumothorax
QUESTION: What causes a crowing sound? COPD (maybe)* laryngeal SPASMS
QUESTION: Stridor? Laryngospasm
QUESTION: Stridor- laryngospasm- blockage of UPPER resp. tract
QUESTION: Epi for laryngiospasm what does it do? (multiple answers- multiple choice with 3 answers
each)- brochodilater, increase HR, increase BP
QUESTION: Theo-phylline
Theophylline is used to prevent and treat wheezing, shortness of breath, and difficulty breathing
caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air
passages in the lungs, making it easier to breathe.
QUESTION: Theophylline – drug used for asthma sometimes. Particularly for wheezing,
shortness of breath, chronic bronchitis, emphysema.
QUESTION: Which drugs for ***asthma?
Albuterol was not in it, levabuterol(xopenex), ipratropium(atrovent), Combivent, Advair,

Smbicort, Spiriva, Budenoside
QUESTION: Most effective during acute asthma attack: albuterol- generic name is Salbutamol
QUESTION: asthma attack – albuterol this is a beta 2 agonist causes bronchodialation
QUESTION: medication for severe asthma attack : aminophiline.

QUESTION: Singulair(montelukast) action? Block action of leukotrienes, is a leukotriene
receptor antagonist.used for asthma tx and seasonal allergies
QUESTION: leukasts block leukotrienes
QUESTION: M.O.A of Albuterol: Give for severe asthma. It’s a bronchodilator
QUESTION: Albuterol question, does not help asthma what do you give next,. Epinephrine
QUESTION: Pt has asthmatic attach, took albuterol, and it didn’t work. What’s next step?
• epinephrine
• atropine
• something else…
QUESTION: A child treated with albuterol. Why? I put asthma
QUESTION: What drug cause asthma? Aspirin
QUESTION: Which of the following drugs is can trigger asthma? a) narcotic

analgesic b) NSAID c) corticosteriod d) sympatolytic amine.
QUESTION: Asthmatic only use Tylenol (not aspirin bc of hypervent) Bronchiospasms

QUESTION: What is used for a severe bronchial asthma attack? Albuterol, corticosteroids,
aminophylline
QUESTION: Patient begins to wheeze what do you not do?
o Beta2 blocker inhaler, sit pt more comfortable, corticosteroid inhaler

o Give oxygen
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QUESTION: If patient starts wheezing? Don’t give oxygen; last thing you would do; other options
give beta 2 blocker inhaler, corticosteroid inhaler, make patient more comfortable
QUESTION: asthma patient, most important thing NOT to give: O2 (rest was inhaler, albuterol, etc.) - i
got it wrong
QUESTION: What cause dry mouth?Albuterol
QUESTION: Pt goes home from elective orthognathic sx and in 24hrs, without sign of inflam or edema,
but a fever of 102oF- Atelectasia (or pneumotosis – depending on answers. Atelectasia and pneumotosis =
most common cause of fever within 24 hour of GA)
Syncope:
QUESTION: Pregnant women with syncope – what hip should they lay on? Right or left (pretty sure
not trendelenburg) --- and why do you do that? To avoid compression of vena cava I think
QUESTION: 5 mo pregnant patient with syncope, what position would u put her in? supine with
legs raised, reverse trendelburg, on her left,
prego – CO increases 30-50%. Gradual increase in BP. 2nd and 3rd trimester- decrease in BP and CO
can occur while pt in supine position. =decrease in Venous return to heart due to compression of
inferior vena cava. =supine hypotensive syndrome. = light headed, hypotension, tachycardia,
syncope. Roll pt onto left side to lift uterus off vena cava. To avoid, prego pt positioned in semi-
reclining position. = elevate right butt and hip 15 degrees.
QUESTION: If a 3rd trimester pt all of a sudden feels a drop in BP what do you do?- Have pt lay on left
side.
QUESTION: Prego question – syncope, which side you put pt? Raise right hip.
QUESTION: Pregnant woman - put her right hip up if she not comfortable in chair or experiences
loss syncope, etc..
QUESTION: pregnant women, with syncope. turn them chicks on the left bc it won't compress the
inferior vena cava.
QUESTION: 2 questions on prego
a. Baby crushing IVC

b. Lay on left hip, Right hip UP
QUESTION: Pregnant women should lay in which direction (Trendelenberg, right hip up, left hip up?)
More proned to what medical emergency?
QUESTION: What causes pregnant woman to syncope – pressure on inferior vena ceva
QUESTION: Pregnant in supine position, what gets too much pressure? – I said Fetus (other choices were,
placenta, inferior vena cava, superior vena cava) ( inferior vena cava…)
orthostatic hypotension (colloquially as head rush or dizzy spell, is a form of hypotension in

which a person's blood pressure suddenly falls when standing up or stretching. Vs
 vasovagal syncope (the most common type of fainting. is a malaise mediated by the vagus nerve.)
QUESTION: Most important thing to do when patient syncope – maintain airway, loosen up buttons,
place head below heart, supine
QUESTION: Crown disappears down patient’s throat, what position do you put them in? Supine, Upright,
Trendelberg
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QUESTION: Place crown in mouth and it comes out and to back of throat, place patient – upright, prone,
supine, trendelburg
QUESTION: Want to determine patient physiologic rest position, place in – supine, upright/standing,
tredenlburg
QUESTION: Purpouse of the trendelberg position is to- maint circulation so that the most vital organs are
never hypoxic.
QUESTION: what position you place the Pt when is having syncope? (TRENDELENBURG
POSITION) (SUPINE WITH FEET ELEVATED SLIGHTLY), The most common early sign of
syncope is PALLOR (paleness).
QUESTION: U walk to office, pt is unconscious? Supine, tendenberg, upright
QUESTION: Trendelenburg position: (for anaphylaxis)

Position in which the patient is on an elevated and inclined plane, usually about 45°, with the
head down and legs and feet over the edge of the table. It is used in abdominal operations to push
abdominal organs towards the chest. This position is also usually used in treating shock, but if there is an
associated head injury, the head should not be kept lower than the trunk.
QUESTION: All forms of shock have?
• Hypovolemia
• Decreased perfusion to tissue
• Sepsis
QUESTION: Vasovagal syncope: Common cause of transient loss of consciousness
QUESTION: Vasovagal syncope is a common cause of transient loss of consciousness
QUESTION: Syncope? Inhale ammonia, irritates es trigeminal nerve sensory. 100% oxygen works,
except hyperventilation syndrome.
QUESTION: High-flow 100% 02 is indicated for treating each of the following types of syncope
EXCEPT one. Which one is this EXCEPTION?
A. Vasovagal
B. Neurogenic
C. Orthostatic
D. Hyperventilation syndrome
QUESTION: most Emergency in dental chair : syncope
QUESTION: Most common dental complication in office? – Syncope
QUESTION: Most common ER after use of local: syncope
QUESTION: What is the most likely emergency in the dental office? Syncope
QUESTION: You gave Local Anesthetic, BP went up to 200/100 and HR went up too, what could be due
to? – Due to vasoconstrictor injected into venous system.
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QUESTION: You gave Local Anesthetic, BP went down to 100/50 and HR went down too, what could it
be due to? – Syncope
QUESTION: After receiving one cartridge of a local anesthetic, a healthy adult patient became
unconscious in the dental chair. The occurrence of a brief convulsion is
A. pathognomonic of grand mal epilepsy.
B. consistent with a diagnosis of syncope.
C. usually caused by the epinephrine in the local anesthetic.
D. pathognomonic of intravascular injection of a local anesthetic.
QUESTION: signs of syncope: blood pressure falls
QUESTION: signs of epi overdose: blood pressure and heart rate rises
QUESTION: Carpopedal spasm seen in? asthmatic attack, hyperventilation,
Seizures:
QUESTION: grand mal seizure – give Dilantin *phenytoin*
QUESTION: Which of these is indicated for grand mal seizure? DILANTIN phenytoin
QUESTION: Most common seizure in children – grand mal
Febrile seizures, which occur in young children and are provoked by fever, are the
most common type of provoked seizures in childhood. Then generalized tonic-clonic
(grand mal)
**** Diazepam is for status epilepticus******

QUESTION: Status epilepticus – give what drug? Diazepam
QUESTION: Drug of choice of status epilepticus (seizure that last for long period)? `1. Valium
(diazapams) (answer) – look up how much too, 5ml?---***5-10 mg IV / per minute
QUESTION: Grand mal seizure : Phenytoin Status epilecticus : Valium
DIAZEPAM CONTRAINDICATIONS: Pregnant, myasthenia gravis, acute narrow glaucoma
QUESTION: Diazepam is contraindicated in the following pt? Asthma**

QUESTION: contraindication of diazepam : Pregnacy
QUESTION: What drug for patient with petit mal seizures in dental office?
Only 2 drugs for absence seizures (petit mal): ethosuximide (Zarontin) – only treats petit mal-
and valproic acid (Depakene, Depacon) – treats grand mal, petit, and myoclonic seizures.
QUESTION: What is best to give for petit mal seizure? I chose phenytoin. They also had diazepam
QUESTION: What may induce seizures? Hyponatremia, hypernatremia, hyperkalemia
QUESTION: cause seizure? Hypoglycemia, hypokalemic…can’t remember the rest, hyponatremia
QUESTION: convulsions where : a) hypoglycemia b) hypokalemia c) hyponatremia

QUESTION: Seizures due to lack of what nutrient/vitamin/electrolyte (sodium)
QUESTION: What causes seizures?
a. Hypocalcemia
b. Hypophosphatasa
c. Hyponantremia
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d. Hypernantremia.
QUESTION: Epileptic pt least likely to take
a. ethosuximide – petit mal seizures
b. diazepam
c. Lasix (furosemide)----? This is a loop diuretic…..
QUESTION: Which of the following drugs, when administered intravenously, is LEAST likely to
produce respiratory depression?
A. Fentanyl
B. Diazepam
C. Thiopental
D. Meperidine
E.Pentobarbital
QUESTION: Which of the following is the current drug-of-choice for status epilepticus?
A. Diazepam (Valium®)
B. Phenytoin (Dilantin®)
C. Chlorpromazine (Thorazine®)
D. Carbamazepine (Tegretol®)
E.Chlordiazepoxide (Librium®)
QUESTION: Each of the following is an advantage of midazolam over diazepam EXCEPT one. Which
one is this EXCEPTION?
D. Less potential for respiratory depression
E. More rapid and predictable onset of action when given intramuscularly
QUESTION: The clinical activity of a single intravenous dose (10 mg) of diazepam is most
dependent on which of the following?
A. Alpha half-life
B. Betahalf-life
C. Renalexcretion
D. Enzymatic degradation
E. Hepatic biotransformation
QUESTION: Each of the following are narcotics used in outpatient anesthesia EXCEPT one. Which
A. Fentanyl
B. Sufentanil
C. Meperidine
D. Diazepam
E. Morphine
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QUESTION: Which of the following describes the titration of diazepam to Verrill's sign for IV
conscious sedation?
A. It is recommended as an end-point.
B. It is recommended only when supplemental 02 is used.
C. It is usually not attainable with diazepam alone.
D. It is not recommended since it can indicate a too-deeply sedated patient.
E. It is not recommended since few patients are adequately sedated at that level.
QUESTION: Which of the following is the treatment of choice for lidocaine-induced seizures?
Epinephrine (EpiPen ̈) Naloxone (Narcan ̈) Diazepam (Valium )̈ Flumazenil (Romazicon ̈)
Succinylcholine (Anectine ̈)
QUESTION Which of these opioid analgesics is associated with a serious life threatening drug interaction
when administered with an MAO inhibitor? Meperidine morphine fentanyl propoxyphene codeine
Can cause life-threatening hyperpyrexic reactions
QUESTION: Drug-drug interaction with MAOI(Hydralazine) and Meperidine.(opioid)
QUESTION: MAOI contraindication? Meperdine

QUESTION: No opioids for patient taking MAOIs )in case of head injury)
QUESTION: Opiate contraindicated in – severe head injury cases
QUESTION: Opioids contraindicated in: severe head injury, renal insufficiency
QUESTION: An opiate type MAA with both agonist and antagonist properties is- pantazocin
QUESTION Which of the following effects are common to pentobarbital, diazepam, and meperidine?
A. Anticonvulsant and hypnotic
B. Analgesia and relief of anxiety
C. Sedation and ability to produce dependence
D. Amnesia and skeletal muscle relaxation
QUESTION: Absolute Contraindications to Opioid Prescribing: Allergy to

Codeine/Oxycodone/Hydrocodone give Methadone or Meperidine or Tramadol..
QUESTION: Which of the following narcotics/opioids is synthetic? Meperidine (Demerol) or

propoxyphene
QUESTION: Use for sedation of children- Secobarbitol or pentobarbital (good for pre-op/anxious kids)
Ketamine is used in emergency situations (good anxiolytic and analgesic at low doses) Meperidine should
not be used in kids
QUESTION: Which is not done by opiates
o Diuresis (opiates cause urinary retention)

o Constipation
o Bronchiolar constrction
o Vomiting
QUESTION: opioids do NOT do what? Peripheral pain block
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o they do: constipation, respiratory depression, somnolence
QUESTION: opioid side effect – constipation
QUESTION: Opiate overdose--> miosis

QUESTION: Opoid overdose side effect (from cocaine) – constipation, respiratory depression,
euphoria, miosis, coma
QUESTION: opioid OD symptoms – answer was hypotension. Other options were irritability
(restlessness), hypertension, insomnia = withdrawl symptoms.
QUESTION: Symptom seen in oral opioid overdose: hypothermia, headache, insomnia, irritability
(rest are withdrawal sympotms)
QUESTION: Symptoms if too much codeine? Cold and clammy skin √
QUESTION: Opioid usage all except: xerostomia, chronic cough, diarrhea, miosis (for sure get
constipation)
QUESTION: adverse effect most severe of opioids: respiratory depression.
QUESTION: What is the most significant side effect of morphine: respiratory depression
QUESTION: Major disadvantage of opioids is respiratory depression.
QUESTION: Miosis seen in opioid abuse - except with meperidine (an exception)
QUESTION: Which of the following symptoms is the most distinct characteristic of morphine poisoning?
A. Comatose sleep
B. Pin-point pupils
C. Depressed respiration
D. Deep, rapid respiration
E. Widely dilated, non-responsive pupils
QUESTION: Opioids : opioids receptors in GI tract, CNS and adrenal medulla
QUESTION: Opioid Receptors- brain, and are found in the spinal cord and digestive tract.
QUESTION: opioid stomach upset - act in the brain, not in stomach receptors (I got this wrong!)
QUESTION: Opioid agonists act by…

a. stimulating GABAergic neuron
b. increase pain threshold
c. acting as Mu receptor agonists
QUESTION: Naloxone: use for Opioid overdose. Used Meperidine (Demerol) to decrease
withdrawl symptoms
QUESTION: Opioid (Fentanyl, Morphine, Meperidine, Methadone, Sulfentanil, Codeine, Heroin,

Dextromethorphan) reversal drug? Naloxone.
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QUESTION: antidote for Percodone overdose (Oxycodone+aspirin)? all opiate antidote is
Nalaxone
QUESTION: True opioid antagonist should have-high affinity and no intrinsic effect
QUESTION: How does an antagonist work? No intrinsic activity, High affinity

QUESTION: Antagonist: Binds to receptor but lacks intrinsic activity
QUESTION: Fentanyl is the opioid analgesic given trans dermally

QUESTION: TRANSDERMAL patch- Fentanyl (opoid)
QUESTION: Which opiate is part of intradermal system? Fentanyl

QUESTION: If you give too much of an opioid (but its not an overdose!), what’s the first sign you
would see?
a. Irritation
b. Headache
c. I don’t remember the other two…I put headache..? I really think it has something to
do with pin point pupils and respiratory depression  constricted pupils and
absent/slow breathing
QUESTION: Methadone? Helps alleviate withdrawl from heroine (opiates). ***Buprenorphine and
Methadone is for opioid addiction. Naloxene is an opioid antagonist for OVERDOSE***
QUESTION: why use methadone: long half life- extra info give to heroine addicts? �to decrease
withdrawl symptoms
QUESTION: Methadone for detoxification of opioid addicts
(Methadone is a synthetic opiod, analgesic, antitussive, antiaddictive, acts on MU receptors so produces

similar effects of opioids…without addictive qualities…receptor antagonist to glutamate)
QUESTION: Why is nalbuphine contraindicated in previous heroin addict: A mixed agonist-
antagonist which may potentiate withdrawal symptoms
QUESTION: Nalbuphine (NUBAIN) (opioid agonist and antagonist)

withdrawal symptoms.
QUESTION: pt is addicted to oxycodone which contra indi--- codeine, pentozocaine 
QUESTION: Sedative drug such as hydroxyzine, meperidine and diazepam are carried in the blood in…
a. serum
b. white blood cells
c. red blood cells
d. hemoglobin
QUESTION: where do opioids act? Medulla (bind to opiod receptors in CNS)

Morphine, codeine, as well as oxycodone, and hydrocodone all belong to the phenanthrenes
class
QUESTION: where are mu receptors?
Medulla
Periphery
QUESTION: The codeine produces nausea because?
145
Activates vasodialator blah blah blah
Works on the medulla (stimulates medullary chemoreceptor trigger zone)
QUESTION: How codeine causes nausea: CHEMOTACTIC RECEPTOR ZONE (CRZ)
QUESTION Mechanism of how codeine causing nausea? Chemotactic receptor zone CRZ
QUESTION: How does morphine cause emesis in the body: know the pathway – via central action
QUESTION: Had a question about codeine—and what effects are—like it being antitussive, antidiarrheal
and analgesics, sedatives and preanesthetic meds
CODEINE: analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative and
hypnotic properties. IS ADDICTIVE
QUESTION: Symptoms if too much codeine? Insomnia, Cold and Clammy skin, irritable.
QUESTION: Allergy to codeine: what do you take for pain – random opioids, tylenol #3, hydrocodone,
acetominophin with aspirin I think
ALLERGY TO CODEINE: can prescribe another opioid from different class: Meperidine or
fentanyl for moderate to severe pain or acetaminophen or NSAID for mild pain.
QUESTION: What give to pt allergy to codein? Propoxyphene
QUESTION: Patient allergic to codeine what do you give?? Naproxen
QUESTION: Patient is allergic to codeine when you look at their medical history tab, (this is the trick
about the exam, look up stuff before you answer questions), what do you prescribe him for pain?
Hydrocodone with Acetominaphen (Other choices were Tylenol 3, Hydrocodone with Aspirin)
Acetaminophen + aspirin
QUESTION: Codeine allergy, pain killer option? - for pts with opioid allergy  use synthetic opioids
(meperidine, tramadol)
QUESTION: Allergic to Codeine what can you give? Demerol(meperidine), Pentazocine
QUESTION: Pt has hx of codeine allergy. What drug to give?

• Tylenol #3 has codeine
• Vicodine
• Naproxen *
• Hydrocodone
 Group 1 (aka opiates) - Naturally occurring agents derived from the opium plant
o Morphine, codeine, thebaine
 Group 2 - Semi-synthetics
o Hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine (heroin is also in this
group)
 Group 3 - Synthetics
o Fentanyl (alfentanil, sufentanil, etc.), methadone, tramadol, propoxyphene, meperidine
All of the group 1 and 2 agents are structurally very similar to each other and should not be given if a true
allergy exists to any other natural or semi-synthetic derivative. Group 3 agents have structures different
enough that they can be given to a patient intolerant to the natural or semi-synthetics without fear of cross
reactivity. They are also very different from others in this same group.
QUESTION: Know the effects of histamine and that it is derived from histidine
histamine is bronchospastic and vasodilator
QUESTION: what is not true about histamine?…it is released by histamine
QUESTION: Benadryl (diphenhydramine) both are H1 blockers
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QUESTION: What is used for motion sickness? Diphenadryin (Benadryl)----I think this is scopolamine
QUESTION: What does diphenhydramine (Benadryl) cause? Xerostomia (anticholinergic,
antihistamine, sedative)
QUESTION: What property of topical diphenhydramine would alleviate pruritus (itching)? I put
anti-cholinergic NO  antihistamine
The antihistamine relieves itchy/watery eyes and itchy throat by blocking a substance
(histamine) released by allergies. The anticholinergic dries up a runny nose and the fluid that
runs down your throat causing itching/irritation.
QUESTION: what antihistaminic cause less drowsiness : H1 blocker 2nd generation zyrtec, allegra,
Claritin (loratidine), Clarinex (Desloratidine) Certizine (Zyrtec) because they don’t cross BBB,
poor CNS penetration
QUESTION: what antihistaminic cause less drowsiness : H1 blocker 2nd generation zyrtec,allegra,
Claritin because they don’t cross BBB
QUESTION: Which one of these has the least sedative effect? (2nd generation H1 blocker)
Diphenylhydramine/ Benadryl (Most)
chlorpheniramine- (LEAST)
Tripelennamine
QUESTION: Least sedating anti-histamine? (2nd generation H1 blocker)

QUESTION: Which antihistamine is least likely to cause drowsiness – Loratidine
QUESTION: Claritin/loratidine – second generation H1 blocker/antihistamine
QUESTION: WHAT DO YOU GIVE SOMEONE WHO IS ALLERGIC TO ESTERS AND AMIDES?
DIPHENHYDRAMINE (BENADRYL)
QUESTION: Which of the following (from a list of H1 blockers) would have slowest onset after IV
administration? Diphenyhydramine, loratadine.. didn’t recognize other options. IDK
Levocetirizine is listed as having an onset of action of one hour with duration of
greater than 24 hours, whereas loratadine has an onset of action within two hours
with duration of action of 24 hours. Hydroxyzine, a first generation antihistamine,
has an onset of action of two hours with duration of action of 24 hours.
QUESTION: How does antihistamines work? Competitive inhibition of histamine receptors

QUESTION: How does antihistamin work? – I put “competitively block histamine receptor”
QUESTION: actions of H1 antagonist. Blocks H1 receptors. Block vasodilation,
bronchconstriction, and capillary permeability. Vasoconstriction, bronchodilation, and
decrease capillary permeability
QUESTION: What property of diphenhydramine causes xerostomia?

a. Anticholinergic
b. Antihistaminic
c. Antimuscarinic
QUESTION: Diphenhydramine/benadryl use results in xerostomia due to its anticholinergic activity.
Side effects of Benadryl – dry mouth and throat, increased heart rate, pupil dilation (mydriasis),
urinary retention, constipation – anticholinergic
147
QUESTION: H2 antihistamine  Cimetidine – decrease ulcers H2 antihisamine ratidine****** that’s
answer
QUESTION: Histamine 2 blocker meds - for gastric reflux Cimetidine all the drugs with “dine”
are histamine 2 blockers
QUESTION: H2 drug. What is it best used for? Gastric ulcer
QUESTION: Histamine 2 blocker meds - for gastric reflux (block the action of histamine on parietal cells
in the stomach…ie. Cimetidine, ranitidine, famotidine, nizatidine…Xtina)
QUESTION: when would you use H2 blocker (they only gave the name cimetidine)- H2 Blocker
(reduce the acid secretion) for GERD (gastro esophageal reflux disease)
QUESTION: H2 antihistamines for (cimetidine ie tagamet) (ZANTAC = RANTIDINE) : gastric ulcers

QUESTION: Detailed mechanism questions on H1 (histamine)  compete with histamine to bind at H1
receptor sites.
QUESTION: effects of H1 blocker EXCEPT: (causes CNS depression)
a. CNS increase
b. CNS decrease
c. increase acid secretion
d. resp depression
e. local anesthesia
QUESTION: Pt is allergic to aspirin? Wat can u give, Tylenol #3 is acetomenophen and codeine. Just
tylenol
QUESTION: Wat does acetametaphine do with codeine? Increase its activity, increase how long its around
due to clearance,...
QUESTION: Why opioid analgesic containing both acetaminophen and hydrocodone so effective?
• acetaminophen and hydrocodone works differently, and combining these effects
makes it stronger* I put this, but not sure.
• acetaminophen blocks the binding of protein with hydrocodone, so hydrocodone
level in blood is high, so it is strong
Narcotics work in brain (CNS) while NSAIDS/acetomenophen work in peripheral tissues (PNS) –
2 diff mechanisms compliment each other for effective pain reduction
QUESTION: How do you treat acetaminophen overdose? I put n-acetylcysteine

QUESTION: What to give when there is overdose of acetaminophen, opioid analgesics? N-
acetylcysteine
QUESTION: Reversal of acethaminophen: NAC , N-acethylcysteine-liposome.
QUESTION: Tylenol- liver toxicity
QUESTION: Tylenol - can cause hepatotoxicity
QUESTION: Pt has hepatic dysfunction which pain medication can prescribe?
a-Oxycodone b. naproxen c-acetaminophen
QUESTION: what is relationship bet Tylenol and aspirin – anti pyretic and analagesic
QUESTION: Another Q: Difference: asprin is antimflammatory common: anti pyretic
148
QUESTION: Which of the following does not have anti-inflammatory action: Acetaminophen
QUESTION: Tylenol and acetaminophen: analgestic and antipyretic
QUESTION: Ibuprofen doesn’t cause as much GI upset as aspirin
QUESTION: Tylenol vs. NSAID: Apirin- reyes fever and adults GI, If liver problems give aspirin
QUESTION: Similarity between Advil and Tylenol: Anti-pyretic and analgesic
QUESTION: NSAIDs--> stimulate asthma attack-->COX inhibitor
QUESTION: NSAIDs – inhibit cyclooxygenase

QUESTION: NSAIDS are....
options included aspirin, Advil, tylenol
they are both irreversible and reversible
go with irreversible (aspirin)
(NSAIDs are a mix of the two…) ->advil = reversible
QUESTION: NSAID irreversible affect platelets
QUESTION: NSAIDS? Suppress inflammatory response (antiinflam, analgesic, antipyretic not

immunosupp)
QUESTION: NSAIDs – mech of action of suppressing platelets – inactivate cyclooxygenase  decreased

prostaglandin synthesis
QUESTION: Asprin stops pain by:
a. stopping the unpward transduction of pain signal in the spinal cord
b.intefere wiht signal intrepretation in the CNS
c. stopping the local signal produtction and transduction
d.stopping the signal transduction in the cortex  
QUESTION: what does NSAID do? Irreversibly block platelets, reversibly, inhibit instric, extrinsic
pathways..
QUESTION: NSAIDS...irreversible or reversible (question which of the following true about

NSAIDS)…answer 1 irreversibly binds answer 2 reversibily answer 3 somethong about bleeding
time answer 4 something about platelets
Cox 2 does not increase bleeding time and less platelet adhesion.
QUESTION: Nsaid least likely to effect stomach –(Rofecoxib…aka Vioxx...however taken off the market)
Cox 2 inhibitor CELEBREX
QUESTION: Dyspepsia =upset stomach what drug can cause it – Less likely to be acetaminophen,
ibuprofen (less GI upset than other nsaids).
QUESTION: Aspirin inhibits platelet aggregation
QUESTION: Plavix and aspirin: alter platelet function

QUESTION: What affect does Plavix has? Inhibits platelet aggregation.(Given to patients allergic to
aspirin) no ulcer side affect, give to patients with past ulcer history
QUESTION: Clopidogrel (Plavix) inhibits platelet aggregation irreversibly
149
QUESTION: Patient is taking baby aspirin.
a)how long before should you stop before surgery?
b)is it necessary to stop?
c) for long will the platelets be inhibited? 5-7days
QUESTION: aspirin stays in body for 7 days
QUESTION: For how long a single dose of aspirin will have effect on the platelets? 2h, 12h, 1 day, 10
days, 1 month – 10 days
QUESTION: After one effective dose of aspirin how long must you wait before there is not effect on
bleeding time (I said 1 week, I think it was an old exam q)
QUESTION: apirin - single dose - how much time- 4 hours, 1 day for baby aspirin (81mg, day)
aspirin is 325mg (to 650mg) q 4-6 hrs (max dose is 4000) 
QUESTION: aspirin is irreversible

QUESTION: Aspirin works on which pathway for pain?- Cyclo-ox pathway
QUESTION: Aspirin works how to inhibit bleeding?- Thrombox A2
QUESTION: Bleeding time: Inhibits thromboxane A2 preventings platelet synthesis
QUESTION: Differences between Bleeding time, PPT, which one it is affected by aspirin(BT)
QUESTION: Patient is on 3-5 grams acetylsylic acid per day for 3 months what is the most likely to see in
this patient?
Choices were
Increased PT and Bleeding time
Increased PT and PTT
Acidosis and increased bleeding time (I am not sure if the second part of this choice was bleeding time
but I rememberly I instantly picked this as soon as I saw acidosis, since acetylsyllic acid is aspirin and its
an acid and 3g daily is a lot!!!!
QUESTION: Pt. on saw palmetto what do u want to avoid? Aspirin
QUESTION: Saw palmetto enhances anticoagulants
QUESTION: which effects (that heighten, I think) anticoagulants...St. John’s wart, cammomile, saw
palmette, licorice(antiviral )
QUESTION: HERBAL supplement that potentiates anti-coagulation (CHAMOMILE DIRECT EFFECT)
a. St. John’s Wort

b. Saw Palmetto (this is what I put)
QUESTION: **Which herb complicates in someone on anticoagulants: st johns wort-dec immunity

in hiv pt on heart mehs and antidepressant, chamomile, ginko, ginseng-anti-platelet (at least 2
questions)
a. Chamomile not ot be had with anti-coagulats
QUESTION: Which one has anticoagulant properties? – St John’s Wort – nope. it’s the saw palmetto
QUESTION: Which one has anticoagulant properties? – Saw palmetto
QUESTION: ibuprofen allergy, dont give aspirin
QUESTION: Allergic to Aspirin? Take acetaminophen. DO NOT take ibuprofen.
QUESTION: similar question: Pt has reaction to aspirin, cannot give what else? Ibuprofen (only nsaid in
the answers)
One very important point is that most NSAID's (or Non-steroidal anti-inflammartory drugs) cross-react
with aspirin - meaning that they can cause the same types of reactions in aspirin sensitive people
QUESTION: If someone can’t take ibuprofen what can u give them?
150
a. aspirin
b. demerol narcotic w/out aspirin
c. pentazocaine - narcotic w/aspirin
QUESTION: Which statement is correct for Ibuprofen?
• ceiling analgesia at 400mg
• safe use for pt w/ peptic ulcer
• safe to use for pt w/
QUESTION: Methotrexate toxicity increases with use of nsaids or penicillin
QUESTION: No NSAIDs for asthmatic patient
QUESTION: in asthmatic patient===nsaid contraindications - NSAIDS cause bronchospasm.
QUESTION: Asthma patient: NSAID contraindication

QUESTION: What causes asthma: NSAID (aspirin)
QUESTION: longterm asthma give corticosteroid
QUESTION: Long acting Corticosteroid – Dexamethasone

QUESTION: What doesn’t affect platelets of list of NSAIDS: Celebrex
QUESTION: Celebrex- Cox 2!!!
QUESTION: Celebrex (cox 2) doesn’t stop bleeding? It causes bleeding as a side effect
QUESTION: Does NOT have an affect on platelets (from list of NSAIDS): Celebrex/celecoxib is a
NSAID
QUESTION: Something about arachidonic acid breakdown….Prostaglandin? Bradykinin?
QUESTION: Oral Ketorolac: NSAID,usually used after IV dose of Ketorolac after surgery
Ketorolac (toradol) can be given orally or IM. Ketorolac is used to relieve moderately
severe pain, usually pain that occurs after an operation or other painful procedure.
The speed of absorption is faster for intramuscular injection compared to

subcutaneous injection. This is because the muscle tissue has a greater blood
supply than the area just under the skin. Muscle tissue may also hold a larger
volume of medication than subcutaneous tissue.
QUESTION: Ketoralac is an NSAID that inhibits prostoglandin synthesis (competitive non-selective

cox inhib)
QUESTION: What med to give for moderate post-op extraction pain? Ibuprofen, Acetaminophen, NSAID,
opioid
QUESTION: pt has mild pain from ortho. What med NOT to give?
• Aspirin
• Ibuprofen
• Hydrocodone *
• Naproxen
151
QUESTION: What would you prefer for a patient with renal vascular disease & why?
a.acetaminophen (the other drugs are nsaids and they affect the kidney in a more negative way. This
drug affects the liver and causes liver toxicity.)
b.aspirin
c.ketorolac
d.ibuprofen
QUESTION: Tylenol – non-narcotic analgesic of choice for pt taking anti-coagulants – no anti-inflamm.

Properties
QUESTION: For pregnant- only give Tylenol- NOTHING WITH CODEINE
QUESTION: Pregnant patient (third trimester) needs pain medication – options: Tylenol 325mg,
Tylenol 3m aspirin, or ibuprofen 600mg?
QUESTION: Pateint is pregnant and needs 2 teeth extracted, needs postop analgesic what do you rx:
ibuprofen vs aspirin vs Tylenol 3 vs regular Tylenol (I said acetaminophen)
QUESTION: Patient pregnant, what NSAID-Acetametaphin

QUESTION: What is a safe pain killer to give a woman who is pregnant? Tylenol (answer)
QUESTION: Breastfeeding mother don’t give her What? I was expecting tetracycline but it wasn’t there
so I put Propoxyphene because it has aspirin. Maybe could cause Reyes
QUESTION: do not give which medication to lactating female? Codiene and tetracycline
QUESTION: do not give which medication to lactating female? codiene (yes)
FDA pregnancy category C. This medication may be harmful to an unborn baby, and could cause
breathing problems or addiction/withdrawal symptoms in a newborn.
QUESTION: Kid has pain – acetominophen
QUESTION: What would you give to 5 year old for pain: Give Tylenol
QUESTION: What analgesic do you give a child with Asthma? Tylenol

QUESTION: Asthmatic only use Tylenol (not aspirin bc of hypervent)
QUESTION: Kids w fever- tylenol
QUESTION: 5 year old patient with fever and pain
• Codeine
• Tylenol
• Asprin
• NSAID
QUESTION: DEA schedules there drugs by their toxicity ABUSE POTENTIAL or dependency
potential
QUESTION: DEA – classifies drugs on addiction
QUESTION: DEA number required for prescribing opioids/narcotics, like codeine, oxycodeine, etc
QUESTION: dentist cant write prescription for schedule class 2 for back pain.
QUESTION: What is not true of drugs? Schedule II drugs cannot get refill without script . the
following are true:
o Schedule 3, 4, 5 drugs CAN be filled over the phone.
o Scripts must have patients name and address
o DEA number must be on each script
QUESTION: Oxycodone, Hydrocodone: schedule 2
152
QUESTION: What can be combined with tylenol to make it a level 2…oxycodone, codeine etc.
Tylenol 1 = 8mg codeine ; Tylenol 2 = 15mg codeine ; Tylenol 3 = 30 mg Codeine ; Tylenol 4 =
60mg Codeine
QUESTION Which one is a class 2 narcotic? Vicodin, percoset, hydrocodone
QUESTION Vicodin schedule?: 2 acetaminophen + Hydrocodone

QUESTION Percocet schedule: 2 acetaminophen + Oxycodone
QUESTION LESS than 15 mg of hydrocodone per dosage unit is schedule 2
QUESTION schedule 2: combination products containing less than 15 milligrams of hydrocodone

per dosage unit (Vicodin®)
QUESTION Schedule 3: products containing less than 90 milligrams of codeine per dosage unit
(Tylenol – acetaminophen- with codeine®).
QUESTION schedule 4 narcotic is propoxyphene (Darvon® and Darvocet-N 100®). alprazolam
(Xanax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam
(Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).
QUESTION: Drug schedules II or III – they are all acetaminophen with opioid except for one that
was hydrocodene with nsaid (vicoprofen)
QUESTION: Schedule II drug- Percocet (it didn’t say oxycodone so know that Percocet is oxycodone
and Tylenol)
QUESTION: Schedule II narcotic and antipsychotic neuroleptic analgesia
QUESTION: if a guy wants to relieve his pain for 8 hours- ibuprofen, naproxen, Tylenol, aspirin
QUESTION: If a patient had some teeth extracted and asked what drug he can take that’ll provide at
least 8 hours of relief
a. Tylenol
b. Ibuprofen
c. NAPROXEN- this is what I put
QUESTION: Naproxen 8hr nsaid

QUESTION: Pt. has pain and wants to sleep for eight hours? Naproxen --- a nonselective cox inhibitor—
nsaid
QUESTION: What are you worried about when a patient is on Naproxin? (DDI w/ aspirin antiplatelet
activity)
QUESTION: Which of the following has least effect on platlets/bleeding?
• Aspirin
• Ibuprofen
• Naproxin
• Difluzole (vaginal candidiasis medication)
Biopsy:
QUESTION: Pt has worn denture for 19 years, now he has a sore on Buccal with swelling what do
you do: refer out, biopsy, cytology, Relieve denture in area and re-evaluate in 2 weeks
QUESTION: White patch on buccal mucusa? Whats best way to get biopsy?? Smear**
153
QUESTION: You have a lesion in mouth, you tried to treat it, still looks the same after 2 weeks –
Take biopsy
QUESTION: You have a lesion in mouth, you tried to treat it, still looks the same after 2 weeks – Take
biopsy
QUESTION: Patient comes in with preliminary diagnosis of candidiasis on ventral tongue and floor of
mouth, white lesion rough and firmly attached. What do you do? Incisional biopsy, Do cultural testing
and confirm that it is/is not candidiasis
 I chose confirm/deny with cultural test because leukoplakia is when you have no other
differential but idk cuz you have to biopsy leukoplakia and the lesion looked like it.
QUESTION: Oral candidiasis biopsy of choice is – incisional biopsy, excisional biopsy, brush biopsy
(collects the cells for cytological smear), cytomologic smear
QUESTION: Biopsy - indicated when treatment doesn’t work after 14-20 days
QUESTION: When do u have to do a biopsy- I wrote if can’t treat in 10-14days**about 2 weeks—any red
or white lesion that doesn’t resolve itself in two weeks – BIOPSY THAT SHIT
QUESTION: When to do biopsy? whenever there is a progressive metasis even though antibiotics are rx
QUESTION: White lesion 2x3x2 cm – excisional biopsy, incisional biopsy, smear
QUESTION: What should you not do initially with a patient with desquamative gingivitis--> BIOPSY,
topical corticosteroids (other choices were, encourage OH)
QUESTION: When you do biopsy, how do you store the specimen before it gets to oral pathologist? 1.
Formalin (answer)
QUESTION: Patient has a sore, shiny red area that when you blow air on it, a white membrane
comes off and the sore starts bleeding. What should you do? Culture and Medical
management (Or biopsy + Med Man)
QUESTION: To test for malignancy what test? Cytology, brush biopsy, etc? Incisional biopsy
QUESTION: Difference between incisional and excisional biopsy
Notes:
Incisional biopsy is a technique used when a lesion is large >1 cm, polymorphic suscpicious for
malignancy, or in an anatomic area with high morbidity,
Excisional biopsy is used on smaller lesions <1cm that appear benign and on small vascular and
pigmented lesions. It entails the removal of the entire lesion and a perimeter of surrounding
uninvolved tissue margin.
Implant:
QUESTION: Diff btween 1 stage and 2 stage, immediate loading vs traditional way
QUESTION: Similarity between bone and implant? Vascular bundle below the bone
QUESTION: What kind of bacteria is under implants? At the apex of root canal?
Gram negative, Gram positive, Cocci, filament, rods. Know each.
Gram (-), rods and filaments anaerobic
Strict anaerobes are predominate in endo
QUESTION: What bacteria is responsible for implant falure?- gram – anaerobics
QUESTION: Bacteria around failing implants? Gram negative,motile, strictly anaerobics

QUESTION: best area to place implant? Anterior mand or posterior mand wasn’t sure
QUESTION: best bone to implant in --- apparently ant md? WORST: post mx
154
QUESTION: when an implant placement where in the least success: MAXILLARY POSTERIOR
QUESTION: Implants osteointergrate best in ? anterior mandible

QUESTION: Best area to place implants? – Anterior Mandible
QUESTION: best reasoning for implant in max lateral
a. no rest on central & canine
QUESTION: what is the least important factor when evaluating for implant: ( concavity of mandible,
bone density , distance to mandibalr cancal, bone width)
QUESTION: Bone should not reach temperatures above? (temperature in Celsius) 47 for 1 min 40
for 7 mins
QUESTION: What is the limit before bone dies in implant procedure (in Celcius!): 47 for 1-5 minutes
QUESTION: Max temperature for bone in implants 47*C
QUESTION: Temperature you don’t want to exceed during implant placement? They had 26, 36, 56. No
47. I chose 56
QUESTION: implant to implant – 3mm
QUESTION: Distance between adjacent implants minimum? 3 mm
QUESTION: Distance between two implants: 3mm
QUESTION: Space between 2 adjacent implants 3mm. 1.5mm teeth
QUESTION: How much space between implant and tooth? Answers were 1.5, 2, 3.5 3,
QUESTION: space from implant to nerve needed…2 mm
QUESTION: Implant diameter is 3.75 mm. What is the minimum labiolingual distance required? 5.75mm
QUESTION: Minimum width (bucco-lingually) bone should be for 4mm diameter implant
Choices were 5mm and 7mm  I put 7mm (4 for diameter + 1mm each side = 6)
QUESTION: Minimum ridge width for 4mm implant is?

a. 6mm
b. 8mm
c. 4mm
d. 10mm
QUESTION: if implant with width of 4 is used what should be the bucolingual width of the ridge----6
Need 1mm bone on each side (facial and lingual)
minimum Vertical height of bone to place implant - 10mm (according to decks)
minimum Width of bone is 6mm
minimum distance of apex of implant From nerve - 2mm
155
platform of implant from adjacent CEJ - 2-3 mm
between implants 3mm
between implant and tooth (height of coutour) is 1mm
Mini implant is 2.4mm
QUESTION: When there is FPD from natural tooth to implant, the max stress is concentrated on the
SUPERIOR PORTION OF THE IMPLANT.
QUESTION: If implant and bridge are done with natural tooth, what is the complication?, there is a
lot of force on crown of implant and cause fracture.  diff mobility
QUESTION: how does fibers grow from crest of bone to implant?

Perpendicular with implant, parallel with implant, other options that didn’t make sense
QUESTION: How does gingival fibers orient next to implant – parallel to implant with no insertion,
perpendicular with insertion, parallel with cuff, perpendicular with cuff.
QUESTION: Tissue around implant? PARALLELL WITH CUFF LIKE
QUESTION: How does gingival fibers orient next to implant – parallel with cuff, (Parallel and/or circular
to implant surface)
Periodontium surrounding the implant: no periodontium, bone and implant.(false)
You have long JE and ct (parallel and circular only)
Periodontium = gingival, pdl, cementum, and bone
QUESTION: CASE: Case shows a picture of a bridge, when you look at it closely it resembles a
Maryland bridge because lateral is intact. What to do if Maryland is removed?
-regular bridge
-implant- she answered this because lateral was intact.
QUESTION: know implants CI:

uncontrolled diabetes
immunocompromised patients
volume and height of bone(anatomic considerations)
bisphosphonate therary
bruxism
tobacco(relative)
cleft palate
young kids
QUESTION: Contraindications to implant placement? Adolescents should not get implants.

QUESTION: never place implants in a patient that had cleft palate
QUESTION: Bruxism is implant CI
QUESTION: Old people can get implants
QUESTION: Implants not CONTRAINDICATED – older patient
QUESTION: All affect implant placement EXCEPT – smoking 1 pack a day, cardiovascular disease,
uncontrolled diabetes, radiation of 60 Gy
QUESTION: Does not affect implant success? Age
156
QUESTION: All these are contributing factors for why implant wud fail in this pt except: smoking,
diabetes, AGE, etc. (AGE)
QUESTION: Implant treatment better option for smoker than perio surgery because perio surgery
in smoker doesn’t work as well as non-smoker.
a. Both statements are true but unrelated
b. Both statements true and related
c. First statement true but reason is not
d. Neither the statement or the reason is true
QUESTION: When getting crown for implant, what occlusal scheme is preferred? metal occlusal is
preferred
QUESTION: When you use screw over cement retained? when you don't have space occlusally,
use screw
 need more interocclusal space for cemented
QUESTION: What is the purpose of hex screw? Antirotational
QUESTION: External hex function: anti-rotation
QUESTION: Implant internal component helps with what? Prevents rotation of the abutment
QUESTION: Hex screw implant – prevent rotation of the crown
QUESTION: A lot of implants have external hex-what is it used for?

• Stabilization of abutment
• For cementation
QUESTION: What is the component of the implant that replicates implant in cast? ---analogue
QUESTION: What is most important for osteointegration in implant procedures? – How well the surgical
procedure is managed.
QUESTION: Osteointegration of implants should be assessed:
prior to placement of restorative abutment- That’s why you torque before restoration.
QUESTION: At what appointment do you first check osseointegration-2nd stage surgery I think
QUESTION: When do you check osteointegration? Before place of abutment

QUESTION: when can you tell the an implant is osseointegrated : a)before taking the final
impression. B)before placing the abutment c) before cementing the crown
QUESTION: All of the following are true about Surgical stents, except? – It tells you the number of
implants you can place. (Other choices were, angulation of implant, location implant, thickness of
implant. I think number of implants to be placed is decided before the stent at the time of CT xray or
during a consult)
QUESTION: why do you use a stent? – make sure implants are aligned properly
QUESTION: Implant question: surgical template for angulation of bur for implant placement
QUESTION: implant guides and what info it relates to the surgeon: location, angulation, size,
number of implants
157
QUESTION: What will you do when implant is inclined too buccally and you don’t want the screw to
be seen on the buccal surface of crown? Angled abutment
QUESTION: implant placed in facial angulation, what do you do to prevent facial access for screw
abutment? I said place an angled abutment and cement it down; other options is correct implant
placement or put composite where facial access for screw will be
QUESTION: Implant placed at angle where screw hole will be on buccal surface. What do you do so
that you can’t see screw on buccal?
Cover with composite?
Angled abutment cemented?
Remove implant?
QUESTION: implant is angled to facial, use custom abutment

QUESTION: Preload of implant is comparable to what force
a. torque
b. compressive
A compressive force presses the components of the system together and normally does not
introduce any mechanical problems in the anchorage unit itself. On the other hand, tensile loading
refers to a force that tends to separate components
QUESTION: What is the problem with preloading a screw implant? Low loading can make it loose, high
loading can make it loose, low loading can lead to implant creep or something, high loading can lead to
implant creep (wtf)
High frictional forces between components decrease as a result of Creep leads to a decrease in preload
QUESTION: In an appointment for the impression of implant what do you do first? put the coping
first
QUESTION: What do you want to do first when taking an impression of the implant and abutment
splinting the 3 implants with a bar?- Make sure the abut is attached right when the pt comes in others
were check fit of custom tray, incert impression coaping, insert imp coaping with acrylic.
QUESTION: Advantages of an open tray impression

Advantage to open tray technique: Reduce effect of implant angulation
QUESTION: open technique impression for implant: to transfer the exact angle of implant to the lab
Open tray: pick up, reduces effect of implant angulation, don’t have to put coping back into
impression, impression material not deformed. Open tray is more accurate
Closed tray: transfer, easier, better for shorter interarch distance, more accurate, not
suitable for deep implants, don’t work for nonparallel implants
QUESTION: Mobility in implants is failure, remove and greft

QUESTION: Implant success is determined by what? – Mobility
QUESTION: During uncovering, you realized implant is mobile and there is bone loss - failed
implant, take it out!
QUESTION: What main reason implants fail? Surgical error , Lack of early loading , Inadequate
occlusal design
158
QUESTION: Most common implant failure due to Screw loosening, occulsal loading, Does not
osseointegrate
QUESTION: Most common complication for crown? screw loosening
QUESTION: 10-year success rate: -I think its 80 for 10yrs and 85 for 5yrs; what is most common
reason of failure
QUESTION: Most important thing about implant success (in the procedure the things are most important
for osseointegration)
QUESTION: Major mechanisms for the destruction of osseointegration are
Related to surgical technique
o Similar to those of natural teeth
related to implant material
related to nutrition
QUESTION: Why implant fails: no osseointegration
QUESTION: What causes the greatest incidence of implant failure? Overheating not smoking.
QUESTION: What is the worst type of force for an implant? Horizontal.
QUESTION: When you place a implant, widening of crestal bone is seen because of which force?
horizontal
QUESTION: What main reason implants fail

Surgical error
Lack of early loading
Inadequate occlusal design
QUESTION: Most likely to cause implant to fail?

Smoking
Osteoporosis with HTN
Hypotension
Allergy to antibiotics
QUESTION: What causes the least buccal-lingual resistance to lateral forces
Two 5mm diameter splinted implants
Two 4mm diameter splinted implants…I chose this but idk
One 5mm diameter implant
QUESTION: What is the strongest from lateral force…2, 5mm implants splinted together, 1 single 4 mm
wide implant, etc,
QUESTION: What causes the least buccal-lingual resistance to lateral forces?
159
QUESTION: In anterior maxilla, for a 4mm diameter implant, how far apical to the CEJ of adjacent tooth
for optimal emergence profile`
CHOICES WERE:
1 mm above cej of adj tooth
1 mm below cej of adj tooth
2-4 mm below cej of adj tooth… I chose this
another one I cant remember
for optimal emergence profile
CHOICES WERE:
2-4 mm below CEJ of adj tooth…I chose this
ANSWER IS 2-3mm below CEJ
QUESTION: Implant…BELOW the gingiva (for better esthetics)

QUESTION: implants placed 2-3mm below adjacent tooth
QUESTION: where should you put implant platform in esthetic area (at level of alv.crest/ below
opposing tooth gingiva, etc.) I didn’t know answer, just went with whatever put it subg
a. 1mm subgingival to adjacent teeth CEJ
QUESTION: To obtain ideal emergence profile, where should the Implant head be in relation to
adjacent gingival margin? 1-2mm above, 3-5 mm above, same level, 1-2 mm apical
QUESTION: If you want the most natural emergence profile for an implant, how far should the
head be from the gingival? I put 2-3 mm apical
QUESTION: Cervical position while placing an implant-How much below CEJ? (3mm…Xtina) **Rest
platforms placed 2-3 mm below adjacent CEJ. Implant 5 mm from mental foramen, because nerve loops
out 4 mm. Implant 2 mm from vital structures. At least 1 mm of bone all around implant. 1.5 mm of bone
between implant and adjacent tooth. 3 mm of space between adjacent implants.
QUESTION: how far up or down from tissue should the implant be placed in relation to adjacent CEJ
***implant platform should be 2-3 mm below adjacent CEJ
QUESTION: Where should implant / abutment interface ideally be?
A: At height of alveolar crest
QUESTION: Trauma from occlusion in implants – no gingivitis
QUESTION: All are symptoms of TFO (trauma from occlusion) on an implant except. Gingivitis, pain,
loosening of implant, breakage of abutment screw.
QUESTION: What evidence is not seen in failed implants: something about gingivitis
QUESTION: 1mm crestal bone remains around implant after 1 year, why? inflammation, heavy occlusal
load,
QUESTION: Which of these show clinically acceptable results of implant placement? ;Periimplant
pathoses, implant mobility, .ans. bone loss less than .1mm per yr or
QUESTION: Implant success criteria--- I think choices included mobility,
(ONLINE) The basic criteria for implant success are?
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immobility, absence of peri-implant radiolucency, adequate width of the attached gingiva,
absence of infection
Average bone loss of 0.2mm for the first year is acceptable
QUESTION: Whats the worst thing you can do to a tooth you plan to re-implant right before you do so?-
Scrape the tooth with a curret.
QUESTION: How does titanium of an implant help in osseointegration? Forms titanium oxide
layer
QUESTION: If doing implant for that area where supposed radiopacity? What are your
considerations; interocclusal height or width; would you excise lesion? NO
QUESTION: Check to see when your placing implants, whether or not radiopaque lesions are of
concerns?
QUESTION: Which of the following is bad for placing implants except…radiopaque
QUESTION: When placing implant mandibular posterior how do you ensure you don’t hit IAN? Look
at panorex and measure with mm caliper, look at PA and put some screen over to measure,
move the nerve down and “be very careful when placing implant”
QUESTION: implant supported bridges and one doesn’t fit.
Section and index
QUESTION: At the time of delivery of an implant supported prosthesis, only 2 of the 3 implants
seat. What do you do next? I put separate the prosthesis and re-index it
QUESTION: Implant retained fixed prosthesis, doctor took radiograph and it showed 2 out of 3 implants
seat positively with good margin. What should doctor do after?
• section and index* This is what I put but not sure
• tighten screw
• take another x-ray
QUESTION: Which one is true about implant placement? – High Torque (other choices were high speed,
etc) **handpieces for implants are low speed and high torque
QUESTION: what speed and torque for implant is used: High Torque, slow speed
QUESTION: use high torque for implant: Implant handpiece = High torque, low speed
QUESTION: Use slow speed handpiece and high torque drill to place implants
QUESTION: Which one is true about implant placement? – High Torque low speed
QUESTION: Which of these is not a consideration for replacing patients lower molars with implants?
Bone quality in the area? (I don’t think that’s the answer, cuz it is but he says in mandibular it should
always be good)
QUESTION: Pano given, sinus very low, what should be done prior to implant? Bone graft should be
done
QUESTION: Max sinus lift implants
QUESTION: In implant preparation, which of the following can be used? A) hydroxyapatite irrigation b)
High Speed Hand Piece c) Low torque Drill d)Air Coolant. IT SAYS COOLING SALINE SPRAY IN
FIRST AID
QUESTION: water is used when implant placement- cooling
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QUESTION: Why you use irrigation in implant surgery? – To prevent bone from over heating. (other
options were to keep it clean, etc)
QUESTION: Why you use irrigation in implant surgery? – To prevent bone from over heating.
QUESTION: Why do you irrigate while preparing osteotomy for implant: keep bone cool (but clear
blood to visualize and remove debris make sense)
QUESTION: When doing an osteotomy for implant placement why do you use saline: to help cool
down the bone
QUESTION: When placing an implant, you keep the temperature of the bone below 56 degrees C how?
Alkaline irrigation,
QUESTION: Percent of implants that are successful after 10 years: think its 80%.
QUESTION: What is the success rate of implants in 10 years? I put 90% (80)
QUESTION: % of implant success after 10 years : 95 %
QUESTION: When not to immediately load an implant
• Denture in contact
• Bone grafting with GTR: ans
QUESTION: Implant supported RPD, where to put occlusal rests None
QUESTION: where do you put occlusal rests for implant abutment rpd? NONE!!!!
QUESTION: I believe u can place implant in patient who has INR less than 2.5 *uhhh normal INR =
1…and higher INRO leads to a higher chance of bleeding.. People on anticoags INR range is around 2-3
or on higher doses 2.5-3.5
QUESTION: 13y/o present for implants : wait until 18-20 y/o
QUESTION: how to clean implants (os decks) ** Plastic scaler
QUESTION: implants, which instrument is ok to use for perio? plastic perio probe
QUESTION: Do we probe like normal for an implant?

A. No because you will disturb the epithelial attachment
B. I put yes. It didn’t say anything about a plastic probe being available but it seems like we still
would have to probe.
QUESTION: How to clean implant- prophy cup, plastic, not stainless steel!
QUESTION: indications for implants vs fixed partials
QUESTION: type of epithelial and connective tissue attachment to implants

QUESTION: Implant interface- how does CT and epithelium react? Like normal or not (for each)
QUESTION: Pt has an implant. Do the connective tissue and epithelium attach the same as they do to
natural tooth, meaning biological width?
A. Both attach the same
B. Neither attach the same
C. epi attaches the same but not connective tissue**
D. CT attaches the same but not Epi.
QUESTION: Epithelial attachment for implat?
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• Hemidesmosome* (epithelial attachment to tooth structure and implant are the
same)
• fibronectin
QUESTION: You are considering the placement of an upper and lower important retained complete
denture. How many implants will you place in the anterior region?
a. maxillary one and mandibular one
b. maxillary two and mandibular two
c. maxillary four and mandibular two
d. maxillary four and mandibular six
QUESTION: After implant placement, an edentulous patient should:

a. avoid wearing anything for 2 weeks
b. immediately have healing abutments placed over the implants
c. should wear an immediate denture to protect the implant site
QUESTION: esthetics of a max central anterior implant replacement determined

• adjacent tissue
• perio of other maxillary central
• wax up to full contour (did not understand this question)
QUESTION: When palciing implant in max central, most important thing to consider in esthetics:
emergence proifile, perio health of adjacent tissues
Extraction:
QUESTION: 13 year old had 2 bombed out molars, asked what treatment is best: extractions,
extractions followed by implants, extractions followed by RPD, Root Canal and Crown
QUESTION: extracting upper posterior molars…order of extraction and reason? First, second then
third molar for visualization, 3rd,2nd,1st to prevent fracture of tuberosity, then the other
options didn’t make sense.
QUESTION: order of tooth extraction…1st molar, 2nd then 3rd for visualization or 3rd then 2nd then 1st to
spare tuberosity MAXILLARY Teeth first and MOST POSTERIOR TEETH FIRST
QUESTION: Same old question of where is the max 3rd molar most likely to be displaced?
A. infratemporal fossa**
B. maxillary sinus
QUESTION: When extracting 3rd molar, which space is it most likely to become dislodged in
QUESTION: What is the most common impacted tooth? Maxillary K-9. (after 3rdmolars? Xtina)
QUESTION: The most frequently IMPACTED teeth are MANDIBULAR 3rd MOLARS (followed by
maxillary 3rd molars and maxillary canines).
QUESTION: Most common impacted tooth? (3rd molars not an option) – max canines
QUESTION: Most impacted tooth? Maxillary canines
QUESTION: Which tooth is least likely to be missing – I said canine (other options are 2nd pm, lat
inc, and 3rd molar)
QUESTION: What is least missing tooth congenitally? – canines, premolars, 3rd molars, lateral incisors
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QUESTION: What is least missing tooth congenitally? –(others were 3rd molars, lateral incisors,
canines) nope. canine is the best option. of all 32 teeth the 2nd mand premolar is the 3rd MOST
congenitally missing. #1: 3rd molars, #2 max lateral.
QUESTION: Least congenital missing tooth (most 3rd molars, mand 2nd premolars, lateral incisors,
max 2nd premolars)
extractions in ortho tx : max 1st premolars.

extraction of molars with divergent roots :hemisection
QUESTION: Easy to extract impaction in max tooth:
-Distoangular, Maxillary: maxillary 3rd molars, mesioangular impactions are the most
difficult to remove, while vertical and distoangular impactions
are the easiest to remove.
-Mesioangular: Mandibular
QUESTION: In which direction do you luxate distoangular max third molar? distal palatal,
distobuccal ,palatal, mesial
QUESTION: #32 - Complete bony impaction, horizontal…main concern? Excessive bleeding,

damage to nerve, etc. (he put damage to nerve)
QUESTION: #16 - half in bone, half in gum  most common kind of impaction & easiest to take out
(both FALSE)
QUESTION: FMX, question about right side of patient, #1 and #32 were both impacted, how would you
describe these impacted teeth? - #1 disto-angular impaction, #32 horizontal impaction (other choices had
other angulations, but with FMX, it should be straightforward to guess them right)
QUESTION: most important in eruption: sequence
QUESTION: RL under the furcation in primary teeth?
1. Diagnosis is pulpal necrosis
2. Treatment: EXTRACTION
QUESTION: ectopic eruption of mand 1st molar in relation to primary mand 2nd molar cause some
resorption –management: extraction of 2nd molar, separation, disking of 2nd molar
QUESTION: When you extract 3rd molar, inform possible damage. Extraction of lower 3/2 molar dmg to
lingual nerve
QUESTION: Greatest risk to injure IA nerve on extraction of third:
Lack of visualization of end of roots
Root tips sit on top of mandibular canal
Horizontal impaction
Forgot last option
QUESTION: Most likely to cause nerve damage during extraction? Nerve canal overlaps apices?,
nerve canal narrows
QUESTION: Mylohyoid surgery can accidentally damage to what nerve? Lingual nerve
QUESTION: where is most likely to damage a nerve in vertical release of flap : lingual, wharton’s
duct and the sublingual gland ( avoid vertical incisions in lingual and palatal )
QUESTION: where is most likely to damage a nerve in vertical realese of flap : lingual, wharton’s
duct and the sublingual gland ( avoid vertical insicions in lingual and palatal )
QUESTION: Doing flap surgery on mandible, what structure do you watch for? I put
mental nerve (If 3rd molar TE= Lingual)
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QUESTION: Doing flap surgery on mandible, what structure do you watch for? mental nerve mentalis
attachment
QUESTION: Where does man branch of trigeminal nerve come thru? Ovale
QUESTION: Old guy with impacted 3rd molar, whats indication for extraction?
QUESTION: Indication to extract third—choices were making space for ortho, prevent crowding, pt has
pain during eruption, there’s an infection
QUESTION: 65 yo has hypertension and congestive heart disease, referred to you to TE impacted molar,
absolute indication to do the TE is when – radiograph shows bone pathology prevent distal pocket of
2nd molar, prevent jaw fracture, prevent distal caries for 2nd molar
QUESTION: Old patient, medically compromised with impacted molar extraction, only reason to extract
them is? if you notice pathology
QUESTION: Patient has pain, trismus, inflammation for 3rd molar – TE
QUESTION: Know pericorinitis treatment, question had nothing to do with surgery though.
Wout surgery…clean and antibiotics
With surgery…. Before surgery..control infection. IND, irrigate drain, antibiotics, then remove the 3rd
molar
QUESTION: MOST common complication of extracdtion? Hemorge, infection, root fracture?
QUESTION: Radiograph of mandibular molar extraction sight. Patient came back having pain and
puss in that area: did not have dry socket as a choice??? Infection? osteomyletits
QUESTION: A picture of Occlusal radiograph with a lot of bone resorption - patient has pain and
something was draining after few weeks of EXT – Osteomylitis (other were radicular cyst, lateral cyst,
etc) Osteomyelitis common following tooth extraction -- bone infx
QUESTION: Xray of Older woman tooth extract 3 years ago, still hurts and exudate, shows (cotton-wool
radiograph, "prob wrong") what is it? Residual cyst, osteomyelitis, 2 other lesions that are radiolucent
QUESTION: X ray: pt had tooth extraction 3 years ago at site, now site has draining tract and painful, x-
ray shows a radiolucent area over ridge no teeth around area—forgot the answer choices
QUESTION: You got patient with Osteomylitis, after EXT, what do you do? you clean the walls of the
socket to remove infection)
QUESTION: patient w/ Osteomyelitis, after EXT, what do you do? I said put dressing in hole (wrong,
you curretage the walls of the socket to remove infection) (Mosby says…for acute treat with appropriate
antibiotic and drainage of lesion…for chronic treat with antibiotics and sequestrectomy…Xtina)
QUESTION: Premolar with huge MO amalgam and recurrent caries and if needing saving needed CL,
endo and crown-didn’t have all there options so i put extraction because C:R ratio would have been
bad
QUESTION: Extraction #30 which way would you section? B-L

QUESTION: Extraction of #30 which way do you section: Buccal- lingual
QUESTION: After fx a mesial root tip on a molar extraction whats the first thing you do?- get hemostasis
and visualive the root. Others, take an xray, pick at it with root pick, surgical retrieval
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QUESTION: resorption of bone takes place in which direction after extraction----
downward/inward,downward outward,forward inward (something)
QUESTION: Aderall 5 yr old kid on prescription. needs an extraction. do u higher the dose? lower
the dose? no change?
QUESTION: Which direct do you luxate tooth #1 and #16? – Distally and Bucally
QUESTION: which direction do you luxate the tooth --**Children: Palatally, bc molars are positioned
more palatally and palatal root strongest. Adults: bucally!!!
QUESTION: Patient is about to undergo radiotherapy, what do you? – EXT all questionable teeth before
radiation. (another answer said, EXT all teeth before radiation)
QUESTION: Patient is taking IV bisphosphanates and need TE – RCT then coronotomy and seal,
hyperbaric oxygen followed by TE, antibiotics and TE, Bisphoshanates.
QUESTION: A patient has begun radiation therapy in the mandible and needs teeth extracted. What do
you do?
DO endo, and amputate the crown without any trauma to soft tissue or bone
QUESTION: A patient received radiation therapy and requires extraction,what should the treatment
be? Extraction, extraction with alveoloplasty and sutures, extraction with alveoloplasty of basal
bone and suture, pre-extraction and post-extraction hyperbaric oxygen
QUESTION: Best tx for bisphosphonate iv patient? 1. Best tx is do rct and section crown off (as oppose to
ext) (answer), 2. Atraumatic ext, 3. Ext under hyperbaric oxygen. The answer was confirm by oral
surgeon.
QUESTION: It pt has been on IV bisphosphonates for two eyars? Do root canals and keep roots,
no exts
QUESTION: Look up side effects of bisphosphonates. Contraindicated except?  RCT is ok!!!!!!!
QUESTION: All of the following are contraindicated for bisphosphonates, except? – Do RCT (other
choices were invasive procedures)
QUESTION: Pt on IV bisphosphonates for 6 months needs tooth extracted what do you do? Atraumatic
extraction, hyperbaric oxygen and then extract, try to do RCT or some other form of restoration
QUESTION: Patient taking bisphosphonates for 6 months, but now needs extractions. Nontraumatic
extraction? Or hyperbaric oxygen and then extraction
QUESTION: Patient is on 6 months of bosphophanate therapy what do u do? Hypo dives and extract,
atraumatic extraction, or endo with crownectomy and place sealants
QUESTION: Pt on IV bisphosphonates for 6 months needs tooth extracted what do you do?
Atraumatic extraction, hyperbaric oxygen and then extract, try to do RCT or some other form of
restoration
QUESTION: if Pt takin biphosphonates for 3 years and tooth non restorable what is the Tx : a) endo
of remaning root b) extraction …. Etc Extract + Abx
QUESTION: pt has history of osteonecrosis and need to do extraction: can do under hyperbaric o2
QUESTION: pat has history of osteonecrosis and need to do extraction: give hyperbaric o2
QUESTION: Iv bisphosphonates and extractions are needed-what do you do? (hyperbaric O2 dives)
QUESTION: Patient has bronj and bone is exposed, what is treatment? hyperbaric oxygen, sc/rp,
chlorhexidine rinse (antibacterial rinse, and oral antibiotics)
QUESTION: Osteoradionecrosis: Swelling, degeneration and necrosis of the blood vessels with
resulting thickening of the vessel wall. Use hyperbaric for angiogenesis
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QUESTION: when do you do serial extraction?
space deficency in the max ant region
b. space deficiency in the max posterior region
c. space deficiency in man ant region
d. space deficiency in man post region
QUESTION: When do you do serial extraction?
a. for space deficiency in mandibular anterior region
b. for space deficieny in mandibular posterior region
c. for space deficiency in maxillary anterior region
d. for space deficiency in maxillary posterior region
#9 Periosteal elevator
#23 Mandibular cowhorn
#74 ash forceps (mand PM)
#151A (premolars)
#65 Bayonet-shaped forceps – Max incisors or roots
Cryer elevator: best for single retained root of extracted mandibular molar
Upper cowhorn forcep is #88 right and left for upper molars
Lower cowhorn forcep is #23 for lower molars
#151A is modification of #151, and it’s for mandibular premolars only
#17 is for mandibular molar but not fused root
#222 is for mandibular molar but fused root
QUESTION: What forcep used for mandibular premolars? 151 or 151A
QUESTION: What number forceps to use when extracting mand premolars: 151A or 74 (ash)
QUESTION: What forceps are best for a mandibular premolar extraction? #17, #23, #151, #150
(whichever is ash forceps)
ASH IS #74!!
Max Molar 150
Mand Molar 151
QUESTION: The universal forceps #151 is commonly used for extracting _______________.
a. maxillary anteriors b. maxillary molars c. mandibular molars d. maxillary premolars
QUESTION: The #65 forceps is typically used for removing ____________.
a. canines b. premolars c. molars d. root tips
QUESTION: extraction a mandibular molar and all of a sudden mesial root break:what instrument
u use? crayer forcep
QUESTION: Elevator can be used to advantage when…
a. Interdental bone is used as fulcrum
b. Multiple adjacent teeth are to be extracted
QUESTION: Elevator in oral surgery acts as what type of machine? Lever, wedge
QUESTION: what does Medicaid cover? Extraction, 1 denture , children until 18
QUESTION: What cover Medicaid? Extractions, one time denture, children until 18.
QUESTION: Biggest risk with extracting remaining max molar? Fracturing tuberosity
QUESTION: When ext erupt max molar what is most like cause of complication (I said It was high
chance of max sinusitis, other is that you can have broken tuberosity/sinus floor, or high chance
of dry socket because low circulation)
QUESTION: Lone molar beware cuz tubersotiy fracture
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QUESTION: removing a single lone max molar: worry about tuberosity fracture and sinus
involvement due to pneumatization
QUESTION: Lone molar ex most likely to fracture maxillary tuberocity (“beware of lone molar”…Xtina)
QUESTION: Can tell its ankylosed if submerged (there was an answer different sound but I think that’s
wrong) **Decks state that an akylosed tooth emits an “atypical sharp sound on percussion” soooo I think
different sound is right. Also “Beware of the LONE molar”  they are usually ankylosed.
QUESTION: Oro-antral communication 2mm- do nothing
QUESTION: You see sinus is open by 2mm with ext what do you do: don’t do anything and
observe
QUESTION: Oro-antral communication of 4mm, what do you do? Observe, buccal flap, palatal flap?
FIGURE 8 SUTURE
QUESTION: Oroantral communication best Tx? DEPENDS: <2 DO NOTHING, 2-6mm AB, nasal
deconjest+ figure 8 suture, more than 6 = flap surgery
QUESTION: If you have 3mm unifected root into sinus, what you do? You do one an attempt, and if
unsuccessful, leave it alone, no surgery.
QUESTION: What is the Caudwell lock technique? Removal of root tip from max sinus, incision over
canine fossa.
Suture:
QUESTION: What kind of suture do you use if you are only removing on one side of tooth…sling,
continuous, interrupted
QUESTION: What suture when only buccal tissue is displaced? I put interrupted
QUESTION: What suture do you place when you only displace facial of mandibular teeth? I put
interrupted; mattress, continuous, etc were other options.
QUESTION: best way to suture an incision? interrupted suture
QUESTION: What does an interrupted suture accomplish?

a. brings the flap closer
b. covers all exposed bone
c. immobilize the flap
QUESTION: what suture allows bacteria to invade – gut, silk, nylon
QUESTION: What suture contains wicks(?) that allows bacteria to enter extraction site?
Gut
Silk
Nylon
QUESTION: suture -movable to non movable

QUESTION: Incision on the corner of lip, where do you put suture: movable to fixed (Most important is
the vermilion border)
QUESTION: If 2cm laceration on lip how do u stich- continous, in middle and work both ways, reconnect
orbicularis oris first, reconnect vermillion border first, continous
Incisions/Flaps:
QUESTION: Types of Periodontal Flaps? Just 3... Modified Widman flap, Undisplaced Flap, Apical
Flap
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Modified widman flap: Instrumentation for root therapy, not pocket depth reduction but removes
pocket lining pocket shrinkage bc healing. Internal bevel incision.
Undisplaced flap: PD reduction. Excisional procedure of gingiva = gingivectomy. internal bevel

gingivectomy. But also reverse bevel. Final placement of flap determined by first incision
Apical positioned flap: pocket elimination (by apical position) and/or increases width of attached
gingiva. Best position is 2mm apical to alveolar crest. Internal bevel incision.
Periodontal flap preferred for mandibular anteriors. Lateral repositioning is done for gingival
recession.
QUESTION: Least desirable place to place graft: mandibular 1st premolar space
QUESTION: Careful with mandibular flap: a. mental nerve, chin, vestibule
QUESTION: Location apical position flap contraindicated: max palatal
QUESTION: Extrusion of canine what flap technique is used except 1)Envelope flap 2) Semilunar
flap 3) Apical repositioning flap
QUESTION: Vertical or oblique flap, where do you make incision? At line angles
QUESTION: modified widman flap can be characterize by all BUT – internal bevel incision, replaced flap,
QUESTION: know actual procedure of modified widmam flap, (Internal or external bevel, is it apically
repositioning? Etc) It is internal bevel and replaced/nonrepositioned flap.
QUESTION: I had many modified widman flap qs, where do you make incision to? (T/F: to the base
of pocket. I put false, not sure tho)
Another side note: Flap reflection with the MWF approach is only 2 to 3 mm beyond the alveolar crest
and not beyond the mucogingival junction. al, Rose et. Periodontics: Medicine, Surgery and Implants.
Mosby, 072004.
QUESTION: Indications for modified widman flap :

QUESTION: modified widman flap can be characterize by all BUT – interal bevel incision, replaced flap
Reflected beyond mucogingival line (which would be false)
QUESTION: With a modified Widman flap you mostly reduce bone if…
a. adapt the flap margin
b. osseous restructuring
c. removal of infected osseous tissue
d removal of malignancy tissue
QUESTION: What type of incision for palatal tuberosity reduction- T, Y **not sure but all I found was
that an “elliptical” incision is made so that from cross section the cut is oblique—and diverges towards
the bone.
QUESTION: Which of the following statements about the flap for the removal of a palatal torus is correct?
A. The most optimal flap uses a midline incision which courses from the papilla between teeth #8 and 9
posteriorly to the junction of the hard and soft palates.
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B. The most optimal flap is a reflection of the entire hard palate mucoperiosteum back to a line between
the 2 first molar teeth.
C. The most optimal flap uses a midpalatal incision that courses from the palatal aspect of tooth #3 across
to the palatal aspect of tooth #14
D. The most optimal flap is shaped like a "double-Y", with a midline incision and anterior and
posterior side arms extending bilaterally from the ends of the midline incision.
QUESTION: Y shaped palatal incision. Maxillary tori removal

QUESTION: where don't you do an apical flap? - maxillary palatal area
QUESTION: An apically displaced flap is generally impossible in which of the following areas?
a. mandibular facial
b. mandibular lingual
c. maxillary facial
d. maxillary palatal
QUESTION: Where can you not do a apical positioning flap:Max palatal area
QUESTION: Where can you not do apical flap: lingual of maxillary molars
QUESTION: Distal wedge contraindication? On 3rd molars without attach gingiva
QUESTION: CI when using distal wedge technique: Not enough keratinized tissue.
QUESTION: Distal Wedge limited to:
• Formation of the ramus
• Long buccal nerve
• Mental nerve
QUESTION: how to fix gingival recession in anterior region: pedicle graft (laterally repositioned
flap) (never lost blood supply)
QUESTION: bleeding points – used for incisional area location
QUESTION: What is purpose of “bleeding incisions” in gingivectomy? No idea what that is: choices
were like: location of dehiscence, location of alveolar defects, guide for incision
QUESTION: Function of bleeding points in gingivectomy: to guide incisions,
QUESTION: Bleeding spots established in gingevectomy to? I think outline incision line.
QUESTION: Gingivectomy indications/contraindications
QUESTION: Gingivectomy is for? supra bony pocket
QUESTION: gingivectomy done for hyperplastic gingiva
QUESTION: Indications for gingivectomy – gingival hyperplasia,
QUESTION: Few questions on when to do and not to do gingivectomy? infrabony pkts, gingival
hyperplasia, little attached gingiva, high smile line…
You do gingivectomy to: eliminate supra bony pockets, eliminate gingival enlagements or eliminate
suprabony periodontal abcess
You DONOT do gingivectomy if osseous recontouring is needed, if the bottom of the pocket is
apical to the mucogingival junction, if there is inadequate attached gingivaa, or if aesthetic is
concerned.
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QUESTION: Which is contraindicated in 2nd molar region to reduce deep pocket with limited
attached gingiva? Gingivectomy
QUESTION: If little attached gingiva is present and have deep pockets, what will you NOT do to get
rid of them
o Gingivectomy
o Cannot recontour bone
o Cannot graft
QUESTION: Gingivectomy is contraindicated in: when the sulcus is apical to gingival groove, sulcus is
apical to convexity of tooth, sulcus is apical to the crest of alveolar bone.
QUESTION: CI of gingivectomy-not enough keratinized tissue
QUESTION: Patient has very little keratinized gingiva which of the following flaps should u not do:
gingivectomy
QUESTION: mandibular molar minimum keratinized gingiva with pocket depth? Which of the
following way is not acceptable is a way to minimize pocket depth? Gingictomy
QUESTION: Patient has crown #18 w/ minimal attached gingival. Which do you NOT do to
expose the finish line? don’t do gingivectomy
QUESTION: gingivectomy is contraindicated with? minimum attached gingiva
QUESTION: Contradiction to do gingevectomy is when ? when there is infra bony pocket – when there
is a defect!!!
QUESTION: When do you not do gingivectomy – apical to the alveolar crest
QUESTION: Gingivectomy is contraindicated when bottom of the pocket is apical to alveolar crest
(infrabony)
QUESTION: Which of these is a contraindication to a gingivectomy? I put if the pocket extends

beyond the mucogingival junction (also infrabony pockets present)
QUESTION: Intrabony bone defect?

Same as infrabony, Vertical bone loss.
QUESTION: What should be considered for gingivectomy? level of attached gingiva*, degree of
attachment loss
QUESTION: The base of the incision in the gingivectomy technique is located
A. in the alveolar mucosa.
B. at the mucogingival junction.
C. above the mucogingival junction.
D. coronal to the periodontal pocket.
E. at the level of the cementoenamel junction
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QUESTION: Gingivectomy type of Bevel used? , external bevel incision ??
QUESTION: gingivectomy - is it incisional (reverse) or excisional

QUESTION: When doing gingivectomy, which is NOT right about internal and external bevel?
QUESTION: Epithelium over connective tissue, how fast per day in mm? 0.5-1mm (RELATED TO
GINGIVECTOMY)
QUESTION: How many mm a day does epithelium grow over connective tissue? 0.5-1, 1-2. 2-3 NO
CLUE
QUESTION: How does external bevel gingivectomy heal? Primary intention, secondary, tertiary, granular
tissue formation
QUESTION: How does external bevel gingivectomy heal? Primary intention, secondary, tertiary,
granular tissue formation
QUESTION: How does a gingivectomy heal? Secondary intention
Primary healing=flap
Secondary healing is for sc/rp and regular gingivectomy
Tertiarty healing: Tissue grafts
QUESTION: After a gingivectomy how does the site heal?

a. from the epithelium of the pockets
b. epithelium of the adjacent alveolar mucosa
c. endothelium of the blood vessels
QUESTION: How does site heal after gingivectomy? Long junctional epithelium
QUESTION: After lay a flap: how does wound healing work: long JE, new ct attachment?
QUESTION: Following flap surgery, new junctional epithelium can form on either cementum or
dentin, junctional epithelium is reestablished as early as one week.. First is False, Second is true.
QUESTION: Following flap surgery, new junctional epithelium can form on either cementum or dentin.
Junctional epithelium is reestablished as early as one week. BOTH ARE TRUE
QUESTION: after you perform a flap where you see regeneration : ephitelial attachement via
long junctional epithelium and connective tissue adhesion.
QUESTION: Healing of flaps surgeries: something about its Long junctional epithelium
QUESTION: What do u want from perio flap: want regeneration of PDL cementum and bone
QUESTION: The soft tissue-tooth interface that forms most frequently after flap surgery in an area
previously denuded by inflammatory disease is a
E. collagen adhesion.  
F. reattachment by scar.  
G. long junctional epithelium.  
H. connective tissue attachment.  
QUESTION: type of healing in SRP and free gingival graft : LJE and CT
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QUESTION: Gingivoplasty is? a reshaping of the gingiva to create physiologic gingival contours,
with the sole purpose of recontouring the gingiva in the absence of pockets.
QUESTION: Gingivectomy means? excision of the gingiva. By removing the pocket wall,
gingivectomy provides visibility and accessibility for complete calculus removal and thorough
smoothing of the roots, creating a favorable environment for gingival healing and restoration of a
physiologic gingival contour.
QUESTION: external bevel incision where is it made? Attached gingiva?

QUESTION: External bevel, ginviectomy: apical to epithelial tissue, vascular bundle(where to you
make incisision) Junctional epithelium (apical to base of pocket (epithelial attachment)
QUESTION: External bevel is put to tooth apical to what? Crest of bone, JE, CT. Junctional
epithelium I think
Starts at top of junctional epithelium
QUESTION: What direction reverse bevel (internal bevel): axial toward bone
QUESTION: How to make inverse bevel incision?
A: Start at crest of gingival margin or step back .5-2 mm and make incision to crestal bone
Gingivectomy base of sulcus
QUESTION: What causes wound healing after Perio flap? I put Long JE but the others were new CT
attachment, CT adhesion and something else
QUESTION: Periodontal regeneration involves - Sharpeys Fibers, Cementum and Alveolar Bone
QUESTION: What is involved in periodontal regeneration? I think pdl, cementum, alveolar bone maybe
one other thing in there. Pdl & bone cells
QUESTION: Perio Surgery. Know what is regenerating? bone, cementum, and more was listed.
Regeneration is defined as the type of healing which completely replicates the original architecture and
function of a part. It involves the formation of a new cementum, periodontal ligament, and alveolar bone.
Repair, on the other hand, is merely a replacement of loss apparatus with scar tissue which does not
completely restore the architecture or the function of the part replaced. The end product of repair is the
establisment of long junctional epithelium attachment at the tooth-tissue interface.
QUESTION: Regeneration vs repair in perio attachment

• REGENERATION: new PDL/cementum made (bone and gingiva too)
• REPAIR: long jxnal epi formed
QUESTION: Know about internal bevel incision and where to cut: I think apical to the base of the
periodontal pockets, but coronal to the MGJ.
QUESTION: After flap surgery, where does repair occur? PDL moves occlusally, apically, laterally
QUESTION: Doing flap surgery on mandible, what structure do you watch for? I put mental
nerve (If 3rd molar TE= Lingual)
QUESTION: A tooth had epithelium above cej what flap would you use? Undisplaced/Replaced flap
QUESTION: Long jxn epith was coronal to CEJ and margin was around cej,
apical position flap, widman flap, replace flap
QUESTION: Extrusion of canine what flap technique is used except:
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1)Envelope flap 2) Semilunar flap 3)  Apically repositioning flap
QUESTION: What type of flap do you use in crown lengthening? Apical Repositioning Flap
QUESTION: Crown lengthening procedure what would u do

Choices were
Modified woodman flap
Apical repositioned flap w/ osteotomy and ostectomy (I chose this)
QUESTION: Rct, getting post and core and crwon lenghteningin, why do crown lengthing:
feral effect, adequate crown length
QUESTION: Crown that came falling off? Inadequate ferrule!!!! or inadequate post
QUESTION: Sliding flap? What do you do it for?

QUESTION: The most common incision given by oral surgeons is?
a. envelope flap
b. y incision
c. Z incision
d. Semilunar incision
QUESTION: To expose a mandibular lingual torus of a patient who has a full complement of teeth, the
incision should be…
a. Semilunar
b. Paragingival
c. In the gingival sulcus and embrasure area
d. Directly over the most prominent part of the torus
e. Inferior to the lesion, reflecting the tissue superior
QUESTION: If removal of torus must be performed to a patient with full-mouth dentition, where
shouldthe incision be made?
a. Right on the top of the torus
b. At the base of the torus
c. Midline of the torus
d. From the gingival sulcus of the adjacent teeth
QUESTION: What has the biggest effect on the flap?

a. initial incision
b. extensiveness of reflection
c. post op oral hygiene
d. final position of flap
QUESTION: Correction of an inadequate zone of attached gingiva on several adjacent teeth is best
accomplished with a/an?
a. apically repositioned flap.
b. laterally positioned sliding flap.
c. double-papilla pedicle graft.
d. coronally positioned flap.
e. free gingival graft.
QUESTION: Whats contraindicated for pt post mand radio tx.?- flap apico on pt.
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QUESTION: During maintenance therapy pt has recurrent 6mm pocket on M of #4 and D of #20 what is
1st tx option: flap surgery, scaling root planning with local microbial administration
QUESTION: Pockets are still the same and oral health care is excellent? Flap and clean out
QUESTION: To prevent exposure of a dehiscence or fenestration what kind of flap? partial or split
thickness flap
QUESTION: Split thickness flap involves what tissues? Mucosa (only) or submucosa or they can say
epithelium and ct (submucosa)
surface mucosa (consisting of epithelium, basement mem brane, and connective tissue lamina
propria
QUESTION: In a partial thickness flap, what do you cut through? I put epithelium, connective
tissue, but NOT periosteum
QUESTION: Perio flap- expose bone?? - Full thickness
QUESTION: Full thickness flap will result in bone atrophy (or loss) in: thin periradicular bone (do
partial-thickness flap for this), thick periradicular bone, thick interproximal bone, thin
interproximal bone
QUESTION: Know about difference between regenerative surgery and flap surgery?
regenerative surgery - for regeneration with bone graft
flap surgery - to get acess for better srp
Grafts:
QUESTION: epithilium of free ging graft----degenerate
QUESTION: Free gingival graft gets blood from base first,
QUESTION: Free gingival graft: Which area can be affected
 Greater palatine nerve bundle

 Nasopalatine nerve bundle
 Nasopalatine artery
 Greater palatine artery
QUESTION: Most likely damage when you take tissue from gingival graft: damage to greater
palatine neurovascular bundle
QUESTION: Donor site complication when free gingiva graft (taken from palate) performed:
cutting the major palatine bundle.
QUESTION: mucosal graft what nerve would u damage ? greater palatine

QUESTION: What nerve is most likely injured when transferring donor tissue to area of free gingival
graft? Greater palatine
QUESTION: mucosal graft epithelization by---connect tissue from underlying tissue (recipient site)
QUESTION: Where does the epithelial for a graft come from?
a. Donor epithelium
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c. Recipient epithelium
d. Recipient connective tissue
QUESTION: What effects the epithelial cells from gingival graft? epi cells from donor, epi cells from
recipient, connective tissue cells or donor or recipient
QUESTION: What has ultimate effect on the thickness of epithelium of free gingival graft?
a. Recipient epithelial tissue,
b. donor epithelial tissue,
c. donor CT
d. recipient CT
QUESTION: What is the disadvantage of a connective tissue graft? Two surgical sites
QUESTION: You only have 4 mm of bone above max sinus, how do you do bone graft (weird
question)…fill towards sinus, fill towards alveolar ridge (I put this, didn’t really get it), fill graft towards
mesial
QUESTION: If question is saying that you currently have 4mm of bone *alveolar ridge*..You can not add
to alveolar ridge, its not gonna integrate. So you FILL TOWARDS SINUS..
QUESTION: Only 4mm of bone below ridge and sinus where do you place graft? Floor of sinus (NOT
Top of ridge)
QUESTION: What graft is best for sinus lift? Autogenous and alloplastic
QUESTION: Sinus lift best to use? Answers are in pairs: Autogenous, alloplastic?
QUESTION: Your patient was referred to an oral and maxillofacial surgeon for an implant, and you were
advised that she was going to need a sinus lift procedure with placement of an autogenous bone graft.
What is the definition of that graft?
A. The graft will use an artificial, bone-like material.

B. The graft uses bone from another human being.
C. The graft uses the patient's own bone, taken from another site.
D. The graft uses bovine bone, or bone from another animal species.
QUESTION: Which is the most predictable when restoring an edentulous mandibular ridge? I put
autograft
QUESTION: Which is the best graft: autograft
QUESTION: how you call a graft from a different species : Xenograft
QUESTION: bone graft : iliac crest
QUESTION: How to replace large chunks of mandible? Freeze dried bone; autogenous
QUESTION: What is the most osteogenic? (Choices: alloplast, autograft, etc) ONLY autograft
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
QUESTION: Know what an allograft is (b/w members of the same species)

QUESTION: Freezed dried cadaver bone is a type of? Allograft
QUESTION: Decalcified freeze dried bone allograft: has bone morphogenetic proteins
QUESTION: Freeze dried graft – allograft

QUESTION: best allograft material: dried freezed bone
QUESTION: Freeze dried bone has the advantage of having which protein: bmp/pdgf
QUESTION: Which hormone is used to bone graft? BMP, GH...

QUESTION: Dfdg- bone morphologic protein
QUESTION: Which type of grafts causes bone growth?: • Osteoinductive •Osteoconductive

QUESTION: Which type of grafts causes bone growth?:
• OsteoINDuctiveAllograph, autograph
QUESTION: Maxillary canine is contraindicated in a grafting procedure
QUESTION: least likely to need bone graft – one wall, two wall, three wall wide, three wall narrow
QUESTION: What is not going to need a bone graft to improve – 1, 2, wide 3, or narrow 3 walled defect –
narrow 3
Wide and deep 3 walled  GTR
Narrow 3 walled  bone graft regeneration
QUESTION: Best prognosis for bone graft: narrow 3 wall defect
QUESTION: Purpose of lateral graft (Peddicle graft)...For gingival recession
QUESTION: how to fix gingival recession in anterior region : pedicle graft ( never lost blood supply )
QUESTION: Recession of a single tooth, what do you do?
• Double papilla graft
• Free gingival graft
• Apical repositioning
QUESTION: 8 year old with anterior crossbite – recession
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a. chlorhexadine
b. lateral sliding graft
c. pedicle graft
QUESTION: Max canine is contraindicated in a grafting procedure
QUESTION: Facial recession on mandibular canine of 14 year old  graft not indicated? Reposition
with ortho?
QUESTION: You take a graft from a patient to another patient, what is this called? – Allograft
(alloplast was a choice, but that’s synthetic)
QUESTION: Which is least likely to be successful facial soft tissue graft? – Lower 1st premolars (no
canine in the choices) ?
QUESTION: Guided grafts- better for max
QUESTION: Best prognosis for a guided tissue regeneration? three walled defect,
QUESTION: GTR in Class II furcations is most effective
QUESTION: Tx for ClassII furcation involvement (called cul-de-sac)? GTR
QUESTION: Furcations distal class II and GTR: better than furcation I and III
QUESTION: Class III furcations are least successful in GTR procedures.
QUESTION: Class 3 furcation which not an option? GTR
Guided tissue regeneration (GTR) is a surgical procedure used by dentists to promote the new
growth of tissue in areas
QUESTION: The purpose of GTR is to prevent: Long J.E, migration of PDL cells Migration of CT cells.
Decks: Guided tissue regeneration is a procedure that blocks the re-population of the root surface by long
junctional epithelium and gingival connective tissue to allow cells from the periodontal ligament and bone
to re-populate the periodontal defect.
QUESTION: In guided tissue regeneration, inserted material is preventing which of the following attached
to tooth structure?
• epithelial
• connective tissue (hinder the migration of fibrous connective tissue while
supporting the growth of bone: Xtina, First Aid)
• gingival
QUESTION: The purpose of a barrier: .Apical movement of PDl cells, coronal movement of
cells
QUESTION: 3 things u need when doing GTR: bone, sharpey’s fibers, & cementum
GTR excludes gingival epithelial cells allows progenitor cells to close the wound. Gingival
epithelium and connective tissue are excluded by the membrane. Progenitor cells form
cementocytes and fibroblasts which form new cementum and PDL fibers. This gives you
regeneration of the attachment apparatus and not long junctional epithelium. LJE is not as
strong as the original attachment apparatus (which is lost by debridement).
QUESTION: In gtr, you get new CT.??? PDL & sharpeys fibers are CT.
QUESTION: which tx is best for type III furcation
a. guided tissue regen—NOT THIS
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b. apical flap
HEMISECTION
QUESTION: In a through and through furcation lesion, which is the least appropriate treatment? I
put GTR
QUESTION: contraindication for max molar with class 2 furcation? hemisection w/ crown
hemisection = mand molar. Mandibular molars to treat Class II or III furcation invasions
For max molar - we do root amputation
QUESTION: Tx plan for furcal involvement ? GTR, Hemisection, Root amputation,
QUESTION: How to treat endo treated mand molar that has furcation: only answer that seemed
logical was hemisection and place 2 crowns to act as 2 premolars. Root amputation is for
maxillary teeth
QUESTION: Hemisection of maxillary molar which has best prognosis

• Furction that is more coronal or apical
• Furcation that is more coronal
QUESTION: Hemisection, one wall remaining (interproximal wall) what’s it called: hemiseptum
QUESTION: Bony area between two premolars has no mesial, facial and lingual wall, what is it
called? Hemiseptum
QUESTION: Class 3 furcation tooth already had RCT, best tx, ext not option? split and tx as two
premolars
Healing (bone & wound):

QUESTION: Indication for periodontal/surgical dressing: Healing the tissue, Protect the wound
QUESTION: For Perio; Why do you put a surgical dressing over a wound?
QUESTION: What is surgical dresses? Just protect wound, DOES NOT accelerate
QUESTION: After periodontal surgery, what type of healing is it most of the time? Repair
QUESTION: What do you want to see healing after perio surgery? PDL, bone, etc.
Restore/regen: PDL Bone Cement. Repair: Long junctional epi and CT.
QUESTION: Where does the epithelial for a graft come from after you place it and its healing?
a. Donor epithelium
c. Recipient epithelium and surviving basal cells of donor epithelium are what supply
for new epithelium
QUESTION: What environment factor alters healing? Smoking

QUESTION: 2 questions on Dry socket...pt comes in 3 days after mand extraction with pain and bad
taste, what is it..also question on how to treat
QUESTION: most common complication after extraction : dry socket.
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QUESTION: What is pt more at risk of getting after ext (pt hx said she was a smoker)? dry socket
QUESTION: What’s the most common complication after EXT? dry socket
QUESTION: Most common complication in extraction: dry socket (alveolar osteitis)
The most common soft tissue injury during oral surgery is the tearing of the mucosal flap during
surgical extraction of a tooth. Hupp. The second soft tissue injury that occurs with some frequency
is inadvertent puncturing of the soft tissue. The most common problem associated with the tooth
being extracted is fracture of its roots. Hupp. Contemporary Oral and Maxillofacial Surgery, 5th
Edition. Mosby, 032008.
QUESTION: pathophysiology of dry socket

QUESTION: how do dry sockets develop? Blood clots not forming
QUESTION: Dry socket: Loss of healing blood clot
QUESTION: Dry socket: fibrinolysis of clot

QUESTION: What causes alveolar osteitis? Active dislodgement of blood clot - I chose this one?
(fibrinolysis of the clot)
QUESTION: What causes alveolar osteitis? Lack of blood clot because lack of bleeding
Active dislodgement of blood clot - I chose this one? (I think the wording was fibrinolysis of the clot)
QUESTION: Main cause of alveolar osteitis (dry socket)? blood clot diminished and fell out
QUESTION: dry socket why

blood clot not produced
blood clot broke
QUESTION: MAIN CAUSE OF ALVEOLAR OSTEITIS (DRY SOCKET)? BLOCK CLOT
DIMINISHED AND FELL OUT
QUESTION: Main symptom of alveolar osteitis – pain
QUESTION: Don’t forget with dry socket = NO ANTIBIOTICS NEEDED! Just medicinal dressing.
QUESTION: Alveolar osteitis  place dressing; don’t need antibiotics and no curettage
QUESTION: Alveolar osteitis tx? Medicated dressing
QUESTION: acute osteitis = dry socket. How to take care of it? Gentle irrigation and Medicated
dressing
QUESTION: Treat dry socket with dressing
QUESTION: Ways to tx dry socket except
a. curette walls to make socket bleed
b. no non-narcotic analgesic as needed
c. sedative dressingg
d. flush out debris w/ sterile solution
QUESTION: Dry socket (except Q)- need for oral antibiotics
QUESTION: What is the treatment for dry socket? sedative dressing
QUESTION: Treatment of alveolar osteitis: placement of a palliative medicament/dressing
QUESTION: Most common negative outcome of routine TE: alveolar osteotitis, hemorrhage, infection
QUESTION: Multiple questions about when you would not give antibiotics: all the answers were
alveolar osteitis (all the others had a systemic infection ie cellulitis), other questions about osteitis
is how would/wouldn’t you treat alveolar osteitis
Fractures:
180
QUESTION: most common trauma: avulsion, intrusion, lateral luxation, fracture
QUESTION: Mand fracture sign? Occlusal discrepency

QUESTION: Key sign of Mand fracture? change in occlusion
QUESTION: Inform about mental nerve damage and fracture of mandible
QUESTION: Patient has a condylar fracture, what happens when mandible grows – asymmetric growth
with damaged side lagging
QUESTION: Fracture near condyle, what happens to growth of mandible? I chose injured side lags behind.
QUESTION: Patient fractures one condyle, what is the expected growth? The fractured side will lag. The
unaffected will continue growth.
QUESTION: What child has mandibular trauma, what do they have later? Midline asymmetry
QUESTION: most common trauma on children what happens to mandible? Asymmetry of face
QUESTION: Retarded growth due to unilateral sub-condylar fracture on child  I think it’s
ipsilateral?
QUESTION: what is primary consequsence of trauma to jaw in kids (normal def of jaw, vs retarded
growth vs hypertrophic growth on one side, etc): retards growth
QUESTION: Fracture 1 condyle the other lags behind: Malocclusion

QUESTION: if kid had a problem with fractures in mand.. later they will have TMJ disfunction
QUESTION: most common area of fracture in children---symphysis, condyle, coronoid
QUESTION: Ankylosis of condyle most likely due to? Trauma? Fracture (looked this one up)
QUESTION: Splinting closed bone fracture – 6 weeks
QUESTION: Fractured mandible. Keep it in closed reduction for how long?? 6 weeks
QUESTION: Splinting closed bone fracture – I said 12 weeks (not sure) ? 6
QUESTION: Closed reduction, immobilize mandible for how long?, 6 weeks,

The standard length of maxillomandibular fixation (MMF) is 4-6 weeks.
QUESTION: Paresthesis occurs most commonly in what type of mandibular fracture? Angle
QUESTION: Lower lip numbness is seen in what kind of mandibular fracture: Body or angle fracture
QUESTION: angle of mandible fracture increases chance of IAN paresthesia and numbness
QUESTION: Fracture of what cause Paresthesia of the lower lip? evident with mandible
fractures distal to the mandibular foramen (in the distribution of the inferior alveolar nerve).
QUESTION: lefort frac 1 associated with- what fracture--nasoethmoidal air cell,frontal sinus,max
sinus,mastoid air cell
QUESTION: Lefort I fracture maxillary sinus
QUESTION: Le fort 1: maxillary

QUESTION: Guerin sign is a feature of Le Fort 1/2/3? Guerin’s sign: ecchymosis in the region of
greater palatine vessels.
QUESTION: The LeFort I tx of? brings the lower midface forward, from the level of the upper
teeth, to just above the nostrils.
181
QUESTION: Lefort I fracture: "floating palate", Disturbed occlusion, palpable crepitation in upper
buccal sulcus
QUESTION: The LeFort III brings the entire midface forward, from the upper teeth to just above
the cheekbones.
QUESTION: LeFort II: separation and mobility of the midface, Gagging on posterior teeth, Anterior
open bite, Pathongnomonic sign is? Periorbital ecchymosis/hematoma, diplopia and /or
subconjunctival hemorrhage , Infra-orbital nerve damage
Le Fort II - separation of the maxilla, attached nasal complex from the orbital and zygomatic fractures
Le Fort III - Nasoethmoidal complex, the zygomas, and the maxilla from the cranial base which results in
craniofacial separation
QUESTION: Lefort II most common injured nerve: infraorbital

QUESTION: subconjuctival hemorrhage seen in what fracture? Lefort 1 , nasal, frontal sinus,
zygomaticomaxillary complex
QUESTION: A patient experiences numbness of the left upper lip, cheek, and the left side of the nose
following a fracture of his midface. This symptom follows a fracture through the
A. nasal bone.
B. zygomatic arch.
C. maxillary sinus.
D. infraorbital rim.
QUESTION: What was the most common fracture in the face? Zygomcomplex fracture. Nasal bone
fractures = 1st, zygomatic = 2nd (but first common midfacial fracture)
QUESTION: Which radiograph would you use to view a fracture of the mandibular symphisis? (A-P?)
QUESTION: What age does mandibular symphysis fuse? I think 6 months 6-9 months
QUESTION: What age does the mandibular symphisis close: birth, 3, 6-9 months
QUESTION: Fracture of which part of the face would compromise pt respiration?

• *Fracture through the body of mand (bilateral)
• Fracture to condyle
• Fracture to angle of mand
QUESTION: if there is a fracture in the left body of the mandible where will the other fracture most likely
be? Right Condyle
• Most COMMON = condyle (29%) 2nd most (angle of mandible 24.5%)
• LEAST COMMON: coronoid (1.3%) 2nd least (ramus of mandible 1.7%)
QUESTION: if hit on the right side of the jaw, what will get broken
• left condyle
• right condyle
• both
• right mandible
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QUESTION: you hit a guy in the right body of mandible and fracture where is other site of fracture
(opposite side condyle)
QUESTION: punched on lower right and broken jaw. What else to worry about? Contralateral
conylar fracture
QUESTION: When pulling out tooth and jaw fractures what do you do? Open flap to see all of the
fracture, remove all the fractured pieces, remove all the fractured pieces that are not attached to
periosteum
QUESTION: What xrays do you take to confirm horizontal fracture? 3 xrays moving horizontally, 3
xrays moving vertically,, ...
QUESTION: Horizontal fracture easily seen with – multiple vertical angulated xrays
QUESTION: What is best view to see zygomatic process?

(other is submentovertex, SMV for zygomatic arch)
QUESTION: Max sinus: waters
QUESTION: Which of the following images shows better the mid-facial fracture? Waters
QUESTION: Pano >>>> best for mandible fracture
QUESTION: Reverse towne‟s>>>> for condyle fracture
QUESTION: Submentovertex>>>>for zygomatic fracture
QUESTION: What causes Trauma in the US? By auto-accidents! (in 3rd world is knife fights)
QUESTION: Pan showing lucency going inferior over the body of mandible close to the angle. Informed
the patient was involved in an accident. Identify the lucency a.pharyngeal
airspace  b.fracture  c.artifact-retake radiograph 
Frenectomy:
QUESTION: thick upper buccal frenum with diastema. Yound kid…wait til upper permanent
canines erupt, frenectomy, use elastics…(a repeat I saw on old exam-answer was wait til max
canines erupt).
QUESTION: Kid has a diastema b/w 8 and 9 at age 10, how do you treat?: wait till permanent
canines have erupted, then do frenectomy
QUESTION: frenun centrals. What age do frenectomy
-when canines have erupted
QUESTION: If diastema is caused by a frenum, you don’t do a frenectomy until the canines have
erupted
QUESTION: sequence to close diastema in a child with low labial frenum:

1)wait for the canines to erupt,
2)close the diastema with ortho and at the end
3)perform the frenum surgery
QUESTION: What do you do for an 8 year old with a fibrous frenum and a large diastema? I put wait till
all ant teeth are in and then fix diast and frenum. (wait for canines..ortho before frenectomy…Xtina)
QUESTION: All of the following are risk for ortho treatment except ? – Frenal displacement (other
choices, were plaque management, bone loss, resorption)
QUESTION: Which of the following explains why the Z-plasty technique used in modifying a labial
frenum is considered to be superior to the diamond technique?
183
a. it is less traumatic
b. it is technically easier
c. it requires fewer sutures
d. it decreases the effects of scar contracture (I believe this is it…because improves the appearance of
scars and porpose is to relax the frenum pull  less contracture)
e. it allows for closure by secondary intention
Orthognathic surgery:
QUESTION: Most commonly used surgery for mand augmentation?- bilateral sagital osteotomy
QUESTION: BSSO = Vertical Osteotomy (when used) push mand. Forward or back for class III.
QUESTION: How would you repair a Class II malocclusion?- BSSO (bilateral sagital split osteotomy)
QUESTION: Class II patient needs sx – saggital split
QUESTION: Bilateral sagital split osteotomy : The BSSO is the most commonly used osteotomy for
mandibular advancement.
QUESTION: Worst complication of BSSO: Damage to IAN BSSO = Bilateral sagittal split osteotomy
QUESTION: whats the main thing you have to be careful with BSSO: INFA
QUESTION: Biggest disadvantage of BSSO?parasthesia
QUESTION: most complication of sagital osteotomy: IAN loss of sensitivity
QUESTION: During which surgery do you have most chance of paresthesia? BSSO, vertical ramus
osteotomy, etc. (don’t know)
QUESTION: Which osteotomy most likely to cause parestesia to lip and tongue: sagital split or
inverted L, vertical
QUESTION: Bsso indications:

• Mandibular advancement or retraction
QUESTION: Correction of severe class II
• Maxillary Impaction and autorotation of the mandible
• BSSO
QUESTION: Patient wants to fix Class 3, what you going to do – lefort 1 with BSSO, lefort 1, BSSO,
max palatal expansion with BSSO
QUESTION: What surgery for class III? Le fort I, BSSO, rapid expansion?
QUESTION: Class III, what kind of surgery? Options include rapid palatal expansion, le forts, BSSO
- BSSO is for CLASS II (lengthen undeveloped mandible)
- Rapid palatal expander is for crossbite or minimal class III
QUESTION: 16 y.o. girl need to do lefort + BSSO – cant do RPE because she’s too old
QUESTION: Main disadvantage of BSSO – damage to the IA nerve

QUESTION: how long do you splint mandibular BSSO: You don’t do MMF, as there is internal plate.
Use an occlusal splint to help with occlusion but not wired shut. Keep splint on 4-6 week.
QUESTION: Most common surgery for maxilla: LeFort I
QUESTION: If a patient has vertical maxillary excess, how would you fix it? I put Le Forte 1
(other choices were mandibular and didn’t make sense)
QUESTION: Which of the following is the MOST common postoperative problem associated with
mandibular sagittal-split osteotomies?
a. infection
b. TMJ pain
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c. Periodontal defects
d. Devitalization of teeth
e. Neurosensory disturbances
QUESTION: A patient has a skeletal deformity with a Class III malocclusion. This deformity is the
result of a maxillary deficiency. The treatment-of -choice is
A. orthodontics.
B. surgical repositioning of the maxilla.
C. anterior maxillary osteotomy.
D. posterior maxillary osteotomy.
E.surgical repositioning of the mandible.
QUESTION: whats the main difference between distraction osteogensis and a regular osteotomy :
DO has less relapse or DO cant move the mandible posterior …. Dunno
QUESTION: Distraction Osteogenesis over traditional osteosurgery: I put more stability during wide
span of movements, (not sure tho, another option was about patient compliance)
QUESTION: Distraction osseogenisis: when to use over convetnial: bigger stable movements
QUESTION: Advantage of distraction osteogenesis is that you can do bigger movements because
muscles can react over time
QUESTION: complication following distraction osteogenesis : Long term follow up
QUESTION: What is the difference btw distraction osteogenesis Max and BSSO Man?
QUESTION: distractive osteogenesis differs from osteotomy by..???
DO = benefit of simultaneously increasing bone length and the volume of surrounding soft tissues.
easier in children, shows less relapse. 2 surgical procedures, hospitalization time is less, more discomfort.
Compliance of patient and parent is a difficulty in DO
distractive osteogenesis is a surgical process used to reconstruct skeletal deformities and lengthen the
long bones of the body.
BSSO = stable for normal/decreased facial height, high relapse in patient with high mandibular plane
angle
An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment
Orthodontics:
QUESTION: Dolycocephalic – long narrow face
QUESTION: Which is correct: Growth of Mandible is both intramembranous and endocondral
QUESTION: Scammon Growth curve: Neural tissue grows until what age? 5 (this was the number
on the test, but on book it is about 6-7)
QUESTION: Which tissue show most growth in first 6 years and then plateaus? lymph, neural,
genital
QUESTION: which is most fully developed at birth

e. muscle system
f. neural system **
gonadal system
185
QUESTION: Which grows faster, maxilla or mandible? Maxilla grows earlier and faster bc it is
closer to brain
 closer to brain, grow faster
QUESTION: What is the best revealing issue for prediction about ossification ? wrist hand
radiograph
QUESTION: Majority of the tissues in FACE are derived from? A) ectoderm, b)mesoderm,
c)ectoderm and mesoderm
 Ectoderm= Afractoderm
QUESTION: Eruption sequence of peds? ABDCE
Order: Central-Central, Lateral-Lateral, 1M-1M, Canine-Canine, 2M-2M
QUESTION: Curve of spee and curve of Wilson? Sagital is curve of spee, frontal curve of Wilson
Sagital: curve of SPEE Anterior-posterior
 Frontal: corve of Wilson Left and right
QUESTION: Overjet in permanent teeth should be ? 2-3mm
QUESTION: What do you do to camouflage class 2? you extract upper premolar
QUESTION: Based on Frank behavioral rating scale, what is the rate that indicates positive rapport
with dentist? rating 4
QUESTION: Tell-show-do? most appropriate
QUESTION: Figure 5.23 (pg 175) which one more stable and which one is problematic
186
Occlusion:
QUESTION: facial profile of class 2 malocclusion---convex, Class III is concave
QUESTION: MB max cusp in mandibular first molar: class 1

QUESTION: MB cusp in buccal groove: class I (in pic)
QUESTION: Normal class1 occlusion has mb cusp in buccal groove of mnd molar
QUESTION: Little girls, ortho casts were taken, what class is she? – Class 1 (her 1st permanent molars
were out, mesiobuccal cusp of upper 1st molars on buccal-lingual groove on lower 1st molars.
QUESTION: What occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st molar
CLASS III
QUESTION: What occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st
molar Class III
QUESTION: Diatalized occlusion w/ uprght cental anterior and deep bite: class II div II
QUESTION: Pt is in Mixed dentition and they are end on, what type of occlusion will this result in
permanent dentition? Class I**, Class II, Class III
QUESTION: What's the difference btw primary class II and permanent class II? Shallow grooves,
broad contacts
QUESTION: What ethnicity with most class 3?

QUESTION: Class 3 is due to what? Max retrusin, mand protrusion
QUESTION: Most common type of occlusion in primary teeth: flush terminal plane
QUESTION: Most common malocclusion- ***CLASS 1***--
QUESTION: highest percentage of malocclusion in the US: class I, class II, class III?
187
QUESTION: What Percentage of population have class I normal occlusion? 30 %
QUESTION: What Class Occlusion gets most ant tooth fx?- Class II Div. 1
QUESTION: most common patients to have anterior tooth fractures : class II div I
QUESTION: Which class is susceptible to trauma? –as(class II division 1)
QUESTION: Most likely to cause fracture in children: class II division 1
QUESTION: in a cl III patient, which of the following is not helpful in establishing whether pt has
retrognathic maxilla or prognathic mandible? photographs, study models, ceph analysis,
clinical exam
QUESTION: A child who has a distal step in the primary dentition generally develops which of the
following molar relationships in the permanent dentition?
A. Class I
B. Class II
C. Class III
QUESTION: What happens to the permanent molar occlusion in the presence of a flush (straight)
terminal plane and mandibular primate spaces?
A. Erupts end-to-end; early mesial shift into Class I occlusion
B. Erupts end-to-end; late mesial shift into Class I occlusion
C. Erupts with Class II tendency
D. Erupts with Class III tendency
QUESTION: primate spaces **MAX: between LATERAL and CANINE; MAND: between CANINE and
1st MOLAR
QUESTION: What makes space for mand teeth when they erupt- primate space
QUESTION: Where are the primate spaces?
Max—b/w lateral and canine Man: b/w Canine and
Primary 1st molar
QUESTION: Primate space tested for maxillary and mandible
a. Max LI-C, Man C-M1
QUESTION: What is the purpose of primary teeth – said it was space holder of permanent teeth
QUESTION: Premature loss of which tooth will cause mesial drift of permanent tooth – primary 2nd
molar
Leeway space = Sum of primary tooth widths is greater than sum of permenant successors.
When primary teeth fall out, there is extra space to help relieve crowding. If nothing done,
then first molars drift forward.
188
QUESTION: The space difference between primary canine, first & second molar and the
succedaneous teeth: Leeway space
QUESTION: How to create space for mand incisors: increase intercanine distance with primate
space?
QUESTION: What will account for the anterior space for the perm. Mandibular incisors?
a. Either the flaring of the max incisors

b. Primate space!! Because this is the space between the canines and the central
incisors
c. Either the flaring of the max incisors

d. Primate space (but decks says this extra space is most frequently due to growth of
the alveolar dental arches)??
QUESTION: allow more space for eruption of secondary lower incisors? Allow them to protrude
buccally, use primate space, use early mesial shift (which actually is primate space), or Leeway
space (aka late mesial shift…I picked this one).
QUESTION: Leeway space  enough room for mandibular teeth to erupt?
Leeway space helps with spacing for the molars
QUESTION: Premature loss of which would lead to arch length deficiency? Primary canine
QUESTION: Class II is formed with distal step
QUESTION: Class I can be formed with edge to edge or mesial step
QUESTION: Primary teeth edge to edge molars...class 1 in perm. teeth w/ mesial shift of perm
molar
QUESTION: When ortho is end to end? Shifts to mesial, turns to class 1. If it remains, class 2.
QUESTION: Distal step and mesial step CLASS II/III
QUESTION: Which of the following will most likely lead to a class 2 malocclusion on a patient (I said
distal step, vs. terminal flush plane, vs mesial step, etc)
QUESTION: What head gear would you use to correct a class III? Reverse pull headgear
QUESTION: What ortho appliance to pull maxilla forward to correct class III? front facing head gear***
its reverse pull headgear****
QUESTION: What head gear would you use to correct a class III Reverse pull headgear/ protraction
headgear or facemask
QUESTION: Which headgear is used for pt who needs to bring maxilla towards protrusive? reverse
pull/facemask (protection headgear)
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QUESTION: Which of the following dimensions are compared in the transitional dentition analysis?
A. Arch width to arch length
B. Leeway space to freeway space
C. Leeway space to size of tooth
D. Space available to space required
E.The arch perimeter of the primary and transitional dentition
QUESTION: A dentist will perform a Moyers' mixed dentition analysis. Which of the following teeth
will be measured to predict the size of the unerupted canines and premolars?
A. Maxillary incisors
B. Mandibular incisors
C. Primary molars and canines
D. Maxillary incisors for the maxillary arch; mandibular incisors for the mandibular arch
QUESTION: Moyers predict MD canine & premolars using a table, with the sum of all 4 primary
lower incisors
QUESTION: Tanaka predict canine & premolars MD width using 1/2 of sum of all 4 lower incisors
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QUESTION: The late mesial shift of a permanent first molar is primarily the result of closure of
which of the following spaces?
A. Canine
B. Leeway
C. Primate
D. Extraction
QUESTION: Ugly duckling stage: maxillary central incisors
  Ugly duckling stage = when 2 maxillary centrals erupt, move labially and have
diastema perm canines erupt & move mesially to close diastema
QUESTION: ugly duckling tage: diastema between 8 and 9 no canines

QUESTION: The duckling phase refers to? mixed dentition
QUESTION: “ugly duckling” stage – maxillary centrals
The maxillary central incisors can also be quite distally inclined when they first erupt
QUESTION: Ugly duckling stage definition: Wait for canines before doing ortho on centrals
QUESTION: If patient has their nose always stuffed and they breathe through their mouth what happens? I
said anterior open bite, some of the other choices posterior open bite, constriction on archesOrtho decks:
Mouth breathing causes “long face syndrome,” which is “SKELETAL OPEN BITE.”
QUESTION: Patient with airway obstructions often have an open anterior bite
QUESTION: Chronic nasal congestion in kid…..open bite (mouth breather)
most posterior cross-bites appear to be unilateral, they are usually the result of a bilaterally
underdeveloped maxilla with a shifting of the mandible to one side during closure.
QUESTION: a patient with maxillary arch constriction of 3mm and a posterior crossbite what will you
see? Normal midline, midline shift towards the unaffected side, midline shift toward the affected side
QUESTION: Maxillary constricted 3mm – pt is closing down
• Which way does the pt attempt to correct.
• To the crossbite side
QUESTION: patient has 3mm palatal constrict what is most likely complication: bilateral crossbite
QUESTION: 3mm max constriction--> Bilateral crossbite
QUESTION: cross bite unilateral and appliance of choice=bilateral expansor

QUESTION: why is the reason for that cross bite unilateral =mandibular shift
QUESTION: Unilateral posterior crossbites in kids are usually due to a MANDIBULAR SHIFT; treat
w/ MAXILLARY EXPANSION
QUESTION: Pt w/unilateral posterior crossbite
 True unilateral maxillary constriction & functional crossbite

 Mandibular shift
 Bilateral constriction
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QUESTION: How would you fix?
 Rapid Palatal expansion

 Nance
If true unilateral maxillary contriction  use unequal W arch or asymettrical maxillary expansion
QUESTION: What is indicated for the tx of unilateral cross bite? Elastics from Lingual of max mol to
Buccal of mand mol,
QUESTION: Hawley appliance for skeletal or non-skeletal deformities? Correction of skeletal crossbites
QUESTION: How do you fix a posterior cross bite? Quad helix, RAPID palatal expansion.
QUESTION: When to fix cross bite-ASAP
QUESTION: cross bite in child : correct immediately
QUESTION: most likely crossbite- maxillary lateral
QUESTION: Anterior permanent tooth most commonly erupts in cross-bite? Max laterals
QUESTION: what kind of appliance for posterior cross bite and when? Quad Helix (with digit sucking) or
Palatal Expander
QUESTION: Most common cause of anterio crossbite: thumbsucking, lack of interdental arch
space,
QUESTION: ant crossbite is done by all except: functional shift vs lower third of face is
hypertrophied
QUESTION: ant crossbite is done by all except: functional shift
QUESTION: Leveling of oclusal plane when? if open bite

QUESTION: Leveling of mandibular teeth OPEN BITE (treats the overbite)
QUESTION: Leveling of mandibular teeth  open bite

QUESTION: In an 8 year old child, there is a recession in a mandibular incisor with posterior crossbite,
which of the following treatment options is the least acceptable?
a. oral hygiene instruction
b. graft
c. correction of cross bite
d. observation
QUESTION: Case: Black,Girl around 7 years old. Presents with unilateral cross bite; she had a cleft
palate that was fixed. Palate in picture looks like a triagle and laterals are towards the palate.
A)What is the pigmentation?-racial pigmentation
B)what is the most likely cause of the crossbite?
-early loss of laterals
-due to cleft palate
QUESTION: 10 year old loses primary first molar, space maintenance? None, since premolar about
to erupt
QUESTION: A 10yo loses a primary M1, what should you do: nothing, band and loop
a. Nothing – the PM1 should be erupting at this age
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QUESTION: Patient is has crown on first primary molar and second primary molar is going to be
extracted due to caries. What should be done in order to maintain space?
b. -nothing- because premolar is about to erupt
c. -band loop
d. -distal shoe
QUESTION: For child w avulsed 4 yr old mand incisor- what would you do? Leave out?
QUESTION: Can tx all with appliances except- crepetis
QUESTION: Loss of a primary right molar in a 3 year old child requires placement of a…
a. band and loop
b. distal shoe
c. removable acrylic appliance
d. none of the above
QUESTION: Lower 1st molar come out too early, what do you do? – Band and Loop
QUESTION: child lost primary 2nd molar : distal shoe

QUESTION: Most common space maintainer- band and loop.
QUESTION: Patient has a Stainless Steel Crown on tooth #L, it’s going to before EXT, but what else will
be needed? – Do band-and-loop for space maintenance.
QUESTION: What does band and loop not have- occlusal stop for tooth above?
QUESTION: characteristics of a band and loop space maintainer include all of the following except?
Potential for decalcification if the cement is lost
provide space maintenance
provides food trap if not properly soldered
provides occlusal stop to prevent opposing dentition from supraerupting
QUESTION: What does band and loop NOT do? Does NOT create a vertical stop
QUESTION: Cementation of band and loop - common outcome
• All of the above except
• Creates space
• If leakage from cement – recurrent decay
• Prevents tooth from super erupting with opposing
QUESTION: What primary reason for restoring primary teeth
a. To maintain arch space
QUESTION: What tooth is the most important to keep for space maintenance: Primary 2nd molar
QUESTION: What is the most common tooth that involves space management in primary teeth? – 2nd
molar, 1st molars
QUESTION: if mandibular primary canine is premature lost what happened : incipient

malocclusion..insufficient arch size in anterior region..when laterals erupt, canine’s root are
resorbed and when canine is shed, midline will shift in the direction of the lost tooth.

resorbed and when canine is shed, midline will shift in the direction of the lost tooth
193
QUESTION: Child lost both his primary mandibular canines prematurely – why? Lack of arch space
QUESTION: Primary tooth lost prematurely, what does that do to perm tooth? Delayed eruption of
perm
**IF the kids’s primary molar is lost, the eruption is delayed. If the pt loses primary after age
7, eruption is accelerated
QUESTION: How do you determine arch perimeter?
Answer: Distal of primary second molar OR Mesial of permanent 1st molar

QUESTION: How to do measure the projected arch length space for permanent teeth? Incisors, Canine to
canine,
***Arch length: Distal p2 to distal p2 or Mesial M1 to Mesial of M1

Arch width: inter-canine space
QUESTION: What tooth erupting FIRST would cause some sort of arch discrepancy? Man 2nd perm
molar erupting before the 1/2nd man perm premolar
QUESTION: Lower 1st primary molar tooth has lower permanent premolar underneath, what will
determine when the premolar will come in? – How fast roots of 1st primary molar resorbs (other choices
were age, how much of root of premolar is formed, etc) (not sure…usually would think how much of a
root of the permanent tooth is formed…about 2/3 formation…Xtina)
determine when the premolar will come in? – How fast roots of 1st primary molar resorbs, how
much of root of premolar is formed, etc
QUESTION: Post emergence eruption is mostly result of: root develompent, bone growth,
QUESTION: The primary tooth is missing/extracted. The perm tooth root is 1/3 formed. What is
driving the eruption of the perm tooth?
a. Either something about vascular supply to the tooth or the fact that the root is 1/3
formed.
QUESTION: When does tooth start to emerge in the oral cavity?
b. When root starts to form

c. Only after crown has been formed WHEN DONE CALCIFYING
d. After complete root formation
e. After ¾ root has been formed (through gingival) (2/3 erupts through bone!)
QUESTION: ¾ root formed-when crown erupts
QUESTION: Root formation (teeth start to erupt) which is associated when teeth are about to erupt?
b. 2/3 root formation when teeth erupt (3/4)
c. crown formation answer choices
QUESTION: teeth erupt when root form is ¾ of root I think (not when root just started I don’t think)
a. erupt through bone when 2/3, erupt through gingiva when 3/4
QUESTION: how long for the root take to complete after eruption? 2.5- to 3.5 was the choice
194
QUESTION: Apical root closes---21/2-31/2 years after eruption,
QUESTION: Takes 2.5-3.5years for root formation to happen after eruption
QUESTION: What race has most deep bites? White? Black? Hispanics? Asians?
Severe deep bite is nearly twice as prevalent in whites as blacks or Hispanics (p < .001), while open bite
>2 mm is five times more prevalent in blacks than in whites or Hispanics
QUESTION: The best age to correct a thumb sucking habit is…
a. The primary dentition. Kids are easier to desensitize (5-6 years)
“Mild displacement of the primary incisor teeth is often noted in a 3- or 4-year-old thumbsucker,
but if sucking stops at this stage, normal lip and cheek pressures soon restore the teeth to their
usual positions. If the habit persists after the permanent incisors begin to erupt, orthodontic
treatment may be necessary to overcome the resulting tooth displacements.” Proffit, William R..
Contemporary Orthodontics, 4th Edition. C.V. Mosby.
QUESTION: The space for the eruption of permanent mandibular second and third molars is created
by the
A. apposition of the alveolar process.
B. apposition at the anterior border of the ramus.
C. resorption at the anterior border of the ramus.
D. resorption at the posterior border of the ramus.
QUESTION: Additional space for successive eruption of permanent maxillary molars is provided by
A. interstitial bone growth.
B. appositional growth at the maxillary tuberosity.
C. continuous expansion of the dental arch due to sutural growth.
D. an increase in palatal vault height due to alveolar growth.
QUESTION: Edgewise bracket- for intrusion motion

QUESTION: Ortho case where patient’s upper central were little flared, and needed to up-righted better,
what appliance do you use? – Rectangular Arch Wire (Other choices were headgear, facemask, etc)
QUESTION: ORTHo- finger springs??? (on removable to move a tooth via tipping)For what-tipping
of anterior mand and maxillary teeth
QUESTION: Labial bow- tipping teeth? (Passive labial bow - treats overjet) (Active labial bow – for
incisor retraction)
QUESTION: Patient needs ortho with partially erupted #17 and #32. Radiographically, both teeth had
crowns with distal area that are susceptible pericornitis. What do you do? – EXT both teeth surgically.
QUESTION: Patient with 16mm overjet  surgical and ortho combo
QUESTION: How to Tx 16mm of overjet: Ortho w/ surgery, premolar extraction route
QUESTION: ortho for kid with very poor oral hygene what treatment to do? Removable
QUESTION: Best time to fix lingaual inclined incisors- when canines erupt.
QUESTION: When to do ortho movement if max central is erupting lingually? During eruption, after
fully erupted?
QUESTION: Primary anterior tooth intruded 5mm-How would you treat it?
195
• Extract
• Splint
• Ortho-bring it down
QUESTION: Ortho uprighting of molar-what is the problem-what should you do?
• Occlusal interferences-need to adjust occlusion
QUESTION: How do you prevent rotation in ortho?
• Anti-rotational clasp
QUESTION: Ortho Treatment sequence question. (prophy, restorative, etc). be able to rank
QUESTION: Ortho sequencing questions
• level and align (light round wire)
• corrects vertical discrepancies (working arch wires) square/rectangular wires
• Finishing arch wires (finishing touches) light round wirest
QUESTION: Perio after the ortho b/c bone will change
QUESTION: Y would u move a tooth before doing perio? I wrote bec more likely to get bone loss after
perio surgery, other choices bec it easier to move now, stable teeth are harder to access...
QUESTION: Why do you restore primary teeth?
1. SPACE MAINTENANCE
QUESTION: Light ortho pressure-direct resorption
QUESTION: Ortho - Light movement causes what type of bone resorption (indirect (I picked) vs
direct): direct
QUESTION: A light force applied to the periodontal ligament during orthodontic treatment is considered?
a. intermittent
b. direct
c. continuous
d. indirect
QUESTION: Which one of the following doesn’t happen in PDL during ortho movement? – Chemical
change (Don’t think it chemical change because there is a release of chemical messengers in the
pression-tension theory…but not sure what the right answer would be…Xtina)
QUESTION: When moving with ortho what does not happen? Chemical change in pdl, pressure on one
side and release on the other...
QUESTION: Orthodontic movement- widened pdl due to decalcification? Due to tension
Compression (where tooth is moving toward) and tension side (where tooth is moving away from). First,
widened PDL occurs on tension side in presence of light prolonged orthodontic forces, indicating tooth
movement is soon to begin.
Compression side: osteoclasts are removing lamina dura
Tension side: Osteoblasts are laying down new bone
QUESTION: Which of the following soft tissue elements (fibers) are commonly associated with relapse
following orthodontic rotation of teeth: Supracrestal
QUESTION: What causes rotation of a tooth after ortho therapy: transeptal fibers
QUESTION: What fibers cause reversement of a rotated tooth after ortho treatment? Transseptal
196
QUESTION: During orthodontic relapse, which fibers are primarily responsible for the relapse? – Oblique
(I can’t remember if circular was on there, but I think I got this wrong!) (should be something to do with
supracrestal fibers…Xtina) **The supracrestal fibers, in particular Transseptal fibers, have been
implicated as a major cause of postretention relapse of ortho treatment.
QUESTION: 2 ortho cases:
a. 14 yr old kid w/ pano; all PM’s congenitally missing except #28 (missing 7 of them);
retained primary molar crowns over congenital missing PM’s
i. 4 primary teeth are ankylosed & 4 perm teeth are missing (BOTH FALSE)
ii. Using a ceph, you gotta tell if facial profile is convex, straight, or concave 
all 3 were CONVEX
iii. This case was dental class III but w/ convex profile
iv. Given ANB = 6 & ask wut class it is  its Class II
v. Other ortho pt: explorer catches in 1 pit of #19? Wut wud you do?  PRR
b. Upper & lower canines are ectopically erupted out of the arch; besides that
everything else was normal in this case (15 yr old?)
i. How do u treat?
1. Extract 1st PM’s & bring canines into arch OR
2. Take out 4 canines & keep PM’s
a. (agu put take out canines)
3. if you’re gonna extract 1st PM’s wut would you NOT use: 150, 151, 3_,
2_ _ (answer must be 1 of the last 2; look em up)
ii. This case was Class I
iii. Ortho pt: has never had a restoration? Wut wud you do?  sealants, do
nothing, etc. (agu put: do nothing)
QUESTION: Ectopic eruption of maxillary first molar? Most likely needs ortho? 50% self resolves?
(66% self correct)
QUESTION: Permanent 1st molar ectopically erupting with slight resorption of primary –
separating device (Can use elastic seperators)
QUESTION: # of vertical planes in the face? 5
Esthetic analysis, face divided:
QUESTION: Vertically by 5 (4 planes)
QUESTION: Horizontally - 3 (2 planes) 
ANB = SNA - SNB.

 A positive ANB angle indicates that the maxilla is positioned anteriorly relatively to the
mandible (Class I or Class II malocclusion cases).
 A negative ANB angle indicates that the maxilla is positioned posteriorly relative to the
mandible (Class III malocclusion cases).
The normal range is 1-5.
197
>5 indicates a Class II skeletal jaw relationship, protrusive maxilla or retrognathic mandible.
<1 indicates a Class III skeletal jaw relationship, deficient maxilla or prognathic mandible.
Normal ANB is 2 degrees
QUESTION: SNA measures maxilla
QUESTION: Bigger SNA means? Maxilla is more protrusive
SNA-SNB=ANB maxilla to mandible relationship
QUESTION: ANB 6, what skeletal classification? Class 2
QUESTION: angle ANB: 6. type of occlusion: class 2

QUESTION: Girl class II, ANB WAS 6(class 2)
QUESTION: ANB -4: class III

QUESTION: ANB is -6 degrees? Whats the facial profile? Class III
QUESTION: With ANB value being -6 what is the patient class/malocclusion: Class III
QUESTION: Ceph- ANB of -6: Class III

QUESTION: SNA 76 AND SNB 78=-2 = class 3
QUESTION: Know snb vs SNA (SNA = 82, SNB = 80)
QUESTION: ANB -2 --> negative ANB so class 3
QUESTION: Frankfort’s horizontal plane = porion (upper external auditory meatus) to orbitale
(inferior border of orbit)
QUESTION: Know the landmarks for the Fox plane.
Fox plane is parallel to campers line (alar of nose – mid tragus line) – for anterior-posterior
plane
Fox plane is parallel to interpuppillary line – for anterior plane

• Lower alla upper tragus and interpuplar distance.
QUESTION: cleft lip and palate? 6-9 weeks in utero

QUESTION: with cleft lip and palate what occlusion is mostly seen? class III malocclusion
QUESTION: Patients with cleft palate, what class will they present? – Class 3.
QUESTION: cleft lip more common in boys cleft palate more common in girls
QUESTION: Pt had cleft lip and palate. Later in life during ortho analysis what do you see?
• *Deficient maxilla
• Normal mand
QUESTION: Most developmental deformity in Maxilla? – Cleft Palate
198
QUESTION: Most prevalence: cleft lip and palate
QUESTION: What is more commonly seen?
o Amelogenesis imperfect
o Ectodermal dysplasia
o Dentinogenesis imperfect
o Cleft lip and palate (I chose this option)
QUESTION: What is cleft palate class 3: soft and hard palate plus alveolar process
QUESTION: What mostly gives cleft palate? Genetic or environmental

QUESTION: Cleft palate and lip is: autosomoal dominant ,
QUESTION: Cleft lip/palate is caused by: autosomal dominat, multifactorial, autosomal recessive?
QUESTION: Cleft palate
o Environmental
o Genetic
o MULTI-FACTORIAL!!
QUESTION: What are the reasons for closing a cleft lip except?- Support the premax on a unilat cleft, felp
speech, and the not is to support the ala of the nose.
QUESTION: Speech impediments from cleft palate are due to? tongue being unable to close
nasopharynx
QUESTION: Speech problems associated with cleft lip and palate are usually the result of: the inability of
soft palate to close air flow into the nasal area.
QUESTION: Why do people with cleft palate have a hard time talking?
because they cannot close the air space between the nose and the soft palate
QUESTION: A cleft lip occurs following the failure of permanent union between which of the
following?
A. The palatine processes
B. The maxillary processes
C. The palatine process with the frontonasal process
D. The maxillary process with the palatine process
E. The maxillary process with the frontonasal process
QUESTION: Age when repair cleft palate for normal canine eruption: When canine tooth is ¾
formed (8-9years old)
QUESTION: When correcting cleft problem how do you end/finish?

• Closing plate
• Suturing lip
Alveolar augmentation (phase 2)
• Suturing lip
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QUESTION: percentage of cleft lip and cleft palate in Caucasians? 1/750, 1/1100, 1/1500…from
OS lecture caucasin=1/1000, blacks=1/2000, Asians=1/500
QUESTION: Cleft palate and lip is seen in how many americans? 1/300. 1/700. 1/1100, 1/1500
QUESTION: Cleft palate prevalence in caucasion? 1/1000 (cleft lip in caucasion 1/800 (Asians
have it the most common)
QUESTION: Caucasions cleft lip and palate: 1:700
QUESTION: incident of cleft palate / Cleft lip in US - 1 in 700

QUESTION: Cleft lip/palate: 1:700
But be careful. It can ask for just cleft lip in White: 1:1000 or cleft palate 1:2000
Cleft PALATE with out cleft lip 1in2,000. (CDC2012)
Cleft LIP with and without cleft palate 1 in 1000. (CDC 2012)
QUESTION: Patient was class I according to molar relationship but skeletal she was class III because
of ANB and cleft palate
QUESTION: Angle class I but skeletal is CL 3 bc it tells you ANB and cleft palate
QUESTION: What surgery will a pt with cleft palate most likely need…move maxilla up or move
mandible back…(mandibular set back)
QUESTION: At 3 months they get the cleft palate and cleft lip surgery. Usually this causes future Class III
issues. So at later age they will need to move back the mandible to correct the class III. This is
called MANDIBULAR SETBACK
QUESTION: Chronic nasal stuffiness assoc with what occlusion? Class III????
QUESTION: What happens to cause class one from edge to edge- both mesial shift, only mand shift, only
max shift**?? I think only mandible—that is the only way it makes sense.
QUESTION: If lose primary max second molar early what happens? Class 2 or class 3 occlusion?
QUESTION: Crowding - will displace centrals…something about how are u gonna fix the anterior mand
crowding, answer was you’ll have to do stripping
QUESTION: WHAT IS A MODERATE Crowding ? less than 4mm is moderate
>4mm severe crowding

QUESTION: Ortho take out pre-molar for crowding, not sure which it was.
QUESTION: If a child has 3mm crowding on the lower and permanent canines haven’t erupted,
what do you do? I put nothing
QUESTION: 9 year old boy, 5 mandibular incisors, primary canines still present, already
crowding, permanent canines still have a long way to come. What would you do
to treat this anamoly: remove one of middle three, remove end, remove primary
canines.
QUESTION: anterior crowding : mixed dentition analysis.

QUESTION: What happens with intercanine distance after mixed dentition?
a. increased
200
b. decreased
c. stable, no change
QUESTION: What does the moyers probability chart predict when a transitional dentition analysis is
performed?
a. The widths of mandibular anterior teeth
b. The space available for permanent canine and premolars
c. The width of permanent canines and premolars
d. The space needed for alignment of permanent mandibular central and lateral incisors
Pharmacology:
QUESTION: alpha 1 - leads to vasoconstriction

QUESTION: What does Alpha-1 do? A.Vasoconstriction of peripheral vessels
QUESTION: When you stimulate alpha 1 receptors what happens? 
a. Vasoconstriction   b. Hypertension 
QUESTION: what does alpha 1 receptors do in the heart ?Vasoconstriction, increase blood pressure,
increase peripheral resistance, MYDRIASIS and urinary retention
QUESTION: Patients BP spike after EPI, what receptor? A1

QUESTION: Adrenalin – stimulates alpha 1, 2 and beta 1, 2 receptors
QUESTION: Heart has beta 1 receptors
QUESTION: Vasoconstriction of the veins – Alpha-1 or Alpha-2 receptors?
QUESTION: slow infusion of epinephrine will cause which of the following and know which receptor is
responsible also. Alpha 1,2, beta 1,2, a rapid increase in heart rate and pressure, decrease in heart rate,
decrease in blood pressure, etc
201
Alpha 1 (Vasoconstriction during anaphylaxis), Beta 1 (Increases cardiac output), Beta 2
(bronchodilation)
QUESTION: hemostatic agents in retraction cord target
• a1 (alpha1 vasoconstriction)
• b1
• b2
• gaba
• muscarinic receptor
QUESTION: retraction cord what can cause : with epi increase HR, BP, do not use in
hyperthyroid or cardiac disease.
QUESTION: Why do have to dry the sulcus before putting retraction cord? A. so hemo is
diluted.
QUESTION: After using a gingival retraction cord, tissue reacts by recession. Where do you see this
the most? Lingual, buccal, interproximal.
QUESTION: Amphetamines – lead to NE release in brain (increase neurotransmitter activity of NE &
Dopa)
QUESTION: ADHD; diagnosis boys=girls, boys > girls, girls < boys?
QUESTION: Know Methylphenidate =Ritalin, Amphetamine = Adderal.
Methylphenidate exerts many of its effects through dopamine uptake blockade of central
adrenergic neurons, in contrast to the amphetamines and cocaine that increase catecholamine
NE SERETONIN DOPAMINE release as a primary mechanism.
QUESTION: Patient is very anxious what do you do? – Tell him to stop taking amphetamine on the day
appointment (Amphetamine can induce anxiety, and are contraindicated for patients who are very
nervous)
QUESTION: Side effect of Amphetamines – Insomnia (difficulty of falling asleep)
QUESTION: Amphetamines- what are symptoms of it- increased heart rate and excitability
QUESTION: Kid is taking adderall (amphetamine), what should you do before the appointment? I
think you tell them not to take it that morning so that there is no adverse reaction with the
epinephrine in anesthesia (or you could just give an injection w/out epinephrine, but that wasn’t an
answer choice)
QUESTION: Insomnia and loss of appatite?
Adderall : psychostimulant medication composed of amphetamine and dextroamphetamine, which is
thought to work by increasing the amount of dopamine and norepinephrine in the brain
QUESTION: Amphetamine - Indirect-acting symphathomimetics
QUESTION: Indirect sympathomimetic drug? Diphenyl amphetamine
QUESTION: ADHD : most common in boys

QUESTION: ADHD is most common in boys
QUESTION: Which one is true about ADHD? – It’s more common in girls than boys (wrong, boys more
than girls. Other choices were they are both same, etc) **10X MORE IN BOYS
QUESTION: Pediatric pt taking amphetamine. What can be observed in pt’s health history? ADHD*
202
QUESTION: Which of the following is incorrect? The kid has ADHD, know the medication for ADHD.
Methylphenidate was one of the medications they asked , but don't remember the question
completely
QUESTION: Smooth muscle relaxation is caused by which of the following drugs?

a. prazosin (I think this one…alpha 1 blocker…allows relaxation of vascular smooth muscle..to lower
BP..)
b. atropine (anticholinergic)
c. theophylline (treat asthma, COPD…it relaxes bronchial smooth muscle…so I guess it does do smooth
muscle…)
d. amphetamine (psychostimulant…increase wakefulness)
QUESTION: Which of the following combinations of agents would be necessary to block the
cardiovascular effects produced by the injection of a sympathomimetic drug?
Atropine and prazosin  
Atropine and propranolol  
Prazosin and propranolol  
Phenoxybenzamine and curare  
Amphetamine and propranolol
QUESTION: Each of the following drugs produces vasoconstriction of vessels if injected into the gingiva
Epinephrine (EpiPen®)
Terazosin (Hytrin®)
Levonordefrin (Neo-Nedfrin®)
Phenylephrine (Neo-Synephrine®) Norepinephrine (Levophed®)
QUESTION: Epinephrine + Propanolol: Propranolol is a nonselective beta blocker. So epi acts

at only alpha receptors, which in the periphery are mainly alpha-1. So you get marked
vasoconstriction, which leads to reflex bradycardia. Increased ⬆ BP --> increased firing and aortic
and carotid sinuses --> increased vagal activity on the heart --> decreased ❤⬇ HR.
QUESTION: Epi and propranolol- increase BP dec HR
QUESTION: epi plus propanol: increases BP, decreases HR

QUESTION: Epi and propranolol-increase BP, decrease HR-patient taking propranolol in history;
QUESTION: If you inject a pt that is taking propranolol directly into their vein what will happen. Increase
BP and HR?
QUESTION: propanolol+ epi. bad reaction due to: Drug interaction, anxiety, allergy,...
QUESTION: Patient taking propranolol with epinephrine. What receptor caused hypertensive crisis?
-alpha 1
203
-alpha 2
-beta 1
-beta 2
If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, however, the beta-
blocker prevents the vasodilation, leaving unopposed alpha vasoconstriction. (alpha-1)
QUESTION: What is the effect seen when propranolol and epinephrine are injected simultaneously - in
cases of mild reactions it causes hypotension; in severe reaction it is malignant hypertension
QUESTION: Change propanolol for ? Metoprolol ... little change on HR, but no marked increase in
BP. METOPROLOL = selective B blocker and is ok to use with EPI!!
QUESTION: Proponolol mechanism..beta-adenergic blockers
QUESTION: Patient got LA injection and started to feel nervous, tachycardia etc: choices were CNS
effect of epi, direct cardiac effect of LA.
QUESTION: After injection of LA, pt experiences tachycardia, nausea, and nervousness: alpha blockade
of the CNS (reaction of epi), cardiac response to lido, cardio vascular peripheral response to epi
QUESTION: Main prophylactic treatment for angina? propanolol
QUESTION: Nitroglycerin, prop3onolol, and something else are all used for- cardiac arythmias, angina
QUESTION: Which is not used in tx of angina? Nitroglycerin, Ca blocker, propranolol, thiazide
(thiazides are usually diuretics)
QUESTION: All these drugs alter ionic movement except- Propanolol, others were CCB, HCTZ, and
Digoxin
QUESTION: A patient recieving propanolol has an acute asthmatic attack while undergoing dental
treatment. The most useful agent for management to the condition is?
a. Morphine
b. Epinephrine
c. Phentolamine
d. Aminophylline
e. Norepinephrine
QUESTION: The drug-of-choice for the treatment of adrenergically-induced arrhythmias is
quinidine.  
lidocaine.  
phenytoin.  
propranolol.  
QUESTION: direct alpha symphatomimetic: clonidine (alpha2), gueanethidine (indirect acts on

neurons to inhibit NE release), methyldopa (alpha2).
204
QUESTION: Epinephrine Reversal with ? Alpha adrenoceptor blockers, like phenoxybenzamine,
inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP
instead of high BP
QUESTION: Epinephrine reversal: what drugs can do this? after giving a patient epinephrine, following
hypertension, which of these drugs would cause a drop in BP? Phenoxybenzamine
Anticholinergic properties
dry mouth and throat, increased heart rate, pupil dilation (mydriasis), urinary retention,
constipation, and, at high doses, hallucinations or delirium. Other side effects include motor
impairment (ataxia), flushed skin, blurred vision at nearpoint owing to lack of accommodation
(cycloplegia), abnormal sensitivity to bright light (photophobia), sedation, difficulty concentrating,
short-term memory loss, visual disturbances, irregular breathing, dizziness, irritability, itchy skin,
confusion, increased body temperature (in general, in the hands and/or feet), temporary erectile
dysfunction, and excitability, and although it can be used to treat nausea, higher doses may cause
vomiting- anticholinenergic
Salivary secretion increases with use of Pilocarpine, Neostigmine (cholinergic agonists)

Salivary secretion DECREASES with use of atropine and scopolamine (anti-cholinergics)
Scopolamine-commonly used for motion sickness Anticholinergic drug The drug is used in eye drops to
induce mydriasis (pupillary dilation)
Remember>ANTIHISTAMINE IS ALSO USED FOR MOTION SICKNESS!
QUESTION: What is used for motion sickness? Diphenadryin (Benadryl)----I think this is
scopolamine
Neostigmine (Increases Salivation)

Neostigmine, etc. cause salivation. **CHOLINERGIC effects: increase salivation, increase urination,
bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation
Know which drugs mimic parasympathetics (cholinergics), be able to pick from a list which does
not belong (Acetylcholine, Atropine, d-tubocurarine, neostigmine, Nicotine, Physostigmine,
Pilocarpine)
Effects of cholinergic drugs – slow heart, constrict pupils, stimulate GI smooth musc, stim sweat, saliva,
Belladonna derivatives – anticholinergic
Neostigmine: Acetylcholinesterase inhibitor, doesn’t penetrate BBB, tx of M. gravis
Physostigmine: used for atropine, scopolamine overdose, tx of glaucoma, acetylcholinesterase
inhibitor
Atropine: Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides
Pilocarpine: Muscarinic agonist, for glaucoma and xerostomia
Scopolamine: anticholinergic agent,
QUESTION: Neostigmine and pilocarpine increase? Salivation. are parasympathomimetic that

acts as a reversible acetylcholinesterase inhibitor.
QUESTION: Glycopyrrolate effect? reduce salivary (is a muscarinic anticholinergic), as well as the
acidity of gastric secretion.
205
QUESTION: Atropine: is sympotatic decrease salivation
QUESTION: what meds to decrease saliva? Should be atropine, scopolamine, etc. Pilocarpine,
methacholine, neostigmine, etc. cause salivation. **Muscarinic effects: increase salivation, increase
urination, bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation
QUESTION: Atropine-anti cholinergic-what does it not cause/cause? Don’t give if patient has
xerostomia
QUESTION: If patient has xerostomia what wont you give---Atropine- anticholinergic
QUESTION: What drug does not cause miosis of the eyes?- atropine
QUESTION: Insufficient cholinesterase leads to hypotension? (bradycardia)

Other answers: tachycardia, restlessness, …
QUESTION: bradycardia: atrophine

***I think the question must have been something like pt have bradychardia what should we give him?
And answer is atrophine. Because atrophine will increase heartrate causing tachychardia.
QUESTION: Drug to decrease saliva because you want to take an impression- ATROPINE
(DECREASES) , Prilocarpine (INCREASES), Neostigmine (INCREASES)
QUESTION: Atropine poisoning tx: physostigmine
QUESTION: Patient salivates a lot, what is tx before surgery? Atropine **antimuscarinic

QUESTION: Xerostomic pt, give pilocarpaine! Or cevimeline.
QUESTION: Cimeviline just like pilocarpine to increase salivation in xerostomia
QUESTION: What drug do you give to a pt with xerostomia? Pilocarpine
QUESTION: Pilocarpine used for? Is a parasympathomimetic alkaloid, for tx of glaucoma and
xerostomia.
QUESTION: What is the side effect of pilocarpine (Tx of dry mouth)in toxic dose?
Bradycardia and hypotension
Apnea
Cardiac shock
Note: nontoxic side effects>>> excess sweating and salivation, bronchospasm
QUESTION: Propantheline bromide (pro-Banthine) is? anti-cholinergic (anti-muscarinic), relieve

cramps or spasms of the stomach, intestines, and bladder.
QUESTION: Which of the following groups of drugs is contraindicated for patients who have glaucoma?
Adrenergic, Cholinergic, Anticholinergic Adrenergic blocking
QUESTION: Which of the following drug groups increases intraocular pressure and is, therefore,
contraindicated in patients with glaucoma?
206
A. Catecholamines
B. Belladonna alkaloids (anti-cholinergic)
C. Anticholinesterases
D. Organophosphates (cholinergic)
QUESTION: A patient has a deficiency in acetyhcholinesterase. After giving her this drug, action
is prolonged. I put d-tubocurarine (inhibits acetylcholine receptorweakness of skeletal
muscles)
QUESTION: Decrease of pseudocholinesterase would lead to increase in? Succinylcholine or

tubocurare
QUESTION: Administration of succinylcholine to patient deficient in serum cholinesterase would casue…

a. convulsions
b. Hypertension
c. prolonged apnea
d. Acute asthma attack
QUESTION: Only LA that is a vasoconstrictor? Cocaine
QUESTION: 2-3 questions on miosis (opioids + cholinergics) vs mydriasis (anticholinergics +

increase serotonin) and which drugs or conditions cause which?
QUESTION: Pt taking narcotic for long term what causes: headache due to increase intracranial
pressure.
Adrenergics:
QUESTION: End plate of adrenergic neuron how is it terminated?
-reuptake of NE? followed by MAO degradation in the neuron
-MAO degrades NE
QUESTION: What receptor or signaling pathway is linked most directly to α2-adrenoceptor

stimulation? Inhibition of � adenylyl cyclase through Gi, resulting from stimulation of α2-
adrenergic receptor, leads to intracellular ⬇ cAMP
QUESTION: A patient who has Parkinson’s disease is being treated with levodopa. Which of the
following characterizes this drug’s central mechanism of action?
a. it replenishes a deficiency of dopamine
b. it increases concentrations of norepinephrine
c. it stimulates specific L-dopa receptors
d. it acts through a direct serotonergic action
QUESTION: why do you need to take carbidopa with levodopa: prevents breakdown of levodopa before it
crosses the blood brain barrier **L-dopa is a precursor to neurotransmitters like dopamine, norepi, and
epi. It is used in tx of parkinson’s. In parkinson’s you want to raise dopamine levels.
QUESTION: How does carbidopa tx Parkinsons? I put potentiates effects of dopamine
QUESTION: Carbidopa - Use in conjunction with levodopa
207
QUESTION: Levodopa used to treat Parkinson’s disease
QUESTION: Levdopa is used in parkinsons in order to do what?- increase dopamine in the CNS
Carbidopa-a drug used to treat PARKINSON'S DISEASE, but only works when combined with
LEVODOPA (treats Parkinson's Disease to replenish the brain's supply of dopamine, which is the
deficient neurotransmitter in Parkinson's.
QUESTION: Parkinsons is def of dopamine
QUESTION: Cause of Parkinson? Dopamine deficiency, give them methyldopa (levadopa)
Methyldopa competively inhibits DOPA decarboxylase decrease in dopamine and NE/EPI. Its an
anti-hypertensive, acts on A2 adrenergic as well.
QUESTION: Theraputic Index LD/ED is a measure of : safety of drug
potency - response to a drug over a given range of concentrations. Potent = depend on dose of drug-
less mg for same efficacy has more potency
efficacy - effect of a drug -efficacy is the max effect of the drug. Max effect is also called as intrinsic
activity. (antagonists are not efficient/no intrinsic activity)
Therapeutic index - is an estimate of the margin of safety of a drug.
TI = Lethal dose 50/Effective dose 50
QUESTION: LD50 means that •At this does 50% of the test animals died
QUESTION: What is bioavailability of a drug? amount of drug that is available is blood. (plasma)
QUESTION: How is bioavailability measured?
How much drug is absorbed in the circulation  
Blood to urine ratio  
Note: efficacy of drug: level of binding a drug to its receptor
QUESTION: what pharmacokinetic factor influences the need for multiple doses in a day (dose
rate): I said half life; other option is bioavailability (maybe should have goe with this), or clearance
Elimination rate of a drug influences its half life  that determines the frequency of dosing
required to maintain therapeutic plasma drug levels.
Bioavailability: Highly absorbed drug (high bioavail.) requires a lower dose that poorly absorbed.
Most important determinant of drug dose is POTENCY of drug.
QUESTION: drug dosing has to do with: half life

QUESTION: two different drugs with same dosages bind to the same receptor and cause same intrinsic
affect however they have different affinities for the receptor: In which aspect these 2 drugs are similar?
Efficacy bc they can both produce the same maximal response if enough is given
ED50
208
Potency is how much they can get response with just a little
QUESTION: There are two drugs that with the same dosages bind to the same receptor and have same
intrinsic affect however different affinities for the receptor: How are these two drugs the same? 
a. ED50
b.   LD50
c. Potency
d. Efficacy
QUESTION: both drug have same intrinsic effect and different receptor affinity---same potency, same
efficacy
QUESTION: Drug A has greater efficacy than Drug B – Drug A will produce higher effect at lower dose
(the other answers got into receptors, but the key here is intensity of drug, not how it interacts with
receptors)
receptors)* depends on the answer choices…. I think this person if referring to POTENCY. Potency =
relative concentrations of two drugs that produce the same effect. So a drug that produces the same effect
as another drug but at a lower dosage.. is MORE POTENT. EFFICACY deals with RECEPTORS.
EFFICACY = NUMBER OF RECEPTORS that must be ACTIVATED to yield maximal response.
Higher efficacy = activates less receptors to produce this response.
**in the Tufts packet—“Drug A had greater efficacy than drug B, so Drug A” – is capable of producing a
greater maximum effect than drug B.
QUESTION: Drug A vs Drug B question: less of drug A to produce a response than B (know efficacy,
potency, theurapeutic index)
QUESTION: Fixed dose drug A w/ low dose of Drug B increase drug B effect when same dose of drug
a is give w/ increased does of drug B: competitive antagonist, synergism , partial agonist
QUESTION: Three carpules (2 ml carpules, 40 mg/ml) of local anesthetic X are required to obtain
adequate local anesthesia. To obtain the same degree of anesthesia with local anesthetic Y, five carpules
(2 ml carpules, 40 mg/ml) are required. If no other information about the two drugs is available, then it is
accurate to say that drug X
0
is less potent than drug Y.
is more efficacious than Y.
is less efficacious than drug Y.
X&Y are = in potency & efficacy.
QUESTION: The maximal or "ceiling" effect of a drug is also correctly referred to as the drug's
A. agonism.
B. potency.
C. efficacy.
209
D. specificity.
General Anesthesia:
QUESTION: A 26 month old child w/ 12 carious teeth. How to treat? General Anesthesia
QUESTION: What would you do with a 26 month year old child and multiple decays on teeth
o General anesthesia
o Oral sedation
o Nitrous oxide
QUESTION: 26 mo old child with 12 carious teeth, how would u treat'? nitrous and local anesthesia,
oral sedative and local in one visit. GENERAL ANESTHESIA !!
QUESTION: 2 year old with 12 fillings that are deeply decayed, how do you tx patient? Under
general anesthesia
QUESTION: Kid under general anesthesia: give chloral hydrate and midazolam
QUESTION: Benzodiazepines which one is used for depression and anxiety for compulsive disorder
(Xanax= Alprazolam - used for anxiety panic disorder not depression)Out of the Benzodiazepines
the only one that has OCD is Xanax-Alprazolam but does not include depression—only
QUESTION: Diazepam: Anticonvulsant & Sedative
QUESTION: Valium causes orofacial clefting   DOES NOT!
QUESTION: Anticonconvulsants can cause cleft palate (teratogenic effect)

QUESTION: valium is used for all of following except: I picked emesis/ other option was insomnia
but im pretty sure its emesis
QUESTION: Diazepam action in GABA: antianxiety and anticonvulsant
QUESTION: hypnosis affects what? voluntary muscles, involuntary muscles, both voluntary
and involuntary muscles, glands
QUESTION: What’s the action of the Benzodiazepines?

A.Facilitates GABA receptor binding by Increasing the frequency of chloride channel opening.*
QUESTION: Mechanism of action of on GABA receptors:
increasing the frequency of chloride channels by Benzodiazepines
Barbiturates increase the duration of chloride channel opening
QUESTION: Benzodiazepines act on: I put GABA receptors

QUESTION: benzodiazepines, anxiolytics how do they work? GABA!
QUESTION: Which of the benzodiazepine you don’t give to seniors? Long acting one (like diazepam,
look up)
Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and
temazepam, midazolam.
QUESTION: Benzos are great for dentistry due to an action of- amnesia and little memory of the event.
210
QUESTION: Best benzo for iv sedation-MIDAZOLAM.
QUESTION: What does IV Midazolam do? Amnesia

QUESTION: Best benzodiazepine for pt with liver cirrhosis -oxazepam
Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)
LOT:
Lorazepam
Oxazepam
Temazepam
QUESTION: Flumazenil: Benzodiazepine antagonist ; competive GABA receptor.

QUESTION: Which drug best reverses the effect of benzodiazepines?
Flumazenil Benzo flu away
QUESTION: Flumazinil - reversal for benzo
QUESTION: contraindication of lorazepam: a)pregnancy b)diabetes ?
QUESTION: diazepam is contraindicated in pregnant lady (ALL BENZOS)
QUESTION: Who cannot take Valium (diazepam)? Pregnant women
QUESTION: Pregnancey, don’t take? diazepam
QUESTION: Benzodiazepines (diazepam, lorazepam) are contraindicated in pregnancy
QUESTION: Reversal for valium (diazepam)- flumazenil

QUESTION: Why do you use benzos or a barb for antianxiety? Reduced depression, does not
propentiate depressents. (less respiratory depression)
QUESTION: How benzos are anxiolytic – rebound sedation or amnesia?
QUESTION: How benzos are anxiolytic: moderate doses ANTIANXIOLYTIC and high doses is
SEDATIVE
QUESTION: Sedative rebound (or something like that) a. Antipsychotic
QUESTION: Sedative rebound (or something like that)

a. Antiphysicotic
 PART OF WITHDRAWL
QUESTION: Which of the following barbiturates MOST readily penetrates the blood-brain barrier?
Thiopental
QUESTION: Sodium Thiopental  rapid-onset short ultra acting barbiturate(IV) for general
anesthesia- for Desensation
QUESTION: A patient has appointment next morning, he is anxious, and the night before he had hard time
sleeping, which of the following tx would you prescribe? Ambien! (sedative and makes patient sleep).
QUESTION: Check what is Ambien (Zolpidem) !!

(Ambien is a nonbenzodiazpine hypnotic…used for insomnia..so not a benzodiazepine but acts
accordingly… anticonvulsant and muscle relaxant but too strong for these purposes…also reversed by
flumazenil just like BDZs…potentiates GABA receptors…short half life…negative side efx: hallucinations
and amnesia…Xtina)
211
QUESTION: Chief mechanism by which the body metabolizes short-acting barbiturates is?
a. oxidation (occurs in the liver…Xtina)
b. reduction.
c. hydroxylation and oxidation.
d. sequestration in the body fats.
QUESTION: why are ultrashort acting(gave me an actual name of a barbiturate) barbituates so fast?
•Redistribution (right answer according to previous test)
QUESTION: A patient's early recovery from an ultrashort-acting barbiturate is related primarily to
redistribution.
breakdown in the liver.
excretion in the urine.
breakdown in the blood.
binding to plasma proteins.
QUESTION: Diazepam -No effect on respiration as oppose to other BZ
QUESTION: The reversal for Versed? (versed = midazolam)

A. Narcon
B. Flumazenil**
QUESTION: Pt is under oral sedation. You should monitor everything except?
• Respiration
• Oxygen saturation level
• *Electo cardiogram
• Skin and oral mucosa color (cyanosis?)
QUESTION: #1 cause for problems during IV sedation?—hypoxia
QUESTION: A 77 years old female 110 lbs weight requires removal of mandibular teeth under local
anesthesia. She is apprehensive. The appropriate dose of i/v diazepam to sedate her?
a. 5 mg
b. 10 mg
c. 15 mg
d. 20 mg
QUESTION: Drug for seizures? Dilantin (or diazepam)

QUESTION: Flumazenil combats benzos (naloxone combats opioids), disulfuriam is for alcoholics
QUESTION: Buspirone - Psychotropic w. anxiolytic; low CNS depression, low psychomotor skill
impairment ***Buspar—different from benzodiazepines because it does NOT cause, CNS depression,
muscle relaxant, or anti-convulsant!!!!!** UNIQUE!!! Anxiolytic and antidepressant
QUESTION: Know drugs used for conscious sedation  SSRIs/BDZ Diazepam and
Prozac(fluoexitine)
QUESTION: 25 yo female breast feeding 12m old child and currently pregnant-which sedative would you
give?
• Halcion
212
• Promethazine
• Nitrous
• Diazepam
• Phenobarbital
QUESTION: What anxiolytic to use for anxious 25 year old pregnant woman who is breastfeeding?
Chloral hydrate (avoid), nitrous (avoid), benzo (avoid)
QUESTION: 25 yo female breast feeding 12m old child and currently pregnant-which sedative
would you give?
• Promethazine
*promethazine OK for pregnancy
QUESTION: -If youre breast feeding what drug should you not take? Something prohibited in the states.
QUESTION: What drug NOT to give to lactating breast feeding mother
QUESTION: Prozac - acts on serotonin

QUESTION: Prozac (fluoxetine) - acts on serotonin SSRI “selective serotonin receptor
inhibitor” this is an antidepressant
QUESTION: Fluoxetine (prozac ) Mechanism of action: SSRI
QUESTION: Patient is in her 70’s, she lives alone, what could she be suffering from? – Depression
QUESTION: Most common psychological problem in elderly? A: Depression
QUESTION: Geriatric population- problem with dementia or depression
QUESTION: Old people have dementia as the most prominent psychiatric issue: depression
QUESTION: What is assoc with depression; age, econ stat, prof status..
QUESTION: Most common mental illness among elderly? dementia, depression..
QUESTION: which one of the things can be seen with TMP pt in elders: Depression
QUESTION: main sign of dementia (I think it should be MEMORY LOSS, dunno short or long)
a. confusion
b. short term memory loss—I think this is the answer.. if they are asking for the first main sign.
Long term loss occurs later.
c. long term memeory loss
QUESTION: 1st sign of dementia
short term memory loss
long term memory loss
QUESTION: Dementia – don’t retain short term memory
QUESTION: main sign of dementia -People with dementia often forget things, but they never
remember them later
confusion **
QUESTION: Dementia: which is not a sign of dementia: long-term memory loss
QUESTION: Substance in the brain where antidepressants works :decrese amine mediated
neurotranmision in the brain
213
QUESTION: TCA mechanism of action: inhibit reuptake of NE and 5-HT (serotonin)
QUESTION: TCA 2nd generation- Nortriptyline (Pamelor, Aventyl)
Desipramine (Norpramin)
Protriptyline (Vivactil)
QUESTION: know the mechanism of action of TCA.? it decreases the re uptake of Norepinephrine
QUESTION: How do tricyclics work?- by not allowing reuptake of neurotransm.
QUESTION: What catecholamine do tricyclic antidepressants affect? Dopamne, serotonin,
acetylcholine
QUESTION: patient is taking TCA antidepressants what do you take into consideration? Limit
duration of procedures, keep in mind the epinephrine limit ….
QUESTION: Side effect of having TCA and epi : HTN, hypotension, hyperglycemia,
hypoglycemia
QUESTION: Most common antidepressant does what?

• Inhibits reuptake of NE, 5-HT, & DA (TCA)
• Inhibit reuptake of 5-HT (SSRI)
• Inhibit reuptake of N & 5-HT (SNRI)
• Inhibit MAO; prevent breakdown of NE & 5-HT (MAOI)
• Block D2 receptor (phenothiazine)
QUESTION: IF someone has a history of depression, what do you give? Zyban (Bupropion), not Chantix
(smoke cessation)
QUESTION: Amitrriptyline – most common tricyclic antidepressant, inhibits reuptake of NE and
serotonin
QUESTION: Tricyclic antidepressant- didn’t remember what the question was: SSRI- prevent uptake of
serotonin
QUESTION: Zoloft works on what receptor?Presynaptic monoamine transporters (inhibit reuptake
of 5-ht)
Sertraline hydrochloride (trade names Zoloft and Lustral, among others) is an antidepressant of
the selective serotonin reuptake inhibitor (SSRI) class.
QUESTION: Most common mood disorder?generalized anxiety or depression?
QUESTION: Depression causes- eating, lonliness, and something else
QUESTION: Depression-st johns wort
QUESTION: What do you use St. John’s Wart? Depression
QUESTION: St johns wort- is for depression
QUESTION: St. John’s Wart: (-) serotonin yeah because is for depression
QUESTION: What does St. John's Wort do? Decrease the body immunity
Note: there is no option “anti depressant” in choices. in Pt with HIV it interact with anti HIV drugs such
as Indinavir(increase immunity) and reduces their function so the immunity decreases
QUESTION: St johns wart- used for? · depressionnot with benz and HIV medication
Antipsychotics
o Phenothiazines: Block DA receptors
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 Act on the extrapyramidal pathway
o Side effects
 Tardive dyskinesia
QUESTION: antipsych drug does what?–DA (dopamine)
QUESTION: Substance in the brain where antipsychotics works : blocking the absorption of
dopamine
QUESTION: What catecholamine does Phenothiazine (antipsychotic) affect? Dopamine, serotonin,
acetylcholine
QUESTION: Phenothiazine (anti-psychotics): SE Tardive Dyskinesia
QUESTION: tardive dyskinesia-psychosis
QUESTION: Tardigive dyskaenesia – antiphyschotic (irreversible)

QUESTION: antipsychotic meds - act on dopamine
QUESTION: What acts on extrapyramidals? Phenothiazines (chlorpromazine)
QUESTION: Onset of action of antipsychotic is: 5-6 days
QUESTION: what is the most common psych disorder? (anxiety, depression, ADD,
schizophrenia)
QUESTION: lithium is used for? Manic phase of bipolar disorder
QUESTION: Lithium- bipolar disorders
QUESTION: a patient on Lithium is indicative of what? Severe depression? BIPOLAR
Anti-inflammatory/Corticosteroids: Side effect profile: gastric ulcers,immunosuppression, acute
adrenal insufissiency, osteoporosis, hyperglycemia, redistribution of body fat.
QUESTION: Strongest glucocorticoid/Long acting Corticosteroid? Dexamethasone,

QUESTION: Stomach ulcers? Excess ..corticosteroids
QUESTION: GI with corticosteroids: Ulcers. Long term effect- osteoporosis
QUESTION: GI effect WITH CORTICOSTEROIDS-ULCERS

QUESTION: Long term side effect of corticosteroids-osteoporosis and hyperglycimea
QUESTION: What is the side effect of prolonged corticosteroid therapy?
o Osteoporosis
o Know the other side effects just in case
QUESTION: patient with long term therary corticosteroid will show?

Hyperglycemia
QUESTION: patient with long term therapy corticosteroid will show?
Osteoporosis
QUESTION: long term glucocorticoids use- shows all of following except? hypoglycemia
does lead to: osteoporosis, hyperglycemia, immunosupp.,
QUESTION: Where do you see moon facies: steroid treatment
QUESTION: Where do you see moon facies: increased steroid treatment
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QUESTION: Containdation use corticosteroid-diabetes (also: HIV, TUBERCULOSIS, CADIDIASIS,
PEPTIC ULCER)
QUESTION: Aspirin contraindicated with: corticosteroid use
QUESTION: Corticosteroid: 20 mg 2 wks
QUESTION: How much and how long of steroid insufficiency: 200mg/two weeks in last 2 years, 20
mg 2 weeks in last 2 years, 10 mg or 1 mg….no idea
QUESTION: Critical dose of steroids for adrenal insuficience- 20 mg of cortisone or its equivalent
daily, for 2 weeks within 2 years of dental treatment
QUESTION: Acute adrenal insufficiency: hypotension
QUESTION: Pt taking corticosteroid with rheumatoid arthritis, pt needs TE, why would you consult with
physician: full blood panel, assess for adrenal insufficiency (want to make sure pt can produce enough
coricosteroid with addition to what they are taking so you won’t have over inflammatory response from
TE)
QUESTION: Pt on 3mo tx of steroids needs what?- no tx and consult gp for dose rase
QUESTION: if a pt. has been using 10 mg of corticosteroid for 10 years, what would you do for pt.
before any tx? Have pt continue and increase the dose
QUESTION: cortisone exerts its action on…(it’s a steroid hormone, so binds to intracellular receptor) -
receptors on membrane, proteins in plasma…etc.
(Enter cell and bind to cytosolic receptor migrate to nucleus gene expression or With plasma membrane
on target cells)
QUESTION: if pt doesn’t get steroid tx in time for their temporal vasculitis what will happened
• hearling loss
• vision loss
• retro-ocular headache

QUESTION: Asthma – why use corticosteroids – decrease inflammation
Inhaled corticosteroids are the most effective medications to reduce airway inflammation and
mucus production.
QUESTION: what Addison disease causes :pigmentation of the mucosa

chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid
hormones (glucocorticoids and often mineralocorticoids)
*Addison= lower steroid hormones…pigmentation of mucosa
QUESTION: Addisons shows what in oral cavity: pigmentation on buccal mucosa
QUESTION: what Addison disease causes : a)bone loss b)pigmentation of the mucosa
QUESTION: What clinical symptoms in the mouth would you see for Addison’s disease?
a. Hyperpigmentation
QUESTION: Addison’s Disease

adrenal insufficiency
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tan skin(J.F.K.)
Tx: give cortisol
QUESTION: Nitrous oxide – in blue cylinder (oxygen in green)

QUESTION: Nitrous oxide oxidizes the cobalt in vitamin B12, resulting in the inhibition of
methionine synthase. Nitrous oxide has greater analgesic potency than other inhaled anesthetics
QUESTION: Dreaming on nitrous, what is it? Overdose, normal
QUESTION: How do u check to see if the oxygen (reserve) bag is ok: It shouldn't be that full or
that collapsed
QUESTION: Contradictions of nitrous, which patient can get nitrous? Hypertention, pregnancy
QUESTION: What is an absolute contra-indication for the use of Nitrous Oxide? Sickle cell anemia
or nasal congestion?
QUESTION: Fear anxiety, which option is better? First we administer Nitrous, then papous , then
anesthesia
QUESTION: devise used in evaluation of N20 : Pulse oximeter

(CORRECT—used to measure amount of oxygen in blood)
QUESTION: The correct total liter flow of nitrous oxide-oxygen is determined by the amount
necessary to keep the reservoir bag 1/3 to 2/3 full.
QUESTION: Nitrous oxide: Total flow rate 4-6 L per min
QUESTION: Nitrous to pedo at 50%-what we do? We stop giving it.

QUESTION: Nitrous safe switch happens? – 50% (I think it’s 70 for N, 30 for O)
QUESTION: Max amount of Nitrous Oxide for a kid
a. 40 %
b. 50%
c. 70% Adult
QUESTION: Safety on nitrous tank – 70%
QUESTION: A questions about the percent nitrous can NOT increase because of a safety?: 30, 70,
QUESTION: safety valve in nitrous tank no more than : a)50 % b)80% c)90%
QUESTION: Abuse of nitrous oxide it results in peripheral neuropathy.
QUESTION: Why is nitrous oxide used on children? alleviate anxiety
QUESTION: child with fear is best treated with : nitrous oxide
QUESTION: What is an adverse effect of nitrous? Nausea,
QUESTION: Most common side effect of nitrous oxide? Nausea
QUESTION: If patient does not have 100% oxygen after nitrous oxide: Diffusion hypoxia
QUESTION: NO2 contraindicated in I put nasal congestion, it is ok for asthma **contraindications for
NO2 include—COPD, resp infx, pneumothorax/collapsed lung, 1st trim of pregnancy, hard to
communicate with pt, contagious disease, middle ear or sinus infx, bowel obstruction, head injury
QUESTION: Nitrous oxide and preg pt, which trimester to avoid? 1, 2, 3, all trimensters
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QUESTION: Nitrous should not be given in 1st trimester of pregnancy
QUESTION: What trimester is nitrous use contraindicated in? first
QUESTION: When is nitrous contraindicated for a child? I put upper respiratory tract infection
QUESTION: Contraindication to nitrous- breathing disorder
QUESTION: When is nitrous contraindicated? Asthma/COPD
QUESTION: What is an absolute contra-indication for the use of Nitrous Oxide? Sickle cell anemia or
nasal congestion?**I think it is nasal congestion. Website states Nitrous is ok for sickle cell anemia, and
relaxing effects can lower chances of a crisis.
QUESTION: Why give hydralazine with chloral hydrate? Decreases nausea

QUESTION: hydroxizyne is used with chloral hydrate because decrease nausea is a first-generation
antihistamine of the piperazine class that is an H1 receptor antagonist. It was synthesized in the
early 1950s. It is used primarily as an antihistamine for the treatment of itches and irritations, an
antiemetic for the reduction of nausea, as a weak analgesic by itself and as an opioid potentiator,
and as an anxiolytic for the treatment of anxiety
QUESTION: hydroxizyne is used with chloral hydrate because decrease nausea
Local Anesthesia:
Lipophilic ring (aromatic) + intermediate chain (ester or amide link) + hydrophilic amino terminus
Esters are more prone to hydrolysis = shorter duration of action
Esters = no I before –caine Amide = “I” before –caine
Amide derivatives: Xylidine, Toluidine, Thiophene
Amides: metabolized in liver

Esters: Metabolized by plasma esterase
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QUESTION: Know where L.A. metabolized? Amide (2 I’s) met. in P450 enzyme of Liver. Esters (1 i)
met. in pseudocholinesterase of plasma.
QUESTION: How does anesthetic work? Decrease sodium influx
QUESTION: Mode of action of Lidocaine: Block sodium channels
QUESTION: What is the mechanism of local anesthetics? Blocks Na channels intracellularly
QUESTION: Mech of action of local anes on nerve axon – decreases sodium uptake through sodium
channels of axon
QUESTION: What is the primary reason for putting epi in LA?- to slow its removal from the site.
PROLONG DURATION OF ACTION
QUESTION: adding a vasoconstrictor like epinephrine decreases its rate of absorption, thus
increasing the duration of action, minimizing systemic toxicity, and helps with hemostasis
QUESTION: Adding a vasoconstrictor to local anesthesia does all the following EXCEPT:
a. Decreases rate of absorption
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b. Increases duration of action
c. Minimizes toxicity and helps homeostasis
d. all of above
QUESTION: Anesthetics broken down by what: biotransformation
***thiopental= redistribution
QUESTION: Biotransformation, what is tendency of molecules, chemical similarities: more polar and
more ionized and less lipid soluble
QUESTION: Which best describes biotransformation: increase/decrease in polarity and water
soluble
Whatever helps its excretion – polar and more water soluble
QUESTION: Conjugating the drug does what ? something about crossing brain barrio more or
other things conjugation reaction = are the Phase 2 reaction of drug biotransformation that occurs in the
liver. metabolizing to a soluble form
QUESTION: In relation to their parent drug, conjugated metabolites do what –more ionized in plasma
(more water soluble)
QUESTION: What happens to a drug after conjugation- more ionic, more hydrophilic, more active...
QUESTION: What do you use sodium bicarbonate for? All drugs or alcohol (phenol barbitals)
Excretion of acidic drugs is accelerated with Sodium Bicarbonate

QUESTION: Excretion of an acidic drug will be enhanced if the patient is given which of the
following? Sodium bicarbonate
QUESTION: After drug goes through liver? More water soluble and less lipid soluble.
QUESTION: First pass metabolism? Concentration will decrease exponentially. Drug eliminated in
proportional fashion.
QUESTION: First pass effect- metabolized in liver
QUESTION: First pass metabolism:
- enzymatic degradation in the liver prior to drug reaching its site of action
QUESTION: oral meds - first pass effect on liver

QUESTION: First pass effect best describes: passing through hepatic, entering the entero-
something
QUESTION: First pass refers to: enterohepatic circulation, metabolism in liver enterohepatic
goes from bile to liver and metabolism is not decreased.
1. Enterohepatic circulation
Substances that undergo enterohepatic circulation are metabolized in the liver (usually by
conjugation), excreted in the bile, and passed into the intestinal lumen (where the intestinal
bacteria break some of the conjugated drug, releasing the unmetabolized drug again) where
they are reabsorbed across the intestinal mucosa (thus returns to systemic circulation
again) and returned to the liver via the portal circulation. Drugs may remain in the
enterohepatic circulation for a prolonged period of time as a result of this recycling process.
thus increase in their halflives.
First pass effect:

After a drug is swallowed, it is absorbed by the digestive system and enters the portal
circulation. The absorbed drug is carried through the portal vein into the liver. The liver is
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responsible for metabolizing many drugs. Some drugs are so extensively metabolized by the
liver that only a small amount of unchanged drug may enter the systemic circulation, so the
bioavailability of the drug is reduced. Alternative routes of administration (e.g., intravenous,
intramuscular, sublingual) avoid the first-pass effect.
QUESTION: Oral drugs – undergo first pass metabolism in liver
QUESTION: what is used to determine whether a drug will cross glomerulus: I said whether its
attached to a protein or not; other option is whether the drug is acid or base; other is if its
positive or negatively charged
QUESTION: Which drug absorbs better in stomach acid? Weak acid

QUESTION: In order for a drug to do its effect in what state should it be?
Weak acid,
Weak base
Liposoluble-NON ionized drugs are soluble in lipid.
Hydrophobic
Hydrophilic-
QUESTION: When a drug does not exert its maximum effect is because its bound to ?
albumin-drugs highly bound to plasma proteins will not enter liver to be metabolized,
resulting in longer half life.
gamma
betasomething
alpha
QUESTION: what protein is used to attach to medication: alpha or beta or gabba globulin, albumin
was also choice: albumin
QUESTION: Which of the following best explains why drugs that are highly ionized tend to be more
rapidly excreted than those that are less ionized? The highly ionized are
A. less lipid soluble.
B. less water soluble.
C. more rapidly metabolized.
D. more extensively bound to tissue.
QUESTION: Patient got LA, their breathing fast, hands and finger are moving, heart rate is up – You
injected into a blood vessel
QUESTION: Patient get LA injection, he started to breathe a lot, HR goes up, due to what? I said due to
vasoconstrictor acting on CNS (correct answer cardiovascular response to vasoconstrictor)
QUESTION: HTN pt. just gave 4 carpules of 2% xylocaine with 1:100k epi. BP went up to 200/100.
what’s possible mechanism/cause?
QUESTION: Patient receives local anesthesia, bp goes up to 200/100, reason? Injection of

epinephrine into circulation
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QUESTION: LA does not work when there is inflammation as the pH has decreased
QUESTION: Infection around a tooth but can't numb patient, why? - Infection reduces the free base
amount of anesthetic
QUESTION: Where do you inject if infiltration in the area will not be able to avoid the infection?- Block
QUESTION: Why doesn’t anesthesia work when you have an infection? Decreased pH (acidic
environment) leads to more ionized form (less nonionized)
QUESTION: Abscess, give LA, decreased in effect why? LA is unstable in low pH, LA is in ionized
form, needs to be in free base form or unionized form to cross membranes
QUESTION: L.A. in inflamed tissue? Not enough free base to be effective.
QUESTION: As LA becomes more ionized, becomes more water soluble

QUESTION What tooth and what condition makes it most difficult to properly anesthetize the tooth:
irreversible pulpitis/necrotic pulp in mandibular/maxillary first molar
QUESTION: the pKA of an anesthetic will affect what. Metabolism, potency, peak effect? ONSET
QUESTION: When do you know that is it a non-odontogenic pain: When pain is not relieved with LA
QUESTION: Lidocaine calculation: a cartridge that contains 1.8 ml of solution at a 2% (20mg/ml)

concentration, how much drug? 36 mg/ml of drug (20 mg/ml X 1.8 ml/cart. = 36 mg/ml)
QUESTION: Calc of anesthetic. 2% lodicaine or 1:100,000. how much anesthetic in it? 1. 36mg (answer)
QUESTION: Know max dosage of lidocaine for a kid in mg/kg 4.4 mg/kg
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QUESTION: Numb the kid, how many hours is the soft tissue numb? 3 hrs
QUESTION: When you numb IA nerve, which roots of primary teeth are numb, (2.3, section C),
Could not find!!
QUESTION: Kids have higher pulse, basal metabolic activity and higher respiratory rate , but lower
BP
QUESTION: Typical pulse for a 4 year old is 110 (12 yr old is 75, adult is 70)
QUESTION: 20 kg child how many mg of lidocaine: 88mg
MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI 7mg/kg) for adult’s 4.4mg/Kg for
Pedo
QUESTION: Kid is 16kg* 4.4 mg/kg max amount of lidocaine? 70mg
QUESTION: 88 lbs (40kg) patient is given 2 cartridges 1.8 ml each of 2% lidocaine with 1:100,000
epinephrine. Approximate what % of maximum dosage allowed for this patient was administered ?
a. 10%
b. 20% (8 carpules max of lido)
c. 40%
d. 60%
88lbs*2.2 kg/lb = 40 kg. 40kg*4.4mg/kg (max dose for lido) = 176mg = max dose for this patient
72mg injected/176mg = 40%
QUESTION: 50 lb patient given 5 carps of 2% lido with 1:100k epi, during procedure he convulses, why –
overdose of lidocaine, overdose of the epi, allergic
Lido: convulsions
 EPI: HTN
QUESTION: know the dosage of both anesthetics (4.4kg/ml) and epi(???) for child. This xxkg boy got
5 x 2% Lido with 100,000 epi, and 20 min later, started twitching his arms and legs and went
unconscious. What’s wrong? I did calculation for anesthetics, but he wasn’t overdosed by
anesthetics but might be by epi, so know the pediatric dosage of epi. If it’s not overdosed, you can
pick other choice.
Choices were 1) this kid is overdosed with anesthetics. 2) by epi 3) some other answers I don’t
remember
QUESTION: Maximum recommended dosage of lidocaine HCl injected subcutaneously ( not i/v) when
combined with 1:1,00,000 epinephrine is?
a. 100 mg
b. 300 mg
c. 500 mg
d. 1 gram[/QUOTE]
QUESTION: How do you treat lidocaine overdose? Diazepam
QUESTION: What slows metab of lidocaine?- propanalol (stays in system longer because propranolol
slows down heart  blood delivery to liver is slowed metabolism of lidocaine is slowerstays in system
longer)
QUESTION: How much epi for a cardio pt? 0.04mg
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QUESTION: Max dose of epi for cardio pt----- 0.04mg, Two carps 1:100.000 (epi 1:50.000
max=1carp.; 1:200.000 max=4carps)
Max dose of epi for healthy pt---- 0.2 mg, Eight carps
QUESTION: Lidocaine-not metabolized in plasma

QUESTION: Lidocaine toxicity is due to - overdose - increased vasoconstrictor, due to preservative
(EPI)
QUESTION: which of the following anesthetic can be used as topical? benzocaine, butamben,
dibucaine, lidocaine, oxybuprocaine, pramoxine, proparacaine, proxymetacaine, and tetracaine
QUESTION: Topical anesthetic- lidocaine
QUESTION: Which pair of anesthetics is most likely to cause cross allergy? 1. Lidocaine and
mepivocaine (answer)
QUESTION: What do you give IV for ventricular arrhythmia?
a. Quinidine
b. Lidocaine
QUESTION: Muscle dystrophy after local anesthetic more likely to? Lidocaine toxicity?) Increase
duration of action? Increase onset? Cant they be supine?
QUESTION: Muscle dystrophy and oral surgery-lidocaine toxicity, duration of action, onset of
action, can they be supine
QUESTION: Pt with muscle dystrophy what can happen in concern with Local Anesthetic? Increase risk
of LA toxicity, need more dosage of LA, LA doesn’t last as much , duration, onset?
Muscular dystrophy: muscle weakness, “long face” which is characterized by a lower vertical facial
height and open bite/
QUESTION: Pt w/ muscular dystrophy condition: lower face with open bite

QUESTION: What can be seen on a patient with muscle weakness of the face? Cross bite, buccal tilting of
molars.. long upper face??
QUESTION: Muscle dystrophy , lower face with open bite.
QUESTION: Considerations for muscular dystrophy: increase in dental disease if OHI is

neglected, weakness of muscles of mastication decrease biting force, open mouth
breathing
QUESTION: Low occlusal plane leads to what? I put decreased biting force, other options were
tongue biting, excessive bite force
QUESTION: Cocaine overdose symptoms? pinpoint pupils, mydriasis
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QUESTION: What is not on cocaine overdose? pinpoint pupil
Vs Opiate overdose symptoms and signs include: decreased level of consciousness and pinpoint
pupils.[2] Heart rate and breathing slow down, sometimes to a stop. Blue lips and nails are caused
by insufficient oxygen in the blood. Other symptoms include seizures and muscle spasms.
*Cocaine OD—mydriasis
*Opiate OD—pinpoint pupil
QUESTION: Cocaine OD will cause? Mydriasis, pint point pupils.. (cocaine cause vasoconstriction to
heart so it will do Mydriasis to pupils)
QUESTION: Which LA causes vasoconstriction? Cocaine
QUESTION: Cocaine -Intrinsic vasocontrictive activity
QUESTION: Cocaine- is a natural drug
QUESTION: Reversal of cocaine overdose?
QUESTION: Pt is on rehab of cocaine. what you prescribe for pain? advil
QUESTION: Prilocaine given. Symptoms of methemoglobinemia (cyanosis, headache, confusion,

weakness, chest pain)- methemoglobinemia
QUESTION: Methemoglobinemia is caused by oexcessive doses of lido, benzocaine, but ESP
prilocaine
QUESTION: Prilocaine causes methemoglobinemia (when given over 500mg)
QUESTION: Administer 600 mg of prilocaine. What possible result? Methemoglobinemia

QUESTION: Prilocaine causes methemoglobinemia. (can be treated with methylene blue…Xtina)
QUESTION: 3.6ml of prilocaine contain how much anesthesia
a. 72mg
b. 80,
c.144
d. 36
QUESTION: 3.6 ml solution of 4% prilocaine contains how many mg?
3.6 36 72 144 360
QUESTION: Levonordefrin is added to certain cartridges containing mepivacaine: To increase
vasoconstriction.
QUESTION: pt has heart problem? Mepivocaine NO EPI
QUESTION: How many carps of 4% [X] anesthetic should be given if maximum amount that you want to
give is 600mg of drug? - approximately 8 carps (go over calculation)
QUESTION: The maximum allowable adult dose of mepivacaine is 300 mg. How many milliliters of 2%
mepivacaine should be injected to attain the maximal dosage in an adult patient?
a. 5
b. 10
c. 15
d. 20
e. 25
2% mepivicaine = 20mg/ml. 300mg/20 mg/ml = 15
QUESTION: calculation of 2% mepivacaine max amnt (I think it’s 5 cartridges for adults…and 3mg/lb in
children
QUESTION: best LA to use w/o vasoconstrictor
a. pro
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b. benzo
c. lido
d. articaine
e. mepivicane (carbo)
QUESTION: Maximum dose of mepivicaine? 400mg
Note: 400mg for prilocaine,300mg for lidocaine without epi,300mg for lidocaine with epi,90mg for
bupivacaine
QUESTION: 3 carps of 1.8cc of .5% bupivacaine 1:200000 epi – total dose

QUESTION: Bupivicaine calc in 3 cartidges- epi and bup
QUESTION: Articaine(septocaine): metabolized in blood .**unique bc it is an Amide, but has
an ester group, and is metabolized in the bloodstream
QUESTION: Articaine - conjugated at liver 1st? (unlike other amides, it metabolized in blood stream).
QUESTION: Articaine - conjugated at liver 1st? Blood Stream, Liver. (unlike other amides, it
metabolized in blood stream).
QUESTION: Know that Articaine is metabolized by esterase in plasma.
QUESTION: Articaine - conjugated at liver 1st? unlike other amides, it metabolized in blood stream
QUESTION: Articaine (septocaine) has an ester group, unlike other amides it is metabolized in blood
stream.
QUESTION: A recently-introduced local anesthetic agent is claimed by the manufacturer to be several
times as potent as procaine. The product is available in 0.05% buffered aqueous solution in 1.8 ml.
cartridge. The maximum amount recommended for dental anesthesia over a 4-hour period is 30 mg. This
amount is contained in approximately how many cartridges?
a. 1-9
b. 10-18
c. 19-27
d. 28-36 (approx 33 cartridges)
e. Greater than 36
QUESTION: anesthesia of facial nerve will cause all but
• instant muscular dysfunction in half the face
• excessive salivation
• inability to smile
• inability to close eye
• corner of mouth will droop
QUESTION: Which drug is LEAST likely to result in an allergy reaction?
a. epinephrine
b. procaine
c. bisulfite
d. lidocaine
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QUESTION: Pt taking MAO inhibitors what you CAN NOT give him: epinephrine, opioids
Local anesthetics containing EPI are contraindicated in patients taking MAO inhibitors.
QUESTION: Mix MAOI and epi get? –HTN
QUESTION: what determines max. dose for anesthetic for a child? 1. Weight (answer)
TABLE 3-5 Recommended Maximum Dosages of Epinephrine
QUESTION: What is the best indicator for success of intra-pulpal anesthesia? I put something
about backward pressure,
QUESTION: What is the best predictor for pulpal anesthesia?
Concentration of anesthetic
Volume of anesthetic
Back pressure
Type of anesthetic
QUESTION: Intrapulpal anesthesia does what – back pressure anesthesia stops hemorrhage, anesthesia
after 30 sec, patient doesn’t feel it
QUESTION: What is a good indication success of intrapulpal anesthesia – feel the back pressure during
injection
QUESTION: Local anesthesia: PSA does not numb MB of M1
QUESTION: Which order will sensation disappear? 1. pain, 2.temp, 3.touch, 4.pressure
QUESTION: Which is incorrect: PSA numb palatal tissue
QUESTION: muscles elevating the jaw : masseter,temporal,medial pterigoid
QUESTION: Trismus includes what muscle: medial pterygoid
QUESTION: The dentist is performing a block of the maxillary division of the trigeminal nerve into which
anatomical area must the local anesthetic solution be deposited or diffused?
a. pterygomandibular space
b. pterygopalatine space
c. retropharyngeal space
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d. retrobulbar space
e. canine space
QUESTION: MS more or less anesthetic? Use Mepivicaine (no epi)
QUESTION: For a patient with multiple sclerosis
A. epinephrine is contraindicated in local anesthetic.
B. the amount of anesthetic needed for a given procedure is less than for a normal patient.
C. the amount of anesthetic needed for a given procedure is more than for a normal patient.
D. a single cartridge of anesthetic will most likely not last as long as it would for a normal patient.
Pre-Medication:
Premedicate these conditions  artificial heart valve, previous IE, congenital heart
(valvular) defect, total joint replacement
Preventive antibiotics prior to a dental procedure are advised for patients with:
1. Artificial/prosthetic heart valves

2. a history of infective endocarditis
3. certain specific, serious congenital (present from birth) heart conditions, including
o unrepaired or incompletely repaired cyanotic congenital heart disease, including those
with palliative shunts and conduits
o a completely repaired congenital heart defect with prosthetic material or device, whether
placed by surgery or by catheter intervention, during the first six months after the
procedure
o any repaired congenital heart defect with residual defect at the site or adjacent to the site
of a prosthetic patch or a prosthetic device
4. a cardiac transplant that develops a problem in a heart valve.
Pre med with odontogenic infection:

• Amox for SBE prophylaxis
• Penicillin for odontogenic infections
• Tetracycline for periodontal infections
QUESTION: Total joint replacement knee? Pre-medicate ??? YES or no**
QUESTION: Knee surgery-no prophylaxis
Patient with pen allergy-true or false-patient had knee replacement
True-patient needs premed and would take amox-no not true
QUESTION: What if someone has joint replacement or high risk procedures? 1. Life time prophylaxis
before dental tx (answer) (not anymore…for joint replacements…within 2 years…Xtina)
QUESTION: Condition that DOES NOT require antibiotic prophylaxis
o Prosthetic heart valve

o Rheumatic heart valve
o Congenital heart formations
o Cardiac pacemaker
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QUESTION: Indication for antibiotic prophylaxis: Prosthetic valve
QUESTION: Need premedication for… prosthetic heart valve,
QUESTION: Prophylactic treatment for Prosthetic heart valves – premedication required
QUESTION: In what situation would a pt need to premedicate? prosthetic heart valve
QUESTION: Prophylactic treatment for Pacemaker – No premedication required
QUESTION: One of his patients has a pacemaker, but don’t premedicate either? Just stay away from
ultrasonic and electric testing and such.
QUESTION: What precaution you need to take for patient who has cardiac pacemaker?
a. antibiotic prophylaxis
b. avoid electrocautery
QUESTION: (Again with different options) need premedication for… congenital heart defect with severe
problems
QUESTION: when to give prophylaxis: congenital heart disease
3 different cases with it asking what’s the premedication regimen and on all three I wrote you don’t need
to premedicate because the problem was a triple bypass or angioplasty or other stuff that didn’t require
prophylaxis
QUESTION: Cyanotic heart valves you must premedicate. Kid had unrepaired cyanotic something valves,
cyanotic congenital heart disease. Premedicate with amoxicillin and you need to know the dosage so that
you pick the right dosage 60 lb kid. 50mg/kg dosage.
QUESTION: premedication for child 44 lbs : 1 gram amoxicillin 1 hour prior Tx.
Amoxicillin: Clindamycin:
• Adults: 2g orally 1hr prior to appointment • Adults: 600mg orally 1hr prior to appointment
• Children: 5Omg/kg (not to exceed adult • Children: 20mg/kg orally 1hr prior to appointment
dose) orally 1hr prior to appointment
44 lbs = 20KgX 50mg/Kg= 1000mg = 1g Amoxicillin
QUESTION: Pt w/ MVP w/ regurgitation – don’t premedicate
QUESTION: Antibiotic prophylaxis for mitrall valve prolapsed with regurgitation- NO

QUESTION: (Patient’s medical tab say he is allergic to Amoxicillin), He needs to be premedicated, what
do you prescribe? – Clindomycin, 600mg 1hr before the dude shows up for the appointment.
QUESTION: If patient is allergic to ampicillin, then what antibiotic should be given? Clindamycin, but
should be 600 mg and the answer choice was wrong since they said 2 g so he picked cephalomycin. Fixin
(I doubt its cephalomycin…because similar to cephalosporin and those are cross allergenic with
penicillin…Xtina) --**I think he meant cephamycin, but yea similar to cephlasporin. **CEPHALEXIN
probably the answer… if allergic to pen give 2 g of it.
QUESTION: one of them pt was taking penicillin everyday so I prescribed Clindamycin to avoid side
intxn
QUESTION: Man has accident and pin placed in arm. What antibiotic prophylaxis does he need?
A: None
QUESTION: Pt w/ total knee replacement but was taking Amoxicillin for a while; how do you
premedicate? (give Clindamycin b/c bacteria are probably already resistant to amox by now)
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QUESTION: Prophylax and pt is taking penicillin already what do u give him? clindamycin
QUESTION: Regular premedication case: Give amoxicillin 2g 1hr b4
QUESTION: What is recommended prophylaxis for pt that can’t take penicillin…clindamycin

QUESTION: prophylaxis antibiotic: Pt with heart transplant with valvulopathy.
QUESTION: IE pre-medications definition? – For patients who has cardiovascular problems and are
at risk of infection over their lifetime. (other choices were wrong). Mine had the option of “benefits
of premedication outweigh potential harm associated with pennicillin”- which sounds pretty right
to me.
QUESTION: definition of endocarditis : is an inflammation of the inner layer of the heart, the
endocardium. It usually involves the heart valves (native or prosthetic valves)
QUESTION: Infectious Endocarditis pre-medications definition? – For patients who has cardiovascular
problems and are at risk of infection over their lifetime. (other choices were wrong)
QUESTION: when is it appropriate to prescribe antibiotic prophylaxis in patient with previous

infective endocarditis: if consequence of potential infection is dentrimental to life
QUESTION: Which of these procedures pose a risk for Infective Endocarditis?

• Primary teeth shedding
• RCT
• Some sort of surgery *
• IA injection
QUESTION: Guideline of antibiotic prophylaxis, specially for kids. ie 2g of amoxicillin, 600mg of
clindomycin. ***for kids Amox is 50mg/kg and Clinda is 20 mg/kg
QUESTION: What is AHA recommended antibiotic prophylaxis conditions?
QUESTION: What are the reasons a dentist needs to pre-medicate?
QUESTION: Know antibiotic classes pretty good, how much to pre-med, what adverse side effects they
can have
Lots of prophylaxis qs on 2nd day, about what to prescribe, amount, mitral valve prolapse with
regurgitation,
Antibiotics:
QUESTION: Most bacteriastatic ab, how does it work ? affects protein synthesis
QUESTION: Most bacteriostatic meds works by: Inhibiting protein synthesis
QUESTION: broad spectrum antibiotics : increase superinfection and resistance.
***TETRACYCLINE ARE BROAD SPECTRUM***
QUESTION: If you increase spectrum of bacteria - leads to more infections
QUESTION: antibiotics least useful: LAP, NUG, chronic periodontitis
QUESTION: Why not use broad-spec or overuse antibiots?- bacterial mutations

QUESTION: Why don’t we use broad spectrum antibiotics? Produce resistant bugs
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QUESTION: Antibiotic metabolism affected by chronic tx with what drugs? Benzos, barbs, ssri, TCA
QUESTION: which antibiotics will not work well on someone taking prolonged drug for awhile. He put
TCA down.
QUESTION: pt taking antibiotic which is metabolized in the liver. Metabolism of antibiotic decreased by
which drug.
a. TCA
b. SSRI
c. phenothiazine
d. diazepam
QUESTION: Antibiotic decrease effect if pt taking? Barbiturates
QUESTION: Doxycyclone - act on 50S ribosome (there were no 30S choice, but google search
says both) (doxycyclone is a derivative of tetracycline which acts upon 30S…however after
searching it says doxy binds to 30S and also possibly 50S…not sure though)
QUESTION: doxycycline - 30S is a kind of tetracycline treats malaria!
QUESTION: 20mg doxycycline works how
a. Anti-collagenase
QUESTION: Something about periodontal dressing and that it has 20mg of Doxycycline and asks
about its mechanism: there was nothing about bacteriostatic or inhibits 30S ribosome????
a. 20 mg = no antibacterial effects
b. It inhibits collagenase
QUESTION: which antibiotic is antimicrobial and anticollagenlyctic: clindamycin, doxycycline,

metronidazole, amoxicillin
QUESTION: You give antibiotics through IV, patient experience sudden allergic reaction, what’s the
FIRST thing you do? – Remove the IV line. (others were clear airway, give oxygen, etc)
QUESTION: Penicillin- Why is this so good to give as an antibiotic? Low toxicity
QUESTION: If not penicillin allergic what’s the adv of pen? It is not toxic, Cheap,
Gram negative anerobe rods

QUESTION: mechanism of action of pen is closely related to ? keflex ( cephalaxin )
QUESTION: What is the effect of Penicillin and Cephalosporins (cell wall synthesis) via beta
lactam ring
QUESTION: Tanspeptidase, enzyme is inhibit by penicillin. Causing effect on cell wall
QUESTION: Which of the following penicillins would be used to treat a Pseudomonas infection? Nafcillin
(Unipen)  ,Amoxicillin (Amoxil),  Benzathine penicillin (Bicillin), Phenoxymethyl penicillin (Pen-Vee
K), Ticarcillin (Thar)
QUESTION: why do penicillins have decreased effectivness in abscess -hyaluronidase, pen unable to
reach organism…
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QUESTION: Cyst-why doesn’t penicillin work well?—b/c can’t penetrate cyst barrier
QUESTION: #1 dental antibiotic for an infection within 24hrs is Pen VK 1gm booster and 500mg q6h
QUESTION: For an infection: give PenVK 500mg  give 1g at once and then 500 mg every 6 hours
(7 days)
QUESTION: Know the doses for someone that is allergic to penicillin, What you can give them. I put
clarithromycin 500mg but not sure if its right. THAT IS CORRECT. Geez.
QUESTION: All are true except- Cephalosporin has a broader spec then Penecillins (cephalosporin is a
beta lactam antibiotic, bactericidal, first generation more concentrated on gram positive
organisms…more resistant to penicillinase…Xtina)
QUESTION: If a patient is allergic to Ampicillin, what else can you premedicate with? Clindamycin
600mg 1-hr before, Cephalexinn2000, Azithromycin 500, or Clarithromycin 500 (look at specific doses!)
all 1-hr before.
QUESTION: Whats an adverse effect of a drug that you cant mix with antibiotics? Methotrexate because it
wont clear out of the system specifically with amoxicillin.
QUESTION: AMOX AND METHOTREXANE: DON’T MIX!!
QUESTION: Chlortetracycline- Broadest antibiotic effect
QUESTION: Tetracycline- SUPERINFECTION
QUESTION: tetracycline mechanism of action : protein synthesis inhibitor (30s)
QUESTION: how does tetracycline work? Block activity of collagenase, bind to 30S (block AA linked
tRNA)
QUESTION: Tetracycline is usually not used because they cause yeast infections, as well opportunistic
infect.
QUESTION: Tetracycline does not do one of the following (reduce host response, reduce bacterial
infection, reduce host collagenase; I said increase gingival crevicular fluid flow)
QUESTION: Tetracycline – interferes w protein synth/bacteriostatic
QUESTION: which drug would inactivate the latter?
a. Antacids- Tetracycline
note: Do not take iron supplements, multivitamins, calcium supplements, antacids, or
laxatives within 2 hours before or after taking tetracycline. Antacids and milk reduce the
absorption of tetracyclines.
QUESTION: Tetracycline is bacteriostatic

QUESTION: Pt. has dark permanent lateral incisor. What is the cause?
A: Tetracycline, damage to primary tooth at age five, damage to permanent lateral*
QUESTION: What affects tetracycline?
-enamel
-dentin-intrinsic stain.
QUESTION: Questions about hypoplasia and integration of tetracycline into matrix: couple
questions on what age most likely get infection that resulted in enamel hypoplasia or tetracycline
staining (before 4mon in utero for primary; birth for permanent)  calcification
QUESTION: Tetracycline not do: dec cervicular fluid
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QUESTION: Minocycline & Doxcycline; all of the following are true except: (both increase GCF
secretion, both released in GCF, etc.) – don’t kno answer (side fact: tetracyclines are more
concentrated in GCF more than in blood)
QUESTION: What drug has the highest concentration in crevicular fluid? Tetracycline
QUESTION: which one of the following drug is chelated with C++? Tetracycline
QUESTION: X-allergenic with Pen: Cephalosporines (Cephaloxin)
QUESTION: cross allergenicity with penicillin : cephalosporin.

QUESTION: cross allergenicity with penicillin : cephalosporin.
QUESTION: Pt allergic to penicillin, what could be cross-reactive?  Cephatriaxone (3rd gen
cephalosporin)
QUESTION: What drug has cross allerginicity with Penicillin? Cephalosporin- both have Beta
lactamase ring. If pt has allergic to penicllin then pt has allergy to cephalosporin
 SO is ampicillin
QUESTION: Child comes in with an oral infection and is NOT allergic to Pen. What do you
prescribe?
a. Penicillin
b. Amoxicillin  mosy (-)
c. Tetracyclin
QUESTION: Pt is taking tetracycline. Which of the following drugs would be contraindicated?Penicillin

QUESTION: Tetracycline-penicillin contraindication
QUESTION: Penicillin is ineffective when you give tetracycline why?

• b/c it causes penicillin to be excreted in kidney (or renal reabsorption)
• less penicillin absorbed in intestines
• metabolized more rapidly
QUESTION: Tetracylcine interacts with? Penicillin
QUESTION: tetracycline will interefere with…answer is penicillin. Look thru tufts pharm
QUESTION: what tetracycline does to penicillin :

Tetracline is bacteriostatic whereas penicillin is bacteriocidal… therefore Tetracycline will
decrease the efficacy of Penicillin.
QUESTION: What happens when you have penicillin and decide to prescribe tetracycline with it?
a. Don’t do it. The two mechanisms of action (CIDAL+STATIC) cancel each other out
because when you need bacterial growth to actually use penicillin, but you don’t
have that growth when you prescribe Tetracycline. ANTAGONISTS
QUESTION: penicillin and erythromycin taken together cause (cidal vs static)

•summation
•potentiation
•antagonists
•something else that I understood as meaning they do the same thing
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**Erythromycin (Azithromycin and Clarithromycin) are macrolides. They are –static and bind to 50S
ribosomal unit to inhibit protein synthesis). Penicillin is –cidal and inhibits peptidoglycan cell wall by
binding to transpeptidase-CK
QUESTION: Penicillin’s can decrease elimination of methotrexate (cancer drug), increasing risk of
methotrexate toxicity. Methotrexate neurotoxicity can cause seizures and can be caused by
antiepileptic drugs. Methotrexate toxicity effects can be reversed by folinic acid (leukovorin) in a
process known as leukovorin rescue
QUESTION: If you have maxillary sinusitis…what antibiotic would you give: Amoxicillin with clav.
Acid (the clav. Acid prevents the b-lactamase from breaking down)
QUESTION: what the clavulanic acid do when is mixed with amoxixillin ( augmentin) decrease
sensitivity from b-lactamase
QUESTION: clavulanic acid in amoxcillin - prevents beta lactam degradation by beta lactamase producing
bacteria
QUESTION: calvonic acid in amoxcillin - prevenst beta lactam degradation
QUESTION: Augmentin: blocks the action of penicillinase: Penicillinase resistant
QUESTION: sinusitis tract: augmentin
QUESTION: Penicillinase resistant penicillins – COMN [clox, ox, methi, naf] b/c of clavulanic acid---
D.COMN—Dicloxacillin, Cloxacillin, Meticillin, Nafcillin!!!!!
QUESTION: what antibiotic used for endo? PEN VK (yes it actually say VK together)
QUESTION: drug of choice for pulpal involvement? Pen V
QUESTION: antibiotic used in perio: Metronidazole
QUESTION: antibiotic used in perio : Metronidazole
QUESTION: Metronidazole is commonly prescribed in necrotizing ulcerative gingivitis;

metronidazole is contraindicated in patients on alcohol causing disulfiram type of reaction and has
red urine
a. Both are true
QUESTION: Metro…given for aggressive periodontitis. Makes your pee a different color? T/F
QUESTION: antibiotic against only anaerobes ab parasites (protozoa): metronidazole

QUESTION: Which med kills only anaerobic and parasites: metronidazole (Only parasites and
anaerobes on the metro)
QUESTION: Clostridium dificile is treated with metronidazole. Unless pt is pregnant or

breastfeeding, then use vancomycin
QUESTION: Mechanism of Metronidazole

• disrupts cell wall synthesis
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• enzyme poisoning
• fungal protozoa disruption
QUESTION: best treatment of localized aggressive periodontitis: tetracycline, Doxycicline
QUESTION: Erythromycin – bacteriostatic – inhibits protein synthesis
QUESTION: #1 side-effect of erythromycin is?- stomach upset.
QUESTION: In Lethal doses of erythromycin, what do you see?

e. Hepatocellular GI damage**
QUESTION: Myasthenia gravis patient, what cant you give them? Erythromycin, clarithromycin,
penicillin or Impemene
QUESTION: All of these effect the protein synthesis except: azithromycin

QUESTION: Which antibiotic is NOT inhibit cell wall synthesis?
• amoxicillin
• vancomycin
• azithromycin** (this inhibits protein synthesis)
QUESTION: Gentamycin- May cause auditory nerve deafness
QUESTION: aminoglycosides : ototoxicity and nephro toxicity
QUESTION: aminoglycosides : oto toxicity and nepho toxicity
QUESTION: MRSA- What do you give for this?  ○Vancomycin
QUESTION: Medicine which helps with MRSA -- vancomycin
QUESTION: Pseudomonas colitis: c.difficile and clindamycin
QUESTION: Which of the following describes clindamycin?n

inhibits cell wall synthesis
b. does not penetrate well into bony tissue
c. it usually given in combination with erythromycin
d. is effective against gram-negative bacteria only
e. is effective against most anaerobes
QUESTION: Which of the following describes ciprofloxacin (Cipro®)?
Inhibits cell wall synthesis.
Effective against Pseudomonas aeruginosa.
Effective only against anaerobic bacteria.
An antibiotic-of-choice for treating otitis media in young children.
Effective against oral anaerobes.
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QUESTION: mechanism of action of Minocycline in the Arestin :
decrease collagenases activity Minocycline, another tetracycline antibiotic, has also been
shown to inhibit MMP activity.
QUESTION: mechanism of action of minociclyn in the arrestin : broad spectrum Bacteriostatic;
Inhibits Protein Synthesis (binds to 30s ribosomal subunit)
*MINOCYCLINE(TCA)—decreases collagenase activity & inhibit MMP
QUESTION: Methotrexate MTX is an? . antimetabolite and antifolate drug. tx of cancer,

autoimmune diseases, ectopic pregnancy, and for the induction of abortions. inhibiting the
metabolism of folic acid.
QUESTION: Which drug will be used to treat an overdose of methotrexate Leucovorin is

indicated to diminish the toxicity and counteract the effect of inadvertently administered
overdosages of methotrexate
***OD Methotrexate—give LEUCOVORIN
QUESTION: drug agonist of folic acid : ? Sulfa, Trimethoprin, Methotrexate

QUESTION: Which medication for anticancer works on folate synthesis/ prevents folic acid
production: methotrexate
QUESTION: Methodextrate- inhibits folic acid in bacteria
production: ***methotrexate
QUESTION: Methotrexate is an anticancer drug that inhibits folate reductase

QUESTION: Anticancer-Methatrexte- folate antagonist which one? Folate reductase
QUESTION: Anticancer drug (Mechlorethamine), that was an alkylating agent what was its affect:
neurotoxic
QUESTION: Alkalizing anti-cancer drug called procarbazine causes HEPATOXITY
QUESTION: Alkalizing anti-cancer drug called procarbazine causes : Hepatotoxicity

When combined with ethanol, procarbazine may cause a disulfiram-like reaction in some
patients. It also inhibits the liver's CYP450 microsomal system, which leads to an
increased effect of barbiturates, phenothiazenes, and narcotics normally
metabolized by the CYP450 enzymes. Has monamine oxidase inhibition properties
(MAOI), and should not be taken with most antidepressants and certain migraine
medications.
Inhibits MAO in the gastrointestinal system thus can cause hypertensive crises if
associated with the ingestion of tyramine-rich foods such as aged cheeses.
QUESTION: Nonalkylating anti cancer med side effect – myelosuppression (?) BONE MARROW
SUPPRESSION
QUESTION: What race most likely to get orpharyngeal cancer: black
QUESTION: What disease is more predominate in males (hemophilia)

QUESTION: What percentage gets oral cancer? 3% of new cancers among males and 1.6% of
new cancer among females
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QUESTION: How many people in the US get oral cancer: 30,000 SSC new cases annually
QUESTION: 1 risk factor for oral cancer Tobacco
QUESTION: What population has the worst survival rate for SCC? (whites, blacks, native Americans…)
QUESTION: Lowest 5 year oral cancer survival rate- black people
QUESTION: Radiation for cancer, which cell is more effected?
Nerve, muscle, bone marrow

QUESTION: Mobile mass initially but is now sessile: indicative of malignancy
QUESTION: Discrete, non-tender, soft tissue swelling, what is it – malignancy, benign tumor, bone
cancer
QUESTION: Which of the following is not a risk of oral cancer - alcohol, tobacco, HPV and HIV
QUESTION: What will cause xerostomia: chemo or radiation?
Anti-viral:
know antivirals:
amantadine-influenza A
ribavirin-hep C and resp syncytial virus
oseltamivi and zanamivir-influenza A and b
gancyclovir: CMV
AZT,Didanosine,Zalcitabine,Abacavir-HIV
Ritonavir,saquinavir,nelfinavir,amprenair-HIV
QUESTION: Picture of lesion at corner of mouth, patient says it comes and goes now and then, what type
of infection would you suspect? – Viral (other choices were Bacterial, etc)
QUESTION: What to use for a viral drug? Don’t remember the answers but there were a couple ending
with azole and that not the answer (that’s for fungus)
QUESTION: Amantadine is an anti-viral and anti-parkinosonian or anti-TB and its anti-viral.
QUESTION: Amantadine is an anti-viral an
QUESTION: Which one is an antiviral agent? Amantadine**
QUESTION: What anti-viral is used to for all the above: HSV, VZV, CMV: Valacyclovir
QUESTION: What virus causes postherpatic neuralgia: VZV (not HSV)
QUESTION: Garlic : lots of uses, usually assoc with CVD: CI: contraceptives and anti-virals
(HIV), caution with bleeding
QUESTION: Acyclovir selective toxicity mechanism of action:

inhibits viral mRNA, inhibits cellular mRNA in infected cells, only phosphorylated and activated
in infected cells
QUESTION: Acyclovir-inhib mRNA?-phosphorylated---can’t make RNA
○only phosphorylated in infected cells and inhibits viral mRNA
237
○does NOT work on DNA 
QUESTION: HIV patient with sinusitis due to what?murcomycosis

QUESTION: Most reliable measure of HIV progression? CD4 count, viral load
QUESTION: Cd4 count and t cell count for HIV symptoms: I put the pt had HIV
// CD4 less than 200
QUESTION: Pt has viral load of 100000 : pt has high virus load and prone to infection
QUESTION: Pt’s viral load was 100,000, and T cell count was 50. What is the right sentence?
• Pt’s T cell count is too low**
QUESTION: Know what a healthy T cell count is. 500-1500units/ml
QUESTION: Need transfusion of platelets? 20,000?
QUESTION: Minimum platelet count for oral surgery?

A: Routine ok w/ 50,000 (emergency can be done w/ as little as 30,000 if work w/
hematologist and use excellent tissue management technique)
QUESTION: Least likely to get oral cancer?
a. Tobacco
b. Alcohol
c. HPV
d. HIV
QUESTION: Which of the following agents is used for HIV infection?

amantadine (Parkinson’s)
b. acyclovir (Herpes)
c. zidovudine (also called AZT)
d. ribavirin (Hep C)
e. isoniazid (TB)
QUESTION: Which of the following is not properly matching the antiviral med with the virus that
caused the disease: answer was retrovir was matched with coxsackie or something (retrovir is
used for hiv/aids)
QUESTION: Give drugs and paired it with the disease. Choose the wrong pair
o Retrovir with varicella zoster WRONG!!

 Retrovir is for HIV- right
QUESTION: What oral manifestation is seen in children with HIV? A* Candidiasis #1

QUESTION: HIV pt with fungi infection systemic med- Fluconazole- diflucan
QUESTION: Fungal agent for HIV: Fluconazole or ketoconazole
QUESTION: Candisiiasis, and HIV what do you give: systemic or topical?????? Niastatin  AIDS PT
likely to have candida
QUESTION: Once a year, you have to check for one of the following
238
HIV
HEP B
HEP C
QUESTION: What test for every year? HepB TB
QUESTION: worker didn’t get hep b vaccine because more concern about HIV? A. tell he its easier to get
hep B  must sign that they legally don’t want
QUESTION: workers that are at least risk for HEP B : a) food servers
QUESTION: workers that are at least risk for HEP B : a) food servers b) down syndrome c) drugs
addicts
QUESTION: Patient has HEB B antigens in surface. What state is patient? HBsAg
-chronic?
-acute hepatitis contagious
-acute hepatitis not contagious
QUESTION: If pt has ABsAb, means that he was either vaccinated or recovered form infection
QUESTION: pATIENT tests POSITIVE HEP B ANTIBODY? All of his organs will be affect except..
Pancrease
Kidney
GI
thyroid**??
QUESTION: pt gets Hep B
a. carriers for life?—5-10% become carriers
b. gets active hepatitis
QUESTION: Hepatitis D through B
QUESTION: What are the hep b vaccine rules by OSHA?- all must always be offered and able to get the
vaccine
Fungal:
QUESTION: Know which ones are systemic and which ones are topical
• Mycelex, nystatin, ketoconazol,Nastatin rinse and Clotrinzol-troch are topical,
• Systemic Ketoconazole, Amphoteracin B.
QUESTION: Easy question on Nyastatin: “swish & swallow”
QUESTION: Systemic antifungal: Fluconazole
QUESTION: Which systemic antifungal would u use? Nysastin, methazole *TOPICAL: Nystatin,
Clotrimazole (dissolve and swallow) Amp B, Ketocanozole, Nystatin (Creams); SYSTEMIC: “FAK”
Flucanazole, Amphotericin-B, Ketocanzole
QUESTION: medication for angular chelitis: nystatin
QUESTION: Oral antifungal infection – Nystatin
QUESTION: Anti fungal for oral candidiasis- no mycelex option  Clotrimazole( Mycelex) and
Nystatin are oral anti-fungals
QUESTION: Griseofulvin: used for athletes foot.
QUESTION: action of clotrimazole: Alter the enzyme for synthesis of ergosterol, alters cell memb.
Permeability
239
QUESTION: mechanism miconazole (antifungal) : inhibis the synthesis of ergosterol a critical component
of the cell membrane
Azoles : inhibit lanosterol conversion to ergosterol.
Polyenes : bind to ergosterol on cell membrane and create a pore.
Perio:h
QUESTION: Which one is predominant in sulcular fluid? – PMN’s
QUESTION: First cells to appear in gingivitis – PMN was NOT an option
QUESTION: Established gingivitis- macrophages or plasma cells?
Initial = PMN, early = lymphocytes, establish – plasma cells
QUESTION: Which of the following species is a usual constituent of floras that are associated with
periodontal health?
A. Streptococcus gordonii
QUESTION: What bacterial species not associated with periodontal disease
A. Actinomyces species
B. P. gingivalis
C. Capnocytophaga
QUESTION: Bacteria that is not in chronic perio – answer is actinomyces viscosus (it’s a fungus..
NO) the other options were c. rectus, t forsytiaas and p. gingivalis
QUESTION: Which is related to periondal disease? – Gram negative bacteria.

QUESTION: What the initiator of decay- plaque
QUESTION: What is the first step in bacterial plaque formation on a tooth? Pellicle formation, etc..
QUESTION: What is the first step in plaque formation? Pellicle formation (glycoproteins, enzymes,
proteins, phosphoproteins). Second step is adhesion and attachment of bacteria. Third step is
colonialization and plaque maturation
QUESTION: What does plaque depend on? Bacterial interactions and bacterial polymers. Does NOT
depend on host antigen
QUESTION: Which is not part of plaque formation? Host anigten, extracellular bacterial polymers
QUESTION: Most plaque retentive thing – calculus

QUESTION: Gingival recession other than plaque is related to – age, tobacco, etc?
QUESTION: Periodontal risk factor ?which one is not? Smoking, OH, malnutrition, diabetic
- between all these, malnutrition is the most correct answer for not being risk factor
QUESTION: Risk factors of periodontitis except. Nutritional, diabetes,,smoking. Oral hygiene
QUESTION: Which of the following things are associated w/ periodontal dz (all answers include list
of 3 things)?
- A: Atheroschlerosis, Diabetes Mellitus, Low birth weight of babies
QUESTION: Difference between primary and secondary occlusal trauma? I put periodontal
support
240
QUESTION: Difference between primary and secondary occlusal trauma? periodontal support/healthy
peridontium
QUESTION: Healthy patient, probing shows bleeding, what could this be due to? – Gingivitis
QUESTION: Which is least likely to occur with occlusal trauma? gingivitis
QUESTION: Plaque index is used for what – gingivitis progression and disease activity are options
but I picked patient motivation
QUESTION: Plaque index done for…pt motivation, to track process of disease, to know plaque amt,
QUESTION: Plaque index is used for what – gingivitis progression, disease activity, patient
motivation
I think the q is asking periodontal index, not plaque index: in that case, it should be disease acitivty
QUESTION: plaque index-ordinal

QUESTION: Gingival index/perio index. Know their flaws: Perio index flaws are that the
gingival recession was not taken into account
QUESTION: Gingival index 1= mild, 2 = moderate, ordinal

QUESTION: What is Gingival Plaque Index? ordinal
a. Nominal like mild, moderate, severe
b. Ordinal include numbers: like furcation involvement 1,2,3
c. Interval like Celcius degree
d. Ratio e.g Kelvin degree, or BP measurement(can not be zero), length(can not be negative),weight
QUESTION: Your office uses perio scale 1=gingivitis 2=mild perio 3=moderate/severe etc, what
type is this? Nominal, ordinal, ratio, cardinal
QUESTION: gingival index is what: ordinal, nominal, ratio, interval (where 0-normal and 3-tendency
toward spontaneous bleeding) 
QUESTION: Gingivitis, nominal and ordinal?
QUESTION: Best scale for gingival index?

a. ratio
b. nominal
c. interval
QUESTION: What is the CTI?- perio incidence index

QUESTION: CPITN: Community Periodontal Index of Treatment Needs
QUESTION: What is predominant in plaque 2 days after prophy: cocci and rods
QUESTION: bacterias present in gingivitis : gram + cocci and rods

gram + cocci and rods normally present, gingivitis transition includes Gram – rods and fillaments
followed by spirochetal and motile organisms.
QUESTION: With the development of gingivitis, the sulcus becomes predominantly populated by
241
a. gram-positive organisms.
b. gram-negative organisms.
c. diplococcal organisms.
d. spirochetes.
QUESTION: After you clean mouth, 2 days later, what bacteria is found? – Rods and Cocci
QUESTION: What kind of bacteria do you have when you have two day old plaque
a. Gram positive, gram negative, cocci, filament

b. (According to decks, its gram negative rods?)
QUESTION: Supra gingival calculus: main crystals are hydroxyl appetite 58%
QUESTION: Chronic periodontitis: has G – anaerobes
QUESTION: 2.04mm is bio width
QUESTION: The biological width is. 2mm
QUESTION: Biological width: from the crest of the alveolar bone to the base of the sulcus. a.gingival
sulcus, b.epithelial attachment. c.connective tissue,
QUESTION: Biologic width definition: junctional epithelium and connective tissue attachment to
the tooth above the alveolar crest (at least 2mm)
QUESTION: measure bio width from what 2 point: base of sulcus to alv crest
QUESTION: How to determine attachemtn level? CEJ to depth of pocket
QUESTION: attach loss is from CEJ to sulcus
QUESTION: Which of the following factor is most critical in determining the prognosis of periodontal
disease? 1. Probing depth, 2. Mobility, 3. Class 3 furcation, 4. Attachment loss (answer)
QUESTION: Attachment loss: loss of conective attachment. Apical migration of the JE away
from the CEJ
QUESTION: When is the prognosis that there is no hope- class 2 mobility or deep class 2 furcation, deep
probings with suparation**Perio prognosis—MOBILITY and Attachment LOSS---poor and questionable
involve class I and II furcations.
QUESTION: which has the worst prognosis? deep probing with suppuration, class II furcation or
class II mobility. ***Deep probing with suppuration= Vertical fracture
QUESTION: Class 2 furcation can treat with all but- GBR, take of enamel of root to make shallow class
2, hemisection and restore
QUESTION: Which teeth commonly relapse after perio tx? I put “maxillary molars due to
furcation anatomy”, but was torn between that and “mandibular molars due to their cervical
enamel projections”
QUESTION: Which tooth long run perio tx u will end up extracting: max pm max molar man molar
242
logical was hemisection and place 2 crowns to act as 2 premolars. Root amputation is for maxillary
teeth
QUESTION: If you have a through-and-through furcation involvement on a tooth, what do you do? –
Extract the tooth. (preferred treatment)
QUESTION: Molar with a III furcation with 5 mm root left in bone what do you do? Splint, extract
place implant?
QUESTION: Patient with class III furcation and 3mm exposure
• Extract
QUESTION: If you have a grade III furcation, you can do all of the following except
a. Section it and crown both as PFMs,

b. Tunneling procedure
c. GTR (this is the answer)
QUESTION: Tx option is class 2 almost class 3 furcation? Main goal of tx on class 2 is converted to
class 1 furcation by doing GTR
QUESTION: treatment of a class 2 that is nearly a class III
-convert class ii to a class i(GTR)
-tunelling
-extraction
QUESTION: class 2 and 3, all of the following would be a part of tx plan except? gtr, tunnel prep,
odontoplasty the class 2 to a class 1 furc, extract + place implant, hemisection
QUESTION: Most likely shape of furcation is?- wide but still not very accessible to dental tools, others
used variations of that.
QUESTION: When you have a through and through furcation (Grade 3 at least),
a. It’s wide enough and you can clean it

b. It’s wide enough and the currette is too big to clean it
c. It’s narrow enough and you cant clean it
d. Its narrow enough and the currete is too small to clean it
e. Wtf something like that. I would assume the currete head is too big to get to the furcation but
then I dunno
QUESTION: Furcation: Usually wide but cannot insert hand instrument
QUESTION: Root amputation of MB root – cut at furcation and smooth for patient to keep clean
QUESTION: Probing furcation from facial is best. Better accesss to facio mesial furcation from facial.
QUESTION: Best way to detect furcation – curve perio probe(naber probe), curette, straight perio probe
QUESTION: The normal recall appointment between periodontal treatment. 3 months,
QUESTION: best time for supportive periodontal therapy? 1, 3, 6, 9, months post srp
QUESTION: how do you treat gingivitis in puberty : debridement and OHI
QUESTION: What is not the initial treatment for gingivitis?- srp, OHI, corticosteroids
243
QUESTION: Common in school kids - Marginal gingivitis
QUESTION: What is most common periodontitis in school-aged children: aggressive PD, ANUG,
marginal gingivitis – I picked this even though its not technically periodontal disease…
QUESTION: Black ppl hav most perio dz

QUESTION: highest incidence of chronic perio? Black males
QUESTION: Which ethnic group has the most periodontitis? Black male
QUESTION: In the US, perio dz seen more in : African american males
QUESTION: most likely to have perio disease? Black males, black females, white males, white females
QUESTION: Black males have the highest incidence of chronic perio
QUESTION: Best for interproximal plaque removal in teeth without contacts: floss, waterpick,
interproximal brush?
QUESTION: What would you use to remove interproximal plaque from a wide embrasure after perio
surgery? interproximal brush
QUESTION: Patient has big embrassure - I said use interproximal brush (other choices, floss, toothpick,
etc)
QUESTION: How do you clean wide interproximal spaces with history of recession (I said
interproximal brushes, but they also had plaque and a waterpik)
QUESTION: Best brushing technique: Sulcular (bass)
QUESTION: Best brushing technique to clean periodontal pockets (charters was an option, sulcular
was an option (they didn’t have bass written, and whitmans was another option and side by side
was another option) – I wrote sulcular(google says its another name for modified bass and is good
for perio pockets/mainteneance)
QUESTION: least effective for crevicular plaque: water irrigating device

QUESTION: What is not good at removing plaque? Waterpik, nylon, toothbrush
QUESTION: Whats not useful for removing plaque?-water pick

QUESTION: Water irrigation removes debirs (not plaque)
QUESTION: Class 2 furcation, what is worst at keeping area clean? tooth brush, floss, waterpik,
rubber stimulating tip
QUESTION: Brush and floss how much can reach in perio pocket (choose one for brush and one for floss
(1mm and 2-3mm)
QUESTION: Max depth of toothbrush and floss going subgingival?
Toothbrush 0mm, floss 2-3 mm Toothbrush 2-3 mm, floss 0mm Tooth brush 1mm, floss 2-3 mm
QUESTION: Ultrasonic: The type of the stroke, know the magnetostrictive and piezoelectric
ultrasonics
QUESTION: Which is true? Water and air from sonic kill bacteria
QUESTION: Which disease would you NOT have success using antibiotics for? I put chronic
periodontitis
244
QUESTION: Which therapy in adding an Ab + debridement have minimal effect for: anug, Localized
aggressive, chronic perio
QUESTION: SRP removes diseased cementum
QUESTION: Pt. just had SRP. Best way to prevent sensitivity of newly exposed root surface?
A: Keep it free of plaque
QUESTION: Have done SRP on pt w/ recession. Best way to prevent sensitivity to newly exposed
root surface?
A: Keep root surface free of plaque
QUESTION: After you do ScRP, how does new attachment form? long junctional epithelium
QUESTION: What happens after you do ScRP therapy? Don’t remember details but it was about
HOW the reattachment occurs SECONDARY INTENSION
QUESTION: Direction of root planning?—from base of pocket to CEJ
QUESTION: most benefits from SRP : more edematosous is the gingival will be more benefitial.
QUESTION: What kind of gingival favorable for ScRP: Erythmatous, edematous
QUESTION: most benefits from SRP : more edematosous is the gingival will be more benefitial.
QUESTION: Best results from srp will be from a patient who has: edematous gingiva vs fibrotic
gingiva vs loss of attachment (idk what answer was I said edematous)
QUESTION: What do you do if after SRP there are 2 probing sites of 6mm: surgery
QUESTION: SRP and they came back for maintenance but still 5-6 mm pocket. What to do? Open
debridement
QUESTION: If you did intial SRP and depth pocket r same what do you do? Perio surgery
QUESTION: why check occlusion in perio abscess
g. cus many perio lesions are caused by occlusion
h. cus edema can cause teeth to supra erupt **
i. some other choices were pretty good to, but I cant remember what they were
QUESTION: What’s the FIRST thing you do in maintenance appointment (recall)? – Update medical
history (other choice were address patient’s pain, prophy, etc)
QUESTION: What do you not do at the perio maintenance apt.?- S&P pockets of 1-3mm
QUESTION: What do you NOT do at the re-eval appointment? I put root plane 1-3 mm pockets
QUESTION: What happens after the periodontal re-eval? I put that the recall interval is set but
may be changed if the patietn’s situation changes
QUESTION: What happens after the periodontal re-eval? the recall interval is set but may be changed if
the patient’s situation changes, should be less to motivate pt, more to motivate pt
QUESTION: How you determine perio maintenance recall – different for each patient
QUESTION: Pt is on a periodontal recall system. What best denotes good long term prognosis:-BOP,
Plaque, Deep pockets (BOP probable answer)
QUESTION: BOP most indicative of what?
A: Inflammation
QUESTION: How long does it take to form mature plaque (I wrote 5- 10 hrs), some others included 24-
36hrs, 1hr
QUESTION: how long for plaque to mature after removed: 24-36 hours
QUESTION: mature plaque in
245
• 1-2 hrs
• 6-8
• 10-12
• 24-48hrs
QUESTION: How many hours until plaque accumulation (after brushing or eating?): 1 hour
QUESTION: Percentage to be considered generalized perio-- *>30%
QUESTION: 40 year old fem generalized bone loss and localized vertical bone defect, gross calcium, dx?
Chronic periodontitis
QUESTION: Fusobacteria nuceatum has what specific characteristic? Bridging microorganism
between early and late colonizers
Fusobacterium nucleatum—important bridging microorganism btwn early and late

colonizers of dental plaque
QUESTION: where perio Tx is more difficult : maxillary molars due to trifurcations.
QUESTION: Whch tooth is most commonly lost due to long term care in perio patients: max molar,
max pm, man molar, man pm
QUESTION: Where are the most teeth lost in local aggressive periodontitis? Max molars.
QUESTION: What kind of bone loss in aggressive perio? Vertical. Others, horizontal, mesial distal,
interprox.
QUESTION: Reason pts get aggressive perio- host cant fight off
QUESTION: localized or generalized aggressive perio : no too much gingival inflammation.
QUESTION: What are two things common among generalized aggressive periodontitis and chronic
periodontitis
distribution among the teeth
QUESTION: Aggressive periodontitis localized: AA . First molar & incisors, circumpubertal onset,
robust serum antibody response to infective agents: the dominant serotype antibody is IgG2
QUESTION: where you find localized aggressive periodontitis localized aggressive periodontitis in
perm dentition
o AA bacteria
o Most common in African americans
Tx: surgery, metronidazole with amoxicillin, tetracycline
incisors and first molars

Localized aggressive perio= AA
QUESTION: Know about Aggressive periodontitis: AA bacteria
QUESTION: What causes Localized Aggressive Periodontitis- AA and capnocytophaga
246
QUESTION: classical sign of aggressive perio ---> something about mobility (tooth mobility and deep
pockets with lack of inflammation are initial signs of LAP)
QUESTION: Which of the following is not associated w/ Localized Aggressive Periodontitis?
local factors (i.e. inflammation, plaque, calculus) consistent w/ bone loss*
QUESTION: localized aggressive periodontitis show – bone loss on first molars and incisor
QUESTION: What is not associated with LAP(Localized aggressive periodontitis): calculus

QUESTION: Do you use antibiotics with local aggressive periodontitis? Yes
QUESTION: Initial tx for Localized aggressive periodontitis
f. Sc/RP
g. AB’s
h. Sc/RP and AB’s **
i. AB’s for 1 week and then Sc/RP
QUESTION: How do you treat localized aggressive periodontitis? – Sc/Rp and ABX
QUESTION: best to use w/ localized aggressive periodontitis
a. chlorhexidine
b. H2O2 rinse
c. systemic antibiotic
QUESTION: 18 year old fem > 5 mm pocket on central and first molars? Localized aggressive Perio
LAP – AA and capnocytophaga; generalized periodontitis involves prevotella and eikenella (know
if spirochete/cocci, etc)
Know well about Localized aggressive periodontitis and ANUG.**LAP: high ab response to infecting
agents; disease on 1st M or I, with attachment loss on at least 2 teeth (one of which is a 1st M). Remmeber
that chronic includes attachment loss on at least 3 teeth (other than M or I) and there is low ab response to
infecting agents.
Aggressive periodontitis generalized: patients under 30 years of age, poor serum antibody
response,of Aggregatibacter actinomycetemcomitans, and in some cases, of Porphyromonas
gingivalis
QUESTION: Which of the following pdl disease causes rapid destruction of alveolar bone? 1. Periodontal
abcess (answer), 2. ANUG, 3. Chronic periodontitis.
QUESTION: 3 questions about ANUG: how to tx(srp/rinse/if systemic ab, if not systemic no ab
needed), Bacteria involved (Spirochetes)
QUESTION: bacterias present in ANUG: fusiform, spirochetes and prevotella intermedia
QUESTION: Which NUG or ANUG, which microorganisms predominate? – Spirochetes
QUESTION: Which NUG or ANUG, which microorganisms predominate? 1. Spirochetes (answer)

QUESTION: Bacteria for anug – spirocytes –(fusoform, spirocytes, pervertoa intermedia)
(intermiated spirocytes- treponema denticola)
QUESTION: ANUG? Usually 15-35 years old, aka Vincent’s infection and trench mouth, punched out
papilla, fetid odor, prevotella intermedia.
247
QUESTION: Electron microscopic examination of the bacterial flora of necrotizing ulcerative
gingivitis indicates the presence of microorganisms within non-necrotic tissues in advance of other
bacteria. The organisms involved are
A. spirochetes.
 Also P.intermedia and Fuso
QUESTION: Patient comes in with gingivitis, no pocketing, pseudomembranous coating gray on gingiva:
anug
QUESTION: ANUG: Interproximal necrosis
QUESTION: Patient has interpapilla damage periodontal condition, what could this be due to? –
ANUG
QUESTION: Patient has interpapilla damage periodontal condition, what could this be due to? – ANUG
QUESTION: Cratered gingival = ANUG (NUG)

QUESTION: Acute ulcertaive gingivitis what could be indicated: host overreacting to infection. Bacteria is
releasing deadly toxins (no toxin in acute periodontitis or is not main reason) and the answer was normal
bacterial flora is what youd find in acute ulcerative gingivitis.
QUESTION: Which of the following is the most appropriate initial treatment for a patient with HIV-
associated necrotizing ulcerative gingivo-periodontitis?
A. Debridement and antimicrobial rinses
B. Definitive root planing and curettage
C. Administration of antibiotics
D. Gingivectomy and gingivoplasty
QUESTION: Normally, you don’t give antibiotic. You only do debridement, rinse, and oral hygiene.
But if the patient has a fever or systemic indications like HIV, give Metroniadozle.
QUESTION: Metronidazole: given to someone to treat ANUG

QUESTION: Localized aggressive perio, treat with-tetracycline
QUESTION: How do you treat ANUG? Debriement, H2O2, Chlo
QUESTION: Tx for NUG pt with no systemic involvement? Debridement, chlorhexidine, OHI

QUESTION: begin tx of ANUG pt w /
a. H2O2 rinse
b. debride & instrument
c. antibiotics
QUESTION: Red complex has 3 bacterias: P. Gingivalis, Tannerella forsythia, Treponema
denticola
red complex = P. gingivalis, Tannerella forsythia, treponema denticola

i. BOP & deep pockets
248
Orange complex = fusobacterium, prevotella, campylobacter
j. Precedes red complex
k. Plaque formation and maturation
QUESTION: Least associated w/ perio disease? Hypophosphatism (related), acrodynia (related)
QUESTION: all associated w/ perio problems accept

a. stevens-johnson syndrome (target lesions, eye, mouth, skin)
b. pap-lefev syndrome (palmoplantar keratoderma with periodontitis)
c. down syndrome (related)
d. hypophosphatasia (bone disease similar to rickets, premature loss of primary teeth)
QUESTION: Least cause of bone loss around primary teeth? Hypophosphatsia, leukemia, plaque,
one other one I didn’t know, I put plaque
QUESTION: The depth of sulcus is 5mm, the distance between CEJ and the base of sulcus is 2mm.what is
the attachment loss: 2mm
QUESTION: Probing depth on pt. is 7mm. Your probe passes 2mm past the CEJ. What is the CAL?
2mm
QUESTION: If recession is 2mm and probing is 1mm how much attachment loss? 0,1,2,3
QUESTION: Pocket depth of 5mm and 2mm from CEJ and gingival margin: 2mm attachment loss
QUESTION: If you have 1mm recession and can probe 3mm, how much attachment loss is
there? I put 4mm
QUESTION: Best angle to place curette on root is 45-90 (repeat)
QUESTION: Perio instrument is held at what angle on the tooth
o 45-90 degrees
o the blade is opened 45 to 90 degrees for working strokes
QUESTION: What edge of curette do u want to be in contact at line angle? Lower 1/3
QUESTION: Curette, which third adapts tooth? – Apical Third, Middle Third
QUESTION: Curette, which third adapts tooth? – (I think correct one was apical) --*lower third of blade??
QUESTION: Which part of instrument do you place on line angle of tooth: middle third, third
including tip, third closest to handle or entire edge
QUESTION: Periostat- twice daily 20 mg has doxycycline which works by inhibiting collegenase/protein
synthesis (30s subunit not an option) Jon put perio chip…Periochip is 2.5mg of chlorohexidine gluconate
though.
QUESTION: Periostat’s mechanism of action: inhibits collagenase, inhibits ribosome 50s (I put
collagenase because it says so in Mosby’s)
QUESTION: Periostat mechanism of action ---- 1mg minocycline local
Reduces elevated collagenase activity in gingival crevicular fluid of patients with adult
periodontitis; no antibacterial effect reported at this dose
QUESTION: Doxycyclin use? intramicobial which inhibits MMP: matrix metaloprometase
249
  Subantimicrobial dose doxycycline (SDD, periostat) inhibits matrix metalloproteinase
(MMP)
QUESTION: •How does Listerine act? Stops cells from binding, (some other choices... this is not the one I
chose) The mechanism of action of Listerine involves bacterial cell wall destruction, bacterial
enzymatic inhibition, and extraction of bacterial lipopolysaccharides.
QUESTION: Action of Listerine?
it disrupts adhesion of bacteria to plaque
is a phenolic compound
QUESTION: What type of agent is Listerine – charged or noncharged?? (according to
google…uncharged…Xtina)
QUESTION: LISTERINE :Antiseptic mouthrinse is a broad-spectrum antimicrobial, and it kills
bacteria associated with plaque and gingivitis by disrupting the bacterial cell wall.
QUESTION: What daily oral rinse would you give to a medically compromised child for plaque control?
(choices were CHX, Listerine, Nystatin, stannous fluoride, sodium fluoride)
QUESTION: What does sodium pyrophosphate do? -Plaque removal-something about removing
crystals of Ca and magnesium, inhibits mineralization of biofilm (inhibits calcium phosphate from
biding)
QUESTION: why are inorganic pyrophasphates in anti-tartar toothpaste: In toothpaste, sodium
pyrophosphate acts as a tartar control agent, serving to remove calcium and magnesium from saliva and
thus preventing them from being deposited on teeth
a. prevent bacterial colonization
b. prevent phosphate…
QUESTION: Why is inorganic pyrophosphate in tooth paste: prevent calcium phosphate crystals,
decrease number of bacteria growth
pyrophosphate, has a higher RDA and, additionally, prevents stain buildup by means of chelation
as well as abrasion.
QUESTION: The role of chlorohexidine is cause: Substantivity (anti-plaque)
QUESTION: Action of chlorhexidine: binds to cell wall cell membrane disruption/rupturefluid

leaks out, cell lysis (CHX bursts membrames)
QUESTION: The use of chlorhexidine  reduce plaque accumulation (broad spectrum against gram
positive and negative bacteria and fungi – Positively charged)
QUESTION: Chlorhexidine :The mechanism of action is membrane disruption
QUESTION: Each of the following is a mode of action of an ultrasonic instrument EXCEPT one.
A. Lavage
B. Vibration
C. Cavitation
250
D. Sharp cutting edge of tip
QUESTION: Ultrasonic Instruments: active portion is the tip, 20-45k cycles/seconds
o Magnetostrictive: elliptical vibration pattern, all sides of tip are active (4 sides total)
o Piezoelectric: linear vibration pattern, 2 sides are more active (sides are only active)
o CONTRAINDICATED in patients with Pacemaker, communicable diseases, titanium implants (use

plastic tip)
QUESTION: Mode of action of ultrasonics. ANS. Vibration in elliptical (magnetostrictive) , sonics

is linear
QUESTION: Why don’t u use Acidulated Fluoridated Toothpaste? Ruins Polish of Crown
QUESTION: Why you do perio before ortho: b/c perio you have gingival and osseous changes
QUESTION: Old and young person w/ same perio. Which has better prog?
• Older (b/c younger pt had shorter time frame to get to the same condition so more aggressive in
nature)
QUESTION: 2 Patients, one young, one old, both have better prognosis if they both had bone loss,
periodontitis, etc? – I said young (apparently old people!) **WTF???
periodontitis, etc? –old people have better prognosis
QUESTION: which tooth most likely to lose from perio dz? mx molars, mx anteriors, md molars,
md anteriors
QUESTION: Lots of questions on cerebral palsy (something about whether or not it is a
developmental disorder) (2nd after autism)
s neither genetic nor a disease, and it is also understood that the vast majority of cases
are congenital, coming at or about the time of birth, and/or are diagnosed at a very
young age rather than during adolescence or adulthood. It can be defined as a central
motor dysfunction affecting muscle tone, posture and movement resulting from a
permanent, non-progressive defect or lesion of the immature brain.
QUESTION: CP patient - which is not true?

a. 95% have cognitive impairment
b. all brux
c. increase in periodontitis
QUESTION: Cerebral palsy – patient will have spastic oral mucosa during treatment
QUESTION: Pt has involuntary uncoordinated movements with larynx problem? ANS. Cerebral palsy
QUESTION: Common finding in a patient with cerebral athetoid palsy. ANS. Anterior Teeth fracture
251
QUESTION: What condition would benefit most from sc/rp. A) edematous gingiva desquamous ging b)

QUESTION: most benefits from SRP : more edematosous is the gingival will be more benefitial.
QUESTION: Which of the following is NOT a sign of periodontal inflamm: color,consistency, bop, and
attachment
QUESTION: Which of the following causes bone loss?

a. C3a, C5a
b. Endotoxin
c. Interleukin
d. B glucorinidase
QUESTION: What cytokine responsible for osteoclasts – IL-1, IL-8,IL-5, IL-3
QUESTION: Root surface tx with what agents? use citric acid, fibronectin and tetracyclin
QUESTION: Which part of dental anatomy on a central collects the most plaque? Facial surface, lingual
surface, cingulum, mamelon, gingivopalatal groove
-Perio: reverse architecture (papilla is supposed to be a mound not a volcano) what is diference between
open bevel and cloesd bevel: both of them would cause the same amount of recovery pain.
QUESTION: Reverse architecture- interproximal is lower than on facial and lingual
QUESTION: Reverse architecture: Interdental bone is apical to the crestal bone
QUESTION: Define reverse architecture? When interdental bone is apical to crestal bone
QUESTION: After periodontal surgery, the dentist leaves interproximal bone apical to radicular
bone.What is this called: negative architecture.
QUESTION: What can make teeth green? Bacteria, gingival hemorrhage, medications or
hyperbilirubinemia
QUESTION: What can make teeth orange? Bacteria
QUESTION: What causes green and orange stain on teeth: Poor ohi I said that, other option are
meds and genetics
QUESTION: Green and orange stains on maxillary incisors can usually be attributed to
A. drugs.
B. diet.
C. poor oral hygiene.
D. fluoride consumption
QUESTION: What are proper ways to reinforce OHI: written and verbal, verbal and in the dental
office
QUESTION: OHI should be? written and oral, Oral in office, written, video tape,
252
QUESTION: What is most difficult to maintain oral hygiene with home preventive care?
• pit and fissure
• proximal smooth surface
• facial smooth surface
• lingual smooth surface
QUESTION: Rapid tooth mobility is due to advanced perio or periapical pathology??
QUESTION: Most common to cause mobility- trauma or perio
QUESTION: Which of these is reversible with tooth movement?
• Tooth mobility *
• Bone resorption
• Crestal bone
• Gingival recession
QUESTION: Which one the following is reversible? – Tooth Mobility (other were, bone loss, gingival
recession, and attachment loss)
QUESTION: Pregnant gingivitis: estrogen, estradiol, progesterone
QUESTION: Pregnant women more gingivitis why- hormones

QUESTION: Pregnancy induced hyperplasia: Progesterone induced
QUESTION: Pregnancy gingivitis has altered metabolism of progesterone
QUESTION: Which one of these bacteria are associated with pregnancy
P. intermedia
QUESTION: Pregnancy gingivitis caused by? hormones (progestrone) and P intermedia
QUESTION: Person who is pregnant,you should not give meds in the section e of page 250 .
Tetracyclin, metronidazole, gentamicin and vancomycin should be avoided
QUESTION: Puberty bacteria? P-Intermedia
QUESTION: patient inter-papilla givgiva is swollen - anticonvulsant meds (dilantin)

QUESTION: Whats the #1 cause of med induced ging hyperplasia?- dylantin-30% of all drug induced, this
was a perio test question.
QUESTION: What does NOT cause gingival hyperplasia?
a. phenytoin
b. cyclosporin
c. nifedipine
d. digoxin** (first three causes gingival hyperplasia)
QUESTION: Verapamil – calcium channel blocker, hypertension

QUESTION: Does not cause gingival hyperplasia?
Cyclosporine A, phenytoin, dilti, nifedipine all cause gingival hyperplasia
NEFEDIPINE doesn’t. the answer was nEfedipine instead of nIfedipine
253
QUESTION: All of the following drugs cause gingival hyperplasia except? Verapamil,
diltiazem(CALCIUM CHANNEL BLOCKER), phenytoin (dilantin), nifedipine and cyclosporine—
all do.
QUESTION: All the following drugs cause gingival enlargement (hyperplasia) except?
-DIGOXIN
QUESTION: Which does not cause gingival hyperplasia
o Phenytoin
o Digoxin
o Nifedipine
QUESTION: Gingival hyperplasia with which drugs? None of the answers were obvious like
phenytoin.. one of them was probably an obscure calcium channel blocker
QUESTION: which of these does not cause gingival hyperplasia: digoxin
a. CCb (vermipril), phenytoin, cyclosporine
QUESTION: All of the following drugs cause gingival hyperplasia except? I forgot what the
answer was but it was an easy question. They listed phenytoin, dylantin, nifedipine and
cyclosporine, which all cause hyperplasia. The answer was whichever I did not list above.
QUESTION: Easy picture of Gingival Hyperplasia due to patient taking drugs that causes this
QUESTION: Know drugs that cause gingival hyperplasia: Cyclosporines, phenytoin, calcium
channel blockers
QUESTION: Patient is on calcium blockers, picture show gingival hyperplasia, what do you do? –
Tell them to see their doctor to switch meds
QUESTION: Patient is on calcium blockers, picture show gingival hyperplasia, what do you do? – Tell
them to see their doctor to switch meds
QUESTION: When pt is on imunosupessents for transplanted liver, what happends in the mouth?- CT
overgrowth and hyperplasia.
overgrowth and hyperplasia.  cyclosporine will lead to gingival hyperplasia
QUESTION: Picture of gingival hyperplasia on 14-year old girl –hormonal induced,
QUESTION: Stress long term cause problem in periodontium bc it increases cortisone and
cortisone and brings immune system down
Dentures:
1. Retentive clasp: engages undercut below height of contour
2. Reciprocal clasp: passively touches above the height of contour
3. if you don’t have good indirect retention, it lifts off the soft tissue
4. SUPPORT (rigidity): Denture base, major connector, and rests
5. STABILITY: minor connector (lingual plates, guide planes, etc)
6. RETENTION: indirect and direct retainers
QUESTION: Main purpose of major connector? support retention,

QUESTION: 2 main purposes of major connector: Rigidity and stability?
254
QUESTION: Purpose of Major Connector – Stability and Rigidity, Stability and Retention, Retention and
Rigidity, Rigidity and Esthetics
QUESTION: Requirement of a major connector? Rigidity

QUESTION: Reciprocating arm of clasp? Stabilization
QUESTION: Reciprocating arm Counteracts the effects of direct retainer
QUESTION: Purpose of reciprocal clasp: Stabilization
QUESTION: What does the reciprocal clasp do? Indirect retainer
QUESTION: what does the reciprocal brace do? Counteract retentive clasp, stabalize the tooth, indirect
retainer
QUESTION: Function of clasp arm? both stability (reciprocal arm) and retention
QUESTION: Reciprocal clasp is placed on or above the height of contour
QUESTION: Where does the retentive clasp engage on abutment: passively on the suprabulge,
**Retentive clasp-- gingival third of the crown w/I the undercut (suprabulge)
**Reciprocal Clasp-- middle third of the crown
QUESTION: Retentive clasp is not base metal alloy
QUESTION: Where does the retenetive clasp engage on abutment: passively on the suprabulge? It
exerts a positive direction movement; sits on the height of contour and another was not touch the
tooth at all (engage in undercut to resist removal of prosthesis and to help prevent dislodgement)
QUESTION: What is function of Rest? Support
QUESTION: What is the primary func of rest seats? To resist vertical tissue force (to provide vertical
support for RPD)
QUESTION: the purpose of the rest seat is: prevent displacement
QUESTION: Whats the purpouse of an indirect retainer?-to prevent distal extention from lifting up
QUESTION: What is the purpose of an indirect retainer? It is located on the opposite side of the
fulcrum line . assists direct retainer to prevent displacement of denture base in an offlucsal
direction. Consists of one or more rests, their minor connectors, and proximal plates adjacent to
edentulous areas. Should always be placed as far as possible from the distal extension base.
QUESTION: Function of minor connector? Stability
QUESTION: Main purpose of buccal flange of Mx denture?

A: Stability,
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QUESTION: What does not have an effect on clasp flexibility? Undercut
o Metal, width, and length all have an effect on clasp flexibility
QUESTION: most important in denture retention: intimate tissue contact or peripheral seal
(former)
(former)
QUESTION: The peripheral seal is the most important part of the denture for proper retention
QUESTION: What is the primary retention for mandibular denture? Buccal shelf
- Primary support area = buccal shelf
QUESTION: Primary retention for mand CD? Buccal shelf
QUESTION: Primary stress bearing area in mandible: buccal shelf --
and incase the residual ridge is in good shape it also contributes to primary support.
QUESTION: Primary support for denture – Mand: buccal shelf Max: ridge
QUESTION: What is main area of support for distal extension RPD? Ridge, buccal shelf, external
oblique ridge…
QUESTION: Primary support for denture – max: ridge, 2nd-rugae
QUESTION: mand: buccal shelf, 2nd-anterior lingual border
QUESTION: Best indicator for success of denture is – Ridge

QUESTION: Primary stability for an edentulous CD on maxillary? Palate and residual ridges.
QUESTION: Definition of a combination clasp: cast reciprocal arm and a wrought wire retentive clasp
QUESTION: Combination clasp: ww and cast  Wrout wire, cast wire
QUESTION: What connects major connector with rest seats- Minor connector
QUESTION: What connects an occlusal rest and major connector? -->Minor connector
QUESTION: For bilateral distal extension - indirect retention because it is supported by tissue
QUESTION: How far do we extend a CD: Hamular notch
QUESTION: post extension of post palatal seal is vibrating line: 2mm past vibrating line (fovea
palatini) anterior is distal of hard palate (blow line)
QUESTION: Post extension of post palatal seal is 2mm beyond vibrating line (fovea palatini)
QUESTION: What should you consider when placing peripheral seal?
Tuberosity, throat form, …

I eliminated the answer choices that included age of patient?
QUESTION: What does dentist look at before placing palatal seal – vibrating line, throat configuration,
tension of tissue throat form, tissue type and fovea location.
QUESTION: Which 3 things determine the posterior palatal seal? throat form, tissue type and fovea
location
QUESTION: Which 3 things determine the posterior palatal seal? I put throat form, tissue type
and fovea location.
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QUESTION: Which of the following best explains why the dentist should provide a postpalatal seal
in a complete maxillary denture? The seal will compensate for
A. errors in fabrication.
B. tissue displacement.
C. polymerization and cooling shrinkage.
D. deformation of the impression material.
QUESTION: Purpose of placing posterior palatal seal: compensates for shrinkage

QUESTION: Excessive depth of the posterior palatal seal usually results in
A. unseating of the denture.
B. a tingling sensation.
C. greater retention.
D. increased gagging.
QUESTION: if the palatal vault is too deep : vibrating line is more pronounced and forward
QUESTION: if the palatal vault is to deep : vibrating line is more pronounced and forward  The
higher the vault, the more abrupt and forward is the vibrating line.
QUESTION: If the palate is very deep, what happens to the vibrating line?
More pronounced
Forward
Backward
*From Dr. Nasr’s lecture: In the class III variation (of palate forms), there is a high vault in
the hard palate. Soft palate has an acute drop and a wide range of movement. The vibrating
line is much more anterior and closer to the hard palate. This gives a narrow posterior
palatal seal area.
QUESTION: When do you remove palatin torus: Prevents seating of denture and formation of
posterior seal
QUESTION: tori patient without peripheral seal what to do? Remove tori
QUESTION: Patient is going to get dentures and he has palatine tori, why should it be removed? To
increase peripheral seal, Because the mucosa is too small and it will hurt him
QUESTION: Indication for removeing max tori: interferes w/ posterior palatal seal
QUESTION: Palatal tori-when should it be removed?

• If undercut-so can’t be cleaned
• If posterior to vibrating line-interferes with posterior palatal seal
• 3mm anterior to vibrating line
• When denture is created around tori and functions properly
QUESTION: Pt has bilateral max tori. Need to make an upper and lower cd. Tori extends to posterior
palatal seal. What should you do?
-make a post palatal strap
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• make cd around tori, remove tori and allow to heal, reline denture
• *remove tori than make cd
QUESTION: major connector design for large inoperable palatal torus
a. horseshoe
QUESTION: Guy has no upper teeth and palatal tori that extends to soft palate what type of major
connector to use? Horshoe, AP, Palatal strap (unless option to remove)
QUESTION: Reason for splint in palatal torus removal (prevent infxn, flap necrosis, hematoma
formation)
QUESTION: Palatal tori removal....after surgery u splint because helps stop HEMATOMA
QUESTION: Mandibular tori in first premolar and canine
If you were to remove the tori would you have the patient sign an informed consent of lingual nerve
injury
QUESTION: Hinge axis : Face-bow
QUESTION: What does the facebow do? I put translates the relationship of the maxilla to the
terminal hinge axis using a 3rd point of reference
QUESTION: Primary purpose of plaster index of occlusal surface of max denture before removing
the denture from the articulator and cast: Preserve face-bow transfer
QUESTION: what is the plaster index for? preserve facebow record
QUESTION: Why do you use plaster index on mounting for facebow: Preserve face-bow transfer
QUESTION: Why take plaster index? Teeth are then put back exactly in their original position aided
by plaster key
QUESTION: Delivered CD/CD. Why do you take impression of max denture and mount it to
articulator?(clinical remount): so you don’t have to take face bow registration again (preserve
facebow)
QUESTION: lab and patient remount? Why are they done- establish and maintain VDO
QUESTION: Why is the WW clasp placed far away from its minor connector?
To have room to solder it on
More retention
QUESTION: What is reason for the altered cast technique when doing an distal extension rpd : I said
it was support but not sure (others were retention, esthetics, etc)
QUESTION: Altered cast technique. The reason for doing this procedure..
“The altered cast method of impression making is most commonly used for the mandibular distal
extension partially edentulous arch (Kennedy Class I and Class II arch forms). A common clinical
finding in these situations is greater variation in tissue mobility and tissue distortion or
displaceability, which requires some selective tissue placement to obtain the desired support from
these tissues. This variability in tissue mobility is probably related to the pattern of mandibular
residual ridge resorption. Altered cast impression methods are seldom used in the maxillary arch
because of the nature of the masticatory mucosa and the amount of firm palatal tissue present to
provide soft tissue support. These tissues seldom require placement to provide the required
support. If excessive tissue mobility is present, it is often best managed by surgical resection, as this
is a primary supporting area.” Carr, Brown. McCracken's Removable Partial Prosthodontics, 12th
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QUESTION: SIBILANT allow maxillary incisors to nearly touch the mandibular incisors,
QUESTION: fricative sounds are made by allowing the maxillary incisors to nearly touch the
slightly inverted lower lip.
QUESTION: If doing a denture try-in: where wud teeth touch compared to vermilion border when
saying “F” sound  they would just touch ->wet/dry lip line
QUESTION: What can’t the patient not say if upper anterior are too superior and forward for denture
teeth? F and V
QUESTION: What do you use to check if VDO and anterior teeth are set correctly for denture teeth?
- F and V
QUESTION: What do you use to check if VDO and anterior teeth are set correctly for denture teeth? - F
and V ** all these file answers say F and V, but when I checked Mosbys it says to evaluate VDO you
make the sound S
QUESTION: Asked about what sound will determine VDO **S sound. This will bring teeth slightly
together with 1-1.5 mm separation. This is the “closest speaking space”
QUESTION: S, z, and ch sounds the teeth must be…close together, far apart
QUESTION: s/ch/z sounds formed by putting tongue between mx and mnd incisors: th
QUESTION: Denture wearer say’s “S” sounds and the post teeth are touching….why? excessive vertical
QUESTION: S, ch, sounds are made: When max and mand ant teeth barely touch… Increase VDO,
decrease freeway/interocclusal space, Decrease VDO, increase freeway/interocclusal space
QUESTION: Making F sound – teeth touches lip

QUESTION: Have large incisors, difficulty with F sounds
teeth? **Decks say that placing anterior teeth too far superior and anteriorly make it hard to say F and
V!!!
QUESTION: If the maxillary incisors are placed too far superior and anterior, what is affected? D
and T sounds (D & T are for labial and lingual)
QUESTION: Maxillary anterior teeth too far superior and anterior: F and V sounds
QUESTION: Too labially placed upper anterior teeth. What sounds are hard to say: Fricative (F-V)
QUESTION: After a couple of months of delivery of upper and lower complete, patient complains of
burning of lower lip: Canidida or impingness of mental nerve.
QUESTION: Burning sensation lower denture? impingement of mental nerve
QUESTION: Which denture base is not light cured?? A really weird question. Never seen it before.
And none of the answers were a 100%
a. Pressure formed
b. Injectable molding
c. Some other type of molding
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d. Pour or fluid resin technique
QUESTION: Why don’t you set denture teeth on the incline up towards the retromolar pad? You’re
impinging on it or because it dislodges the denture
QUESTION: Which of the following explains why mandibular molars should NOT be placed over the
ascending area of the mandible?
A. The denture base ends where the ramus ascends.
B. The molars would interfere with the retromolar pad.
C. The teeth in this area would encroach on the tongue space.
D. The teeth in this area would interfere with the action of the masseter muscle.
E. The occlusal forces over the inclined ramus would dislodge the mandibular
denture.
QUESTION: Why don’t put posterior tooth on inclination of ramus? Occlusal forces dislodge
QUESTION: You give patient maxillary denture and they come back with generalized soreness under the
denture. no sore spots or anything visible clinically, what's causing this? allergy, significant
malocclusion(gross occlusal misalignment)
QUESTION: Soreness all along the ridges? Hyperocclusion

QUESTION: Pt has general soreness along ridges from complete denture…what should you do…reline,
adjust occlusion
QUESTION: Generalized maxillary soreness over ridge of a patient that just got a new denture what
is it due to? The options did not help… Like excessive interocclusal space, decrease VOD, lack of
interocclusal space
QUESTION: If there is a lesion under a denture, relieve the denture and do a follow up
QUESTION: A 6x3 mm white lesion seen under old man wearing a denture for 19 years. Its
aymptomatic. What is first thing done at initial treatment? –adjust and check in one week
adjust denture and the observe ,Incision,excision, cytologic Relieve any trauma from
intaglio, watch for 2 weeks, then biopsy, when you biopsy, you can do incisional
QUESTION: you tell patient who has dentures to take off at night - to relieve the bone
QUESTION: What is the main reason for removing complete dentures at night? providing rest to tissues
QUESTION: you tell patient who has dentures to take off at night - to hydrate denture in water (it should
be to rest gum/bone?)
QUESTION: Patient is edentulous and has red upper palate - allergic to denture (it should be don’t take it
off when they go to bed)
QUESTION: When tx planning an RPD for a pt what is the first attachment placed on the serveyor?-
analyzing rpd
QUESTION: When tx planning an RPD for a pt what’s the first thing you do?- Mount casts. Others, find
undercuts, find abutments, extract hopeless and perio teeth.
QUESTION: best way to eval available space for rests-mounted casts
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QUESTION: patient has mobile upper anterior maxillary tissue that is inflamed. Before making
new denture you do what? A) gingivectomy, B) apply conditioner to existing denture, C) make
new denture that will immobilze the existing tissue D) something else
QUESTION: pt's max denture made her tissue inflamed and weird, you decide to make her a new
denture after?
a. you place tissue conditioning material in her old denture
QUESTION: Pt. with inflamed abused tissue and needs new cd, what do u do? Tissue conditioning
QUESTION: What appointment do you check for sibbilings sounds? – When verifying VDO
(basically at intermaxillary records appointment, another choice was tooth try-in) ?
QUESTION: At what point do you check the proper placement of teeth: At the wax-try in phase
QUESTION: when do you check for syllabus sounds: at the Wax rim try-in appt.
QUESTION: when do you check for silabount sounds : at the try-in appt.
QUESTION: At what visit do you test phonetics in complete denture? Tooth try-in
QUESTION: When do you check phonetics for a CD/CD? Wax try-in
QUESTION: What appointment do you check for sibilant sounds? – When verifying VDO (basically at
intermaxillary records appointment, another choice was tooth try-in)
QUESTION: During try-in of denture, check for tongue to do all movements: all working movements
QUESTION: Lingual of a denture, how do u know if its good? want to have a full movement of the
tongue
QUESTION: If teeth on the wax tryin don’t occlude like they did on the articulator what do you do?-
Remount, redo teeth and retry!!
QUESTION: A denture tooth falls of y is that? She put down there was some wax that was not removed
QUESTION: Which one of the following is usually an issue for denture patients? – Lower denture
(other were maxillary dentures, and some other things)
QUESTION: Saliva and denture, which one is correct? – (thin watery)

QUESTION: Retention of denture is impacted by saliva flow
QUESTION: Disadvantage of reduced saliva? Reduced retention
QUESTION: Saliva and denture, which one is correct? – Relationship that leads to denture and tissue
adhesion, no relationship
QUESTION: Saliva and denture, which one is correct? – No relationship (Of course I’m wrong, there is a
relationship that leads to denture and tissue adhesion) **THIN saliva is better and aids in adhesion
QUESTION: Full denture- a lot of saliva better for retention/ worse? Less saliva worse?
QUESTION: Physiologic rest position: When mandible and all of supporting muscles are in their
resting posture, Muscle guided position
QUESTION: no posterior teeth and incisal wear on the anterior-because of absence of posterior
teeth
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QUESTION: No posterior teeth and anterior incisal edge why? Abcense of posterior teeth
QUESTION: Patient feels fullness of upper lip after delivery of complete denture: Overextended
labial flange
QUESTION: RPD modification- to remove indirect retainer or add lingual palatoplate? It was an
palatal strap and missing some molars and premolars bilateral with circumferential clasps
QUESTION: VDR-Freeway Space=VDO
QUESTION: what happens when Vertical is lost-signs that is reduced VDO
QUESTION: Which position depends on patient’s posture? I put VDR
QUESTION: what changes with patient posture (sitting up vs laying down) : VDR (other options are
centric relation or vdo and someone else)
QUESTION: What problem causes bilateral angular cheliits: high vertical dimension, low
interocclusal space, high occlusal distance: Low VDO
QUESTION: Angular chielitis – unbalanced Centric occlusion, or unilateral… decrease VDO

QUESTION: Angular chelitis- increase interocclusal space **angular chelitis associated with overclosure
QUESTION: Angular chelitis is caused by all of the following except:
a. Fungal infection
b. Decreased VDO (causes it, b/c increase interocclusal distance; also cheek biting!!)
c. Increased VDO (causes clicking of teeth)
d. Other options
QUESTION: Patient has short lower face and sagging lips. What should you do? I put increase
VDO
QUESTION: Patient has clicking with dentures – instead of saying vertical dimension too high, the
answer choice said something about inadequate resting space
QUESTION: clicking of denture teeth → excessive VDO- teeth
QUESTION: Teeth clicking in dentures: excessive vertical dimension
QUESTION: If you hear clicking in denture patient it is due to? excess VDO =too little VDR
QUESTION: Reason for cheekbiting with dentures? inadequate horizontal overjet
QUESTION: Pt wearing a complete dentures… pt is cheek biting: posterior teeth set up with no
horizontal overlap.
QUESTION: cheek biting → not enough horizontal overlap of posterior teeth, insufficient OVD
QUESTION: You fit new completed denture and the patient complains of cheek bite, what will
you do?
a. grinding buccal of lower teeth
b. grinding buccal of upper teeth
c. grinding lingual of lower teeth
d. grindinging lingual of upper teeth
QUESTION: When find VDO-the max tuberosity touches retromolar pad-what should you do?
• Make metal extension on mand RPD
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• Surgery on max tuberosity
• Surgery on retromolar pad
• Open VDO
QUESTION: An examination of a complete denture patient reveals that the retromolar pad contacts
the maxillary tuberosity at the occlusal vertical dimension. To remedy this situation, which of the
following should be performed?
Reduce the maxillary tuberosity by surgery.
Cover the tuberosity with a metal base.
Increase the occlusal vertical dimension.
Reduce the retromolar pad by surgery.
Omit coverage of the retromolar pad by the mandibular denture.
QUESTION: Immediate denture and has undercuts and tuberosity, what do you do? Remove
tuberosity, remove both don’t remove any?
QUESTION: A patient who has a moderate bony undercut on the facial from canine-to-canine needs
an immediate maxillary denture. There is also a tuberosity that is severely undercut. This patient is
best treated by
A. reducing surgically the tuberosity only.
B. reducing surgically the facial bony undercut only.
C. reducing surgically both tuberosity and facial bony undercut.
D. leaving the bony undercuts and relieving the denture base.
QUESTION: an examination of a complete denture patient reveals that the retromolar pad
contacts the maxillary tuberosity at the occlusal vertical dimension. To remedy this situation,
which of the following should be performed
a. reduced the maxillary tuberosity by surgery
b. cover the tuberosity with a metal base
c. increase the occlusal vertical dimension
d. reduce the retromolar pad by surgery
e. omit coverage of the retromolar pad by the mandibular denture.
QUESTION: When making a denture base, the hamulus is too close to the retromolar pad ? Surgery, don't
put base on hamulus don't put base on retromolar pad or increase vd?
QUESTION: In an edentulous patient, the coronoid process can
A. limit the distal extension of the mandibular denture.
B. affect the position and arrangement of the posterior teeth.
C. limit the thickness of the denture flange in the maxillary buccal space.
D. determine the location of the posterior palatal seal of the maxillary denture.
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QUESTION: When taking impression and patient is open what can interfere with fully seating- coronoid
QUESTION: coronoid process displace upper denture if : too bulky at max distobuccal
QUESTION: Coronoid – when open mouth can dislodge denture (mand denture=masseter)
QUESTION: Open mouth while maxillary border molding- Coronoid process will block buccal
extension
QUESTION: best way to prevent speech problems in complete dentures keep teeth in same position
QUESTION: Dentist mounted maxillary cast without using facebow, but now wants to increase
vertical dimension 4mm: open articulator 4mm, get new CR, take new facebow, lateral movements
QUESTION: If you want to increase patient’s VDO by 4mm, what do you do? - I said take new CR (other
choices were take new facebow, adjust articulator, etc)
QUESTION: Need to increase vertical dimension by 4mm in denture patient. How do you do it?
Increase VDR, retake CR, change condylar angulation
QUESTION: new CR if you raise a pin if 4mm

QUESTION: Cd/cd and want to open bite 4mm? take new centric relation
QUESTION: What to do if you increase VDO after mounting? New bite registration and remount
QUESTION: Made pt denture which shows to much of max teeth. There are 3 mm of freeway space.
What would you do?
lift up occlusal table
*?decrease VDO (not sure about this…because the freeway space doesn’t seem excessive…would seem
like the only solution is remake the CD…Xtina)
QUESTION: you are correcting the VDO of a patient, your articulator emminentia is set at 20 degrees, you
later correct it to 45 degrees. What do you do next? Adjust bennet angle, new centric relation record,
increase the VDO, others? Decrease incisal guidance, or increase compensating curve. Bennet angle
is calculated using condylar incline so you can adjust bennet angle too
QUESTION: if denture teeth were set to a 20 degree condylar setting when the teeth need to be at 45
degrees, what will need to be changed?
• Incisal guidance increased??
• Posterior cusps decreased
• Increase compensating curve
DECREASE INCISAL GUIDANCE (to compensate for increase in condylar guidance)
(Steep condylar path requires steep compensating curve, and decreased incisal guidance)
QUESTION: The condylar guidance is increased from 20 to 45 degrees,what do you do.
�Increase the compensatory curve
the curvature of alignment of the occlusal surfaces of the teeth that is developed to compensate for
the paths of the condyles as the mandible moves from centric to eccentric positions.
A means of maintaining posterior tooth contacts on the molar teeth and providing balancing
contacts on dentures when the mandible is protruded.
264
Corresponds to the curve of Spee of natural teeth.
QUESTION: Setting condylar inclination on articular using protrusive , what do with the pin?
Remove the pin (lift up)
QUESTION: incisal guide pin position while checking protrusive,why (determine condyle guidance)
QUESTION: purpose of incisal guidance,mount casts..? adjust condylar guidance ..begin prep
QUESTION: Reason for Incisive guide table?. Anterior guidance

QUESTION: When making a guide table….Lift the pin up about 2 mm
QUESTION: What is the best way to preserve the anterior guidance? translating the horizontal and
vertical relationship onto the incisal table
QUESTION: What is the best way to preserve the anterior guidance? I put something about
translating the horizontal and vertical relationship onto the incisal table
QUESTION: How to determine the angle of the incisal table? By the horizontal plane (occlusal plane)
of occlusion and a line in the sagittal plane between incisal edges between maxillary and
mandibular central incisiors.
QUESTION: Which plane is most important on anterior guidance.: Horizontal/occlusal
QUESTION: pt with class III will lhave the mandibular incisal angle? Increased, decreased
QUESTION: Another case, lower natural anterior teeth, upper PFM anterior teeth. Lowers had incisal wear
facts, what do you think this is due to? – Heavy incisal guidance (this was the most logical answer, as
PFM vs natural teeth, natural teeth wear off)
QUESTION: Same patient from #56, a picture of him doing incisal guidance, what is this patient doing? –
Incisal guidance (lower teeth and upper teeth were at edge to edge position)
QUESTION: Same patient as question 56 and 57, when he does anterior guidance, what is happening to
the TMJ? – Rotational (I was wrong, it’s translation!)
*anterior guidance…TMJ TRANSLATES!
QUESTION: A patient presents for try-in evaluation of balanced occlusion of complete maxillary and
mandibular dentures. A dentist notes that protrusive excursion results in separation of posterior
teeth. This dentist can best correct this problem by
A. changing the condylar inclination.
B. increasing the incisal guidance.
C. increasing the compensating curve.
D. using a flat plane cusp for the posterior teeth.
QUESTION: Protrustion denture causes dislodging. Change condylar inclination increase

compensating curve!!
QUESTION: Reline for Kennedy class one: Make sure rpd is seated
QUESTION: First step in religning a distal extention denture you must first- try in the framework
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QUESTION: In Max CD opposing Mand bilateral distal extension (Kennedy class 1) why is the
anterior of the wax rim beveled? I put because the length is good esthetically but there is not
enough interocclusal space @ that length.
QUESTION: Beveling on upper occlusan rim due to? length is adequete for esthetics but inadequete
interach space
QUESTION: Patient has occlusal rims prepared and bevels the max,why?
-VDO and lenght of max occ rim was adequate
-vdo was incorrect bur length of occ rim was adequate
-Always bevel max occ rim
-Lengh of occ rim as adequate but vdo was wrong
QUESTION: How should distal extension RPD fit in comparison to other RPDs? Passive clasp fit
QUESTION: Which one of the following is usually an issue for denture patients? – Lower denture (other
were maxillary dentures, and some other things)
QUESTION: what is the best way to treat a tooth supported lower denture? Use metal copings to
cover teeth
QUESTION: Retruded tongue habit with full denture means what?- difficulty swallowing
QUESTION: Denture border sitting on what muscle due to its orientation of its fiber: I think its
masseter.
QUESTION: Posterior buccal extention of a mandibular complete denture is limited by : Masseter

muscle
QUESTION: Posterior buccal extention of a mandibular complete denture is limited by: Masseter
muscle
QUESTION: What muscle can u impinge on with denture- maseteer, medial pterygoid, or lateral pterygoid
QUESTION: The denture base completely covers what muscle
a. Medial pterygoid
c. Masseter
d. Buccinator
a. Medial pterygoid
c. Masseter
d. Buccinator (Fibers of buccinator and buccal shelf)
QUESTION: what muscle covers dentures flanges and no affect stability : Buccinator- the
buccinators does not affect stability!!
QUESTION: Which muscle will not interfere with the denture base?
• Buccinator
• Lateral pterygoid
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• Masseter
QUESTION: lower denture impression lingual area muscle – mylohyoid
QUESTION: Which muscle helps border bold in the posterior lingual flange? Mylohyoid was the
answer. Other muscles that help are: palatoglossus, superior pharyngeal constrictor, genioglossus
(lingual border of mandibular impression)
QUESTION: lingual flange on lower complete is around which muscle? Geniglossus, medial
pterygoid, lateral pterygoid, mylohyoid.
QUESTION: man. Lingual flanges are affected by

• geniglossal
• mylohyoid
QUESTION: Mand CD interfere with what muscle in lingual side?
• Mylohyoid.
QUESTION: What determines lingual border of Mandibular impression? BOTH Superior Pharyngeal
Constrictor/mylohyoid muscle and buccal is masseter.
QUESTION: lower denture impression lingual area muscle – mylohyoid / superior pharyngeal
constrictor / palatoglossus, genioglossus
QUESTION: What muscles help in retention of lower complete denture : palatoglossus , superior
pharyngeal constrictor, mylohyoid and genioglossus.
QUESTION: Denture outline in border molding affected on the lingual of mandible by what?
Superior constrictor, palatoglossis, genioglossis, mylohyoid
QUESTION: Border molding of lingual mandibular portion done by what movement? Wetting of lips
with tongue
QUESTION: you would relieve a mandibular denture in the area of the buccal frenum to allow which
muscle to function properly? Buccinator? Orbicularis oris
QUESTION: pt presents with a restricted floor of the mouth, only 6 mandiblar anterior teeth and
diastama b/w several teeth, which of the following major connector is appropriate for this pt: a
lingual plate with interruptions In the palate at the diastemas
QUESTION: RPD rocks when you apply pressure on either side of fulcrum line, why? Indirect
retainer
QUESTION: RPD pops off when press on one side – inadequate indirect retainer
QUESTION: Insufficient indirect retention on RPD when what happens?

A: Distal extensions lift away from mucosa
QUESTION: Edentulous bilateral and rocking of denture- inadequate seating of denture or
inadequate indirect retainers.
QUESTION: What happens when no indirect retainer on distal extension: see distal extention pop
up off of tissue
QUESTION: With mandibular bilateral distal extension RPD, when you place pressure on one sides the
opposite side lifts and vice versa, what is the problem?
267
a. no indirect retention used
b. rests do not fit
c. acrylic resin base support
QUESTION: Why is there a tissue stop under distal extension rpd – acrylic resin
QUESTION: Pt complains “it feels loose” from a new bilateral distal extension RPD. Why? I put retainers
are passive on the abutments they should fit passive .Thin flanges bases, Occlusion , Indirect retainer
QUESTION: Pt comes in w/ new bilateral distal extension RPD that’s loose. Why? I put retainers
are passive on the abutments. (retainers are supposed to be passive)
QUESTION: Pt comes in w/ new bilateral distal extension RPD that’s loose. Why? Deflective
Occlusal contacts
QUESTION: Lower denture is loose whats wrong with it? (over extended, under extended????
QUESTION: Distal extention lower rpd u push on that area and the indirect retainer rest comes up….how
do u tx?
Reline (if its excessive altered cast)
Tell them to use denture adhesive
Tighten clasps
QUESTION: multiple failures in FPD : poor framework design.
QUESTION: Breaking clasp? Poorly designed something

QUESTION: The main reason of breaking of RPD clasp?
High Mudule of Elastisity
work Work Hardening
QUESTION: What property of rpd framework will limit adjustments of clasps?
a. Yield strength?
b. Ductility
c. Stiffness
QUESTION: What mechanical property effects permanent composition for RPD clasps – yield strength
QUESTION: Why do you use canine for incisal rest: esthetics, surface area, cingulum
QUESTION: Base metal: Long span bridge
QUESTION: Pt comes in w/ interim; if u fabricate cast partial, how is it gonna be different?

Aesthetics of teeth, retention, resistance to occlusal loading, etc. (agu’s answer: resistance to
occlusal loading – cuz interim doesn’t have rest seats)
QUESTION: Which of the following explains why a properly designed rest on the lingual surface of a
canine is preferred to a properly designed rest on the incisal surface?
A. The enamel is thicker on the lingual surface.
B. Less leverage is exerted against the tooth by the lingual rest.
C. The visibility of, as well as access to, the lingual surface is better.
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D. The cingulum of the canine provides a natural surface for the recess.
QUESTION: How do you protect roots under an overdenture – RCT with cast copings,
QUESTION: What is not important for over denture? clinical crown size
QUESTION: Which teeth roots to retain under overdentures? PICK roots from dense bone areas.. Such as
Mandibular Canine
QUESTION: Overdenture…how do you choose which teeth to retain?...which is most important…no freaking
clue…based on crown, # roots, location etc… Pref = canine  premolars  incisors molars
Bilateral, symetrrical, with healthy attached gingiva, adequate perio support (>1/2 root in bone), limited/no mobility
QUESTION: A patient has acromegaly and needs dentures. Which denture will not fit?
Maxillary
Mandibular
QUESTION: which of the following is the endocrine involvement that is related to jaw deformity:
Acromegaly
QUESTION: If acromegaly is not controlled, lower jaw protrudes
QUESTION: Which of the following is the endocrine involvement that is related to the jaw deformity?
a. acromegaly
b. cherubism
c. Albrights
d. pagets
QUESTION: Denture patient with a big ball around canine and premolar
neurofibroma
QUESTION: First sign of increased (we think in reference to VD) occlusion? TMJ, myofascial,
attrition, abfraction
QUESTION: After surveying and designing which is the first step to do? reduction the axial for
proximal plate
QUESTION: In which is a direct retainer very important? Kennedy class 2

QUESTION: Describes a denture with bilateral edentulous space anterior to natural teeth. Kennedy
class 4
QUESTION: Which type of kennedy classification doesn’t have a modification? Kennedy Class IV**
QUESTION: which kennedy class has no modification-Class IV
QUESTION: Chromium for corrosion resistance
QUESTION: What prevents corrosion on a noble metal? Chromium or nickel
QUESTION: What is expected from a high noble metal? No tarnish or corrosion??
QUESTION: RPD denture frame what metal causes allergy, nickel, chromium , cobolt and copper
QUESTION: Allergy mostly to nickel
QUESTION: Metal most likely to cause allergic rea3ction  NICKEL
QUESTION: Which metal is responsible for allergic reaction? Nickel or cobalt? I THINK NICKEL
QUESTION: KELLY Syndrome=Combination syndrome (CS). pt with completely edentulous

maxilla and partially edentulous mandible with preserved anterior teeth, consists of severe anterior
maxillary resorption combined with hypertrophic and atrophic changes in different quadrants of
maxilla and mandible.
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QUESTION: Which is not a symptom of combination (Kelly) syndrome? Increased VDO
(class I mandibular RPD vs. Max CD, bone loss in anterior maxilla, overgrowth in max tuberosities,
papillary hyperplasia of hard palate, supraeruption of mandibular teeth, bone loss beneath distal
extensions: Xtina, First AID)
QUESTION: Guy has treatment plan that is going to be combination syndrome so what is the
ultimate goal when you make his cd upper and rpd lower: balanced occlusion on both anterior
and posterior teeth of mouth during centric relation;
ultimate gola when you make his cd upper and rpd lower: I said you want balanced occlusion on
both anterior and posteror teeth of mouth during centric relation; (other option was wanting
balanced occlusion (didn’t mention ant vs post teeth, during excursive movement)
QUESTION: Combination syndrome = Kelly syndrome : Pt with maxillary complete denture –

retained mandibular anteriors and not lower RPD . Pt shows : denture anteriors teeth doesn’t show
, flabby anterior ridge , tuberosities flabby and enlarged, lower anterior teeth extruded above plane
of occlusion and atrophy of lower posterior ridge.
QUESTION: Pt has flabby anterior tissue

• Caused by combination syndrome
• Causes decreased VDO
QUESTION: Combination syndrome = Kelly syndrome
1)denture anteriors teeth doesn’t show ,
2)flabby anterior ridge ,
3)tuberosities flabby and enlarged,
4)lower anterior teeth extruded above plane of occlusion and
5)atrophy of lower posterior ridge.
QUESTION: A flabby, maxillary anterior ridge under a complete denture is frequently associated
with
A. V shaped ridges.
B. Class II patients.
C. osteoporosis.
D. retained natural mandibular anteriors.
Down Syndrome/Birth Problems:

QUESTION: Down syndrome patients have small maxillas and midface deficiency
QUESTION: DOWN syndrome:
they don’t have more caries
QUESTION: Trisomy 21 face: Low Caries Risk
QUESTION: Trisomy 21
o Down syndrome
o Mandibular prognathism
o Thickened tongue (macroglossia)
o Class III profile
QUESTION: Down syndrome : midfacial hypoplasia
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QUESTION: Downssyndrome: trisomy 21, which is a description ? small mandible Mid Facial
discrepency
QUESTION: Trisomy 21 (Down syndome)

Manifestations
Mid-face deficiency, Class III
Delayed eruption
Super-numerary teeth
Does not have a higher chance of caries
HIGHER chance of periodontal disease
QUESTION: What orthomanifcastion does Turner syndrome and trisomy 21 associated with? short
midface
QUESTION: What is telurism- eyes wide apart--- example Crouzan’s Disease (gorlin and down
syndrome for extra info)
QUESTION: What is hypertelorism-
Wide-set eyes (seen in Crouzon, Cleidocranial dysostotosis, GOrlin Sydrome,)
QUESTION: Hypertelorism definition: Increased distance between eyes, or other body parts
QUESTION: asked of definition of hypertolerism – increased distance between eyes.
(crouzon’s)
QUESTION: Which does NOT result in delayed development:

Trisomy 21, Trisomy 18, Hurler Syndrom (mucopolysaccharides), Cru di Chat
QUESTION: which one doesn’t show late development trisomy 18(Edward syndrome),
Edwards syndrome (also known as Trisomy 18 [T18]) is a genetic disorder caused by the presence of
all or part of an extra 18th chromosome.
some physical malformations associated with Edwards syndrome include small head (microcephaly)
accompanied by a prominent back portion of the head (occiput), low-set, malformed ears,
abnormally small jaw (micrognathia), cleft lip/cleft palate, upturned nose, narrow eyelid folds
(palpebral fissures), widely spaced eyes (ocular hypertelorism), drooping of the upper eyelids
(ptosis), a short breast bone, clenched hands, choroid plexus cysts, underdeveloped thumbs and/or
nails, absent radius, webbing of the second and third toes, clubfoot or rocker bottom feet, and in
males, undescended testicles.[3][4] (sheshe added this)
Cri du chat syndrome, also known as chromosome 5p deletion syndrome, 5p- (said minus)
syndrome or Lejeune’s syndrome, is a rare genetic disorder due to a missing part (deletion) of
chromosome 5.
QUESTION: Fetal alcohol syndrome

anencephaly, mid face deficiency, cleft lip
QUESTION: How it looks in a kid fetal alcohol syndrome? -midface deficiency
QUESTION: Fetal alcohol syndrome causes – cleft lip
QUESTION: Teratogen definition: anything that messes with the fetal development
QUESTION: What causes problems in babies in emryo? Teratogens (Any agent that can disturb
the development of an embryo or fetus) Carcinogen
QUESTION: teratogenic definition - cause deformity / birth defects
QUESTION: Definition of teratogen: Any agent that can disturb the development of an embryo or
fetus. Teratogens may cause a birth defect in the child. Or a teratogen may halt the pregnancy outright.
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Bone & Sutures:
QUESTION: Epiphyseal plate is most like a synchondrosis
QUESTION: what resembles epi plate: synchondrosis
QUESTION: What age does the mandibular symphisis close: 6-9 months
QUESTION: Sphenooccipital synchondrosis: cartilage*
QUESTION: Sphenooccipital closure…what kind of tissue fills it in – its cartiledge

Interstitial growth – occurs by the mitotic division and deposition of more matrix around chondrocytes
already established in the cartilage.
Ex – CONDYLE, nasal septum, and spheno-occipital snychondrosis
QUESTION: Sphenooccipital synchondrosis: cartilage* or bone
QUESTION: which of these undergo suture closure latest?

• sphenoethmoidal
• Sphenoccipital
• Intrasphenoid
• Intraoccipital
QUESTION: What is synostosis? ABNORMAL FUSION OF BONES
QUESTION: synostosis definition:
(abnormal fusion of neighbor bones…wiki…Xtina)
QUESTION: What is craniosynostosis? Early closure of suture
QUESTION: What is synostosis?

• Abnormal fusion of two bones. Craniosynostosis is early closure of a suture between
bones.
• Abnormal development of a joint.
QUESTION: Synostosis (fusion of 2 bones)- CROUZON

QUESTION: Patient w/ deficient synostosis mid-face, proptosis,? Crouzon syndrome
Synostosis means fusion of two bones…proptosis) - a bulging of the eye anteriorly out of the orbit
QUESTION: Patient w/ deficient mid-face, proptosis, etc? I put Crouzon syndrome, Could also
be Apert Syndrome
QUESTION: Ocular proptosis, max hypoplasia, premature suture closing? treacher-collins, crouzon,
Pierre robin, cleido cranial
BEATEN METAL SKULL
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Crouzon’s syndrome
 The most notable characteristic of Crouzon syndrome is cranial synostosis, as described
above, but it usually presents as brachycephaly, which results in the appearance of a short and
broad head. Exophthalmos (bulging eyes due to shallow eye sockets after early fusion of
surrounding bones), hypertelorism (greater than normal distance between the eyes), and
psittichorhina (beak-like nose) are also symptoms. Additionally, a common occurrence is
external strabismus, which can be thought of as opposite from the eye position found in Down
syndrome
QUESTION: Hurler and Hunter’s syndromes- what do they have in common? They both have
mucopolysaccaridosis- build up of GAGs
HURLER SYNDROME = also known as mucopolysaccharidosis type I (MPS I), Hurler's disease, also
gargoylism, is a genetic disorder that results in the buildup of glycosaminoglycans (formerly known as
mucopolysaccharides) due to a deficiency of alpha-L iduronidase, an enzyme responsible for the
degradation of mucopolysaccharides in lysosomes
HUNTERS SYNDROME = It is a result of a defect in anchoring between the epidermis and dermis,
resulting in friction and skin fragility
Both are lysosomal storage diseases
mucopolysaccaridosis- build up of GAGs
QUESTION: Hunter-hurler syndrome, mucopolysaccaridosis is buildup of glycosaminoglycans

QUESTION: Hunter-Hurler is mucopolysacchrides
QUESTION: Mucopolysaccharosis is a common finding in Hurler and Hunter syndrome
QUESTION: Hunter syndrome has what?

Lysosome storage disease. Get abdominal hernias, ear infections, colds, prominent forehead, enlarged
tongue, mental retardation.
Type of MCUOPOLYSACCHARIDOSIS
X-linked, appears @ 1-2 yrs of age, clear corneas, growth retardation, stiff joints, mental retard
QUESTION: hunter syndrome : build up of glycosaminoglycan due to lack of an enzyme : enzyme
iduronate-2-sulfatase (I2S).
QUESTION: Hurlers Syndrome? genetic disorder that results in the buildup of mucopolysaccharides due
to a deficiency of alpha-L iduronidase, an enzyme responsible for the degradation of
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mucopolysaccharides in lysosomes. Without this enzyme, a buildup of heparin sulfate and dermatan
sulfate occurs in the body.
QUESTION: 15 yr old edentulous and keratosis on hands and feet.

Papillon Lefevre syndrome ***Think PERIO + PALMOPLANTAR KERATODERMA********* ugly
pic of thick soled FOOT GROSS!—wiki it
QUESTION: What is Papillon–Lefèvre syndrome? You get periodontitis, keratosis on hands and soles, and
premature loss of primary teeth.
QUESTION: Hyperkeratosis in hands and feet – Papillon-Lefevre Syndrome
QUESTION: Hyperkeratosis in hands and feet – Papillon Le-Favre Syndrome this also cause
severe periodontal disease which cause primary tooth loss by the age of 4 and permanent
tooth loss by the age of 14
QUESTION: Papillon-Lefevre syndrome -basic question on hand and feet derm
Pierre Robin Syndrome = micrognathia, occurring in association with glossoptosis, cleft palate, and
absent gag reflex.
QUESTION: Pt. has glosoptossis (downward displacement or retraction of tongue), Mn
micrognathia, and cleft palate?
A: Pierre-Robin Syndrome
QUESTION: triad of glossoptosis, mand. Retrognathia, and cleft palate? Pierre Robins?
QUESTION: Glossoptosis = refers to the downward displacement or retraction of the tongue
QUESTION: Glossoptosis – micrognathia - cleft palate? Pierre,Robin syndrome
QUESTION: Triad of cleft palate, glossoptosis and absent gag reflex. What is it? Pierre-Robin
Syndrome
QUESTION: Sturge-Weber syndrome? vascular malformation, eye and hemangioma  Port-

wine stain
QUESTION: Sturger webber syndrome : Port Wine Stain.

*Sturger Webber—Port Wine stain
QUESTION: Sturge Weber syndrome – port wine stain; Angiomatosis of leptomeninges
QUESTION: alveolar bone is open over root, this is: fenestration, dehiscence ( I put fenestration, b/c
dehiscence refers to wounds according to wiki)
QUESTION: What is it called when you have a hole in the bone that exposes the root? Fenestration
QUESTION: Dehisense defined as? The loss of buccal or lingual bone overlying a tooth root.
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QUESTION: Dehiscence? The loss of the buccal or lingual bone overlaying the root portion of a tooth,
leaving the area covered by soft tissue only.
QUESTION: Dehiscence - dehiscence is loss of alveolar bone on the facial (rarely lingual) aspect of a
tooth that leaves a characteristic oval
QUESTION: Each of the following osseous defects would be classified as infrabony EXCEPT one. Which
A. A trough
B. A dehiscence
C. A hemiseptum
D. An interdental crater
Thyroid:
QUESTION: Which is not endocrine gland? Parathyroid, thyroid, adrenal, parotid
QUESTION: Which do you give a hypoparathyroid child for normal development of teeth: vit D 
Brings in Ca+
QUESTION: Give a kid Vitamin D or calcium for hypoparathyroidism
QUESTION: Thyrotoxocosis symptoms
a. DIAPHORESIS, fever and TACHYCARDIA
QUESTION: Thyrotoxic shock and its symptoms: fever, tachycardia, hypertension, and neurological
and GI abnormalities.
QUESTION: Thyrotoxic pt. manifestation? Tachycardia,

QUESTION: Characteristic of excess thyroid?
A: Hypotension, bradycardia, restlessness, sweating → probably due to heat intolerance
QUESTION: Thyroid crisis resembles….
Hyperthyroidism….thyroid storm (thyroid storm is a severe version of thyrotoxicosis)
QUESTION: Symptoms of hypothyroid

QUESTION: symptoms of hypothyroid attack: weight gain, bradycardia, cold, fatigue, constipation
QUESTION: Which endocrine system does thick hair become thin hair: thyroid – hypothyroidism
(cretinism in kids and myxoedema in adults)
QUESTION: loss of weight, sweating and fine hair : hyperthyroid
QUESTION: Increase in alkaline phosphotase is related to? – Hyperparathyroidism
QUESTION: the decreased alkaline phosphatase is related to: it’s hypophosphatasia
QUESTION: Hypophosphatasia leads to a Decrease in Alkp,
QUESTION: What disease causes decrease in alkaline phosphatase? Malnutrition,
hypophosphatasia, hypothyroidism, pernicious anemia
QUESTION: Central Giant Cell Granuloma is seen with pts with which condition? Hyperparathyrodisim
QUESTION: Osteoporosis is associated with which of the following diseases? Hyperparathyroidism
QUESTION: Thyroid drug, which doesn't let iodine bond to hormone? Radiated Iodide (for
hyperthyroidism)
QUESTION: Pheochromocytoma involves – thyroid,
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QUESTION: Graves Disease (Hyperthyroidism) - exopthalmos
QUESTION: Thyroid hormone decrease, which drug do you give? Levothyroxine (for
hypothyroidism)
QUESTION: Pt has high cholesterol, hypertention and diabetes, metabolic problem, which does he
have: metabolic syndrome,
QUESTION: BMI of 36 what syndrome? Overweight always going to pee-; high lipids high
cholesterol; what syndrome? METABOLIC SYNDROME
QUESTION: What other organs would not be effected? Pancreas, colon, thyroid, kidney? THYROID
QUESTION: Blood tests back from together hematocrit, etc….hematocrit again
QUESTION: What is the normal %fat intake per day- 30

QUESTION: Recommended daily dose of fat: 30% of total calorie and saturated fat is 10% of daily calorie
intake
ETHICS & Patient Managament:

Beneficence- “Do good”.
Patient Autonomy- “Self governance”.
Nonmaleficence- “Do no harm”. Dentists are to keep skills and knowledge up-to-date and practice within
their limits in order to protect the pt from harm.
Justice- “Fairness”.
Veracity- “Truthfulness”.
LOTS OF ETHICS QUESTIONS: what to say what to do in these situations. If your patient is
looking around a lot at your masks and gloves, safety equipment, whats the most appropriate
response? Some of the answers are vague.
QUESTION: Dentist tells patient amalgam is hazardous – veracity
QUESTION: Know veracity: truthfulness: tell patient that he needs to take of amalgam fillings bc
they are not good for his health: not practicing veracity.
QUESTION: If a dentist tells the patient “I need to remove all your amalgams because they are
toxic” he is violating? I put Veracity
QUESTION: telling truth is veracity
QUESTION: What principle has to do with patient self-governance and privacy? I put autonomy
QUESTION: Informed consent – autonomy
QUESTION: Informed consent  autonomy

QUESTION: Informed consent – figure out if patient is able to understand and sign
QUESTION: Definition of Autonomy - patient choose to sign consent
QUESTION: Dentist lets the patient sign informed consent-autonomy
QUESTION: What you do first before choosing informed consent: make sure patient can sign or has
guardian, consult physician, discuss options with relatives …
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QUESTION: 82 y/o pt comes w/ younger person who hands dentist paper saying the pt has a
legal guardian. Now what? I put that you must have consent of this guardian before
treating the 82 y/o pt
QUESTION: 90 year old patient comes in with son who has a document mentioning the guardian of
the patient- must have consent from them to treat the patient
QUESTION: The 16 yr old can take the decisions for the elder pts if: If the elders are deaf and dumb,
if the boy makes thepayment, if the elders are over 60yrs, if the kid has the power of an
attorney
QUESTION: Consent- do not need to discuss the witness signature (I think)
QUESTION: When should patient sign informed consent forms for surgery? I put AFTER there
has been a discussion w/ the dentist about the surgery
QUESTION: inform consent most contain all except : cost of Tx.
QUESTION: Treatment without informed consent is battery

QUESTION: What happen when patient doesn't sign the consent? Battery, health care provider
commits a battery if the provider performs a procedure for which the patient has not given consent.
QUESTION: Dentist keeping up with new data – non-malfecence
QUESTION: Something about dentist needs to keep up to date with new technology and learn and
practice new procedures: Non-malfecience
QUESTION: Dentist keeps on current dental medicine to provide current standard of care. What part of
the ethical code does this relate to?
A: Nonmalefacence
QUESTION: Definition of non-malifacence - Knowing your limitations and referring patients out to
specialists
QUESTION: Dentist refers a difficult case to a speacialist-non malfiecence
QUESTION: Reason y we need to CE and know our limitation- forget the name the one where we do no
harm to patient (non-malfiecense)
QUESTION: Dentist keeps on current dental medicine to provide current standard of care. What
part of the ethical code does this relate to?
A: Nonmalefacence
QUESTION: Like if a child came with a history of aggressive behavior and is crying then should the
dentist show empathy or sympathy or control LOOK BACK **Apathy-indifferent; Empathy-to walk in
their shoes, share the emotional state they are feeling; Sympathy-to be concerned about someone, do not
have to share the same emotional state as them.
QUESTION: Rapport best with : empathy I put: other choices were sympathy, compassion
QUESTION: What best characterizes rapport? Understing patients feeling and talking with
patient
QUESTION: Definition of rapport? mutual openness / harmonious relationship*

Rapport = mutual sense of trust and openness between individuals that, if neglected, compromises
communication. 
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QUESTION: A successful practice is built on- friendship COMMUNICATION? Good clinican-patient
relationship
QUESTION: what is the best to communicate with patient- apathy, empathy, or some other stuff
QUESTION: to show empathy you don’t need which of these? An imagination, understanding.... I don’t
remember what I put down though...
QUESTION: Empathy is not: shared personal experiences Imagination, understanding
QUESTION: which does not show empathy to the patient?
a. open-mindedness
b. sharing personal experiences**
c. reflection and showing understanding
QUESTION: Definition of Empathy – Patient wanted to give you paperwork, and you acknowledge
their concerns
QUESTION: to paraphrase a question you do not need to agree with it
QUESTION: When should the dentist NOT use paraphrasing? When trying to speak to a patient in his
second language, When the dentist is upset with what patient says, when giving factual values.
QUESTION: When should the dentist not use para-phrasing?
a. When trying to speak to a patient in his second language
b. When the dentist is upset with what patient says
c. when giving factual values
QUESTION: Which statement is NOT correct about “Paraphrasing”?
• to put in your own words – it’s correct meaning of paraphrasing
• there were a few other example, but can’t remember…
Paraphrasing=repeating, in one’s own words, what someone has said. This serves to confirm one’s
understanding, validate a patient’s feelings, convey interest in the patient’s experience (thereby building
rapport), and highlight important points.  
QUESTION: Patient complains of pain in relation to a particular tooth.So the best answer/reply of the
dentist would be:
If you came here earlier things would not be bad
If you took more care this would not have happened
I will take care of everything
QUESTION: While the dentist is preparing a large carious lesion in Tooth #30 for a restoration, a
pulp exposure occurs. The patient angrily shouts at the dentist, "You incompetent 'creep'- -you're
responsible for this problem!"- Of the following possible responses the dentist could make, which
one is the most emphatic?
A. Calm down, I can still restore your tooth adequately.
B. Not when I'm preparing a tooth with caries like you had.
C. I can see that you're very upset. You thought the tooth could be restored and
now this problem has occurred.
D. If you took care of your mouth the way you should, I wouldn't have been close to the pulp.
E.I'm sorry this happened, but we must get on with the procedure.
QUESTION: Patient comes in and they say “oh I hate the dentist, I hate being here”
• What would be your response
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QUESTION: if the patient tell you why you fees are so high, what would be your response:??
QUESTION: Pt complains of high fees of dentist, how should the dentist answer? Fee is fine
according to the geographic area, it is fair and reasonable, I have to make a living too
QUESTION: Patient says, “I’ve been brushing like you showed me but I still have cavities.” What do
you do?
a. Go over OHI?
b. Tell him you understand that it is frustrating?
QUESTION: The closest a dentist should get to their patient is? 1. Tap their shoulder
QUESTION: Reason to not have parent in room with dentist and kid- communication barrier
between dentist and child, osha violation, hipaa violation,
QUESTION: Don’t have parent in room with child  disrupts relationship between child and dentist
QUESTION: Why a parent would be contraindicated from being in the room? barrier to
communication btwn dentist and child
QUESTION: Health behavior: Precontemplation/contemplation/action definition
QUESTION: Pt. says, “I do not have time to quit smoking.” What stage is s/he in?
A: Precontemplation*, contemplation, action, denial
Operant Conditioning:
o Positive reinforcement : u brush u get sticker
o Negative reinforcement: stop pain from toothache pt realizes he should brush)
o Positive punishment =Aversive Conditioning: everytime u don’t brush u have to
clean ur room
o Negative punishment= don’t brush no allowance
o Operant extinction= child cries don’t give attention
Positive reinforcement- Positive consequence that increases behavior

a. Negative reinforcement- Removal of negative consequence that increases behavior
b. Positive punishment- (adversive conditioning)- negative consequence that
decreases negative behavior
c. Negative punishment- (adversive)- Removal of positive stimulus in order to
decrease an undesirable behavior
d. Basically, know that reinforcement is more effective than punishment because in
punishment, you have resentment, you avoid the punisher, and you are not taught
positive behavior.
Systemic desensitization
a. Relaxing strategy like diaphragmatic breathing

b. Most important component of systematic desensitization is exposure to
fearful stimulus
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QUESTION: MOST of the questions where of behavior modification techniques in children and
“what would you say” questions
a. Autistic kid, down syndrome
b. Kid that kicks and screams
c. Shy kid
QUESTION: During the child's first visit, the dentist requested that the parents wait in the reception
room. The child cried moderately, but tearfully, throughout the dental examination and
prophylaxis. The dentist "gave her permission" to cry while he/she worked and then took no notice
of her crying. Her crying diminished in intensity over time and then stopped. With respect ONLY to
the crying behavior, the dentist has)
A. used positive reinforcement.
B. used negative reinforcement.
C. extinguished the behavior.
D. ignored the problem.
QUESTION: Pt with manic depression disorder not willing to get treated for that is now getting dental
treatment from you. What do you see in this patient:
A) bipolar b)depression c)excitement
QUESTION: Def of Operant extinction? removal of reinforces to decrease a behavior
QUESTION: How to reduce Stress-dental anxiety? tell-show-do
QUESTION: Emancipated minor: if the kid is under 18, know exceptions of how they become
emancipated minor, page 230
- If he graduated from high schoo, has been married, has been pregnant, or
responsible for his or her own welfare and is living independently of parental control
and support.
QUESTION: How is FACT witness is different from expert specialist? fact witness just determines
the quote pg.231
QUESTION: Behavior shaping: providing positive reinforcement for approximation of behavior you
are desiring
QUESTION: Which describes a stage in Piaget’s model of congnitive development? I put
preoperational.
QUESTION: A behavior modification device (ie thumb sucking deterant) is an example of: choices
where things like positive or negative reinforcement and other conditioning terms POSITIVE
PUNISHMENT
QUESTION: Patient is given oral habit reducing appliance to prevent an oral habit, what is this
considered? – Negative reinforcement (other choices were positive reinforcement, and some other
behavioral modification stuff. My thinking was, the lil dude was probably not going to listen to anyone
about his oral habits, so the appliance is used to modify his little addiction, so if the appliance is in the
way he has no choice but give it up, thus the desired behavior will be increased in the future, fo sho!).
POSITIVE PUNISHMENT
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considered? – Negative reinforcement POSITIVE PUNISHMENT
QUESTION: 6 year old mentally retarded child.Treatment is recall. Would you give sedation,
antianxiolytic, voice control or positive reinforcement.--- with int. disabled—you want to be short and
brief, explain things, tell-show-do, and REWARD. So I would think positive reinforcement.
QUESTION: What is the best way to treat a developmentally disabled patient? I put consistency
QUESTION: Autistic kids have what characteristic. Repetitive behavior
QUESTION: Autistic behavior: ?? I put they have a desire for physical contact. There was no choice
that they are sensitive to loud noise.
QUESTION: Disable patient comes in and not cooperative, how should you act? Permissiveness
(give patient freedon and treat in the way patient feel comfortable)
QUESTION: Disabled pt, should be treated by flatterness, permissible, consistent

QUESTION: Mentally disabled, approach by dentist? Strict, freedom
QUESTION: patients with autism will usually show?

a. decreased rate of caries
b. heightened sense of lights and sounds
c. the compassion to interact with people
Children with autism are easily overwhelmed by sensory overload. This can cause “stimming”
(flapping of arms, rocking, screaming, etc). Autistic children are hypersensitive to loud noises,
sudden movement, and things that are felt.
QUESTION: Providing reward for desired behavior: positive reinforcement

QUESTION: Eye contact, smiling, and telling pt doing good job: social reinforcement
QUESTION: Praising, smiling and congratulating is what type? Social reinforcement
QUESTION: Child patient – you smile, tell him good job, and pat him on the shoulder. These
are examples of negative reinforcement, social reinforcement, token reinforcement.
QUESTION: If kid complained and whined in the beginning but at the end were very good: you
compliment how well they were at the end of the procedure
QUESTION: Voice control method used with children’s : Aversive conditioning= punishment to
deter unwanted behavior ex Hand over mouth
QUESTION: What is the purpouse of the voice control technique? Sets boundaries Aversive
conditioning
QUESTION: 8 year old patient, 1st time ever, scared of dentist? Whats the most likely answer?
d. Television
e. Parents
f. Tv
QUESTION: If pt is afraid, because of
g. Parents
h. Peers
i. Tv
QUESTION: If child is afraid: Allow the child to express fears
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QUESTION: Desensitization works if the base of the behavior problem is Fear

QUESTION: How do you treat a fearful child- use sedation, let him watch another patient,
QUESTION: Patient is scared bec he has no control what to do- I said tell him to raise his hand if he needs
a break/ you to stop
QUESTION: Dental anxiety can be caused by Pt‟s helplessness. What would reduce it? Telling Pt
to raise her/his hand when feels pain
QUESTION: A kid is on recall appointment and is not cooperative. You should do voice control
followed by? Alternating appraisal
QUESTION: Patient is very young amd fearful first time you meet them – try to talk to them going down
at their height.
QUESTION: Patient is very young and fearful first time you meet them – try to talk to them going down
at their height.
QUESTION: Patient 2 yrs old and scared – ask parent to position patient for you (others were get assistant
to do it, you do it yourself, the point here is knee-to-knee position)
QUESTION: Patient 2 yrs old and scared – ask parent to position patient for you (others were get
assistant to do it, you do it yourself, the point here is knee-to-knee position)
QUESTION: The restraining of uncooperative 2 yr child should be done by.Dentist, Assistant, Parent
QUESTION: 2 year old kid, best technique?
Knee to knee with head on dentist lap
Knee to knee with head on parents lap
QUESTION: Patient comes in with 1 year old child, how do you do exam? parent and dentist are
knee to knee, baby's head is in dentist's lap
QUESTION: 8 year old boy, when will he behave better?

Mom inside the dental office
Dad inside the dental office
Nobody inside
QUESTION: pediatric fears correlated with age
QUESTION: what is a 2 yr old most afraid of? 4 yr old?
• 1-3 yr old: SEPARATION
• 4-6 yr old: UNKNOWN
QUESTION: Uncooperative 2 year old- separation anxiety
QUESTION: 4-5 year child scared of?  unknown
QUESTION: Boy 4 yrs old: afraid of unknown.
QUESTION: You help a child help recognize what they are afraid of and make outward positive
connection:
- cognitive restructuring: is a psychotherapeutic process of learning to identify and dispute
irrational or maladaptive thoughts,
QUESTION: Modeling behavior is used when: when the kid is afraid and use a sibling or
someone older to show how they should behave
QUESTION: What is behavior modeling?
QUESTION: Patient had a flu shot done and she is afraid of dental needle even though she never had
one: what is term called (generelaization vs transference idk what answer was)
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QUESTION: A patient is going to the dentist and has never had local anesthetic. He recently got a
vaccine and is now afraid of needles.The fear is due to what?
Location
Generalization?
Translation
QUESTION: When pt say I have anxiety to pain from needle… when flu needle fear is extended to dental
needle fear means general anxiety/specific anxiety
QUESTION: A 4 yr old child management-ANS .empathy and respect
QUESTION: Management of moderately apprehensive child
QUESTION: Replacing words like LA with sleepy juice is called as Euphamism (relabeling)
QUESTION: classic condition, which is an example? – pain (as in, you see dentist, you assume pain is
coming
QUESTION: classic condition, which is an example? – pain (as in, you see dentist, you assume
pain is coming
What is an example of stimuli in classical conditioning: DEntist (all others were responses)
QUESTION: What is an example of stimuli in classical conditioning: dental chair (all others were
responses)
QUESTION: What is conditioned stimulus with pt that had previous bad experiences: --dental chair
(dentist)
QUESTION: Conditioned stimulus?
a. Dental chair
b. High blood pressure
c. Fear
d. Anxiety
Fear: results from anticipation of a threat arising from an external origin.
Anxiety: results from anticipation of a threat arising from an unknown or unrecognized origin.
Anxious patients: most difficult patients as they often cause the dentist to become anxious as
well.
QUESTION: Difference between fear and axiety- fear is on something anxiety is everythin (harder to treat)
Fear decreases pain and anxiety increases pain, fear is painful, anxiety is a disease, Fear is local,
anxiety is generalized
QUESTION: What do Freud and the other guy say about anxiety? I put something about how it’s
a part of personality that must be controlled to be socially acceptable. Probably wrong.
QUESTION: Define anxiety according to Freud and K- aversive inner state that people seek to
avoid or escape.
QUESTION: What do Freud and Erikson say about anxiety? I put something about how it’s a part of
personality that must be controlled to be socially acceptable. Probably wrong. Their inability to overcome
a conflict in a particular stage that will lead to anxiety. Inadequate resolution ->Anxiety
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An inadequate resolution in this case would Indicate a child's insecurity and anxiety. An
Adequate Resolution would mean that a child was able to overcome the conflict in each stage and
develop properly. This applies similarly to the other 8 stages.
QUESTION: Freud anxiety concept
D. Kid overcomes it
QUESTION: Patient has dental fear, what is most likely due to? – previous traumatic dental procedure.
QUESTION: what would most cause a man to have anxiety: traumatic past experience, or finances,
peers, unpleasent staff
QUESTION: constantly exposing the pt to get from the fear factor is---desensitation
QUESTION: Impending doom: panic attack, fear, anxiety, pain
QUESTION: Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear
of losing control.
QUESTION: Impinguing doom
panic attack
QUESTION: What is maturity: Environmentally dependent, environmentally independent
QUESTION: Pedo t 1st visit. Multiple carious teeth on anteriors. During anesthesia is well
cooperative and doesn’t cry or move. Once begin tx, begins to cry. What do.
 Keep working
 Voice control **
 More anesthesia **
 Oral sed
 N20
Included in ADA code of ethics and professional conduct:

Fees (discusses overbilling), Advertising & marketing, ethics (patient values & harm), credentials
(dentist cannot state they are certified in a speciality when they’re not)
Not included: List of credentials needed to be a dentist, licensure
QUESTION: what is not included in the ADA code of ethics?
• Licensure by credential
• Advertising
• Issues concerning pt
• Fees
QUESTION: Each of these is covered in the ADA code of ethics except:, advertisement, patient
values…
QUESTION: Which one is not covered by ADA code of ethics – Advertising (fees)
QUESTION: All of these are included under the code of conduct except: harm, advertising, list of
credentials needed to be a dentist, fees
QUESTION: Something about the code of ethics and what it includes- it did not include snitching on other
dentists that use electronic advertising
QUESTION: What cannot be advertised by a general dentist?

a. Cost
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b. Specialty (obvious…no?...Xtina)
c. License agreement
QUESTION: A dentist has an ethical obligation to report a colleague is all situations ... except?
a. working under substance abuse
b. advertising on electronic media
c. abusing patients
QUESTION: What do you not report to the ADA? Reporting an advertisement for a colleague or an
announcement for specialty practice? Principles of ethics and conducts does not cover and you have to
pick one
QUESTION: if you find problems, medical conditions occurring with a certain drug, who do you
contact? OSHA, FDA, EPA,
QUESTION: If there is an adverse reaction to a medication in the office, who do you notify? FDA
QUESTION: allergy to meds or dental instrument - report to FDA
QUESTION: toxic reaction to a medication the dentist most contact : a) FDA b) CDC c) HIPPA d)
OSHA e) EPA.
QUESTION: Asked which statement was correct for HIPPA? Must give privacy form to pt but you
don’t need confirmation of receipt, fax and email standard, etc.
QUESTION: Something about HIPAA. Something about a fax machine and who can pick up the
phone and if a patient receipt counts as something….I don’t know.
QUESTION: Which example is not discussed in the HIPAA ethical privacy manual??: Something
about providing privacy information to patient and document, sending information over email and
fax, idk
QUESTION: If you need a medical record from your patient’s physician, your patient needs to give
you a permission to do that. Based on which principal/policy?
I picked Medicaid/medicare bc the choices were CDC, OSHA, bloodborne, some random
nonsense. There wasn’t HIPAA
QUESTION: Where does the government spend all its dental money? I put Medicaid.
QUESTION: which insurance have dental coverage medicaid: Medicaid (poor people!!).
QUESTION: What sector of government provides funding for dental care? Medicaid, medicare,
grant, HMO
QUESTION: Who pays MedicAid: States and the federal government share in the cost of Medicaid,
States may pay health care providers directly on a fee-for-service basis or states may pay for
Medicaid services through prepaid, capitated payments to health plans or other entities. Within
federally imposed upper limits for certain services, each state has broad discretion to determine the
payment method and payment rate for services
QUESTION: Who pays for MediCare: federal program that pays for covered health services for
most people 65 years old and older and for most permanently disabled individuals under the
age of 65.
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QUESTION: Government spends most of the money in Medicare. Medicaid, HMO
QUESTION: Medicare cover dental routine care? NO
QUESTION: Medicare is a federal thing that provide health care for elderly . It does not cover
dental. Answer: Both statements are true
QUESTION: Most aid for finance: Medicaid, medicare, and hmo

Pt pays for service fee/insurance pays the rest:
• Insurance pays a flat fee/patient pays the rest – co payment
• Provider is payed per patient not per procedure – capitation
• HMO – limited to selection
• PPO – allows patient selection
QUESTION: Most of the dental payments are by?- cash for service-67%
QUESTION: Most dental procedures for the elderly are paid for by out of pocket cash
QUESTION: which of the following is the leading payer for dental treatment, Insurance or self pay?
QUESTION: Who pay for most of dental care?

a. government
b. insurance
c. cash (should be this one)
QUESTION: Majority of health service in USA : is private insurance.

QUESTION: who pays most of dental Tx : 56% patients. 33 % third parties private insurance
QUESTION: Patient makes $23,000/year, 73yo woman, how should she receive dental care?
• Medicaide
• Medicare
• Private insurance
QUESTION: A 65 yr old lady living on 40k pension per year, wants to get a treatment. She does not have
any other physical abnormality besides tooth pain in her molars. From where does the money covered for
her treatment come from?
a. Medicaid does not cover dental for adults
b. Medicare. - does not cover dental for elders
c. Private Insurance - private dental IF she has it
d. Others insurance.
QUESTION: What is the name of the federal funded medical care for the elderly and its coverage?
a. medicare wI dental coverage
b. medicare w/o dental coverage
c. medicaid wI dental coverage
d. medicaid w/o dental coverage
QUESTION: insurance question about adverse selection (adverse selection deals with the idea that those at
higher risk are more likely to buy an insurance policy. If the price for the policy is the same for non
smokers and smokers, it is more likely that smokers will buy the insurance, because it is more “worth it”
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to them—because they are at higher risk for disease. This is adverse to the insurer. So the prices need to
be different.
• only take pt with high risk
• only take pt with low risk
• take both
• something about taking pt of all ages
QUESTION: Health care plan adverse beneficiary risk
-high risk-individuals that present a high risk for insur
-low risk
-equal
QUESTION: What is capitation? Cap off how much the dentist gets reimbursed per procedure.
QUESTION: Know about capitation: Dentist is paid a fixed fee to see patients enrolled in
program
QUESTION: Capitation= hmo
QUESTION: HMO = capitation dental plan
QUESTION: HMO’s – dentists are paid a fixed rate for each individual per month. Dentist is paid
regardless patient was seen or not. If value of services exceeds payments, dentists loss. If payment
exceeds value of services, dentists gain.
QUESTION: You work at a HMO office and the patient has used up all his yearly benefits, what can you
do?
a. still accept the same fee under the HMO* this is what I put, but I don’t know
b. Charge your regular fee like you would for cash pt
QUESTION: Your office is fee schedule and pt needs new crown but pt used up all of her
allowance (or something like that)? what do you do?
QUESTION: Which one is related to employee insurance, where you get a discount from the insurance and
also you can go to a dentist of your preferance? – PPO, HMO
also you can go to a dentist of your preferance? – PPO
QUESTION: Which one is related to employee insurance, where you get a discount from the
insurance and also you can go to a dentist of your preferance? – PPO, at the same rate mine
didn’t say anything about the company recommending any list of providers who were in in their
“preferred plan” or not
QUESTION: Insurance allows pt to only see certain set of providers…. PPO, HMO, Closed panel
QUESTION: Which one is related to a dental insurance, that only allows you to go to a group of dentists at
a specific location? – Closed Panel (other choices were open panels and other things)
QUESTION: Company offers dental insurance to its employees that can go to selected dentist, what
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QUESTION: Which one is related to a dental insurance, that only allows you to go to a group of
dentists at a specific location? – Closed Panel (other choices were open panels and other things)
QUESTION: On a prepayment basis, dental patients receive care at specified facilities from a limited
number of dentists. This practice plan is classified as which of the following?
A. Closed panel
B. Open panel
C. Group practice
D. Solo practice
QUESTION: Which of the following represents a dental program in which eligible patients receive
services at specified facilities from a limited number of dentists?
A. An open-panel
B. A closed-panel
C. A capitation group
D. A prepaid group
QUESTION: DR is a self-funded group dental plan in which the employee is reimbursed based
on a percentage of dollars spent for dental care provided, and which allows employees to
seek treatment from the dentist of their choice.
1. If Direct Reimbursement is there-- Pick It
QUESTION: If you are an employer and you provide your employee with reimbursements for dental care
they received from a dentist of their choice it is called: direct reimbursement,.
QUESTION: patient goes to the dentist and needs to pay something before seen
-copayment
-deductible
QUESTION: If patient agrees to pay certain percentage of treatment plan:
copayment (vs deductible?) another term
Unbundling of procedures as "the separating of a dental procedure into component parts with
each part having a charge so that the cumulative charge of the components is greater than the total
Bundling is the exact opposite of unbundling and can occur on the insurance carrier end.
Bundling is defined by the ADA as "the systematic combining of distinct dental procedures by
third-party payers that results in a reduced benefit for the patient/beneficiary."
Upcoding or overcoding is defined by the ADA as "reporting a more complex and/or higher cost
procedure than was actually performed."
Downcoding on the other hand is defined by the ADA as "a practice of third-party payers in which
the benefit code has been changed to a less complex and/or lower cost procedure than was
reported except where delineated in contract agreements."
QUESTION: dentist didn't ask for copayment and he didn't report to insurance - overbilling
QUESTION: Dentist did not accept a copay and did not report it to the 3rd party (why would any
dentist do this? Over Billing
QUESTION: If a dentist waives the copayment and doesn’t tell the third party, what is this called?
OVERBILLING.
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QUESTION: You let patient not pay copay but you tell insurance that you charged the pt
overbilling
QUESTION: Dentist charge for crown $500. insurance only covers $400.Dentist waves copayment($100)
but still let insurance he charges $500 for crown. what this action called?
a.Down coding
b. Overbilling
c.Price fixing
d.Unbundling
QUESTION: Bill out for a core build up and crown and insurance says build up is only covered, what
is this? Bundling
QUESTION: The dentist charges separately for core build up and the crown but the insurance
company says that the core build up is part of crown.what is this called? bundling
Bundleing : many procedure to a crown they only pay u for one
QUESTION: What's downcoding—had example of a dds who did 2 2 surface composites and insurance
made it 1 1 surface comp
QUESTION: Dentist do the treatment for 2 crowns but the insurance company pay the money for one
crown what is it: downcoding
QUESTION: You performed a two surface restoration and coded it that way. Insurance came back with
coding it as only one surface restoration. What is this called…downcoding, upcoding
QUESTION: When you charge for multiple codes when you actually did one thing  unbundle
QUESTION: Doctor billed insurance couple of procedures, when actually there is a global procedure that
combines them all, what did he commit? – unbundling
QUESTION: One big procedure, but if you divide it to many sub procedures..  unbundling
QUESTION: Unbundling  coding procedures

QUESTION: Bundling --- bundling of procedures: The systematic combining of distinct dental
procedure codes by third-party payers that results in a reduced benefit for the patient/beneficiary
QUESTION: What is it called when a patient charges several procedures instead of one?
a. upcoding
b. downcoding
c. unbundling
d. bundling
QUESTION: Pt asks u to change date of service on insurance claim, what is this called? Fraud
QUESTION: The patient retires and loses health benefits.the treatment is done on the next day.the pt
requests the dentist to enter the previous day date and the dentist does so.what is this called.ANS. Fraud
QUESTION: Whats not the reason for rising dental costs?- the number of dental students in dental schools.
QUESTION: When treating elderly patients what should be your concern?
• Health of patient
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QUESTION: Whats true about abuse cases? You’ll see at least 2 a year
Child abuse sign
• multiple untreated injuries
• lag time bt injury and tx
• comminuted facial fractures
• parents with different stories
Most common in children under 3
QUESTION: It is required mandatory to report all except -child abuse, reaction to drug, one more
choice
Abuses that have to be reported to authorities - colleague practicing with chemical impairment,
colleague advertising on electronic media, child abuse, domestic violence, elderly abuse
QUESTION: You suspect child abuse. Who do you call? I put social services
QUESTION: If there is an old women in ur chair and u think there might be abuse what do you have to
do?- tell family or tell human health services
QUESTION: You suspect elder abuse. Who do you call? I put dept of health and human
services
QUESTION: Which is not true of elder abuse: Most of the elder abuse is at victims home, mostly it is by
victims relative, elder’s abuse is often over reported and exaggerated,
QUESTION: elderly people abuse question --under reported
QUESTION: which is not true of elder abuse? Most of the elder abuse is at victims home, mostly
it is by victims relative, elder‟s abuse is often over reported and exaggerated, un-authorized
use of ATM card is some times considered crime but not abuse
QUESTION: using ATM card of elder is not applicable but some suitation is not under consideration-
--both true,both false.1st true 2nd flase
QUESTION: Opening a dental practice – what makes it more successful: Better communication
QUESTION: Finding out wether a pt is listening: Eye contact
QUESTION: Dentist report most problems with-business/financial issues, staff training, fearful
patients
QUESTION: What do general dentists report as being their biggest issue? I put fearful patients
QUESTION: Pt was bothering the dentist, dentist got upset and assistant drop instruments in the
floor, the dentist was so piss that he had it out with the assistant : how you you call that reaction ?
transference
Transference is a phenomenon characterized by unconscious redirection of
feelings from one person to another
QUESTION: Most eye injury in practice happens to who: dentist, dental assistant, hygienist,
custodian
QUESTION: Personnel most at risk for eye injury-dentist
QUESTION: Least chance of needle injury? Setting up, Cleaning up, Recap
QUESTION: When do you most likely get a puncture wound: Cleaning up
QUESTION: When do most punctures occur? pre procedure, during, post-proceduring cleanup,
needle recapping
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QUESTION: Most injury/percutaneous cuts happen when recapping needles
QUESTION: Dentist can diagnose which of the following? – Bellumia

QUESTION: if a pt presents with a problem reflexted in the mouth , how the dentist recongnize the
problem : anorexia, bulimia etc…
QUESTION: A patient comes in with rampant decay. What is the primary responsibility of the
dentist? I put figure out etiology of decay FIRST
QUESTION: Patient is in your office for a treatment plan, all of the following should be done when you
explain the proposed treatment to the patient, except? – Use professional terminology. (other choices were
the risk of not getting a procedure done, the fee of the procedure, etc)
QUESTION: New patient comes into office, not of record, what do you do 1st visit?
Full exam, record probing, med history, impressions.
QUESTION: First step before/in treatment planning: make sure patient doesn't need translator, consult
with physician about pre-existing medical conditions
QUESTION: Patient is ready to hear your treatment plan, all of the following are true except? – Guarantee
the success of treatment!
QUESTION: First step in tx planning is?- treat the initial pain and discomfort of the pt. others, see how
you can make a preventitive plan, treat all restorations.
QUESTION: Proper order for treatment planning – emergency care, disease control,
reevaluation, definitive treatment, maintenance care
QUESTION: Which are the two most imp. steps for diagnosis: History and clinical examination
QUESTION: Best way to determine outcome of disease?

 Med history of the patient (If the lab test was choose may be that)
 ESR lab results
QUESTION: Patient comes to your office, complains about how other dentists did really bad job, and tells
you how you are the best dentist in the world. What mental condition is she suffering from? – Paranoia.
(the definition of this is baseless or excessive suspicion of the motives of others)
QUESTION: pt comes in saying she’s been to 5 different dentists the last 6 months. A few mins later
she’s telling you how great of a dentist you are and that she’ll refer all of her friends to you. This
example is…schizo, narcissistic, paranoid.
you how you are the best dentist in the world. What mental condition is she suffering from? –
Borderline, Paranoia.
QUESTION: a patient have been visiting several dentist in the past, the first time she see you she
tells you that she likes you and she will refer family and friends to your office, what type of attitude
is she showing ? borderline
QUESTION: Patient has been to multiple other dentists before you and says you are the best what
does her personality resemble: schizoid, borderline, paranoid, etc
QUESTION: Patient with bipolar disease comes in for dental care, choses not to take his medication
and states he is in the “manic phase,” what do you expect from treating this patient?: he will have
unpredictable reactions during the treatment, he is will be obsessed about is esthetics (not sure
if it means he is going to be continuously manic or just general bipolar disorder)
QUESTION: Trying to change person what is most importation : trying to determine whether they
are willing to change
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QUESTION: Patient who has medical history but is not debilitating but will require medical
management and dental modifications – ASA 3
QUESTION: ASA2- mild systemic disease, ASA3-severe systemic disease
QUESTION: You have a test that is not accurate but gives consistent result: I said this means test is
reliable
QUESTION: Which of the following are necessary for a test to be accurate: Specificity, reliability,
validity
QUESTION: Something about nonverbal vs verbal communication – nonverbal is not as reliable
QUESTION: What happened in 1997: SCHIP (state insureane health program)
QUESTION: SCHIP: The State Children's Health Insurance Program provides matching funds to
states for health insurance to families with children. cover uninsured children in families with
incomes that are modest but too high to qualify for Medicaid.
QUESTION: 1997 law passed that state must look after children that cannot afford healthcare - State
Children's Health Insurance Program (SCHIP) AKA Children's Health Insurance Program
(CHIP)
QUESTION: in 1997 there was a program which stated that all childrens needed dental coverage (
even with no insurance ) : how it this call ??? Children’s Health Insurance Program. medicaid
QUESTION: in 1997 there was a program which stated that all children needed dental coverage
(even with no insurance ): Children’s Health Insurance Program. Medicaid
QUESTION: Who is protected under Americans with disabilities act? AIDS pt. and accommodate the
handicapped.
QUESTION: Dentists have to have proper accommodations for disable people. Dentists have to treat
HIV people the same as others. Both statements are true
QUESTION: American disabilities act does not include HIV: False
QUESTION: Disinfecting spray  let it sit for 10 minutes and then wipe
QUESTION: One patient left, and before getting another patient, how would you clean your
operatory?
-Gross cleaning, spray disinfectant for 10min, then wipe off

-disinfect every 10 min
-some other choices.. try to pick one that makes the most sense.
QUESTION: Disinfectants- kills mycobacterium (benchmark organism)

QUESTION: Disinfection? Destroy majority of microorganisms but not bacterial spores. Bacterial spores
= benchmark organism for sterilization
QUESTION: Definition of disinfectants – Innanimate objects
QUESTION: Definition of disinfectants – Innanimate objects non living
QUESTION: Asepsis – antiseptic…can be safely applied to tissues, but will kill most living organisms
QUESTION: Denaturation of the proteins - alcohol and autoclave; Coagulation of proteins - dry
heat
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QUESTION: Dry heat, chemical sterilization , know about them. Autoclave, what are the exact
numbers?120 ce, 20 min, 15 Psi
QUESTION: Steam Autoclave: 20 minutes at 121C and 15 psi.
QUESTION: Which method of sterilization needs higher temperature:

steam
dry heat-320
oxide pressure
QUESTION: Temperatures for autoclaves is governed by: FDA
QUESTION: Benchmark for sterilization: =bacillus spores
(I think it is Clostriduim Botulinium) First aid page336)
QUESTION: OSHA
• Hep B vaccinated
• if employee does not want it need prrof that they didn’t get it
shit
QUESTION: OSHA rule on hepatitis B vaccination

QUESTION: OSHA is for inside the office to see how you handle stuff in the office. EPA is for the
outside.s OSHA IS NOT FOR BOTH INSIDE AND OUTSIDE
 EPA is for transferring IN/OUT of the office
QUESTION: Whats not found on the OSHA poster?- How many days each employee is allowed to work
with that chemicals.
QUESTION: Which one applies to OSHA guideline? – Update it once a year!

QUESTION: What does OSHA mandate in regards to hep b?
• employers must take the vaccine
• *employees have to take vaccine that are in contact with pt (I don’t think so…all
employers are supposed to be offered the vaccine after education of Hep B within 10 days of
employment…Xtina)
• Front office employees must take the vaccine
QUESTION: OSHA does all except: material safety data sheet MSDS (by manufacterur)
QUESTION: Hazard Communication Standard: Created by OSHA to make sure employees know
about hazardous/toxic materials
QUESTION: HAZARD COMMUNICATION LAW:
a)OSHA
b) what does it control:
sharps
blood
amalgam
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QUESTION: Hazardous communication regulation
a. train worker right after you hire (T/F)
b. train worker when new hazardous product in office (T/F)
QUESTION: OSHA Bloodborne pathogen standard for dentistry HIV and HBV
QUESTION: OSHA-HIV, HBV; bloodborne pathogen standard
QUESTION: MSDS  manufacture directions
QUESTION: MSDS-responsible to make it-manufacture
QUESTION: Who is in control of writing the material safety data sheet (MSDS): Manufacturer
QUESTION: Which is NOT a reason for dentist becoming addicted:

Reasons: easy access to and knowledge of drugs, feel the pressure to be perfect, feeling vulnerable
QUESTION: dentist and drug abuse. all are true except: high stress, perfectionist personality,
vulnerability, knowledge and access to drugs
QUESTION: which of the following is not a reason dentists become drug addicts? Stress level, strive for
perfection, access and knowledge of drugs, (some other off the wall answer)
QUESTION: Dentist potential for abuse not likely due to
a. Vulnerability
b. Pressure of being perfect
c. Knowledge and access to drugs
d. Stress
•What is t test? –used to compare whether the means of two groups are statistically different—assume
that standard deviation is unknown. Small sample size
•Z test—to see if the means of two groups are statistically different if the variances like standard deviation
are known. Large sample size.
•Know questions about Case control—RETROSPECT study. Study that compares people that have the
disease to people that do not have the disease. And also looks back to see how the risk for the disease is
compared to actually getting that disease.
Case-control (retrospective) studies - start with disease and look backwards for exposure
•Cohort study—study where there is more than one sample/cohort, and evaluations are done to see how
certain risk factors the groups have are related to developing a certain disease.
Cohort (prospective) studies - look forward from exposure to disease development
•Cross sectional study—study the entire population. Not like case control, that only studies a certain
group with a specific characteristic. Studies a population with certain characteristics.
Cross-sectional (epidemiological) studies - all variables measures simultaneously at one point in time
Example – It was observed that there was less caries in certain geographic areas. Higher fluoride
in water supplies was suspected as the probable cause
•Longitudinal study—studies a certain set of people (same people) over a long period of time.
Longitudinal Studies - Hypothesis Testing Observational Studies
Example – Hypothesis testing observational studies supported the explanation of increased
fluoride levels causing a reduced rate of caries
294
Clinical Trial - Use randomization and blinding to compare effects of treatment with non-treatment. This
is the Gold Standard for establishing cause and effect
Hypothesis Generating Observational Studies
Descriptive studies - time, place, person
Ecologic studies - use groups rather than individuals
• Correlation studies - measure linear relationship between two factors within
defined groups, no cause and effect established
Clinical trials: Trials to evaluate the effectiveness and safety of medications or medical devices by
monitoring their effects on large groups of people.
Clinical research trials may be conducted by government health agencies such as NIH, researchers
affiliated with a hospital or university medical program, independent researchers, or private industry.
Typically, government agencies approve or disapprove new treatments based on clinical trial results.
While important and highly effective in preventing obviously harmful treatments from coming to market,
clinical research trials are not always perfect in discovering all side effects, particularly effects associated
with long-term use and interactions between experimental drugs and other medications.
There are four possible outcomes from a clinical trial:
•Positive trial -- The clinical trial shows that the new treatment has a large beneficial
effect and is superior to standard treatment.
Non-inferior trial -- The clinical trial shows that that th
what is progressive relaxation

a. intermittent relax & tense (T/F)
b. something about visualized images or something… (T/F)
QUESTION: where would you look in an article for the Dependent and Independent Variables :
Methods.
QUESTION: If a dentist is reading an article, where should he look for the definition of dependent and
independent variables? method -introduction- discussion- results summary
QUESTION: Where would you look in a scientific journal to find the dependent and independent
variables
 Intro
 Materials
 Methods **
 Conclusion
 Summary
QUESTION: Introduction-where in article you find a summary (ABSTRACT)
QUESTION: What section states the purpose of the research? INTRO (ABSTRACT)
QUESTION: double blind q, except - you need 2 controls (you don't)
QUESTION: double blind q, except - you need two controls (you don't)
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QUESTION: What are the qualities of a double blind study except? I put everything EXCEPT 2
control groups.
QUESTION: Researcher wants to find incidence of oral cancer in nursing home what study
a. Cross-sectional
QUESTION: I had one about a teacher and doing a survey on kids = cross sectional
QUESTION: Research done to determine caries rate at a nursing home. What kind of study is this?
A: Cross-sectional
QUESTION: which type of study determines relative risk ratio: Cohort
QUESTION: What parameter study lets you have a risk quotient?- Cohort
QUESTION: Case control study = odds ratio
QUESTION: Efficacy, what study would u go? Cohort, longitudinal, multiple short ones, CASE
CONTROL
QUESTION: Cohort: studying for the next 10 years
QUESTION: Study among smokers and nonsmokers in a period of 6 years (2000-2006) to develop
disease? Cohort, cross sectional
By: disease/non-disease: case control
QUESTION: study how do you find causation- analytical (cross-sectional, case-control, cohort)
QUESTION: Myestena Gravis patients are involved in a study. The doctor is conducting a study and
is trying to find out how many of these patients has periodontitis. What study is he conducting?
-Cohort
-Study case
-Cross sectional?
QUESTION: Doctor conducting a study on myasthenia gravis patients wants to know how many of
these patients have periodontitis. This is a study case, maybe cross sectional
QUESTION: The problem with this study is that you don’t know if the disease came from drinking or
not. What study is it?
By: drinking/nondrinking
Followed a group for 6 years  cohort
Gave patients survey about their treatment  cross sectional
QUESTION: Dentist is doing research on 5 unrelated patient with different background. He record data
……etc. Dentist is doing what kind of research?
a. clinical trial
b. cohort
c. sectional
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QUESTION: Study group A and B give some agents for plaque control then compare which agent is
more effective. Which study is that? Clinical trial
QUESTION: A study is done to determine the affectiveness of a new antihistamine .To do this ,25
allergic pt‟s are assigned to one of the two groups ,the new drug (13 pt‟s) , placebo (12 pt‟s) . The
pt‟s are followed for 6 months . This study is called: Cohort, Cross-sectional, Case controlled,
historical cohort, clinical trial. ( assigned or give is the clue )
QUESTION: A study is designed to determine the relationship between emotional stress and ulcers.
To do this, the researchers used hospital records of pt's diagnosed with peptic ulcer disease and pt.
diagnosed with other disorders over the period of time from july 1988 to july 1998 . The amount of
emotional stress each pt. is exposed to was determined from these records. This study is:
A) Cohort B)Cross-sectional C)Case-study* D)Historical Cohort E)Clinical Trial
QUESTION: There are 4 people with a disease and guy wants to report/describe them: I said ti was
case report but idk
QUESTION: Analyze statistical difference between two means? T-test

QUESTION: Means of caries risk assessment for 3 groups: white, black, Hispanic what test do u use to
compare? t-test A) chi square b) variance c)
QUESTION: How do you compare between 2 constant variables? I put regression analysis
QUESTION: How do you compare between 2 constant variables? CHI SQUARE regression analysis
QUESTION: 2 groups of 100 ppl, gave them different foods & asked how they felt afterwards; which
test to compare the 2 groups answers  chi squared test
QUESTION: Want to compare 2 groups of people, male and female for something, what test do you
look at? Multiple regression, Chi square Test, -
QUESTION: Chi test, two common variables

QUESTION: What test measures 2 nonparametric data: Chi-square
QUESTION: Which of these tests are non-parametric? Chi square test
QUESTION: calculating for a non-paramater….what test would you use? Chi-square, normal
distrubition, spearman, wilcoxin, kruskal wallis
QUESTION: Chi test (tests correlation b/w two independent variables)
QUESTION: Two common VARIABLE..what statistical test would you use? Chi-test, T-test,
correlation analysis, or standard deviance
QUESTION: what test for variability variance, standard deviation
QUESTION: Given a case – what is the dependent variable? independent variable influences a
dependent variable, or variables. Ie: effect of Temperature on plant growth, temp = independent
and growth; height, weight, # of fruits = dependent
QUESTION: confounding variants? A confounding variable, also known as a third variable or a

mediator variable, can adversely affect the relation between the independent variable and
dependent variable. This may cause the researcher to analyze the results incorrectly. The results
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may show a false correlation between the dependent and independent variables, leading to an
incorrect rejectionof the null hypothesis.
QUESTION: If you have a study of confounding variable? Controlled variables are used to reduce
the possibility of any other factor influencing changes in the dependent variable, known
as confounding variables.
QUESTION: If you have a study of confounding variable – minimize confounding variables by

randomizing. minimize confounding variables by randomizing groups, utilizing strict controls, and
sound operationalization practice all contribute to eliminating potential third variables.
QUESTION: Crossover study advantages? influence of confounding covariates is reduced

because each crossover patient serves as his or her own control and are statistically efficient and
so require fewer subjects than do non-crossover designs (even other repeated measures designs).
The null hypothesis (H0) is a hypothesis which the researcher tries to disprove, reject or nullify.
The 'null' often refers to the common view of something, while the alternative hypothesis is what
the researcher really thinks is the cause of a phenomenon.
QUESTION: Experiment wa done and error 0.05 was the goal but when completed it was 0.01. The
question asks what type of error was it?
-type I
-TYPE 2
-no error: Error of less or equal of 0.5 no statistical significance..
*If the observed probability is less than or equal to .05 (5%) the null hypothesis is rejected and
outcome is judged as “no effect”.in this case the alternative hypothesis is adopted
*If the observed probability is greated than 5% the decision is to accept the null hypothesis and the
results are called “not statistically significant.
QUESTION: P-significant value is equal to 0.01, your theory should be right, so you you will reject
null hypothesis
QUESTION: Type I – false rejection of null hypothesis (false negative/incorrect regection) = less
dangerous in terms of research and Type II – false acceptance of null hypothesis (false
positive/failure to regect) – less problematic bc no conclusion is made from a rejected null. But type
2 is more dangerous medically bc a patient is diagnosised as HEALTHY when they actually have the
HIV.
QUESTION: fail to reject, what null? TYPE II error

QUESTION: The power of a statistical analysis is ultimately to:
a. I put reject the null
Type I and Type II Null hypothesis.
Type I Error- rejecting the null hypothesis when it is true. This is an alpha error. Another way to say
this is, to reject a null that should be accepted.
Type II Error- accepting a false null hypothesis. This is a beta error. Another way to say this is, to
accept a null that should be rejected.
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Null hypothesis (H0) is true Null hypothesis (H0) is false
Type I error Correct outcome
Reject null hypothesis
False positive True positive
Correct outcome Type II error
Fail to reject null hypothesis
True negative False negative
Sensitivity –correctly identifying those ppl who have dx
Specificity –correctly identifying dx free people
specificity, tn/tn+fp
Sensitivity – tp/tp+fn
FN= false negative
FP= false positive
TP=sensitive
TN=Specific
sensitivity = percent of persons with the disease who are correctly classified as having the
disease
True Positive-Those that actually have it
False negative- Those that are misdiagnosed as not having it
specificity = percent of persons without the disease who are correctly classified as not having
it
a. true negative, false positive
True Negative-Those who are ACTUALLY disease free
False positive- Those that are misdiagnosed as not as being disease free
Incidence – new cases
QUESTION: Incidence is when number of people like to get disease in given time
QUESTION: dentist in his clinic notice new diseases this is ? incidence
Prevalence – all cases
QUESTION: What is the statistical measure for the total number of cases per population,
regardless of time of onset? I put prevalence
QUESTION: For a population, the research divides the number of disease cases by the number of people.
By so doing, this investigator will have calculated which of the following rates?
a. incidence
b. odds ratio
c. prevalence
d. specificity
QUESTION: Specificity? Proportion of truly nondiseased persons who are so identified by a screening test
(measures “how good a test is at correctly identifying nondiseased persons). Sensitivity tests identifying
diseased persons.
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QUESTION: Dentist finds a group of individuals are free of (do not have the) dental disease: specificity
QUESTION: If a dentist was able to correctly ID disease free patients w/ the diagnostic study, it
has? I put high specificity.
QUESTION: investigator finds patients that don’t have a disease: specificity
QUESTION: You were looking for a disease in a study, disease was not present, what’s this called? –
Specificity!
QUESTION: “if test determines those who do not have the disease is…specificity, sensitivity,
validity.
QUESTION: Specificity, true negative !!!

QUESTION: Study says 95 out of 100 people had the disease what is lab value: I said 95%
sensitivity
QUESTION: sensitivity= sick people

QUESTION: Specificity (without disease) and sensitivity (with disease)
QUESTION: A study failed to report 5 cases of caries. What is this called? 1. True Positive, 2. True
Negative, 3. False Positive, 4. False Negative 
QUESTION: Biggest difference across cultures regarding pain… Variability in pain threshold rather
than pain tolerance, variability in pain tolerance rather than pain threshold, difference in stimulus
awareness rather than pain tolerance, difference in stimulus awareness rather than pain threshold
QUESTION: few questions about mean (average), median (middle number), mode (number that
shows up the most):
QUESTION: Which does not describe the spread of data? I put median.
QUESTION: Which does not describe the spread of data? median. Range. Variance, stand deviation,
standard error
QUESTION: What do you use for average Q? Mean, median, mode

QUESTION: Which of the following represents the variability about the mean-value of a group of
observations?
A. Sensitivity
B. Standard deviation
C. t-Statistic
D. Specificity
QUESTION: What most common form of standard deviation? 1. 2 stand deviations (answer)
QUESTION: Histogram is used to show (standard deviation): mean, correlation of 2 variables,
variance
QUESTION: Histogram  variance
variance
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QUESTION: Outliers control…
a. mean
b. median
c. mode
d. standard deviation
QUESTION: An outlier has the biggest effect on which of the following?
a. Standard deviation **
QUESTION: Scale of 1, 2, 3, - is it ordinal, nominal, interval, rational. Answer is ordinal.

Nomial- categories. Just naming items.
Interval- is not constant. A constant interval but lacks true zero point.
Ratio- units of time, distance, weight.
QUESTION: GI mild, moderate severe – Ordinal
QUESTION: BP and pulse Kelvin – ratio
QUESTION: BP, pulse- ratio; same as Kelvin

QUESTION: pulse n bp what kind of measurement - nominal, ordinal, interval, ratio 
QUESTION: temperature – kelvins is ratio and Celsius is Interval (32 is freezing) is interval
 Categorical (nominal) is like black hair, blonde hair

 ORDINAL is like Low, medium, high…or highschool, college, graduate school
 Interval is like ordinal but the values are EQUALLY SPACED – 10,000, 15,000, 20,000
 Cardinal tells how many: 8 puppies, 14 friends
 Ordinal shows ranking – 3rd fastest, s
 Nominal names something. Jersey number 4.
1. Which is least complicating for OH? Fixed bridge, rheumatoid arthritis, open contact?
2. Mask metal, reduce porosity, make coefficients of expansion more similar
3. Growth in buccal vestibule by flange of mandibular RPD? Most likely traumatic neuroma,
neurilemma, or neurofibroma? -_-
4. Older woman tooth extract 3 years ago, still hurts and exudate, shows cotton-wool
radiograph what is it? Residual cyst, osteomyelitis, 2 other lesions that are radiolucent
5. Macroglossia seen in all EXCEPT?
6. All of the following are an indication for putting a temporary on a deep caries and restoring
at a later time except? Lack of time due to it being an emergency appt, weakened dentin
under cusps, to assess pulp condition
7. Edema (by eye) due to? Chemotaxis, hemorrhage, chymosis

8. Pt has pain lower right 3rd molar and can’t take intraoral xray, what kind of xray indicated?
Lateral oblique mandibular, reverse town’s, lateral ceph, anterioposterior
9. You have pano, what can’t you do without intraoral photos? I said space analysis…
10. Force put on crown, where is center of translation or rotation? Halfway down root, CEJ, past
apex
o Center of resistance – half the distance from alveolar crest to root apex (translation)
o Center of rotation: Apical to center of resistance (apical to halfway down root) –
during translation movements and tipping movements
o During rotation movements: center of rotation=center of resistance
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o 1st: rotation, 2nd: tipping, 3rd: torque
Anti-retraction valves for what? I put prevent patient to patient cross-contamination
11. Best to use on infected oral wound? I put hydrogen peroxide, chlorhexidine
12. Initiation of first menstruation cycle is best indicative of what? Cognitive age, dental age,
skeletal age …
13. Menarche onset: before growth, during peak of growth, after peak of growth?
14. menarche begins at what point in growth spurt? Before, during, after, when completed.
15. Menarche definition:• At peak of puberty (AFTER PEAK GROWTH)
Neuropraxia definition:
• Neurapraxia describes nerve damage in which there is no disruption of the nerve or its sheath. In this
case there is an interruption in conduction of the impulse down the nerve fiber, and recovery takes place without
true regeneration, as Wallerian degeneration does not occur. This is the mildest form of nerve injury.
Axon damage most likely to cure on itself – neuropraxia …
Definition of Neuropraxia - interruption of axon, but not nerve all together (reversible nerve damage)
…neuropraxia is reversible
Neuropraxia: involves both perineurium and epineurium, only perineurium, only epineurium, none
of the above
a. None of the above? (temporary damage, nerve left intact) – asked in a strange way
Neuropraxia: It is a transient episode of motor paralysis with little or no sensory or autonomic

dysfunction
o Neurapraxia describes nerve damage in which there is no disruption of the nerve or its sheath
16. Tiny line noticed in an isthmus between an MO and DO amalgam. It is not a separation
between two different restorations. What tx? Re-do or leave and monitor
17. Which is more damaging to the PDL? Extrusion or intrusion, lateral luxation
18. Crazy question about a dentist putting an elastic around patient’s maxillary centrals to close
diastema.. I forgot options but I put: eventual loss of teeth? Due to the elastic traveling
upwards. No clue.
19. No obvious clinical caries in a child. Radiographically, interproximal caries on primary tooth
20. Extract a tooth and give Penicillin, the next day patient has high fever, swelling, dysphagia,
what do you do? Change to different antibiotic, refer to OMFS, add another drug to regimen
21. Which muscle mainly responsible for positioning and translating condyles? Lateral
pterygoids
22. Cracked tooth with no pulpal involvement, what is the treatment? Endo, extracoronal
restoration, occlusion reduction, amalgam with adhesive
23. When you smile what is the black space buccal of teeth and next to cheeks? Buccal corridor or
something?
27. Picture of ulcerated tumor on palate? SSC, salivary gland tumor, tori
28. advantage of rectangular orthodontic wires
What is Trephination? Hole is drilled or scraped into the human skull
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Dentinogenesis Imperfecta
Lymphoid epithelial cyst – odontogenic origin
Cemetoblastoma – RO mass that replaces root; tooth is removed with lesion
Periapical Cemento-Osseous dysplasia – vital, lower anteriors, middle age women, RL then RO; no
symptoms
� Florid Osseous dysplasia involves entire jaw
Migratory glossitis
Nicotinic Stomatitis
303
Dentinogenesis imperfecta
Coronoid process of mandible
Ameloblastoma
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reverse polarization (follicular type), nucleous moves away
from basement membrane, seen in ameloblastoma
305
Calcifying Epithelial Odontogenic Tumor (pindburg tumor):
calcified intracellularbridge
Odontoma (complex)
Complex odontoma
zygomatic process of maxilla on PA
306
U, V, J radiopaque line
superior to maxillary first and second molars
Drug induced hyperplasia (cyclosporine)
Drug induced
Bells palsy
307
epilus fissuratum
Erythema multiforme
Vertical root fracture –J shaped radiolucency
308
IMPORTANT RQS: RITA
Q1: By encircling an abutment tooth 180 degrees, a removable partial denture clasp
assembly serves to
A- Prevent tooth movement away from the clasp
B- Increase the retention provided by the clasp
C- Increase the support derived from the abutment tooth
D- Decrease the applied occlusal torquing forces
ANS:A IT IS ASDA QUESTION AND ANSWER CONFIRMED FROM MASTRY APP
Q2: Which of the following is contraindicated as a pre-prosthodontic regimen

to optimize soft tissue health?
A- Oral hygiene instructions
B- Prophylaxis
C- Daily rinses of chlorhexidine
D- Premedication with oral antibiotics
ANS:D
Q3: Diazepam-mediated effects include

D- Analgesia
ANS:C
Q4: primary drug for The treating oral candidiasis in patient with HIV is
A- Nystatin (Mycostatin)
B- Acyclovir (Zovirax)
C- Penciclovir (Denavir)
D- Chlorhexidine (Peridex)
ANS: A
Q5: Which of the following represents the major cause of pulpal damage
associated with cavity preparation?
A- Vibration
B- Heat generation
C- Dentin desiccation
D- Adverse effects of local anesthesia
ANS:B CONFIRMED FROM DD
Q6: A new diagnostic test is evaluated against an independent “gold”

standard” in 100 subjects with the following results:
True positive = 48
True negative = 8
False positive = 12
False negative= 32
What is the negative predictive value of this new diagnostic test?
A- 20 percent
B- 40 percent
C- 60 percent
D- 80 percent
ANS: A
TN/TN+FN *100% = 8/8+32*100% = 20%
Q7: Adrenal suppression may result from which of the following regimens of
hydrocortisone?
A- 20 mg for 2 weeks within 2 years
B- 2 mg for 2 weeks within 2 years
C- 10 mg for 1 week within 1 year
D- 1 mg for 1 week within 1 year
ANS:A
Q8: Which of the following 2 designs in tooth preparation can be used with
all-ceramic crowns?
A- Butt-joint shoulder or chamfer
B- Bevel or butt-joint shoulder
C- Bevel or feather edge
D- Chamfer or feather edge
ANS: A
Q9: The highest incidence of caries around Class II composite resin

restorations occurs on which of the following margins?
A- Occlusal
B- Facial proximal
C- Lingual proximal
D- Gingival proximal
ANS: D
Q10: Which of the following is the best treatment for a traumatically intruded
primary tooth which in not impinging on the permanent tooth bud?
A- Extraction
B- Allow tooth to spontaneously re-erupt
C- Reposition tooth orthodontically
D- Reposition tooth surgically
ANS: B
Q11: Which of the following is NOT correct concerning informed consent?

A- It must be obtained in advance of treatment
B- It must be in writing
C- It must include risks, benefits, and complications
D- It must include treatment options
ANS: B
Q12: When performing a pulpal evaluation, the dentist should ideally use
which of the following as controls?
A- Adjacent teeth only
B- Adjacent teeth and opposing tooth
C- Adjacent teeth and contralateral tooth
D- Opposing tooth and contralateral tooth

ANS: C
Q13: In recurring necrotizing ulcerative gingivitis, which of the following is

most associated with exacerbation?
A- Occlusal trauma
B- Stressful episodes
C- Amount of suppuration present
D- Increase in gram positive organisms
ANS: B
Q14: The means by which dental patients are treated to eliminate the caries
process is called
A- Antibiotic prophylaxis
B- Primary prevention
C- Secondary prevention
D- Tertiary prevention
ANS: C
Q15: A fail-safe mechanism on an analgesia machine for nitrous oxide and

oxygen prevents the delivery of nitrous oxide greater than
A- 20 percent
B- 50 percent
C- 70 percent
D- 90 percent
ANS:C
Q16: A wear facet is seen on the mesio-buccal incline of the mesio-buccal

cusp of a mandibular first molar complete metal crown. This facet clould
have been formed during which jaw movements?
A- Working only
B- Protrusive or working
C- Protrusive or non-working
D- Non-working or retrusive
ANS: B
Q17: Which of the following drugs are categorized as tricyclic

antidepressants?
A- Tranylcypromine (Parnate) and parglyline (Eutonyl)
B- Gabapentin (Neurontin) and tramadol (Ultram)
C- Imipramine and amitriptyline
D- Promethazine and hydroxyzine
ANS: C
Q18: What is the most likely pulpal diagnosis for a primary molar with deep
caries and a history of transient cold sensitivity with an intact periodontal
ligament space on radiographic examination?
A- Reversible pulpitis
B- Irreversible pulpitis
C- Pulpal necrosis
D- Calcification metamorphosis
ANS: A
Q19: In removing a torus palatinus, the practitioner inadvertently removed
the midportion of the palatine process of the maxilla. One would expect to
see
A- The nasolacrimal duct
B- The inferior nasal concha
C- An opening into the nasal cavity
D- An opening into the maxillary antrum
ANS: C
Q20: Smooth surface lesions resulting from flexure of the tooth structure are
known as which of the following?
A- Abrasion
B- Erosion
C- Abfraction
D- Attrition
ANS: C
Q21: Damage to biological systems from ionizing radiation is due primarily to

A- Trasmutation of a key atom
B- A direct hit on a key atom or molecule
C- Radiolysis of water molecules
D- Excitation of macromolecules
ANS: C
Q22: Which of the following clinical entities is most likely to be misdiagnosed

as an endodontic lesion?
A- Lateral periodontal cyst
B- Periodontal abscess
C- Tori or exostoses
D- Gingival cyst
ANS: A
Q23: A patient is complaining about bleeding and pain when they brush.
Which is the most appropriate initial response to initiate the patient’s oral
health behavior change?
A- “So you want healthy teeth and the gums but it hurts when you brush”
B- “No pain no gain. You want the benefits of brushing but it hurts”
C- “Keep brushing even if it hurts. You know you have to do it”
D- “I’d to hear that you are brushing every day when you come back”
ANS: A
Q24: Low-dose aspirin therapy prevents the formation of thromboemboli by

preferentially inhibiting which of the following?
A- Phospholipase A2 in the blood vessels walls
B- Prsotacyclin synthetase in the blood vessels walls
C- Tromboxane synthetase in the platelets
D- Vitamin K in the liver
ANS: C
Q25: What is the predominant method of financing dental care in Health

Maintenance Organizations?
A- Fee for service
B- Capitation
C- Usual, customary, and regular fee
D- Table of allowances
ANS:B
Q26: Billing for a full-mouth series of radiographs as if they were a number of
individual radiographs is an example of
A- Non-rendering services
B- Upcoding
C- Unbunding
D- Mischaracterization
ANS: C
Q27: Which of the following is the most likely cause of ankylosis of the
temporomandibular joint?
A- Neoplasm
B- Rheumatoid arthritis
C- Traumatic injury
D- Developmental abnormality
ANS: C
Q28: Which differential diagnostic method is best for determining whether

pathosis is endodontic or periodontic in nature?
A- Pulp vitality testing
B- Nature of symptoms
C- History of periodontal disease
D- Location of swelling, if present
ANS: A
Q29: Which action represents the most effective means of preventing caries
on overdenture roots?
A- Daily treatment with prescription fluoride gel
B- Coverage of roots with cast copings
C- Daily treatment with antimicrobial rinse
D- Placement of amalgam restoration in root canal orifice
ANS : B FIRST FROM DD IF NOT AVAILABLE THEN A
Q30: Which type of enamel caries has a broad area of origin with a conical or
pointed extension towards the DEJ?
A- Pit and fissure caries
B- Smooth surface caries
C- Cusp tip caries
D- Root surface caries
ANS: B
Q31: What is the maximum recommended dose of acetaminophen that can be

prescribed in a 24 hour time period?
A- 2.5 grams
B- 3 grams
C- 3.5 grams
D- 4 grams
ANS: D
Q32: A patient on intravenously administered bisphosphonate therapy for 2

years has caious and non-restorable anterior teeth. Which is the best
treatment option?
A- Surgical extraction with primary closure
B- Endodontic therapy of retained roots

C- Discontinue bisphosphonates for 3 months before extraction
D- Surgical extraction, alveoloplasty, and primary closure
ANS: B CORONOCTOMY , EXTRACTION CONTRAINDICATED HERE
Q33: Which of the following represents the dentist primary responsibility

when caring for the elderly dental patient?
A- Speak slowly and simply to the patient
B- Involve a caretaker/surrogate in decision making
C- Provide long appointments so the patient will have to travel less often
ANS: B
Q34: Behcet disease has oral lesions which are most similar to which of the
following
A- Aphthous ulcers
B- Candidiasis
C- Herpangina
D- Herpes zoster
ANS:A
Q35: Although the results of a diagnosis test are NOT necessarily accurate,
they are consistent. This test has high
A- Generalizability
B- Specificity
C- Reliability
D- Validity
ANS:C
Q36: Which of the following conditions is associated with hypodontia?
A- Ectodermal dysplasia
C- Apert Syndrome
D- Gardner syndrome
ANS: A
Q37: Cervical caries can be secondary to the effect of radiation on

A- Enamel
B- Dentin
C- Cementum
D- Salivary gland
E- Alveolar crestal bone
ANS: D
Q38: During an extraction under sedation, the patient aspirates the crown of
the tooth. Where would the crown most likely appear on a chest x-ray?
A- Esophagus
B- Right bronchus
C- Left bronchus
D- Infundibulum
ANS:B
Q39: Methods to prevent overheating of the bone implant site preparation
include the use of which of the following?
A- High speed handpiece
B- Chlorhexidine irrigation
C- High torque handpiece
D- Air cooling
ANS: C LOW SPEED HIGH TORQUE
Q40: When the isthmus of a MOD cavity preparation is extended beyond 1/3 of
the cusp-tip to cusp-distance, the restoration of choice is a
A- MOD amalgam
B- MOD inlay
C- MOD onlay
D- Full crown
ANS:C RESISTANCE ISSUE
Q41: What final process in coronary arteries causes myocardial infarction

rather than angina?
A- Atherosclerotic lesions
B- Arterial spasm
C- Thrombosis
D- Fatty deposits
ANS:C
Q42: Which of the following occurs with the use of dipherhydramine
(Benadryl)
A- Increased salivation
B- Bronchoconstriction
C- Antagonism of motion sickness
D- Increased capillary permeability
ANS:C
Q43: The maxillary and mandibular definitive casts have been articulated.
The maxillary cast was mounted without a face-bow transfer. If the dentist
were to increase the occlusal vertical dimension by 4 mm, it would be
necessary to
A- Open the articulator by 4 mm
B- Change the condylar guide settings
C- Obtain a new centric relation record
D- Increase the rest vertical dimension
ANS:C
Q44: The minimum required bony buccolingual ridge width in millimeters for
placement of 4.0 mm root form implants is which of the following?
A- 4
B- 6
C- 8
D- 10
ANS:B
Q45: What is the EXCEPTION to the 5 principles of the ADA Principles of
Ethics and Code of Professional Conduct?
A- Nonmaleficence
B- Competency
C- Justice
D- Veracity
ANS:B
Q46: An articulating paper mark on the lingual incline of the buccal cusp of
the mandibular molar represents which type of interference?
A- Working
B- Non-working
C- Protrusive
D- Retrusive
ANS:B
Q47: Which of the following is most likely to create complications when

making an acrylic resin temporary restoration for a large MOD onlay
preparation?
A- Overextended resin removed
B- Undercuts in the preparation blocked out
C- Completion of polymerization outside the mouth
D- Occlusal surfaces left in slight infraocclusion
ANS:D SOME SUGGEST B, it is not c because it says outside the mouth, check it
Q48: Nitrous oxide/oxygen is contraindicated for patients
A- With anxiety
ANS:D
Q49: Administration of nitrous oxide/oxygen is contraindicated in which of

the following conditions?
A- Asthma
B- Hemophilia
C- Nasal congestion
D- Sickle cell anemia
ANS:C
Q50: A dentist administered a survey to patients to determine their

satisfaction with practice characteristics and services provided. The survey
was administered to patients seen during 1 month. Which type of study
design was used by the dentist?
A- Cross-sectional
B- Cohort
C- Case control
D- Clinical trial
ANS: A
Q51: A protrusive jaw relation record is made in order to set the
A- Horizontal condylar inclination of the articulator
B- Anterior guide table of the articulator
C- Lateral condylar guidance of the articulator
D- Lateral translation of the articulator
ANS : A

ANS: A
Q53: For a patient with myasthenia gravis, which of the following

medications is acceptable?
A- Erythromycin
B- Clarithromycin
C- Imipenem
D- Penicillin
ANS: D
Q54: The gingival around teeth and the mucosa around implants have similar
A- Connective tissue attachments
B- Alignment of collagen fiber bundles
C- Non-keratinized junctional epithelia
D- Distribution of vascular structures apical to the junctional epithelia
ANS:C
Q55: 40-year- old patient has 32 unrestored teeth. The only defects are deep-
stained grooves in posterior teeth. The grooves are uncoalesced. What is the
treatment of choice?
A- Periodic observation
B- Pit and fissure sealant
C- Preventive resin restoration
D- Application of topical fluoride
ANS:A
Q56: Which of the following conditions is most often characterized by a

painful response that subsides quickly with stimulus
A- Normal pulp
B- Nonvital pulp
C- Reversible pulpitis
D- Symptomatic irreversible pulpitis
ANS:A because it subsides quickly it is normal , if it took few time then it is

reversible
Q57: Which statement most accurately describes the finish line and margin of
crown?
A- The finish line should be placed in hard dentin when it is possible
B- The crown margin at the gingival crest accumulates the least amount of food
C- The location of the crown margin is more important than the fit and finish
D- The subgingival crown margin may be an etiologic factor in predisposing periodontitis
ANS:D some suggested A still arguing on this , check it
Q58: The diagnosis of pulpal status is predicated upon assessing the amount
or extent of
A- Decay
B- Pain
C- Inflammation
D- Pathologic resorption
ANS:C mosbey second edition page 5
or extent of
A- Decay
B- Pain
C- Inflammation
ANS:C
Q60: Clicking of the dentures during speech most often indicates which of
the following?
A- Inadequate denture retention
B- Decreases occlusal vertical dimension
C- Insufficient interocclusal space
D- Improper buccolingual position of the teeth
ANS:C
Q61: A person best exemplifies active listening by doing which of the
following?
A- Rephrasing the listener’s understanding of the speaker’s communication
B- Using direct eye contact
C- Gathering pertinent information from the speaker quickly and succinctly
D- verifying that the speaker has heard what the listener has said
ANS:B
Q62: Which of the following is the drug of choice for a 5-year-old child with
pain following routine extraction?
A- Aspirin
B- Clindamycin
C- Acetaminophen
D- Codeine
ANS:C
Q63: Which of the following conditions is rarely a symptom of combination

syndrome?
A- Hyperplastic/redundant soft tissues
B- Resorption in the anterior maxilla
C- Increased occlusal vertical dimension
D- Downgrowth of the maxillary tuberosities
ANS:C
Q64: Which of the following represents the most frequent cause of failure of
dental amalgam restorations?
A- Moisture contamination
B- Improper cavity design
C- Improper condensation
D- Inadequate trituration
ANS:A failure is due to moisture contamination , fracture is due to improper cavity design
Q65: Which primary tooth, if lost prematurely, will most frequently result in
space loss?
A- Maxillary canine
B- Maxillary first molar
C- Mandibular second molar
D- Mandibular first molar
ANS: C
Q66: Which of the following explains why proper contouring of the axial
surface of complete cast restorations is extremely important?
A- Retention
B- Occlusal wear
C- Effect on gingival tissue health
D- Ability to provide caries resistance
ANS:C
Q67: Gastric regurgitation causes which of the following in the teeth?

A- Erosion
B- Abrasion
C- Attrition
D- Abfraction
ANS:A
Q68: A 52-year-old female presents with red, glossy, and swollen gingival.
She has denuded and red areas on both buccal mucosae. The lesions have
been present for months and vary from time to time in severity. Which of the
following represents the most probable diagnosis?
A- Vitamin deficiency
B- Linear gingival erythema
C- Erosive lichen planus
ANS: C
Q69: Hyperplastic palatal tissue (papillomatosis) is best treated by

A- Chemical cauterization
B- Radical excision
C- Temporary cessation of denture use
D- Supraperiosteal dissection or electrosursery
ANS: D
Q70: Stridor is diagnostic for

A- Laringospasm
B- Bronchospasm
C- Hypotension
D- Hypothermia
ANS: A
Q71: Which of the following represents the function of occlusal (night)

guards?
A- Reduce mobility
B- Prevent bruxism
C- Increase attachment level
D- Redistribute forces on the teeth
ANS:D it doesn’t prevent bruxism, it eliminates its effects on teeth by distributing forces
Q72: The difference between a 330 carbide bur and 245 carbide bur is
A- The 245 creates sharp line angles whereas the 330 bur creates rounded line angles
B- The head of a 245 bur is narrower than the head of a 330 bur
C- The head of a 245 bur is longer than the head of a 330 bur
D- The 245 is tapered
ANS: C
Q73: Which of the following refers to a decreased occlusal vertical

dimension?
A- Vertical dimension that leaves the teeth in a clenched, closed relation in normal position
B- Occluding vertical dimension that results in a excessive interocclusal clearance when the mandible is
in rest position
C- Insufficient amount of interarch distance because of the bony ridges
D- Condition in which the patient cannot open mandible because of temporomandibular joint pathology
ANS:B
Q74: Which of the following is NOT an indication for removal of a third molar?
A- The presence of bony pathology
B- History of repeated pericoronal infections
C- Prevent crowding and displacement of the incisor teeth
D- Advanced, generalized periodontal disease that endangers the second molar
ANS:C
Q75: The decision to reduce a cusp and restore it should be based primarily
upon which principle?
A- Outline form
B- Retention form
C- Resistance form
D- Convenience form
ANS:C
Q76: A patient says, “I have been avoiding coming to see you because there
is an ugly, red sore spot on the roof of my mouth”. Which of the following
responses by the dentist best exemplifies a reflective response?
A-“Has you diet changed lately”
B-“You really shouldn’t worry about it”
C-“Don’t be afraid, I’ll take a careful look”
D-“You should have had something like that looked at right away”
E-‘It sounds as if you’re quite concerned about this condition”
ANS:E
Q77: Filtration is used in dental x-ray machines to remove

A- Scatter radiation photons
B- High energy electrons
C- Long wavelength photons
D- Low energy electrons
ANS:C
Q78: In examining a maintenance patient, the dentist observes residual

calculus, bleeding on probing, and probing depths less than 5 mm. The
dentist should do which of the following?
A- Scaling and root planing
B- Osseous surgery
C- Continued maintenance
D- Open flap debridement
ANS:D some suggested a , but it is a secondary visit , it means dentist failed to

eliminate all the calculus at the first visit , maybe because improper access or
visualization , so the suggested tt here to open flap for debridement
Q79: Which of the following sealer components interferes with composite
resin polymerization?
A- Zinc oxide
B- Zinc stearate
C- Polyvinyl resin
D- Eugenol
ANS:D
Q80: Which of the following is LEAST important in determining the outline

form a class III composite restoration?
A- Convenience for access
B- Extension for prevention
C- Size, shape, and location of caries
D- Esthetics
ANS:B
Q81: A 9 year old presents with acute gingival pain of four days duration.
There are small, round ulcers on the interproximal gingival and buccal
mucosa. Which of the following is the most likely diagnosis?
C- Apthous stomatitis
D- Gingival abscess
Ans:B or A , STILL NOT CONFIRMED , NUG is not seen in childs nor in buccal
mucosa , and herpes the interdental papillae is intact , so check this please
Q82: Compared to permanent molars, primary molars have

A- Comparatively higher pulp horns
B- Thicker enamel caps

C- Less pronounced cervical constrictions
D- Deeper occlusal fissures
ANS: A
Q83: If there is insufficient space between the maxillary tuberosity and the
retromolar pad, then the dentist should
A- Open the articulator to gain space
B- Avoid covering the pad with the mandibular base
C- Avoid covering the macillary tuberosity
D- Surgically reduce the occlusal aspect of the tuberosity
ANS:D
Q84: Which of the following factors has the LEAST effect on the prognosis of
a periodontally involved tooth?
A- Degree of mobility
B- Suppuration from the pocket
C- Amount of attachment loss
D- Degree of furcation involvement
ANS:B
Q85: Which of the following represents the purpose of periapical palpation?

A- To evaluate the gingival involvement of pulpal disease
B- To determine if the periapical inflammatory process has penetrated the cortical bone
C- To improve the tactile skills of the clinician relative to periapical disease
D-To massage localized swelling of the alveolar tissue to promote drainage
ANS:B
Q86: In treating a tooth with both endodontic and periosontic involment,

which of the following would the dentist perform first?
A- Antibiotic regimen
B- Endodontic therapy
C- Periodontic therapy
D- Endodontic and periodontic therapies should be performed simultaneously
ANS:B endo first
Q87: Pressure on the midpalatine suture will improve

A- Denture retention only
B- Denture stability only
C- Both denture retention and denture stability
D- Neither denture retention nor denture stability
ANS:D it is a relief area
Q88: The incisal guide table is designed to

A- Allow selective grinding of anterior teeth
B- Prevent overclosure of the vertical dimension
C- Prevent posterior cusps from exceeding the condyle angle
D- Protect the function and arrangement of anterior teeth
ANS:D
Q89: Pseudomembranous colitis can occur most readily after prolonged oral
administration of which of the following drugs?
A- Erythromycin
B- Penicillin V
C- Clindamycin
D- Sulfisoxazole
E- Azithromycin
ANS:C
Q90: Trough the bloodborne Pathogen Standard, the Occupational Safety and
Health Administration (OSHA) directs all health-care workers, in carrying out
infection control, to use universal precautions.
- Based on these OSHA guidelines, patients identified as carriers of blood-

borne pathogens require special infection-control considerations
ANS:C
Q91: Which finding would most likely suggest a non-odontogenic toothache?

A- Pain intensified by heat
B- Local anesthesia does not eliminate pain
C- Dull, aching, throbbing pain
D- Pain intensity changing over time
ANS:B
Q92: A patient complains of pain, trismus, fever and dysphagia associated

with and impacted third molar. The best course of action for this patient is
A- Curettage utilizing local anesthesia
B- Prescription of a nonsteroideal anti-inflamatory agent
C- Referral to an oral an maxillofacial surgeon
D- Immediate extraction of the offending tooth
ANS:C
Q93: For the porcelain veneer preparation, the standard amount of tooth
reduction in the middle one third of the facial surface is
A- 0.3 mm
B- 0.5 mm
C- 0.8 mm
D- 1.0 mm
ANS:B
Q94: What should the dentist use to begin managing an apprehensive 5 year
old child?
A- Voice control
B- Oral sedation
C- Tell-show-do technique
D- Nitrous oxide/oxygen conscious sedation
ANS:C
Q95: Sensitivity to cold and pressure 2 weeks after cementation of a

posterior crown is most likely related to
A- Occlusal trauma
B- Luting agent
C- Vertical root fracture
D- Food impaction
ANS:A
Q96: Which form external root resorption is associated with pulpal necrosis?
A- Inflamatory
B- Replacement
C- Surface
D- Idiopathic
ANS:A
Q97: When designing a clinical study, one uses the power of the statistical
test to accomplish which of the following?
A- Measure validity
B- Set the alpha level
C- Reject the null hypothesis
D- Determine sample size
ANS:C
Q98: Which type of root resorption results in ankylosis?

A- Inflamatory
B- Replacement
C- Internal
D- External
ANS:B
Q99: - Which of the following can have prodromal symptoms which mimic
dental pulp pain?
A- Cytomegalovirus infection
B- Herpangina
C- Herpes zoster
D- Primary herpetic stomatitis
ANS: C
Q100: The drug of choice for marked bradycardia is which of the following?
A- Atropine
B- Epinephrine
C- Propanolol
D- Calcium chloride
ANS: A
Q101: Diagnostic radiology is based on which of the following iteractions of
X-radiation with matter?
A- Thompson effect
B- Pair production
ANS:C
Q102: Which of the following is NOT an advantage of the connective tissue

graft procedure?
A- Good gingival color match
B- Requirement of two Surgical sites
C- High predictability for root coverage
D- Palatal donor site can be completely sutured closed
ANS:B
Q103: Rubella embryopathy is an example of which of the following causes of

mental retardation?
A- Generic
B- Cultural
C- Acquired
D- Chromosomal
ANS: C
Q104: Which part of the cutting edge of the curet should be adapted to the
line angle of the tooth?
A- Lower third
B- Middle third
C- Upper third
D- Entire cutting edge
ANS:A
Q105: After a patient places an aspirin directly on his oral tissue for an
extended period time, the tissue become white. Which of the following
accounts for this change in color?
A- Edema
B- Necrosis
C- Acanthosis
D- Hyperkeratosis
E- Vasoconstriction
ANS:B
Q106: The complement cascade is activated by the
A- B-cells
B- T-cells
C- Lymphokines
D- Immune complex
ANS:D
Q107: Primary dentition calcification begins at

A- 2 months in utero
B- 4 months in utero
C- 8 months in utero
D- Birth
ANS:B
Q108: Which is the best approach for a a patient who becomes very
uncomfortable when a planned surgical procedure is discussed?
A- Explain post-operative instruction only after the procedure
B- Explain post-operative instructions, obtain informed consent, and help the patient to resolve anxiety
before the procedure
C- Explain and obtain only informed consent before the procedure, and apologize for making the patient
uncomfortable
D- Explain and obtain informed consent before the procedure and explain post-operative instructions
after the procedure
ANS:B you need to relax the patient first , some suggested D , I ll do with b
Q109: A patients with a large composite resin restoration placed 1 year ago
reports sensitivity in the tooth. Which of the following is the most likely
cause?
A- Trauma
B- Fracture of the restoration
C- Microleakage of the restoration
D- Pulpal reaction to the phosphoric acid
ANS: C
Q110: Angioedema is associated with which of the following medications?
A- Angiotensin-converting enzyme (ACE) inhibitors
B- Calcium channel blockers
C- Beta-blockers
D- Diuretics
ANS: A
Q111: Periodontal maintenance following completion of active periodontal

therapy
A- Should only be done by periodontist
B- Should be tailored to the needs of the individual patient
C- Is not a cost-effective approach for ongoing patient care
D- Requires strict adherence to a 6-month interval
ANS:B
Q112: Which pigmented lesion of the oral cavity will resolve spontaneously?
A- Varix
B- Hematoma
C- Ephelis
D- Oral melanocic macule
ANS:B
Q113: - Naltrexone (Revia) can be used
A- To treat strong pain
B- In opioid rehabilitation program
C- To treat diarrhea
D- To manage muscle tremors
ANS: B
Q114: What is the optimal average amount of fluoride, in ppm, for public
drinking water of most communities?
A- 0.5
B- 0.7
C- 1.0
D- 1.2
ANS:C OR B , STILL ARGUING ON THIS ONE
Q115: Which of the following is the most important factor in determining

patient satisfaction with dentures?
A- Dentist-patient relationship
B- Bone height for denture fit
C- Patient personality traits
D- Technical quality of the denture
E- Cultural definitions of esthetics
ANS:E OR C NOT CONFIRMED YET
Q116: After receiving an inferior alveolar nerve block the patient develops a
needle track infection. Which of the following anatomic spaces might have
been involved?
A- Temporal
B- Submandibular
C- Pharyngeal
D- Pterygoid
ANS: D
Q117: Which of the following conditions describes steatorrhea, increased

pulmonary mucous retention, chronic respiratory infections, and functional
disturbance in secretory mechanisms of various glands including elevated
sodium chloride in the sweat?
A- Lead poisoning
B- Cystic fibrosis
C- Juvenile onset diabetes
D- HIV/AIDS
ANS:B
Q118: Which of the following is the diameter, in millimeters, of a 21 mm long,

#35 K-file at D16?
A- 0.35
B- 0.41
C- 0.67
D- 0.74
ANS:C
Q119: Which of the following agents is active against herpes simplex virus,
varicella-zoster virus, and cytomegalovirus?
A- Amantadine (Symmetrel)
B- Zidovudine (Retrovir)
C- Ribavirin (Virazole)
D- Valacyclovir (Valtrex)
ANS: D
Q120: Which of the following would be the best orthognathic surgical option
for a patient that has an 8mm anterior open bite?
A- LeFort I osteotomy
B- Intraoral vertical oblique osteotomy
C- Sagittal split osteotomy

D- Sliding genioplasty
ANS:A
Q121: Some metal elements used in ceramic restorations have been known
to cause reactions in patients. The most common causative element is
A- Cobalt
B- Nickel
C- Chromium
D- Beryllium
ANS:B
Q122: Which of the following analgesics has the greatest margin of safety for
a patient with renal disease?
A- Acetaminophen (Tylenol)
B- Flurbiprofen
C- Ibuprofen (Motrin)
D- Ketoprofen
E- Keterolac (Toradol)
ANS:A
Q123: - The epithelium of a free autogenous gingival graft undergoes

degeneration at the recipient site
- Genetic information as to the nature of the epithelium overlying the

connective tissue is contained within the graft connective tissue
A- Both statement are true
B- Both statement are false

ANS:A
Q124: Tree months ago, an epidemiologist conducted clinical examinations to

assess the dental caries experience of elementary school children. The study
could best described as
A- Retrospective
B- Case- control
C- Cross-sectional
D- Prospective
ANS:C
Q125: Which of the following is used primarily as filter material in a dental X-

ray machine?
A- Oil
B- Lead
C- Aluminum
D- Tungsten
E- Molybdenum
ANS: C
Q126: In arranging the patient’s maxillary anterior teeth, the dentist should
create a pleasant, natural-looking smile line. This can be done by contouring
the incisal edge to follow the
A- Lower lip when smiling
B- Upper lip when smiling
C- Lower lip without smile
D- Upper lip without smile
ANS:A
Q127: Which of the following is NOT a clinical presentation of oral
Candidiasis?
A- Erythematous patch
B- White, hyperplastic patch
C- White, curd-like patch
D- Ulcerative patch
ANS:D
Q128: In conducting a patient interview, the dentist should begin by asking

questions that are general, because it provides the patient with a greater
opportunity to express his or her concerns and emotions
A- Both 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 in NOT correct, but the reason is correct
E- NEITHER the statement NOR the reason is correct
ANS:A
Q129: -What pathogenic microbiota is most likely associated with a failing

implant?
A- Gram-positive facultative cocci
B- Gram-negative facultative cocci
C- Gram-negative anaerobic rods
D- Gram-positive anaerobic rods
ANS:C
Q130: What is true regarding wheelchair transfers?

A- A wheelchair-bound patient is often the best source of how to do the transfer
B- The patient should be asked to remove his/her catheter and collection bag before attempting the
transfer
C- The patient’s belt should not be used during transfer process
D- Sliding board transfers continue to be the best approach
ANS: A ACCORDING TO ADA CODE OF ETHICS
Q131: Which of the following is NOT true regarding orthodontic tooth

movement?
A- Blood flow within the PDL is altered after force application
B- Pulpal tissue activates a neural response
C- Chemical changes in the compressed PDL stimulate cellular differentiation
D- Oxygen tension is increased in some areas of the PDL and decreased in other areas.
ANS: B
Q132: The dentist places a MOD amalgam restoration on tooth 30. The
patient bites down immediately after carving, and the marginal ridge
fractures easily. Which amalgam properties contributed to this failure?
A- Creep
B- Resilience
C- Edge strength
D- Setting time
ANS: D
Q133- Which of the following is NOT an internal line angle found in a disto-
occlusal (DO) class II cavity preparation?
A- Axio pulpal
B- Axio gingival
C- Distoaxial
D- Mesio facial
ANS:C
Q134- When used for intravenous conscious (moderate) sedation, midazolam

(Versed) produces
A- Amnesia
B- Analgesia
C- Antitussive activity
D- Cardiovascular depression
ANS:A
Q135- Perforation at which of the following sites has the poorest prognosis?
A- At the apex
B- 3mm coronal to the apex
C- 3mm apical to the gingival sulcus
D- 3mm coronal to the gingival sulcus
ANS: C
Q136- Auxilliary resistance from features in fixed dental prostheses such as

boxes and grooves should ideally be located?
A- Facially
B- Lingually
C- Occlusally
D- Proximally
ANS: D
Q137- If a local anesthetic without a vasoconstrictor is required, then which

of the following local anesthetics should be used?
A- Procaine
B- Benzocaine
C- Lidocaine
D- Articaine
E- Mepivacaine
ANS: E
Q138- Which of the following causes speech problems in a patient with cleft
palate?
A- Inability of the tongue to close the nasopharyngeal air flow
B- Inability of the soft palate to close the nasopharyngeal air flow
C- Poorly aligned teeth that make articulation difficult
D- Poor nasal resonance because of oroantral fistula
ANS:B
Q139- Which of the following is a disadvantage of using an elastomeric

material for making an interocclusal registration?
A- The material offers too much resistance to the jaw closure
B- The fragility of elastomeric records requires handing with extreme care
C- There is a potential for inaccurate mounting of casts due to rebound of the material
D- The material lacks adequate long term stability
ANS:C
Q140- Which of the following represents the initial consideration in the

treatment planning progress?
A- Medical/systemic evaluation
B- Periodontal evaluation
C- Radiographic evaluation
D- Elimination of pain and discomfort
ANS:A KAPLAN
Q141- Which of the following dental treatments require antibiotic prophylaxis
fot those at risk for infective bacterial endocarditis?
A- Local anesthesic injections
B- Shedding of primary teeth
C- Mucosal or lip lacerations
D- Periapical surgery
ANS:D
Q142- An HIV-infected patient’s viral load is 100,000 and T cell count is 30.
Which of the following statements is true?
A- There is no contraindication to providing treatment
B- The virus is under control suggesting improved ability to resist infection
C- The virus is almost under control and there is low risk for infection
D- The T cell count is low, putting the patient at risk for infection and complications
ANS:D
Q143- What is the most common form of wound healing after a periodontal
flap surgery?
A- Long junctional epithelium
B- New connective tissue attachment
C- Connective tissue adhesion
D- Regeneration of the new periodontal ligament, cementum and bone
ANS: A
Q144- Which of the following statements most describes the purpose of using
sodium hypochlorite during biomechanical preparation?
A- Dissolves necrotic tissue
B- Reduces hemorrhage
C- Produces cavitation
D- Chelates inorganic tissue
ANS:A
Q145- The purpose of electronic pulp testing is to differentiate

A- Various stages of pulpitis
B- Normal pulp from diseased pulp
C- Between pulpitis and periodontitis
D- Between responsive and unresponsive pulpal nerves
ANS:D
Q146- A Patient who has been wearing a maxillary denture for 15 years
notices multiple, reddened, nodular lesions on his palate. The lesions are soft
and painless. The most likely diagnosis is
A- Torus palatinus
B- Epulis fissuratum
C- Nicotinic stomatitis
D- Inflammatory papillary hyperplasia
ANS:D
Q147- Which of the following best describes the outcome of and intrapulpal
anesthetic injection?
A- Provides anesthesia by back-pressure
B- Control intrapulpal hemorrhage
C- Does not create any period of discomfort during injection
D- Usually provides anesthesia after 30 seconds of depositing anesthetic
ANS:A
Q148- Smokeless tobacco has NOT been associated with which of the
following?
A- Tooth abrasion
B- Gingival recession
C- Verrucous carcinoma
D- Nicotine stomatitis
E- Squamous cell carcinoma
ANS:D
Q149- Opiates do NOT produce which of the following effects?

A- Diuresis
B- Euphoria
C- Mental clouding
D- Cough suppression
E- Respiratory depression
ANS:A
Q150- What pathogenic microbiota is most likely associated with a failing

implant?
ANS: C
Q151- In conducting a patient interview, the dentist should begin by asking

questions that are general, because it provides the patient with a greater
opportunity to express his or her concerns and emotions
A- Both 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 in NOT correct, but the reason is correct
E- NEITHER the statement NOR the reason is correct
ANS:A
Q152- Which of the following is NOT a clinical presentation of oral

Candidiasis?
D- Ulcerative patch
ANS:D
Q153- In arranging the patient’s maxillary anterior teeth, the dentist should
create a pleasant, natural-looking smile line. This can be done by contouring
the incisal edge to follow the
ANS: A
Q154- Which of the following is used primarily as filter material in a dental X-

ray machine?
A- Oil
B- Lead
C- Aluminum
D- Tungsten
E- Molybdenum
ANS: C
Q155:A 6-year-old patient exhibits defiant behavior at a recall examination.

Which of the following techniques is indicated for the examination?
A- Conscious sedation
B- General anesthesia
C- Physical restraint
D- Voice control
Ans: D
Q156: Which of the following is the most frequent cause of porosity in a

porcelain restoration?
B- Excessive firing temperature
C- Rapid cooling
D- Inadequate porcelain condensation
Ans: D
Q157: A 21-year-old male has a painless, compressible and fluctuant, slowy

growing enlargement of the anterior midline of the neck. Which of the following
is the most likely diagnosis?
A- Squamous cell carcinoma
B- Branchial cleft cyst
C- Thyroglossal duct cyst
D- Epidermoid cyst
Ans: c
Q158: Which of the images below can best be used to visualize the integrity of
the zygomatic arches?
A- Panoramic
B- Waters view
C- Lateral oblique
D- CT scan
Ans: D
Q159: Dens invaginatus is most commonly associated with which tooth?

B- Mandibular central incisor
C- Maxillary lateral incisor
D- Mandibular lateral incisor
Ans: c
Q160: Which of the following anatomic structures CANNOT be seen on

periapical radiographs?
A- Mental foramen
B- Hamular process
C- Mandibular foramen
D- Anterior nasal spine
E- Intermaxillary (median palatine) suture
Ans: C
Q161: A child watches her older brother receive dental treatment. The dentist
notices that the next time the child is in the dental chair her behavior is greatly
improved. This is an example of
A- Classical conditioning
B- Primary reinforcement
C- Modeling
D- Cognitive coping strategy
Ans: C
Q162: Each of the following is a property of sodium hypochlorite EXCEPT one.

A- Chelating agent
B- Lubricating agent
C- Solvent of necrotic tissue
D- Antimicrobial agent
Ans: A
Q163: Patients with Sjogren syndrome are at increased risk for developing
A- Carcinoma
B- Sarcoma
C- Lymphoma
D- Leukemia
Ans: C
164. Which of the following is the best initial treatment for a patient with
localized aggressive periodontitis?
A- Dental prophylaxis plus subgingival irrigation
B- Dental prophylaxis
C- Scaling and root planing
D- Scaling and root planing plus systemic antibiotics
Ans: D
165. The strength of a soldered connector is best increased by
A- Using a higher carat solder
B- Electroplating the joint with gold prevent corrosion
C- Increasing its dimension in a direction parallel to the applied force
D- Increasing its dimension in a direction perpendicular to the line applied force
E- Increasing the with of the joint by having a space of at least 0.5 inch between
the parts to be soldered
Ans: C
166.Which of the following odontogenic lesions occurs most frequently
A- Ameloblastoma
B- Odontoma
C- Ameloblastic fibroma
D- Adenomatoid odontogenic tumor
Ans: b OR A .. STILL UNCONFIRMED, I WILL GO WITH B

167: A radiograph of a 12-year-old child’s asymptomatic permanent maxillary
right central incisor reveals an obliterated root canal. Which of the following is
the treatment of choice?
A- Extraction
B- Apicoectomy
C- Endodontic therapy
D- Periodic observation
Ans: D
168: Microscopic suprabasal intraepithelial bullae and acantholysis characterize

which of the following diseases?
A- Pemphigus vulgaris
B- Erythema multiforme
C- Lupus erythematosus
D- Mucous membrane pemphigoid
Ans:A
Q169: A patient with syphilis is highly infectious during which of the following
stages?
A- Secondary stage only
B- Tertiary stage only
C- Primary and secondary stages
D- Primary, secondary, and tertiary stages

Ans: A
Q170: Rising with a new mouthrinse results in a statistically significant decrease

in the Gingival Index (GI) score, but does NOT result in improved oral health for
the patient. This finding suggest which of the following?
A- Non-clinical significance
B- Double-blind study
C- Improper study desing
D- Bias
Ans: A
Q171: Which of the following agents is available in the form of troches for the
topical treatment of oral candidiasis?
A- Ketoconazole (Nizoral)
B- Intraconazole (Sporanox)
C- Clotrimazole (Mycelex)
D- Fluconazole (Diflucan)
Ans:c
Q172: Upon mastication, a patient has severe pain in a mandibular first molar.
Clinical examination reveals furcal bone loss, a sinus tract that is draining
through the sulcus, normal interproximal bone height, and no response to
vitality testing. The treatment of choice is
A- Root canal treatment only
B- Periodontal therapy only
C- Periodontal therapy first, then root canal treatment, should the lesion not
resolve
D- Root canal treatment first, then periodontal therapy, should the lesion not
resolve
ANS: D
Q173: Which of the following is NOT one of the major classes of drugs used to
treat angina?
A- Thiazides
B- Beta-blockers
C- Nitrates and nitrites
D- Calcium channel blockers
ANS:A
Q174: Which of the following can best determine asymptomatic apical

periodontitis?
A- Ice test
B- Radiographs
C- Electric pulp test
D- Transilumination
Ans: B
Q175: Infections arising from the periapical region of mandibular third molars
perforate through the lingual cortex to the
B- Submental space
C- Sublingual space
Ans: D
Q176: What is the best indicator of periodontal stability over time for the
patient on periodontal maintenance therapy?
A- Plaque control
B- Bleeding on probing
C- Probing depths
D- Attachment levels
Ans: B
Q177: Hypotensive effect and itching from oxycodone is due, in part, to its
A- Allergenicity
B- Release of histamine
C- Antispasmodic effect
D- Cardiac depressant effect
E- Excitation of the chemoreceptor trigger zone
Ans: b
Q178: A 45-year-old patient has undergone scaling and root planing in all 4
quadrants. The oral hygiene of the patient is excellent but generalized 5 mm
and 6 mm pockets remain that bleed upon probing. What is the next step and
the best treatment for the patient?
A- Periodontal surgery
B- Maintenance therapy
C- local drug delivery
D- additional round of scaling and root planning
Ans: a
Q179: A dentist considers using nitrous-oxide conscious sedation for a patient.

This type of sedation will be contraindicated, however, if the patient has a
history of which of the following?
A- Psychosis
B- Chronic pain
C- Hypertension
D- Dental anxiety
E- Depression
Ans: A
Q180: A patient’s measured stimulated salivary flow volume is 0.5 ml/minute.

The term that best describes this condition is
A- Xerostomia
B- Normal salivary flow
C- Hyposalivation
D- Hypersalivation
Ans:C
q181:Which of the following is NOT true regarding topical fluoride?
A- Promotes remineralization of surface enamel
B- Inhibits bacterial plaque glycolysis
C- Has a direct antibacterial effect on plaque
D- Enhances enamel pt and fissure coalescence
ans:D
Q182:A diabetic child is experiencing insulin shock in a dental office. In

managing this emergency, the dentist should immediately
A- Administer oxygen
B- Have the child drink a glass of orange juice
C- Administer xylitol by mouth
D- Administer insulin
ANS: B
Q183 : An extended course of cortisone therapy can produce
A- Osteoporosis
B- Osteopetrosis
C- Osteoclerosis
D- Osteochondritis
ANS:A
Q184: Which of the following symptoms or clinical findings would indicate that a
tooth has an irreversible pulpitis?
A- Spontaneous toothaches
B- Sensitivity to sweets
C- Radiographic evidence of pulpitis
D- Sensitivity to palpation of the mucoperiosteum
ANS: A
Q185: A patient with hypertension arrives for a scheduled crown preparation

appointment with a blood pressure of 160/100 mm Hg and a pulse rate of 90
bpm. The initial response by the dentist should be to
A- Call the patient’s physician
B- Reschedule the patient
C- Have the patient take nitroglycerin
D- Wait 15 minutes to re-take vital signs
ANS: D
Q186:A 55-year-old patient with a history of angina pectoris requires extraction

of several teeth. Which of the following should NOT apply to this patient?
A- Preoperative sedation
B- Preoperative sublingual nitroglycerin
C- Preoperative prophylaxis with an antibiotic
D- Limiting the local anesthetic with epinephrine 1:100,000 to 4 ml
ANS:C
Q187:According to ADA recommendations, a professionally applied topical
neutral sodium fluoride application should remain in contact with teeth for
A- 1 minute
B- 2 minute
C- 3 minute
D- 4 minute
ANS:D
Q188: Repeated fracture of a metal ceramic partial fixed dental prosthesis

is primarily caused by
A- Insufficient retention form
B- Improper firing schedule
C- Failure to use a metal conditioner
D- Inadequate framework design
ANS:D
Q189: Which of the following is most likely to result from prolonged use of
antibiotics in children?
A- Candidiasis
B- Histiocytosis X
C- Ulceromembranous stomatitis
D- Lichen planus
ANS:A
Q190: Which of the following mesial root surfaces is unlikely to be

thoroughly cleaned with the use of floss?
B- Mandibular fist premolar
C- Maxillary first premolar
ANS:C
Q191: A posterior tooth has a large carious lesion extending

subgingivally. Which of the following is the best initial treatment?
A- Endodontic therapy
B- Crown lengthening surgery

C- Caries excavation
D- Crown fabrication
ANS:b
Q192: Which characteristic is most frequently associated with

osteoradionecrosis?
A- Maxillary location
B- History of radiation therapy with 42.50 Gy (4,250 rads)
C- History of bisphosphonate usage
D- Mandibular location
ANS:mostly d
Q193: What is the most likely cause for hemorrhage 3 day after removal of a
mandibular third molar?
A- Vascular fragility
B- Platelet deficiency
C- Prothrombin deficiency
D- Fibrinolysis
Ans: D
Q194: A posterior tooth has a large carious lesion extending subgingivally. Which
of the following is the best initial treatment?
A- Endodontic therapy
ANS: b
Q195: The primary etiologic factor associated with periodontal

attachment loss in a furcation is the presence of
A- Occlusal trauma
B- Accessory root canals
C- Oral biofilm
D- Cervical enamel projections
ANS:C
Q196: A patient has received a new mandibular removable dental prosthesis. Soon
afterward, the throat of this patient becomes sore. Which of the following has
probably caused this soreness?
A- An overextension of the distofacial flange

B- An overextension of the distolingual flange
C- An impingement of the lingual bar upon the patient’s lingual frenum
D- An insufficient relief provided for the lingual bar
ANS:B
Q197: An 82-year-old presents as new dental patient. The son provides paperwork
that names the patient’s guardian. How will that impact the dentit’s approach to
care?
A- Does not impact care if a first degree relative has brought the patient to the
office
B- The guardian must be consulted for consent to treat the patient
C- The patient may provide consent to care
D- The guardianship applies to consent involving only irreversible procedures
ANS:B
Q198: The access opening for a maxillary central incisor of a 14-year-old patient is
triangular in shape
A- To establish straight line access

B- Due to the shape of the crown
C- To include any remnants of pulp horns within the access opening
D- To facilitate the final restoration of the access opening
Ans:c
Q199: 20mg doxycycline hyclate’s primary mechanism of action is
A- Breackdown of the phospholipid bilayer

B- Inhibition of DNA gyrase
C- Inhibition of the 50s ribosomal subunit
D- Inhibition of collagenase
Ans:d
Q200: Which of the following would be the first step to perform during
a reevaluation appointment?
A- Establish a plan for maintenance intervals
B- Identify need for additional therapy
C- Update medical history
D- Determine plaque index
Ans:c
STILL NOT CONFIRMED
Q201: A patient has a 7-years-old chipped porcelain veneer on tooth 9

and desires to have the veneer repaired instead of replaced. Which of the
following should be done to the porcelain before repairing with
composite?
A- Pumice, etch, bonding resin, silanate

B- Sandblast, etch, bonding resin
C- Silanate, pumice, bonding resin
D- Micro-etch, etch, silanate, bonding resin
Ans:d
Q202: Beclomethasone (Beconase AQ) is used for bronchial asthma

because it
A- Has a short duration of action

B- Stimulates beta adrenergic receptors in the lung
C- Produces little adrenal suppression when administered by inhalation
D- Is only effective orally
E- Is less potent than cortisol
Ans: A
Q203: What would be found in a patient with untreated acromegaly?

A- Excessive mandibular growth
B- Excessive maxillary growth
C- An anterior deep bite
D- A posterior open bite
Ans:a
Q204: When designing a clinical study, one uses the power of the statistical test to
accomplish which of the following?
A- Measure validity
ANS: C
Q205: A dental office employee wishes to verify that instruments have been sterilized.
Which of the following methods is most accurate?
A- Place indicator tape on the instruments

B- Use biological monitors
C- Examine the sterilizer packages for color changes
D- Observe the temperature gauge on the sterilizing unit
ANS:B
Q206: Phenytoin is most often recommended for controlling which of the following
seizures?
A- Status epilepticus
B- Tonic-clonic (grand mal)
C- Absence epilepsy (petit mal)
D- Myoclonic seizure in childhood
ANS: B
Q207: What is the easiest method for examining a 12-month-old child?

ANS: C
Q208: Which of the following has been most strongly implicated in the cause of aphthous
stomatitis?
A- Cytomegalovirus
ANS:E
Q209: Which of the following represents the best way to increase a patient’s pain
tolerance?
A- Stress that pain does not signify damage

B- Tell the patient that the procedure will be completed soon
C- Tell the patient that he/she should be able to tolerate the pain
D- Increase the patient’s sense of control over the denture of the pain
ANS:B
Q210: A normal stimulated salivary flow rate for an adult patient should be
A- .01 mL per minute

D- 10 mL per minute
ANS: C
Q211: The decision to replace an existing amalgam restoration should be made as soon as
the restoration exhibits
A- Creep
B- Recurrent caries
D- Ditching around occlusal margings
ANS:B
Q212: A child’s behavior problem can be managed by desensitization if the basis of the
problem is
A- Pain
B- Fear
C- Emotional
D- The parents
ANS: B
Q213: Drug-induced hypnosis can be produced by depressing which of the following?
A- Cerebellum
B- Hypothalamus
C- limbic system
ANS:C
Q214: Surgical flap access therapy is indicated and most beneficial when used
control
ANS:A
Q215: Auxiliary resistance from features in fixed dental prostheses such as boxes and grooves should
ideally be located?
A- Facially
B- Lingually
C- Occlusally
D- Proximally
ANS: D
Q216: Informed consent reflects which of the following ethical principles?
A- Justice
B- Autonomy
C- Beneficence
D- Nonmaleficense
ANS: B
Q217: Which of the following most closely resembles normal parotid gland histologically?
ANS:A
Q218: A developmentally-disabled patient should be treated with
A- Flattery
B- Deference
C- Consistency
D- Permissiveness
ANS: C
Q219: Which of the following premolars is most likely to have three canals?
A- Maxillary first
B- Maxillary second
C- Mandibular first
ANS: A
Q220: A 14-year-old female has gingival tissues that bleed easily on gentle probing. The color
of the gingiva ranges from light red to magenta. Probing depths range from 1 - 3mm. Some of
the interdental papillae are swollen. Which of the following represents the most likely diagnosis?
A- Gingivitis
ANS:D
Q221: A 65-year-old white male smokes 2 packs of cigarretes per day. He had a heart attack six
weeks ago and continues to have chest pains even while at rest. He is transported to the office by
wheelchair because be becomes extremely short of breath with even mild exertion. The physical
status that best describes the above patients is
A- P.S.I
B- P.S.II
C- P.S.III
D- P.S.IV
ANS:
Q222: A displaced fracture of the mandible courses from the angle to the third molar. This
fracture is potencially difficult to treat with a closed reduction because of

ANS:D
Q223: Which of the following is the most reliable method for determining the pulp
responsiveness of a tooth with a full coverage crown?
C- Thermal test
D- Palpation
ANS:C
Q224: Which of the following statements is true about setting expansion of plaster, stone, and
improved stone (Type IV)?
A- The setting expansion of improved stone is the highest

B- Increasing the spatulation decreases expansion
C- Increasing the water/power ratio decreases the setting expansion
D- Adding water to surface during setting decreases expansion
ANS:C
Q225: The water supply of a community has 0.28 ppm fluoride. Which of the following
procedures is appropiate for a 4-year-old child exhibiting moderate caries risk?
A- Prescribing a fluoride mouthrinse

B- Prescribing a systemic fluoride supplement
C- Applying fluoride topically at each visit
D- Additional fluoride is unnecessary
ANS:B
Q226: Which of the following type(s) of amalgam alloy provide the best clinical durability?
A- High copper spherical only

B- Conventional spherical only
C- High cooper admixture and high cooper spherical
D- High cooper admixture and conventional spherical
ANS:C
Q227: What is the minimum amount of bone needed between 2 adjacent implants?
A- 1mm
B- 2mm
C- 3mm
D- 4mm
ANS:C
Q228: Which of the following would be LEAST likely to lead to the development of root
surface caries on facial surfaces?

ANS:C
Q229: A dentist has planned in-office-bleaching and porcelain laminate veneers for a patient’s

ANS:A
Q230: Which of the following has been most strongly implicated in the cause of aphthous
stomatitis?
A- Cytomegalovirus
ANS:D
Q231: A patient with Stage I medication related osteonecrosis of the jaw (MRONJ) with
exposed bone in the maxilla is best treated with
ANS:D
Q232: If a particular test is to correctly identify 95 out of 100 existing disease cases, then that
test would have a
D- Validity of 95%
ANS:B
Q233: Disadvantages of oral sedation include which of the following?
A- Multiple drugs needed for proper sedation

B- High incidence and severity of adverse reactions
C- Unpredictable absorption of drugs from the GI tract
D- Short duration of action
ANS:C
Q234: Which of the following directly image the TMJ disc?
A- TMJ tomography
B- TMJ arthrography
ANS:D
Q235: Which of the following explains why the fovea palatini are not used as landmarks for
determining the precise posterior border of maxillary denture base?
A- They have no relation to the vibrating line area

B- They are inconsistent in their relationship to the vibrating line
C- They are opening of mucous glands that should not be covered y the denture border
D- They are located on the horizontal hard palate
ANS:C
Q236: Which of the following might precipitate an asthma attack?
A- Narcotic analgesics
B- Nonsteroidal antiinflamatory drugs
C- Corticosteroids
D- Sympathomimetic amine
ANS:B
Q237: Which of the following factors does NOT impact the development of xerostomia in an
aging population?
A- Chronological age
B- Medications
C- Radiation therapy to the head and neck
D- Systemic disease
ANS:A
Q238: Infections arising from the periapical region of the mandibular first premolars perforate
through the lingual cortex to the
B- Submental space
C- Sublingual space
ANS:C
Q239: A ‘W” in front of the rubber dam clamp number indicates that the rubber dam clamp
A- Is made from work-hardened metal

B- Has a non-reflective surface
C- Has a wing
D- Is wingless
ANS:D
Q240: A dentist will make impressions for a patient who has an excessive salivary flow. To
decrease the flow, this dentist might appropriately prescribe which of the following drugs?
A- Propantheline (Pro-Banthine)
B- Salsalate (Disalcid)
D- Neostigmine (Prostigmin)
ANS:A
Q241: The best time perform oral surgery on a patient receiving dialysis 3 times per week is
A- Day of dialysis
ANS:C
Q242: The mother of an 8-year-old patient insists on staying in the room during treatment. In
the past, she seemed to be very overprotective of her child with her body language and
comments. Which were disruptive to treatment. How could the dentist best address this patient’s
mother?
A- “You seem really concerned, perhaps you need to be talking with someone about this”
B- I know you care, however you are causing your child to be more upset, no less”
C- “I’m sorry, but I need you to stay in the waiting room so we can get his work done”
D- “I know you are concerned. Please stay in the room, and try to be as positive and quiet as
possible”
ANS:C
Q243: The purpose of scaling is to remove acquired deposits on the teeth.
Scaling can be performed on both enamel and root surfaces

ANS:C
Q244: Mandibular hypoplasia, coloboma of the lower eyelid, and malformations of the prinna
of the ear are fracture of which of the following diseases?
A- Apert Syndrome
D- Crouzon syndrome (craniofacial dysostosis)
ANS:C
Q245: What percent of hydrogen peroxide should be used for debriding and intraoral wound?
A- 3 percent
B- 10 percent
C- 20 percent
D- 37 percent
ANS:A
Q246: During clinical evaluation of a complete crown on a mandibular right first molar, a
premature contact causes the mandible to deviate to the patient’s left. One would expect to see
the interfering contact marked on which surfaces of the crown?
A- Mesial marginal ridge

B- Buccal inclines
C- Mesial inclines
D- Lingual inclines
ANS:D
Q247: At 90 kVp and 15mA at a BID distance of inches, the exposure time for a film is 0.5
seconds. In the same situation, which of the following should represent the exposure time at 16
inches?
A- 0.25 seconds
B- 1.0 second
C- 2.0 seconds
D- 4.0 seconds
ANS:C (0.5*4=2.0 SEC)
Q248: A 55-year-old male patient, who is currently prescribed warfarin (Coumadin) 5 mg daily,
requires surgical therapy. What is the most appropiate pre-surgical laboratory test?
A- Fibrinogen time
B- Partial thromboplastin time
C- International normalized ratio
D- Bleeding time
ANS:C
Q249: Dental phobia is classified as a personality disorder

experience

ANS:D
Q250: Causality (cause and effect) may NOT be inferred from which of the following studies?
A- Cross-sectional
B- Cohort
C- Case-control
D- Clinical trial
ANS:A
Q251: One advantage of using a fiber-reinforced post for restoring an endodontically treated
tooth is that it

ANS:B
Q252: Which of the following represents the 3 essential factors for the initiation of the carious
lesion?
A- Bacteria, polysaccharides, and enamel

B- Bacteria, suitable carbohydrate, and susceptible tooth *
C- Lactobacilli, easily fermentable carbohydrate, and susceptible tooth
D- Lactobacilli, suitable substrate, and enamel
ANS:B
Q253: Each of the following is a common cause of denture gagging EXCEPT one. Which is the
EXCEPTION?
A- Inadequate posterior palatal seal

B- Excessive vertical dimension
C- Bulkiness of denture
D- Excessive anterior guidance
ANS:A
Q254: Which of the following is a interference during working movements for a posterior
complete crown restoration?
ANS:D
Q255: Which permanent teeth are least often congenitally missing?
A- Lateral incisors
B- Canines
C- Premolars
D- Third molars
ANS:B
Q256: Adolescents undergoing orthodontic treatment often have problems with home oral
hygiene regimens. The MOST effective management plan is to
A- Educate the patient about the importance of oral hygiene when wearing braces
B- Develop a plan of contingent reinforcement for brushing and flossing
C- Refuse to continue treatment unless oral hygiene improves
D- Have parents remind adolescents to brush
E- Provide limited praise for small progress made at each visit
ANS:E
Q257: The most dominant emotional factor in management of 4-to-6-year-old children is fear of
A- Pain
B- The unknown
C- The dentist
D- Being separated from parents
ANS:B
Q258: Which of the following substances is contraindicated for a patient taking ginseng?
A- Penicillin
B- Digitalis
C- Aspirin
D- Alcohol
ANS:C
Q259: Excessive trituration of amalgam should be avoided because it will
A- Cause excessive expansion

B- Cause the amalgam to set prematurely
C- Remain soft for too long
D- Cause the amalgam to lose its anatomy in 24 hours
ANS:B
Q260: Which of the following is most likely the major consideration prior to performing a
gingivectomy?

ANS:D
Q261: In which of the following mandibular fracture cases should the intermaxillary fixation be
released earliest?
A- A high condylar fracture

B- A fracture through the site of an impacted third molar
C- An angle fracture and contralateral parasymphyseal fracture
D- A jaw in which the treatment has been delayed by the management of other injuries
ANS:A
Q262: A panoramic radiograph of a 55-year-old female reveals generalized widening of the

periodontal ligament space and bilateral resorption of the mandibular angles. What is the most
likely diagnosis?
A- Fibrous dysplasia
B- Progressive systemic sclerosis
C- Osteosarcoma
D- Marfan syndrome
ANS:B
Q263: A new patient presents with severe chronic periodontitis and has a history of two heart
attacks. The patient is not sure when the heart attacks occurred or the severity. The dentist’s next
step in treatment should be to
A- Complete gross scaling to decrease the bacterial load

B- Have the patient rinse with chlorhexidine gluconate (Peridex)
C- Request a consult from the patient’s physician prior to any treatment
D- Confine the treatment to simple restorative procedures
ANS:C
Q264: Which hematologic disorder represents a malignancy of plasma cell origin?
A- Burkitt lymphoma
B- Hemophilia
C- Thalassemia
D- Multiple myeloma
ANS:D
Q265: Plaque microorganisms produce extra-cellular substances that separate one bacterial cell
from another and that form a matrix for further plaque accumulation. This “matrix” is made up
of dextrans and
A- Levans
B- Mucoproteins
C- Disaccharides
D- Monosaccharides
ANS:A
Q266: Which of the following represents a common side effect of the alkylating-type anticancer
drugs such as mechlorethamine (Mustargen)?
A- Ototoxicity
B- Nephrotoxicity
C- Bone marrow depression
D- Accumulation of uric acid
ANS:C
Q267: Which of the following is NOT a characteristic of a modified Widman Flap procedure?
A- Submarginal incision
B- Replaced flap
C- Inverse bevel incision
D- Flap margin placement at the osseous crest
ANS:D
Q268: A furcation radiolucency in a 5-year-old child’s primary molar is most due to
A- Trauma
B- Pulpal necrosis
C- Normal anatomy
ANS:B SOME SAYS C CHECK IT
Q269: Which of the following neuralgias is correctly associated with its cranial nerve?

ANS:B
Q270: Gingivectomy is NOT indicated when the base of the pocket is located
A- Apical to the alveolar crest

B- Below the free gingival groove
C- Coronal to the cementoenamel junction
D- Apical to the cervical convexity of the tooth crown
ANS:A
Q271: Compared with high noble alloys for metal-ceramic restorations, base metal alloys are
best used for which of the following?
A- Optimum esthetics
B- Single crowns
C- Long-span bridges
D- Patients with allergies to metals
ANS:C
Q272: The pathogenic microorganisms of chronic periodontitis includes each of the following
A- Porphyromonas gingivalis
B- Prevotella intermedia
C- Tannerella forsythensis
D- Actinomyces viscosus
ANS:D
Q273: What is the indicated treatment for a primary molar with a carious pulp exposure and a
furcation radiolucency?
A- Formocresol pulpotomy
B- Indirect pulp cap
C- Extraction
D- Direct pulp cap
ANS:C
Q274: Regeneration of the periodontal attachment apparatus include

ANS:A
Q275: Which of the following is NOT true regarding paraphrasing?
A- Paraphrasing is restating the patient’s views in one’s own words

B- Paraphrasing is agreeing with and accepting the other person’s position
C- The secret to good paraphrasing is voicing patient values
D- Paraphrasing is attempt to understand and acknowledge another’s perspective
ANS:B
Q276: Patients with low health literacy are
A- Less likely to ask questions during their dental visits

B- More likely to fail to show for dental appointments
C- Likely to look over written materials and say they don’t understand
D- High school graduates
ANS:B
Q277: A normal unstimulated salivary flow rate for an adult dentate patient should be
A- 0.01 mL per minute

D- 10.0 mL per minute
ANS:B
Q278: Which teeth are the most susceptible to recurrence of periodontal disease after active
periodontal treatment is completed?
A- Maxillary premolars because of lateral occlusal forces

B- Mandibular premolars because of non-working interferences
C- Maxillary molars becauses of anatomy of their furcations
D- Mandibular molars because of increased number of cervical enamel projections
ANS:C
Q279: In attempting to correct a single tooth anterior crossbite with a removable appliance,
Which of the following is the most important for the dentist to consider?
A- Making periodic adjustments

B- Incorporating maximum retention
C- Patient’s overbite
D- Making sure there is adequate space
ANS:D
Q280: Which of the following represents the most significant finding regarding ectodermal
dysplasia?
A- Multiple osteomas
B- Supernumerary teeth
C- Multiple impacted teeth
D- Sparse hair
ANS:D
Q281: During a routing examination, the dentist sees a large radiolucency at the apex of the
maxillary right first premolar. The tooth is not painful, does not respond to pulp testing, and has
no evidence of a sinus tract. The most probable diagnosis is

ANS:A
Q282: A 32-year-old male patient reports a history of having been hospitalized for psychiatric
evaluation, and is currently taking taking lithium carbonate on a daily basis. Which of the
following diseases does this patient most likely have?
A- Parkinsonism
B- Schizophrenia
C- Bipolar disorder
D- Psychotic depression
E- Paranoia with delusions
ANS:C
Q283: To achieve ideal overjet and overbite in an adult patient with a 16 mm pretreatment
overjet, orthodontic treatment would most likely require
A- Orthodontic tooth movement only

B- Orthognatic surgical treatment only
C- Combined orthodontic/surgical treatment
D- Premolar extraction therapy only
ANS:C
Q284: Which term refers to a physician or dentist performing an operation for which there was
no consent?
A- Assault
B- Nonmaleficence
C- Disclosure
D- Battery
ANS:D
Q285: Which of the following is the best choice to avoid the effect of metamerism?
A- Select a porcelain shade using light only

B- Select the shade that looks optimal under multiple light sources
C- Avoid fluorescent lighting when selecting a porcelain shade
D- Add additional layer of opaque porcelain prior to placing body porcelain
ANS:B
Q286: What is the LEAST likely reason for postoperative sensitivity after a Class I occlusal
composite restoration is placed?
A- Gap formation which allows bacterial penetration into the dentin tubules
B- Gap formation which allows an outward flow of fluid from through the dentin tubules
C- Direct toxic effects of a 15 second acid etc on the pulp
D- Cuspal deformation due to contraction forces of polymerization shrinkage
ANS:I THINK C
Q287: Subgingival margin of crown is indicated when
A- Surrounding soft tissue is thick bio-type

B- Porcelain laminate veneer is planned
C- An all-ceramic crown is planned
D- Cemental hypersensitive is suspected
ANS:D
Q288: Which area of the mouth has the LEAST amount of keratinized tissue on the buccal
aspect?
A- Maxillary incisors
C- Mandibular incisors
ANS:D
Q289: Pain referred to the ear derives most often from which teeth?
A- Maxillary molars
C- Mandibular molars
ANS:C
Q290: Most dens invaginatus defects are found in which of the following types of teeth?

B- Maxillary lateral incisor
C- Mandibular first premolar
D- Maxillary first premolar
ANS:B
Q291: The patient should sign the informed consent for surgery
A- At the time of filling out history and insurance forms

B- After medical history and physical examination
C- After formulation by dentist of a surgical treatment plan
D- After a full discussuion of the surgical treatment plan
ANS:D
Q292: Metastatic disease to the oral region is most likely to occur in Which of the following
locations?
A- Tongue
B- Posterior maxilla
C- Posterior mandible
D- Floor of the mouth
ANS:C
Q293: Which of the following is the single most important factor affecting pulpal response to
tooth preparation?
A- Heat
B- Remaining dentin thickness
C- Desiccation
D- Invasion of bacteria
ANS:B
Q294: A 16-year-old patient has a long history of mild pain in the area of the mandibular left
first molar. Radiographs reveal deep caries in the tooth with an irregular radiopaque lesion apical
to the mesial root.
Which of the following represents the most likely diagnosis?
A- Periradicular granuloma
B- Condensing osteitis
C- Asymptomatic apical periodontitis
D- Periapical cyst
ANS:B
Q295: Distinctly blue color of the sclera is a feature of Which of the following conditions?
A- Gardner syndrome
B- Osteogenesis imperfecta
C- Hypohydrotic ectodermal dysplasia
D- Stuge-weber angiomatosis
ANS:B
Q296: Glossitis and angular cheilitis are oral manifestations of what type of nutrient deficiency?
A- Calcium
B- Vitamin D
C- Iron
D- Zinc
ANS:C
Q297: Blocking the synthesis of prostaglandins does NOT produce which of the following
conditions?
A- Antipyresis
ANS:B
Q298: A patient has only the mandibular anterior teeth remaining. The treatment plan calls for a
maxillary complete denture and mandibular removable partial denture. Which of the following is
desirable in the occlusal scheme?
A- Bilateral simultaneous contact of anterior and posterior teeth in centric relation position
B- Canine guidance with posterior disclusion during excursive movements
C- Bilateral balanced contact during excursive movements
D- Unilateral group function during excursive movements
ANS:C
Q299: An edentulous patient is to be treated using maxillary and mandibular complete dentures.
The patient is healthy and the ridges are well healed. A maxillary torus is present and extends
beyond the area of the proposed posterior palatal seal. Which of the following represents the
A- Removal of torus, followed by fabrication of maxillary and mandibular complete dentures
B- Extension of maxillary denture base onto the moveable soft palate to achieve adequate seal
C- Fabrication of a maxillary denture with an open/horshoe palate which avoids the torus
D- The use of relief over the area of the torus during maxillary and mandibular denture
fabrication
ANS:A
Q300: Leukemia is suspected when a patient demonstrates which of the following sighs or
symptoms?
A- Red sclera
B- Pale conjuntivea
C- Splinter hemorrhage under the finger nails
D- Spontaneous gingival bleeding
ANS:D
Q301: A patient’s mandibular canal is positioned lingually to her mandibular third molar. In
what direction would the canal appear to move on a radiograph, if the X-ray tube were moved
inferiorly (i.e., if the x-ray beam were pointing superiorly)?
A- Apically
B- Mesially
C- Distally
D- Occusally
ANS:A
302: The prostaglandin analog misoprostol (Cytotec) is most commonly used in treating gastric
ulcers associated with
A- Chronic use of anti-inflamatory drug

B- Chronic use of tobacco products
C- Hypersecretory conditions such as Zollinger-Ellison syndrome
D- Hyperactivity of the gastrin-secreting chief cells
ANS:A
Q303: At 90 kVp and 15mA at a BID distance of 8 inches, the exposure time for a film is 0.5
inches?
A- 0.25 seconds
B- 1.0 second
C- 2.0 seconds
D- 4.0 seconds
ANS:C
Q304: What is the most common side effect when administering nitrous oxide and oxygen?
A- Allergic reaction
B- Respiratory depression
C- Tachycardia
D- Nausea
ANS:D
Q305: Xray shows caries on distal and mesial on one primary tooth, pulp is not involved,
cannot detect lesion clinically, how do you tx?
a) MOD amalgam
b) MO and DO composite
c) MOD composite
d) Stainless steel crown
ANS:D
Q306: Hypotensive effect and itching from oxycodone is due, in part, to its
A- Allergenicity
B- Release of histamine
C- Antispasmodic effect
D- Cardiac depressant effect
E- Excitation of the chemoreceptor trigger zone
ANS:B
Q307: A patient says, “I have been avoiding coming to see you because there is an ugly, red sor
spot on the roof of my mouth”. Which of the following responses by the dentist best exemplifies
a reflective response?
A- “Has you diet changed lately”

B- “You really shouldn’t worry about it”
C- “Don’t be afraid, I’ll take a careful look”
D- “You should have had something like that looked at right away”
E- ‘It sounds as if you’re quite concerned about this condition”
ANS:E
Q308: Although the results of a diagnosis test are NOT necessarily accurate, they are consistent.
This test has high
A- Generalizability
B- Specificity
C- Reliability
D- Validity
ANS:C

D- Analgesia
ANS:C
Q310: Which of the following is related to reciprocal anchorage in orthodontic therapy?
A- Tipping a tooth
B- Extraoral force
C- Equal and opposite forces
D- Bodily movement of a tooth
ANS:C
Q311: A 6-year-old patient exhibits defiant behavior at a recall examination. Which of the
following techniques is indicated for the examination?
A- Conscious sedation
B- General anesthesia
C- Physical restraint
D- Voice control
ANS:D
A- With anxiety
ANS:D
Q313: Diagnostic radiology is based on which of the following interactions of X-radiation with
matter?
A- Thompson effect
B- Pair production
ANS:C
Q314: Each of the following would be included in a differential diagnosis of the palatal
pigmentation EXCEPT one. Which is the EXCEPTION?
A- Lentigo
B- Melanotic macula
C- Melanocytic nevus
D- Melanotic neuroectodermal tumor
ANS:A
Q315: Paresthesia of the inferior alveolar nerve is most often seen after the fracture of which
area of the mandible?
A- Angle
B- Condyle
C- Symphysis
D- Coronoid process
ANS:A
Q316: Which of the following does NOT produce a pharmacologic decrease in saliva
production?
A- Atropine (AtroPen)
B- Scopolamine (Trasderm-Scop)
D- Glycopyrrolate (Robinul)
ANS:C
Q317: 1- The patient
A- Is at increased risk for bleeding

B- Is at increased risk for hepatocellular carcinoma
C- Is a potential carrier for hepatitis A
D- Had a disease that does not involve a bloodborne pathogen
D- Aphthous ulcers
3- The patient states that “all of my teeth are sensitive to hot and cold, and my gums bleed
whenever I brush my teeth”. The initial treatment should involve each of the following EXCEPT
one. Which one is the EXCEPTION?
A- Full-mouth scalling and root planning

B- Prescription for a desensitizing toothpaste
C- 4 quadrants of periodontal surgery
D- Home care instruction, then follow up visit
4- The most likely cause of the V-shaped radiolucency between the roots of the teeth 2 and 4
would be
A- An idiopathic bone cavity

B- A maxillary sinus pseudocyst
C- Maxillary sinus
D- A radicular cyst
5- Which would NOT be included in a differential diagnosis of the right mandibular

radiolucency?
A- Keratocystic odontogenic tumor

B- Ameloblastoma
C- Periapical (radicular) cyst
D- Lateral periodontal cyst
D- Aphthous ulcers
7- The best initial management for the mandibular radiolucency would be
A- Radiographic follow-up in 6 months

B- Endodontic therapy on tooth 31
C- Incisional biopsy
D- Block resection
8- The technique to image the lingual opacity was
A- An occlusal radiograph
B- A modified panoramic image
C- An axial plane cone beam CT
D- A modified periapical radiograph
9- What is the Angle Classification of the molar relationships?
A- Left Class I, Right Class II

B- Left Class I, Right Class III
C- Left Class II, Right Class I
D- Left Class II, Right Class III
E- Left Class III, Right Class I
10- An exaggerated curve of the occlusal plane and loss of the image clarity of the roots of the
anterior teeth is indicative of a
A- Normal finding
B- Panoramic positioning error
C- Film processing error
D- Developmental disorder
11- Preventive oral health behavior is influenced by each of the following factors EXCEPT one.
A- Public policy
B- Social context
C- Psychological factors
D- Access to preventive measures
12- What is the most likely cause of the chalky-white appearance of the enamel of this patient’s
teeth?
A- Fluorosis
B- Ectodermal dysplasia
C- Amelogenesis imperfecta
D- Dentinogenesis imperfecta
13- Which is true about the position of tooth 27?
A- Missing premolar on the mandibular left has allowed more space for the left canine
B- Mandibular incisors have shifted to the right blocking out the right canine
C- Posterior teeth have drifted mesially more on the mandibular right than the left
D- Right canine has ankylosed whereas the left canine has undergone normal eruption
14- The lesion between teeth 30 and 31 is treated by enucleation and curettage. Each of the
following are risks with this procedure EXCEPT one. Which is the EXCEPTION?
A- Devitalization of teeth 30 and 31

B- Damage to the lingual nerve
C- Post-operative infection
D- Damage to the inferior alveolar nerve
E- Lesion recurrence
● Fast setting and normal alginate - difference in composition of them. Answers
like calcium phosphate, etc.
● Which tooth is difficult for flossing in medial side
● Bisphosphonates - osteoclast or osteoblast?
● Tmj ankylosis most common reason - injury or developmental
● Tmj radiograph- what is used?
● Tmj DISC radiograph - what is used?
● Effect of gastric -- options like oral granulomatosis
● Systemic antibiotic and surgery is treatment for what?? -- LAP or chronic
periodontitis
● Nickel most allergic metal
● Wheelchair transfers- pt is best source
● Unstimulated saliva - 0.1ml/min due to hypofunction of salivary gland
● First pass metabolism - liver
● Diabetes causes blindness - [they asked about either 1 or 2 , not sure]
● Swallowed by accident - right bronchus
● Initial stage of HIV
● Alkylating agent side effect
Extra notes [bone- bone marrow suppression, hair - alopecia, kidney -
nephropathy, git - nausea]
● C factor ratio - inc in ratio = inc in polymerization stresses
● Oral wound - 3% hydrogen peroxide
● Pemphigus - suprabasilar split, intraepithelial, nikolsky sign
● Smokeless tobacco - verrucous carcinoma -- NOT PRESENT IN Nicotinic
stomatitis
● Osteogenesis imperfecta - blue sclera
● Stage 1 MRONJ treatment- mouth rinses
● Osteoradionecrosis- IN MANDIBLE!!! They put 40gyri, dont let that
confused you, its 60gyri!!!
○ Extra notes: Osteoradionecrosis(60 gyri) - MORE IN MANDIBLE,
Deterministic, DAMAGE TO BV PREDISPOSES IT ; c albicans
● Sjogren's - associated with lymphoma ** [asked twice for my exam]
● lichenoid reaction - least = erythema multiforme
● sinusitis treatment - amox + [instead of clavulanic acid, they had clavulanic
something , but i still chose this answer ]
● Rheumatoid arthritis test - ESR
Extra notes- other tests = ASa2, ESR, CRP[c-reactive protein test]
● Aphthous stomatitis- associated with human leukocyte count
● Some question about osteoarthritis related with tmj
● Mwf - reverse/internal bevel
● Marginal gingivitis - high school kids
● PLAQUE
- 2 day old- gram (+) cocci and rod
● Healthy gingiva - g(+) facultative
● Periimplantitis - g(-) anaerobic
● In examining a maintenance patient, the dentist observes residual calculus,
bleeding on probing, and probing depths less than 5 mm. The dentist should
do which of the following?
-scaling and root planing
-osseous surgery
-cont’d maintenance
-open flap debridement
● Something about free gingival graft
● Bacteria in periodontitis
Extra notes p.gingivalis, t.denticola, t.forsythia
● What's not true about demineralization? -- they have the ph of both plaque
and dentin so please know those values!!
● Short tooth - put crown
● Also the question with the ANSWER veneer crown with grooves [ i think the
question is short crown abutment for fpd, not sure]
● Best amalgam - high copper & spherical , but they have 2 answers with
copper and spherical with an added word, so be clear on that.
● Zinc phosphate what happens if you inc powder
● -The head of a 245 bur is longer than the head of a 330 bur
● Fiber post
Extra notes : -modulus elasticity near to dentin
-tend to absorb and dissipate stress (masticatory and traumatic) like
natural dentin, thereby protecting the root from fracture
- better biocompatibility, more rapid treatment, esthetics, and corrosion
resistance
● W on clamp = wingless
● -Eugenol interferes with composite resin polymerization
● Sodium hypochlorite - NOT chelate, removed organic debris
● Halogen = better curing depth than led
● Know the order of treatment!! Atleast 2-3 questions about that
Endo-perio-operative-surgery-ortho
● Class 2 div 1 -most chance of trauma
● A patient on intravenously administered bisphosphonate therapy for 2 years
has carious and non-restorable anterior teeth. Which is the best treatment
option?
● Treat pt 1 day after dialysis *
● Question about neuropraxia
Extra notes: AXONOTMESIS -- neural injury where axon is damaged
but intact epithelium (schwann cells, the endoneurium, perineurium and
epineurium remain intact)
Neurotmesis- nerve sheath and nerve is interrupted, complete
recovery is impossible
neuropraxia is the mildest form of neural injury, without nerve
degeneration, loss of motor function, does not involve perineurium or
epineurium, REVERSIBLE, lasting 6-8 weeks, ASSOCIATED WITH ACC
From most to least serious : neurotmesis - axonotmesis - neuropraxia -
paresthesia
● Which of the following would be the best orthognathic surgical option for a
patient that has an 8mm anterior open bite?- lefort 1
● first click heard when pt opens to 25 mm at 5 mm what is the cause of the
second click sound close with reduction. Disk is anterior. 1st sound- when
mouth opens and pops back on the condyle. 2nd sound- when mouth
closes and disk again goes anteriorly
● Treatment for dry socket
● Trephination
Extra notes: perforation of alveolar cortical bone to release
accumulated tissue exudates.
● Cd clicking - due to inc VDO, dec interocclusal space (also if porcelain teeth
are used in dentures)
● More monomer = ?? more shrinkage
● Veneer reduction for ⅔ of facial
● Stability for mand denture - into buccal shelf?
● A protrusive relation record should be made by instructing the patient to
protrude the mandible 3-6mm.
● A wear facet is seen on the mesio-buccal incline of the mesio-buccal cusp
of a mandibular first molar complete metal crown. This facet could have been
formed during which jaw movements? --WORKING/PROTRUSIVE
● you made a zirconia crown on right mandibular molar. When patient bites, it
shifts to the right. What area is affected?
--lingual incline of buccal cusp *
● Something with cast coping - i think the question was about overdentures
● Pressure on the mid palatine suture will improve -- relief area, Neither denture
retention nor denture stability
● Fovea not included in denture - becuz itll cover salivary glands
● Alot of questions about anticholinergic and cholinergic !! make sure you know
those PROPERLY! DON'T GET IT MIXED UP! [question about
PILOCARPINE]
● Warfarin(coumadin) - INR/PT
● -Clotrimazole ( mycelex troche) - topical antifungal (nystatin) - available in
TROCHES for the TOPICAL tx of CANDIDIASIS
● All benzodiazepines - SIDE EFFECT = AMNESIA!! So many questions that
REPEATS ON THAT. any diazepam you see, the most common side effect
will be amnesia!!
● Diphenhydramine- ANTIEMETIC
Extra notes: (benadryl) - given when allergic to both amide and ester
Antihistamine, anticholinergic
● Beclomethasone.- SHORT ACTING, ONLY USED FOR ASTHMA ATTACKS
● Valacyclovir (Valtrex)- same drug for HSV, VZV , CMV
● A fail-safe mechanism on an analgesia machine for nitrous oxide and oxygen
prevents the delivery of nitrous oxide greater than 70%
● Inc in corticosteroids = OSTEOPOROSIS
● Mepivacaine - without epi
● What you give when allergic to lidocaine
● Extra notes : because its an amide, if allergic, can use ESTER
(procaine, tetracaine, cocaine)
● Implant distance bucco-lingually = 6?
● Mandibular foramen - cant be seen on periapical radiographs
● Question on SLOB technique
● Question about sensitivity and true negative/positive KNOW THE FORMULAS
PROPERLY, DONT LOOSE 1 POINT. THIS IS A SURE QUESTION.
● Question about reduction for primary tooth, in one answer BOTH buccal and
lingual reduction was there, so not sure about that!
● Know the case control, clinical trial, cross sectional, etc properly. At Least 3-4
questions came on it, including day 2!!!
● Unbundling
● ear pain - mand molar
● least likely to locate ---asympto necrotic pulp, symptomatic , etc.
● A 9 year old presents with acute gingival pain of four days duration. There are
small, round ulcers on the interproximal gingival and buccal mucosa. Which of
the following is the most likely diagnosis?
C- Apthous stomatitis
D- Gingival abscess
● Which of the following odontogenic lesions occurs most frequently
A- Ameloblastoma
B- Odontoma
C Ameloblastic fibroma
D- Adenomatoid odontogenic tumor
● What is the best indicator of periodontal stability over time for the patient on
periodontal maintenance therapy?
A- Plaque control
C- Probing depths
● A posterior tooth has a large carious lesion extending subgingivally. Which of
the following is the best initial treatment?
A-Endodontic therapy
● Which of the following would be the first step to perform during a reevaluation
appointment?
A-Establish a plan for maintenance intervals
● Incisal and coronal parts matched in pfm crowns by:
A. Internal coloring of porcelain
B. External glazing
C. Polishing and grinding to change light reflection
D. Firing under high temp
● To evaluate an existing occlusion, diagnostic casts should be mounted on an
articulator in
A. centric relation.
B. balancing occlusion.
C. either centric relation or balancing occlusion.
D. horizontal protrusive relation
● Apthous stomatitis - caused by tomato allergy
● Prevalence of the disease affects
Sensitivity
Specificity
Predictive value
Repeatability
● X-ray sensor resolution
Spatial resolution
Chemical resolution
Detector resolution
● Another question about xray recording fine details with same options from
above
● Candidiasis : - Erythematous patch ,White, hyperplastic patch, curd like patch.
NOT: ULCERATIVE
RQs JUNE 4-5:
Day 1
1. Enamel hypoplasia is seen in:
- 6 weeks inutero to birth
- 1mo – 7mo
- 1-3yrs
- 4-7yrs
2. Primary failure of eruption is due to the defect in the:

- Formation of crowns
- Resorption of bone
- Dental propulsive mechanism
- Resorption of primary roots
3. Drug for insomnia:

- Alprozolam
- Zolpidem
4. A Prostaglandin analogue Misoprostol is used in the treatment of ulcers caused by

- Chronic inflammation
- Tobacco use
- Zollinger syndrome
- Gastric ulcers
5. An asymtpmatic tooth with apical radiolucency, no evidence of sinus tract and negative
to pulp vitality and percussion. Diagnosis:
6. Alkylating agents like Mechlorethamine, Cyclophosphamide, Melphalan side effects

include all except:
- Oral ulcers
- Reduced renal blood flow
- Other confusing options
7. 8 year old kid with overprotected mother, she insisted to stay in the room, but last time
also she was disturbing during treatment, what will you say to mother?
- I understand you care, please stay inside and keep calm
- I would like you to stay out and let me do procedure
- Other options
8. Community water = 0.38ppm fluoride, what to give to a 4 years child?

- Systemic supplements
- Topical fluoride
- Oral hygiene instructions
9. Thyrotoxic crisis
10. Max CD and mand bilateral rpd, what occlusion,
- Bilateral balanced in lateral excursions

- Balanced in contacts in centric relation (Something in these lines with similar
wording)
- Group function
11. Test to check for long term diabetic control:

- Fasting blood sugar
- Glucose tolerance
- Glycosylated Haemoglobin
12. What will not affect the need for increasing insulin in Diabetes
- Trauma
- Sedation
- Other options
13. Chest pain, left and right arms tinglind. There was more description I forgot . Diagnosis
(Angina not in options)
14. Drug for status epilepticus
- Diazepam
- Phenytoin
15. Stage 1 MRONJ treatment:

- Hyperbaric oxygen
- Mouth rinses
16. Mouth wash to control plaque in medically compromised:

- NaF
- Chlorhexidine
17. Patient with lower eyelid colobomas, mandibular hypoplasia, microtia. Diagnosis:
- Treacher Collins
- Crouzons
- Downs
18. Initial treatment for dry socket:

- Irrigate with antibiotic solution
- Palce sedative dressing
19. 16mm of Overjet can be treated with:

- Orthodontic correction
- Orthognathic surgery
- Both combined
20. 5 years old kid, radiolucency in the furcation of molar, what is it:
- Normal
- Pulp necrosis
- Erupting permanent
21. Dentist wants to replace anterior teeth. Esthetics should be considered starting from:
- Clinical evaluation
- Survey of diagnostic cast
- Evaluation of mounted casts
22. What is it true about C factor:
- It is the ratio of the unbounded to bonded
- It is the lowest for class 1
- With the increase in bonded surfaces, increase shrinkage
- With the decrease in bonded surfaces, increase shrinkage
23. What is not included in the intital phase of perio treatment:

- Oral hygiene instructions
- Root planning
- Exraction of hopeless teeth
- Occlusal adjustments
24. Old patient signs of physical abuse, dentists ethical responsibility:

- Call 911
- Report to approximate state agency
25. Broad spectrum antibiotic:

- Amoxicillin
- Penicllin G
- Pencillin G procaine
- Pencillin G potassium
26. Pinkahm preccoperative child

- Any child who cannot cooperate
- 3 years or younger
- 2 years or younger
27. Mandibular growth occurs by:

- Anterior deposition
- Posterior deposition
- Posterior resorption
- Much growth changes in the chin region (Something in these lines)
28. Most possible indicator for tori removal:
- Prosthetic reasons
- Esthetics
- Because it has thin overlying mucosa
- Some other option
29. Oral ulceration with bone sequestration due to trauma but no systemic disease is found
where? (I don’t remember the options but I think one of the options were osteomyleitis)
30. Question on spatial resolution (not the regular pixel and resolution but Something related
to fine details)
31. T/F question about CCD
32. Teeth least common to be missing:
- 3rd molars
- 2nd premolars
- Canine
- Lateral
33. Not related to Modified Widman Flap:

- Submarginal
- Inverse bevel
- Flap margin placed at the osseous crater (Something in these lines)
- Replaced
34. Autoclave, how to check if the instrument is sterilized 9something like this)
- Biological monitors
- Temperature sensitive controls
35. If ridge is resorbed how will the anterior teeth look like
- Long
- Narrow
- Lingual
- Buccal
36. How to check if the junctional epithelium is formed:
- Microscope
- Explorer
37. Study to know the affect of gastric bypass surgery on nutritional status:
- Observational
- Clinical trial
- Descriptitve
- Cohort
38. If the total stimulated amount of saliva is 0.5ml/min, what I indicates:

- Xerostomia
- Salivary hypofunction
39. Why fovea are not included in dentures:

- It covers minor salivary glands and they need to be relieved
- Because fovea determines the posterior border
- Some other options
40. Mandibular canal is present lingual to the 2nd mandibular premolar . if the xray tube head
moves inferiorly, where the canal appears to move:
- Apically
- Coronally
- Mesially
- Distally
41. Easy questions of VDO and interocclusal space. Know the following important facts that
will help you to answer these VDO questions:
- Excessive VDO means less interocclusal space (freeway space at rest)
- Decreased VDO means more interoccusal space (Freeway space at rest)
- Excessive VDO causes – clicking of dentures (Correction – dec VDO)
- Decreased VDO causes – angular chelitis (Correction – Inc VDO)
42. I got 5-6 interfernce questions

43. I got 7-8 patient management questions with all different type of dentist – patient
conversation situation kind of questions like the one I mentioned in question 7 above.
(We don’t have proper source to read or know these kind of questions. It was very hard to
choose between these options because all were so close 
44. I just got 2 xary identification on day 1whch were

1. Soft tissue of the nose
2. Fibrous dysplasia (Not the same x-ray. But it was kind of similar. I was confused with
ossifying fibroma. Know the differences)
Day 2:
Case 1:
50 years, came for for paim in max right upper jaw. Smokes 40 pacls per year. 30 and 31
were aymptomatic and respond to vitality tests.
1. All can be differential diagnosis for pigmentation on palate except :
- Lentigo
- Malignant melanoma
- Melanotic macule
- Melanotic neoplasm
2. There is a movable bony soft tossue in buccao lingual vestibule. What it can be
(Radiograph had radiopaque mass in the buccolingual region)
- Sialolith
- Ranula
- Lymphoepithelial cyst
- Plebolith
3. What is the radiograph taken to see the radiopaque mass in the buccal vestibule?
- Occlusal -- answer
- Cbct
- More options
4. All are differential diagnosis for lesion found in between 30 and 31 except (xray was
similar to this but the molar is nicely erupted.
- OKC
- Amelobalstoma
- LPC
- Radicular cyst
(remember teeth 30 and 31 are vital)
5. What will you do this lesion:
- Incisonal biopsy
- Excision biopsy
- Resection
- Observe for 6 months
6. Xray of max sinus mucous retention pseudocyst
7. In order to design a new study to assess caries 9Somethimg like this), what you need
- Incidience of caries need to be known

- It should reflect dichotomy – disease and no disease
- Wrong definition of specificity (So this option is obviously wrong)
8. Chalky white appearance of teeth could be because of

- Flourosis
- AI
9. Asymptomatic mass in the marginal gingiva opposite to 6. It was pinkish in color in

clinical picture, diagnosis
- Peripheral ossifying fibroma
- Peripheral Ginat cell grnualoma
- Pyogenic granuloma
- Papilloma
Case 2:
5 years old came for check up,
1. He need to get his primary incisors extracted within a period of 6 months. What space
maintainer?
- LHA
- PHA
- No space maintainer
2. His K is extracted, wgat space maintainer

- LHA
- Diatl shoe
- Band and loop
3. His lower 1st molar extracted on both sides. What space maintainer
- Band and loop
- LHA
4. Difference between ECC and nursing bottle caries

Case 3:
9 years old kid
1. Asked if dental age corresponds with chronological age
- Yes it corresponds
- Lags behind
- Much ahead
2. What is the kind of resorption seen in the mesiobuccal root of 2nd primary molar
- Inflammatory
- Normal resorption
- Replacement
- Infectious
3. 1st molar is ankylosed. What to do?

- Extract
- Leave it
4. Calicifiction of how many permanent teeth buds are seen?
- 28
- 30
- 32
5. 8 is darker in color clinically than 9. Reason for the darkness could be (8 had already
some endo done in it.
- Previous trauma
- Apically filled amalgam
6. Best treatment of 8
- Redo rct with post and core and composite build up with crown
- Composite build up with crown
7. Lateral incisor in cross bite. Reason could be:

- Crowding
- Don’t remember others (Just try to known all the causes of cross bite)
8. What is the movement needed to correct the lateralcross bite - tipping
Case 4:
1. Patient had multiple amalgam restorations. They asked which one was filled with low
copper. It was easily identifiable. All amalgam restorations were shiny except one. That
one was the answer because low copper increase corrosion
2. She took many medicines. Most common reason for xerostomia – medications
3. She had cold sores in the corners of mouth. Reason could be what?
4. Radiolucency inferior to 1st premolat – normal anatomy (I think it was mental foramen)
5. Identigy radiolucency beside the condyle – I chose external auditory meatus
6. Identify – genial tubercles on iopa
Case 5.
Prostho related (Not bad it was doable. Basics were enough)
Total I had 9 cases. Please be aware of the time. It was hardly sufficient.
Please pray for me. Good luck to you all!!!

1)Uses for pomp regimen
2) not an ingredient of pomp regimen
3) difference between the pomp regimen and mopp or something like that
4) which one of them for ALL : pomp or mopp
5) something about pomp and cytotoxicity
6) major side effect of pomp
7) marginal gingivitis mostly in : white , black , Hispanic , Asian
8) 8-year-old patient with all primary molars still present exhibits a cusp-to-cusp relationship or
permanent maxillary and mandibular fist molars. The dentist should
A. continue regular recalls
B. plan serial extractions for more normal adjustment of the occlusion
C. refer the patient to an orthodontist for consult ion
9)major disadvantages of treatment using a cervical headgear is

B. extrusion of maxillary incisors
C. extrusion of maxillary molars
10) anatomic crossbite, as contrasted with a functional crossbite, usually demonstrates

A. marked wear facets
B. smooth closure to centric occlusion
C. deviated closure to centric occlusion
11)Alcoholic euphoria results from

A. increased activity of the cerebrum.
B. increased activity of thalamic areas.
C. increased activity of limbic synapses.
D. decreased activity of medullary centers.
E. removal of the inhibitory effect of the cortex.
12) portion of an artificial tooth that is found only in porcelain anterior teeth is
A. the pin.
B. the collar.
C. the finish line.
D. the diatoric.
E. None of above
13) Which of the following is a disadvantage of glass ionomer cement?
A. Difficulty in mixing
B. Irritation of the pulp
C. Low bond strength to dentin
D. Moisture sensitivity during initial set
14) Primary herpetic gingivostomatitis is most likely to occur in which of the following age
groups?
A. 1-5 years
B. 6-10 years
C. 11-15 years
D. 16-20 years
E. 21-25 years
15) In a Class II cavity preparation, preparing the gingival wall at a right angle to the long axis of
the tooth is a function of which of the following
?
16) Gingival irritation during dentist supervised at-home bleaching procedures is best minimized
by;
17) Which most appropriate sequence when restoring a case is indicated?
18) Administration of digitalis glycosides

A) increase the heart rate
decrease the ejection fraction
C) increase the end-diastolic volume
D) increase the sympathetic activity
E) decrease the peripheral resistance
19) Each of the following is an advantage if the free gingival graft auto graft is placed directly on
bone tissue during widening of attached gingiva EXCEPT one. Which one is this EXCEPTION?
A) Less swelling
😎 Better hemostasis
C) Less postoperative mobility
D) Less shrinkage
E) Faster healing rate
20) Which of the following type of cells can be categorized as radio responsive?
A) Lymphocytes
😎 Myeloblastic cells
C) Fibroblasts
D) Hepatocytes
E) Corneal cells
21) Each of the following is a precaution taken during an informed consent EXCEPT one. Which
A) A description of the propo
Material risks but not foreseeable risks
C) Benefits and prognosis of the proposed treatment
D) All reasonable alternatives to the proposed treatment
E) The risks, benefits, and prognosis of the alternative treatment
22 ) Each of the following oral signs and symptoms is seen in Down’s syndrome EXCEPT one.
A) Macroglossia
😎 Fissured tongue
C) High arched palate
D) Enamel hypoplasia
E) Bifid uvula
23)A posterior tooth under a heavy occlusal load has cusps undermined with caries. The
restorative material of choice would be
1. cast gold. 2. silver amalgam. 3. composite resin. 4. direct filling gold.
24)For a 12 year old, the treatment of choice for a fractured mandibular lateral incisor involving
the mesioincisal angle but not the pulp is
1. etching and placement of a resin restoration. 2. a lingual dovetail inlay. 3. a pin-retained

metallic restoration. 4. a porcelain-fused-to-metal crown
25)An incipient carious lesion on an interproximal surface is usually located

1. at the contact area. 2. facial to the contact area. 3. lingual to the contact area. 4. gingival to
the contact area. 5. occlusal to the contact area
26)In the preparation of a cavity for restoration with composite resin, all cavosurface angles
should be
1. well-rounded. 2. right angles. 3. acute angles. 4. obtuse angles.
27)The dietary carbohydrate most I ikely involved in the etiology of dental caries in man is
1. glucose. 2. sucrose. 3. dextran. 4. polysaccharide. 5. that produced by Streptococcus mu
tans
28)Untreated dental caries may cause

1. pain. 2. gingivitis. 3. dietary deficiency. 4. occlusal interferences. 5. all of the above. 6. only
(1) and (4) above
29)A decrease in which of the following properties of saliva is likely to cause a decrease in
caries activity?
1. pH 2. Flow 3. Viscosity 4. Mineral content 5. Buffering capacity
30)Which of the following agents may be used on dentin as a cavity medicament because it
does not irritate the dental pulp?
1. Silver nitrate 2. Phenol 3. Prednisolone 4. Alcohol 5. Chloroform 6. Ethyl chloride
31)Which of the following is the best substitute drug for a patient allergic to penicillin?
1. Lincomycin 2. Tetracycline 3. Sulfonamide 4. Erythromycin 5. Ampicillin
32)Each of the following is useful as an antihypertensive agent EXCEPT 1. reserpine. 2. amyl

nitrite 3. hydralazine. 4. chlorothiazide. 5. alpha-methyldopa.
33) The principal factor in minimizing the firing shrinkage of porcelain is the
1. fusion temperature. 2. ratio of flux to feldspar. 3. uniformity of particle size. 4. thoroughness
of condensation.
34) When crowns are to be placed on abutment teeth for a partial denture, the
1. wax pattern contours should be surveyed. 2. crowns should be placed prior to surveying for
clasp design. 3. wax pattern should be carved by the direct method. 4. wax pattern should be
carved to the original morphology. 5. All of the above
35)The cuspal inclines of the maxillary buccal cusps and the mandibular lingual cusps should be
ground if they are in deflective occlusal contact in
1. working position only. 2. balancing position only. 3. both working and balancing positions. 4.
centric position
36) Esthetics of a removable partial denture may be dependent on the

1. morphology of natural anterior teeth. 2. established path of placement. 3. type of indirect
retention. 4. All of the above 5. None of the above .
37) Proper lip support is provided primarily by the
1. labial face of the teeth and simulated attached gingiva. 2. thickness of the border in the
vestibule. 3. festooned carvings on the labial surface. 4. convex surface of the labial flange.
38) The Bennett movement exerts its greatest influence in

1. lateral movements. 2. protrusive movements. 3. opening movements. 4. closing movements
39) The face-bow is used to record

1. centric relation. 2. relation of the mandible to the maxilla. 3. relation of the maxilla to the
temporomandibular joint. 4. relation of the mandible to the temporomandibular joint.
40)A midline fracture of the maxillary denture is most often due to

1. the acrylic being too thin. 2. the patient biting too hard. 3. use of a poor grade of acrylic. 4.
excessive resorption of the alveolar ridges.
41) Palatal tori should be removed when

1. lobulated and irregular in contour. 2. overlying mucosa becomes thick and fibrous. 3. first
detected and, if possible, before growth is completed. 4. they cause chronic ulcers or
cancerphobia, or prevent good prosthodontics.
42)Lidocaine {Xylocaine®) is an example of an

1. acid. 2. amide. 3. este(. 4. aldehyde.
43) Inflammation of a salivary duct is referred to as

1. pneumatocele. 2. sialodochitis. 3. Sjtsgren 's syndrome. 4. chronic sialadenitis. 5. acute
sialadenitis
44) Which of the following may be a feature of acromegaly?

1. Large tongue 2. Micrognathia 3. Hypoglycemia 4. Crowded teeth
45) A disadvantage of a removable space maintainer is that it

1. is difficult to keep clean. 2. cannot be made esthetic. 3. will not maintain vertical dimension. 4.
may not be worn.
46) Dentinogenesis imperfecta differs from amelogenesis imperfecta in that the former is
1. a hereditary disturbance. 2. the result of excess fluoride ingestion. 3. characterized by a
brown color of the enamel. 4. the result of faulty enamel matrix forr:nation. 5. characterized by
calcification of the pulp chambers and the root canals of the teeth.
47) The major etiologic factor responsible for Class 11 malocclusion is
1. sleeping habits. 2. growth discrepancy. 3. thumb and tongue habits. 4. tooth-to-jaw size
discrepancy
48) Frankfort-horizontal is a reference plane constructed by the joining of the following

landmarks:
1. porion and sella. 2. porion and nasion. 3. porion and orbi tale. 4. nasion and sella.
49) A child"s behavior problem can be handled by familiarization if the basis of the problem is
1. fear. 2. pain. 3. anxiety. 4. attitude of the parents.
50) The most common local cause of malocclusion is

1. hypothyroidism. 2. presence of supernumerary teeth. 3. early loss of primary teeth. 4. late
eruption of permanent teeth. 5. congenital absence of third molars.
51) To achieve normal occlusion, provided the molar relationship is correct, the most favorable
eruption sequence in the maxillary arch is
1. first premolar, canine, second premolar. 2. canine, first premolar, second premolar. 3. first
premolar, second premolar, canine. 4. second premolar, canine, first premolar.
52) A nonvital primary incisor (abscess due to trauma) in a four-year-old patient can be
effectively treated by
1. pulpectomy. 2. extraction. 3. 5-minute formocresol pulpotomy. 4. 7-day formocresol
pulpotomy
53) Amalgam often tends to discolor the tooth. This can be inhibited by using
1. a rubber dam. 2. a zinc.free alloy. 3. an alloy containing zinc. 4. calcium hydroxide on the
pulpal floor. 5. cavity varnish on all cut surfaces.
54) A diagnosis of small occlusal cavities is most readily made by the use of
1. bite-wing radiographs. 2. periapical radiographs. 3. panoramic radiographs. 4.
transillumination. S. an explorer and compressed air.
55) Mesial drift may occur as a result of

1. interproximal caries. 2. interproximal attrition. 3. premature loss of primary molars. 4. all of
the above
56) An ankylosed primary molar may result in all of the following EXCEPT
1. loss of arch length. 2. a serious problem of extraction. 3. delayed eruption of the succeeding
premolar. 4. failure of calcification of the permanent successor.
57) Two or more teeth united only by cementum is designated as

1. fusion. 2. sclerosis. 3. gemination. 4. dilaceration. 5. Concrescence
58) An oral condition which predisposes an individual to an increase in incidence and rate of
development of dental caries is
1. xerostomia. 2. leukoplakia. 3. pharyngitis. 4. herpes stomatitis. 5. median rhomboid glossitis.
59) The most common malignancy within the oral cavity is the
1. ameloblastoma. 2. adenocarcinoma. 3. basal cell carcinoma. 4. malignant mixed tumor. 5.
squa,nous cell carcinoma. .
60) The acute periapical abscess

1. may be accompanied by regional lymphadenopathy. 2. is usually asymptomatic. 3. has
inevitable severe systemic manifestations. 4. is not relieved by drainage.
61) Sulfur granules" are of d iagnostic value in suspected cases of

1. h istoplasmosis. 2. actinomycosi·s. 3. lead sulfide tissue deposits. 4. scrofula. 5. Furunculosis
62) Multiple giant cell lesions of bone are associated with

1. pituitary deficiency. 2. hyperparathyroidism. 3. Addison's disease. 4. hypothyroidism. 5.
diabetes.
63) Chronic osteomyelitis with proliferative periostitis of the mandible (Gard's chronic
nonsuppurative sclerosing osteitis) is characterized clinically mainly by marked
1. endosteal bone formation. 2. periosteal bone formation. 3. resorption of cortical bone. 4.
resorption of medullary bone.
64) Leukemic gingivitis, because of spontaneous hemorrhage and necrosis, may be

misdiagnosed as
1. necrotizing ulcerative gingivitis. 2. thrombocytopenic purpura. 3. infectious mononucleosis. 4.
desquamative gingivitis.
65) The most reliable single histologic criterion for a diagnosis of oral squamous cell carcinoma
is
1. invasion. 2. degeneration. 3. pleomorphism. 4. encapsulation. 5. Hyperchromatism
66) The most common cyst in the oral regions is

1. a median cyst. 2. a radicular cyst. 3. a follicular cyst. 4. a nasolabial cyst. 5. an epidermal
inclusion cyst.
67) A patient has a swelling of long standing at the ala of the nose on the left side. Examination
reveals a swelling in the floor of the nostril and beneath the upper lip. There is no pain and
regional teeth arc vital. Radiographs show no bone change. The preliminary diagnosis would be
1. alveolar abscess. 2. incisive canal cyst. 3. nasolabial cyst. 4. dermoid cyst. 5. maxillary
sinusitis
68) The primary cause of radiation damage is

1. ionization. 2. direct effect. 3. genetic damage. 4. indirect effect.
69) Which of the following would most likely be associated with a nonvital tooth? 1. Radicular
cyst 2. 2. I nternal resorption 3. Periapical cementoma 4. Hyperplastic pulpitis 5. Active
formation of a true denticle
70) Congenital syphilis and Hutchinson's triad include each of the following EXCEPT
1. Ghon complex. 2. mulberry molars. 3. notched incisors. 4. interstitial keratitis. 5. nerve
deafness, rhagades, saddle nose.
71) Of the following locations, the one in which the prognosis of epidermoid carcinoma is least
favorable is the
1. lower lip. 2. upper lip. 3. hard palate. 4. buccal mucosa. 5. posterior lateral border of the
tongue.
72) A two-day old developing plaque would consist primarily of

1. filamentous organisms. 2. gram-positive cocci and rod-like organisms. 3. a structureless,
non-mineralized pellicle. 4. spirochetal organisms.
73) A common gutta-percha solvent is

1. alcohol. 2 chloroform. 3. Cresatin®. 4. beechwood creosote. 5. camphorated p-chlorophenol.
74) Percussion is a dental diagnostic procedure
1. the tooth is vital. 2. the pulp is hyperemic. 3. a periodontitis exists.. 4. the pulp is
metaplastic.. 5. All of the above
75) aging of pulp cause increase in :
76) Histologically, the dental pulp most closely resembles what type of tissue?
1. Nerve tissue 2. Vascular tissue 3. Granulation tissue 4. Loose connective tissue
77) The main result of trauma from occlusion is

1. mobility of teeth. 2. pain on percussion of a tooth. 3. faceting of the cusps of the teeth. 4. pain
on drawing cold air into the mouth. 5. a widened periodontal space on radiographic examination.
78) Defense cells of the pulp include

1. fibroblasts. 2. polycytes. 3. histiocytes. 4. Kupfer's cells. 5. all of the above
79) A patient complains of a dull pain in the area of the maxillary right molar and premolar'
region. There is no radiographic evidence of pathosis or sensitivity to percussion; however, the
teeth in the quadrant respond weakly to the electric pulp tester and respond within normal limits
to other tests. The correct procedure is
1. pulpotomy. 2. extraction. 3. root canal therapy. 4. further observation.
80) The purpose of electric pulp testing is to

1. differentiate the stages of acute pulpitis. 2. differentiate between vital and nonvital pulps. 3.
differentiate between acute and chronic pulpitis. 4. determine whether pulps are normal or
diseased. 5. determine whether a stimulus applied to a tooth is perceived by the cortex of the
brain
81) A young man who is a hemophiliac has a maxillary first molar which has a putrescent pulp
and a radiolucent area around the lingual root. Which treatment is best from the standpoint of
the patient's welfare?
1. Conventional root canal treatment 2. Leaving the tooth alone until it gives rise to pain 3.
Extracting the tooth because hemophiliacs do not respond to root canal treatment 4. Sealing
paraformaldehyde in the pulp chamber to fix the necrotic material in the canals
82) from RITA ; 6 - 11 - 12 - 15 - 19 - 21- 23- 31 - 34 -35 - 41 - 46 - 49 - 53 - 58 - 60 - 61 - 62 -

70 - 76 - 77 - 81 - 87 - 90 - 111 - 119 - 155 - 187 - 215 - 227 - 268 - 288 - 301 - 309
83) why do we use he magnificaton ruler in cephalometric radiograph ?
84) from MANGO ; 14 - 26 - 33 - 36 - 49 - 56 - 77 - 80 - 88 - 105 - 113 - 138 - 156 - 158 - 159

-193 - 195 - 197 - 204 - 214 - 219 - 220 - 222- 225 - 246 - 252 - 266 - 269 - 278 - 314 - 351 -
356 - 363 - 378 - 403 - 414 - 425 - 429 - 439 - 462 - 484 - 492 - 560 - 566 - 588 - 604 - 638 -
688 - 720 - 737 - 748 - 753 - 872 - 886 - 914 - 952 - 1006 - 1050 - 1077 - 1080 - 1093 .
85 ) ab for sinusitis ; no augmentin in options
86 ) radioraph that has the soft tissue of nose over the max incisors
87) DAY 2 ; cases similar to kiwi cases # 3 - 6 - 17 - 26 - 32 - 35 .
That’s all i remember please pray for me to pass .
ff,ko
6
17
26
32
35
From kiwi file
MAY 3 218 RQ
EPT:
I got 4 Q on EPT, two of them were asking about how EPT works, these were a little pit confusing
all are true about EPT except ?

It is more reliable than cold testing for necrotic teeth
give relative health status of pulp
Tells if there are vital nerve fibers ( or some words similar to conductivity of nerve)
Note: EPT only tells if there is conduction of nerve or not ..

VITALITY OF TOOTH IS DETEWRMINED BY BLOOD SUPPLY,, as long as it has blood supply ,, it is vital it
does not matter weather it is responsive or not ,, that is why ept is not accurate in open apex or recently
traumatized tooth
Another q about percution ,, I don’t remember the exact q but they also asked about the basic concept
of percution - It indicate PDL inflamation
Xray tech : maxillary sinus appears closer to roots? Bisecting technique
Minimum width of the maxillary palatal strap? 8 mm width & thickness 1.5 mm
For treatment planning for an implant what is NOT considered? Age / Bone quality/Region /Smoking
Most important feature in a single implant placement: Antirotational element in the implant(HEX)
Internal connection in the implant:  cementing the pontic to abutment ( they used these exact word in
the exam CEMENTING ,,, in files they used word attaching the abutment to the implant )
Which drug works by mechanism other than acting on receptors; Osmotic diuretics
2ry hyperparathyroidism caused by : Renal failure
Route of spread of Hepatitis A Food and beverages ( this the only option given comply with feco-oral
route ,, other options were respiratory ,, blood porne…etc)
Two factors that will decide the placement of the posterior composite
Tech and pt selection
Resin type and technique
Support for kennedy class 3 with modifica on one

Indirect retainers / Occlusal rest / Denture base / Major connector
Acute Herpetic gingivostomatitis is common in
4 month
2 yrs
6 yrs
8 yrs
Histologic or microscopic feature of Herpes  Lipschultz bodies
Longest LA agent
lidocaine
Articane
Bupvicane
Fixed partial denture , the palatal cusp tips interfere in all excursive movement. What is ur next step
Make the prosthesis
Grind the palatal cusp tips
Mount and evaluate the diagnostic cast
Occlusion in which all the posterior teeth disarticulate during right excursive movement
- Balanced occlusion
- Group function
- Mutually protected
- Fully balanced occlusion
Which is least important in causing root caries

Low salivary rate
Elevated levels of sucrose consumption
History of chemo/ radio therapy
S. sanguis present in plaque
Site for caries initiation  Pit and fissure enamel
Rubber dam does NOT protect against

Exhaled nitrous oxide
Mercury vapor inhalation during amalgam removal
Aspiration of inlay
Laceration of tissue
Unecessary chemical exposure
(( this Q had been debated in the Fb group and we came up with nothing,, I picked Hg vapor because
N2o is not harmful ))
Fetal alcohol syndrome :: cleft lip / midface deficiency / anencephaly

I got some Q about smoking, alcohol and cancer relationship, I don’t remember weather they combined
these 3 in a two statements T/F q or they had been asked separately,, anyways, U HAVE TO KNOW THE
FOLLWING FACTS: and u will be able to answer any Q regarding this topic.
- smoking is the most approved worldwide material that cause oral cancer ( they used word worldwide )
- Alcohol predispose cancer ( notice the difference because they used this word predispose in the exam )
- alcohol when combined with smoking  synergetic effect ,,,i.e the probability of developing cancer is
much higher than smoking alone or consuming alcohol alone
which of the following is in charge of dental materials and devices FDA
Border molding for the masster what movement is done  Close mandible against pressure
To capture the masseter under function  ask the pt to clinch during border molding
To record lingual flange  FUNCTIONAL movement of tongue (be cautious :: there is another option - full
movement of tongue – don’t chose it )
candida albicans will increase in  chemotherapy
What make age 11 characteristic

-. Maxillary canine and 1st premolar
- all 1st premolar and mandibular canines
- all 2nd premolar
- all 2nd molar
headgear used to move the maxillary dentition forward  face mask (reverse pull head gear)
( I am not sure weather they used the word protraction in this q or not ,, anyways be careful because they will
through words like protraction / retraction to confuse u )
not found in trisomy 21

macroglossia
Class 3
Rampant decay
Delayed eruption
intraoral + skin nodules + macular pigmentation , no other clinical sign or symptom

peutzjegher
Mc Albright
Neurofibromatosis
Hereditary familial
Dentition in achondroplasia
Normal (but crowed)
Macrodontia
Supernumary
least desirable in making a crown seat completely
Use die spacer
Using cast ring for investement
Use disclosing agent to identydiscrpencies
Altering the w/p ratio
what will happen when u increase the powder in zinc phosphate cement
Decrease viscosity
Increase initial irritation in the cavity
Decrease film thickness
Decrease solubility
Initial treatment for gingival bleeding , loss of strippling and rolled margins
SRP
radiographic feature of sickle cell anemia

Step ladder trabeculation
Multiple radiolucencies
Multiple radiopacities
Pt has von will brand disease  desmopressin

( this q was a quite long ,, ,,, once u c von will brand disease ,,, go to the answers and find desmopressin even if
they put it with other drug name like (desmopressin and clooting factor )
handing out questionnaire at the end of a evalution . what type of study  Cross sectional
First pass metabolism  Enterohepatic circulation

Metabolism in liver
Absorption in the small intestine
34. a ques on on drug response and drug percent graph. What they have in common. ( I don’t remember
exactly)
Clinical attachment loss is seen is which stage
Intial / Early / Established / Advanced
Dentifrice for dentin hypersensitivity

5% Cacl2
5% KNO4
White spot on facial surface non cavitated and has matte finish. Treatment
5% fluoride varnish
No treatment
10% chlorhexidine is used in

Pit and fissures
Secondary caries prevention ◄
Incipent enamel lesions
Ideal material to replace the loss of large alveolar bone

Autologous / Dried freeze decalcified
Side effect of allkylating anticancer agents  Bone marrow suppression
which orofacial pain will you refer the patient to a physician  Temporal arthritis
another Q about Temporal arthritis  the most serious complication  blindness
which of the following is not part of scientific article

Interpretation
Method
Result
Introduction
Best method to deliver xylitol  Chewing gum
child with ortho ttt is completed ,,, he has poor oral hygiene, best retainer  Removable
Avulsion is classified according to WHO  Luxation
in rela on to the marginal ridge , height of matrix band for class 2 should be
Below
At same level
1mm higher
3 mm higher
You did a large MOD amalgam . after 2 days pt complains of sensi vity and pain of 2 sec on cold .
Thin liner thickness- observe

Thin liner thickness- initial pulp therapy
GIC linear- redo
Calicium hydroxide liner – redo( myb. Dnt remember the treatment given with this option )
hypoxia in a patient under GA. First sign
Increase pulse rate
Bluish tinge in the skin
all of the following affect the base thickness except

Size of tooth
Remaining dentin thickness
Base thickness
Thickness of the restorative material used
Pt present with moderate celluli s and fever of 100.8 . a er incision and drainage what will u do
Penicillin VK – 1g followed by 500mg 4-6 hrs for 7-10 days, penicillin drug of choice
interdental bone is apical to redicular bone. Its called

Reverse architecture
which of the test is Not used for type of bacteria and its metabolic products
DNA test
Enzyme test
Interleukin (IL -1 ) test
Dark field micrscopy
Antibiotic for Non odontogenic Maxillary Sinusitis ?Augmentin amoxicillin +clavulanic acid ( for any upper
respiratory infection augmentin)
local anesthetic for hyperthyroid patient? Mepivacaine
MOA of H1 Histamine blocker??competitive antagonism of histamine binding to cellular receptors (specifically,

the H1-receptors)
how to motivate the pt for proper oral hygiene, you do all except?  carrot & stick
hydroxyzine?? Antihistamine used to treat anxiety, used with anesthesia before medical procedures
Tooth with a ledge- how to manage? Bypass with smaller instrument
sag factor low deformity
clopidogrel?  antiplatlet , increase bleeding time
Purpose of making record of protrusion relation... To adjust horizontal condylar guidance
Sedative Meds for pregnant and lactic mother ; Promethazine
ANUG  Debride h2o2 and an bio cs only if systemic involvement
Who LEAST affected by N/O (nitrous oxide ) patient ( den st and other dental staff are exposed to n2o
frequently)
Meds for pet mall Ethosuximide
Kids most having what type of seizure? febrile)
What meds not use in Angina  diuretics
Major connector function? Stability and rigidity
Ca hypochlorite ( 3 or 4 q) , u have to know what ca hypo does

 don’t remove smear layer , only necrotic tissue ,
 no cleations
 antimicrobial effect
 lubricant, irrigant
EDTA function Chelating agent ( remove smear layer and hard tissue)
Hystodifferention what happening Amelogenesis imperfecta dentinogeneussimperfecta ,dentin dysplasia -

structural deformity
SLOB ??Same lingual opposite buccal used for interposed objects
Most radioresistent  nerve
Reason why people have supernumerary teeth Genetic
Who responsible for dental materials and technology??
Powder in ZOE?? Zinc oxide
Xerostomia treatment??Pilocarpine, civemiline
Pilocarpine does not increase xerostomea ,,, it does treat xerostoma
Pt has bad OH, calculus , gum bleeding. She wants prophylactic cleaning , what is your treatment ? 1.you do
prophy as Pt request.2 explain her that it can take 2 visits.3 tell her that she need to do be er job with OH 3 SRP
Fusion, germination
When you need to use papoose blanket? Uncooperative patient
Translumination use for kids for?Sialolithiasis
N/O q all contraindica ons?NO is contraindicated in nasal conges on and COPD,+ 1st trimester
What age you can place implants.??a er 18
Q about pt transfer  Sliding remain the best method

A new diagnos c test is evaluated against an independent “gold” standard” in 100 subjects with the following
results: NPV=TN/(FN+TN) 8/(32+8)
True posi ve = 48
True nega ve = 8
False posi ve = 12
False negative = 32
What is the negative predictive value of this new diagnostic test?
A- 20 percent
B- 40 percent
C- 60 percent
D- 80 percent
Ludwings angina doesn’t involve?Retropharyngeal
Antifungal Troche – clotrimazole
Effect of traumatic cyst on roots

Scalloping around roots ◄
resorb roots
displace roots
what is the radiolucency in the pic:

it is stafen bone cyst but in the exam they gave other name : salivary gland depression or something like
idiopathic salivary gland depression
it is same cyst ,, it is very rude Q because there is many nomenclature for this cyst
perforation- anteriors mesial,ant teeth are inclined distally,, so there is a great chance to perforate the mesial
wall of canal during instrumention
hairy tongue. which papille? filliform
NO2 is teratogenic and not recommend : 1st trimester
Abscess,, what cell predominate? – neutrophils have PMN)
frankfort line?Prion to orbit

chronic perio? black male
The wall absent in class v  Pulpal
Battery  ttt without consent
You are going to remove palatal tori from a pt`s palate,, which drug regimen you don’t have to modify before
proceeding in ur surgery?
Methotrixate (rheumatrex) 15 mg per week for 18 monthDenosumab (Prolia) 2% 60 mg for 2 months

Bevacizumab ( Avas n) 70% or 6 month
Alendronate sodium (fosamax)
Another 5th drug ,, I don’t remember it but is was belong to Denosumab family
 I picked 1st choice Methotrixate because the rest of drugs are bone stabilizer and could induce MRONJ
optimum reduction for buccal cusp in PFM crown :

0.5
1.0
1.5
2.0
hex in implant for antirotational abutment
feldspar main ingredient??

silica
alumina
which medicine is not good to give in patients with kidney disease? ibuprofen, aspirin, codeine
melasma is seen in - preganant.
alveolar bone graft whole mandible area what should be used??

autograft
decalcified freezed
Disadvantage of using elastomeric impression material in taking occlusal record? Rebound
How deos wrought wire loose its elasticity.??Overadjustment
use of arcan articulator?? record condylar guidance in the maxilla and axial rotation in mandible
pt suffering from bone disease , ( pic below) , want new denture because his old one is no longer fit
Ans: pagets disease ,,, u can notice that his bone is extremely opaque
what is the error in the pic :: ( the xray they gave in the exam was extremely white, u can easily detect that it is
over developed ,,, overdevelopment was not in the options
options were related to exposure time,,too warm developer
I picked too warm solution

DAY 2
Case 1: old man , has MI, had adenocarcinoma before, took radiotherapy for that, hepa s before 24b yrs,
smokers, knee replacement before 6 months,
Oral findings: white patch on floor of mouth, anterior cross bite, missing maxillary molar and exostosis on the
buccal of mandibular premolar /molar area, melanotic macule on the palate
Quest:
3. Patch on the floor can be all except: stoma s nico nia
4. Which lab test for the viral infec on : HgSab ,/ HgcAb/, Transaminase ,/ no test
5. The pa ent is at increased risk for all except:
Procedure related bleeding / Hyposalivation / Osteoradionecrosis / SCC
Related only to the anterior region ( on the left side he had a missing canine maxillary and the posterior bite
looked collapsed)
8. Most important to consider when deciding for the an bio c prophylaxis : me elapsed since the surgery
Case 2: 8 yr old girl with many missing teeth due to caries and poor oral hygiene.. anterior cross bite and a
supernumary tooth

Injury to the nerve due to any previous accident can be increased(or somthg like that) during ortho
2. All are nega ve sequel of extrac on of the supernumary tooth except

Necrosis of 7
Non erup on of 7
Necrosis of 8
Necrosis of 6
3. Correc on of the anterior cross bite will result in all except
Improve erup on of tooth 11
One more option
4. Correc on of cross bite ASAP
Case 3:
Take albuterol
Quest:
3rd molar
Occlusal trauma
Caries
2. She starts wheezing on expira on . what will u Not do
Steroid inhaler
B2 agonist inhaler
Give oxygen

Quest:

2. All are risk of extrac on of the upper teeth. Which is LEAST excepted
Dry socket
Tuberosity fracture

Extract all anterior except canines on both sides, crown on the canine and removable
Extract all, implant and fixed from 27- 25 and 22- 24, remaning removable
Case 5
with 18 present. Has radio opaci es in that edentulous area.
Extrac on of 18
1. Smoking is a contribu ng factor for periodontal disease

2. Extrac on of 32 causes damage to the lingual nerve

A er extrac on of 32 the so ssue should be biopsied

MIA JONES – RQs (May 24-25)
Bisphosphonates – 4 questions (please study this thoroughly, the basics)

14 y/o boy – X ray – Fibrous dysplasia
Identify the soft tissue – Nose
Calculation of Negative prediction value. Simple calculation with the formula
Salivary secretions (3 questions) – when is it 0.1, when 0.5 and when 1
Adenoma with the same histology of parotid gland
4 questions on working interferences
Mandibular spaces- 2 questions, drainage of PM and drainage of Molars
Unbundling
Same Wheel chair question
Inter implant distance
Null hypothesis
Cross sectional study 2 questions
Diff between pulpal and periodontal disease – EPT
JE attachment
Asthma medication
Additional anchorage in ortho
75 y/o 6 week ago heart attack, transported to the clinic in wheelchair. – classification
3 questions on active listening and paraphrasing
4 Q on appropriate response to patients
Lithium used in
Nitrous oxide side effects
Moisture contamination – Delayed expansion and failure
Thyroid crisis symptoms – all except
Short crowns
Antibiotic for Myasthenia Gravis
Mao and TCA depressor
Mech. of action of phetolamine
Osteosclerosis – 2
Ectodermal dysplasia – oligodontia, sparse hair
Battery and autonomy
View for TMJ disc
Oxycodone – side effect
Neuropraxia
Gingivectomy – incisions and contraindications
Prone to fracture crown
Relapse on its own – hematoma, freckle, macule, varix
Plaque control in a 5 y/o medical compromise – NaF, CHX, Listerine
Abfraction
Erosion
Attrition
Tetracycline in 5 year old
PJ syndrome
Pemphigus lesions
Epidermolysis Bullosa- lesions
Dens in Dente – which teeth
Macroglossia seen in – amyloidosis or Hyperparathyroidism
Loss of arch space due to exfoliation of which teeth
5%, 35%, 55% - non verbal
6 y/o refuses to sit on the chair, what do you do
furcal radiolucency – occlusal trauma, cervical enamel eruptions
Taurodontism – which stage of development
12 y/o Max central Incisor obliterated – what is the treatment
etiology of rubella embryomyopathy
Pt needs bleaching and porcelain veneers, what is done first and in which order
Veneer broken- steps to repair
4 VDO questions
hemophilia tests
Coumadin and alcohol tests
Q on erosive lichen planus
Anticancer drugs side effects
Cisplatin Q
Troche – antifungal
AIDS symptoms – 1st stage
Linear gingival erythema
Spontaneous bleeding gums
HZV – mimics tooth pain
H stomatitis
SE of Antibiotics on kids
Root caries
Margin of porcelain and degree – 1 mm 120 deg, 1.5 mm 120 deg, 1mm 90 deg, 1.5mm 90 deg
Modelling
Behavior questions – 2Q
Which Periodontitis do you do SRP and systemic antibiotic
16mm overbite – treatment
Misprostol uses
staff wants to verify if instruments are clean – do you check the bag for the color change or bio
test
palatal tori – 2 Q
Condyloma acuminatum
Coxscakie virus
2 Mx PM questions
Metamerism
sensitization for a patient who is in pain or fearful
disinfect GP
combination syndrome
Area of class II on composite restoration commonly recurrent decay
Porcelain 2 Q – firing, condensed improperly
Adv of glass fibreposts
What in saliva helps remineralization
Adv of base metal alloy over high noble
2 questions on Alpha1 and B2 receptor
Day 2
1. 2 pediatric cases
1 exclusively featured on ortho issues (all 9 questions)
2nd was more about plaque control, marginal gingivaitis, assessing need for Space
maintainers
2. Lady with a H/O of smoking, drug usage needs a complete Upper and lower partial.
Prostho questions.
I will add the other cases in the comments, soon.

!**Kat’s!NBDE!II!NOTE!AWESOMENESS!**!
!
Biomaterials!
• Noble&Metals&!&Gold,&Palladium,&Platinum&!&do&NOT&oxidize&
• Elastic&modulus&(resistance&to&bending)&!&HIGH&=&hard&
• Coefficient&of&Thermal&Expansion:&tooth&<&gold&<&amalgam&<&filled&resin&<&unfilled&resin&
• PMMA!!&power&(benzoyl&peroxide&=&initiator)&+&liquid&(hydroquinone&=&polymerization&inhibitor&in&storage)&
o Activators:&AutoLpolymerized&(tertiary&amine&or&dimethylLpLtoluidine)&+&HeatLpolymerized&(heat)&
o Exothermic&reaction&
• What&material&would&distort&in&100%&humidity&!&Irreversible&Hydrocolloid&(shrinks&–&releases&water&!&“syneresis”)&
• Good&wettability&!&hydrocolloids&(hydophillic)&>&hydrophilic&materials&(polyether)&>&hydrophobics&material&
• Condensation!silicones&!&least&wettability&with&slurry&water&(ethyl&alcohol&byproduct)&+&saliva&effects&it&
• Addition!silicones&(PVS)&!&Hydrogen&gas&release&(can&create&porosities&in&die)&+&retardation&by&latex&gloves&+&
hydrophobic&
• Polyether!(Impregum)&!&hydrophilic&+&absorbs&water&(distorts)&+&Rigid&(tears&if&stuck&in&undercuts)&
• What&inhibits&polymerization&of&composite!&&Eugenol&&
• Gypsum!(type&4&stone)&!&more&(water)&is&less&(expansion)&!&high&strength,&low&expansion&
• Amalgam&–&Mercury&+&silver&+&tin&+&Cu&(decreases&corrosion)&+&Zn&(scavenger&prevents&oxidation)&
o Copper&!&10L30%&!&eliminates&ϒ2&phase&(Sn3Hg)&!&weakest&most&corrosive&phase&
o ORGANIC&form&of&Mercury&is&most&toxic&
o Good&condensation&+&carving&minimizes&mercuryLrich&matrix&
o If#contaminated#with#moisture#during#condensation,#H2O#reacts#with#zinc#to#form#H2#gas#!#greater#expansion#+##
decreased#compressive#strength#+#post<op#pain#+#increased#corrosion#
o Spherical&&!&easier&to&condense&around&pins&(less&resist.&to&condensation&pressure)&!&strong&lateral&forces&+&
large&condensers&+&does&NOT&contain&more&Hg&
o Admixed&!&use&for&proximal&contacts&+&latheLcut&+&spherical&particles&!&withstand&forces&of&condensation&
BETTER&than&spherical&!&higher&levels&of&creep&+&corrosion&
o UnderLtitrated&!&“wet”&
o Overmixed&!&“dry”&+&decreased&working&time&+&increased&creep/contraction&+&doesn’t&decrease&strength&
o Precarve&burnishing&!&Denser&amalgam&at&margins&
• Composites&
o Initiators&!&camphorquinone&(470nm)&makes&free&radicals&+&Accelerators&(organic&tertiary&amines)&
o SelfLcure/autoLpolymerizing&cure&!&initiator&(Benzoyl&peroxide)&+&Accelerators&(organic&amines)&
o Silanes&!&bind&inorganic&and&organic&materials&with&hydrogen&and&covalent&bonds&!&make&stronger&bond&btw&
resin&+&tooth&surface&!&forms&hybrid&layer&with&dentin&+&resin&
o Increased&filler&!&reduces&coeffient&of&thermal&expansion&+&improved&workability&+&harder,&denser,&more&
resistant&to&wear&+&decreased&water&sorption&+&increased&radiopacity&
o “Snow&Plow&Technique”&!&uncured&flowable&with&packable&on&top&
o Flowable&!&no&difference&in&postLop&sensitivity&
o LED&curing&light&!&1000mW/cm2&
o Etching&!&reduces&Microleakage&
o Primer&!&remove&water&from&enamel&prisms,&dentin&tubules&+&expose&collagen&network&!&forms&hybrid&layer&
because&made&of&solvents&+&biLfunctional/amphiphilic&penetrating&monomers&which&allows&adhesive&resins&to&
form&microtags&within&intertuberular&dentin&
o “Direct”&!&B/L&width&of&prep&is&<1/3&interLcuspal&distance&
• Zinc&Polycarboxylate&!&zinc&oxide&+&polyacrylic&acid&
• Zinc&phosphate&!&acidic&–&need&varnish&over&pulp&!&mix&with&cold&glass&slab&&
• What&cement&is&used&for&ceramic&inlay&seating?&
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL&
Complete!Denture!
DENTURE&DESIGN:&
• Mandibular&denture&!&covers&2/3&retromolar&pad&
• Max&denture&!&extents&1L2mm&beyond&vibrating&line&
• DB&flange&is&determined&by&MASSETER&
• STABILITY&(resist.&of&denture&base&against&lateral&forces)&
• SUPPORT&(resist.&of&forces&directed&against&tissues)&
o Primary&stress&bearing&areas:&
" Maxilla&!&&Horizontal&portion&of&hard&palate&+&residual&ridges&(2nd&=&rugae&+&max&tuberosity)&
" Mandible&!&buccal&shelf&
• RETENTION!(resist.&to&dislodgement&of&denture&base&away&from&tissues)&
o Most&important&factor&!&peripheral&seal&(post.&Palatal&seal&for&max&+&lingual&flange&for&mandibular)&
MAKING&DENTURE:&
• After&trying&in&anterior&teeth,&make&record&of&anterior&guidance&to&determine&condylar&guidance&!&in&lab&must&RAISE&
THE&PIN&while&setting&the&condylar&inclination&
• Preserve&anterior&guidance&with&a&protrusive&record&
• TryLin&after&processing,&get&the&CR&by&placing&small&balls&of&wax&on&the&occlusals&and&remount&to&adjust&occlusion&
• Porcelain&denture&teeth&have&PINS&for&retention&into&acrylic&because&you&shouldn’t&grind&them&
PROCESSING:&
• Excessive&monomer&!&increased&shrinkage&
• With&respect&to&temperature,&the&processing&cycle&of&a&denture&is&designed&to&!&prevent&boiling&of&monomer&
• Excessive&heating&of&acrylic&resin&avoided&to&prevent&!&evaporation&of&monomer&
• Compressing&the&acrylic&resin&in&a&rubbery&stage&will&probably&result&in&!&incomplete&filling&of&mold&details&
o Pack&in&“doughy”&stage&(stage&right&before&“rubbery”)&
• Following&compression&of&acrylic&into&denture&flasks,&placing&flasks&into&processing&tanks&at&curing&temperature&is&
delayed&to&!&allow&flasks&and&acrylic&to&reach&a&stable&temperature&
CLINICAL&ISSUES/SCENARIOS:&
• Combination&syndrome&!&mandibular&incisor&EXTRUSION&(due&to&no&anterior&guidance&with&denture&teeth&)&+&max&
tuberosity&flabby&tissue&(hypertrophy)&+&max&anterior&ridge&atropy/bone&loss&+&posterior&mandible&bone&loss&+&
papillary&hyperplasia&
• Excessive&VDO&!&trauma&to&underlying&supporting&tissues&(redness&on&ridges)&
• What&sounds&is&altered&with&altered&VDO&!&“Sibilant”&sound&
• Not&enough&room&when&closes&!&adjust&MANDIBULAR&denture&
• Full&extractions&!&how&long&do&you&wait&for&max&denture?&&
• Remount&outside&the&mouth&!&so&muscles&won’t&interfere&
• Pt&wore&denture&for&15&years&then&got&irritation&!&Neurofibroma?&
• What&material&do&you&use&to&capture&VDO&!&&wax&occlusal&rims&
• Which&is&most&uncomfortable&for&pt&!&increased&VDO&
• Max&teeth&chewing&down&on&mand&anterior&edentulous&ridge&(looked&white&+&beat&up)&!&which&layer&of&cells&has&
increased&&!&Stratum&corneum&(top&layer&of&thick&dead&cells&containing&keratin)&
• Fricative&“f”&and&“v”&(“FiftyLfive)&!&maxillary&incisal&edge&position&
• “M”&sounds&(“Emma”)&!&bring&mandible&to&its&rest&position&
• Max&esthetics&for&setting&max&denture&teeth,&the&incisal&edges&of&max&incisors&should&follow&the&LOWER&LIP&when&
SMILING&
&
Endodontics!
• PM&most&likely&to&have&3&canals&!&1st&Max&PM&
• 1st&max&molar&has&50%&chance&of&having&4th&canal&(MB2)&!&most&common&tooth&to&have&failed&RCT&&
• 11&year&old&intruded&#7&!&splint&for&2&weeks&+&followLup&
• 4&year&old&intrudes&primary&maxillary&central&!&Leave&it&+&wait&for&it&to&reLerupt&
o INTRUSION&of&PRIMARY&!&no&treatment&unless&impinging&on&perm.&successor&(should&reLerupt&on&own)&
o NEVER&reLimplant&avulsed&primary&teeth&!&ANKYLOSIS&
• Max&centrals&+&molars&!&triangular&
• Mand&molars&!&trapezoidal&(everything&else&is&oval)&
• Vertical&root&fracture&!&most&common&in&mand&molars&+&pain&with&cold&and&upon&biting&+&
most&commonly&crack&in&BLL&direction&
• “Incomplete”&crown&fracture&!&without&loss&of&tooth&structure&
• Constriction&(anatomical&apex)&0.5L1mm&!&apical&FORAMEN&!&radiographic&apex&
• Replanting&MATURE&avulsed&teeth&(closed&apex)!&reposition,&splint,&canal&debridement,&
CaOH&therapy,&GP&fill&(NOT&a&single&appt&RCT)&&
o Closed&apex&!&no&matter&what&will&need&RCT&
• Cracked&tooth&syndrome&!&sensitive&to&cold&+&pain&upon&release&of&biting&+&crack&in&MLD&direction&(can’t&see&on&xLray)&
• Causes&of&RCT&failure&!&imcomplete&debridement&of&bacteria&+&failure&to&obtain&straight&line&access&+&accessory&canals&
uninstrumented&
• Replacement&resorption&=&ANKYLOSIS&
• Pt&calls&in&the&middle&of&night&with&irreversible&pulpitis&!&see&pt&in&office&+&INITIATE&RCT&
• Apexogenesis!!&Vital&Pulptomy&(MTA&or&CaOH&placed&over&canal&stumps);&does&NOT&increase&blood&supply&
• Apexification&!&clean&canal&+&placed&CaOH&!&week&later&appt&clean&out&CaOH&then&place&MTA&or&ProRoot&into&canals&
(stimulates&cementum&formation&to&close&apex)&!&3rd&appt&months&later&do&RCT&
• Pulp&capping&!&indicated&for&caries&exposure&into&pulp&2mm&or&less&
o >2.5mm&needs&apexification&or&RCT&
• Most&common&cell&in&necrotic&pulp&!&PMNs&
• Did&RCT,&pt&went&home,&still&sensitive&!&most&likely&OVERINSTRUMENTATION&
• Open&apex&tooth&!&use&THERMAL&testing&(NO&EPT&bc&ALdelta&fibers&not&complete&until&root&closure)&
o NO&EPT&for&crowns&(use&cold&test&also)&
• Percussion&!&most&reliable&test&for&KIDS&
• Zinc&oxide&!&basic&component&found&in&most&root&canal&seals&(antibiotic&properties&to&prevent&reinfection)&
• Root&performation&(can&be&in&pulpal&floor)&!&MTA&(seals&in&presence&of&moisture&+&induces&periradicular&tissue&repair&
+&cementum&deposition&
• Intrusion&of&a&MATURE&tooth&!&Necrosis&(blood&vessels&crushed)&
o For&PRIMARY&teeth&!&better&blood&flow&at&apex&so&90%&will&reLerupt&after&2L6&months&on&their&own&
• Horizontal&root&fracture&!&best&prognosis&if&closer&to&apex&!&Calcific&metamorphosis&(fragments&are&closely&
approximated&will&be&filled&in&due&to&the&trauma&inducing&osteoblasts&to&rapidly&form&dentin)&
o Following&trauma,&tooth&can&become&“yellowish”&looking&due&to&calcific&metamorphosis&within&3Lmonths&
• Mid&root&fracture&!&apical&half&of&root&can’t&be&engaged,&clean,&shaped&!&“Intentional&reimplantation”&!&extract&apical&
segment&+&replant&coronal&segment&that&recently&received&root&end&filling&
• Perforation&of&which&area&has&greatest&risk&of&RCT&failure&!&furcation&
• Location&of&perforation&with&BEST&prognosis&!&APICAL&
• Max&canine&!&most&consistent&root&canal&morphology&(long&root&+&most&straight&except&at&apex)&
• Reamers!!&used&to&ENLARGE&the&canal&(round&shape)&!&can’t&use&in&filing&motion&
• KJfiles&!&can&file&+&ream&(#15&and&#45&kLfiles&!&WHITE)&
• Plexus!of!Raschkow&(cellLfree&zone&of&pulp)&!&myelinated&ALfibers&(sharp&pain)&+&nonLmyelinated&CLfibers&(dull&pain)&
&
Esthetics!
• Value!!&most&important&factor&for&shade&matching&
o Complementary&colors&!&decreases&value&
• Hue&!&to&change&hue,&decrease&chroma&or&value&+&place&complimentary&color&over&it&(after&5&secs&look&at&something&
blue&to&readapt&vision&to&orange/yellow&portion&of&spectrum)&
• Orange&stain&is&added&to&porcelain&in&order&to&_______&&
• With&age&!&chroma&increases,&incisal&display&decreases,&value&decreases,&hue&varies&more&
• Fluorescence&(dentin)&!&absorbs&short&wavelengths&(UV)&+&reemits&longer&(visible&light)&!&fluorescence&decreases&
chroma&+&increases&value&
• Opacity&!&no&light&passes&through&because&all&light&is&reflected&
• Opalescence&(enamel)&!&hydroxyapatite&prism&refracts/scatters&shorter&wavelengths&(blue/violet)&+&transiluminates&
(lets&pass&through)&longer&wavelengths&(red/yellow)&
• Most&underLprepped&area&for&anterior&crown&!&cervical&1/3&(then&incisofacial&if&2nd&plane&of&reduction&not&placed)&
o Crown&can&look&too&opaque&because&not&enough&room&for&1mm&of&porcelain&after&metal&+&opquae&layer&
&
Fixed!Pros!
CERAMICS:&
• Most&likely&cause&of&failure&in&the&preLceramic&soldering&technique&is&!&overheating&the&parts&to&be&joined&together&
o Can&use&higher&melting&temp&when&you&preLceramic&solder&(once&porcelain&is&added,&you&have&to&be&careful&
about&using&a&temp&that&is&too&high&when&soldering&because&it&will&melt&the&porcelain&
• Porcelain&crown&has&green&stain&!&Silver&or&Copper&
• Porcelain&!&QUARTZ&(strength)&+&feldspar&(lowers&fusion&temp)&+&Kaolin&(binder)&
• Do&NOT&use&GI&resin&cement&for&all&ceramic&restoration&!&expansion&could&crack&porcelain&
&
CAST&Metals:&
• Casting&shrinkage&of&cobaltLchromium&allows&!&2.2%&
• Brittle&!&HIGH&compressive&strength&+&LOW&tensile&strength&
• GOLD&properties&(vs.&base&metal)&!&higher&melting&point&+&yield&strength&+&hardness;&lower&specific&gravity&&
• Cast&gold&restoration&might&be&indicated&for&replacement&of&faulty&amalgam&to&obtain&more&ideal&contours&
• Cast&gold&onlays&superior&to&cuspal&coverage&amalgam&!&higher&compressive&strength&+&more&precise&interproximal&
contacts&&
• Tin&+&Indium&added&to&metal&ceramic&alloys&!&oxide&layer&for&chemical&bond&of&metal&to&porcelain&
• Gold&inlay&opposing&dissimilar&metals&(galvanic&shock)&but&most&common&cause&of&pain&after&seating&is&fracture&of&tooth&
&
CASTING&GOLD&CROWNS/&LAB&STUFF:&
• Thinnest&portion&of&wax&pattern&(where&MARGINS&of&crown&will&be)&placed&!&in&deepest&part&of&ring&
o Attach&sprue&to&thickest&area&of&crown&(MB&cusp&usually&for&molars)&
• Increased&water&of&gypsumLbonded&casting&investment&!&more&setting&time,&less&setting&expansion,&less&strength&
• Flux!(Borax)!&displaces&gases&+&dissolves&corrosive&products&during&soldering&(removes&oxides&from&metal&surfaces)&&
o AntiJflux&(graphite)&
• Shrinkage&porosity&in&a&gold&casting&is&associated&with&!&Sprue&diameter&too!THIN&!&Back!pressure!porosity&!&air&
not&escaping&so&you&will&have&rounded&margins&on&the&casting&(thinnest&part&of&the&crown&is&the&margins&which&will&be&
farther&away&from&the&sprue)&
• Casting!ring!liner&!&compensate&for&casting&material&expansion&(uniform&investment&expansion/setting)&
&
CLINICAL&ISSUES:&
• RESISTANCE&FORM&!&lateral&forces&(more&important&than&retention&–&path&of&insertion)&
o Increased&height&of&prep&+&parallel&walls&+&boxes/grooves&+subgingival&margins&
o Want&parallel&walls&to&increase&resist/retension&
• Crown&doesn’t&seat&!&#1&reason&is&PROXIMAL&CONTACT&
• Most&important&area&to&have&thickness&of&metal&on&FPD&connector&area&!&OcclusoLgingival&
• Where&are&retentive&grooves&placed&on&crown&prep&!&Interproximal&
• Post&length&=&2/3&to&¾&root&or&length&of&crown&(4L5mm&GP&remaining&to&seal&+&prevent&microleakage)&
• PFM&!&Metal&CTE&slightly&higher&than&porcelain&
• 20L40&μm&space&for&cement&
• Most&traumatic&effect&on&abutment/cantilever&!&the&more&posterior&postion&of&tooth,&the&more&force&on&cantilever&
• Between&pontic&and&retainer&is&where&you&would&split&an&FPD&
• Male/female&abutments&are&placed&on&DISTAL&of&pier&abutment&!&prevents&mesial&drifiting&!&same&with&distal&
extension,&want&a&distal&rest&to&prevent&mesial&movement&of&denture&
Implants!
• 90%&success&rate&!&highest&success&in&mandibular&anterior&(densest)&+&lowest&success&in&maxillary&posterior&
• Titanium&oxide&layer&forms&and&prevents&corrosion&so&osseointegration&can&occur&
• PeriLimplant&mucocitis&(like&gingivitis)&+&periLimplantitis&(deepening&of&PD&+&loss&of&bone)&
• Placement:&1mm&apical&to&adjacent&CEJ&
• After&implant&placement,&edentulous&pt&should&!&avoid&wearing&anything&for&2&weeks&
• Minimum&of&3&months&healing&time???&to&allow&for&osseointegration&before&loading&implant&with&crown/overdenture&
• Necrosis&of&bone&occurs&at&47°C&(1L5&mins)&
• To&drill&implant&space&!&use&HIGH&TORQUE,&SLOW&SPEED&drill&&+&saline&(hydroxyappetite&irrigant)&+&NO&air&
• Internal&component&purpose&!&ixternal&hex&gives&antiLrotation&
• Minimal&vertical&height&of&bone&to&place&implant&!&8mm&(6mm&width)&
• Space&between&implants&3mm&
• Space&from&abutment&to&adjacent&tooth&(1mm&at&HOC)&!&2L3mm&from&platform&to&adjacent&tooth&CEJ&
• 2&implants&for&denture&!&implantLsupported,&tissue&supported&denture&
• 4&implants&or&more&!&implantLsupported&AND&implantLretained&denture&(need&4&in&mand&+&6&in&max&minimum)&
• Want&implant&in&slight&INFRALocclusion&(no&PDL&so&no&give&when&biting&down)&
• PreLload&=&amount&of&torque&force&used&to&tighten&the&abutment&to&the&implant&
• 6&or&more&implants&!&want&to&use&“open&tray&technique”&impression&(pick&up&method)&&
o impression&coping&–&with&guide&pin&sticking&up&!&there&is&a&hole&in&tray&where&guide&pin&is&sticking&out&!&let&
material&set&then&remove&guide&pins&then&remove&tray&from&mouth&
o Advantage&of&this&method&!&prevents&torqueing&which&would&be&beneficial&for&multiple&implants&or&if&implants&
are&NOT&parallel,&or&if&you&have&very&deeply&placed&implants&
o Open&tray&technique&!&transfers&exact&angle&of&implant&to&lab&
• “Closed&tray&method”&!&impression&coping&snaps&or&screws&onto&implant&!&cap&comes&off&with&impression&and&
impression&coping&stays&!&after&impression&is&removed&from&mouth&you&unscrew&the&impression&coping&from&implant&
and&place&it&into&impression&
• Implant&Analog&!&place&into&impression&and&is&poured&up&into&cast&to&“replicate”&the&implant&&
• Occlusal&trauma&!&bone&loss&(usually&not&pain&in&gum&area)&
Medical!Stuff!
• Diabetics&!&HYPOGLYCEMIA&more&dangerous&than&hyperglycemia&!&OHAs&(oral&hypoglycemic&agents)&should&be&
withheld&the&evening&before&and&morning&of&surgery&(sulfonylureas&for&DM2)&–&be&aware&that&Chlorpropamide&+&
Glibenclamide&have&a&very&long&duration&of&action&+&should&be&stopped&a&couple&of&days&in&advance&
o Insulin!shock&!&weakness,&mental&confusion,&cold&sweat&(NOT&convulsions)&
o Hyperglycemia&!&ketone&breath&
o NEVER&withhold&insulin&or&food&for&diabetes&(even&before&surgery)&
• “Constitutional!symptom”&!&can&effect&many&different&systems&of&the&body&(weight&loss,&fatique,&malaise,&decreased&
appetite,&night&sweats,&chills&
• Signs&of&severe!CNS!oxygen!deprivation&!&DILATED&pupils&+&absence&of&light&reflex&
• Multple&Sclerosis&!&Epinephrine&contraindication&
• AIDS&!&CD4&count&(<200),&Neutrophil&count&(<500)&
• Subacute&sign&of&mercury&toxicity&!&
• Aspirin&!&irreversibily&binds&to&COX&which&inhibits&synthesis&of&TXA2&(prevents&platelet&aggregation)&+&prostaglandins&
o Arachidonic&acid&!&precursor&for&Prostaglandin&
• Excessive&alcohol&can&alter&INR&test&
• Schedule&apt&for&pt&the&day&AFTER&dialysis&treatment&
• Blood&transfusion&before&surgery&!&when&platelet&count&falls&below&20,000&
• Exhalation&WHEEZING&(whistling)&!&Asthma&+&Emphysema&(COPD)&
• “Crowing”&sounds&!&acute&asthma&attack&&+&laryngospasm/tracheal&tug&!&want&to&suction&tongue&forward&
&
Operative!
• Accidently&don’t&see&occlusal&caries&and&place&sealant&over&it&!&STOPS&progression&&
• Sensitivity&to&COLD&for&recently!placed!amalgam&filling&&
• WIDTH&+&cutting&edge&angle&+&LENGTH&+&blade&angle&
• Most&critical&for&pulp&protection&!&Remaining&dentin&thickness&2mm&
• Remineralized&tooth&!&darker&color&than&surrounding&enamel&
• Teeth&appear&larger&when&they&are&smoother&than&usual,&value&is&increased,&increased&length&with&vertical&highlights&
• Indirect&pulp&cap&(more&aggressive&with&caries&excavation&+&PERMANENT&restoration&placed&that&appt&VS.&Stepwise&
caries&removal&(wait&6&months&to&place&final&restoration)&
o Indirect&pulp&cap&!&deep&caries&with&minimal&pulp&inflammation&(CaOH,&GI&liner,&final&restoration)&
• Increments&of&composite&no&greater&than&2mm&
• Large&caries&near&pulp&!&place&GI&liner,&restore&with&composite&
• When&can&you&have&unsupported&enamel&!#I#answered#class#III#on#the#facial#but#not#sure#if#it's#the#right#answer&
• Pulp&cap&!&calcium&hydroxide&with&GI&liner&
• What&would&cause&discoloration&of&margin&of&porcelain&veneer&a&few&days&after&seating?&
• Smooth&surface/interproximal&caries&!&apex&towards&pulp&(blows&up&at&DEJ)&
• Cavity&liner&minimal&thickness&!&>1mm&
• Threaded&pins&provide&the&most&retention&(cemented&pins&are&least&retentive&but&less&stress&on&dentin)&
• Direct&restorations&(composite&or&amalgam)&have&better&marginal&adaptation&(vs.#indirect)&
• Can&make&pt&look&younger&by&rounding&incisal&point&angles&of&anterior&max&incirsors&
• Distal!Slot!indications:&!&proximal&root&caries&&+&no&adjacent&tooth&+&proximal&tooth&with&severe&attrition&+&caries&
that&has&not&violated&DEFJ&
• Enamel!bevel!45°&cavosurface&margin&!&remove&fragile&enamel&+&strengthen&restoration&+&smooth&cavosurface&
margins&+&exposed&more&SA&of&enamel&rods&
• Open!Sandwich/Bonded!Base!technique&!GI/RMGI&liner&+&composite&on&top&!&recommended&in&composite&
restorations&with&margins&in&thin&enamel&near&CEJ&or&on&cementum&or&dentin&
• GV!Black!Cavity!Preparation:!
o OUTLINE&form&based&on&location&+&extent&of&caries&
" External&finish&line&(along&cavosurface&margin)&!&determined&by&extent&of&carious&lesion&+&depth&
(need&2mm&depth&for&amalgam)&
o RESISTANCE&form&(resist&fracture)&
" Flat&pulpal&floor&(even&occlusal&load)&+&depth&of&prep&+&rounding&of&internal&line&angle&
o CONVENIENCE&form&
o Removal&of&any&remaining&residual&caries,&enamel&pits&+&fissures,&infected&dentin&or&old&restorative&material&
• Class!I:!
o Amalgam&!&M&+&D&walls&divergent&in&order&to&prevent&undermining&of&marginal&ridges!
o !
• Class!II:!
o Burnish&matrix&!&accurate&interproximal&contact&
o DO&amalgam&less&likely&to&fracture&between&occlusal&+&distal&portions&if&!&axioLpulpal&line&angle&is&beveled&
o Large&MOD&sensitive&to&cold&+&mastication&pressure&!&premature&occlusion&(exces.&PDL&pressure)&
o Large&MOD,&what&is&disadvantage&!&occlusal&wear??&
o Rounded&pulpoLaxio&line&angle&!&resistance&to&fracture&for&amalgam&(lessening&occlusal&stress&concentration)&
o Extension&of&facial&+&lingual&preparation&within&gingival&box&should&be&out&of&contact&to&adjacent&tooth&!&room&
for&access&+&instrumentation&+&proper&restoration&of&contacts&
o Proximal&cavosurface&angle&!&90°&(adds&support&+&retention&strength&of&restoration)&
• Class!IV:!
o Esthetic&bevel&on&facial&(60°)&of&2mm&!&increases&bond&(x2)&+&decreases&fracture&+&more&conservative&prep&
• Class!V:!
o Discomfort&24Lhours&after&placement&!&root&dentin&exposed&(inadequate&filling)!
o If&you&have&a&class&V&lesion&(bottom&part&on&cementum)&!&bevel&occlusal,&part&on&cementum,&90&degree&butt&
joint&(look#up#answer,#but#these#were#the#answer#choice#options#on#the#exam)&
o Retentive&undercuts&!&incisal/occlusal&+&gingival&walls&in&dentin&to&prevent&undermining&(opposing&parallel&
walls&improves&retention)&
o Amalgam&!&all&walls&are&DIVERGENT&due&to&enamel&rod&direction&
o For&abfraction&lesions,&use&COMPOMER&(more&flexible&than&composite)&
!
• Amalgam!Restorations:!2mm&depth!
o Proximal&Resistance&to&displacement&!&retension&grooves&in&axiobuccal/axiolingual&walls&
o RETENSION&!&dovetail&+&occlusal&convergence&+&undercut&in&dentin&on&floor&
o Why&amalgam&fails&!&bad&prep&design&
o Advantage&of&inlay&vs.&amalgam&!&esthetics&+&less&tooth&reduction&
o MOD&onlay&vs.&amalgam&!&more&ideal&contours&
o Faulty&amalgam&!&cast&gold&restoration&!&more&ideal&contours&(bc&made&outside&mouth)&
o Rounded&line&angles&direct&occlusal&forces&towards&long&axis&+&more&resistant&to&occlusal&load&
o Superseal&+&dentinal&sealers&!&prevent&sensitivity&
o Open&gingival&margin&of&proximal&box&!&inadequate&condensation&(loading&too&much&amalgam&before&
properly&condensensing&
o If&polished&too&much&(too&shiny)&!&can&look&unesthetic&!&polishing&doesn’t&increase&longevity&
• Primary&Teeth:&
o Satisfactory&gingival&seat&for&class&II&not&possible&due&to&cervical&constriction&
o Enamel&rods&of&gingival&1/3&extend&occlusally&
• Veneers:&
o Reductions&(middle&1/3&of&facial&=&0.5mm&
• Instruments:&
o 330&vs.&255&(longer)&
&
Occlusion!
• Bennet!angle&!&nonLworking&condyle&during&lateral&excursion&(anterior&+&medial)&!&FLATTER&CUSP&=&GREAT&SIDE&
SHIFT&
• SemiLadjustable&!&Whipmix&(what&we&have)&!&can&use&for&full&mouth&restorations&as&long&as&good&AG&exists&
• FullyLadjustable&!&needed&if&restoring&at&different&VDO,&full&mouth&restorations&with&group&function,&extensive&occlusal&
pathology&
• For!Anterior!veneers&!&Custom&incisal&guide&table&(blob&of&composite&on&the&guide&table&+&as&the&material&is&setting&
while&you&move&the&teeth&on&the&articular&to&simulate&protrusive&+&lateral&movements)&&
• Don’t&need&CR&if&only&doing&veneers&
Oral!Surgery!
• Most&common&complication&of&Sagittal&osteotomy&!&I#put#lingual#nerve#damage#but#look#up#answer&
• Alveolplasty&following&closed&extraction&is&usually&performed&with&!&FINGERS&(compressing&plates&together)&
• Correct&maxillary&retrognathia&!&Lefort&1&Osteotomy&(can&move&maxilla&in&ALL&3&planes)&
• BSSO&!&can&correct&mandibular&retrognathia&
Prognathia?
• Osteomyelitis&of&mandible&most&likely&develops&due&to&!&low&resistance&of&patient&
• Don’t&adjust&occlusion&of&TMD&pt&until&pt&is&symptomLfree&and&shows&improvement&during&splint&therapy&
• Removal&of&Palatal&tori&!&most&optimal&flap&is&shaped&like&a&“doubleLY”&with&a&midline&incision&and&anterior/posterior&
side&arms&extending&bilaterally&from&ends&of&midline&incision&
• Removal&of&mediumLsized&mandibular&tori&!&removed&by&grooving&the&superior&surface&then&shearing&torus&off&with&
monoLbeveled&chisel&then&smooth&with&bone&file&
• TMJ!Problems:&
o Pain&most&likely&from&V3&(auriculotemporal&nerve)&
• Extract&POSTERIOR&to&anterior&
• Which&direction&do&you&luxate&a&distoangular&3rd&molar&(crown&tipped&to&distal)&!&DISTOBUCCAL&
• Bisphosphonates&!&dental&infections&should&be&managed&aggressively&and&nonLsurgically&if&possible&–&ENDO&therapy&is&
preferred&to&extractions&(when&necessary,&coronal&amputation&with&RCT&on&retained&roots)&
• Cavernous&sinus&thrombosis&!&can&be&caused&by&subcutaneous&abcess&of&upper&lip&(infections&of&max&anteriors&
• Most&common&midLfacial&fracture&!&Zygomatic&complex&fracture&(bleeding&in&lower&eyelide&seen?)&
• If&jaw&is&broken&and&is&allowed&to&heal&on&its&own,&how&does&growth&occur?&Bilateral,#symmetrical#effective,#condylar#side#
less#or#more#growth#(these#were#the#answer#choices#on#exam#but#not#sure#which#one#was#correct#
• What&do&you&NOT&use&for&extraction&of&mandibular&preLmolar?&&150,&151,&23,&286&!&don’t&use&23&(cowhorn)&
• Osteoradionecrosis!!&radiation&damages&blood&vessels&(mandible&is&LESS&VASCULARIZED&than&maxilla&to&begin&with&
so&at&higher&risk)&
• What&type&of&drill&is&a&surgical&handpiece?&
• Trismus&!&submasseteric&space&
• Intrapulpal&anesthesia&!&works&in&30&seconds&via&“back&pressure”&
• Distraction&Osteogenesis&!&way&to&length&bones&by&slowly&separating&2&parts&and&letting&bone&fill&in&!&advantages&over&
ostectomy&!&better&pt&compliance,&wider&range&movements,&less&relapse,&can&be&done&in&YOUNGER&pts&
o used&to&advance&mandible&(pt&with&mandibular&retrognathia)&!&BSSO&also&a&technique&used&
• Max&Sinus&communication&(2L6mm)&!&surgical,&suture,&decongestant,&antibiotic&(<2mm&!&no&treatment)&
• Mandibular&lingual&tori&exposure&!&incision&in&gingival&sulcus&+&embrasure&area&
• Bony&healing&begins&at&3L4&weeks&
• Most&difficult&type&of&extraction&!&distoangular&
• Neuropraxia&!&compression&of&nerve&(“practical”&one&because&nothing&really&happens)&
• IV&bisphosphonates&!&discontinue&then&wait&6&months&until&invasive&procedures&(or&do&nonLinvasive&endo)&
&
&
Orthodontics!
• Serial&extractions&!&&primary&cuspid&!&first&molar&!&bicuspid&(allows&permanent&canines&to&erupt)&
• Cervical&pull&headgear&!&14&hours&(restrains&maxilla&so&mandible&can&grow&for&class&II)&
• Growth&of&cranial&base&precedes&jaw&growth&!&cessation&of&growth&of&jaw&!&width,&depth,&height&
• What&kind&of&headgear&is&used&for&maxillary&and&mandibular???&&
o Maxilla&Excess&!&hold&maxilla&&
" Cervical&pull&(pulls&down&+&back)&!&use&for&deep&bite&deep&bite&
" High&pull&(pulls&up&and&back)&!&
o Maxilla&Deficient&&!&&
o Mandibular&Excess&(Class&III)&!&camouflage&or&surgery&(BSSO)&
• Skeletal&class&II&!&cervical&head&gear&if&&
o Lefort&I&osteotomy&!&advance&maxilla&in&adult&that&has&stopped&growing&
• If&1st&max&molar&is&superLerupted&and&lower&opposing&is&missing,&which&will&you&NOT&do&!&Intrusion&(crush&vessels)&
• Bad&oral&hygiene,&what&type&of&braces&!&NO&TREATMENT&
• NonLcompliant&pt&completes&ortho,&what&kind&of&retainer&!&FIXED&
• ANB&=&3°&(+/L1)&!&larger&than&3°&(class&II&malocclusion)&!&less&than&1°&=&class&3&
o What&is&ANB&!&relation&of&maxilla&to&mandible&
• Hawley&Appliance&!&retention&after&braces&(wires&connected&to&acrylic&palate)&
• Most&likely&to&have&trauma&to&max&incisors&in&sports&!&class&2&division&1&
• Best&way&to&correct&class&2&in&adult&!&surgery&or&remove&PMs&for&the&illusion&of&moving&maxilla&back&
• Cleft&palate&!&median&nasal&process&+&maxillary&process&fail&to&fuse&
• Jaw&stops&growing&transversely&at&7&or&8&years&old&!&ALP&stops&growing&!&vertically&stop&growing&
• All&primary&teeth&erupted&by&age&2L2.5&years&
• Roots&are&½&to&2/3&developed&when&tooth&starts&to&erupt&(3/4&root&of&canine&complete&when&erupts)&
• 2L3&years&for&root&formation&to&complete&after&eruption&into&occlusion&
• Leeway&space&(3mm&on&maxillary&+&5&mm&on&mandible)&
• Synchondroses&of&cranial&base&are&centers&of&ossification&(growth)&until&they&fuse&
• Intramembranous&!&growth&within&sutures&
• Appositional&bone&growth&!&new&bone&on&surface&(back&of&mandible)&
• Posterior&crossbite&!&Rapid&palatal&expander&=&most&useful&
&
!Pathology!
• Undiagnosed&ulcer&in&oral&cavity&!&local&contraindication&for&surgical&removal&of&impacted&tooth&
• PDL!widening&!&hyperparathyroidism,&osteosarcoma,&scleroderma&
• Delayed&eruption&(retained&primary&teeth)&!&Ectodermal&Dysplasia&(anodontia/oligodontia),&Hypothyroidism&+&
Multiple&odontomas&+&Osteopetrosis&
• Premature&exfoliation&!&PapillonLLefevre&+&Hypophosphatasia&(primary#incisors)&
• Gingival&Hyperplasia&!&PapillonLLefevre,&drugs,&Leukemia,&Neutopenia,&Fibromatosis&
• Hypertelorism&(eyes&too&far&apart)&!&Gorlin&and&Down&Syndrome,&Nevoid&Basal&Cell&Carcinoma,&Osteopetrosis&
• Oral!cancer:!
o Most&common&site&of&NEW&cancer&in&mouth&!&TONGUE&
o Highest&risk&areas&!&floor&of&mouth,&lateral&+&ventral&tongue&+&soft&palate&
o Cancer&from&other&parts&of&body&metastasizes&mostly&to&SOFT&TISSUE&(attached&gingiva&then&tongue)&
o Breast&cancer&most&common&metastatic&to&mandible&(Lung&cancer&2nd&most&common&appearing&in&soft&tissue)&
• HandLSchullerLChristian&Triad&(diabetes&incipidus,&exophthalmos,&bone&lesions/langerhans)&
o Oral&signs&!&bad&breath,&sore&mouth,&loose&teeth,&PUNCHED&OUT&RADIOLUCENCY&of&skull&+&FLOATING&TEETH&
o Multiple&Myeloma&!&also&has&punchLout&radiolucencies&of&skull&+&floating&teeth&
• Cementoblastoma&!&intimately&associated&with&root&+&radiolucent&halo&
• Hypercementosis&!&“thickening&of&root”&+&can&trace&PDL&+&Paget’s&
• Neck!Swelling&!&Warthin’s&tumor&(more&diffused)&+&Infectious&Mono&(more&localized/rounded)&
• Fibrous&Dysplasia&!&groundLglass&
• Osteosarcoma&!&sunburst&(Chrondrosarcoma&+&Central&Hemangioma&of&IAN)&
• Candidiasis&!&burning&tongue&+&altered&taste&
• Sjogren’s&!&altered&taste&(sicca&syndrome&!&pilocarpine)&
• Multiple&Myeloma&!&Bence&jones&proteinuria,&punchedLout&radiolucencies,&floating&teeth&
• Most&common&benign&salivary&gland&tumor&!&Pleomorphic&Adenoma&
• Most&common&malignant&!&Adenoid&Cystic&Carcinoma&(major);&Mucoepidermoid&Carcinoma&(minor)&
• Proliferative!Verrucous!Leukoplakia&(PVL)&!&white&plaque&that&is&progressive&and&multifocal&(can&be&everywhere&in&
mouth),&females,&usual&risk&factors&(smoking/alcohol)&NOT&present,&almost&100%&malignant&and&recurrent&is&VERY&
HIGH&
• Herpes!(keratinized&–&palate/gingiva)&+&Apthous&ulcers&(nonLkeratinized&!&buccal)&
o Primary&Herpes&–&multiple&areas&(keratinized/nonLkeratinized)&+&low&grade&fever&+&malaise&(fluLlike&
symptoms)&+&marginal&gingiva&very&painful/inflammed&
• Chronic&(>3weeks)&nonLhealing&ulcers&!&SSC&+&deep&fungal&infection&+&TUGSE&&
• Neurofibromatosis!!&neurofibromas&+&café&au&lait&spots&+&lisch&nodules&(brownLpigmented&spots&on&iris)&+&
enlargement&of&fungiform&papilla&+&mandibular&foramen&+&MENL2B&(medullary&thyroid&carcinoma)&
• Gorlin!Syndrome!(Nevoid!Basal!Cell!Carcinoma)&!&multiple&OKCs&+&bifid&ribs&+&falx&cerebri&
• Crohn’s!Disease!!&recurrent&aphthous&ulcers&+&granulomatous&gingivitis&(cobblestone)&+&rectal&bleeding&
• Pemphigous!!&Acantholysis,&suprabasilar&
• Pemphigoid&!&histological&loss&of&rete&pegs&
• Differentiation&between&OKC&+&ameloblastoma&!&reactive&light&microscropy&
• White&spongy&nevous&!&buccal&check&of&60&year&old&pt&+&can’t&wipe&off&+&bilateral&
• Adenomatoid!Odontogenic!Tumor&(female/maxilla)&!&extends&apically&beyond&CEJ&(unlike&dentigerous&cyst)&
• Adenoid!cystic!carcinoma&!&80%&seen&with&perineural&invasion&
• Varicela!Zoster!virus&(Shingles)&!&postLherpetic&neuralgia&(extreme&unilateral&pain)&+&unilateral&lesions&due&to&
reactivation&of&virus&from&SACRAL&region&induced&by&stress&and&sunlight&
• Syphillis!!&most&contagious&stage&(secondary)***&
• Healthy&pt&with&lesion&in&middle&of&tongue&and&had&it&on&palate&before&!&Candidiasis&
• Anemia&!&Microcytic&(ironLdeficiency,&chronic&disease,&thalassemia&–&sickle&cell?)&+&Macrocytic&(Pernicious)&
• If&something&growing&on&lateral&tongue&!&incisional&biopsy&(used&for&diagnostic)&
o For&a&2x3x3mm&lesion&!&EXCISIONAL&biopsy&for&D.D.&(Large&lesion&=&>1cm)&&
o toluidine!blue&!&binds&to&DNA&–&high&rate&of&false&positives&for&inflammatory&lesions&+&high&rate&false&
negatives&+&works&well&for&erythroplakia&(not&leuko)&
o cytology&!&
o Laser&!&avoid&when&biopsying&potentially&malignant&leukoplakias,&malignant&and&mucotaneous&disorders&
(need&epithelium&intact)&
• Varicose/large&veins&on&tongue&of&elderly&pt&!&due&to&HTN&
• Paget’s!!&usually&over&40&year&old&+&maxilla&+&hypercementosis&+&osteosarcoma&
• ALL&!&children& AML&!&worst&prognosis&(adults)&
• HIV!&Neutrophils&<&500&+&CD4&<200&
• Sjogren’s&!&increased&risk&for&lymphoma&
• Dentogenesis!Imperfecta&!&bulbous&crown&+&opaque&dentin&+&short&roots&+&obliterated&pulp&!&premature&
exfoliation&
• Dentin!Dysplasia&!&short&roots&+&obliterated&pulp&+&periapical&radiolucencies&w/o&caries&
• Amelogenesis!Imperfecta&!&taurodontism&+&pitted&
• Leukoedema&!&disappears&on&stretching&(always&bilateral)&
• Rubella!Embryopathy&(1st&trimester&+&microcephaly&+&heart&disease&+purpura&+&deaf&+&cataracts&
• PeutzJJehger’s&–&multiple&pigmented&lesions&+&intestinal&polyps&(but&not&cancerous)&&+&higher&risk&of&BREAST&CANCER&
+&adenomas&
• Recurrent&Apthous&ulcers&!&smoking&cessation&+&Crohn’s&
• MENL2&(neurofibromatosis)&!&medullary&thyroid&carcinoma&
• Downs&Syndrome&!&lower&caries&(higher&IgA)&+&drool&+&increased&perio&+&hypodontia&+&microdontia&
&
Pediatrics!
• KNOW&ERUPTION&+&CALCIFICATION&SEQUENCE***&
o How&long&does&root&take&to&complete&!&3&years&from&eruption&
o Calcification&of&primary&teeth&begins&3L6&months&(2nd&trimester)&
o Pt&has&12&primary&+&12&permanent&teeth&!&8L9&years&old&
o Apex&closure&!&2.5L3.5&years&after&eruption&
• Eruption&of&primary&teeth&(7&+&4&rule)&
o Central&!&lateral&!&1st&molar&!&canine&!&2nd&molar&
• Eruption&of&permanent&teeth:&
o Maxillary:&1st&molar&!&central&!&lateral&!&1st&PM&!&2nd&PM&(10L12&yrs)&!&canine&(10L12&yr)!&2nd&molar&
o Mandibular:&follows&sequence&
• Fluoride&toxic&dose&(5mg/kg)&+&Lethal&(20L50mg/kg)!
o less&than&8mg/kg&(give&milk)&+&more&than&8mg/kg&(induce&vomiting)!
• Age&4L7&years&!&afraid&of&the&UNKNOWN!
• Primate&space&!&provides&space&for&permanent&anterior&teeth!
• Pulp&horn&in&primary&teeth&most&susceptible&to&exposure&during&operative&!&MB&of&2nd&molar!
• Primary&tooth&with&highest&chance&of&pulp&exposure&!&mandibular&1st&molar&(proximal&box&is&here&u&would&hit)&!&why&
we&usually&do&SSC&instead&of&class&2!
• If&you&extract&a&primary&tooth&!&will&SPEED&UP&the&permanent&eruption&if&2/3&root&is&form&(only&0.5mm&of&bone&on&
top)&+&about&6&months&before&scheduled&eruption!
• Child&is&allergic&to&ampicillin&!&what&do&you&give&for&prophylaxis??&AZITHRO&(15)&Clindamycin&(20mg)!
• If&there&is&a&space,&what&is&most&likely&to&prevent&tooth&distal&from&it&to&move&into&space&!&occluding&opposing&tooth!
• When&do&max&centrals&calcify&!&2L3&months!
• Most&common&cause&for&cardiac&arrest&in&children&!&congenital&heart&disease!
• Most&common&congentially&missing&tooth&!&3rds&!&mand&2nd&PM&!&max&lateral&!&max&2nd&PM!
• Most&common&tooth&to&erupt&in&crossbite&!&maxillary&1st&molars!
• 4&year&old&looses&primary&1st&molars&!&Band&and&loops!
• Thumbsucking&!&anterior&open&bite&+&posterior&crossbite&+&constriction&of&maxilla,&class&II!
• Morphodifferentiation&!&germination/fusion!
• Histodifferentiation&!&Amelogenesis&Imperfecta/Osteogenesis&Imperfecta&(defects&in&enamel&or&dentin&layers)&–&could&
also&be&Apposition&or&Mineralization&stages!
• 14&year&old&pt&that&has&asthma&(uses&inhaler&a&lot&of&soccer)&!&light&sulcular&patches&on&palate&that&can&be&scraped&off&
!&Candidiasis&
• Herpangia!!&ulcers&caused&by&COXSACKIEVIRIS&(a&few&lesions&on&soft&palate&or&tonsillar&pillars&–&red&macules&to&
vesicular&lesions&that&heal&in&7L10&days)&–&unsymptomatic&or&symptomatic&(sore&throat&+&fever)&!&selfLlimiting&
• Under&6&months&+&over&16&+&fluoride&level&greater&than&0.6ppm&!&NO&supplemental&fluoride&
• <0.3ppm&(no&fluoridation)&!&6&months&to&3&years&old&!0.25mg&of&supplemental&fluoride***&
• School&water&fluoridation&4.5ppm&(community&=&1ppm)&
• 2.2mg&NaF&provides&1mg&of&Fluoride***&
• Highest&caries/untreated&in&KIDS&(Hispanic)&!&highest&unrestored&caries&in&ADULTS&is&BLACKS&(most&filled&=&whites)&
• Transillumination&used&to&visualize&Koplik&spots&(measles)&!&clustered&white&lesions&on&buccal&mucosa&near&stenson’s&
duct)&
Periodontics!
• PERIO&DIAGNOSIS*****&
• Oral&Hygiene:&
o Brush&goes&1mm&into&sulcus&(floss&=&2mm)&
o Least&successful&for&pt&to&remove&plaque&with&floss&!&maxillary&molars&(1st&max&PM&on&mesial&is&concavity)&
o Plaque&accumulates&1&hour&after&eating&
o 65%&of&US&has&fluoridation&!&community&water&fluoride&level&=&1ppm&(1mg/L)&
o 5&years&with&systemic&disease,&what&MW&used&for&plaque&control?&Sodium&Fluoride&
• Chlorohexidene&!&substantivity&(remains&effectiveness&in&mouth&for&long&period)&+&bacteriostatic/cidal&
• Periostat&=&20mg&Doxycyline&(inhibits&MMPs)&–&tetracyclines&have&higher&levels&in&GCF&
• Semilunar&flap& &best&surgical&access&to&apical&aspect&of&tooth&root&with&least&reflection&of&soft&tissue&
• Flaps&to&expose&bone:&
o Modified!Widman!flap&!&exposed&roots&+&alveolar&bone&+&NO&apical&repositioning&
o Mucoperiosteal!flap!!&full&thickness&
• Fenestration&technique&for&mandibular&vestibuloplasty&is&based&on&premise&that&the&mucosal&attachment&will& &not&
cross&a&fibrous&scar&band&(prevents&gingival&movement)&
• Base&of&incision&for&gingivectomy& &above&mucogingival&junction&
• ANUG! &Tetracycline&(immunocompromised)&+&Metronidazole&(only&if&lymphadenopathy&present)***&
• Localized!Aggressive!Periodontitis!L&antibiotics&
o Centrals&+&molars&+&3&or&more&teeth&!&“generalized”&
• Structure&most&likely&damaged&with&gingival&graft&on&palate!&Greater&palatine&nerve&(adjacent&to&1st&molar)&
• Most&associated&with&developing&stage&of&gingivitis&!&macrophages&
• What&is&considered&“HOPELESS”&prognosis&!&mobility&
• Class!2!furcation&!&GTR&
• Class!3!furcation&!&most&likely&treatment&=&extraction&(least&likely&=&regeneration?)&
o Hemisection&+&tunneling&(APF&to&clean&furcation)&
• Negative!architecture!! !interseptal&(crestal)&bone&is&lower&than&radicular&bone&
• If&doing&a&graft&in&mandibular&molar/PM&areas,&what&interferes?#I#answered#external#oblique#ridge#but#my#2nd#answer#
choice#was#mylohyoid#attachment#!#not#sure#which#is#the#answer#so#look#up&
• Pt&goes&to&periodontist&for&flap&surgery,&who&does&the&reLeval&!&dentist,&periodontist,&both???&
• Purpose&of&GTR&is&to&prevent&!&long&JE,&migration&of&CT&cells&migration&of&PDL&cells&
o Prevent&migration&of&epithelial&+&CT&cells&!&want&PDL&cells&to&have&chance&to&come&in&
• What&has&the&ultimate&effect&on&thickness&of&epithelium&of&FGG&!&recipient#CT#is#answer#I#chose#
• Internal&bevel&incision&extends&from&(look&up&answer&!&had&this&question&on&my&exam)&
• Gingivectomy&!&healing&by&secondary&intension??&
• Positive&Architecture&!&interproximal&bone&is&coronal&to&radicular&(supporting)&bone&!&want&more&bone&in&between&
the&teeth&
• Ultrasonics&!&Cavitron&(elliptical&–&magnostrictive)&
• Sonics&!&Piezo&(linear&–&works&with&air)&
• Gingival!plaque!index&is&ordinal&(0,&1,&2)&and&nominal&(name&–&light,&moderate,&heavy)&&
o Interval&cannot&be&0&
&
Pharmacology!
DRUGS:&
• Heparin&!&interferes&with&fibrinogen&to&fibrin&
• Erythromycin&+&Seldane&(antihistamine)&!&serious&cardio&events,&even&death&
• Phenytoin&!&IV&or&IM&(used&to&reverse&Digitalis/DigoxinLinduced&ventricular&fibrillation&
• Digitalis!!&give&to&patients&with&ALfib&who&are&taking&Quinidine&to&avoid&ventricular&tachyarrhythmias&
• DJtubocurarine&!&central&skeletal&muscle&relaxation&produced&by&depressing&polysynaptic&reflex&arcs&
• Neuroleptic&analgesia&!&schedule&2&narcotic&+&antipsychotic&(neuroleptic&drug&=&antipsychotic)&
• Chlorpromazine!!&alpha&antagonist/blocker&
• Hydroxyzine&!&1st&generation&antiLhistamine&(dry&mouth)&
• Hydralazine&!&vasodilator&(HTN#+CHF)&
• Amyl&Nitrite&!&vasodilator&(angina)&
• Tramadol&is&NOT&structurally&similar&to&morphine&!&it&inhibits&uptake&of&NE&and&serotonin&+&minds&to&mu&receptor&
• Rifampin&!&antibiotic&most&associated&with&oral&contraceptive&failure&
• Isopropyl&alcohol&!&acetone&
• Buspirone&!&relieves&anxiety&&(but&NOT&a&strong&sedative&like&barb&or&impair&psychomotor&skills&like&BZs)***&
• Tetracycline&!&prolonged&use&leads&to&phototoxicity,&superinfection,&diarrhea,&discoloration&of&newly&formed&teeth&
(but&NOT&visual&disturbances)&
• Atropine&–&anticholinergic&(mydriasis&–&pupil&dilation&!&NOT&for&glaucoma)&reduces&saliva&
• Polymixin!!&renal&necrosis&
• Chloramphenicol!!&bone&marrow&suppression&!&aplastic&anemia&
• Amphotericin!B!!&neprotoxicity&
• Gentamycin!!&auditory&nerve&deafness&
• Cortiocsteroids&!&block&PGs&!&increased&acid&+&decreased&protective&mucous&!&stomach&ulcer&&
o Overdose&of&Methotrexate&!Leucovorine&
• Nitrous!Oxide!!&signs&pt&getting&too&much&(giddiness,&euphoria,&nausea)&+&hand&tingling&=&first&sign;&keep&reservoir&
bad&1/3&to&2/3&full&!&70%&is&max;&contraindicated&in&respiratory&infections&
• Ventricular&arrhythmias&!&treated&with&Lidocaine,&Phenytoin&(DigoxinLinduced)&
• Haloperidol&!&schizophrenia&
• Diazepam&!&status&epilepticus&
• How&does&biofeedback&work?&Enables&pt&to&gain&control&of&certain&physiological&functions&(breathing&exercises)&
• Proproxyphene&(opiod)&!&WITHDRAWN&from&market***&
• Bupropion&(Wellbutrin/Zyban)&!&atypical&antidepress&(smoking&cessation)&!&NE&+&dopamine&reuptake&inhibitor&
• Prilocaine&(over&500mg)&!&methemoglobinemia&
• Methadone&!&used&for&opioid&withdrawal&(longLacting)&
• Gingo!Biloba&+&Saw!palmetto!&contraindicated&when&taking&anticoagulants/antiplatelets&!&heparin)&
ANTIFUNGALS:&
• Ketoconazole&(best&systemic)&+&Fluconazole&(systemic&for&vaginal&yeast&infection)&
&
GENERAL&PRINCIPLES:&
• PreJmedication&!&& AMOXICILLIN& & 2&g& & 50&mg/kg&&&& 3&x/day&
CLINDAMYCIN& & 600&mg& & 20&mg/kg& 4&x/day&
AZITHROMYCIN&& 500&mg& & 15&mg/kg& 1&x/day&
• IM/IV&!&Ampicillin&+&Cefazolin&+&Ceftriaxone&(same#dosage#as#AMOX)&
• Oral&!&Cephalexin#(same#dosage#as#AMOX)&
• 1st&pass&metabolism&!&reduces&bioavailability&(drug&absorbed&from&stomach&then&metabolized&in&liver&resulting&in&
largest&loss&of&active&drug)&
• Major&effect&of&drug&is&produced&by&amount&of&drug&that&is&FREE&IN&PLASMA&(protein&binding&decreases&potency)&
• LD50&for&alcohol&!&0.50%&
• POTENCY&!&response&do&a&drug&over&a&given&range&of&concentrations&(more&potent&means&a&smaller&amount&of&drug&is&
needed&to&get&max&effect&of&drug&
• Tylenol&#3&has&30mg&of&codeine&
• EFFICACY&!&“intrinsic&activity”&L&maximal/ceiling&effect&of&drug&+&how&much&of&an&effect&drug&is&capable&of&producing&
• Allergic&reactions&to&local&are&caused&by&antigenLantibody&reaction&
• Physiologic&antagonist&(actions&cancel&each&other&out)&!&Epinephrine&+&Histamine&
• Verill’s&sign&=&upper&lid&ptosis&!&indicates&pt&is&adequately&sedated&
• Max&Epinephrine&=&0.2mg&(8&carpules)&for&normal&pts&(0.04mg&for&cardiac&pts&–&2&carpules)&
• 0.018mg&epi&per&carpules&of&1:100k&epi&
• Stannous&fluoride&causes&the&most&staining&
• Pain&med&for&pt&with&hepatic&dysfunction&!&oxycodone&(needs&something&that&does&NOT&need&to&be&metabolized)&
• Vasoconstriction&caused&by&!&alpha&agonist&+&Beta&Antagonist&
o If&you&want&to&reverse&vasoconstriction&to&get&dilation&!&Propranolol&with&Epi&
• Epinephrine&+&Metropropol&(cardioLselective)&is&OK&together&!&nonLselective&betablocker&+&epi&is&NOT&ok&bc&would&
cause&hypertensive&crisis&&
o Propranolol&is&synergistic&with&epi&in&Lidocaine&!&hypertension&
• ACEJInhibitor!Side!effects&!&“CAPTORIL”&!&cough,&angioedema,&potassium&excess,&taste&changes,&orthostatic&
hypotension,&pregnancy&contraindication,&rash,&indomethacin&inhibition&(NSAID),&liver&toxicity&
• HMGJCoA!Reductase!Inhibitor!Side!effects/contraindications&!&Hepatotoxicity,&myositis,&girl&in&
pregnancy/growing&children,&Coumadin/Cyclosporin&interactions&
• Contemplation&phase&!&pt&wants&to&quit&in&6&monthsL1year&
• Preparation&phase&!&made&decision&to&quit&
• Penicillin&+&Cephalosporins&!&bacterioCIDAL&
• Tetracycline&=&STATIC&(30S&protein&synthesis)&
• Histamine&!&bronchospastic&+&vasodilator&
&
Radiology!
• Kilovoltage!(kVp)&!&QUALITY&(intensity&+&degree&of&penetration&of&beam&+&energy&+&contrast)&
o #kvP&&=&#darker&film&+&$contrast&(longer&gray&scale)***&
o To&go&from&low&contrast&to&high&contrast&(short&scale&intensity)&but&maintain&image&density&!&decrease&kVp&+&
increase&mAs&
• Milliamperage!(mA)!!&QUANTITY&(#&photons&created&/&amount&of&xrays&produced)&
• Exposure!time!!&affects&QUALITY&
• $ !Target/objectJfilm!distance&(focal&spot&closer&in&shorter&xLray&tube&so&#divergent&rays)&!&MAGNIFICATION&of&
objection&
• #&density&of&film&when&you!#kvP,&mA&or&exposure&time&&or&&$&SourceLfilm&distance&(tube&closer&to&pt)&
• Wavelength!–&(mean&energy)&affected&by&kVp&+&FILTRATION&(ALUMINUM&filters&lowLenergy&particles&out)&
• Increase&in&radiographic&density&caused&by&a&decrease&in!!&SourceLfilm&distance&(denser&if&xLray&machine&closer)&
• Smaller!focal!spot!! !#&definition&+&sharpness&(affected&by&sixe&of&cone&+&angulation&of&beam)&
• Crook’s!Tube&!&high&voltage&current&excites&electrons&carry&energy&from&cathode&to&Tungsten&anode&(converted&to&
HEAT&+&1%&PHOTONS&at&target)&
• Bremsstrahlung!radiation&!&high&speed&electrons&interact&with&Tungsten&nuclei&at&target&(converts&lost&kinetic&
energy&into&photon)&
• Aluminum&!&used&as&filter&to&reduce&exposure&of&pt&by&removing&lowLenergy&xLrays&
• Least&helpful&in&determining&anatomical&integrity&of&TMJ&!&pano&
• Caries&and&bone&loss/defects&are&always&WORSE&than&they&look&in&xLray&(xLray&underestimates)&
• Subtraction&Radiology&!&bone&density&changes&
• Maxillary&sinus&!&best&view&=&Water’s&
• Townes&!&condyles&+&mastoid&air&cells&+&orbit&floor&+&middle&ear&(30&degrees&above&Frankfort)&
• Low&radiosensitivity&!&muscle&cells,&chondrocytes,&nerve&cells&
• Bitewings:&+5&to&+10&degree&angulation&
• 60Gy!!&tissues&start&to&not&heal&(ORN)&can&manifest&months/years&later&–&4Gy&to&hand&!&erythema]&
• Be&able&to&identify:&
o “ULshaped”&radiopacity&in&max&sinus&!&zygomatic&process&
o Faint&radiolucency&with&radiopaque&border&in&max&sinus&!&mucocele&
o Nutrient!canal&!&come&from&apex&!&radiolucent&(anterior)&+&radiopaque&(posterior)&
o Coronoid&process&
• XLray&film:&covered&in&lead&to&prevent&accidental&exposure&(lead&also&used&for&collimation)&
• Intensifying!screens&!&extraoral&radiographs&!&decreases&radiation&dose&to&pt&!&makes&film&more&sensitive&to&
blue/green&light&
• Developer&!&alkaline&pH&(sodium&carbonate)&
o Reducing&agents&(Hydroquinone)&!&converts&exposed&silver&salts&into&silver&metallic&ions&(turns&BLACK)&
o Lighter&film&!&need&to&change&developer&
o YellowishLbrown&!&needs&more&time&in&developer&
• Fixer&!&removes&silver&halide&unexposed&crystals&+&preserves&emulsion&
o Clearing&agent&(ammonium&thiosulfate)&!&removes&UNEXPOSED&silver&halide&crystals&(what&gives&you&shades&
of&gray)&
o Tanning&agent&(aluminum&salts)&!&hardens&+&preserves&emulsion&
o Activator&(acetic&acid)&!&maintains&acidity&+&neutralizers&developer&
o Preservative&(sodium&sulfite)&!&precents&spontaneous&oxidation&
o Solvent&
• Developing!Problems:!
o Fogged!film!!&presence&of&light&in&dark&room&+&faulty&safety&light!
o Film!too!dark!! !too&long&in&developer&+&too&high&of&temp!
• Errors:!
o Herringbone&!&film&was&exposed&backwards&
o Too&much&angulation&!&foreshortening&
o SemiLlunar&radiopacities&!&bite&mark&or&overbending&
o Cloudy&(“film&fog”)&!&exposure&by&other&sources&of&xLray&other&than&main&beam&
o Clear&film&!&film&not&exposed&to&xLrays&
o Pano&!&Reverse&occlusal&plane&!&chin&tilted&too&high&
• XLray&photons&!&high&energy&electromagnetic&waves&(xLrays&+&gamma&rays)&
• Pt&comes&in&with&pain&but&had&COE&+&xLrays&less&than&a&year&ago&!&NO&xLrays&indicated&(don’t&take&PA)&
• HalfLvalue&layer&=&thickness&of&material&(usually&aluminum)&that&decreases&the&intensity&of&xLray&beam&by&½&!&the&
higher&the&halfLvalue&layer,&the&thicker&the&aluminum&(2mm)&needs&to&be&to&block&beam&
• Collimation&!&reduces&pt/operator&exposure&+&reduces&film&fog&(increases&quality)&
• Severity&of&response&increases&with&amount&of&xLray&exposure&!&“Deterministic”&
• What#decreases#prenumbra#on#an#x<ray#(had#this#question#on#my#exam)#
!
JJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJJ!
Removable!Partial!Denture!
• Wrought!wire!clasp&!&FLEXIBLE&(reduces&torque&force&(used&for&perio&involved&teeth)&+&distal&extensions&on&
canine/PM&
• RPD&rocking&on&fulcrum&line&!&problem&with&indirect&retainer&
• Combination&clasp&RPD&!&look#up#(had#this#question#on#my#exam)&
• Refractory&cast&!&wax&up&RPD&framework&
• Needs&to&fit&PASSIVELY&
• Where&does&the&clasp&fit&!&INFRABULGE&
• Major!connector&!&RIGIDITY&(connects&components&of&two&sides&of&arch&together)&
o Lingual&bar&needs&8mm&(5mm&bar&needs&to&be&3mm&away&from&gingival&margin)&
• Minor!connector&!&connects&all&parts&to&major&connector&+&distributes&stress&&
o metal&part&of&mand&denture&want&it&to&extend&all&the&way&back&until&bone&starts&to&curve&up&on&the&retromolar&
pad&(extends&¾&of&length&of&edentulous&ridge)&
• Rests&!&prevent&displacement&of&RPD&towards&tissue&+&transfers&mastication&forces&to&supporting&teeth&
o Occlusal&(1/3L1/2&MD&width&or&½&BL&width&cusp&to&cusp)&+&floor&must&be&inclined&towards&center&of&tooth&+&1L
1.5mm&thickness&of&metal&
• Direct!Retainers&!&prevent&RPD&from&moving&away&from&hard/soft&tissue&
o Intracoronal&(located&within&contours&of&abutment&crown&
" Precision&(in&metal)&+&Semiprecision&(cast&into&metal&from&wax)&
o Extracoronal&!&Retentive&clasp&assemblies:&
" Infrabulge&(come&from&below)&+&Suprabulge&+&Attachements&
• Indirect!Retainers&!&only&needed&for&distal&extension&RPDs&
&
Patient!Management!
• DJHMO&!&Health&Maintanence&Organization&–&aka&“Capitation&dental&plan”&!&dentist&paid&fixed&amount&month&
• DJPPO&!&more&pt&volume,&less&money&(discounted&rate)!
• DJIPA&!&may&be&owned&by&dentist&(hybrid&DLHMO&risk&!
Patient!Managements!and!Random!Junk!
• OVIDLMEDLINE&!&has&references&to&dental&literature&electronically&
• Overbilling&!&Dentist&charges&$500&for&crown,&insurance&company&only&covers&$400&and&dentist&waves&$100&coLpay&
so&pt&doesn’t&own&anything&but&dentist&tells&insurance&they&are&charging&$500&
• DJHMO&(Health&Maintanence&Organization)&–&aka&“capitation&dental&plan”&!&dentist&paid&fixed&amount&monthly&
• Third!Party!Reimbursement!(Dental&Managed&Care&!&mediates&btw&doctor&+&patients)&
o Fee!Schedules&–&“medicaid”&!&list&of&fees&agreed&by&dentist&that&the&government&pays&+&paid&in&full&
o Table!of!allowances&!&3rd&party&insurance&company&decides&&
o Capitation&!&dentist&paid&FIXED&amount&monthly&for&pts&assigned&to&plan&regardless&of&services&given&&
o UCR&
o Reduced&Fee&for&service&!&PPO&&
• OpenJpanel&!&dentist&willing&to&accept&third&party&payment&
• ClosedJpanel&!&dental&services&provided&by&salary&dentists&at&specific&locations&
• Balanced&billing&!&dentist&charges&pt&the&difference&between&what&insurance&covers&+&the&usual&customary&rate&
• “Bundling”&!&Dentist&bills&the&crown&and&buildLup&separately&but&insurance&company&says&buildLup&is&part&of&crown&
• Dentist&=&conditioned&stimulus&(get&scared&as&soon&as&you&see&them?)&
• Descriptive&epidemiology&!&investigator&studies&occurrence&of&oral&cancer&in&private&nursing&home&
• Downcoding&!&dentist&does&2&crowns&but&insurance&company&pays&for&one&
• Good&Samaritan&Act&–&accepted&in&all&states&but&dentists&not&included&in&all&states&
• Smoking&!&ASK,&ADVISE,&ASSESS,&ASSIST,&ARRANGE&
• Case&control&study&!&using&hospital&records&(establishing&exposureLdisease&relationship)&
• Cohort&!&study&among&smokers/nonLsmokers&in&period&of&6&years&to&develop&disease&!&PROSPECTIVE&study&that&
FOLLOWS&the&groups&of&people&over&period&of&time&
• ChiLsquare&test&!&measures&ASSOCIATION&between&2&variables&(counts&or&proportions)&to&compare&2&groups&
• TLtest&!&compares&mean&value&of&two&groups&(difference&between&the&2&means)&
• Sterilzation:!
o Steam&(autoclave)&!&250°F/121°C&for&15L20&mins&at&15&psi&!&MOST&efficient&
o Dry&Heat&(long&+&hotter&320°F)&+&Unsaturated&Chemical&Vapor&!&does&NOT&dull/corrode&metal&instruments&
(for&metal/glass)&
o Ethylene&Oxide&Gas&!&(chemiLclave)&alkalkating&agent&irreversibly&inactivates&DNA/proteins&10L16&hours&
(long)&
o Iodine&!&MOST&effective&SKIN&ANTISEPTIC&)&!&Iodophors&can&penetrate&mycobacteria&lipid/wax&
o Cold&Sterilization&!&2%&Glutaraldehye&!&10&hours&(long)&
o Quaternary&ammonium&compounds&!&cationic&!&good&for&gramLPOSITIVE&bacteria&
o Alcohols&!&denatures&proteins&+&MOST&WIDELY&USED&ANTISEPTIC&
o SemiLcritical&item&=&mucous&membranes&
So my exam was on 26th-27th Feb...you will find most of the qs you solve in the group..ALL X-
RAYS and clinical pictures are fair to get the answer so don’t worry about these things..DAY-1 :
It was not bad guys..Many Many Qs were form the group , Mango and latest rqs.. Surprisingly, I
didn’t get any of mandibular movement (Working and non-working things) Except ONE Q and it
was about the cusps of non-working interference so I was so so happy :D but instead, I got A
LOT about VDO , VDR ,wax trial denture bases , ..I got pt management from Golden and ADA
Code of Conduct….I got a lot of easy flaps … Many qs about Operative and how to deal with
MOD and MODBL ..MOST of Qs are about the LEAST or ALL do something EXCEPT which
they’re sometimes fine bec. You can answer with exclusion and some other get you confused
and stuck with 2 options and you don’t know which one you’ll exclude..Many Qs from ASDA or
Mastery app if you have..Many Qs like two statements and which is true or false (I hated these
Qs )...O MY GOD, I just found that there’s a man called Andres Gomez ..many of his qs I got them
EXACTLY ..FOLLOW His Qs or ask him from where he gets these Qs.. About DAY-2 : I didn’t sleep
well before that day, so I was sleepy at the exam, didn’t like the qs but it’s doable if you read the
cases thoroughly ..Most of cases I got are from Mango but with more qs ..I got an ortho case-
prostho case - third molar eruption case - perio case ..Stay positive in the group, it is the best place
ever to make mistakes and learn ..Thanks to everybody shares their rqs and thanks to all who post
qs and discussions..they help a lot .. I will recommend to know the basics and search for the right
answer..don’t just follow people’s answers.. HOPEFULLY, I pass this exam and you all the same
..GOOD LUCK TO YOU ALL
1- Ortho case ..young girl with anterior crossbite..has impacted canine.
-how to correct anterior crossbite (the q was all these correct anterior crossbite Except)
2- a reason for gingivectomy: pocket depth(the ans.) or osseous defects or other options.
3- for a lower complete denture, level of occlusal plane in relation with the tongue.
(lower - higher - no relation)
4- 2 qs about crown lengthening
5- 2 repeated qs about fusion
6-Battery
7-Informed consent (2 different qs and Cost was not in options so Know the exact contents of
informed consent)
8-2 qs about fusion and how to differentiate it from Gemination
9-Sample size is irrelevant to ( case history - cross sectional - cohort study - case study)
10-Mesloma ( or something like that) is classically associated with ( lupus - pregnancy-other
options)
11-The best method to treat a patient who is manipulated ( Nitrous oxide-and other options can’t
remember)
12-non-working interference. Just one q
13-Maxillary molar thin attached gingiva what you do not do on the distal-FGG, Apically PF,
Distal wedge ( the exact q from the group)
14-test for 2 means (T-Test)
15-a questionnaire in a course, what study (cross sectional-case study-cohort)
16-FDA and a new drug ( randomized clinical trial)
17-patient with hearing impairment.how to deal with him(talk to the interpreter and then he
explains the ttt to the pt or depend of pt understanding the lips language or other options)
18-pics about exostosis , ameloblastoma(soap bubble), submandibular gland lesion, hyoid bone
on panorama) ,hemangioma on the tongue, retained root fragments (2 times) , idiopathic
osteosclerosis
19-nitrous oxide contraindicated in (1st trimester or 2nd or 3rd or all)
20- case q about pins in x-ray if they’re short, thick, normal and how to treat it
21-What final process in coronary arteries causes myocardial infarction rather than angina?
B- Arterial spasm
C- Thrombosis
D- Fatty deposits
22- Which of the following conditions is most often characterized by a painful response that subsides
quickly with stimulus
A- Normal pulp
B- Nonvital pulp
C- Reversible pulpitis
D- Symptomatic irreversible pulpitis
23- Administration of nitrous oxide/oxygen is contraindicated in which of the following conditions?
A- Asthma
B- Hemophilia
C- Nasal congestion
24- responsible for dental materials and dental devices: ( FDA , or other names never heard of) so
search for the right ans.
25-Adult child can decide a treatment plan for his 65 year old parent in what situation
A. when he is paying
B. when he is impaired either ear or eye
C. patient wants his decision
D. Has a healthcare power of attorney (this Q from Golden)
26- Chronic Periodontitis ( black males- white males - black women - white women)
27- Type 2 Diabetes ( blacks - Hispanics - Caucasians )
28- The poorest Prognosis of Oropharyngeal Cancer is found in (black males - White males or other
options)
29- the rate of success of non-surgical Endodontic Treatment : ( 91-100% , 81-90% , 71-80% , 61-
70% )
30- Rapport is ( persistent eye contact , Active listening (both are in options) )
31- Exact mechanism of action of H1 Histamine blockers ( physiological antagonism , block
histamine at the receptor , other options)
32- What is not given to patient with Hyperthyroidism ( Epinephrine , other options)
33- Persist the Asthmatic Attack ( NSAID , other options)
34- Antibiotic for Non-Odontogenic Maxillary Sinusitis ( Augmentin - Penicillin -Metronidazole)
35- Local Anesthetic without a vasoconstrictor (Mepivacaine , other options)
36- Local Anesthetic for Hyperthyroid Pts ( Mepivacaine 3% , Lidocaine with Epinephrine, other
options)
37- A characteristic feature in Fetal Alcohol Syndrome (midface deficiency , Anencephaly , Cleft lip ,
distinct philtrum)
38- A characteristic feature in Down Syndrome ( Relative macroglossia - Class III -other options)
39- Dermatologist most commonly referred patient to dentist (Nevoid Basal Cell Carcinoma)
40- description of Non-maleficence
41- Informed Consent - Autonomy
42- Topical Antibiotics can be used for supragingival calculus and gingivitis
Topical antibiotics are used as a adjunctive of home care
Both true - both false - first true,second false - first false,second true
43- Not true about Tetracycline ( bactericidal - teratogenic - develops bacteria during course of ttt)
44- what is the use of infra-orbital pointer in a Facebow
45- Facebow function
46- How to motivate the pt for proper OH you do all except
a. Positive reinforcement
b. Pt something
c. Operant conditioning
d. Motivational interviewing
e. Carrot stick
47- Longest Local Anesthetic
48- For dentist to avoid a lawsuit he needs? Competence
49- A lot of qs about VDO , VDR , Trial denture bases
50 - the Sound that helps in determining Vertical dimension of occlusion( S - T - F )
51- Another Q about S sound
52- Antibiotic used in Osteomyelitis
53- Antibiotic used for Perio treatment (Minocycline was in options )
54- Many Qs from ASDA or Mastery app if you have
55- MANY Qs two statements and which are true or false
56- Most common medical emergency in dental office (Syncope - Asthma -hyperventilation)
57- Most common respiratory emergency in dental office ( Asthma only in options ,No
hyperventilation)
58- how to measure attached gingiva.
59- Probing depth from where to where
60- Epinephrine and Nitroglycerin which interaction (physiological antagonism ,other options)
61- Epinephrine and Propranolol ( hypertension - hypotension - other options)
62- Epinephrine and Atenolol (same effect as non-selective - less effect - other options)
63- Marginal discoloration in porcelain ( silver - copper -other options)
64- After a month, there is marginal discoloration of veneer ( amines - Microleakage -
polymerization shrinkage )
65- Gingival third of PFM is very translucent , the cause of that ( improper metal framework -
inadequate reduction -other options can’t remember)
66- Light Cure Color stability ( TEGDMA)
67- Partial Veneer Crown Vs Full veneered crown all Except ( increase retention - Easy to clean
margins - save tooth from more reduction )
68- Ideal reduction for venner middle third ( 0.3 - 0.5 - 0.7 )
69- amount of reduction of Occlusal rest at the marginal ridge ( 0.5mm - 1mm - 1.5mm - 2mm )
70- Major connector function ( Rigidity and stability - retention and stability - other options)
71- Major support in Class III Kennedy Classification with modification 1 comes from :
( occlusal rests - denture base - Minor connectors - Major connectors)
72- Reciprocal Arm ( Cross-Arch Stabilization)
73- what indicated to remove torus palatinus ( when interfere with posterior palatal seal -other
options)
74- What are Primary stress bearing areas for maxillary and mandibular CD :
(each option has two things and the most logical one was residual ridge for maxillary and
mandibular arches--other options were mix of one primary with one secondary )
75- Effect of Aspirin : (there were long options , and I found these options from the group .it is
the SAME)
1 Increase in prothrombin and bleeding time
2 decrease prothrombin and clotting time
3 hypoprothrombinemia, defective platelet aggregation and defective bleeding time
4 hypoprothrombinemia, defective platelet aggregation and decreased prothrombin time
76- which of these options are Antidepressant drugs : Imipramine and Amitriptyline
77- Side effect of Methotrexate : bone marrow depression - other options
78- a q about Naloxone effect on receptors ( the same Q from ASDA)
The drug-receptor activity of naloxone is best characterized by which of the following pairs?
High affinity, No intrinsic activity
Low affinity, High intrinsic activity
No affinity, High intrinsic activity
No affinity, Low intrinsic activity
High affinity, High intrinsic activity
79- Antagonist for Oxycodone
80- Antagonist for Diazepam
81- Phenytoin is used to relieve which type of epilepsy
82- Analgesic for renal failure ( Ibuprofen - Acetaminophen - Other drugs ending with profen )
NO oxycodone in options
83- breastfeeding
84- a q about hydroxyzine
85- Morphine : all are side effects of cocaine Except (mydriasis - miosis - other options)
86- 29 yr - pregnant and breastfeeding 1 yr old needs sedation which will you give
Nitrous -- Chloral -- Diazepam -- Promethazine -- Phenobarbital
87- Apexification and apexogenesis
88- Calcium hydroxide is used for (direct pulp capping for primary teeth - intracanal medication -
other options)
89- Many Many Qs in operative..they were like small case and how to treat the tooth.
90- 16 kg pt..calculate max. Amount of lidocaine ( 70 mg - 50 mg - 90 mg)
91- negative predictive value calculation
92- Specificity and sensitivity definition
93- Gutta Percha disinfection
94- tooth with a ledge..how to manage
95- another calculation ..a number of decayed teeth ..another number of filled teeth ..a number of
both decayed and filled teeth … calculate the probability of teeth to be decayed or filled : the options
were like percentages (70% - 90% ) can’t remember anything more about that q.
96- best implant where ( mand. Anterior - max. Anterior - mand. Posterior - max. posterior)
97- Patient stand on the corner looking at the floor and his hand is folded together after you give him
an introduction what you ask him or do next ?
a) what's bring you here today?
b) why are you angry?
c) is my assistant didn’t tell you to have a seat
d) is there anything annoy you ?
98- Long term exposure to low, chronic doses of X radiation poses what serious risks?
(1)Radionecrosis (2)Purpura (3)Diarrhea (4)Carcinogenesis
99- low sag factor
100-IF you increase the POWDER of cement , what happened
101- know the side effects of clopidogrel
102- zygomatic process --x-ray
103- Osteogenesis Imperfecta is associated with ( Amelogenesis Imperfecta - Dentinogenesis
Imperfecta -other options)
104- Mineralization of MAndibular permanent first molar Crown is completed in ( at birth , 2-3 years ,
4-5 years , 6-7 years)
http://forums.studentdoctor.net/threads/official-nbde-part-2-study-q-a-thread.814471/page-4
Endo Diagnosis:
QUESTION: which teeth do you perform pulp eval on?

a. tooth only
b. tooth and neighboring teeth---?
QUESTION: When testing tooth for cold; test adjacent teeth and opposing teeth & contralater
teeth)
QUESTION: Is an apical radiolucency present for a long time with no symptoms and no sinus tract
associated with necrotic pulp or asymptomatic apical periodontitis? Asymp chronic periodontits
QUESTION: You have a tooth, no pulp, but periapical radiolucency, you do access and find no canal,
what do you do? - I said don’t try to be a hero, refer to an endodontist
QUESTION (DAY 2): A molar is super-erupted, but has irreversible pulpitis, what do you do? – RCT
and Crown (other choices were EXT, just do crown – this was tricky because to answer the
question, you have to look at the patient dental chart and findings)
QUESTION: 5yrs old patient, he fell down 2 months ago, and hit his #E when he fell down, the tooth
is now discolored, what do you suspect? – Necrotic pulp.
QUESTION: Same patient as above, there is a red swollen lesion on the gingival of tooth #E, what is
most likely be? – Sinus tract (other choices, periapical cyst, periapical granuloma, etc)
QUESTION: Same kid from above, What do you recommend for this tooth? – EXT!
QUESTION: What does radiolucency at furcation of primary M1 in 5yo usually indicate: erupting
permanent PM1, necrotic pulp, normal anatomy
a. Necrotic pulp – it is in a 5yo so man PM1 shouldn’t be causing resorption yet
QUESTION (DAY 2): A case of a patient with tooth that has sensitivity that lingers with thermal test,
and positive to percussion, what does the patient have? – Irreversible pulpitis with acute
periapical abcess (other choices were Irreversible puplitis with no acute peripical abcess, and 2
other choice with reversible pulpitis in them).
QUESTION: Prolonged, unstimulated night pain suggests which of the following conditions of the
pulp?
A. Pulp necrosis
B. Mild hyperemia
QUESTION: X-ray of PA R/L of a primary teeth: Normal R/L because perm tooth is erupting
underneath
QUESTION: Lucency is seen in PA, it’s under the furcation of primary molar, what could this be due to? –
Necrotic pulp (other options were roots are resorbing, permanent tooth caused it, some other stuff)
QUESTION: Little girl had ALL, had radiolucency in furcation of primary 2nd molar. What is the
treatment?
• Extraction
• Pulpotomy
• Pulpectomy
QUESTION: primary tooth got necrosis, and the inflammation went down through furcation and
affects permanent tooth. What is it gonna cause to permanent tooth? Can disturb ameloblastic
layer of permenant successor or spread infection
QUESTION: Radiolucency in furcation of primary tooth? Necrotic, extract

QUESTION: In a primary tooth apical infection the first radigrapoh sign is where?- in the furcation.
QUESTION: calcium hydroxide is contraindicated in pulpotomy in a child because it causes

irritation leading to resorption in primary teeth
QUESTION: 5.38 picture: know when to extract
If it’s a primary 1st with furcation involvement: EXT
If it's a primary 2nd, furcation, but restorable: PE
If its any other primary tooth no furcation: PO

QUESTION: The best method to test newly erupted primary teeth – percussion
QUESTION: Least reliable test on primary teeth

• Electric pulp test
• Percussion (MOST RELIABLE)

Hargreaves, Cohen. Cohen's Pathways of the Pulp, 10th Edition. Mosby, 052010.
QUESTION: pulpal pain that only occur at night with no stimulation: pulpal necrosis
QUESTION: when the heat apply to tooth, lingering pain for several minutes: irreversible pulpitis
QUESTION: what is diagnosis: lingering pain to cold and sensitivity to percussion?Irreversible pulpitis
and acute periapical abscess
Usually periodontal abscess is sensitive to percussion…irreversible is usually percussion
positive
QUESTION: A tooth is not responsive to cold, not to percussion, and palpation is tender: necrotic pulp
and chronic apical periodontitis. – irreversible pulpitis and normal apex) there was not an item saying
necrotic pulp and normal apex)
QUESTION: Which of the following least important factor in referring an endo case to specialist?
Dilacerations, calcifications, inability to obtain adequate anesthesia? Lease import is mesial inclination
of a molar*** correct answer
QUESTION: 7 yr old boy has vital exposure of tooth 1st perm max molar. What do you do for
treatment. Pulpotomy carious? Pulpotomy.
QUESTION: Child had carries exposure on primary 1st molar….what to do pulpotomy

QUESTION: A 7-year-old patient fractured the right central incisor three hours ago. A clinical
examination reveals a 2-mm exposure of a "bleeding pulp." The treatment-of-choice is
QUESTION: Did pulpotomy in a 7 yr old’s pulp exposed decayed tooth #30 why? To allow
completion of root formation (apexogenesis)
QUESTION: Why would you do a pulpotomy in a mandibular first molar of a 7 year old? To continue
physiologic root development
Apexification: Create an apical barrier in a necrotic tooth with an open apex.

• Induce a calcified apical barrier by placing dense calcium hydroxide paste after the
instrumentation. Canals are obturated when barrier is formed in 3–6 months.
• Placement of an artificial apical barrier, such as MTA, prior to obturation. This method, can
be completed in a day or two, appropriate when patient compliance or long-term follow-up
care is questionable.
Apexogenesis: Vital pulp therapy performed to allow continued physiologic development and
formation of the root.
• Place calcium hydroxide over the radicular pulp stump. Recall every 3 months to check for
the pulpal status.
• RCT is indicated when the root development is completed.
apexogenesis & apexification on primary vital & non vital teeth

• apexogenesis: tx of VITAL tooth w/ an OPEN apex & pulp exposure using calcium hydroxide to
preserve vitality & encourages the continued development of the root
• apexification: tx of NONVITAL tooth w/ incomplete apex formation & pulp exposure using
calcium hydroxide to achieve apical closure
Apicoectomy: (Root-end resection): Prep of flat surface by excision of apical portion of root.
QUESTION: Know when to do indirect pulp cap, pulpotomy, apexification (non vital teeth with MTA),
and pulpectomy (ZOE if apex is not closed in primary teeth) in pedo patients.
QUESTION: Indications for apicoectomy: RCT can’t be done by conventional means, failed existing
RCT and can’t re-treat
QUESTION: why you do apico surgery except : When an apical portion of canal cannot be cleaned,
healing.
QUESTION: When do you use an apicoectomy? →failing RCT and can’t do retreat also w/ post and
cant get to area
QUESTION: If a tooth with previous endodontic treatment becomes reinfected, it is best to retreat it
conventionally by removing the filling material, debride the canals, and refill. However, if the tooth has
been restored with a post, core, and crown, then apical curettage, then an apicoectomy and retrofill
should be performed.
QUESTION: PEriapical lesion biopsied after apicoectomy of RCT treated tooth, tooth still sensitive
tooth, with neutrophils, plasma cells, nonkeratanized stratified epithelieum (islands of), and
fibrous connective tissue→ abcess, granuloma, cyst,
QUESTION: There is a study that shows there is extraradicular plaque in an infected tooth what
does this mean the Dentist might need to do: I was deciding between mechanochemical irrigation
and debridement of the canal vs doing surgical endo (apicoectomy)
QUESTION: Extraradicular biofilm theory recommends endo with: Crown down, debridgement, Ca(OH)2
therapy? (irrigate and debride)
QUESTION: Why you perform apexification: When you have necrosis on an open apice tooth.
QUESTION: why you do apico surgery : When an apical portion of canal cannot be cleaned,
healing.
QUESTION: Why you do apico surgery: When an apical portion of canal cannot be cleaned, persistent
apical pathology after RCT, apical fracture, overextension.
1. Apexification (Non vital) 2. Apexogenesis, (vital) 3. Root Canal Treatment
QUESTION: why you perform apexification(non-vital) :→When you have necrosis on an open
apex tooth
QUESTION: Definition of apexification:The process of induced root development or apical closure of the
root by hard tissue deposition NONVITAL
QUESTION: Tx for Traumatic pulp exposure on max incisor that root has not completed formation?
Apexogenesis
QUESTION: pt comes to you and theres non vital tooth with open apex-apexification→ NONVITAL
QUESTION: irreversible pulpitis with open apex apexification
QUESTION: Six months ago you did a RCT on central with an open apex (the pt was young, but can’t
remember the exact age). You place calcium hydroxide in canal and waited the 6 months. You open the
canal but can still pass #70 file through the apex. What would you do?
- *calcium hydroxide
- Zinc oxide eugenol
- gutta percha
QUESTION: Pt is 13 years old and has a non-vital maxillary central. The apex is still open what do you
do.
A. Apexogenesis
B. Apexification** I think this is right I put A.
C. Pulpectomy
D. Nothing
QUESTION: Pulp is vital, pt’s a 8 year old. Apex is open. What do you do.
A. Apexification
B. Apicoectomy
C. Pulpectomy
D. calcium hydroxide pulpotomy.**
Tooth Avulsion: complete dislodgment of a tooth out of its socket by traumatic injury. Short extra-
oral dry time and proper storage medium are key factors in offering favorable treatment outcome.
• Indications for treatment: Treatment is indicated when a tooth is completely dislodged from
its alveolus.
QUESTION: Reason for failure of replantation of avulsed tooth: external resorption, internal
resorption
QUESTION: Most important factor about avulsed tooth – Time (other options were like what you store it
in, etc)
QUESTION: why an implanted avulsed tooth fails: outside of mouth too long: too much extra oral
time
QUESTION: Before 15 min what is success rate of avulsed tooth? 90 percent success rate, by 30
min➔ success rate decreases to 50%
QUESTION: why an implanted avulsed tooth fail : a) the dentist curettage the socket b) too much
extra oral time c)the dentist clean the root surface d)failure to place the tooth in the solution ( Fl )
QUESTION: Splinting Avulsed tooth – 1-2 weeks **yes..mosbys says splint for 7-10 days
QUESTION: Splinting avulsed teeth – for how many days? 7-10 days
QUESTION: Best substance to place avulsed tooth.? hanks solution(na, K,calcium plus glucose) if not
milk.
QUESTION: What is best storage media for avulsed tooth? HANK(HBSS: Hank’s balanced salt
solution) Best solution
QUESTION: If tooth has closed apex, immerse tooth in 2.4% sodium fluoride solution with what pH
for how many minutes? pH of 5.5 (changed the pH) for 5 min…
QUESTION: Avulsed tooth should be treated with what to reduce root resorption? 2% Sodium
fluoride for 20 minutes.
QUESTION: Avulsed tooth, extraoral time was less than 60 mins, primary tooth, what you do? Don’t put
it back.
QUESTION: CaOH tx for an avulsed tooth????? Yes or no?
QUESTION: Splint tooth for pt comfort
Avulsion – 7-10 days non rigid splint, antibiotics
Rigid splint for horizontal root fractures 3 months
Extrusion is a splint for 2-3 weeks

QUESTION: Patient intrudes mature maxillary incisor. Trauma causing deep intrusion to a
permanent tooth causes PULP NECROSIS and conventional RCT is necessary.
QUESTION: Intrusive trauma pulp necrosis, what percent is rate of pulp necrosis? 96 %
RCT related:
Endo tests?
Percussion- presence of inflammation in PDL or not.
Palpation- spread of inflammation to perodotium from PDL or not.
EPT- Pulp vitality (necrosis or not).
Thermal test (hot & cold)-pulp vitality. Hot (irrev), cold (rev)
***Sodium hypochlorite NaOCl is NOT a chelator, (it dissolves organic tissue)
QUESTION: Bleach is not a chelating agent
QUESTION: Sodium hypochlorite is not a chelating agent. **It is an 5.25% irrigation solution—
germicidal. It is also vital to tissue. Other irrigation solutions include urea peroxide (glycerol based) and
3% hydrogen peroxide. Chelating agents are good for sclerotic canals. Substitute sodium ions and soften
canal walls.
QUESTION: which is a chelator for endo? EDTA, sodium hypochlorite, etc.

EDTA is chelator, removes SMEAR LAYER and inorganic material.
(NaOCl = sodium hypochlorite only dissolves organic material, only disinfects and is most
common irrigant.)
QUESTION: EDTA: **Percentage of EDTA: 17%
QUESTION: What is the function of EDTA: remove inorganic material and smear layer
QUESTION: Which one is false about NaOH? – It’s a chelating agent.
QUESTION: Which one is correct about EDTA? – It’s a chelating agent.

QUESTION: Chelating agent: EDTA
QUESTION: contraidication for CaOH: Pulp symptomatic for last month..
QUESTION: PAR seen on asymptomatic tooth, when opened the canal is calcified what do you do: do
nothing, refer to endodontist, place EDTA
QUESTION: Internal resorption left untreated can lead to? I think Pink tooth
QUESTION: Similar question: What causes Pink Tooth Mummery? Trauma and infection internal
resorption
QUESTION: treatment for internal resorption (endo): RCT
QUESTION: How to treat internal root resorption : Endo
QUESTION: Internal resorption shows all BUT – radiography is symmetrical with the pulp space, can
resorb all the way to the PDL, a treatment option is observe until resorption stops, resorb to create
pink tooth
QUESTION: when a tooth is ankylosed what type of resorption : replacement resorption
QUESTION When you replant teeth, what will happen
a. Ankylosis (will not say that) – replacement bone formation ANS
QUESTION: Inflammatory external root resorption? What do you do? Extraction ENDO!
QUESTION: The treatment-of-choice for an external inflammatory root resorption on a non-vital tooth is
A. Extraction  
B. Surgical curettage of the affected tissue  
C. Pulpectomy and obturation with gutta-percha and sealer  
D. Removal of the necrotic pulp and placement of calcium hydroxide  
QUESTION: when a reimplanted tooth presents external resorption what is the Tx : a) RCT with
gutta percha JUST OBTURATE AND PLACE CaOH
QUESTION: How you manage tooth with external root resorption
b. Instrument and put CaOH
QUESTION: when a reinplanted tooth presents external resorption what is the Tx : a) RCT with
gutta percha b) obturation with CaOH c) extraction
(do CaOH every 3 months until PDL is healthy then complete RCT)
QUESTION: which has the best prognosis
• perforation in internal resorption??
QUESTION: least likely to result in endo failure? overfilling with gutta percha, inadequate either
obturation or cleaning and shaping (can't remember), lateral root resorption, perforating
internal resorption
QUESTION: cause of grey tooth
• blood products in the dentinal tubules (what I put, I think this is correct)
• calcified canal
QUESTION: Why are traumatized primary incisors discolored? Pulpal Necrosis and Pulpal
Bleeding
QUESTION: elective endo
• pulp exposure
• unrestorable tooth…
• endo contraindicated in: non restorable tooth
QUESTION: Biggest reason for failure of RCT – cleaning of the canals, proper obturation …
QUESTION: root canal failed on upper canine - due to cleaning and shaping
QUESTION: root canal failed on upper canine - (lack of seal)
QUESTION: Pt comes in for a RCT on a non-vital tooth with 1mm apical lucency. 5mo later comes back
with 5mm lucency, why?- Improperly done endo, retx. Others another canal, osteosarcoma, carcinoma.
Most common cause of RCT failure is inadequate disinfected RC, 2nd most common cause is poorly
filled canals.
QUESTION: Incomplete removal of bacteria, pulp debris, and dentinal shavings is commonly caused
by failure to irrigate thoroughly. Another reason is failure to
A. use broaches.
QUESTION: least likely cause for failed RCT

a. GP beyond apex---causes of failure 1) insufficient canal debridement 2) insufficient
obuturation/leakage.
QUESTION: Gutta percha, all except – adapts to tooth (needs sealer)
QUESTION: Which of the following is not a property of gutta-percha . radiopacity, Biocompatibility,
Antibacterial, →Adaptation
QUESTION: Gutta percha has the following advantages EXCEPT: 1.easy manipulation, 2. Adapts to
tooth surface, 3.Anti- microbial,4. Biocompatible 
QUESTION: Patient comes back few months after RCT & Crown with pain upon biting, what
happened…cracked tooth, hypersensitivity
QUESTION: Pt has pain in tooth after crown and root canal: vertical root fracture, a lot of these type of
questions, know wehter it’s vertical, or occlusion problems (sensitive to cold, hot and all that).
QUESTION: Similar questions: Crown cemented two weeks ago is sensitive to pressure and cold, why?
Occlusal trauma
QUESTION: Pain on tooth 2 weeks after crown placement? I put root fracture
***No why would it be root fracture after a crown placement?? it would make more sense that it’s a root
fracture after RCT not crown placement. I think answer should be hyperocclusion, if the option was there
****
QUESTION: Tooth with endo treated and post with crown have pain after several days esp during biting
and cold: →vertical root fracture
QUESTION: Patient has pain 1 month after cemented crown and post and rct, pain on biting, why?
QUESTION: You did endo on patient, weeks later you did CPC after that? Patient has post-op pain on
tooth? Vertical fracture
QUESTION: Vertical root fracture – non restorable after
QUESTION: Most common cause of vertical rt fracture?
QUESTION: Which teeth do vertical fractures more common? – Lower posterior teeth.
QUESTION: What causes most vertical root fractures? Condensation of gutta percha
QUESTION: most probability of vertical root fracture- isolated pocket depth
QUESTION: isolated pocket . What condition? Vertical root fracture
QUESTION: Patient get paid every now and then on a tooth when he eats meal? – Cracked tooth
syndrome
QUESTION: Which one has a different transillumination? I said cracked tooth (other choice were crown-
and-root fracture, have no idea!)
QUESTION: which allows the enitre tooth tooth to light up under transillumination? I said
cracked tooth (other choice were crown-and-root fracture, separated tooth, have no idea!) I said
ccraze lines? →? CRAZE LINE (WHOLE TOOTH)
QUESTION: When does transillumiator show evenly through tooth: craze line, crack, fracture from
crown to root: Craze line
QUESTION: when does translumination shows the whole crown : a) fracture cusp b) cracked tooth
c) craze lines
TRANSILLUMINATION: shows cracks. Whole tooth = craze line
QUESTION: Type of fracture that lets light pass completely through…
a. crazed CRAZE LINE
b. split tooth
Cracked tooth
Fractured cusp
Craze line
QUESTION: Vertical root fractures are also called cracked teeth. The prognosis of cracked teeth varies
with extent and depth of crack.
QUESTION: If two cavities were thought to be two separate fillings but upon exam it was a crack through
the isthmus. What do we tx this symptomless crack with?- observe
QUESTION: most common tooth associated w/ cracked tooth syndrome: Mandibular second molars,
followed by mandibular first molars and maxillary premolars, are the most commonly affected teeth.
QUESTION: Most common to have cracked tooth = mand 1st molar (mand 2nd first) MD
direction
QUESTION: horiz root fracture
a. reduce & immobilize
Rct
Splint
CaOH
QUESTION: Apical horoziontla root fracture: no pain, what do you do? Rct, scaling, rct if tested
nonvital, monitor 1 year
QUESTION: Horizontal Root Fracture more common in anteriors, the success and healing of
horizontal root fractures is the immediate reduction of the fractured segments and the
immobilization of the coronal segment 12 weeks
QUESTION: What teeth most likely to have crown/root fracture … max anteriors, mand anterior, max
posteriors, →mand posteriors- a strong majority are lower molars (1st)
QUESTION: Most common teeth with crown to root fracture? Mand molars
QUESTION: which tooth is least likely to fracture: mx premolar, mx molar, md premolar, md
molar
QUESTION: which tooth is most commonly fractured? mx incisors, md incisors, etc.
QUESTION: Chronic endo lesion, what type of bacteria? Anerobes ANS (multiple anerobes)

Bacterial infection
Forgot other one
QUESTION: Endo file breaks when you at 15 file. refer to endodontist.(retrieving it was not an option)
QUESTION: If file breaks tooth asx:
• Leave and monitor
QUESTION: You being the best doctor in the world, you broke a 5mm dental instrument in a canal during
RCT procedure, what’s the best thing to do? – Tell the patient what happened, and refer her to an
endodontist. (Other choices were, take a picture and only tell patient if you see the instrument in there, re-
schedule patient to continue with RCT, Put a watch on it)
QUESTION: Endo on a molar.
Break a file on apical level, what should you do?
-write on med history and continue?
-refer patient to specialist?- if it was in middle third you would continue treatment.
QUESTION: what file was the endodontist using?
Stainless steel
Ni Ti
QUESTION: What is not an advantage of NiTi over stainless steel

Ability to stay centered in canal
Something aided depth penetration into canal
My bad don't remember this question very well
QUESTION: all are advantages of using nickel titanium endo files over regular steel files except?
c. direction of the flutes (no)?
QUESTION: What is the weakness of Ni files vs regular- strength, flexibility... and some other choices ( I
wrote strength)
QUESTION: What is the NOT an advantage of stainless steel files? 1. More flexible.., 2. Less chance for
breaking, 3. Allows the file to be centered in canal, 
NiTi rotary files remain better centered, produce less transportation, and instrument faster than stainless
steel files due to their superior flexibility and resistance to torsional fracture. They have 10x the stress
resistances of stainless steel (stronger).
b. flexibility,
c. resistance to fracture.
QUESTION: you separate an endo file 3mm from the apex and obturate above it... which case will
show the best prognosis?
a. vital pulp w/ no periapical lesion(yes)
QUESTION: Best prognoses for a broken instrument at apical third?

Vital pulp with no PA abscess
Necrotic pulp with no PA abscess
Vital pulp with PA abscess
Necrotic pulp with PA abscess
QUESTION: which has worst prognosis? File fracture, transportation, I put perf through furcation
QUESTION: How many canals do you expect in primary M2: four
QUESTION: Access design –mandibular is trapezoid

QUESTION: What is the shape of the access of mandibular 1st molar?
A. Square
B. Trapezoid**
QUESTION: maxillary 1st molar access opening: triangular
QUESTION: Pulpal anatomy dictates a triangular-access cavity preparation in the MAXILLARY

CENTRAL INCISOR.
QUESTION: why do you do triangular access on incisors (max central inccisor?)

QUESTION: Ept tests whether its responsive or nonresponsive that’s it (not tell level of
necrosis/how vital the tooth is, etc.): Nerve
QUESTION: EPT – responsiveness (not health)

QUESTION: How does a tooth covered with crown react to pulp testing--- cold is better test (thermal)
QUESTION: what can you diagnose with the EPT test : pulpal necrosis
QUESTION: How do you differentiate between an endo/perio lesion? EPT
QUESTION: EPT: to differentiate if perio (some response to ept) or endo(necrotic, no response to EPT)
involvement
QUESTION: Vitality test used to distinguish periodontal from endo lesion – vitality and probing
depths
QUESTION: know best way to diagnose irreversible pulpitis ? heat. Cold/ thermal test
QUESTION: EPT is more accurate than cold test for pulp necrosis? FALSE

QUESTION: EPT- compared to cold test it is superior (False)….

QUESTION: What is not true regarding electric pulp test: Doesn’t tell you about vascular or
something like that (doesn’t tell you about vascularity of pulp which is true pulpal diagnosis)
QUESTION: Did not respond thermal and ept but response to palpation and percussion? Necrotic pulp
QUESTION: Most reliable way to test vitality of a tooth? EPT (I think Thermal was more correct, damn I
was tired at this point, and I was low on RedBull) **Mosbys states that thermal tests must be done before
a final diagnosis, because EPT can have may false readings
QUESTION: Luxated tooth, negative EPT - disruption of nerves to tooth
QUESTION: Best prognosis of perio endo lesion
• Endo with rct – perform first
• Perio scaling and root planning
QUESTION: what is initial treatment of combination perio and endo lesion: do rct first or perio first,
etc: RCT first
QUESTION: Pulp vitality testing. Difference between perio and endo periapical lesions. Best
prognosis – perio started from endo, or endo started from perio?
QUESTION: test performed to differentiate endo vs. perio lesions : Percussion
QUESTION: Percussion: can identify perio involvement
QUESTION: Difference b/w acute apical abscess and lateral periodontal abscess: Vitality test
QUESTION: lateral periodontal abscess is best differentiated from the acute apical abscess by?
a-pulp testing
b.radiographic appearance
c.probing patterns
QUESTION: how do you distinguish acute apical absess and periodontal absess : vitality
QUESTION: differential diagnosis of periodontal abscess and periradiculal abscess?
a.percussion
b. vitality test
c.palpation
QUESTION: on primary teeth you dont want to use ept → thin enamel false results and after
trauma you don't want to use electronic pulp tester.
QUESTION: What is test to diagnose acute periradicular periodontitis – sensitive to percussion
QUESTION: Good way to diagnose acute periradicular periodontitis – sensitive to percussion
QUESTION: acute apical periodontitis is best diagnosed with: percussion

QUESTION: acute periradicular periodontitis sensitive to what? Cold, Percussion
QUESTION: radiographically the acute apical abscess
b.may not be evident
c.has more diffuse margins than other lesion
QUESTION: What is test to diagnose chronic periradicular periodontitis? Percussion (palpation?)
QUESTION: How do u test a tooth to differentiate between chronic perio and supperative perio?
a. cold test
b. percussion (and lateral percution of course)
c. EPT
QUESTION: Indications of perio lesion vs endo lesion: apical radiolucency and pain upon lateral
pain pressure (not apical)
QUESTION: Which of following is not endodontic in origin: tooth with wide sulcular pocket not
extending to apex
QUESTION: What is feature that makes it a perio lesion that’s not seen on an endo lesion: I said it
was there is pain on lateral percussion of tooth and wide space of pocket against tooth
QUESTION: Which of the following conditions indicates that a periodontal, rather than an
endodontic problem, exists?

(true perio-endo lesion) Evaluate strategic value of the tooth. If tx is warranted, initiate endo
therapy first. Perio treatment may be combined with periapical surgery, if needed. Prognosis is
poorest.
If Endo lesion is draining through periodontal ligament space, Complete endodontic treatment and
wait several months to evaluate healing of periodontal lesion
If Perio Lesion has spread to the periapical region, Evaluate vitality of the pulp, institute
periodontal treatment alone if vital (treatment may devitalize pulp).
Endo-perio: pulpal necrosis leading to a perio problem as pus drains from PDL.
Perio-endo: infection from pocket spreads to pulp causing pulpal necrosis.
QUESTION: Endo abscess but no sinus tract, can pus drain through the PDL: True
QUESTION: endo lesion with sinus tract. Do RCT and leave the sinus tract alone, will heal
QUESTION: What treatment is required with tooth with draining sinus tract has been treated via RCT:
→no further treatment
QUESTION: when do you puncture? An abcess.
Localized chronic fluctuant in palpation.
QUESTION: A patient has a non vital tooth and a fistula is draining around gingival sulcus. What to
do
perio and then endo
only endo
only perio
QUESTION: There usually is no lesion apparent radiographically in acute apical periodontitis. However,
histologically bone destruction has been noted.
QUESTION: Based solely on the sharp transient response of pulp to hot stimuli, what is the periradicular
diagnosis?

d. Cyst formation.
QUESTION: Hallmark of periradicular abscess - sinus tract

QUESTION: A periradicular radiolucent lesion of endodontic origin on the radiograph may be any of these
histological diagnoses except one. Mark this exception.
a. A cyst
b. A granuloma
c. An Abscess
d. Dentigerous cyst
QUESTION: What complete endodontic diagnosis could be completely asymptomatic but should require
endodontic therapy?
QUESTION: A lesion of non-endodontic origin remains at the apex of the suspected tooth regardless of X-
ray cone angulations.
a. True
b. False (the radiolucency stays at the apex regardless of angulation for endodontic lesions)
QUESTION: Periapical abscess, what do you do? DO NOT DO RCT FIRST, YOU ARE SUPPOSE TO
INCSION AND DRAINAGE AND PRESCRIBE ANTIOBIOTCS AND WAIT TO DO RCT AT A
LATER DATE
QUESTION: How do you treat perio abscess? I put ENDO first, then possible perio tx later
QUESTION: Acute perio abscess – you must drain lesion
QUESTION: Acute perio abscesses that require drainage are usual firm, localized lesion (other
options are fluctuant, local lesion; generalized firm lesion)
QUESTION: First thing do with periapical abscess? Incise and drain,

Use gutta percha to find it
QUESTION: number one thing for acute apical abscess is drainage and cleaning the canal (multiple
questions reformatted that ask about this)
QUESTION: after an endo in maxillary molar what Tx would you for sinus track : no tx
QUESTION: Most critical for pulpal protection ANS. Remaining dentin thickness (2mm)
QUESTION: Each of the following can occur as a result of successful rct tx except which one? - formation
of reparative dentin
QUESTION: Boy has horizontal root fracture in apical 3rd, no symptoms or mobility, what tx? Monitor,
RCT, extract, pulpotomy, splint
QUESTION: A maxillary central incisor of an adult patient is traumatized in an accident. The tooth is
slightly tender to percussion, is in good alignment, and responds normally to pulp vitality tests.
Radiographic examination shows a horizontal fracture of the apical third of the root. The best treatment is
C. Apexification
D. Apicoectomy to remove the fractured apical section of the root followed by root
canal treatment
QUESTION: Worst prognosis for RCT – ledge formation, vertical fracture during obturation,
instrument gets stuck in apical 1/3 …
QUESTION: a Pt with an endo in a molar tooth, after one year a cyst form, the tooth was extracted,
after another year the cyst was bigger what happened : bad endo, the dentist did not curettage
well when the extraction was done
QUESTION: during root canal you notice you left debris in the canal most likely due to lack of use of
which? Gates burs, broaches, chelating agents? Others? Irrigant??
QUESTION: Taurodontism has enlarged pulp chamber in which direction? apical, occlusal or apical
AND occlusal **** know what tauradontism looks like on x-ray****
QUESTION: Taurodontism pulp bigger: apically
Operative:
QUESTION: Critical pH of developing cavity? pH 5.5*
QUESTION: pH that enamel starts to demineralize – 5.5
QUESTION What can tell best thing about caries: past caries history
(I would have prob put amount of caries and restorations b/c this is known to be an indicatior of
past caries not future caries.)
QUESTION: 3 factors that affect caries initiation? substrate, bacteria, host susceptibity
A. Radiolucency
• Can live in plaque,
QUESTION: Most Cariogenic? Sucrose... S.mutans adheres to the biofilm on the tooth by
converting sucrose into an extremely adhesive substance called dextran polysaccharid.
QUESTION: How do cells first attach- dextran or lextran? **I think its dextran. S. Mutans is involved in
converting sucrose → dextran like long chain polysaccharides (glucans/fructans) using enzyme
Glucosyltransferase. This is the main way caries develop.
QUESTION: Caries progression – lactobacillus
QUESTION: what contributes to caries formation – Lactobacillus
QUESTION: What helps in carious process but it is not the primary inititator for caries:
Lactobacillus
QUESTION: Lactobacillus: does not initiate caries but is part of the progression of caries

Saliva ph
Refined sugar
fluoride tx
saliva flow
QUESTION: Which race has most caries in kid population?
• Hispanics
QUESTION: What race for children has highest caries incidence? HISPANIC
QUESTION: early childhood caries- centrals and molars
QUESTION: Which population has the most number of UNRESTORED caries: black
QUESTION: White females have the most caries in permanent teeth
QUESTION: most recent increase in caries is seen in: roots
QUESTION: What one of the following increasing in the US? – Root caries
QUESTION: New data regarding caries shows: more smooth surface caries, more pit-fissure caries,
same, more root caries
a. More root caries
QUESTION: Recent survey, what kind of stats on caries?

• inc in smooth surf caries - wrong
• inc in pit/fissure caries - wrong
• smooth surf caries and pit/fissure caries is same - wrong
• inc in root caries****
QUESTION: How do you diagnose root caries? Soft
QUESTION: Best indicator of root caries is a soft spot
QUESTION: best clinical determinant of root caries ?
sensitivity to cold
soft spot on tooth - visual and tactile methods are used for detect caries
QUESTION: Remineralized teeth are they stronger than regular enamel?
QUESTION: For a lesion in enamel that has remineralized, what most likely is true? 1. The enamel has
smaller hydroxyapatite crystals than the surrounding enamel, 2. The remineralized enamel is softer than
the surrounding enamel, 3. The remineralized enamel is darker than the surrounding enamel, 4. The
remineralized enamel is rough and cavitated
QUESTION: Sign of remineralization: I put rougher than tooth structure and darker, but not sure
QUESTION: What’s the characteristic of a remineralized tooth? Darker, harder, more resistant to acid
QUESTION: Remineralized lesion is shiny and more resistant to future decay
black, dark, bright
black, dark, opaque
QUESTION: remineralized lesions, yellow: -more resistant to future caries
QUESTION: Remineralization? Harder than normal. (Pit and fissure are most prevalent caries)
QUESTION: What does arrested caries look like? Black dark
QUESTION: Leathery brownwhite lesion? arrested, acute, chronic
QUESTION: Scleoritc dentin: harder, better to bond to?
QUESTION: Which of these is NOT an important reason for a clinician to be able to distinguish
remineralization? I put color. I have no idea what this was asking.
QUESTION: Most common area for caries initiation? I put cervical to contact, Pit and Fissure
• pit and fissure*
QUESTION: location of interproximal caries lesion : below the contact
QUESTION: Most interproximal decay happens where? – Just under the contact.
QUESTION: When do you restore a lesion? – When there is cavitation (others were when it’s half
through enamel, when it passes CEJ, when you see it on xray).
QUESTION: When do you tx caries: half way to the enamel, through enamel, when you can see it
on xray (NO) Answer: cavitation
QUESTION: In which of these cases do you start restoration: can see on x-ray, cavitation present,
lesion ½ into enamel, cross CEJ (not DEJ)
QUESTION: when you start to do a caries : a) more than half way into enamel b) in the DEJ c) in CEJ
d) when you see it in the xray
QUESTION: When do you restore a tooth?
a. Either when its CAVITATED or when its ½ in enamel (but this can remineralize..)?
b. Nothing about dentin involvement.
QUESTION: Tx of root surface caries (pg 40): what kind of dentin should not be restored?
Eburnated dentin(Sclerotic dentin)
QUESTION: Fluoride is used for? Smooth interproximal surfaces.
A. interproximal**
prr/sealant)
QUESTION: What caries lesion has a V shape pointing to pulp- occlusal, smooth, root caries
QUESTION: Which of the following is a factor for smooth caries and sugar in-take? – Consistency (others
were volume, and other option. Consistency I thought would be like if you keep taking a lot sugar diet on
daily basis)
QUESTION: Which of the following is a factor for smooth caries and sugar in-take? – Consistency–
consistency b/c if it’s the sticky type it stays on the tooth longer allowing bacteria to keep pH lower
longer
QUESTION: Caries in children depend most on: amount, consistency, time
QUESTION: occlusal caries where is base and cone? Triangle point at enamel and base to dentin,
dentin base to tip at pulp

 b. Two apexes are pointing toward pulp>>>> in smooth surface (proximal caries)
d. Both bases facing DEJ
QUESTION: Pit and fissures caries have the base of both triangles lie along the DEJ
QUESTION: pit and fissure caries, base is at dej

QUESTION: DEJ- diff btw smooth caries(conical), occlusal (apex at occlusal), interprox (apex at
DEJ)
QUESTION: conical shaped caries w/ broad base with apex towards pulp is commonly seen in?
a. root caries
 b. smooth caries
 c. pit/fissure caries
QUESTION: Dx of pit and fissure caries, explorer catch, or dark stained grooves? Others? Inverted V on
x-ray
QUESTION: Most likely dx indicator of pit and fissure carries is what?- explorer catch. Others, xray,
adjacent tooth decalcify, contralateral tooth thingy
QUESTION: enamel caries best detected by explorer catch, pit and fissure stain.

QUESTION: Pt 32 year old, none of the teeth has restoration, pits and fissure stain? What do you do?
Observe, Fluoride
QUESTION: if you inadvertently seal over caries what happens? Arrested caries.
QUESTION: Fill over a caries – arrested caries
QUESTION: If a dentist seals a caries lesion on tooth, what would be the most likely result? 1. Arrest
caries (answer), 2. Extension caries, 3. Discoloration of tooth, 4. Micro-leakage
QUESTION: If you feed a person through a tube, then you decrease risk of caries
QUESTION: mechanism of caries indicator: enters the dentin and binds to the denatured collagen
QUESTION: Caries die- marks denatured collagen
QUESTION: How does caries indicator dye work. Bind to surface collagen of caries
QUESTION: How does caries indicator work? (p.17)
• A colored dye in an organic base adheres to the denatured collagen which distinguishes between
infected dentin and affected dentin
QUESTION: What does caries indicator do – I put it only stains affected dentin, not infected dentin
QUESTION: What type of caries detection is the Dyfoti used for? Class I Class II, Class III
•detection of incipient, frank and recurrent caries, demineralization
QUESTION: DaignoDent is Class I – ONLY OCCLUSAL CARIES (pit and fissure)
it for this year? 300/1000
QUESTION: Number of people with caries or other stat your looking for in your office this year is
300 out of 1000, last year it was 200, so what is it for this year? 300/1000 im pretty sure incidence
is NEW cases. And the answer is 100/1000. DESCRIPTIVE STUDY
it for this year? 300-200/1000= 100/1000= 0.1
QUESTION: dentist has 300/1000 patients with periodontitis; last year only 200 had periodontitis
what is the incidence for this year: 10%
QUESTION: Radiographic decay most closely resemble which zone of carious enamel? Body zone*, dark
zone, translucent zone, surface zone
QUESTION: When looking at a radiograph, what zone of caries are you looking at? Body zone
Demineralization.
QUESTION: Know what DMFS stands for decay missing filling surface
QUESTION: Know DMFS : Decayed, missing, filled, surfaces
QUESTION: DMFS is for surfaces including 3rd molars 0-160, for primary use def index
QUESTION: what is DMFS : Decayed, missing, filled surfaces…It is a dental epidemiologic
indice
QUESTION: in DMFS “ s” stand for ----------- surface DECAY MISSING FILLED SURFACE
QUESTION: In the DFMS system whats the S stand for?- Surfaces
QUESTION: DMFS stands for? – Decayed Missing Fillings and Surfaces
QUESTION: DMFT index→ measures how permenant dentition is affected by caries
QUESTION: Dmf-measures the amount tooth decay
QUESTION: DMFT is for permanent teeth ( no 3rd molars nor primary teeth ) 0-28
QUESTION: DMFT- who has the most F- white, blacks, Hispanic, Indians
QUESTION: Which race has a higher F in DMFT index: White
QUESTION: Which population has the most number of unrestored caries: Black
QUESTION: deft= for primary (e=extraction)
QUESTION: which of the following acronyms is only used for kids? PI, def, DMF, OHI-S, another weird
acronym
QUESTION: DEFT for kids
QUESTION: Whats the D__ the one that’s only three letter system of tooth carries tracking, what can it
not do?- Track how teeth were lost.
QUESTION: Differences between 245 and 330 burs- 245 bur is 3mm in length, 330 is 1.5mm. All
other dimensions the same except for length.
QUESTION: Difference between but 225 and bur 330: ive never seen 225 before, deciding between
longer bur length for 225 and sharper line angles made with 225 (old exams say 245/255 burs
have longer head so im assuming it was the same, I went with this)
QUESTION: 245 carbide and 330 carbide have what difference? Length distance
QUESTION: 245 bur vs 330 bur - 245 is longer (3mm) 330 (1.5mm) inverted cone
QUESTION: burs 245 vs 330 question = 245 is longer!!! (3mm) 330 is 1.5mm in length.
QUESTION: difference between 330 bur and 245 bur: how is the shape, what angle they form,
length and 245 has sharper angle
QUESTION: Example pear shape bur- 56 or 699? (Isn’t pear shaped…more like a 330?)
Pear = 329, 330, 245 (330L)
QUESTION: Bur used that converges F and L walls? # 169, 245, 7901,
QUESTION: Bur used that converges F and L walls? #245, 7901, 169 if 169 is not there pick 245
245 = 330L = pear and elongated bur, 169 = tapered bur, .9 diameter
QUESTION: What bur do you use to shape convergent walls for amalgam
The bur # that aids in wall convergence!! They had 169 and 245 not 254!!!
QUESTION: Which bur do you use for peds? A.245 B.18 C.51
QUESTION: which is best for occlusal convergence in a prep, 245 (169 is better for occlusal)
QUESTION: Diameter of 245 bur ? 0.8
QUESTION: What bur use for Amalagam retenetion in class II- 245 or 330
QUESTION: Burs and smoothing out preps? More flutes and shallow, more flutes and deeper, less flutes
and shallow, less flutes and deeper
QUESTION: more Blade? less efficient more smooth,
QUESTION: More blades on bur: SMOOTHER, DECREASED CUTTING EFFICIENCY
QUESTION: More blades on carbide bur = less efficient cutting, smoother surface
QUESTION: More blades on bur = smoother! But poor cutters Less blades = cut better but less
smooth.
QUESTION: increase # blades = increase smoothness, decrease cutting. Decrease blades of bur =
better cut of decrease smoothness.
QUESTION: Which burr is used to smoothe the prep? diamond, carbides with flutes??????
QUESTION: Which high speed bur gives a smoother surface? Plain cut fissure bur = best
cross cut fissure have a higher cutting efficiency
QUESTION: Bur used for polishing – Carbide more threads STEEL FOR POLISH
QUESTION: Use a large bur and start in the middle of a cavity

QUESTION: What is the correct method of excavation of deep caries. Long bur from periphery to the
center, large bur from center to periphery, small bur from periphery to center, small bur from center to
the periphery
QUESTION: How to excavate if think might be close to pulp- small or large bur, take out first in deepest
or periphery first **I would think you would use the largest bur that fits, and go around the periphery
and then towards the deepest
QUESTION: Rotary hand instruments: high speed how many round per min? 200,000 rpm
QUESTION: know applications of chisel and spoon
Chisels are intended primarily to cut enamels, but spoons remove caries and carve
amalgams
QUESTION: whats difference btwn an enamel hatchet and gingival marginal trimmer (both chisels)
GMT has curved blade and angled cutting edge. Enamel HA: cutting edge in plane of handle
QUESTION: main difference and advantage of using GMT instead of Enamel hatchet?

QUESTION: what can't you use to bevel inlay prep? a. enamel hatchel b. ging marg trimmer c. flame
diamond d. carbide.
QUESTION: Instrument to plane gingival margin on a class II?

• 2 with 3 number and 2 with 4 numbers
• Answer has 4 numbers – last number is different.
• 13,8
• 15,80
• 15,95
QUESTION: How do you bevel occlusal floor (gave list of instruments): 15,80
QUESTION: What instrument would not be used to bevel the gingival margin of an MOD prep?
Enamel Hatchet
QUESTION: Proper pulpal floor depth using Bur 245?
is 3mm, so half of it is 1.5 mm which is proper pulpal floor depth

QUESTION: Hydrodynamic theory?
Definition: Postulates that the pain results from indirect innervation caused by
dentinal fluid movement in the tubule that stimulates mechanoreceptors near the
predentin
QUESTION: Most commonly accepted theory of dentinal sensitivity?

A: Hydrodynamic theory
QUESTION: Best theory to explain dentin hypersensitivity. ANS Hydrodynamic theory
QUESTION: You did a prep with high speed and diamond bur, tooth is sensitive, what is it about bur
and handpiece that it caused sensitivity?
A) Desiccation b) traumatized dentin? Heat

QUESTION: What would cause displacement of odontoblastic processes? Thermal, “dessication”
/mechanical/chemical/
QUESTION: Displacement of odontoblastic nuclei caused by: mechanical, thermal, chemical
QUESTION: What causes the displacement of nuclei in the dental tubules?
Thermal? Chemical?mecanical?dessication???
QUESTION: Displacement of odontoblasts in tubules: Thermal, mechanical, chemical, caries:
related to hydrodynamic theory I think so I put thermal
QUESTION: Wat doesn’t cause corrosion of burs? Dry heat

QUESTION: Which method of sterilization does not corrode instruments – Dry Heat, Ethylene oxide
QUESTION: Which method of sterilization does not dull carbide instruments – Dry heat
QUESTION: Sterilization most destructive to burs: steam heat
QUESTION: What is best to sterlize carbide burs? Autoclave…? DRY HEAT or unsaturated chemical
vapor->no corrode or dull
Ethylene oxide is for heat-sensitive instruments.
Amalgam:
QUESTION: Symptom of amalgam toxicity for dentists
QUESTION: Acute mercury toxicity for dentists, first signs – nausea, muscle weakness (hypotonia)?, …
QUESTION: Acute mercury toxicity for dentists, first signs – nausea, muscle weakness?, …
Paresthesia = first sign or tremors
QUESTION: Subacute mercury poisoning symptoms – hair loss and muscle weakness
QUESTION: Subacute mercury poisoning: Hypotonia- muscle weakness
QUESTION: Mercury poisoning effects? Loss of hair was a choice (I looked it up, and I think that is the
answer)
QUESTION: MOD amalgam with hole why? -poor condensation
QUESTION: Most common reason for Amalgam fracture occuring in a primary tooth: Inadequate
cavity prep (especially the isthmus area)
QUESTION: Most common fracture of Class II amalgam: isthmus
QUESTION: Most common reason for failed amalgam= depth
QUESTION: Most likely reason for fracture line in amalgam? Inadequate depth on prep
QUESTION: Similar question: Most common reason for failed amalgam = depth (prep design)
QUESTION: Most common reason for failure of dental amalgam:
improper prep design- not enough depth
improper titrutration,
QUESTION: Failure of amalgam - poor condensation (water or saliva contamination during
condensation) –
QUESTION: Patient had occlusal amalgam on tooth #30 few weeks ago, one day the dude went to China-
town and was having lunch with his hommies. He bit down on something and the amalgam broke off. He
came back to your office demanding how could this happen with a new filling. What should be crossing
your mind? – The prep was not deep enough.
QUESTION: Page 48. Table 2-3….Prepped the amalgam, which is incorrect?: Cavo surfaces is
greater than 90 degree
QUESTION: Axial pulp should be ? 0.2-0.5 into DEJ
QUESTION: how far extend pulpal floor in class I amlgam cavity on primary dentition
a. 1mm into dentin **
b. Just into dentin
QUESTION: Greatest wear on teeth enamel? Enamel, hybrid composite, amalgam

QUESTION: Greatest wear on opposing tooth: amalgam, porcelain, microfill, hybrid composite?
Porcelain
QUESTION: Causes greatest wear on enamel? … porcelain, amalgam, enamel, hybrid composite
QUESTION: Picture of deep amalgam with overhang but it looks really bad why does it look like
that? Corrosion
QUESTION: What is wrong with marginal ridge of DO amalgam of #29? All of the following (except
maybe)? Occlusal wear, over carving, wedge not placed right, i put OVER CARVED
➢ Pic of deep amalgam w/overhand but it looks really bad why does it look like that ?
o corrosion
➢ What is wrong with marginal ridge of DO amalgam of #29? All of the following?
o overcarve
to give an idea of the anatomy of the region: mesial on maxillary first molar b/c of the cusp of
carabelli also Mesial Of max 1st premolar (MOST DIFFICULT) > Distal of max molar
QUESTION: worse restorative material for ID canine? gold, glass ionmer, composite,
amalgum? worst will be Composite > GIC> Amalgam> Gold( according to dental
decks composite not given for class 3 DL in canines)
QUESTION: class 3 on a canine, all are appropriate except: gold inlay, composite, amalgam,
glass ionomer
QUESTION: More corrosion in which phase? Tin-mercury phase
QUESTION: What causes corrosion? Silver and tin.....according to first aid pg 76 noble metals
(gold, pd, platinum) are CORROSION RESISTANT, Tin and gold, Gold and silver
QUESTION: What is the corrosive phase of amalgam? Tin/Copper phase, Gamma2 – tin/mercury
QUESTION: What causes corrosion in amalgam? Tin
- The most common corrosion products found with conventional amalgam alloys are oxides
and chlorides of tin.
- The chief function of zinc in an amalgam alloy is to act as a deoxidizer, which is an oxygen
scavenger that minimizes the formation of oxides of other elements in the amalgam alloys
during melting.
QUESTION: Zinc in Amalgam, what is used for? **Decreases oxidation of other elements, deoxidizer
QUESTION: Amalgam- most toxic mercury- Elementary murcery, ethyl murcey, methyl mercury
QUESTION: most toxic mercury - methyl mercury (organic mercury)
QUESTION: Type of mercury most hazardous to dentist health: methylmercury, ethylmercury,
inorganic mercury, elemental mercury
QUESTION: What type of amalgam needs to be condensed more? Spherical.

QUESTION: MC amalgam: Irregular cut last cut.
QUESTION: Material to use for best interprox contact of a CLASS II is Admix Amalgam (others
Spherical amalg., Composite w/ and w/o filler)
QUESTION: Over triturating amalgam? sets too fast, decreases setting expansion (increase compressive
strength)
QUESTION: Similar question: Over titrate amalgam?? Decrease setting expansion, (increases strength)
QUESTION: Overtrituation of amalgam causes? Decreased setting time and decreased expansion and
makes it stronger
QUESTION: Huge MOD in posterior → restore with amalgam
QUESTION: MOD amalgam with tooth pain? – fractured
QUESTION: Tooth #30 has huge MOD amalgam and is deep. Hurts pt when he eats french bread. what
is the cause? a. root fracture
QUESTION: Patient has a line of separation coronoapical (the wont say vertical fracture on the test),
the tooth is asymptomatic and it only hurts when patient eats French bread. What should you do?
Ext only if moveable pieces. If asymptomatic & not moveable →fair prognosis →RCT
QUESTION: days after placed an MOD amalgam pt present pain in biting and cold : check occlusion.
QUESTION: Placing pin in amalgam restoration, only choices I remember are 1mm pin or 1.5mm
pin. Others didn’t make sense. 2mm into amalgam
QUESTION: Threaded pin- Amt in tooth/restoration/angulation

The optimal depth of the pinhole into dentin is 2mm.
Threaded pins used in a dental amalgam restoration should be placed -2mm in depth at
a position axial to the DEJ and parallel to the external surface between the pulp and
tooth surface. Pins should be 2mm into dentin, 2mm within amalgam, and Imm from the
DEJ (to be safe) with no bends in the pins.
QUESTION: What happens to amalgam if it is contaminated with water? Loss of strength
QUESTION: Moisture contamination during amalgam restoration? Decreased strength
QUESTION: If there is water while you are condensing amalgam, what happens? I put decrease
in strength
QUESTION: If there is water while you are condensing amalgam, what happens? Delayed explansion
(severe expansion, corrosion and decreased compressive strength)

No marginal leakage
QUESTION: Marginal leakage in an amalgam after 1 year, then what happens? I put that it
decreases.
QUESTION: You have an amalgam that is ditched at the margin by .5mm and no signs of recurrent
decay what do you do: observe/monitor, remove and replace
QUESTION: Amalgam restoration is good, margin is .5 mm open, what do you do? Repair with
amalgam, repair with comp, don't touch it
QUESTION: Know the ideal preps of Amalgam Class I and V. (can leave unsupported enamel in class V)
both into dentin.
QUESTION: Where is it acceptable to leave unsupported enamel? Occlusal of class V amalgam
QUESTION: What do class I & class V Ag ideal prep have in common
QUESTION: Indirect restoration over amalgam: in order to get ideal contours

QUESTION: What is the reason you would do MOD onlay vs Amalgam: Better facial contour &
Microleakage
QUESTION: Class 2 amalgam vs class 2 gold inlay except:

QUESTION: Is the isthmus the same for inlay and amalgam→ YES
QUESTION: Proximal retention in class II box for amalgam? Retentive grooves, convergence of facial
lingual walls, bevel on axiopulpal line angle, all of the above, none of the above
QUESTION: Resistance form for amalgam prep : bevel in the axiopulpal line angle to reduce stress
and increase RESISTANCE form- “ways to resist stress”. Flat walls are right angles of tooths long
axis
QUESTION: resistance form for amalgam prep : bevel in the axiopulpal line angle to reduce stress
and increase RESISTANCE form.
QUESTION: how to prevent proximal displacement of Cl II filling - b/l convergence
•
• depth of prep
QUESTION: Proximal resistance form of amalgam restoration comes from what?

a. convergence of buccal/lingual wall
b. retention grooves in axiobuccal/axiolingual walls - for proximal resistance
c. Dovetail - provides retention form
QUESTION: Mesial and distal walls of class I amalgam must be divergent not to undermine
marginal ridges
RETENTION: 1st = BL walls converge, 2nd = Retention grooves/Occlusal dovetail

RESISTANCE: 1st = Flat floors, rounded angles (bevel in axiopulpal line angles)
QUESTION: How to account for mesial concavity on maxillary 1st premolar when restoring with
amalgam: custom wedge? Other options, acrylic within matrix, normal matrix create overhang and
recontour
QUESTION: BWX, Tooth #18 has mesial amalgram restoration with overhang and very light contact.
What lead to this Doctor? – A wedge was not used! (or poor adaptation of matrix band)
QUESTION: premolar restored with open contact, why?

Wedge not placed right-I think ive seen this question before
Matrix band was not well adapted
QUESTION: Put wedge after matrix
QUESTION: From pt images, Which amalgam filling has the lowest Copper content? One that looks
corroded.
QUESTION: a pt presents with amalgams restorations in good shape, the dentist suggest to change
them for composites due to systemic toxicity of the amalgam what ethic principle is there or the
dentist is violating what principle:,
veracity,
QUESTION: Dentist tells patient they need to replace all amalgams because mercury is toxic to body.
Which principle of ethics does it violate? Veracity? Beneficence
QUESTION: Definition of Veracity - doctor lied to patient about amalgam should be replaced with
composite, because amalgam causes toxicity
Gold:
Malleability – deform (without fracture) under compressive strength; ability to form a thin
sheet; gold is malleable
Greatest malleability to least: gold, silver, lead, copper, aluminium, tin, platinum, zinc, iron, and
nickel
Ductilty – deform (without fracture) under tensile strength; ability to stretch into wire
greatest ductility to least: gold, silver, platinum, iron,nickel, copper, aluminium, zinc, tin, and lead.
Gold inlay/onlay – divergent walls (2-5 degrees per wall), 30 degree bevel margins for better
fit, skirt – extend beyond line angle
QUESTION: onlay resistance/retention: 2 to 5 degrees of taper per wall, as long a wall as possible, .
primary retention is from wall height and taper. Secondary retention is from retention grooves,
skirts, and groove extensions.
QUESTION: most rigid: type 4 gold

QUESTION: What is the hardest metal? Gold Type IV
QUESTION: only advantage of porcelain over gold : esthetics.
QUESTION: advantage of gold on occlusal surface, porcelain in facial surface----conserve tooth

structure, minimal reduction...???? Gold is compatable in wear with natural tooth, porcelain gives
esthetics. Gold crown is more conservative.
QUESTION: Reduction dimension for functional/non-functional cusps in gold and PFM
Gold: functional = 1.5, non-function = 1. PFM = 1.5-2mm

answer was obvious…had to do with better adaptation. Other choices were not right
QUESTION: What is the reason the burnish gold to the margin: Acute angle of gold margin
QUESTION: Weakest part of the gold mod inlay is its??- cement layer (cement = weakest part of cast
gold restoration)
QUESTION: Gold crown being cemented, which is wrong? Zinc phosphate is not an option. DOES
NOT REMEMBER WHAT THE QUESTION IS ASKING
QUESTION: When is base metal indicated over gold alloy: fpd
QUESTION: What is the most accurate pulpal test to determine vitality of a tooth with a full-gold
crown? Electric testing, 2. Percussion test, 3. Palpation test, 4. Thermal test
QUESTION: Recently placed gold inlay; what is the most common reason for pain afterwards?
Fracture of the tooth has to be suspected
Galvanic shock Sensitivity - choose this if only question says opposing dissimilar metal
QUESTION: gold on upper tooth, lower amalgam, patient has severe pain? Galvanic shock.
QUESTION: Gold casting --? Due to hygroscopic expansion or setting expansion

QUESTION: Isthmus of MOD prep extend over 1/3 of cusp to cusp, how to treat? amalgam, onlay,
inlay crown
>1/3 intercuspal dimension
QUESTION: Which indicated for MOD with intercuspal dimension > 1/3? MOD amalgam, MOD
onlay, MOD inlay, full coverage
QUESTION: Preparation with isthmus more than 1/3 wide between cusps-inlay or onlay
QUESTION: Best indication for onlay? Low caries index, dentin not supporting cusps.
Want atleast 1mm of dentin supporting cusps.
QUESTION: When is onlay indicated: when cuspal coverage is needed or when cusp undermined by
not enough dentin,
QUESTION: 14 year old with MOD restoration, decay interproximally and undermined enamel in all
cusps.
-onlay(maybe)
-inlay
-crown
QUESTION: Why bevel for a gold onlay? Resistance; percent elongation for burnishing and remove
unsupported enamel

c. better adaptation
QUESTION: What is the reason the burnish gold to the margin
• Acute angle of gold margin
QUESTION: which is the only surface not beveled for an onlay (pulpal)
QUESTION: Dentist has to reduce a weak cusp during onlay preparation is to : a) outline form b)
resistance form c) retention form
QUESTION: what form are you taking into account to involve the cusp during the prep of a tooth (I
said resistance, could be outline but I doubt it)
QUESTION: when you include cusp into preparation, what is it called? Is it convenience or retention
form? Unsure of this answer, KA
Removing cusp affects resistance form
QUESTION: Cuspal coverage – retention form

QUESTION: Reason for using porcelain for posterior onlay (bond to dentin, to correct occlusion,
etc)
QUESTION: use of indium (tin & iron) with alloy is mainly to provide chemical bond with porcelein 
QUESTION: Purpose of addition of tin and iron to metal ceramic allows: Chemical bond, covalent
bond with porcelain
QUESTION: Cut onlay…find out margin of crown w/in 1 mm of interseptal bone

b. crown length surgery----impinges biologic width…
c. use amalgam
QUESTION: In a gold MOD onlay, how are the axial pulpal walls? Converging
QUESTION:
QUESTION: Which are incorrect? Inlay and onlay are divergent. They are convergent. ONLY
WALL TO CONVERGE IN INLAY ONLAY = AXIAL WALL
QUESTION: Axial walls Diverge in inlay preps. KA
QUESTION: Which is a characteristic of a gold inlay?

A: Axial walls Diverge toward the pulpal floor
QUESTION: From facial to lingual, the axiopulpal line angle of an onlay preparation is longer than the
axiogingival line angle (if it were not, the preparation would be undercut and the onlay would not seat).
For an MOD onlay prep, the axial walls must converge from the gingival walls to the pulpal wall (for
the same reason, the onlay would not seat if they diverged).
QUESTION: Indication for inlay? → low caries risk
QUESTION: When is the best case to use an inlay? – Patient with low caries index.
QUESTION: all of the following u can use inlay except (high caries risk)
QUESTION: Where is the MOD inlay hitting when it contacts early?- interprox
QUESTION: What causes most post op sensitivity in direct inlay: Polymerization shrinkage
QUESTION: Patient receives a blow to the chin who has a MOD inlay placed on the maxillary molar 3
months earlier. Now the patient has a vague pain on biting, there are no other symptoms. why? maxillary
sinusitis, m-d fracture,
QUESTION: Reason of reduction of tooth for MOD inlay except- amt of enamal on teeth
QUESTION: Disadvantage of gold inlays. Lack of resistance to wear??
QUESTION: main disadv of gold inlay
a. deform under load- since it is high noble gold and softer, it may have higher creep
b. wear opposing
c. cement is soluble
QUESTION: Cement onlay and see black lines few months later MICROLIKAGE
QUESTION: Coefficient of thermal expansion
is most for which material - tooth<gold (most) <amalgam<filled resin<unfilled resin
QUESTION: What has the largest thermal expansion? Composite? Unfilled resin = 8x. highest
Prosthodontics:
QUESTION: only advantage of resin over porcelain : done in one appointment
QUESTION: Common feature between porcelain veneer and all-ceramic crown preparation – rounded
internal
QUESTION: What is the most important thing for retention? surface area
QUESTION: Most lab complain? tooth is under reduced
QUESTION: Porcelain greatest in compression
QUESTION: Reason for porcelain porosity - inadequate condensation
QUESTION: What is the weakest porcelain? I put Feldspathic
QUESTION: What is the weakest porcelain? pressed leucite, unless feldspathic dental porcelain was an
answer
… Feldspathic porcelain <Leucite-reinforced ceramic< Castable glass <Glass-infiltrated
alumina
QUESTION: Best way to see if a crown seats: die spacer
QUESTION: Silver turns porcelain what color? Green
According to Mosbys, silver (Ag) is not considered noble; it is reactive and improves
castability but can cause porcelain “greening.”
QUESTION: what component makes a PFM green in the cervical 1/3 →copper at the margin its
copper, other places its silver
QUESTION: Dentist has most control in success of PFM: parallelism

QUESTION: What parts of tooth prep can be managed by operator: parallelism, surface area, length,
circumference
QUESTION: What is function of opaque porcelain EXCEPT

to decrease contamination of additional porcelain with metal in ensuing firing and baking
procedures
c. Margins
QUESTION: for a crown try in what would check first : interproximal contacts. (remember check
shade first!)
QUESTION: First thing to check when trying in metal-porcelain FPD? Contacts… true if esthetic is not
an option
QUESTION: First thing to check when trying in metal-porcelain FPD? I put contacts, esthetics
Porcelain veneer measurements:
QUESTION: Pt had veneers cemented with light cured resin. Now comes back few weeks later with
brown staining at gingival margins. Why?
Chromogenic bacteria **
Breakdown of light cured resin cement released some chromogenic substance
Pretty much all the choices other than a had to do with the cement. I didn’t know the
answer. They all seemed right. The only think we were taught in Hewlett’s lecture
was you get brown/black precipitate when you mix viscostat and nephrostat cus of
the action when alum chloride and ferric sulfate mix. But that wasn’t an answer
choice.
QUESTION: There is a veneer which is bonded with resin and the patient comes back after a month or so
with a dark stain near margin,reason? Microleakage
QUESTION: The dentist cements the porcelain veneer with light cured resin and the patient returns with
brownish discoloration at the margins.why? not enough cement or microleakage(depends on duration
of pt return)
QUESTION: How much tooth structure needs to removed on the facial for a porcelain veneer? .5
mm
QUESTION: Mid facial reduction of a porcelain veneer? →.5mm

QUESTION: when preparing for a porcelain veneer how much would you reduce in the facial 1/3 :
Gingival third:0.3 mm veneer reduction
Facial third: 0.5 mm veneer reduction
QUESTION: Veneer fractures, what do you do? Pumice, etch, microetch, etch, microabrasion,
silane…know what to do and the order, application of etch to the prep, bonding resin to prep, etch the
inside of veneer, silane the inside of the veneer, luting agent
QUESTION: Patient has an all veneer on incisal edge, small piece of porcelain came off and wants
you to fix the chip only, what is the sequence of events: microethc, etch, silanate, and bonding
agent

• Resin cement
• Polyacrylic
QUESTION: Opaque coming through on veneer whats the problem? Veneer under prepped
QUESTION: Advantage of a direct composite vs. a veneer? --direct composit-only 1 appointment vs.
veneer is at least 2
QUESTION: When will you bleach teeth in anterior veneer prep- before veneer prep, wait for 2-3
weeks, after preping veneer and then bleach, after cementing veneer and bleach 
C. Acid Flouride
QUESTION: where will you place the margins in a anterior PFM prep: Subgingivally
QUESTION: minimum incisal reduction in anterior PFM : 2 mm

QUESTION: The necessary thickness of metal substructure is 0.5mm . The minimal porcelain
thickness is 1-1.5mm. Thus, the tooth reduction required for a PFM crown is -1.5-2.0mm. The labial
shoulder width is ideally 1.5mm.
QUESTION: Facial reduction for PFM at gingival 3rd is 1.5mm
QUESTION: Reduction for functional cusp bevel on porcelain? 1.5-2mm
→ minimum metal thickness of 1.5 mm for functional cusp & 1 mm for nonfunctional
▪ 2 mm for porcelain
QUESTION: How much reduction would you do for a PFM crown on anterior- 1.5mm on facial
incisal plane not incisal angle
QUESTION: How do you make sure your all ceramic restoration does not fracture? I put you must
have NOT LESS than 1.5mm porcelain @ occlusal
QUESTION: What to do to increase retention of the crown . (All are possible options, EXCEPT!)-
options were- proximal boxes, buccal grooves, functional cusp bevel?
QUESTION: When you have a short crown for pfm: place proximal boxes and vertical grooves to
increase retention
QUESTION: Reason for functional cusp bevel = resistance

QUESTION: Why do a functional cusp bevel on a crown prep? To prevent fracture of the cusp and for
proper casting/fabrication of the crown
QUESTION: Reason for functional cusp bevel: Prevent cusp fracture
QUESTION: In PFM, Porcelain fractures because the junction should be? right angle, not round
QUESTION: When you want to cement crown, what is the sequence?, look inside the
crown(internal fit), contact, then margin Interna;→contact→ margin
QUESTION: Which of the following do you not do in cementation of a porcelain crown: etch enamel
with hydrofluoric acid
QUESTION: With resin cement on all porcelain what is NOT the reason why you use it: I put down
for added retention bc I thought cements shouldn’t be used for added retention (other choices,
was to fill small openings at margin and something else)
QUESTION: Porcelain is strongest under compression or right after being processed and cooled???
QUESTION: #10 crown on a patient is PFM. It looks longer than #7. All of the following maybe the
reason why the crown looks like this, except? – Incorrect shade. (Other choices; insufficient tooth prep
(yes), too think metal (yes), too thick porcelain (yes) – all of these could have caused it).
QUESTION: what didn’t cause the unesthetic opacity of crown: shade selection; other choices were
under-prepared tooth, too thick metal, too thick base porcelain or something like that
QUESTION: What could the reason be if you see opaque porcelain in the incisal third of the facial of
the PFM crown: inadequate reduction of the inciso facial part of the tooth
QUESTION: Incisal 1/3 of pfm is opaque white why? Too little reduction
QUESTION: Incisal 1/3 of pfm is opaque white why? Isa id because of too much base porcelain
placed
QUESTION: Anterio pFM, incisal 3rd was radioopague? Improper second plane of reduction**
QUESTION: If incisal edge of PFM is opaque it is because they didn’t do a second plane of reduction
QUESTION: Lab overbulks porcelain…why? Not enough reduction on tooth, compensate for 20%
shrinkage
QUESTION: All porcelain crown on 8 that is too light but it is a good crown what would u do and I
put to whiten the other teeth. (vital tooth bleaching)
QUESTION: crown of inferior molar has a wear facet in porcelain on the mb inclination of MB cusp.
Most likely associated with?
Interference in protrusion? & working interference
Dotn know the other choices
QUESTION: Where do you attach a non-rigid retainder from a FPD? Don’t know and don’t remember
choices, they were medial and distal of and to somethings.
QUESTION: For a stress breaker on a FPD to be effective it must be- don’t know and don’t remember but
something mesial of the distal abut and so on and so forth.
QUESTION: A fixed partial denture…keeps breaking. POOR FRAMEWORK.
QUESTION: Most common reason for PFM bridge breakage? Firing schedule, high contact,
inadequate design
QUESTION: FPD is seated during framework try in but when come back for final cementation holds up:
→interproximal porcelain overcontoured
QUESTION: All ceramic FPD should cover how much of abutment? I put 270 degrees
QUESTION: ¾ crown advantageous except for? I put it has LESS retention than full crown
QUESTION: Resistance to lingual movement of ¾ crown? Lingual wall of groove, facial wall of
groove, facial aspect of prep
QUESTION: What prevents lingual displacement of a ¾ crown? Lingual wall ( of grooves)
QUESTION: What is the basis for classification of different F P D pontics: Relation of the pontic to
the supporting tissue
QUESTION: Modified ridge lap pontic: Minimal ridge contact
QUESTION: Modified ridge lap has what kind of contact? Minimal contact with residual ridge
QUESTION: The modified pontic how should it touch the gum?

Barely touch it
Impinge on it
QUESTION: pontics : should not blanch tissues
QUESTION: pontics :→ should not blanch tissues
QUESTION: Pontic of 3-unit fpd should rest gently on the soft tissue
QUESTION: Anterior teeth, which pontic is best? ovate or modified ridge, read the case and see
if ext or not, if you can do the ext prior, you can do ovate which is best aesthetic
QUESTION: Pontic length on a bridge, whats most important AP dimension, MD dimension**

QUESTION: Strength of Abutment connection to pontic which is more important? occlusogingival
width
pontic is sufficient (in 3-unit fpd bridge)? occlusal-gingival,
pontic is sufficient (in 3-unit fpd bridge), I said cross section (idk if that makes sense); other options
are buccal-lingual, occlusal-gingival and mesial-distal (I would think its all three but it wasn’t an
option)
QUESTION: a pontic in the bridge shows the metal, why?

Underreduction
Framework was not done well( since is a pontic this is probably the answer)
QUESTION: if patient has ging 1/3 translucent of a pontic: prob because of poor shade selection
QUESTION: Edentulous space is wider than adjacent anterior tooth, how to match them? Make
pontic line angles farther apart and deeper interproximal embrasures, make pontic line angles
closer and deeper interproximal embrasures, make pontic line angles farther and shallower
interproximal embrasure, make pontic line angles closer and shallow interproximal embrasures
QUESTION: How do you decrease the width of an artificial tooth? Deepen the facial line angle
proximally and increase the interproximal embrasure, Deepen the facial line angle proximally and
decrease interproximal embrasure, take the facial line angle labially and increase the
interproximal embrasure, take the facial line angle labially and decrease the interproximal
embrasure.
QUESTION: How do you make a crown narrower?   move line angles more facially
QUESTION: Anti’s law; 3 abutments, one being lateral, with 2 pontics, prognosis good, poor, excellent?
Poor? (root surface of abutment teeth have to be greater than root surface of pontic)
QUESTION: Which of the following is not ideal abutment-pontic connection? – Lateral Incisor-Central
Incisor (other choices, Central Incisor-Lateral Incisor, Canine-Lateral Incisor, etc)
QUESTION: What is most damaging in canteliever: it was between mand molar pontic-premolar
abutment
QUESTION: Which canteliever bridge would be most destructed of abutment tooth: →lateral incisor as
abutment with central incisor as pontic (larger root surface of pontic than abutment)
QUESTION: worst cantilever → lateral abutment with central pontic

QUESTION: The strength of soldered connector of FPD in enhanced? 1. Using higher carat solder, 2.
Increasing height (answer), 3. Increasing width, 4. Increasing gap
QUESTION: When soldering, what is the most important factor?

• width
• height**
• etc..
QUESTION: Fixed -do preparation and design.Ex type of margin for ceramic (shoulder). What should be
placed against porcelain bridge. What is a "key"
**NONRIGID CONNECTOR: Key and keyway—for pontics and shortspan bridges where you can’t get
proper draw without a lot of tooth reduction. POI is parallel to pathway of retainer.
QUESTION: Keyhole for post and core to prevent rotation

QUESTION: What is an active screw (post) vs. inactive post?
An active post is one that engages (screws into) the dentin in the canal space. Traditionally, the major
concern about active posts has been the potential for vertical fracture of the tooth during placement of the
post. active posts are indicated when the canal length is insufficient to gain adequate retention with a
passive post
QUESTION: What is the advantage of a fiber post over a cast post? Forgot the options but the one I
put was the fiber post is stronger and causes less fracture of the tooth… Not sure one other option
was it was fiber post is more radiopaque and another saying that fiber post has the same modulus
of elasticity as dentin.
QUESTION: How does a dowel post and core help prevent vertical fracture? Ferrule, Ventilating groove,
bevel, vertical stop
QUESTION: Dowel core = vertical stop FURREL
QUESTION: What is the point of putting a post on an endo treated tooth? retain the build-up and
restoration (not sure about the restoration part). Retain core
QUESTION: Purpose of placing a post after RCT = retain core
QUESTION: Function of a post?

A: Retain the core
QUESTION: Dowel after endo for: Retention of core (Dowel=post Im guessing)
QUESTION: cast post and core - you put extra slit - what is that for? prevent rotation
QUESTION: how should prep for cast post? Etc. Need at least 4 mm of GP to preserve apical seal
QUESTION: Most important when selecting shade? VALUE. value, transluceny, chroma,
concentration, and hue, color . Value is the most critical of the three parameters when attempting
to match an adjacent natural tooth; hue is the least important
QUESTION: Most important is value when selecting a shade

QUESTION: What is chroma- saturation
QUESTION: What is value- black and white
QUESTION: Hue, Value, Chroma (which one is color?)
QUESTION: Most important color: value
QUESTION: Least importatnt: fluorescence, hue, etc?
QUESTION: When you have color index of 100, which of the following is effected? I said Chroma. (others
were value, hue, etc)
QUESTION: When you have color index of 100, which of the following is effected? I said Chroma. (others
were value, hue, etc)
QUESTION: Scale of 100
a. Chroma
b. Value
c. Or Hue?
QUESTION: Color value : 0 black 100 : white

QUESTION: Staining a porcelain restoration: Decrease the value
QUESTION: What does staining do for ceramics? Alters hue. Decreases value. Alters chroma.
QUESTION: Crown #9 and #10. One of the crowns looks very light(white). What did the dentist pick
wrong?
Hue
Chroma
Value
QUESTION: When you add a different color to a resin, you increase what? Hue? Value? Chroma
QUESTION: Dentist changes shade with complementary color what does he do: increase chroma?
QUESTION: Add complement color: Decrease Value
QUESTION: A dentist adjusts the shade of a restoration using a complementary color. This
procedure will result in
A. increased value.
B. decreased value.
QUESTION: complementary color that changes ? Old TQ A. Value
QUESTION: Complimentary color decreases value

QUESTION: Which can you not do: increase value
QUESTION: brightness is equal to: Value ( you can decrease but not increase it )
QUESTION: What can’t occur with the addition of stain? Increase value, decrease value, increase
chroma, increase hue, decrease chroma
QUESTION: What cant you change: hue, increase value, decrease value, change chroma
QUESTION: how to change hue: add orange to it
QUESTION: How do you lower value in a restoration? STAIN, Complement color or orange
QUESTION: Value least, due to lack of variation in mouth=Hue
QUESTION: What complement color to darken porc? gray, orange, ochre, violet. Add gray to
decrease value.
QUESTION: Use complimentary color to change/stain crown to decrease the value most common is:
Violet Orange, gray, yellow
QUESTION: complementary color used to change-orange

QUESTION: If you add a complementary color yellow, what happens to the hue? Dec red content of
yellow red shade Side note: adding yellow stain=Inc chroma of basic yellow shade
Pink purple makes yellow → yellow red
QUESTION: Which represents position on the spectral wavelength? hue
QUESTION: Wavelength assoc with hue
QUESTION: which color characteristic is dependent on spectral wavelength: hue
QUESTION: what is best way to determine value: open eye as wide as you can, arrange the shade
guide in increasing value (chose the latter)
QUESTION: Value? Most important, Lightness. Put shade guide from light to dark. Half close eyes to
increase sensitivity to better select value.
QUESTION: How pick shade - place values in order, Squint for chroma
QUESTION: Which one can human eye see, hue vs value, vs chroma? Value. (more rods than cones, and
eyes are more sensitive to value)
QUESTION: Avoid metamarism→ Want consistant look in light

QUESTION: How to prevent metamerism – shade under multiple light sources

➢ Balancing→ LUBL
➢ Working→ BULL
➢ Protrusive→ DUML

QUESTION: Non-working contacts… mand buccal cusp lingual incline
QUESTION: Contact on lingual portion of buccal cusp of mandibular molar = what kind of
interference? Non-working, working, protrusive
QUESTION: questions on nonworking interference. wear facets on lingual incline of mx lingual
cusp and facial incline of md facial cusp on left side. pt has : left nonworking interference,
protrusive interference, right nonworking interference, etc
QUESTION: Working side interferences are seen on what surfaces? palatal inclines of buccal
cusp of upper and buccal incline of lingual cusp of lower; (the nonworking cusps on the fxnal
side are interfering)
In MIP or CO, the buccal incline of palatal cusp of upper and lingual incline of buccal cusp of
lower. Balanced side interferences are buccal incline of palatal cusp of upper and lingual incline
of buccal cusp of lower (it‟s the working cusps interfering)
QUESTION: Wear on buccal of maxillary premolars due to, due to mandibular movement working
or nonworking?
QUESTION: When will the bull rule be utilized with selective grinding? Working side
QUESTION: The mesiobuccal incline on the mesiobuccal cusp of mand molar (with stainless steel
crown) has wear: this is because of movement in which direction(s): I said working and
protrusive movement
QUESTION: #30 gold crown has wear located on the MB cusp of the MB incline, cause – protrusive and
working side movement
QUESTION: Max molar on mesial slope of mesial lngula cusp wher do you have wear on lower
teeth? Mesial or diatal incline of either mesial facial aor mid facial cusp? Distal incline of midfacial
cusp
QUESTION: The mesial angle of the ML of max 2nd molar occludes with what on the man 2nd molar
a. Mesial MB cusp
b. Distal MB cusp
c. Mesial DB cusp
d. Distal DB cusp
QUESTION: mesial angle of the L of maxillary second molar occludes with what on the mand 2nd
molar.? Distal of MB CUSP
QUESTION: Pt bites down after cementing down and deviates to the right #30
• Lingual incline of the buccal cusp
QUESTION: Crown on number 30, pt tries to close, contact interference deviates to left, lingual incline of
buccal cusp needs to be altered buccal incline of the lingual cusp
QUESTION: In restoring a canine protected occlusion, with anterior overbite of about 2mm. The buccal
cusps of posterior teeth should be flat, BECAUSE they will guide the protrusion.
a. both are true
c. both are false
QUESTION: what kind of occlusion is if in right lateral movement all posterior teeth are not in
occlusion : canine guidance
QUESTION: which of the following would result in inaccurate terminal hinge record? acutely
apprehensive patient, severe skeletal cl III, tooth contact, muscle pain, etc
QUESTION: IF you are making a crown but before you begin, when you do equilibration, what are
you trying to achieve to get rid of the non-working interference?
a. Posterior dissocculusion??
Bimaxillary protrusions, Refers to a protrusive dentoalveolar position of maxillary and

mandibular dental arches and flare teeth.
QUESTION: Where to the condyles go in CR?-Superio-anterio-Medial

QUESTION: Which anatomical components are responsible for rotation of the mandible? Disc
and condyle
QUESTION: If you both condyle break, what you get? Posterior open bite!

movement
b. it is the angle that is formed by the condyle and the horizontal plane during protrusive movements.
c. It is an difference in condylar inclination between protrusive and lateral movements
QUESTION: bennett shift mainly on: lateral movement or working side
Composite:
QUESTION: what type of bond is composite on tooth structure?
a. chemical bond
c. organic coupling
d. adhesion
QUESTION: Two things that account for a successful posterior composite restoration? type of resin
and type of prep
QUESTION: Postoperative MOD composite pain, most likely due to? hyperOcclusion
QUESTION: Few days after placement of composite restoration complains of pain especially with biting
but relieved by cold: →check occlusion
QUESTION: What determine class 1 composite prep? - The depth of decay!

45 degree bevel cavosurface
Ortho
QUESTION: When doing a class 1 with composite what is the requirement: contain to only pit and
fissure caries
QUESTION: consideration for a class I posterior composite restoration :

Case, selection, isolation
QUESTION: What determines composite class 2 prep? Caries, Access
QUESTION: prep shape for composite is determined by caries extent
QUESTION: 2 things that account for successful post composite restoration – type of resin and
type of prep
QUESTION: When do you replace class 2 composite? - When you have recurrent decay!
QUESTION: When do you replace class 2 composite? – When you have ditching at the margin (other
choices were discoloration, and roughness)
QUESTION: You are doing a composite slot on mesial and distal of 1st molar, dds decided to connect
by crossing the oblique ridge, why? Only answer that made sense was that when oblique ridge is
less than 1.5mm you involve it
QUESTION: Restoration of class 2 for posterior with heavy occlusion – amalgam, composite, microfill …
QUESTION: Class II prep into cementum, how should you restore? GI, Hybrid , non-restorable
QUESTION: What is the main problem with class 2 composite- water or constructions of material
QUESTION: Small occlusal fillings need to be done on posterior, what do you use – amalgam,
composite? (small lesion so don’t want to take away too much with amalgam), GI
QUESTION: Large MOD composite, what’s disadvantage? Occlusal wear  
QUESTION: What is not a class I cavity preparation? gingival 1/3 of #19, Lingual pit of #7, Lingual pit of
#18
QUESTION: C factor in class 1 composites, which one is correct? – less walls is lower C factor (you
need less walls) for ex, class I composite: 5 bonded/1 unbonded: 5
QUESTION: C factor in class 1 composites, which one is correct? –More walls, higher C Factor
QUESTION: which has the highest C factor- class 1 & class 5
QUESTION: What has most stress on it? ( c factor) class IV, CLASS 1
QUESTION: C factor question. Asked which is correct—class 5 is worst, bonded/unbonded,
QUESTION: Which part of composite stains the most- gingival proximal, facial proximal, lingual
proximal, or occlusal
QUESTION: 2ndary caries is most likely at gingival mrgin
QUESTION: Transillumination is useful in the diagnosis of .Class 1, class 2, class5, class 3
QUESTION: What do u place on a 75 yo patient with like 8 class v carious lesions? I put GI just
because there a lot of caries but the other options were composite, amalgam and something else.
QUESTION: Class V lesions? Composite or GI?
QUESTION: Pt w/ a lot of cervical caries – Resin composite best material to use – false. Best would
be GI
QUESTION: Patient had a lot of cervical caries in posterior-resin would be the best to use FALSE GI
QUESTION: pt. comes in and has a lot of class 5 caries- RMGI
QUESTION: 65 y/o pt shows several new caries in molars and pre molars class V what material
would you use : a) amalgam b) composites c) glass ionomer
QUESTION: #5 cervical lesion Class V what do you need to consider? Isolation
QUESTION: Class V onto root: Bevel enamel, 90 butt margin on cementum

a. sensitivity,
b. esthetics,
c. prevention of decay,
d. prevention of further structure loss,
QUESTION: Too light on class v composite, how would u treat?

QUESTION: if a class IV is too light what to do? Add more composite
QUESTION: what to do if Class IV is too light? Stain composite, or veneer ? Or replacement?
QUESTION: Class IV composite, notice it is too light 2 weeks later. Add composite tint or do direct
facial composite in new color
QUESTION: If a dentist notices that a large but acceptable composite is too light a few weeks
after placing it, what should he do? I put nothing
QUESTION: Class 4 stained. Veneered with composite

QUESTION: class 3 extends to facial. The restoration is pigmented but margins are perfectly sealed,
however they have bad color. What should you do? -remove 1mm prep and add more composite
QUESTION: If a patient has a stained but acceptable composite and wants it fixed, what do you
do? I put remove 1mm and replace
QUESTION: Class 3 stained ? Removed? Veneered with composite
QUESTION: Marginal stain on class 3 composite, how would u treat? REPAIR ?? or replace? I would
guess repair I dunno
QUESTION: Patient has class 3 on facial with marginal staining what do you do to fix it: I said
replace with composite
QUESTION: Recently placed a class 3 comp, pt isn’t happy with it and has a huge staining on margins
what to do? Replace, remove on margins and place composite, extract/implant, etc
QUESTION: After caries removal sound tissue is on cementum. How do you restore? Build up with GI
and place composite
QUESTION: Prep you did went down to cementum , what d you do to fill it: pdf old exam question
answer says put rmgi then composite on top
QUESTION: Class 3 prep subgingival, restore with GI, followed by composite

QUESTION: Subgingival composite where cementum is exposed- what type should u place? Dual cure or
fluoride releaseing composite?
QUESTION: Class 3 composite w/ radiolucency under it → this cud result from all the following
except: liner, recurrent caries, contraction from shrinkage of curing, etc. (agu’s answer:
contraction…)
QUESTION: MOD amalgam that passes the 1/3 distance of cusp height, do what – MOD amalgam, MOD
composite, MOD onlay, MOD inlay
QUESTION: All are advantages of indirect composite over direct except: better marginal
adaption/seal
QUESTION: Direct composite vs inlay- what is better about the direct composite- I wrote seal
QUESTION: main advantage of doing direct composite over composite onlay?
a. less shrinkage-Ive seen this in other tests
b. better marginal adaptation - best answer among the options

QUESTION: Most important factor when placing a composite in post teeth. Case selection
QUESTION: Posterior composite fails because usually… water degradation or shrinkage?
QUESTION: Main reasons for failure of posterior composites? I put case selection and technique.
QUESTION: Composite for back molar: technique and case selection
QUESTION: Main reasons for failure of posterior composites? I put case selection and
technique.
QUESTION: Posterior composite failure mostly due to – shrinkage
QUESTION: sensitivity following composite restoration in post most common cause---???due to
resin,polymerization shrinkage in margin,shrinkage floor...???
QUESTION: You place a conservative composite on a posterior tooth and the patient returns due
to sensitivity. What is the most likely reason? I put trauma to dentin during preparation, as in
they didn’t use bonding agent? But I read in the questions that a lot of people put
“microleakage.”
Failure→ decay, microleakage
Sensitivity→ occlusion, debonding
QUESTION: You place a conservative composite on a posterior tooth and the patient returns due to
sensitivity. What is the most likely reason? Putting large amount of comp while filling, microleakage,
trauma to dentin during preparation, Etch causing pulpal pain, bacteria, gap, cuspal
QUESTION: Post op composite: sensitive

QUESTION: Cause for post-operative sensitivity of composites – shrinkage
QUESTION: reason for replacing posterior composite, and factors that affect success
QUESTION: Most common reason for replacing posterior composites: RECURENT caries, inadequate
margins, fracture of composite (ONLINE SAYS: The two main causes of posterior composite
restoration failure are secondary caries and fracture (restoration or tooth)
QUESTION: What is the most common reason that posterior composites need replacement? I put
recurrent decay
QUESTION: After placing a crown with composite resin, after six month around the porceline
gingiva there is a discoloration ( brown color) what is the cause: ? Amin discoloration of resin
QUESTION: an anterior composite placed 10 years ago without caries what is the most common
reason to make a new one : →color change
QUESTION: How long should you wait after bleaching to do a composite on an anterior tooth? I
put 1 week at least
QUESTION: How long after vialt tooth bleaching can you bond resin to it? 24 hours, 3 days, 1 week
QUESTION: Why do you replace anterior composites- staining
QUESTION: Why do you bevel when placing anterior composite?

Beveling does everything except strong margin in composite
QUESTION: beveling in acid etching composite for.... more surface area.
QUESTION: why do we bevel cavosurface of comp? A: more surface area

QUESTION: Which one is not reason for post-op sensitivity Class I comp? cusp deformation due to
shrinkage force,
QUESTION: You have a pt. with a composite filling that complains of pain to cold a chewing, you ditch it
out with a bur, no more pain. What was the cause of the pain? Polymerization Shrinkage.
QUESTION: Post op sensitivity on MOD so removed a portion of the occlusal and placed more
composite what was cause: fracture, microleakage, inadequate margins and water coming out of the
tubules, acid etch, compression pulling on cusps
QUESTION: Which of the following Is not the reason for postop hypersensitivity of a composite:
options are toxic effect of aci etch on the pulp (I said this one), polymerization shrinkage on the
margins so that bact can come in, poly shrinkage on the occlusal floor (idk what answer is)
QUESTION: Restore tooth with MOD comp. then pt. comes back 2 days later with sensitivity. Then
you put composite over it and relieves the pain.
QUESTION: What is the least likely cause of sensitivity after composite placement? Fluid
movement in pulp caused by open margin
QUESTION: Composite recently placed. all could be a reason for sensitivity. EXCEPT:-polymerization
shrinkage, pulpal irritation from etch, shrinkage created gap for bacteria to go in
1 etchant causes sensitivity
2 gap causing microleakage of bacteria
3 gap causing movement of fluid out of pulp
Same amount of time as if done with rubber dam?
2 weeks later
2 months later
QUESTION: Class 2 done without rubber dam, how long until you see microleakage – 2-4 weeks, 4-6
weeks, same time as with rubber dam on
QUESTION: When do u start to see lines if u do class 2 without rubberdam? 4-6 Weeks? when not
applied under rubber dam isolation 4-6 weeks you see leakage compared to RDI
QUESTION: You did class II composite without rubber dam. When do you start having marginal
leakage?
4-6wks, 6mo-1yr (something like that), same time as the one you did with rubber dam on, ??
QUESTION: Highest chance of leakage under rubber dam? Holes too wide, Holes too far apart, Too
close
QUESTION: What is not an advantage of rubber dam when compared to not using it: Improved properties
of materials, shortens operative time, facilitates the use of water spray
QUESTION: Placement of rubber dam affect the colour selection by →dehydration of tooth gives
inaccurate tooth shade  
QUESTION: Placement of rubber dam affect the colour selection by →black background
QUESTION: W on the rubber dam clamp means it is? wingless
QUESTION: repairing porcelain veneer with composite → microetch, etch, silane, resin
QUESTION: How to fix porcelain chip on PFM with composite? Microetch, etch, silane, bonding
QUESTION: Steps for adding to porcelain? Microetch, etch, silane, bonding agent
QUESTION: Veneer replacement: microetch, etch, silane, bond

QUESTION: Similar question Patient has an all veneer on incisal edge, small piece of porcelain came off
and wants you to fix the chip only, what is the sequence of events: microetch, etch, silanate, and
bonding agent
QUESTION: Patient has an all veneer on incisal edge, small pice of porcelain came off and wants you
to fix the chip only, what is the sequence of events: microethc, etch, silanate, and bonding agent
(there was another option that has silanate involved so not sure)
QUESTION: pt has composite restoration with severe pain with localized swelling---- Incision & Drainage
QUESTION: Pt had #8 & had a bunch of little pits in #8; how would you fix it? Composite over pits,
or over entire tooth, or veneer w/ porcelain, etc. (agu put: composite over pits only)
QUESTION: pt complains of a marginal stain on #8, what do you do? i said polish it
QUESTION: Similar question: Patient’s chief complaint is #8 and #9 don’t look right. Picture shows
nothing is wrong with #9, #8 has extra enamel at the incisal-distal aspect. What do you do? – Shave the
inciso-distal aspect of #8. (Other choices were stupid; like put composite on both teeth, put a crown on
#9, etc)
QUESTION: Advantage of a direct composite vs. a veneer? direct composite- 1 appointment vs. veneer
=atleast 2
QUESTION: You place a CaOH on the tooth for a direct pulp cap what is needed: placement of a
liner
Cement & Materials:

QUESTION: Beveling in acid etching composite Increase surface area
QUESTION: beveling in acid etching composite use more surface area.
QUESTION: Etch cleans the tooth and creates micropores for micromechanical retention.

QUESTION: Etchant does all except? Increase surface area, remove debris, Increase wettability of
enamel, or decrease irregularities at cavosurface margin.
QUESTION: What does acid etching NOT do: Cleans surface debris, Roughens enamel surface, Gives
more surface area, Helps in wetting the enamel
QUESTION: Etch dissolves smear (does not)- dry out collagen

Etch removes the smear layer, exposed collagen fibers can form hybrid layer with resin
QUESTION: Hybrid layer. ANS primer within intertubular dentin
QUESTION: Acid-etching does not cause. Reduced leakage, better esthetics, increased strength of
composites.
Acid etch technique: conserves tooth structure, reduces microleakage, improves esthetics and provides
micromechanical retention.
Etch does improve marginal seal, helps in wetting enamel, cleans surface debris, created micropores
(roughness of surface)
QUESTION: if contamination after etch : re etch
QUESTION: Pg 62, current dentin bonding system: know the difference of total etch and self etch
QUESTION: The most unreliable? self etch
QUESTION: Function of filler in resin—strength (reduces polymerized shrinkage and increases hardness)
QUESTION: Filler composites: Larger fillers have more strength, but do not polish as well
QUESTION: denstist who work with HEMA( composite) can have what kinda complication.? contact
dermatitis
QUESTION: HEMA can give dentist what health problems HEMA causes → contact dermatitis
QUESTION: HEMA used by dentist, what phenomenom happens – anaphylaxis, contact dermatitis,
immune mediated reaction, arthus phenomema?
QUESTION: What acid is in GI cement > silicate glass powder & polyacrylic acid.
Components of GI CEMENT – alumina silicate and polycarboxylate
QUESTION: Asked about use of glass ionomer what is liquid made of? ***P= fluoroaluminosilicate glass
L=polyacrylic acid
QUESTION: What is the acid in glass ionomer? Phosphoric acid, Polyacrylic acid-in durelon
QUESTION: conditioner in glass ionomer : polyacrylic acid- = liquid
QUESTION: Cool glass slab why? More powder incorporated, less powder incorporated, decrease
working time
QUESTION: purpose of a cool glass slab when mixing cement is to incorporate the most powder into
liquid as possible.
QUESTION: Veneer after a month time has some brown stain: not enough cement at margin,
Microleakage
QUESTION: Which indicated for high caries risk or multiple class Vs? GI
QUESTION: Check proximal contacts first when cast that fits on die cannot be seated on the tooth in the
mouth
QUESTION: When you seat a crown, it isn’t seating. What is the first thing you do?
Check contacts?
Look for nodules on casting?
QUESTION: What is the most practical way to seat a casting at the time of cementation? grind the inside
away since the other answer choices would be either impractical or not done at cementation
QUESTION: Make sure casting seats do the following EXCEPT:
• Mix cement thin
QUESTION: if you have a bubble in an impression for a crown that is not visible what is going to
happen with the crown when comes from the lab and you try to seated in the mouth → does not
seat
QUESTION: Void in die, crown was processed, what will happen? – crown will seat in die, but not on
tooth
→ It wonr fit tooth, it WILL fit cast
QUESTION: You notice void on occlusal of cast. Crown will
c. Fit on both
QUESTION: What do you not do if your crown doesn't fit? - can't change the cement ratio mixture
QUESTION: Why do we lute all ceramic crowns with composite: increase strength, color stability,
sealing of margins, enhance retention
- Composite Resin-the luting material of choice to cement a ceramic crown and can provide the
→STRONGEST BOND
QUESTION: Why don't you use GI resin cement in cementation of all ceramic restoration? its expansion
could cause cracking of porclain
QUESTION: Sensitivity of pulp in regards to cement, which is correct? resin ionomer and glass
ionomer cause highest pulp sensitivity
QUESTION: which cement is the easiest to remover after procedure? Zinc Phosphat
QUESTION: Zinc phosphate pH is is 3.5, what is the significance of that? this might also cause
pulp sensitivity
QUESTION: what component of cement contributes to adhesion? Polycarboxylic acid, benzoyle

peroxide, others, Polyacrylic side group →chelation between carboxyl groups and calcium in tooth.
QUESTION: Photo initiator of composite? Camphoroquinone
QUESTION: resin activator: camophoroquinone
QUESTION: Diketones activate by ? visible light, blue light to produce slow reactions. Amines are
added to accelerate curing time. Cross link reaction.
QUESTION: the most radiopaque in composite is: Barium ( it is a metal)
QUESTION: most radioopaque in porcelain
b. silica
c. quartz
QUESTION: Heat cured indirect composite (increase strength )vs direct composite. Which is
incorrect?
c. Heat = Less irritation to tooth due to less shrinkage
d. Heat indirect has better bonding to the dentin and enamel **
QUESTION: Which composites have more color stability? I put light cure due to TEGDMA
HEAT CURED (light cured) RESINS HAVE SUPERIOR COLOR STABILITY
QUESTION: Which composites have more color stability? light cure due to Triethylene glycol
dimethacrylate TEGDMA
QUESTION: with tegdma and hema: light cure to maintain proper shade
Microfill composites are more color stable than hybrid. Microfill have the
smoothest finish compared to hybrids which are rougher. Rougher will pick up stain
easier.
QUESTION: What is importance of light cured vs autocured in terms of shade balance (question
didn’t make sense): I said it was the less number of nitrates when you lightcure; other option is
light cure
QUESTION: What is importance of light cured vs autocured in terms of shade balance; the less
number of nitrates when you lightcure;
QUESTION: curing light intensity: 400
QUESTION: What is false about LED vs halogen curing lights:
a. blue light is 340-370→ 450-750

e. Blue light is not 340-370
QUESTION: Lasers and LED lights don’t cure all resins b/c some resins photoinitiatiors have require
light sources is out of range: true and correct logic
QUESTION: Which of the following will be not be good against enamel? – Hybrid resins (other
choices, enamel, amalgam and unfilled resins – Hybrids have silica filler, which increase
hardness wear resistance) mine also had porclelain though. →porcleain
QUESTION: Which of the following will be not be good against enamel? – Hybrid resins (other choices,
enamel, amalgam and unfilled resins – Hybrids have silica filler, which increase hardness wear resistance)
--hybrid is the most abrasive
QUESTION: Which one is true about Glass Ionomers – It has good tensile strength (others choice
were compressive strength, or something that’s for more stronger material like amalgam) there was
one more option that seemed to be a better attribute than tensile – don’t remember. →?
QUESTION: GI non benefit- good tensile (not compression)
GI is brittle = high compressive, low tensile strength
QUESTION: *** VRMGI? Advantage beside fluoride release? Ionic bond btwn enamel and dentin,
QUESTION: Something about glass ionomer: forms ionic bond.

QUESTION: GI forms ionic bonds
QUESTION: Direct Pulp cap w/ CaOH; wuts most important thing to do? Put 2mm of it, put 3mm of
it, put a hard liner/base above CaOH, etc. (agu’s answer: put hard liner/base above CaOH)
QUESTION: direct pulp cap- do you put 2mm of calcium hydroxide or calcium hydroxide liner and
a glass ionomer base
QUESTION: How do you improve the success of calcium hydroxide on a direct pulp cap? Place GI liner
over calcium hydroxide,
QUESTION: 1 mm away from pulp horn, large carious lesion what do you do? Pulp cap, with liner etc…
Other options too
QUESTION: Pulp Capping use calcium hydroxide, in order to protect the pulp put 2mm
thickness base
QUESTION: What is the composition of Glass Ionomers? Silica glass and polyacrylic acid.
Know GI cement/GI restorative--**think GI joe! He leads a double life and can be both a cement and
restorative material! As a cement---low pH can cause sensitivity, pulp irritation, least erosive (because GI
joe is super strong you can’t beat him up). As a restorative material---releases F, low solubility, thermal
ins, sim therm exp to tooth, chemical adhesion, biocompatible. However, GI has less surface hardness,
compressive strength, and tensile compared to COMmander COMposite!
QUESTION: What is a compomer? (p. 26) GI and Composite modified with polyacid groups, used in
low-stress-bearing areas (Less wear resistant than composite, Releases fluoride)Root caries and Class V.
RMGI is better.
QUESTION: What is compomer combined benefits of composites (the “comp” in their name) and glass
ionomers (“omer”).
QUESTION: Reinforced Zinc Phosphate Eugenol: Best luting agent? (This statement does not make
sense…reinforced ZOE is biocompatible but has very low strength and is only used for very retentive
restorations…nowadays only used as a temporary cement…Xtina)
QUESTION: The strength of Zinc Oxide Eugenol can be increased by adding what? Methylmethacrylate
QUESTION: Methyl methacrelate (reinforced ZOE)
QUESTION: *Zinc oxide eugenol is IRM but theres an extra component that makes it IRM which is the
methylmethacrylate which is an inactive ingredient.
QUESTION: zinc oxide-eugenol with polymer reinforcement.
QUESTION: IRM is ZOE mixed with what? Titanium, MMA
QUESTION What has been added to IRM: ZOE + PMMA beads added to poweder to increase strength
QUESTION: pH of ZOE (near 7), zinc phosphate **pH of 3.5—acidic irritates pulp.
QUESTION: Zinc eugenol good temp filling: gives a good bacterial seal, high compressive strength,
high tensile strength, good biological seal
QUESTION: the main component of any root sealers is? Zinc oxide
QUESTION: when you used ZOE in a primary what kind? ZnOE without catalyst., Lack of catalyst
gives adequate working time filling the canals

• ZOE without catalyst
• Gutta percha
• Sealer alone
• ZOE with accelerator
• ZOE without accelerator
QUESTION: What is the material in reinforced IRM that give it strength

A. amalgam powder
B. Zinc phosphate
C. Poly methyl methacrylate**
D. Titanium powder
QUESTION: Zinc phosphate cement is used as luting agent : the initial acidity may elicit a traumatic
response if…
A. a, c, & d
B. a or d
C. b only
D. all of the above
QUESTION: If you add BIS-GMA to PMMA→ increases strength or results in the doughy texture to
have more working time
QUESTION: PMMA resin? bis-GMA

QUESTION: Crosslinking factor of P-MMA? bis-gma, benzoyl peroxide
QUESTION: Crosslinker in pmma: bisgmma, benzoyl peroxide
QUESTION: Bis-GMMA- provides the CROSS LINK
QUESTION: PMMA and what crosslinking does? I put strength but not sure
QUESTION: Addition of long chains in PMM is for what reason: increase strength, allow doughy
consistency before set, allow for addition of more powder without crazing, prevent shrinkage
QUESTION: If too much monomer is added to polymer: Causes excessive shrinkage
QUESTION: Increase monomer causes shrinkage

QUESTION: By having excess amount of monomer in acrylic can create excessive amounts of what:
shrinkage, expansion, thermal conduction are 3 of the 4 options
QUESTION: Adding more monomer increases

a. Expansion
b. Shrinkage?
c. Brittleness
d. Harness
QUESTION: KNOW WHAT INCREASES AND DECREASES SETTING TIME:
increased water:powder ratio increases setting time, decreases expansion,
mix faster, increase water temp → decreases setting time
QUESTION: Increase set time with Alginate (Irreversible Hydrocolloid)? Cold water and more water
QUESTION: IF you have decrease spatula/mixing, you decrease expansion
QUESTION: IF you have increase spatula/mixing, you increase expansion
QUESTION: Increased trituration time will increase compressive strength/decrease setting

expansion;
QUESTION: Increasing trituration time→Reduced the setting expansion
QUESTION: Know what increases and decreases setting time for gypsum
(slurry/temperature/spatulation) – longer spatulation time, greater expansion (shorter time) ----
***Gypsum bonded investments. Type I, II, III gold. Gold shrinks, so mold must expand to compensate.
Older invst—decrease expansion; Increased time between mixing in water bath immersion---dec exp;
Increase water:powder ration—dec exp; Increase spatulation time—increase expansion
QUESTION: What decreases setting time of Gypsum: Decrease water:powder ratio
QUESTION: What happens if you increase water in gypsum stone? Less expansion and strength (b/c
particles are farther apart)
QUESTION: How to decrease setting time (increase spatulation time, increase water temperature,
use of slurry water, decreases water:powder ratio)
QUESTION: How to increase setting time? Hot water, increase water/powder ratio, decrease
water/powder ratio
QUESTION: Same thing but with increase/decrease in setting expansion-more water, less
expansion, less strength
QUESTION: what happens when you increase w/p ratio of an investment: increase thermal
expansion, decrease thermal expansion, increase setting expansion...?
QUESTION: Similar question with how to increase setting time of alginate

QUESTION: take an impression and lip immediately swells? Angioedema
QUESTION: C1 esterase inhibitor – angioedema
QUESTION: C1 Esterase Ihibitor question-hereditary angioedema
QUESTION: Which of the following systems is thought to malfunction in the hereditary form of
angioneurotic edema?
A. C-1 esterase
B. C-1q inhibitor
C. CH50 consumption
E.Complement synthetase
QUESTION: Alginate 100% humidity: Shrinks due to syneresis.

QUESTION: Alginate impresssion shrinks due to - syneresis.
QUESTION: Alginate imp 100% humidity will shrink: syneresis= extraction or expulsion of a liquid
from a gel →shrinkage
QUESTION: With alginate in 100% humidity, why will shrinkange still occur? Imbibemnt,
syneresis, historgysm
QUESTION: Synerisis imbibition applies to which impression mat? Reversible hydrocolloid. Irreversible
is not an option
QUESTION: when pouring gypsum material into an impression which material will cause the least amount
of bubbles? Polysulfide, polyether, silicone, irreversible hydrocolloid
QUESTION: Dimensionally stable impression- additional silicone (polyvinylxsiloxane?...Xtina)
polysulfide
QUESTION: Most stable impression material: additional silicones ( aka PVS ) they just used
QUESTION: which provides best dimensional quality (PVS)
QUESTION: polyvinyl siloxanes gets affected by latex (handle with latex gets messed up the sulfer
in latex gloves that retards the setting of PVS addistion silicone))
QUESTION: PVS➡ Polyether-Most!
QUESTION: Polyether – wuts bad about it? Hard to take out cuz it sticks to teeth
QUESTION: Polyether disadvantage compared to other elastomerics?choices: sticks to teeth,

longer working time, less accuracy
QUESTION: Biggest disadvantage of polyether? I put hard to remove from teeth
QUESTION: Which one most likely to get stuck in mouth? Polyether??***

QUESTION: Impressions: whats wrong with polyether- its hard engages undercuts
QUESTION: When compared to other materials, which of the following is the main disadvantage of using
polyether elastomeric impression materials: Are much stiffer
QUESTION: Most rigid impression material, Polyether
QUESTION: Most rigid impression material – polyether
QUESTION: which is hardest one to remove from the oral cavity (STIFFEST) (polyether)
QUESTION: what material you would not use for a single crown : a) polyether b) polysulfide c) PVS
etc
QUESTION: Polysulfide gives out ? water
QUESTION: Catalyst of polysulphide POLYSULFIDE impression material- lead dioxide
QUESTION: Condensation silicone – ethyl alcohol as by product

QUESTION: Condensation silicone releases? Alcohol
QUESTION: Don’t use for casting impression? Reversible Hydrocolloid.

QUESTION: Acceptable impression material for a casting?
• Irreversible hydrocolloid
• Reversible hydrocolloid
QUESTION: Which of the following is not good for use in taking impression of a cast restoration – I
said irreversible hydrocolloid (other option was reversible hydrocolloid, and addition silicone)
QUESTION: Which is not recommended for final FPD impression?

• irreversible hydrocolloid*
• PVS
• Polyether
o Polysulfide
o PVS
QUESTION: All of the following are good impression materials for crowns except: →irreversible
hydrocolloid,
QUESTION: addition silicone is the most stable elastic impression material in a moist environment
QUESTION: Addition silicon(PVS) releases? H2 (as secondary reaction)
a. polyether
b. additional silicon
c. condensation silicon
d. polysulfide
QUESTION: Which impression least distorted by water? Addition silicone (Condensation silicone
better ans if available
QUESTION: imbibition and syneresis affect which one the most

a. reversible hydrocolloid----
c. polysulfide
d. silicone
FLUORIDE:
QUESTION: how many mg of fluoride in 1 liter of water at 1 ppm : 1 mg
QUESTION: What does floried replace in hydroxyl appetite: hydroxyl
QUESTION: What ion is replaced to get hydroxyfluoroapatite? HYDROXYL

Hydroxyapetite + Flouride ------> Flourapetite + Hydroxy
The incorporation of fluoride into the enamel hydroxyapatite crystal: Fluoride ions replace the hydroxyl
radicals of the hydroxyapatite crystals in the enamel, producing fluorapatite. This form of enamel is less
soluble in catabolic acids produced by oral bacteria.
QUESTION: least soluble
a. fluorapatite
QUESTION: Fluoride becomes fluoroapetite which is insoluable
QUESTION: ***Fluoride works in all these ways except: Increases strength of collagen**
Fluoride BREAKSDOWN collagen, is bacteriocidal, fluoroapetite is more resistant to acid
attack, decreases solubility of enamel, excreted by kidneys, helps remineralize
QUESTION: Fluoride helps prevent caries in all ways except? I put lower pH of the oral cavity,
since it does not do that! Fluorapetite has a lower critical pH of 4.5
QUESTION: Flouride accumulated most- away from DEJ (surface of tooth)
QUESTION: Where does fluoride localize? Outer enamel**
QUESTION: Fluoride spot makes enamel more resistant to future caries
QUESTION: Fluoride does all the following, except? – Direct action on plaque
QUESTION: What does floride do? Floroapitate that’s acid resistance.
• Higher the fluoride level, greater degree of enamel change
QUESTION: Flouride in acidualted flouride. 1.23 %
QUESTION: What conc of acidulated phosp fluoride is used in the dental office? 1.23
QUESTION: ADA recommends to apply in-office floride foam for how long?- 4 MIN
QUESTION: How many minutes do you place Neutral sodium fluoride tray on teeth? 4 minutes
QUESTION: Floride supplementation is effective in: everybondy, only kids, anyone but most
beneficial to children.
QUESTION: Supplemental fluoride when can you give it? 6 mos
QUESTION: what age should fluoride supplements be started? 6 months

QUESTION: What age does fluoride incorporate into primary dentition? 4 months in utero
QUESTION: At what age does florousis of teeth anterior permanent teeth occur?- 4-6mo (others 0-4mo,
1year, 2years and 6 years)
QUESTION: Usual water flouridation- 1.0 ppm
QUESTION: 1ppm for average fluoride in water (FYI in January of 2011 this statement was
issued: “The Department of Health and Human Services today announced that it will revise the
recommended levels for optimally fluoridating community water systems. Historically, the
recommended optimal level for community water fluoridation has been 0.7 to 1.2 parts per million.
The new recommended level is 0.7 ppm.”)
QUESTION: What is the EPA highest conc of natural fluoride in drinking water? 4 or 1ppm????
QUESTION: Maximum allowed fluoride in the water by EPA (environmental protection agency)?
4.0mg/liter
QUESTION: Maximum fluoride according to some agency is ? 4ppm (options were 1,2 ,3, 4mm)
QUESTION: Community fluoride: 0.2% / week in udnerprivelaged areas
QUESTION: Flouride is given to children in schools usually by what method: .05 daily, .2 daily,
.05 weekly, .2 weekly ( I guessed this, I have no idea because this question is a total waste of my
time and I cant think of any situation where knowing this would be useful)
QUESTION: What happens when a kid with primary teeth ingests fluoride? - It affects their
permanent teeth.
QUESTION: Fluoride table, 5yrs old with .75ppm intake - I said don't give more (answer said 0ppm)
QUESTION: Floridation supplement for a 5 year old drinking .75ppm h2o?- 0mg
QUESTION: 4 yrs old patient, 0.25ppm fluoride intake, what do you? – Give her systemic Fluoride
(other were apply fluoride, change diet to more fluoride intake).
fluoride rinse
QUESTION: 4 yo with .4ppm fluoride. Supplement? 0.25PPM or 0.25mg/L
fluoride rinse
QUESTION: 2 yo takes 20mg fluoride pill – coma, nausea, renal failure, cardiac arrest
QUESTION: a child has injested 20 mg of fluoride. What will likely happen? Nausea
QUESTION: 7 year old patient has no fluoride in drinking water. What do you give them systemically…
5 mg, 1 mg, .25 mg
6 months-3 year = 0.25mg
3 -6 years = 0.5mg
7 – 16 y.o. = 1mg
QUESTION: IF PATIENT GETS 0.3-0.6mg from water then half supplement from 3-16years
QUESTION: 4.5 years old child with .75ppm fluoride in their water req. how much fluoride
supplement? 0 mg. optimal range of fluoride in water lies between 0.7 and 1.2 ppm
QUESTION: The appropriate amount of fluoride in the community water: 0.75-1.2
QUESTION: Supplementation for 10 year old with no other fluoride source? 1 mg every day or 1 mg
every week?!?
QUESTION: 2.5 year old with 0.4 ppm fluoride in water… normally I would say rx nothing but that
wasn’t a choice – I put 0.25 mg supplement
QUESTION: The drinking water supply of a community has a natural F level of .6ppm. The F level is
raised by .4ppm. Tooth decay is expected to decrease by what % after 7 years?
40%
QUESTION: 3 year old patient lives in area with 0.4ppm fluoride. How much do you
supplement? 0.25 mg
QUESTION: 7 year old child living in area with .2 ppm fluoridated water-supplement 1.0
QUESTION: what type of Fl in water: include fluorosilicic acid (hydrofluorosilicate) – most

commonly used, sodium fluorosilicate, and sodium fluoride
QUESTION: Types of Fluoride used in toothpaste: sodium fluoride, Stannous fluoride(most

effective), Sodium monofluorophosphate
QUESTION: Which fluoride is not found in toothpaste? Acidulated (???)
QUESTION: what toothpaste should not be used in a patient with multiple porcelain crowns?
acidulated
QUESTION: Best thing for child to rinse with? Sodium fluoride
QUESTION: What mouthwash is good for children with caries? NaF
QUESTION: What rinse is used at home for developmental disabled child to reduce of plaque: NaF,
stannous fluoride, chlorhexidine
QUESTION: the usual metabolic path of ingested fluoride primarly involves urinary excretion
with remaining portion in? skeletal tissue
QUESTION: where is the biggest store of fluoride in tissues? Skeletal tissues

A. interproximal**
prr/sealant)
QUESTION: In history of dentistry, which of the following has decreased?
• Interprox-due to fluoride
• Pit and fissure

c. water with no fluoride
d. juice
QUESTION: ECC cause by all at night except – bottle feeding with formula with fluoridated water, breast
feeding, sippy cup with OJ, bottle feeding with processed water with no fluoride
QUESTION: ECC which location?
a. Max incisors and molars?
b. Max incisor and molars?
c. Max canine
d. Man canine and molars?
Primary max incisors (B&L), then primary molars, mandibular unaffected bc
tongue blocks
QUESTION: ECC early childhood caries. Question asked which teeth specfically affected. 1) Max and
mand incisors 2) max central and 1st molar 3) man central and 1st molar Max anterior and primary
molars
QUESTION: What teeth are assoc with ECC? primary incisors, incisor and canine, incisor and molar
QUESTION: Question about what determines fluoride supplementation for a city - temperature
QUESTION: percentage of fluoride water in US - 85% (should be about 65-70%)**ADA site talks about
percentage of people receiving fluoridated water.. couldn’t find percentage of fluoridated water itself.
Percentage went up from about 65% to 74%.
QUESTION: What percentage of americans have public fluoride in water: 66%, 85%, other lower
numbers Update: CDC 2010 reports Americans have 79.6% water fluoridation
QUESTION: porcentage of cities in U.S with fluoridate water : 69or 75%???
QUESTION: water fluoridation in what percentage of towns/cities? 30%, 70%, 85%

QUESTION: What is percentage of communities that are fluoridated in America? 60, 85%...
QUESTION: Fluoridation for water: effectiveness: early studies showed that it prevents 50%-70%
of caries in permanent teeth, Howerver currently the effectiveness is 20%-40%
QUESTION: Effectiveness of Water fluoridation in the U.S. is 20%-40% (40%)
QUESTION: Fluoridation: know the primary/secondary/tertiary prevention differences.
Primary: aims to prevent the disease before it occurs. Health education, community fluoridated water,
sealants.
Secondary: Elimates or reduces disease after they occur. Composite filling

Tertiary prevention: Rehabilitates an individual in later stages to restore tissues after the failure of
secondary prevention. Examples include dentures and crown and bridge.

QUESTION: Fluorosis does what – inhibits remineralization, however fluoride induced enamel
hypoplasia or hypocalcification which is characteristic of fluorosis is caries resistant
•Higher the fluoride level, greater degree of enamel change
QUESTION: Which fluoride do you give and why? Do certain fluorides stain? Stannous fluoride
may stain. Better to recharge GI? APF
because – acid of fluoride will wear away at GI. TRUE
because – acidulated fluoride will wear away at GI?
QUESTION: Applying Fluoride (APF) on GI cement what happens? A. dissolves it b. stains it
(decks says loos glace) roughens it
C. Acid Flouride
QUESTION: What fluoride tx used in a pt with amalgams, pfm’s , composite restorations, implants? NaF
→more profound= acidulated
QUESTION: Pt has fillings and full porc. Crowns, but has decalcification on class V? 1.1 % NaF,
QUESTION: Caries in elderly, which one is not useful in managing: use of 1.1% fluoride as a standard
of care
QUESTION: what is her dental age based on xrays → advanced, chronological lags behind dental, Tx for
#D → TE, c. what to do with lesion on distal of #S (look incipient, resorbed) → apply fluoride varnish
every week, do DO comp or amalgam, observe and reassess next visit, disc the distal surface, d. both
child and guardian should receive oral health instructions, oral health care should include daily fluoride
rinses → both statements are true.
QUESTION: Sealants- mechanical microretention binding to tooth

QUESTION: Contradiction of sealant: when you have rampant or gross caries
QUESTION: a child with no decay but deep pits and fissures what is the Tx plan : sealants
QUESTION: Patient has deep grooves but no decay on permanent molars, what do you suggest? –
Sealants
QUESTION: Patient has deep grooves but no decay on permanent molars, what do you suggest? - Sealants
QUESTION: Ortho pt: has never had a restoration? Wut wud you do? → sealants, do nothing, etc.
(agu put: do nothing)
QUESTION: High caries risk patient, when is he indicated for sealants? Obvious clinical cavitation on the
occlusal, deep fissures without caries
QUESTION: Pt at high caries risk? Place sealants in deep fissures

QUESTION: pictures of molars in 16 y/o – does it need sealants, no treatment, Class I. Book says do
sealant age 6-12, so no treatment most likely unless caries visualized.
Bleach:
QUESTION: In-home bleaching percentage - 10% carbamide
QUESTION: 25% carbamide peroxide for home bleaching: False, its 10% carbamide peroxide
QUESTION Material used for mouth guard vital bleaching: 10% carbamide peroxide.
QUESTION: Home bleaching kit. Maximum dosage? Carbamide peroxide 10%

QUESTION: home bleaching what causes : sensitivity
QUESTION: What is the most effective way of bleaching teeth? In-home vital bleaching.
QUESTION: Non vital bleaching is with? hydrogen peroxide 35%, carbamide peroxide, and
sodium perborate.

QUESTION: Difference b/t dentist and home bleaching.. strength of peroxide
QUESTION: Bleaching tray at home? Make sure custom fit
QUESTION: best way to decrease gingival irritation w/ home bleaching? well fitting trays
QUESTION: Bleach used to dissolve organic tissue
QUESTION: Purpose of bleach except- getting past foramen to treat bone
QUESTION: most common complication of internal bleaching → cervical external root
resorption
QUESTION: How do you treat it? Scale the area
QUESTION: What is worse outcome of nonvital bleaching (internal bleach for endo)…external root
resorption, internal root resorpotion /CERVICAL RESORPTION. Non vital bleaching
consequence: internal resorption /cervical resorption
QUESTION: You are about to prep a tooth for PFM crown, patient also needs teeth bleached, how do
you go about it? – Bleach first, wait 2 weeks, prep tooth, then restoration.
QUESTION: You are about to prep a tooth for PFM crown, patient also needs teeth bleached, how do you
go about it? – Bleach first, wait 2 weeks, prep tooth, then restoration. (Other choices, Bleach and prep 1st,
then wait 2 weeks, Bleach last after prep and crown).
QUESTION: Anterior crown lighter than rest of teeth → bleach rest of teeth
QUESTION: Patient is complaining about a very light colored anterior PFM crown she had done
sometime ago, there is nothing clinically wrong with the crown. What do you do Doctor? – Bleach
natural teeth (other choices, re-do the crown, put a darker shade composite on crown, some other
stupid answers).
QUESTION: #8 PFM is too light but good margins and been there for 10 years – vital night guard
bleaching
QUESTION: Anterior crown placed 10 years ago, 45 yr old woman, color doesn’t match natural teeth
now, appears clinically acceptable, what will you do?
a. vital bleaching
b. new crown
QUESTION: The office bleaching changes the shade through all except…
a. dehydration
b. etching tooth
d. surface deminearalization
QUESTION: No obvious clinical caries in a child. Radiographically, interproximal caries on primary tooth
Oral Pathology:
http://www.aapd.org/media/Policies_Guidelines/RS_LabValues.pdf
QUESTION: Hairy tongue – hypertrophy filly form papilla
QUESTION: What is usually seen with affected hypertrophic filiform pappilae: Hairy tongue
QUESTION: Causes ofHairy tongue ? antibiotic , corticosteroid, hydrogen peroxide
Many people with BHT are heavy smokers.[4] Other possible associated factors are poor
oral hygiene,[4] general debilitation,[4] hyposalivation (decreased salivary flow rate),[5]
radiotherapy,[4] overgrowth of fungal or bacterial organisms,[4] and a soft diet.[5]
Occasionally, BHT may be caused by the use of antimicrobial medications e.g.
tetracyclines,[5] or oxidizing mouthwashes or antacids
QUESTION: Which of the following is seen with hyperplastic(or was it associated with) foliate
papilla: hairy tongue, Lingual tonsil hyperplasia
QUESTION: Which of the following is seen with (or was it associated with) hyperplastic foliate
papilla: I put hairy tongue, other option was median rhomboid glossitis, also lyphadenopathy)
a. Lingual tonsil hyperplasia

c. Squamous cell carcinoma
e. Prominent fungiform papillae.
QUESTION: Loss of filliform papilla- vitamin def- vit b
QUESTION: Bilateral swelling of parotid cannot be caused by: Anorexia,
QUESTION: Patient has bilateral white lines @ occlusal plane, what is primary microscopic finding?
Epithelial hyperkeratosis
QUESTION: Pt has hyperkeratosis around occlusal? linea alba
QUESTION: What is white and bilateral on buccal mucosa (leukoedema not choice), Linea Alba
QUESTION: Ulcer on tongue repeated every 4 months- apthous ulcer
QUESTION: why brush tongue - to reduce odor
QUESTION: Pic: had a red thing on tongue where is it from (candidiasis, Kaposi, syphilis, gonnaria)
QUESTION: Behçet's disease Pic of something on tongue: aphthous ulcer – related to bechet’s disease
QUESTION: Behcet’s syndrome? Oral lesions similar to apthous ulcers?
QUESTION: Bechets syndrome produces what type of mouth lesion: Apthous Ulcers , apthous stomatitis,
recurrent. herpes
Behçet disease sometimes called Behçet's syndrome,Morbus Behçet, Behçet-Adamantiades syndrome, or
Silk Road disease, is a rare immune-mediated small-vessel systemic vasculitis that often presents with
mucous membrane ulceration and ocular problems. Triple-symptom complex of recurrent oral aphthous
ulcers, genital ulcers, and uveitis. As a systemic disease, it can also involve visceral organs such as the
gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems. This
syndrome can be fatal due to ruptured vascularaneurysms or severe neurological complications.
QUESTION: Pathognomonic for measles? Koplik’s spots

QUESTION: koplick spot? buccal muscosa ulcerated, related to measle
*Koplick—ulcerated buccal mucosa…MEASLES
QUESTION: Transillumination in children – Koplik? (Koplik’s spots are associated with

measles)
QUESTION: Syphilis: hutchinson triad (presentation for congenital syphilis, and consists of three
phenomena: interstitial keratitis, Hutchinson incisors, and eighth nerve deafness.)
QUESTION: indents on incisal edge with narrowing at mesial and distal? I guessed congenital
syphilis (Hutchinson’s tooth?)
QUESTION: A chanker due to Syphilis mostly resembles: Aphthous ulcers.
QUESTION: stages of syphilis is most infectious: primary and secondary, primary, secondary, tertiary,
primary secondary and tertiary
QUESTION: Heck disease: 13 and 32

(also known as focal epithelial hyperplasia) is a cutaneous condition characterized by
white to pinkish papules that occur diffusely in the oral cavity.[1]:411 It is caused by the
human papilloma virus types 13 and 32.
QUESTION: baby with streaks on palate

• bone nodulus
• Epstein pearls
QUESTION: Kid has nodule on palatal suture-what is it
• Ebstein pearl
• Bohn nodule→ hard/soft palate+ B/L of ridge
QUESTION: neonate with a bunch of nodules on alveolar ridge. What is it?

a. Bohn’s nodule
- keratin-filled cysts of salivary gland origin on palate of newborn
• Eruption cyst
• Congenital cyst of newborn
Oral Pathology:
Systemic Lupus Erythematosus:
Lupus Erythematosus –collagen/CT multisystem disease. Unknown cause. Women 10x more
frequently. Avg age =31yo. Malar rash, kidney problems 50% of time &lead to organ failure.
Pericarditis also frequent complication; warty vegetations on valves =Libman-Sacks endocarditis.
Oral lesions if evident- palate, B mucosa, gingiva.
QUESTION: Xerostomia, complication of :Sjö gren's syndrome, dry moth dry eye PAROTID
SWELLING LUPUS RHEUMATIOD ARTHRITS poorly controlled diabetes,
QUESTION: Which syndrome has rash on cheeks, ulcers, kidney, etc? lupus
QUESTION: Which skin condition has endocaditis and glom- lupus
Cavernous Sinus Thrombosis:
QUESTION: cavernous sinus problem - due to infection of upper lip / canine space infxn / max ant
teeth
QUESTION: Most likely to cause cavernous sinus thrombosis: valve infected by endocarditis, soft tissue
abscess in upper lip (veins of face don’t have valves)
QUESTION: a cavernous sinus infection would most likely come from, maxillary sinus, paranasal sinus,
frontal sinus, ant. Max. teeth
QUESTION: Site of infection most likely to enter cavernous sinus? Anterior triangle, naso-labial
cyst
QUESTION: Danger triangle of the face – cavernous sinus (no valves in the veins)
QUESTION: Why are you afraid of having infection in anterior triangle (i.e. upper lip) because there
are valve-less veins that can send infection back to the brain
QUESTION: Which of the following causes Cavernous sinus thrombosis: A)Subcutaneous Abscess of
upper lip b)Subcutaneous abscess of lower anterior region
Infections in upper front teeth are within the area of the face known as the "dangerous triangle". The
dangerous triangle is visualized by imagining a triangle with the top point about at the bridge of the
nose and the two lower points on either corner of the mouth
vision
QUESTION: first sign of cavernous sinus:

bulging eye??
loss vision
***HEADACHE***
QUESTION: Pathognomonic sign of CST? Ptosis, bulging eye, headaches(1st one)
QUESTION: Cavernous sinus thrombosis early indication? Peri-orbital swelling, blurry vision
QUESTION: Cavernus sinus has : ptosis, decreased vision, opthalplagia
vision
Cavernous sinus thrombosis (CST) is the formation of a blood clot within the CS at the base of the
brain which drains deoxygenated blood from the brain back to the heart. usually from a infection
from nose, sinuses, ears, teeth or Forunculo. Staphylococcus aureus and Streptococcus are often
the associated. symptoms include: decrease or loss of vision, chemosis, exophthalmos (bulging
eyes), ptosis, headaches(1st one) and paralysis of the cranial nerves which course through the
cavernous sinus. This infection is life-threatening and requires immediate TX.
Ludwigs Angina:
QUESTION: Which space is not involved in ludwig’s angina? (sublingual, submandibular,
retropharyngeal, or submental)
QUESTION: What space is not associated with ludwigs angina? Associated with sublingual,
submental, submandibular
QUESTION: Ludwig’s angina seen in all spaces except: Retropharyngeal
QUESTION: Cellulitis most of the time involves unilateral, ludwigs angina is bilateral and complication is
edema of GLOTTIS
QUESTION: patient has bilateral submand infection, tongue is raised due infection - Ludwig's
QUESTION Bilateral submandibular infection, tongue was elevated due to infection - Ludwig's
Notes: Ludwig angina is the bilateral cellulitis of submandibular and sublingual spaces.
QUESTION: What u need to worry most abt ludwigs? swelling of glottis
QUESTION: Ludwigs: edema of glossitis
QUESTION: complication of lugwig’s angina:edema of glottis
QUESTION: Ludwig’s Angina symptoms? Swelling, pain and raising of the tongue, swelling of the neck
and the tissues of the submandibular and sublingual spaces, malaise, fever, dysphagia (difficulty
swallowing) and, in severe cases, stridor or difficulty breathing.
QUESTION: Mandibular 2nd molar infection spreads to what space? Submandibular space.
QUESTION: What space is mand 2nd molar below buccinators? Submandibular, submenal, sublingual, or
Buccal ???
QUESTION: Infection on the mand buccal side of premolars is most likely to go where? Submand space.
QUESTION: Infxn of mnd 2nd pm goes into submandibular space
QUESTION: Mand premolar infection→ can go to submandibular space
QUESTION: Premolars and molars infection –submandibular space
QUESTION: Which muscle separates 2 potential infection spaces from a maxillary 2nd molar?
Buccinator or Masseter
QUESTION: if you have an infection in the lateral pharyngeal space what muscle is involved? Medial
pterygoid
The lateral aspect is more involved, and is bordered by the ramus of the mandible, the deep lobe of
the parotid gland, the medial pterygoid muscle, and below the level of the mandible, the lateral
aspect is bordered by the fascia of the posterior belly of digastric muscle.
QUESTION: You are extracting a mandibular 3rd molar and the distal root disappears into which
space? submandibular space
QUESTION: Root of Mand molar displaced into what space? submandibular
QUESTION: If you extrad madibular molar where to goes, submandibular space.
QUESTION: IAN tract infection, involves what space? Pterymandibular space
Treacher Collins Syndrome:
Downward facing eyes
QUESTION: Which disorder least developmental delay-trecher collins syndrome

QUESTION: Treacher Collins-loss (hypoplasia) of zygomatic bone, what do patients with cleidocranial
dysplasia have? Loss of clavicle
QUESTION: Malformed ear, mandibular hypoplasia – Treacher Collins
QUESTION: Describes patient saying they have mandibular hypoplasia, Malformed ear
eyelids, ear pinna-- Treacher Collins
Scarlet Fever:
QUESTION: Strawberry tongue seen in scarlet fever, Also in Kawasaki disease and toxic shock syndrome
QUESTION: Picture of strawberry tongue (scarlet fever)
QUESTION: Strawberry tongue seen in scarlet fever
Fordyce Granules:
QUESTION: Fordyce granules – ectopic sebaceous gland

• salivary gland
• sebaceous gland*
• sweat gland
Turner Tooth:
QUESTION: Turners teeth is assoc with?
QUESTION: Most probable reason for a Turner Tooth? Syphilis? Trauma
QUESTION: Most probable reason for a Turner Tooth? Trauma at birth, trauma when young
QUESTION: turners tooth – single tooth affected
QUESTION: Turner’s tooth is caused by: I put “trauma or local infection”
QUESTION: What gives you Turners incisors
• syphilis
• trauma during delivery
• *trauma during pregnancy (occurs when developing permanent tooth is damaged
by periapical infection in overlying deciduous tooth. This causes defect in enamel)
Recurrent Aphthous Stomatitis:

aphthous stomatitis: recurrent discrete areas of ulceration that are almost always painful. occurs
on freely movable mucosa that does not overlie bone,Aphthous can be differentiated since it
usually does not occur over bone, does not form vesicles and is not accompanied by fever or
gingivitis.
QUESTION: Patient has ulcer at mucolabial fold, it goes away and comes back, what could it be? –
Apthous!
QUESTION: Pt has occasional sores on mucolabial fold on mandibular arch that healed without scarring:
minor aphthous
QUESTION: Ulcer that appears often on buccal vestibule that goes away without scarring after a week or
so? Minor Apthous ulcer.
QUESTION: Ulcer healing with scar tissue: major
QUESTION: A chancre due to Syphilis mostly resembles: Aphthous ulcers.
QUESTION: What don’t u treat aphthous ulcers with – acyclovir
Benign Mucous Membrane Pemphigoid (cicatricial):
Pemphigoid = D = DEEPER (subepithelial separation) than pemphigus S = SURFACE (epithelial
separation)
vulgaris because—less severe and HISTO: vesicles are SUBepidermal and NO acanthylosis.
QUESTION: Pemphigoid – separation of basement membrane

QUESTION: Subepithelial separation on immunofluorescence indicates? benign mucous membrane
pemphygoid
QUESTION: Most likely to cause desquamative gingivitis:
lichen planus-
Pemphidus vulgaris
Pemphigoid- I would think this one!
Disease with Desquamative gingivitis: lichen planus, mucous membrane pemphigoid (95%),
and pemphigus
A band of red atrophic or eroded mucosa affecting the attached gingiva is known as dequamative
gingivitis. Unlike plaque-induced inflammation it is a dusky red colour and extends beyond the
marginal gingiva, often to the full width of the attached gingiva and sometimes onto the alveolar
mucosa
pemphigoid
QUESTION: Desquamative gingivitis? Answers are in pairs: Pemphigoid and lichen planus
QUESTION: Sloughing of gingiva epithelium in max and mand arches: pemphigus or pemphigoid
QUESTION: Which pemphigoid like lesion most often in infants? Bullous Pemphigoid , Pemphigus
Vulgaris, Pemphigoid etc don’t remember.
QUESTION: A child is most likely to have which of these: pemphigus, pemphioid, erythema
multiform, epidermolysis bullosa
QUESTION: Child formed blisters with minor lip irritation? Epidermolysis bullosa
QUESTION: Which pemphigoid like lesion most often in infants? Pemphagus Vulgaris, pemphigoid etc
don’t remember. Epidermolysis bullosa—small blisters that develop from mild provocation over areas of
stress—ie elbows and knees****
QUESTION: Young child/infant exhibits ulcerations of mouth: →epidermalysis bulosa
QUESTION: Said something about a kid who formed blisters with minor irritation to the lips
a. EPIDERMOLYSIS BULLOSA
Condyloma Acuminatum:
QUESTION: Condyloma accuminatum (genital wart) is caused by which virus? HPV*

QUESTION: Condyloma acumulatum- caused by HPV (venereal warts)
QUESTION: Which of the following does not have cauliflower like , pebbly appearance? Verrucous
carcinoma, fibroma , condyloma accuminata, papilloma.
QUESTION: HPV: know the subtypes, 6 and 11 for condyloma acumintam
→ HPV types 6 and 11 are most frequently the cause of genital warts
Candidiasis:
Candida forms – ulcer, Erythema, white hyperplastic, white/curd
QUESTION: Hiv patient with oropharyngeal candidiasis, what would u prescribe- fluconzole ????
QUESTION: Systemic antifungal in HIV patient?? Fluconazole
QUESTION: Patient with HIV has candidiasis- bec it is HIV related, increased CD 4... ( I wrote increase
CD4...?)
QUESTION: which oral medication would you give to tx vaginal candidiasis? Nystatin, griseofulvin,
monistat, Diflucan (fluconazole)
QUESTION: If pt undergoes radiotherapy for cancer, the most common oral infection that necessitates
drug tx in this stage is? 1. Candida albicans (answer)
QUESTION: Candidasis in cancer patients due to- chemotherapy, radionecrosis
QUESTION: Inhaled methacholine (steroid) produce oral candidiasis
QUESTION: Pt has multiple white patches that can be scraped off → candidiasis
QUESTION: Oral cytology smears are MOST appropriately used for the diagnosis of which of the
following? Pseudomembraneous candidiasis
QUESTION: What oral manifestation is seen in children with HIV? Candidiasis #1
QUESTION: Patient is 4yrs old on lots of AB what is most likely? Candidiasis
QUESTION: Candida- can wipe away: Nysatatin

QUESTION: systemic med for candida: amphotericin B
QUESTION: broad spectrum antibiotics : →increase superinfection (infxn by candidiasis) and
resistance.
QUESTION: Lesion in the middle of tongue also pt had it on palate before and pt is healthy?
Karposi, candidiasis, Syphilis
QUESTION: Rhomboid tongue thought to be- a type of candidiasis

QUESTION: Median rhomboid glossitis—***smooth red area of tongue that lacks the papillae
QUESTION: Healthy 36 year old, red patch on palate, redness in middle of tongue:
-kaposi sarcoma,
-syphilis
-median rhomboid glossitis
-gonorrhea
Primary Herpes:
Gingivostomatitis Herpetica: initial presentation during the first ("primary") herpes simplex
infection. of greater severity than herpes labialis (cold sores) which is often the subsequent
presentations. is the most common viral infection of the mouth,affects both the free and attached
mucosa. Tx Acyclovir, valacyclovir, Penciclovir Famciclovir.
a. 65-90% worldwide; 80-85% uSA
QUESTION: Kid with herpes. What is the age of infection?

2 years
QUESTION: Age of primary infection of herpes? 2 yo, 4 yo, 6 yo, 8 yo, 10 yo (added info below)
QUESTION: Age of primary infection of herpes? 2 months, 4 yr , 6 yr, 8 yr

From oral path book under viral infections; “acute herpetic gingivostomatitis arise between 6
months and 5 years, with peak prevalence btwn 2-3 years of age. Development before 6 months is
rare due to protection of maternal anti-HSV antibodies.
QUESTION: Young person w/ fever & vesicles: FEVER = PRIMARY herpes stomatitis
QUESTION: Primary herpatic gingivostomatitis- fever, ulcer in mouth. No symptoms
QUESTION: Primary herpatic gingivostomatitis- child 2 yrs , fever, not ant to eat
QUESTION: After orthodontic tx, pt with no other systemic disease develop high fever? due to
canker sores by newly placed brackets.
QUESTION: ways to treat kid w/ herpetic gingivostomatitis EXCEPT
a. antibiotics
b. give numbing anesthetic before eating
c. have pt rest and drink lots of water
Recurrent Herpes Simplex:
QUESTION: Herpes can be diagnosed by exfoliative cytology. A characteristic multinucleated cell

appears in the smear of herpes infections.
QUESTION: Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone.
The hard palate is the most common site, alveolar mucosa
QUESTION: 2ndary herpes ? lip, gingival, and palate pg 106, table 4-1

QUESTION: Herpetic withlow? Herpes on finger
DRUG OF CHOICE:
ganciclovir (IV): CMV or (valancyclovir – oral)
recurrent herpes medication: docosanol (abreva), acyclovir (zovirax)

Know drugs that are used for Herpes: Acyclovir, valtrex (valacyclovir), docosanol (abreva), and
PENCICLOVIR
QUESTION: Acyclovir given for herpetic lesions. Also, phosphorylated and activated in infected
viral cells.
QUESTION: herpes, zoster – Valacyclovir treats herpes labialis
QUESTION: Patient gets recurrent herpetic lesions very often with gingivostomatitis. What should
be done?
Acyclovir.
Palliative trt
QUESTION: Hiv pt with oral herpes, what would u prescribe- vir
QUESTION: Tx for herpatic gingivostomatitis?
• palliative tx**
• acyclovir
• systemic antibiotic
• steroids
QUESTION: Patient has all clinical signs of Herpes (with lesion on corner of mouth that comes and goes)
which medication do you recommend? – The one that ended with a vir. (no acyclovir in the answer
choices)
QUESTION: best med for herpes, CMV…acyclovir.
QUESTION: Tx for herpes simplex and herpes zoster : Valtrax

QUESTION: Pain lesion - Herpes Zoster
QUESTION: Patient comes with recurrent herpetic stomatitis on the lips and history shows no signs
of primary herpetic gingivostomatitis. Why? Most primary infections are subclinical
QUESTION: 2nd recurrent herpes, supposed to have a primary phase but no sign? It is subclinical
QUESTION: pt presents at 3 days with secondary herpes lesion? What the treatment of choice?
Antiviral?
Palative treatment****
Acyclovir was an answer choice (but acyclovir works best before you get the lesion)
QUESTION: Herpetic gingivostomatitis – within 3 days of onset: treat with Acyclovir 15mg/kg 5 times
per day for 7 days
All patients: palliative care: plaque removal, systemic NSAIDS, and topical anesthetics
Contagious when vesicles are present
QUESTION: Primary herpretic stomatitis? Reactivation of the primary can cause recurrent herpes
infection
QUESTION: Which dz is caused by the virus that causes acute herpetic gingivostomatitis?
A: herpes simplex 1
QUESTION: Herpes lesion intra orally how do u treat? Palliative, acyclovir?? *Tx is supportive—topical
before eating, analgesics, maintain fluid/electrolyte balance, anti-viral agents. DO NOT GIVE
CORTICOSTEROIDS.
QUESTION: acyclovir inhibits mrna. How does it have selective toxicity MOA? Only
phosphorylated in infected cells and inhibits viral mRNA…does not work on dna
QUESTION: Acyclovir-inhib mRNA?-phosphorylated-. nucleoside analogues--can’t make RNA
The mechanisms of antiviral action of acyclovir are well known (Figure 40-9). The nucleoside
analogue is phosphorylated to form acyclovir monophosphate by herpesvirus-encoded
thymidine kinase and phosphorylated further by other enzymes to acyclovir diphosphate and
triphosphate. Acyclovir triphosphate acts to inhibit viral DNA polymerase and to terminate
elongation of the viral DNA chain as spurious nucleotide is incorporated into DNA. In the
noninfected host cell, phosphorylation of acyclovir occurs to a limited extent. Acyclovir
triphosphate inhibits HSV DNA polymerase 10 to 30 times more effectively than it does
mammalian cell DNA polymerase.
1. only phosphorylated in infected cells and inhibits viral mRNA
2. does NOT work on DNA
QUESTION: Post herpetic neuralgia cause by: (VZV)herpes zoster, HSV 1, HSV 2, CMV
QUESTION: What does histoplasmosis oral lesion look like? I put recurrent herpes
Painful, ulcer with irregular borders, similar to cancer
QUESTION: Same patient as #49, has upper denture, when he removes it, there is unilateral lesion on the
palate. What could it be? – Herpes (other choices were more serious pathological lesions).
QUESTION: Pic with half the tongue (left side) that looks like herpes lesion and other nothing on it- I
wrote zoster
QUESTION: Pic of tongue one side with messed up: herpes zoster
QUESTION: Antivirals(wrong match)- azt with herpes zoster

QUESTION: Herpetic neuralgia seen after Herpes Zoster (complication of longer shingles) (hh3,
VZV)
QUESTION: Syphilis Chancre resembles 1) Cancer 2)Herpes: 3)Herpangina 4) Apthous Ulcer
QUESTION: Kaposi sarcoma by herpes 8
QUESTION: Kaposi sarcoma most likely on hard palate
Traumatic Neuroma:
QUESTION: A patient has a denture and a firm, swelling under the buccal flange midway
between incisors and molars. What is it? traumatic neuroma
QUESTION: Mandibular Denture: Lump hurts: Anterior to posterior areas cause is: traumatic neuroma
Pyogenic Granuloma:
QUESTION: Picture said: “erythematous, bleeding swelling” mandibular swelling right next to
premolars on R side? I put pyogenic granuloma
QUESTION: Pyogenic granuloma develops RAPIDLY
QUESTION: Pink growth on palatal between canine and 1st pre? Papilloma, pyogenic granuloma,
peripheral ossifying, irritation fibroma?
• fibroma
QUESTION: fastest growing tumor????
a. oncocytoma
QUESTION: Which one is common in pregnancy and in normal condition--pyogenic granuloma
QUESTION: Patient is female and pregnant and is said to have this enlargement and picture has it
on the corner of her mouth (vermillion border) and she said it just developed; the picture had it
shown as a boil and very red, said it bled, and was no painful – I went with pyogenic Granuloma
other option that could have made sense bc I didn’t know what it was a varix (dilated vein)
QUESTION: Picture... Lesion near labial comissure? Canditits Pyogenic Granuloma???
QUESTION: Lesion on gingival – if you press, it blanches and it bleeds easily – dx = pyogenic
granuloma

QUESTION: Where do u find giant cells? Hyperthyroidism, Hypothyroidism, Hyperparathyroid,
Hypoparathyroid
QUESTION: Giant cell lesion found in bone what test would you run to help with diagnosis? Bence
Jones(from multiple myeloma, this is what I put), calcium levels, Complete blood count
QUESTION: Giant cell lesion is most like histology of congenital epulis of the newborn. NO!—
Granular cell Myoloma
Squamous Papilloma:
QUESTION: Lesion on the palate verrucous and pedunculated: Papilloma
QUESTION: The causes of Verrucus xanthoma? Human papilloma virus

QUESTION: Cauliflower looking lesion, no picture given - Papilloma
QUESTION: lesion in lip with cauliflower shape : PAPILLOMA - the most common benign
neoplasm of EPITHELIAL TISSUE ORIGIN. It appears as apedunculated (foot-shaped), or sessile
whitish cauliflower-like mass on the tongue (posterior border), lips, gingiva, or soft palate.
QUESTION: pedunculated lesion on palate what is it? Papilloma
QUESTION: The most common between five? 1-Papilloma 2-Rhabdomyoma 3-Leiomyoma 4-

Lymphangioma 5-Neurofibroma
Fibroma:
a. Fibroma (and a question about how to treat a patient with old denture and epulis –
usually make new denture or modify; don’t just wear same denture)
QUESTION: there was a picture of Fibroma but the term fibroma was not used instead they used
another name: Focal Fibrous Hyperplasia
QUESTION: Fibromas are a result of what dysfunction? Neoplaisa, dysplaia, hyperplasia
QUESTION: In most of the cases, localized fibromas are often: Dysplasias, metaplasia, anaplasia,
hyperplasia
QUESTION: Which of the following does not have cauliflower like , pebbly appearance: Verrucous
carcinoma , fibroma, condyloma accuminata, papilloma.

pseudoepitheliomatus hyperplasia: resembles SCC. It is seen in inflamm papillary hyperplasia, chronic
hyperplastic candida, Granular Cell Tumor, blastomycosis.
QUESTION: Congential epulis histological similar to: hemangioma, lymphangioma, granular cell
myoblastoma
Leukoplakia:
QUESTION: If you have leukoplakia for biopsy, do you incise or excise for biopsy? 1. Incision (answer)
QUESTION: Leukoplakia all over- incise multiple areas w incisional.

Erythroplakia:
QUESTION: In smoker’s soft palate, theres red points, wut could it be? → erythroplakia, initial
stages of SCC, nicotinic stomatitis (hard palate), etc.
QUESTION: what presents with severe dysplasia? Erythroplakia, white sponge nevus
QUESTION: Lesion commonly with dysplasia and carcinoma in situ-- Erythroplakia
QUESTION: White ppl have least oral carcinoma: or asian, Indian, blacks
QUESTION: Worse rate of SCC is in? I put Black men
QUESTION: Etiology of Squamous Cell Carcinoma, external factors and stress.
(alcohol, tobacco, UV radiation, certain HPV types, vitamin deficiency, immunocompromised, iron
deficiency anemia – plummer Vinson syndrome…etiologies added from First Aid)
QUESTION: Xerostomia increases risk of SCC
QUESTION: lateral boarder of the tongue picture looked like squamous cell carcinoma
QUESTION: Lesion that resembles SCC…16wks and then disappers

a. papilloma
b. keratoacanthoma
b. adenocarcinoma
c. osteosarcoma
QUESTION: SCC on tongue, What you do? Incisional
QUESTION: #1 risk factor for oral cancer Tobacco
QUESTION: Most likely site for SCC? Ventrolateral tongue (other choices were weird…palate
(least)…)
QUESTION: Beetle nut case→ SCC, xerostomia ? gingival recession ?

QUESTION: Pt has been a smoker (60 pack yr history); ulcer in lower lip, non-indurated; wuts most
probable diagnosis? SCC

e. adenoid cystic ca (second most cmoon salivary gland carcinoma)
QUESTION: Most malignant cancer in oral cavity? Epidermoid carcinoma ***SCC! (look it up)
QUESTION: Which of these is the most likely to become malignant? low grade mucoepidermoid
carcinoma;
QUESTION: Radiographic Picture: image was upside down, had pink tissue-two teeth on bottom, bump
on palate-what is the lesion? ---SCC?
Leukoedema:
QUESTION: Leukoedema – blanches, no treatment

QUESTION: Leukoedema: Stretch and it disappears
QUESTION: dr stretches buccal mucosa, white, and spreads out thinner: leukoedema
QUESTION: Similar question: Which white lesion disappears upon stretching? Leukoedema
QUESTION: White on mucosa-no information-hyperkeratosis? Gauri put leukoedema; white sponge
nevus other option, lichen planus
QUESTION: Lesion that blanches -Leukoedema- it disappears on streching, it is always bilateral
QUESTION: A patient presents with a bilateral, grayish-white lesion of the buccal mucosa. This lesion
disappears when the mucosa is stretched. Which of the following is the MOST likely condition?
A. Leukoedema
B. Leukoplakia
C. Lichen planus
Leukemia:
lymphocytic leukemia-involves Iymphocytes.

• Chronic lymphocytic leukemia runs a variable course (older patients may survive years
even without treatment). lymph node enlargement is the main pathologic finding. May
be complicated by autoimmune hemolytic anemia.
CML – Philadelphia chromosome (chromosomal translocation)**Chronic myelogenous leukemia

o 20 yr old patient
QUESTION: Patient shows up with kid always bleeds, discomfort – leukemia
QUESTION: Leukemia Picture: young person that is fatigued and has a jacked-up mouth
QUESTION: Pic of kid with bleeding gums problem healing- leukemia

QUESTION: Most common type of leukemia in children? 1. ALL (answer) (lymphoblastic)
QUESTION: Pt had erythematous and gingival enlargement over past 5 weeks. And increased report
of bruising on body – cause is acute leukemia: Specifically, AML
QUESTION: A 6 years old patient has acute lymphatic leukemia. Her deciduous molar has a large carious
lesion and furcation lucency. How will you treat this person?
a. pulpotomy
b. pulpectomy
c. extraction
d. nothing
QUESTION: An 18 year old man complains of tingling in his lower lip. an examination discloses a
painless, hard swelling of his mandibular premolar region. the patient first noticed this swelling three
weeks ago. radiograph indicate a loss of cortex and a diffuse radiating pattern of trabeculae in the mass.
which of the following is the MOST likely diagnosis?
a. leukemia
b. dentigerous cyst
d. osetosarcoma
Verrucous Carcinoma:
QUESTION: Best prognosis? Verrucous carcinoma in vestibule, verrucous carcinoma floor of mouth,
SCC floor of mouth, SCC in other areas
QUESTION: smokeless tobacco : verrucous carcinoma
QUESTION: Verricus leukoplakia, HPV 16 and 18
QUESTION: Most common most pathogenic location verrucus carcinoma-floor mouth →buccal vestibule
QUESTION: Verrucous carcinoma presents with
• warty lesion
• I put large warty mass- variant of SCC
(large broad based exophytic papillary leukoplakic lesion: Xtina, First aid)
Salivary Gland Tumors:
Most common salivary gland benign major or minor : Pleomorphic adenoma  
Most common malignant minor: Adenoid cystic carcinoma  
Most common malignant major: Mucoepidermoid carcinoma  
QUESTION: Pleomorphic adenoma – most common benign tumor of salivary glands
QUESTION: which s most common salivary gland tumor pleomorphic adenoma and
mucoepidermoid
**Pleomorphic adenoma-most common belign
Mucoepidermoid: Most common malignant
QUESTION: Which of the salivary tumor glands has the best prognosis: Mixed Tumor, Adenoid
cystic carcinoma (perineural spread), Mucoepidormoid Carcinoma (most common)
Acinar Cell Carcinoma (better answer if there)
QUESTION: Which of the salivary tumor glands has the best prognosis: Mixed Tumor (plemomorphic
adenoma), Adenoid cystic carcinoma (perineural spread), Mucoepidormoid Carcinoma (most common)
Acinar Cell Carcinoma (better answer if thereI put polymorphous low grade adenoma but I think the
answer is adenoid cystic…
QUESTION: Best prognosis for oral cancers: Adenomatoid od. Tumor, low-grade --, malig. Mixed tumor
Benign Mixed tumor (pleomorphic adenoma) = best prognosis
Low grad mucoepidermoid is also good
Malig Mixed tumor & adenomatoid = worst
QUESTION: Perineural invasion is seen in: adenoid cystic carcinoma, Pleomorphic adenoma or low
grade mucoepidermoid carcinoma. This tumor has a marked tendency to invade nerves. Perineural
invasion is seen in about 80% of all specimens.
QUESTION: Adeno cystic carcinoma : neurotrophic factor and perineral invasion
QUESTION: perineural invasion—ACC (adenoid cystic carcinoma) other choices were OKC, etc
QUESTION: Table 4. 3: swish cheese? adenoid cystic carcinoma
• → Adenoid cystic carcinoma

o High grade salivary malignancy
o Most common malignant
o “swiss cheese” microscopic pattern
o spreads through perinueral spaces*****
Ameloblastoma:
Most common EPITHELIAL ODONTOGENIC TUMOR...mand molar area
QUESTION: Ameloblastoma histology : stellate reticulum in bell stage, epithelium in net flex
pattern
QUESTION: Which one can leads to ameloblastoma? – Dentigerous Cyst.
QUESTION: Which describes ameloblastoma best? I put local invasion
QUESTION: What is the most definite way to distinguish ameloblastoma from OK?
a.smear cytology
b.reactive light microscopy
c.reflective microscopy
QUESTION: Ameloblastoma case Q. You get a picture, slow progessing, other false choices included
dentigirous cyst.
• → ameloblastoma
o benign, aggressive odontogenic tumor w/recurrence
o most common tumor
- →Ameloblastoma – consists entirely of odontogenic epithelium. MOST AGGRESSIVE odontogenic tumor.
MOST COMMON epithelial odontogenic tumor.
Solid (multicystic or polycystic) – most aggressive kind and requires surgical excision
QUESTION: A painless, well-circumscribed radiolucency and radioopacity in the posterior mandible of

11yrs old boy. what is the differential diagnosis? Ameloblastic fibro –odontoma
QUESTION: Xray - Ameloblastic fibro odontoma/odontoma?
Odontoma:
QUESTION: pic of compound odontoma

QUESTION: x-ray of odontoma ( anterior lots of little tooth in the x-ray around the canine)
QUESTION: recognize odontoma--- **compound odotoma—looks like a tooth more defined; complex
odontoma—giant mass that is also radiopaque, but does not look like a tooth—
QUESTION: Syndrome with multiple odontomas-gardners syndrome
QUESTION: Picture of multiple small teeth within a radiolucency: compound odontoma, pindborg
tumor, calcifying odontogenic
- The other tumor of mixed, (epithelial and mesenchynal) origin is the odontoma. These
calcilied iesions take one or two general configurations. They may appear as multiple
miniature or rudimentary teeth, in which case they are known as compound odontomas,
Adenomatoid Odontogenic Tumor (AOT):

QUESTION: AOT (Adenomatoid odontogenic tumor) radiograph picture
o Exact picture used
QUESTION: Max canine surrounded by lesion: AOT

QUESTION: 2/3 tumor: adenomatoid odontogenic tumor: 2/3rd in maxilla, 2/3 in female, 2/3rd
in anterior jaw
QUESTION: Radiolucency at the end of a tooth that looks like there might be an AOT but the patient is
having symptoms (I wrote pericapical cyst)
QUESTION: Radiolucent lesion Between canine -lateral with radiopacity inside: adenomatoid
tumor
QUESTION: mixed density young child: AOT
QUESTION: AOT on xray- REMEMBER lesion goes to apex
QUESTION: A 16 year old boy. Xray showed maxillary anterior tooth with a radiolucency with
“SPECKS” in it (yes that’s the word that was used). Adenomatoid Odontogenic Tumor
Amelogenesis Imperfecta:
QUESTION: amelogenesis imperfecta is autosomal dominant.
QUESTION: Amelogenesis imperfect: X-ray: open contacts
QUESTION: Pictures of teeth, premolars just erupted. Thick dentin thin enamel, pulps not
obliterated, no contact – AI
radiolucency what other thing do you see? amelogenesis imperfecta (tooth lacks enamel)
QUESTION: Know the Imperfectas Amelogenisis: Hypoplastic pitting enamel

c. regional odontodysplasia
QUESTION: Question describing regional odontodysplasia: ghost teeth. (enamel, dentin and pulp
are all affected. Non hereditary)
QUESTION: when does enamel hypoplasia occur: Altered matrix formation. (BELL STAGE)
DI vs Dentinal Dysplasia:
DI: Crowns are short & bulbous, narrow roots, obliterated pulp
DD: Short roots (sometimes rootless), obliterated pulp, sometimes PA RL, mobile teeth
QUESTION: Dentingenesis imperfecta related to osteogenesis imperfect
QUESTION: What is seen with Osteogenesis Imperfecta: Dentinogenesis Imperfecta
QUESTION: osteogenesis imperfecta usually assoc w/

a. DI
b. AI
c. hypercementosis
QUESTION: pulp is gone: DI Dentinogenesis imperfect
QUESTION: Dentinogenesis Imperfecta: Obilterated pulp chambers
QUESTION: all of the following are differential for Dentinogensis imperfecta except?
ectodermal dysplasia,
amelogenesis imperfecta,
enamel dysplasia,
dentinal dysplasia
QUESTION: Which is not associated with dentogenesis imperfecta? Ectodermal dysplasia because
the enamel is the ectoderm, dentin is mesoderm I think
QUESTION: Differential diagnosis of Dentingenesis imperfect includes all except:

-OI
-ECTODERMAL DYSPLASIA
-enamel hypoplasia (AI)
-dentin dysplasia
QUESTION: Dentinogenesis Imperfecta poorly mineralized dentin, enamel frequently fractures

from the teeth leading to rapid wear and attrition of the teeth.
QUESTION: Dentinogenesis imperfect type I when? part of osteogenesis imperfect BLUE
SCLERA..... or it can be a separate inherited dominant trait without OI (DI type II)

• blue sclera (this is from osteogenesis imperfecta)
• hypodontia
• Other characteristics of this condition: opalescent teeth, affects both primary and
permanent, teeth are bluish-brown and translucent, enamel is lost early, type 1 is with osteogenic
imperfecta, type 2 is not with OI, type 3 is the bradywine type which occurs in absence of OI and is
isolated to Maryland. Type 3 also exhibits multiple periapical radiolucencies and large pulp chambers.
QUESTION: Dentin dysplasia looks like dentinogenesis imperfect, WITH ONE DIFFERENCE?
dysplasia has radiolucency.
QUESTION: Radiograph what is it: Aentinogenesis Imperfecta pulpless tooth 1 and 2…Type 3 are shell
teeth
dentinal dysplasia (coronal type II) –no/short roots, large pulp chamber-looks like dental
imperferca radicular is type-1-complete pulpal obliteration, short roots, PA RL
QUESTION: Dentinal dysplasia type 1 is pulpless

QUESTION: Dentinal Dysplasia Clinically the dental crowns appear normal while radiographically,
the teeth are characterized by pulpal obliteration and short blunted roots. The teeth are generally
mobile, frequently abscess and can be lost prematurely.
QUESTION: KID x ray cant see shit on xray however you can tell the roots are short. Sister also has
same condition. What condition is this?
DI-autosomal dominant!!
AI-autosomal recessive
Detin dysplasia – autosomsal dominant
QUESTION: Teeth with very large pulp chambers and open apex, 12 yo boy, sister also effected:
Dentinal dysplasia
QUESTION: Some teeth appear to be clinically normal, but exhibit (1 ) globular dentin, (2) very
early pulpal obliteration, (3) defective root formation, (4) periapical granulomas and cysts, and (5)
premature exfoliation. The condition is known as which of the following?
A. Shell teeth B. Dentin dysplasia C. Regional odontodysplasia D. Amelogenesis imperfect

E.Dentinogenesis imperfecta
QUESTION: Ectodermal dysplasia expressed as? anodontia or hypodontia, with or without a cleft
lip and palate. Anodontia also manifests itself by a lack of alveolar ridge development; as a result,
the vertical dimension of the lower face is reduced, the vermilion border disappears, existing
teeth are malformed, the oral mucosa becomes dry, and the lips become prominent. The face of an
affected child usually has the appearance of old age.
QUESTION: Ectodermal dysplasia definition

QUESTION: Ectodermal dysplasia? Abnormality of 2 or more ectodermal structures. Hair loss, thick nails,
light skin, no sweat glands, missing teeth.
QUESTION: Ectodermal dysplasia: which of the following is correct? It is xlinked, not autosomal
dominant
- → Ectodermal dysplasia – hereditary, abnormal skin, hair, nails, teeth, sweat glands. Teeth develop
abnormally causing anodontia or oligodontia (partial). Retained primary teeth. CONICAL shaped anterior
teeth.
QUESTION: Characteristic of Ectodermal Dysplasia is? – Oligodontia (some missing teeth, not all)
QUESTION: Ectodermal dysplasia: Oligodontia
QUESTION: ectoderman dysplasia : partial or complete anodontia

QUESTION: hypohidrotic child --> ectodermal dysplasia
QUESTION: Ectodermal dysplasia- sparse hair
QUESTION: ectodermal dysplasia…oligodontia and lack of sweat glands
QUESTION: what characterizes ectodermal dysplasia? Skin, hair, nails, SWEAT GLANDS?
QUESTION: What does hypodontia affect the most? I put growth of the alveolar bone?
QUESTION: Having hypodontia/anodontia will prevent/undermine formation of what? I said
alveolus (others were maxillary and mandibular arch but not together)
QUESTION: What do you see when you have hypodontia: maxillary deficiency, mandibular
deficiency, atrophic ridge, midface deficiency
QUESTION: Hypodontia affects maxillary constriction
1. max deficiency
2. man deficiency
obliterated; and the roots, shortened. These findings are associated with which of the following?
A. Osteogenesis imperfecta
obliterated; and the roots, shortened. These findings are associated with which of the
following?
Porphyria
QUESTION: Blue sclera seen in? osteogenesis imperfect
QUESTION: Blue sclera? Ectodermal dysplasia or OI
QUESTION: What is the most common? Dentinal dysplasia, amelogenesis imperfecta, dentinogenesis
imperfecta, cleft lip (Cleft Lip/palate)
Cherubism:
QUESTION: Cherubism: Bilateral jaw expansion
QUESTION: A kid presents for bilateral enlargement, painless, etc (they are implying Cherubism, what is
the Tx? No Tx required!
Fibrous Dysplasia:
QUESTION: Fibrous Dysplasia – ground glass appearance**Mccune-Albright Syndrome—polyostotic

fibrous dysplasia—areas of radiolucent/radiopaque---potential for malignant transformation
QUESTION: fibrous dysplasia on xray: lucency w/ no opacity, no tooth involved

-fibrous dysplacia: it is diffuse radiopacity-vital tooth
-osseous fibroma:radiolucent vital tooth
-cementous dysplacia
QUESTION: Fibrous dys (diffuse expansion of the mandible)
QUESTION: Picture of couple radiolucency lateral to lateral incisors, asymptomatic, 35 yo female:
fibrous dysplasia- Monostotic fibrous dysplasia may be completely asymptomatic and is often an
incidental finding on x-ray
QUESTION: Which of the following is frequently accompanied by melanin pigmentation (cafe-au-

lait spots)?
A. Osteomalacia
D. Polyostotic fibrous dysplasia
QUESTION: McCune Albright’s Syndrome – Café au lait spots (coast of Maine)—bone and skin
disorder—brown spots! Coast of maine hahaha
Condensing Osteitis:
QUESTION: Cause of radio opacity of infected tooth- condensing osteitis

QUESTION: Xray – condensing osteitis
Traumatic Bone Cyst:
QUESTION: Scalloped and vital : traumatic bone cyst

QUESTION: Traumatic bone cyst (simple bone cyst) – nothing inside
QUESTION: Traumatic bone cyst pic-
QUESTION: Picture said: “scalloped border, patient is asymptomatic” I put traumatic bone
cyst- Psuedocyst, heals by itself
QUESTION: question about traumatic bone cyst—not a true cyst b/c not epithelial lined
d. scallops around the roots of teeth
QUESTION: Young patient with traumatic bone cyst, what tx? None, spontaneous healing
Pagets Disease of Bone:

QUESTION: Pagets disease : increase alkaline phosphatase
QUESTION: Pagets disease : →increase alkaline phosphatase
QUESTION: Which one most likely has potential for malignant transformation: osteomas, paget’s,
QUESTION: what has high incidence of becoming malignant? Cant remember options but I put
Paget’s disease
QUESTION: Which of the following has the potential for undergoing spontaneous malignant
transformation?
A. Osteomalacia
QUESTION: Which has the highest potential for malignant transformation? Pagets disease->
Osteosarcoma
QUESTION: Pagets can lead to osteosarcoma

QUESTION: Denture does not fit anymore as a result of? paget disease aka osteitis deformans! –
cotton wool
- -->Paget’s Disease – aka Osteitis Deformans – chronic bone disorder where bones become enlarged and
deformed – dense but fragile. Seen in pts OLDER pts. Dentures stop fitting. Develops slowly. COTTON
WOOL appearance, hypercementosis, and loss of lamina dura. Labs – INCREASE serum ALKALINE
phosphatase but normal serum phosphate and calcium. Risk of osteosarcomas.
Langerhans, Histocytosis X:
QUESTION: Langerhans x- floating teeth in air.

QUESTION: Radiographic Picture: Floating tooth-not in bone, opacities in lesion-what is it?
• Whole jaw cyst
• Ameloblastoma
• Keratocyst
QUESTION: Hand-Schuller-Christian triad
o Diabetes insipidus
o Exophthalmos
o Bone lesions (Langerhans dis)
Oral signs of hand-schuler-christ. = bad breath, sore mouth, loose teeth
lesion are sharply punched out radiolucency and teeth appear as FLOATING IN AIR
Nasolabial Cyst:
QUESTION: Not a bone cyst? Nasolabial cyst, occurs outside of bone

QUESTION: Which one is soft tissue involvement, not bone - Nasolabial Cyst
QUESTION: Soft tissue cyst- nasopalatanine duce, nasolabial,
QUESTION: A patient has a swelling under the upper lip that is by her lateral incisor and raises
the ala of the nose from the outside. What is it? I put nasolabial cyst
QUESTION: Radiolucency radiating from root of central incisor toward midline, could be all of the below
except … lateral periodontal cyst, nasopalatine cyst, some sort of fibrous dysplasia, →nasolabial cyst
- Because this cyst is extraosseous, it is not likely to be seen on a radiograph.
QUESTION: Which one not seen radiographically? Naoslabial cyst
QUESTION: Nasolabial angle: angle b/w base of nose and lip; should be perpendicular, if its acute,
that means patient has big lips
QUESTION: Lining of nasolabial cyst- pseudo stratified squamous
• Nasolabial cyst?
Lymphoepithelial Cyst:
QUESTION: Round yellow-white bump underneath tongue? Lymphoepithilial cyst? Yellowish cyst on
floor of mouth? Oral lymphoepithelial cyst
QUESTION: Round yellow-white bump underneath tongue? Lymphoepithalial cyst?
QUESTION: Patient (young child) w/ nodules on right side of tongue that are fluid filled the rest of
the mouth is WNL no other systemic signs
b. Lymphangioma *
Odontogenic Keratocyst:
OKC
• High recurrence
• Intrabony, post mandible;
• basal cell nevus syndrome (a.k.a. Gorlin’s syndrome, multiple OKC’s seen:
Xtina)
QUESTION: Which is most likely to recur? I put OKC
High recurrence!
– Intrabony, posterior mandible but anywhere; BCNS association
QUESTION: Largest incidence of recurrence? OKC
QUESTION: Most reccuring :okc

QUESTION: What has the highest recurrence rate?
• *Odontogenic keratocyst
QUESTION: initial treatment for OKC is enucleate or resect?? (Usually therapy is enucleation and
cryosurgery…not sure…Xtina)
Nevoid Basal Cell Carcinoma:
QUESTION: Gorlin syndrome = nevoid basal cell carcinoma. Commonly seen OKCs and palmar
pitting, plantar keratosis (odontogenic keratin cyst)
QUESTION: which disease has multiple OKC’s? nevoid basal cell carcinoma. Is answer.
QUESTION: Basal cell nevus syndrome (a.k.a. Gorlin’s syndrome, multiple OKC’s seen Nevoid basal cell
carcinoma: lots of cyts OKC or NEW NAME ---keratocystic odontogenic tumor (KCOT) multiple OKC
- nevoid basal cell carcinoma
QUESTION: Has Lots of odontogenic keratocysts (OKC): Nevoid Basal Cell Carcinoma Syndrome
(Gorlin Syndrome; Basal cell nevous syndrome)
QUESTION: What else most often seen w bifid rib, nevoid basal cell? Odontogenic keratocyst.
QUESTION: What does multiple OKC tell you? Gorlin syndrome! **also called basal cell nevus
syndrome
QUESTION: multiple OKC=GOrlin gotz
QUESTION: Basal cell nevus bifid rib syndrome (gorlin-goltz syndrome)
QUESTION: Nevoid basal cell carcinoma causes – cyst in the jaws?
QUESTION: nevoid BCC and palmer melatonin indicative of: OKC
OKC – from remnants of dental lamina
QUESTION: Gorlin’s- calcified falx cerebri
QUESTION: Which syndrome Pt has calcified falx cerebri, multiple okcs, bifid ribs? - Gorlin Goltz
syndrome aka Basal cell bifid rib syndrome.
Gardner Syndrome:
QUESTION: Which syndrome includes osteoma? Gardners
QUESTION: multiple osteomas are found in--> garderners
QUESTION: Which condition presents w/ many osteomas? Gardner’s Syndrome (Multiple

facial osteomas & skin nodules)
QUESTION: Gardner→ multiple osteomas and intestinal polyps
QUESTION: In which syndrome Pt has ? Gardner's syndrome and esophageal stenosis syndrome
QUESTION: Colon polyps and some kind of oral lesion? Gardners syndrome
QUESTION: gardners syndrome with multiple osteoma and intesbtinal polyps
QUESTION: What has polyps…Gardners , Peutz-Jegher, and Crohn’s

QUESTION: In Gardners Syndrome there may be cancerous transform of what?- polyps in intestine.
Bells Palsy:
QUESTION: unilateral eye and lip, unable to close (picture of black chick) - bells palsy photo of a
person to identify the condition : bell palsy ( see mosbys photo )
QUESTION: Know bell’s palsy: unilateral facial paralysis

QUESTION: What causes bells palsy? I chose idiopathic.
Decks: Bell's palsy: involves unilateral facial paralysis with no known cause, except that there is a loss of
excitability of the involved facial nerve. The onset oft his paralysis is abrupt, and most symptoms reach
their peak in 2 days. One theory of its cause is that the facial nerve becomes inflamed within the temporal
bone, possibly with a viral etiology.
QUESTION: Which cranial nerve affected bells palsy? Facial nerve (7th )
Temporomandibular Dysfunction:
QUESTION: Clicking in tmj: internal derangement with reduction
QUESTION: Which artery supplies the TMJ? Deep auricular, maxillary, superficial temporal…MADS
Middle meningeal from maxillary, ascending pharyngeal, Deep auricular, superficial temporal
QUESTION: Best imaging for TMD: MRI
QUESTION: Best way for soft tissue ( disc of TMJ ) : MRI

QUESTION: Mri is best way to look at condyle/tmj
QUESTION: best diagnostic eval for TMJ disc? MRI, CT, PA radiograph
QUESTION: Which radiograph will give you a direct view of the TMJ? (TMJ Tomography?)
QUESTION: Scanning disk tmj- mri best view

QUESTION: Part of the TMJ that purely rotates : Articular eminence of condyle
QUESTION: Rotation involves what structures? condyle, glenoid fossa, disc, TMJ
Condyle and articular fossa
QUESTION: Which anatomical components are responsible for rotation of the mandible? Condyle and
articulating disk
QUESTION: When TMJ is in rotational movement, rotation is in →lower compartment
QUESTION: Lower compartment of TMJ is for? Rotation, upper compartment – translation
QUESTION: what causes tmj ankylosis? Trauma?? Rheumatoid arthritis

QUESTION: Patient can’t speak English well, she doesn’t work, she has TMJ problems, she is on meds.
Which one will not affect her oral hygiene prognosis? - TMJ problems. (Rationale here is; she may not
be able to afford hygiene procedure, she might not understand doctor’s recommendations, and her meds
can contribute to hygiene issues. TMJ problem was not serious enough, as in she can open her mouth to
clean her teeth)
QUESTION: Man comes in after years of tmjd with reduction and is now only able to open 25mm and
that’s it with muscle pain. Whats his disorder?- Myofacial pain syndrome.
QUESTION: Pt is clicking in the jaw suddenly cannot open 25 mm: myofacial pain syndrome (can
cause clicking, limited opening, pain), internal derangement without reduction has no noises or
clicking but limited opening to <30mm
QUESTION: Patient always had internal derangement with clicking all of a sudden no noise and
open max 30 mm what happened? Myofascial pain
QUESTION: Football player with mouthguard, crepitation of left TMJ, trigger zone tenderness L
temporalis, stiffness upon wakening: Myofacial pain syndrome
QUESTION: Highschool football player wears a mouthguard, very tender to palpation of temporal
area, muscle soreness..? question never said about noises: Myofacial pain disorder (possibly
osteoarthritis)
QUESTION: Football player with a mouthguard tenderness to temporalis and hard to open mouth in
morning
• myofacial pain
• tmj dislodgement
QUESTION: Most immediate sign after high occlusion bridge? Myofacial pain
QUESTION: symptoms of pain and tenderness upon palpation of the TMJ are usually associated with
which of the following
c. flaccid paralysis of the non painful side of the face
e.deviation of the jaw to the painful side upon opening the mouth.
QUESTION: What branch off facial nerve gets damaged the most during TMJ surgey?  Temporal
QUESTION: Nerve most damaged in tmj surgery- FACIAL
QUESTION: TMJ ligaments purpose – limit the movement of mandible, helps open mandible, helps
closes mandible
QUESTION: Which muscle mainly responsible for positioning and translating condyles? Lateral
pterygoids
QUESTION: Stress causes immune weakness which leads to disease and bruxism
QUESTION: Occlusal guard-distribute occlusal force
QUESTION: Main function of the occusal guard:
• Distribute forces more evenly
• Bruxism
Erythema Multiforme:
QUESTION: Steven-Johnson syndrome? conjuctiva, and genital problems
Pemphigus:
QUESTION: A patient has painful lesions on her buccal mucosa. A biopsy reveals acantholysis and a
suprabasilar vesicle. Which of the following represents the MOST likely diagnosis?
A. Pemphigus
B. Psoriasis
E.Systemic lupus erythematosus
QUESTION: intraepithelial-pemphigus
QUESTION: immunofluorescence of antibodies , Pemphigus intraepithelial , demosomas.

Pemhigoid and pemphigus: which one comes apart from Connective Tissue
QUESTION: immunofluoresence used for dx of

a. pemphigus
b. LP
vulgaris because—less severe and HISTO: vesicales are SUBepidermal and NO acanthylosis.
Pemphigus--**autoimmune disorder where there is acanthylosis, tzanck cells. Antibodies are directed
against the epithelium. Target the desmosomal Dsg3 and cause sloughing. Nikolsky’s sign is when the
epithelium can just be rubbed off of an unaffected area—HISTO: vesicles are suprabasilar and there is
presence of acanthylosis
QUESTION: Pic that looked like herpangia in back of palate- qusion stated there are nikoski signs what
is it- I wrote herpangia... but pemphigus was also a choice (Erythema multiform and pemphigus vulgaris
both show Nikolsky sign
QUESTION: White film w/ pos nikolsky-pemphigus tx w incisional biopsy
QUESTION: Blow cold air on mucosa causing a positive Nikosky sign a) erythema multiformb) herpes
c) phemphigoid NO PEMPHIGUS AS ANS CHOICE. eipdermolysis bullosa IS THE ANSW (maybe
erythema mutiforme)
INFO: In Pemphigus this disease, patients have autoantibodies against desmogleins, which are part of
the spot desmosomes
Types: Most commonly Vulgaris
INFO: In Pemphigoid, the antibodies are directed against hemidesmosomes
Types of Pemphigoid (Bullous -Rarely affect mouth), Blisters of skin
Cicatrical-- Affects mucous lining, MOUTH
1. nikolski sign: pemphigus
2. basement separation between ET: pemphigus
Scleroderma:
QUESTION: Widening of PDL and loss of ramus of mandible: Scleroderma
QUESTION: scleroderma: symmetrical widening of PDL and deposition of collogen in organs leads
to failure
QUESTION: CREST Syndrome=SCLERODERMA . connective tissue disease of skin, blood vessels,

muscles, and internal organs. autoimmune disorder. Blue fingers, Hair loss Skin hardness Skin that
is abnormally dark or light
Geographic tongue:
QUESTION: Picture of fissured tongue

QUESTION: Description of geographic tongue
QUESTION: Guy with lesions on his tongue that seem to move locations --> erythema migrans
(geographic tongue)
QUESTION: burning sensation on tongue,, moves around: geographic tongue
QUESTION: cause of geographic tongue: unk
a. ulceration of mucosa
QUESTION: Xray – Erythema migrans
QUESTION: Migratory glossitis picture

QUESTION: red whiteborder path-migratory glossitis.
QUESTION: Lesion hurts after eating spicy food, has white lesions with red borders that move
Geographic tongue
Aspirin Burn:
QUESTION: aspirin burn is due to: → coagulation necrosis.

Basal Cell Carcinoma:
QUESTION: Oral path picture of Basal Cell carcinoma. – round bluish lesion on side of lip
QUESTION: Picture of basal cell carcinoma on patient’s face
QUESTION: a picture of basal cell or kerato ancathoma ......on the face crater like with a crust in the
middle **remember keratoacanthoma has a bump with a crusty crater in the middle, but BCC can be
pink, waxy/pearly, or skin colored or brownish. BCC is more reddish/can be flat while keratoacanthoma
has a crust and looks really gross
Mucocele:
Mucocele: Caused by ruptured salivary duct, Usually due to trauma, Seen on the lower lip
NEVER ON GINGIVA

QUESTION: Mucocele most likely is on the Lower lip!
QUESTION: Patient had SSC removed and now has a mucocele looking lesion on the lower lip what is it?
I wrote mucocele, other choices fibroma, SSC
QUESTION: Mucocele, what causes it clinical term that refers to two related phenomena: mucus
extravasation phenomenon, and mucus retention cyst. The former is a swelling of connective
tissue consisting of collected mucin due to a ruptured salivary gland duct usually caused by local
trauma, in the case of mucus extravasation phenomenon, and an obstructed or ruptured salivary
duct (Parotid duct) in the case of a mucus retention cyst
QUESTION: most common site for mucous retention cyst? Lip
Ranula:
QUESTION: Ranula: blue mass under tongue
Blue nodule floor of mouth, fluctuant..ranula
QUESTION: Lady presents w/ blue swelling under tongue? I put ranula
QUESTION: ranula due to –mucus plug
sialolith
mucus plug
trauma
fibrous plug
• Mucocele
• Ranula
QUESTION: How do you treat a ranula? excise (all of it)
QUESTION: ranula treatment: excision of sublingual gland
QUESTION: Ranula txt…Excisional, incisional, or aspiration
Texture/consistency of dermoid cyst vs ranula

dermoid is doughy/rubbery consistency
ranula is more fluctuant, bluish
QUESTION: Sialolithiasis is found where? - submand duct (wharton’s)
QUESTION: Sialolithiasis (calcified salivary stone) is found where? REPEAT question - submand duct
QUESTION: Sialoliths most commonly associated with submandibular gland

QUESTION: Sialoliths most common in what gland: Submandibular gland and duct
QUESTION: Some histology question about the paratoid gland. Mentions “SAUSAGE LINKS”: Answer
is Sialodochitis
QUESTION: Gland most frequently involved in Sialolithiasis? Parotid? Small glands? SM? SL?
QUESTION: Parotid gland – chronic sialodochitosis

QUESTION: Most probable cause of swelling of the upper lip? Sialolithiasis? Mucous plug?
QUESTION: Pt with sialadenitis (actini enlarge) caused by sialith in the duct
• Procedure: No removal of the gland
• Non sx therapy
• Attempt removal non sx (supposed to give moist heat, or citrus foods to encourage
dislodgment…wiki…Xtina)
• Intra oral sx
QUESTION: How do u tx painful Sialolith in whartons duct….. initially?
Moist heat
Dilation of duct
(If it is a smaller stone…moist heat is the first option…wiki…Xtina)
QUESTION: tx for large sialolith near orifice of Wharton’s duct
c. cannulation & dilation---***?? Canulate the duct (sialotomy) to remove stone
QUESTION: mucous retention cyst
Antral Pseudocyst (mucous retention pseudocyst):
QUESTION: something in maxilla - muco-retention cyst?? Antral pseudocyst?

QUESTION: Pic of inverted Y xray (antral y??)
QUESTION: Radiograph 6 arrows - inverted Y – floor of nasal fossa
QUESTION: What is the inverted Y made up of? Maxillary sinus/floor of nasal cavity
QUESTION: what is the isthmus of Y (where nasal floor (straight radiopaque line) and maxillary sinus
(curved radiopaque line) start and meet). What are the two anatomical factors that border this?
Floor of nasal cavity and maxillary sinus
QUESTION: radiograph of earlobe and turbinate: inferior nasal turbinate or mucous retention cyst
or antral pseudocyst
QUESTION: Radiographs of the ear lube, mucous retention cyst aka antral pseudocyst in maxillary
sinus
QUESTION: Huge PA radioopacity in maxillary sinus – mucus retention cyst
QUESTION: diffuse but distinct radiopacities in max sinus: mucous retention pseudocyst made
sense, others were sinusitis and something else
QUESTION: something radiolucent in the entire sinus with was sinusitis. was not Mucous retention
cyst
QUESTION: What is this lesion seen in patient’s right maxilla (pano picture)? – Mucoretention cyst.
QUESTION: photo of maxillary sinus with radiopacity in one of the sinus and you have to identify
the condition: mucous retention cyst- →antral cyst
QUESTION: antral pseydocyst
Ankyloglossia:
QUESTION: Ankylglossitis- tongue tied!!
Dentigerous Cyst:
QUESTION: which can become ameloblastomic ?? dentigerous cyst, lymphedema, epidermoid,
QUESTION: Radiographic picture: upside down molar with lucency around crown-what is it? Dentigerous
cyst
STARTS AT CEJ
a. dentigerous
b. residual
c. radicular
Varicies:
QUESTION: Varicosities in ventral tongue in – elderly
QUESTION: What causes varices on the tongue? I put hyperthyroidism HYPERTENSION

QUESTION: bilateral asymptomatic blue stuff under tongue
a. hemangioma
b. varices
Parulis (gum boil):
QUESTION: picture #30 endo txed…parulis….
QUESTION: Reason for parilis- incomplete root canal (redue root canal)
Tuberculosis:
QUESTION: Oral signs of tuberculosis- cervical lymph nodes, larynx, and middle ear. Oral lesions of
TB are uncommon- usually chronic painless ulcers. Secondary lesions on tongue, palate and lip.
Primary lesions usually enlarged lymph nodes. Rare is leukoplakic areas.
QUESTION: What does tuberculosis lesion in the oral cavity look like? large ulcer
The most frequently affected sites were the tongue base and gingiva. The oral lesions took the
form of an irregular ulceration or a discrete granular mass.
QUESTION: What does tuberculosis lesion in the oral cavity look like? large ulcer (Painful nonhealing
indurated often multiple ulcers)
Extravasated Blood:
QUESTION: 4 yr old kid has hemangioma on his tongue from when he grew. It grew at the same rate he
did. chroistoma, hamartoma, teratoma
HAMARTOMA- Normal tissue overgrowth
CHORISTOMA- TISSUE overgrowth in Wrong location
QUESTION: patient has had a hemangioma on tongue since birth, it grows at the same rate as the tongue.
Hamartoma, teratoma, etc….hamartoma grows at the same rate as the surrounding tissues
QUESTION: What goes away from mouth by itself- eccymosis
Allergic Mucositis:
QUESTION: Allergic Stomatitis of the mouth is commonly seen because of the: flavors in a
toothpaste: Cinnamon
QUESTION: Allergic gingivitis caused most by- toothpaste flavor(cinnamon)

QUESTION: cause of allergic gingivitis
a. flavoring in toothpaste---?
QUESTION: Patient has red gums and is told she has “plasma cell gingivitis”. Common cuase is?
I put cinnamon flavoring in the dentrifice
QUESTION: Plasma cell gingivitis- cinnamon!!
Crohn’s Disease:
QUESTION: Child with granulomatous gingiva and bleeding rectal-anus has what?
•Crohn’s
QUESTION: Oral granulomas, apthous ulcer, rectal bleeding is seen in…
a. Wegeners granulomatosis
c. crohn’s disease
QUESTION: Crohns – granulomatous gingival hypertrophy
QUESTION: Couple questions on crohns disease and mouth- I think one of the questions mentioned
something about ulcerations in the rectum (that’s right we are going to be dentist and checking peoples
buttholes out for our differential diagnosis!)mouth ulcers and swollen gums!!
Dermoid Cyst:
A Ranula, this is what I put but could be B or C not sure
B. Dermoid cyst DOUGHY
C Lymphoepithelial cyst **
Multiple Endocrine Neoplasia Syndrome
QUESTION: MEN- adrenal over production
Nasopalatine Cyst:
QUESTION: most common nonodontogenic cyst
nasopalatine duct cyst
a. dermoid
b. thyroglossal
c. lymphoepithelial
QUESTION: Nasopalatine X-ray- heart shaped central
QUESTION: Nasopalatine cyst tx- enucleation

QUESTION: Pic of nasopalatine canal
Intraoral picture of nasopalatine cyst by incisive papilla on backside of 7 and 8. The foramen and
nasopalatine canal is where the incisive papilla is and if theres a cyst there then what does it look
like clinically? Soft tissue is swelling and discolored.
QUESTION: The clinical radiograph and picture didn’t match up. The clinical pictures were taken after
the radiographs so it could have developed afterwards and there was fineprint that this was written and
not for other cases so it was a trick and it was a nasopalatine cyst probably…
White sponge nevus:
QUESTION: leukoplakia that you can’t wipe off…I put white sponge nevus.
QUESTION: White on movable mucosa- leukoplakia or white sponge nevus
QUESTION: Patient has bilateral white lines @ occlusal plane, what is primary microscopic
finding? White Spongy Nevus
Picture of something white. Said it was not wipeable/stretchable.
a. Lichen planus or
b. White sponge nevus.
QUESTION: White lesion, cannot be scaped away, picture: leukoplakia is not there in the options
QUESTION: Pic- white sponge nevus *white sponge nevus usually presents bilaterally/symmetrically. It
usually appears before puberty. Often mistaken for Leukoplakia. /// Leukoplakia differs in that it presents
later on in life.
It presents itself in the mouth, most frequently as a thick bilateral white plaque with a spongy
texture, usually on the buccal mucosa, but sometimes on the labial mucosa, alveolar ridge or floor of
the mouth. The gingival margin and dorsum of the tongue are almost never affected.
QUESTION: Buccal cheek of 60 yrs man, not wipe-able? leukoplakia( more on floor 50%,
tounge25%), candida, white spongy nevous bilatral- autosomal dominant
Trigeminal Neuralgia:
QUESTION: Patient feels pain on biting and feeling of fullness in maxillary posterior teeth, why?
sinusitis, atypical trigeminal neuralgia,
QUESTION: ***Maxillary sinusitis bacteria: Strep pnuemoniae
→ Drug for max sinusitis: Amox with clavulnic acid (for b-lactamase strep)
QUESTION: Which of the following is most likely to be interpreted as toothache by Pt?
maxillary sinusitis →can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache)
tmj dysfunction
otitis media
QUESTION: lady, pain, hurts at night, can’t find pain:

-trigeminal neuralgia
-something about mandibular teeth intruded
QUESTION: A fews qs on trigeminal neuralgia. Affects what age group? What type of pain?
Age: The average age of pain onset in trigeminal neuralgia typically is sixth decade of life, but
it may occur at any age. Symptomatic or secondary trigeminal neuralgia tends to occur in
younger patients. >35 years
Nature of pain: Pain is stabbing or electric shock like sensation and is typically quite
severe. Pain is brief (few seconds to one to two minutes) and paroxysmal, but it may
occur in volleys of multiple attacks. Pain may occur several times a day; patients typically
experience no pain between episodes.
Distribution of pain: Pain is one-sided (unilateral, rarely bilateral). One or more

branches of the trigeminal nerve (usually lower or midface) are involved.
QUESTION: Carbamazapine - Tx trigeminal neuralgia

QUESTION: Carbamazepine:used for Trigeminal Neuralgia, Do not use to treat constant, fascial pain.
Use NSAIDS
Actinic Cheilitis:
QUESTION: Actinic chelitis---> SCC
QUESTION: How do you treat actinic cheilitis? According to wiki, its 5-fluorouracil or imquimide,
but im not sure if those were even answer choices
QUESTION: Actinic Chelitis: lower lip shows epithelial atriohy and focal keratosis → same as
Actinic Keratosis
A. Leukoedema
B. Lichen planus

Attrition is wearing away from natural dentition

a. caries,
b. candidiasis
c. dental attrition
QUESTION: Xerostoma causes the following except:
o Caries
o …
o Attrition
QUESTION: Most attrition of an enamel against what? (porcelain not an option in the answer)
a) Enamel
b) Amalgam
c) Hybrid resin
d) Microfill resin
QUESTION: attrition or bruxing on mand anteriors (posterior looked fine)
a. prevent future erosion
c. esthetic
QUESTION: Erosion? Chemical & Bulimia.
QUESTION: Bulimia and gastric reflux cause...erosion
QUESTION: Type of wear from gastric acids: erosion
QUESTION: Erosion- chemical wearing of tooth (gerd)

QUESTION: Which one is chemical cause of tooth destruction: Erosion
QUESTION: chemical wear of tooth : erosion
QUESTION: Abfraction: if not too deep don’t touch it. If deeper, fill with glass ionomer cement?
Compomers
QUESTION: Abfraction: flexure of tooth
Know Cemento-osseous dysplasia aka CEMENTOMA:
• Asymptomatic periapical radiolucencies which transform to radiopacities
QUESTION: Cementoma (periapical cemental dysplasia)-usually occurs in the anterior region of
the mandible, starting as a radiolucent lesion that eventually calcifies. Cementoma DOES NOT
affect pulp vitality. Asymptomatic= no bone expansion. Periapical cemental dysplasia; periapical
osseous dysplasia)
QUESTION: Periapical cemento-osseous dysplasia….on a radiograph, anterior mandible, black women
***REACTIVE; vital teeth, radiolucencies around apices of mand incisors—usually!!!! Ck
QUESTION: X-Ray: Black women, middle aged , anterior radioluceny (can be radio opaque):
cemento osseous dysplasia, periapical cemental dysplasia
QUESTION: Radiographic Picture: lower mand incisors, slight radiolucency-kind of smeared together-
what is the lesion—cemento-osseous dysplasia
QUESTION: Most common place for periapical cemental dysplasia : Lower anteriors
QUESTION: Black woman, middle aged, case Q’: osseous cemental dysplasia.
QUESTION: Most common site for cementoosseous dysplasia→mand ant vital teeth, no pain or
expansion, multifocal periapical lucencies which mature over time and become mixed then finally
opaque.
anterior mandible
Periapical cemento-osseous dysplasia
QUESTION: Tooth with normal PDL, totally vital, tissues normal, but radio-opaque lesion @
apex? periapical cemento-osseous dysplasia
QUESTION: cemento-osseous dysplasia – pic, but don’t forget lower anterior, black female.
Florid Cemento-osseous Dysplasia:

Florid Black females vital all four Quads: Florid Cemento-Osseous Dysplasia
Focal White females vital edentoulous one lesion: Focal Cemento-Osseous Dysplasia
Lichen Planus:
a. pemphigus
b. lichen planus
c. pemphigoid
d. syphills
pemphigoid
QUESTION: Lichen planus →discription
QUESTION: Lichen plannus: Target T lymphocyte
1. Lichen planus
a. Mucocutaneous disease
b. T lymphocytes target (destroy) basal keratinocytes, (reason unknown)
c. Hyperkeratosis, lymphocyte infiltrate at the epithelial CT interface
d. Basal zone vacuolation due to basal keratinocyte destruction
e. Epithelium may exhibit a “saw tooth” pattern
f. Bilateral on buccal mucosa***
g. Reticular type: interlacing lines (wickhams striae)
h. Tx: corticosteroids
QUESTION: Pic of 55 yo woman with erosion: lichen planus

QUESTION: Lichen planus more common in women
QUESTION: Erosive lichen planus – gingival is magenta to bright red

QUESTION: Lichen planus, what do you treat with? Choices (don’t remember the specific names)
were antifungal, antiviral, etc. so know the etiology of each pathology, many pharm questions are
simple, but it’s just that I couldn’t remember etiology of certain diseases. TOPICAL
CORTICOSTEROIDS OR ANTIHISTIMINE
Peripheral Ossifying Fibroma:
QUESTION: Which of the following reactive lesions of the gingival tissue reveals bone formation
microscopically? Peripheral ossifying fibroma
Cleidocranial Dysplasia:
QUESTION: What is the most significant finding in cleidocranial dysplasias: odontomas, supernumery
teeth, sparse hair, multiple impacted teeth
QUESTION: Cleidocrainal dysplasis - supernumerary tooth
QUESTION: Cleidocrainal dysplasis – retained teeth, REPEATED AGAIN

QUESTION: Cleidocranial dysplasia- over retained primary teeth
QUESTION: Cleidocranial: can your shoulders touch? Absence of teeth, also has supernumerary
QUESTION: Cleidocranial dysplasia? Disease of the bones of the skull and clavicles. Short, big head,
shoulders move in, high palate, retention of primary teeth, and supernumerary teeth.
QUESTION: Cleidocranial dysplasia- no clavicals
QUESTION: Heridatary / hypoplastic clavicle? cleidocranial dysplasia
• → Cleidocranial dysplasia
o Autosomal dominant
o Delayed tooth eruption, supernumerary teeth, hypoplastic or aplastic clavicles,
cranial bossing, hypertelorism
• *cleidocranial syndrome
• downs syndrome
QUESTION: questions on cleidocranial dysplasia : Multiple supernumerary teeth, prognathic jaw-
class III, delayed eruption, fontanelle failed to close
QUESTION: Many questions (5) on Cleidocranial dysplasia: Multiple unerupted supernumerary

teeth, Retention of primary teeth, delayed eruption of permanent teeth, Missing clavicle
QUESTION: Head distortion at birth? Fontanelles

QUESTION: What allows for compression of skull during birth? Fontanelles -_-
• Fontanelles (enable the bony plates of the skull to flex…according to wiki…not sure if it would be
the correct answer but I guess…Xtina)
a. Fontanelles
QUESTION: Which structures in a baby allow the head to deform in the birth canal? I put
fontanelles
QUESTION: Fontanelas close anterior-12-18months, posterior 3-4 months
QUESTION: Fontanelles, child skull, close by age 2
Neurofibromatosis (Von Recklinghausen):
QUESTION: Clinical picture with nodules & café laut spots: neurofibromatosis
QUESTION: Neurofibromatosis ? café au lait spots.
QUESTION: Café-Au-Lait – Neurofibromatosis **Von Recklinh..disease—neural tumors… all these
spots-Neurofibromatosis
QUESTION: An adult patient presents with multiple, soft nodules and with macular pigmentation of the
skin. Which of the following BEST represents this condition?
lipomatosis
QUESTION: which of these have supernumerary teeth, lisch nodule on iris, ____
• neurofibromatosis
QUESTION: Neurofibromatosis clinical presentations: Café au lait, lisch nodules, neurofibromas
Calcifying Odontogenic Cyst/Gorlin Cyst:

QUESTION: “Ghost cells”: keratinized calcifycing odontogenic cyst
Auriculotemporal Syndrome/Frey’s Syndrome:

QUESTION: Pt has problems on one side of their face when they eat, they recently had parotid surgery,
also had to do with something with their nerve
A. Papillon Leferve
B. Frey’s Syndrome* --strong salivation
QUESTION: Freys syndrome**symptom where you sweat near cheek area when eating. Usually after
parotid surgery.
QUESTION: Patient had portid surgery now sweats before he eats only on one side this is due to what? I
wrote Freys syndrome (whatever it is the guy needs serious help and should not be in my office!)
QUESTION: Injure arteritemporal nerve-sweating out of parotid (auriculotemporal syndrome)
QUESTION: frey’s syndrome – parotid gland
QUESTION: Auriculotemporal nerve is severed, what are symptoms? gustatory sweating,
Actinomycosis:
QUESTION: Actinomycosis has pus, antibiotics
• Abscess, Draining fistula, contains yellow sulfur granules
• I&D + antibiotics
QUESTION: Which dz is most likely to cause suppuration?
A: Actinomycosis
Condylar Hyperplasia:
QUESTION: A patient presents with malocclusion and a unilateral, slowly progressing elongation of her
face. This elongation has caused her chin to deviate away from the affected side. The MOST probable
diagnosis is which of the following?
A. Ankylosis
B. Osteoarthritis
C. Myofascial pain
Dens Invaginatus:
QUESTION: Dens in dente: Most common seen in max lateral incisor
→ Evangelicals believe in Eagles ( Talons)
Epulis Fissuratum:
Keratoacanthoma:
QUESTION: Lesion looks like squamous cells: Keratoacanthoma
a. palate
b. buccal mucosa
c. floor of mouth
d. upper lip
Warthin Tumor:
QUESTION: Warthin tumor most common in what gland: Parotid (don’t get mixed up with whartons
duct)
Stafne Defect (salivary gland depression defect)

QUESTION: Radiograph of mandibular gland depression. 1. Stafne defect (answer)
QUESTION: A picture of stafne's defect, but there was no stafne answer - submandibular fossa defect
(this is what I wrote)
QUESTION: very well defined round radiolucency in panoramic, posterior mandible below inferior
alveolar canal – →static bone cyst (stafne defect)
QUESTION: ID salivary bone cyst (another name for stafne bone cyst) on PAN
QUESTION: Pan of jaw…lucent lesion…salivary gland inclusion…

QUESTION: Xray of Stafne defect (only option was salivary inclusion defect)
QUESTION: Stafne defect: salivary inclusion
SjÖgren’s Syndrome:
QUESTION: Complications of Sjogrens syndrome –features of (Stevenson sth) Answer was with
keratoconjunctivitis it involes the genitalia too.
QUESTION: Sjogrens – autoimmune destroy glands
QUESTION: Sjogren’s syndrome: destruction of salivary and tear ducts→ dry mouth
QUESTION: Sjogrens Synd associated with all EXCEPT
Herpes
SLE
QUESTION: what is most common with sjogrens? lymphoma (or maybe lipoma or some other
growth)pleomorphic adenoma, increased sweating and osteoarthritis.
QUESTION: Which articular disease most often accompanies Sjö gren’s syndrome?
E. Lupus arthritis.
QUESTION: xerostomia is present in all of the following except? Options were : Sjogrens syndrome, Vit
C. Defenciency (Other parotid problems) Xerostomia is rarely due to a vitamin deficiency
QUESTION: Sjogren syndrome? Laboratory test: SS-A / SS-B (also ANA or Rheumatoid factor)
QUESTION: Secondary Sjogren Syndrome: dry eye, dry mouth, Rheumatoid Arthritis
QUESTION: Which of these are used in lab test for sjogren,? ANA
→ Typical Sjögren's syndrome ANA patterns are SSA/Ro and SSB/La
Sarcoidosis:
abnormal collections of inflammatory cells (granulomas) that can form as nodules
QUESTION: Treatment of sarcoidosis? Corticosteroids, antibiotics...
QUESTION: question on sarcoidosis? Know that it is granulomatous
QUESTION: Sarcoidsis commonly involved organ: lungs
QUESTION: ***Girl with caries into the pulp on tooth #3 – radiograph shows alternating RL/path at
inferior border of mandible (a.k.a “onion skin”, bacterial)→Garre’s Osteomyelitis aka chronic
osteomyelitis
QUESTION: Garre's (prolifrative periostitis) and Ewing sarcoma are both onion skin
Peutz-Jeghers Syndrome:
QUESTION: Peutz Jeghers and Pierre showed up on my exam. They gave only description and you
had to diagnose.
QUESTION: Peutz Jeger syndrome ? Not cafe au lait, but freckles on lips.
QUESTION: Peutz-Jeghers syndrome – multiple menanotic macules and gastrointestinal polyposis
QUESTION: Peut-jeghers syndrome : intra oral melanin pigmentation also intestinal polyps
Osteosarcoma:
QUESTION: Widening of pdl is early sign of what? Osteosarcoma!
QUESTION: most common primary malignant tumor of young people-osteosarcoma
QUESTION: osteosarcoma in x ray : sun burst and simetrical widening of pdl.
QUESTION: Enlarge PDL and radiolucency at mandibular angle? A. Osteosarcoma sunburst
QUESTION: Osteosarcoma: causes early lesion of PDL widening (Symmetric widening of the
periodontal ligament space is an early radiographic sign of osteosarcoma)
QUESTION: Uniform wdining of PDL and there is resorbtion in the bone : osteosarcoma, fibrous
dysplasia
QUESTION: osteosarcoma in x ray : SYMMETRICALLY WIDENED PDL SPACE, SUN-
RAYAPPEARANCE
QUESTION: Patient has paresthesia and grows in mandible: is going to be osteosarcoma (young
patient)
Osteoporosis/Osteopetrosis:
QUESTION: Which one is NOT RO? (choice: osteopetrosis – marble bone, extremely rare; osteoporosis,
pagets – cotton wool)
Multple Myeloma:
QUESTION: Multiple Myeloma: Punched out lesions.
QUESTION: Considerations for multiple myeloma
QUESTION: first sign of multiple myeloma : bone pain ( in limbs and thoracic region)
QUESTION: first sign of multiple myeloma: bone pain ( in limbs and thoracic region)
QUESTION: multiple myeloma -> plasma cell
QUESTION: Multiple myeloma appearance? punched out lesion
• → multiple myeloma/plasma cell myeloma

o tx: chemo→ poor prognosis
Necrotizing Sialometaplasia
QUESTION: Know necrotizing sialometaplasia….painless ulcer on hard palate…goes away on its own.
Heals without scarring
Odontongenic Myxoma:
QUESTION: Pic of Myxoma pt. Usually in post. mandible, no symptoms, moves teeth, **cortical
explansion and root displacement, always radiolucent and honeycombed pattern!!!!!
QUESTION: soap bubble lesion in xray , what is it, there was no cherubisum ????? Giant cell
Odontogenic Myxoma , often seen with impacted tooth
*Soap bubble lesion= odontogenic myxoma

Radiology:
QUESTION: When there is no barrier, protection of dentist: 6 feet, 90-135 degrees
QUESTION: most of the x-ray is converted to? heat
QUESTION: most of the x-ray is converted to: heat
QUESTION: what is the oil in the x ray tube for : dissipate the heat ( cooling)
QUESTION: why oil in x-ray tube: heat: cools off the anode
QUESTION: purpose of oil in x-ray tube housing: prevent rust, reduce radiation, dissipate heat
to the target, lubricate
QUESTION: Something about what is best x-ray: short wavelength, high energy
QUESTION: What is primary source of radiation to the operator when taking xrays: I said it was
radiation left in the air, other options were scatter from the patient, scatter from the walls,
leakage from the xray head.
QUESTION: In performing normal dental diagnostic procedures, the operator receives the greatest
hazard from which type of radiation?
C. Gamma
QUESTION: Radiology-sievert dosage allowed in a year for dentist – 50msv
QUESTION: Max dose for dental personnel for radiation is? I put 50 Msv per year
QUESTION: Max radiation dose: 50 msv or 5 rem per year

Per month = 4msv, Per week = 1 msv
QUESTION: Collimation and what it does: reduces xray beam size and volume of irradiated
tissue, usually with circle diameter of 2.75 in
QUESTION: What does collimation do? Reduce area of exposure, remove scatter
QUESTION: Collimater function is all but- increase penetratability

QUESTION: collimnation in xrays - reduces low energy radiation
QUESTION: collumnation in xrays – decreases the diameter of the beam
QUESTION: Collimator: reduces size of xray beam to reduce patient radiation
QUESTION: what the collimator does : reduce the 1)volume of tissue being irradiated and
2)reduce the amount of scatter radiation by 60%
QUESTION: what the collimator does : reduce the volume of tissue being irradiated and reduce the
amount of scatter radiation.
QUESTION: Collimation does everything except: reduce pt exposure, reduce operator exposure, film fog,
reduce average energy of xrays (energy is unchanged)
Scatter radiation decreases with change to rectangular collimator, film fog(scattered radiation that reaches
the film, unwanted darkness → decreased by collimation) decreases and image quality increases.
QUESTION: Collimating device on the x ray

• Except: prevents fogging
QUESTION: Collimation is?
The accurate adjustment of the line of sight of a telescope.
Control of size and shape of xray beam
QUESTION: By what % do you decrease radiation when you use a square collimator vs.
rectangular? 80%
QUESTION: How do you minimize exposure radiation – I remember one answer choice that I took
into account was minimizing the amount of tissue being radiated but that’s not what I selected
QUESTION: the use of intensifying screens --> reduce the radiation
QUESTION: Xray filters are used for? Reduces intensity of electron beam, selectively absorbs low
energy photons. LONG WAVELENGTH Inherent filtration=glass, oil. Total filtration=aluminum and
inherent filtration (from Gohel’s lecture)
QUESTION: filter absorbs….

a. Long wavelength
b. “Filtration is a mechanism where the low quality, long wavelength xrays are
absorbed from the exiting beam. Alumnium disks absorb lower penetrating xrays.”
241 First Aide
QUESTION: X-ray tube target made out of: tungsten, lead copper
QUESTION: Target metal in xray: tungsten
QUESTION: Filament produces heat in the xray
QUESTION: which material is used as a filter in xray machines? Lead, aluminum, others
QUESTION: filtration = filter (aluminum)
QUESTION: Digital image: which is digital detector? Charge coupled device (pg132)
QUESTION: The greatest decrease in radiation to the patient/gonads can be achieved by…
b. thyroid collar
c. filtration
d. collimation
QUESTION: Which of the following safety techniques provides the GREATEST DECREASE in overall
radiation-risk to patients?
QUESTION: What happens when you don’t have proper vertical angulation when taking xrays – I
said it was elongation of the object other options were fuzzy pic (either resolution or contrast)
QUESTION: Change vertical angulation when taking a PA will cause what? Distortion?
Magnification? ELONGATION OR FORESHORTENING
QUESTION: Change in vertical angulation of the xray what happens—
o Distortion
o Increase- shorten if decrease- elongates
QUESTION: Vertical angulation → distortions

QUESTION: Excessive vertical angulation, distort (xrays)
QUESTION: change in vertical angulation in xray what happens? Distortion
QUESTION: xray with shortened teeth. Whats wrong? I put vertical angulation
QUESTION: If you take a PA and the tooth is foreshortened, why did it happen? I put because
the vertical angulation was too large
QUESTION: Foreshortening of roots caused by...excess vertical angulation
QUESTION: xray beam is perpendicular to the film, not to the tooth, = forshortening
***Elongation & foreshortening occurs when there is excessive vertical angulation

Central ray needs to be perpendicular to film and object
Perpendicular to object but not film: elongation
Perpendicular to film but not object: foreshortening
QUESTION: Overlap on bitewings → horizontal angulation

QUESTION: BW Overlap? Horizontal angulation off.
QUESTION: if you horizontally angle in BW, you can get- overlap
QUESTION: xray with cone cut. Whats wrong? I put PID, other choices are horizontal, vertical, etc
MISALIGNED of XRAY TUBE HEAD, incorrect beam centering
QUESTION: Pano – max centrals look abnormally wide – has to do with position of pt head either too
back, forward
the patient is positioned too far backward, (Figure 2, position 3) the skin anterior to the tragus can
be felt immediately posterior to the head support. The further the patient is positioned backward in
the focal trough, the wider the images of the anterior teeth will become until they are so wide that
the outlines of the crowns of the teeth can hardly be discerned.
QUESTION: Something that causes teeth to look longer has to do with angulation – how much tilt up and
down
If the head/chin position is too low the images of maxillary anterior teeth will appear elongated and the
mandibular anterior teeth will appear foreshortened.
If the head/chin position is too high (a lack of negative vertical angulation On the radiograph, the occlusal
plane of the teeth will then appear horizontal or, with a positive occlusal plane, as a "frown line."
QUESTION: Reversed occlusal plane on pano – chin raised too high

QUESTION: Pan has a reverse occlusal plane – patient head tilted too far upward
QUESTION: Know the positioning of panoramic films (why is there an error? ex: chin tilted to high/low,
etc.)
• CHIN UP = frown
QUESTION: Pano, with short upper roots? 1. Patient’s didn’t put tongue on the top of their mouth (correct
answer)

• Umbra
• Pneumbra
QUESTION: Pneumbra affected by all except:
• Moving film
• Larger Penumbra—DECREASE contrast

• Larger penumbra = more unsharpness
QUESTION: Penumbra – how to prevent this in x-rays: decrease size of focal spot, increase
source-object distance, and reducing object-film distance (should be parallel), central ray
must be perpendicular to tooth, object and film, no movement.
QUESTION: how to reduce penumbra? Choices were moving object, decrease object/source
distance, decrease object/film distance
QUESTION: How do you prevent prenumbra?
o Xray should be parallel
QUESTION: What is pneumbra. it was in a qs and i had no idea what it was talking about pneumbra
• The area on the film that represents the image of a tooth is called the umbra, or complete
shadow. The area around the umbra is called the penumbra or partial shadow. The
penumbra is the zone of unsharpness along the edge of the image; the larger it is, the less
sharp the image will be. The diagram at right shows how the penumbra is formed. X-rays
from either extreme of the target, and from many points in between, pass through the edge
of the object and contribute to the penumbra.
QUESTION: PA distortion answer according to an article online is 14% , there was answer choices
3-5% , 11-15%
QUESTION: Margin of error of PA daiograph - 3-5% (this is what I wrote)??
QUESTION: Pano distortion is : 25% but could range 10-30%
QUESTION: What does it look like on a pano when your patient moves during the pano? A vertical blur
line vs horizontal defect.
QUESTION: tear drop shaped in max sinus - pterygomaxillary fissure
QUESTION: Earlobe on the pano was asked from yesterday.
QUESTION: BW placed vertically why? More alveolar bone

QUESTION: Vertical BWX are better than horizontal BWX because of what Doctor? – You see more
bone.
QUESTION: What cannot be seen with a PA? pterygoid hamulus, coronoid notch, mental foramen,
mand. Canal
QUESTION: What structure can you not see on a PA radiograph
-Hamular process Visible
-Mental Foramen Visible
-Coronoid process Visible
-Mandibular foramen
QUESTION: If you have lesion of maxillary sinus, what kind of radiograph do you take? 1. Waters
(answer)
QUESTION: Which is most important for diagnosis of maxillary sinus xray: occlusal, panaromic,
Waters- Water's view is best to evaluate orbital rim areas.
QUESTION: Which is most important to see the maxillary sinus xray: CT, occlusal, panaromic, MRI,
Waters
QUESTION: Best imaging for sinusitis or sinus infection: I put CT, but had occlusal radiograph, PA
radiograph, Panoramic. Know that sinuses are best viewed with Waters technique, but this was not
in answer choice neither was none of the above as a choice.

QUESTION: Xray taken from mesial of max 1st premolar, buccal root will be where? mesial, distal,
occlusal
QUESTION: Max sinus diagnostic tool: waters, towne, ap, pano
QUESTION: best way to diagnosis sinus problems: CBCT
QUESTION: Same question but answer for that one was waters x-ray
QUESTION: best radiograph for max sinus problem – waters
QUESTION: Which picture is best for max sinus lesions? CT (no waters in the choices)
QUESTION: Which picture is best for max sinus AGAIN? Waters!
QUESTION: best radiograph for max sinus problem – waters (CT)
QUESTION: Which picture is best for max sinus lesions? Pano (no waters in the choices) (NO)-- CT
QUESTION: Which picture is best for max sinus AGAIN? Waters! (NO)—CT
QUESTION: Best diagnostic image for pathology in max sinus: waters, CT, MRI, periapical, pan?
a. CT
QUESTION: all types of x rays to diagnose or to see maxillary sinus ? Waters, panoramic, CT scan
QUESTION: Which radiograph would you use to view a fracture of the mandibular symphisis? Posterio-
Anterior also Mand occlusal works too. Lateral oblique for fractures in angle, body and ramus
QUESTION: They liked to ask intermaxillary suture a lot which comes up clear on radiograph and it looks
like a fracture (which is an answer choice), but its not. The decks are good enough.
Nose vs lip line in radiograph
LIP LINE
QUESTION: best view for zygomatic arches: Pano
Zygomatic arch on radiograph
1. Coronoid process of the mandible. Begin at the right coronoid process. Examine for
coronoid hyperplasia. Tip of coronoid should not be more than 1cm above superior
border of zygomatic arch.
2. Sigmoid notch. Do not mistake a rarefied medial sigmoid depression for pathosis.
3. Mandibular condyle. Evaluate for erosions, remodeling, eburnation, subchondral cysts,
osteophyte formation which may signal arthritis.Less commonly, erosions may be
caused by neoplastic disease.
4. Subcondylar (condylar neck) region. Evaluate.
5. Ramus of the mandible. Evaluate.
7. Inferior border of the mandible. Evaluate #4 - 7 for cortical integrity. Rule out fractures.
Repeat steps 1 - 6 on the patient's left side.
8. Lingula. Evaluating the precise location in any individual patient assists in determination
of where to give inferior alveolar nerve block.
9. Inferior alveolar neurovascular bundle (mandibular canal). Follow from lingula to mental
foramen. In some patients the anterior extension which exits out the lingual foramen will
be visible. Evaluate relationship of impacted teeth to the canal. Evaluate general bone
quality and check for focal osseous defects.
10. Mastoid process. Evaluate structures on the left side of the maxilla first.
11. External auditory meatus. Evaluate.12 Glenoid fossa (temporal component of the TMJ).
Check for erosions, sclerosis, and other signs of arthritis.
12. Glenoid fossa (temporal component of the TMJ). Check for erosions, sclerosis, and
other signs of arthritis.
13. Articular eminence. Look for zygomatic air cell defect (ZACD).
14. Zygomatic arch. Do not mistake a wide zygomatico-temporal suture for a fracture. May
also contain ZACD in the posterior half of the arch.
15. Pterygoid plates. Evaluate.
16. Pterygomaxillary fissure. Check for cortical integrity to rule out neoplasia.
17. Orbit. Evaluate.
18. Inferior orbital rim. Check for cortical integrity to rule out fracture.
19. Infraorbital canal. The infra-orbital foramen should not be viewed if the patient was
properly positioned.
20. Nasal septum. Evaluate for septal deviation or perforation. Evaluate the nasal fossa for
polyps.
21. Inferior turbinate/soft tissue concha covering. Evaluate.
22. Medial wall of the maxillary sinus. Evaluate.
23. Inferior border of the maxillary sinus. Evaluate.
24. Posterolateral wall of the maxillary sinus. Evaluate the integrity of the sinus walls to rule
out developmental, inflammatory, traumatic or neoplastic processes. Examine the
content of the sinus for the degree of pneumatization. Check for antral pseudocysts,
chronic mucosal hypertrophy, polyposis, mucocele or neoplasia.
25. Malar process. Repeat 10 - 25 on the right side of the patient.
26. Hyoid bone. Evaluate.
27. Cervical vertebrae 1 - 4. Observe for osteophyte formation, loose bodies or other
evidence of osteoarthrosis. Remember the circular radiolucency in C2 is the transverse
foramen.
28. Epiglottis. Evaluate.
29. Soft tissues of the neck. Evaluate for a wide range of soft tissue calcifications.
30. Auricle (earlobe). Evaluate.
31. Styloid process. If elongated/ calcified stylo-hyoid ligament, rule out Eagle's syndrome.
32. Oropharyngeal airspace. Evaluate.
33. Nasal air. Evaluate.
QUESTION: Look at pano picture on mosbys pg 141. I messed up on it but it was an arrow pointing
b/w posterior wall of maxilla and posterior wall of zygomatic process of maxilla: ans. Is
pterygomaxillary fissure
QUESTION: Identify the following on xray :External oblique ridge, genial tubricle, Stylo hyoid
ligament on xray
→ External oblique: running down roots on mandibular molars
→Genial Tubricle: radiopaque line under mandibular abteriors
Stylohyoid ligament:
QUESTION: Showed a pan, what is the round opacity under #24 and #25 … genial tubercles
nutrient canal, zygomatic process of maxilla, normal anatomy (I had lateral canal and I put that.
Other choices were all pathological findings)
QUESTION: Nutrient canals seen radiographically most common where? Mandibular incisors
Nutrient Canal
X-ray of nutrient canals in mandibular anterior
There was a x-ray pointing with arrow to the lower lingual anterior. The answer was nutritional
canal.
MAND. TORI
know the SLOB rule. Also know Vertical rule, which is same as SLOB but in a vertical dimension.
QUESTION: Digital X-rays less exposure from d-films to digital films. digital 50% less radiation
exposure (75% less radiation exposure)
QUESTION: Digital xray vs D speed film, numbers: 10, 30, 60 , I put 60. I forget what it was asking
QUESTION: Going from a d speed film to digital film whats the speed diference (speed increases)
Film Speed Group Speed Range (reciprocal

roentgens)
C 6-12
1. (is Digital speed equal or similar to F film?)
QUESTION: going from d speed film to digital film, speed is increased

QUESTION: By reducing film speed from D to E and still keeping film density the same what would you
need to change? Decrease Exposure time
D to E will reduce radiation by 30-40%
QUESTION: Latent period of xrays is time btw when you exposed patient and clinical reaction to
xray
D. radiation exposure and onset of symptoms.
QUESTION: Which electron shell has highest power? (f/d...outermost shell)
QUESTION: which electron level has the highest binding energy? N K L OR M

K is located closest to the nucleus →highest energy
QUESTION: Radiographic Picture: looked washed out, no contrast, what was adjusted?
• Decrease kvp
• Increase kvp
• Increase time
QUESTION: what was the problem of x ray that appears too white: incorrect distance from target to
QUESTION: what was the problem of x ray that appears to white : incorrect distance from target to
QUESTION: light films (underexposed/image not dense enough): due to incorrect milliamperage
(too low) or exposure (too short), incorrect focal-film distance, or cone too far from the patient's
face, or film is placed backwards.
QUESTION: If xray is too dark : It was too long in developer solution
QUESTION: Dark films (overexposed/image too dense): due to incorrect milliamperage (too high),
exposure (too long), incorrect kVp (too high).
QUESTION: You take an xray at a certain mA, KvP and exposure time is 8 seconds when the
beam is 10 inches away. What if everything were the same except the beam was 20 inches
away? I put quadruple the exposure time
QUESTION: You increase the distance of the tube by 2 times the length, how much does the xray
exposure decrease – I said by 4
QUESTION: I aka intensity inversely proportional to 1/D2: -if increase distance by 2- intensity is
decreased by 4
QUESTION: If change from 8mm cone to 16mm how much exposure time do u need to increase by?
2.4.6.8? **inverse square law—going from 8 → 16 = double distance 2r → 1/22 = ¼ radiation exiting so
increase exposure by 4!!!! Another example, if you go from 8 → 24 = triple distance 3r → 1/9 radiation
leaks so increase exposure by 9!!! Remember that going from an 8 mm to 16 mm cone means the
cone/target is LONGER. This is the PID (target to film distance). If the PID is increased there is LESS
magnification. If the PID is shorter there is MORE magnification. Also density increases when kA, mA
and exposure are increased. That means the xray looks darker
QUESTION: By what factor would you increase kVp if the doctor doubles the distance. It’s a factor of 4
since its squared distance.
QUESTION: Increase BID distance from 8 to 16, exposure time change from 0.5sec to? .25, 1, 2, 3......
with parallaling technique ….....
QUESTION: The x-ray of an interproximal underestimates the size of the actual crater (other is
overestimates and is same size)
QUESTION: If developer is used up, what will happen?—lighter picture

QUESTION: The severity of response increases with the amount of X-ray exposure. This effect is called:
􏱒Deterministic, Stochastic, Genetic
QUESTION: How do you minimize exposure radiation? minimizing the amount of tissue being
radiated
QUESTION: which type of radiation is constantly in effect: Inhaled radon radiation, not terrestrial or
cosmic
QUESTION: Most radiation from nature – inhaling radon internal, terrestial, cosmic
QUESTION: Radiation that is stochastic, with non threshold effects would a clinician notice first –
leukemia, skin burn, hair loss, bone marrow effect
Stochastic effects are associated with long-term, low-level (chronic) exposure to radiation.
("Stochastic" refers to the likelihood that something will happen.) Increased levels of exposure make
these health effects more likely to occur, but do not influence the type or severity of the effect.
QUESTION: Thermionic emission where? Filament Cathode

QUESTION: Therm-ionic emission of x-ray comes from – filament
Emission of electrons from heated cathode. Cathode has a filament circuit.
QUESTION: Irradiation cause saliva to have lower- sodium content
QUESTION: know how xrays interact with matter: photoelectric effect
In the photoelectric effect, electrons are emitted from matter (metals and non-metallic solids, liquids
or gases) as a consequence of their absorption of energy from electromagnetic radiation of very short
wavelength and high frequency, such as ultraviolet radiation. Electrons emitted in this manner may be
referred to as photoelectrons.
X ray photon interacts with an orbital electron, all of the energy of the photo is absorbed by the
displaced electron in the form of kinetic energy
QUESTION: if something is a structure in mouth thick – it absorbs more radiation, appears more radio-
opaque on xray

Scatter tube
Scatter patient
Scatter wall
QUESTION: how does x-rays primarily damage cells: Hydrolysis of water molecules
QUESTION: Radiation induced mutation is the result of? 1. Hydrolysis of water molecules.
QUESTION: which kind of radiation causes most cancer? Hydrolysis of water, etc
QUESTION: Which structure is most radio sensitve: →hemopoitic bone marrow
QUESTION: What cells are radiosensitive? Bone marrow cells, reproductive cells lymphoid cells,
immature cells, intestine. **REMEMBER radioRESISTANT – salivary glands, kidney, liver
QUESTION: What is most radio-resistant cell: Muscle (also nerve and mature bone)
QUESTION: Which one of the following tissues is least sensitive to ionizing radiation: muscle,
lymphocytes, squamous epithelium
QUESTION: radiation least likely to cause damage: muscle cells
QUESTION: Tissue least affected by radiation- muscle

QUESTION: basic osteoradionecrosis question…bisphos with radiation
QUESTION: To get osteoradionecrosis radiation dose must be: Above 50 gys (above 60)
QUESTION: 69 Gray= osteoradionecrosis
QUESTION: Bisphosphonates used for all except: multiple myeloma, osteomyelitis, metastasis to
bones from breast cancer, metastasis to bones from prostate cancer
QUESTION: Bisphosphonates used to treat everything except? multiple myeloma, osteomyelitis
QUESTION: What conditions not to use bisphosphonates: Metastatic disease to bone, Multiple myeloma,
Metastatic breast cancer, Metastatic prostate cancer?

QUESTION: Does bisphosphonate add calcium to bone (know this so you can answer one question)
→No, It inhibits osteoclast via apoptosis
QUESTION: What is the mechanism of action of bisphosphonates? Inhibit osteoclasts,
QUESTION: Osteonecrosis is more common with IV drugs like zolmeda(zoledronic acid) and
aredia(palmidronate) (NOT fosamax or boniva)
Zolendronic acid- IV bispho

Aredia (is a bisphophosate)- Its IV
Boniva is- oral bisph
QUESTION: Which one these IV bisph would be contraindicated for orthro? Aredia
QUESTION: Why is orth contraindicated: pt is taking bisphosphonates (Aredia)
QUESTION: What is Aredia: IV Bisphosphonate
QUESTION: Why one is not true about a patient who takes Fosamax and will need an invasive procedure?
– Discontinue Fosamax 1 week before procedure (that stuff stays in the system longer than that)
QUESTION: pt taking bisphosphonates for 1yr IV, highest risk during dental tx? Osteonecrosis
QUESTION: Pt doesn’t like her bridge didn’t like her smile. Can you do bone graph in
bisphosphonate and would last? → NO BONE GRAFTING
QUESTION: A scenario about a patient who is taking bisphosphonates and gets osteonecrosis of the
jaw.

c. Answer is the first one bc it did not say anything about osteoRADIOnecrosis. You get
necrosis due to the bisphosphonates.
QUESTION: Osteonecrosis of jaw (2 questions): more common in mandibular; nothing to do with

radiation
QUESTION: How does Osteoradionecrosis negatively effect dental healing?

(well causes presence of non vital bone and loss of circulation to the area…would have to see answer
choices…Xtina)
QUESTION: Osteoradionecrosis most associated w/ what?
A: Mandible
QUESTION: Cause of ORN: Loss of vascular supply
QUESTION: osteoradionecrosis:
underdeveloped film
QUESTION: If need to extract teeth after patient had radionecrosis- I think refer to OS
QUESTION: Osteoradionecrosis scenarios..pre extract questionable teeth, hyperbaric oxygen pre
and post if doing invasive procedures
QUESTION: Kvp – energy
QUESTION: A higher kilovoltage produces x-rays with:Greater energy levels More penetrating
ability Shorter wavelenghts , increase in density
QUESTION: KVp inc more penetrating , high energy
QUESTION: Increasing milli amperage results in an increase in: Temperature of the filament &
Number of x-rays produced MA increase
QUESTION: If you increase distance,then u need to increase mA
QUESTION: What does ma and kvp do? Longer KVP, shorter Wavelenght, Higher energy
QUESTION: how do you change from a low contrast (longer scale of contrast) to a high contrast
(shorter scale) without changing density: increase mA and kvp, decrease mA and kvp, increase
kvp decrease mA, decrease kvp increase mA
Anemia:
QUESTION: sickle cell anemia - storm from …infection, trauma, nitrous oxide,
QUESTION: Which is not Contraindication for sickle cell anemia or something like that ? Nitrous,
infection, trauma, cold
QUESTION: All increase risk of sickle cell crisis except: cold, infection, trauma (of these 3)
QUESTION: sickle cell anemia in children’s : risk factor for nitrous and cold
QUESTION: which hemoglobin is affected- S
QUESTION: sickle cell anemia what is trigering it
QUESTION: A question about sickle cell anemia and you have a thromolytic crisis…what could
precipitate this?
a. Nitrous oxide / oxygen use – used for treatment?

b. A cold
c. Trauma
d. Something else
QUESTION: **Infection (cold) can trigger a crisis bc decrease of o2***
Sickle cell anemia is seen exclusively in black patients. Periods of unusual stress or of O2
deficiency (hypoxia) can precipitate a sickle cell crisis.
QUESTION: Chloramphenicol-aplastic anemia

QUESTION: hemolytic anemia – RBC are destroyed but bone marrow cant produce fast enough
QUESTION: which happens more in males? Mandibular dysostosis, hypothyrodisim, diabetes, sickle
cell anemia
QUESTION: Macrocytic anemia which vitamin deficient? A, B, C, D, E
QUESTION: which one is microcytic anemia? iron deficiency anemia.
QUESTION: ***Difference between aplastic, pernicious, sickle cell anemia

Aplastic anemia: bone marrow doesn't make enough new blood cells.
Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S.
Pernicious anemia: body can't make enough healthy red blood cells because lacks vitamin B12
because they lack intrinsic factor, a protein made in the stomach. A lack of this protein leads to
vitamin B12 deficiency.
Microcytic hypochromic anemia- iron def anemia (most common)
Oral Surgery:
QUESTION: Warfarin(Coumadin) what test? INR
QUESTION: warfarin pt. what test do you run prior to extraction or surgery: INR/PT
QUESTION: how does warfarin work on anticoagulation: decrease K+ needed to synthesize

factors II, VII, IX, X
QUESTION: The most important anticoagulant effect of heparin is to interfere with the conversion of
A. PTA to PTC. B. PTC to Factor VIII. C. fibrinogen to fibrin. D. prothrombin to thrombin. E.

proaccelerin to accelerin.
QUESTION: pt taking dicumorol (vit K antagonist) is probably treated for? coronary infarct
QUESTION: Pt is taking dicumarol what are they being treated for? This was an old board repeat
A. Myocardial infarction (dicumarol is similar to warfarin)
QUESTION: Patient is on Coumadin, what do you need…INR, ptt
QUESTION: Pt using Warfarin, what lab test would help determine if pt is treatable? INR, PTT, PT
QUESTION: INR of patient on Coumadin….2-3
QUESTION: warfarin patient and when should you do treatment: INR = 2.0-3.0
QUESTION: Coumadin - INR
QUESTION: What is the best way to test clotting function on a patient taking Warfarin?→ INR
QUESTION: Patient is taking warfarin, what could u do? proceed with treatment because his INR is <2.5
QUESTION: Patient is taking Coumadin and you wan to know the coagulation status of patient
before surgery, what do you order?
INR
QUESTION: INR deals with PT
QUESTION: INR – value of 1 is normal (12 sec)
The higher the INR, the greater the anticoagulant effect.
QUESTION: question that was testing INR numbers .....i forgot the details **normal INR =1, higher
INR→ more bleeding, PT value,
QUESTION: suspend warfarin 3 days prior to extraction (stop drug 5 days before, and resume the
day after surgery)
QUESTION: suspend warfarin 5 days prior to extraction
QUESTION: Patient comes in and is on Coumadin, what do you do?
a. Stop for 1 day
b. Stop medication of 3 days
QUESTION: what INR is ok to place implant? 2.5, 3.5, etc I believe u can place implant in patient who
has INR less than 2.5
bleeading measuments : PTT 25-36 sec PT 5-7 sec platelets 150K-450K minimum platelets 50 k
bleeding time : less than 9 min INR : 1 do not treat with more than 3.5
QUESTION: Coumadin (warfarin): give vitamin KKKKKKKKK
QUESTION: alcoholic patient, order:

PT/INR
QUESTION: severe alcoholic now recovering need 24 tooth extraction which test needed----INR,CBC
QUESTION: Alcoholic patient come for extractions: INR?
QUESTION: Alcoholic patient, is about to undergo surgery. Which blood work test is most
important?
-creatinine
-PT→ extrinsic system (Vit. K coagulation factors-2,7,9,10); used to test warfarin/coumadin
effectiveness, for liver damage, and Vit. K status
-PTT→ intrinsic system; used to test Heparin
-Bleeding time
QUESTION: accurate way to detect blood alcohol in the body except
weight
amount of food in stomach **amt of food in stomach dictates how fast your blood alcohol level
will increase
percentage of alcohol in drink
how fast you drank it
QUESTION: best way to determine platelet fxn

a. platelet count
b. bleeding time
c. PTT
d. INR
QUESTION: What aspirin affects? Extrinsic, intrinsic, bleeding time, common pathway?
QUESTION: What determines the bleeding time? Intrinsic, extrinsic, platelet adherence, common
pathway
QUESTION: Aspirin: platelet count
QUESTION: aspirin decrease platelet fxn

QUESTION: Bleeding time has to do with platelet count - Bleeding time = time required for blood
to stop (2-6min normal) Bleeding time is increased in disorders of platelet count, uremia, and
ingestion of aspirin and other antiinflammatory medication
QUESTION: asprin has no affect on PT or PTT or INR... it affects platelets..

E.Methylprednisolone (Medrol®)
QUESTION: Patient taking aspirin for hypertension: Consultation with physician
QUESTION: prostaglandin inhibitor cause all expect: increase gastric mucous
PG:decrease gastric acid and increase gastric mucous ..... Inhibiting PG will increase gastric acid and
decrease mucosa. That's why people taking too much aspirin can get stomach bleeding cause more
acidic and no protection
QUESTION: What makes prostaglandin: Arachidonic acid
QUESTION: ginseng- antiplatelet ( interferes with coagulation – not given with aspirin). pt on warfarin,
aspirin
QUESTION: Before doing extraction you look at a patient’s CBC report. What causes to contact
patient’s physician? Hematocrit was given as 25. While in males it is 45% and females 40%
QUESTION: Anticoagulants act antagonize Vitamin K to work, prolong bleeding.

QUESTION: Anticoagulants – antagonize vit. K, INR used for Coumadin patients
QUESTION: INR 1.75 what do you do after extraction to control bleeding? Keep stuffing shit in it, bite
on normal gauze, squeeze b/l plate to collect bone fragments,
QUESTION: Warfarin = INR. Know numbers! I got pt with INR of 12.5, then asks what to do next.
Classmate had same questions with INR of 2.
QUESTION: extractions for a pt with an INR of 2. what should you do? Nothing
QUESTION: Safe INR is 2 for coumadin pt

QUESTION: pt on coumadin, INR 2--- I think it is okay to continue tx. Mosby’s states that normal INR of
people on anticoagulants is 2.5-3.0.
b. get pt off coumadin for 2 days before extraction
QUESTION: Patient had extraction and socket is still bleeding 5 hours later? refer for INR
QUESTION: Tooth extraction, 3 days later starts to hemorrhage what is the cause? Fibrinolysis
QUESTION: PT (12-14 secs, Factors 2, 7, 9, 10) and INR are extrinsic pathway
QUESTION: PTT – intrinsic factor 8.9.11.12 test for detecting coagulation defects of the intrinsic
system - hemophiliac
QUESTION: Factor VIII is hemophila A
QUESTION The drug contra indicated in pt taking gingko biloba: HEPARIN
Diabetes:
QUESTION: Glucocorticoides are contraindicated in: Diabetes
QUESTION: Glucocorticoids side effects? Infection, reduce inflammation, hyperglycemia.
QUESTION: Negative effect of chronic use glucocorticoids? Pg. 303 mosby section D adverse effect
QUESTION: Overweight patient that has to piss 2wice at night? Diabetes
QUESTION: Oral hypoglycemic drug for diabetes --?sulfonylurea and metformin (MOA)
QUESTION: Why don’t you give Sulfonylureas to Type I diabetic patients? They do not have beta cells
for insulin & Sulfonylureas MoA is to stim those cells
QUESTION: Sulfonyl ureas – diabetes drugs: They act by increasing insulin release from the beta cells in
the pancreas.
QUESTION: MOA of sulfonylureas: release of insulin
QUESTION: How do Sulfoneureas work? Stimulate insulin release from Beta cells, stimulate
binding, decrease glucagon levels.
QUESTION: MOA of sulfonylurea- increase insulin PRODUCTION and SENSITIVITY by Beta cells
stimulation
receptor name?binds to ATP-dependet K channels
QUESTION: Metformin suppresses glucose production in liver (decreasing hepatic gluconeogenesis
→decreases glucagon levels) – bind to AMP protein kinase receptors
QUESTION: Proposed modes of action for the oral antidiabetic agents include each of the following
A. Blockade of glucagon release from pancreas

B. Blockade of catecholamine release from adrenal medulla
E. Increase affinity of tissues for utilization of available plasma glucose
QUESTION: Diabetes – more in men?
QUESTION: Hb1AC: →Measuring glucose level over extended period
QUESTION: Pt who took too much insulin will have all except- Hyperglycemia
QUESTION: decrease in ⬇ glycogenolysis in the liver would be expected with insulin

• *hemophilia (it is carried by the female but only effects the male)
• downs
• diabetes
QUESTION: which happens more in males? Mandibular dysostosis , hypothyrodisim, diabetes, sickle cell
anemia
QUESTION: Sign of hypoglycemia- I put bradycardia but later checked I think answer is mydriasis …other
options were diaphoresis (sweating),
Signs of hypoglycemia: headache, mental confusion, somnolence, sweating, tachychardia, tremors,
nervousness
QUESTION: Which is risk factor for hypoglycemia? Age, alcohol, hypertension
Well-known risk factors for the development of hypoglycemia include exercise, alcohol, older age,
renal dysfunction, infection, decreased intake of energy, and mental health issues, including
dementia, depression, and psychiatric illnesses. In the ADVANCE trial, cognitive dysfunction
increased the risk of hypoglycemia
QUESTION: Controlled diabetes has same perio problems as those who don’t have diabetes TRUE
QUESTION: Controlled diabetic patients do not get more perio disease than non-diabetic
QUESTION: What is not true regarding patient with diabetes and perio: either increase of
crevicular fluid or increase of sugar in crevicular fluid (of these two choices, 1st is better cuz there
is sugar in the fluid)
QUESTION: Patient with diabetes which finding is not consistent … increase collegenase in crevicular
fluid, increase glucose in crevicular fluid, increase gram negative in crevicular fluid, decrease in
thickness of basilar lamina of blood vessels in periodontium.
QUESTION: Diabetic patients have more of the following except: higher glucose levels in gingiva,
increased anaerobic bacteria in pockets, …
QUESTION: increases in diabetics except? IL1, collagenase, glucose, bacteria
QUESTION: Diabetics are more prone to perio and are less resistant to the effects of bact.- both statements
are true.
QUESTION: By recent studies, which one has a correlation with periodontitis? Diabetes -
diabetics are 15 times at risk
QUESTION: pt presents with aggressive bone loss, bleeding gums, mobile teeth…. Etc
• non hodgkins lymphoma
QUESTION: ASA III: uncontrolled diabetes
QUESTION: Diabetes you get infections more likely, not bleed easier
QUESTION: diabetes most common: black men
QUESTION: Endo surgery contraindicated when… diabetes? HTN
QUESTION: When would elective endo treatment be contraindicated? diabetes, hiv, etc
QUESTION: What disease will alter healing after root canal treatment? HIV or diabetes?think its diabetes
since they have altered wound healing..
QUESTION: Periodontal disease is associated with what systemic diseases? Diabtes and HIV
QUESTION: Diabetes can you place implant if HbA1c is 8: refer to physician, and no cant place implants
QUESTION: Pt with hemoglobin A1C of 12%. Pt just visited the MD, what kind of TX we can do?
Consult with an MD prior to tx
In most labs, the normal range is 4-5.9 %.
In poorly controlled diabetes, its 8.0% or above
In well controlled patients it's less than 7.0
QUESTION: LA with epinephrine contraindicated in? Uncontrolled Diabetes, hypothyroidism,

hyperthyroidism
QUESTION: LA with epinephrine contraindicated in? Diabetes, hypothyroidism, hyperthyroidism

QUESTION: epinephrine is contraindicated in what disease? Cardiac patients hyperthyroidism,
diabetes mellitus...sorry can't remember the rest
QUESTION: Common complication of Type 1 diabetes: I wrote as blindness assuming retinopathy!!
QUESTION: Treat diabetic patient 2 hours after eating and taking insulin
QUESTION: Kidney dialysis: best to do tx when, I put day after dialysis, or inbtwn days of dialysis
QUESTION: Insulin shock, what do u give?- give insulin, give OJ, give oral sucrose **glucagon shot?
Do NOT give more insulin, blood sugar is already low enough. Give OJ or oral sucrose maybe.. depends
on the answer choices.
QUESTION: what would you give to a patient who goes into a diabetic shock (hypoglycemia)?
QUESTION: Pt is a child and is diabetic undergoes hypoglycemia in the chair if conscious give him
orange juice (unconscious give him 50% dextrose IV)
QUESTION: child goes into insulin shock in the chair (hypoglycemia)

a. give OJ----?
QUESTION: Unconscious diabetic is treated with: 50 % dextrose in water I V.
QUESTION: HgbA1c is 12 for a patient in your office? – Get him out of there, haha! , refer him to
physician for diabetic/sugar management. (I believe normal A1c levels are 4.0-6.0…Xtina) HbA1c stands
for Glycosylated hemoglobin. Measures blood glucose in past 2-3 months. NORMAL = 4-6%. Increased
is above 7%
QUESTION: Diabetic for IV sedation. If insulin dependant, have them not eat, not take short acting
insulin and take half dose of long acting insulin. If not dependant, no food and no meds
QUESTION: Patient is non-insulin dependent diabetic and needs minor oral surgery w/ IV
sedation. What should he do? I put clear-liquids and regular dose of diabetes meds. Minor
surgery: normal as long as procedure occurs within 2 hours of eating and taking
meds.
QUESTION: Day of surgery- diabetic what do u tell him- no food no insulin, food and insulin, clear liquid
and ½ insulin, clear liquid and normal insulin
QUESTION: You have a diabetic patient, you can manage him all the following ways except? – Tell him
to eat light breakfast on the day of the appointment (the other choices were, schedule the dude a morning
appointment, tell him not to take his hypoglycemia meds for his appointments, monitor his blood sugar
level on the day of the procedure)
QUESTION: pt with diabetic having sedation IV and LA---ask the pt to take high calorie food with
insulin, low calorie food with insulin (reduce dose of insulin and no food)
QUESTION: DM pt. What to instruct before conscious sedation procedure?

A: Low calorie meal and reduce insulin dose
QUESTION: IV sedation Diabetic patient comes for surgery. What are the instructions? dependent-
don’t eat, remove short duration insulin, half dose of long, type II not dependent- no eating no
medication.
QUESTION: how are the diabetic drugs classified- by duration
QUESTION: Various preparations for diabetes are differneces in what? Duration of action,
QUESTION: Patient has ketone breath and is confused. Why? I put HYPerglycemia.
QUESTION: Ketone breath: Diabetes type 1
QUESTION: Ketone breath and alter state of consciousness? Hyperglycemia
Congestive Heart Failure/Heart:

QUESTION: Patient with orthopnea(shortness of breath-dyspnea-while laying flat), dyspnea,
pedal edema
a. Emphysema
b. Pulmonary edema
c. COPD
QUESTION: Dypspnea, orthopnea seen in? CHF

QUESTION: What is common symptom of CHF? Orthopnea* (other symptoms: dyspnea, fatigue,
paroxysmal nocturnal dyspnea, edema)
QUESTION: Common s and s of ChF
QUESTION: Dyspnea, orthopnea seen in? CHF What is common symptom of CHF? Orthopnea*
QUESTION: Tx of CHF pt? early morning appts?
QUESTION: Most common reason for cardiac arrest of kid – respiratory distress
QUESTION: what is the most common heart problems in children: c) Ventricular septal defects
QUESTION: Most common cause of heart failure in kids: congestive heart failure, cyanotic heart
disease,…didn’t know answer, according to google, its respiratory failure
QUESTION: heart failure in kids - due to defect in heart respiratory distress
QUESTION: what is the most common heart problems in childrens : a)congestive heart failure b)
septical Atrial. Etc…. ventricular septal defects or communications between the bottom
chambers(structural heart defects)
QUESTION: Peripheral edema : →congestive heart failure.
QUESTION: Patient has distended jugulars, pitting edema and dyspnea? I put
congestive heart failure
QUESTION: Pt edematous pitted, shortness of breath? Congenital heart failure,
QUESTION: why is pt taking ACE inhibitor (hypertension / CHF)

QUESTION: pt taking cardiac glycosides. what is it used for? (choices: hypertension,
congestive heart failure, etc...can't remember)
QUESTION: what do cardiac glycosides(Digitalis) do? Inhibit NA/K atpase and Increase Na and ca in
cell and increases the refractory period.
QUESTION: how does digitalis works : blocks Na/K/ATP ase = influx more Ca
QUESTION: how does digitalis works : →blocks Na/K/ATPase = increase influx more Ca
QUESTION: Digitalis -Increase Ionotropic (contractions) effect of the heart, know the mechanism as well
QUESTION: Use of digitalis: Post myocardial infarction, Supraventricular arrhythmia, (digitalis...cardiac
glycoside…common indications for use is for atrial fib)
QUESTION: Action of Cardiac glycosides,(Digoxin ) binds and inhibits Na+/K+ ATPase for atrial
fibrillation
QUESTION: How does Digoxin work? Inhibits Na/K ATPase of cardiac cell membranes resulting in
increase of Na concentration intracellularly. cardiac glycoside. ALSO increases intracellular Ca++
QUESTION: mechanism of Digoxin – blocks Na/K+ pump increase intracellular sodium promote
calcium influx contractility
QUESTION: Ginseng question! – pt takes for energy, but it will interfere with…digitalis, can’t
remember the rest. ASPIRIN. Ginseng = antiplatelet
QUESTION: Ginseng: CI with aspirin or digoxin??
QUESTION: Pt. on ginsing what do u want to avoid? Warfarin/nsaids and Aspirin

• Penicillin
• Aspirin*
• Digitoxin
QUESTION: Peripheral edema : increase systole : congestive heart failure.
QUESTION: Peripheral edema : →congestive heart failure.
QUESTION: Patient has distended jugulars, pitting edema and dyspnea? I put congestive heart
failure
QUESTION: Pt has history of cardiovascular disease and now pt is taking aspirin. Pt needs ext. What
should dentist do?
• Med consult with physician*
QUESTION: Mechanism of most drugs that tx arrhythmias? Decreases repolarization rate, Prolongs
refractory period.
QUESTION: Cardiac referred pain not consistent with? Pain goes away with LA
QUESTION: When you have artial arrythimia….whats the mech of action for the drug for it?
a. Well, I know you can give Quinidine, Verapamil, and Digitalis for atrial…and the side
mechanism of Quinidine is it increases the refractory period..thats the only
answer that made sense
QUESTION: general question about arrhythmias. They increase calcium inotropic effect, decrease SA
node transmission, increase refractory period…
QUESTION: If a patient has chest pain while at rest, what kind of angina is it? Unstable
QUESTION: Angina at rest?
a. Pseudo-angina
b. Unstable angina
c. Infarction
QUESTION: patient has pain in heart when sleeping-unstable angina.
QUESTION: side effect of nitroglycerin : orthostatic hypotention and headache.
QUESTION: side effect of nitroglycerin : orthostatic hypotension and headache.
QUESTION: nitrates and nitriles have what systematic effect? Vasodilation of arteries → decreased
BP → tachycardia
QUESTION: Nitrates/Nitriles, how do they respond to Angina? –blood vessels.

QUESTION: Nitrates/Nitriles, how do they respond to Angina? – I said they act on muscle cells, correct
answer was through blood vessels. (dilate blood vessels)
QUESTION: How do nitrates work on the heart- relaxing and widening the blood vessels in the
body, allowing more blood and oxygen to flow to the heart. Since the arteries are wider, it is easier
for the heart to pump blood, so it does not require as much blood and oxygen.
QUESTION: You give the nitroglycerin to the pt with angina and heart rate goes up what's the
reason? natural reflex to the decrease in blood pressure
QUESTION: Nitrates and how they affect the heart: something with relaxation of smooth muscle
QUESTION: Nitrates effect in blood vessel? . Nitroglycerin is a nitrovasodilator. It produces nitric

oxide, which activates guanylyl cyclase which, in turn, catalyzes the production of ⬆ cGMP.
QUESTION: Amilnitrate & Nitroglycerine? Vasodialate coronary arteries **for angina pectoris—chest
pain caused by occlusion of coronary arteries!!!
QUESTION: *** For Angina drug, which drugs can’t you take: some type of hydrothiazide med
QUESTION: Diuresis(excessive urine production) after tx of angina w/ a glycoside ? b/c of
increased blood flow caused increased blood flow to kidney
QUESTION: Epi and Nitroglycerine : ....antagonist,

QUESTION: Transient Ischemic Attack what is false
o More prone to heart attack

o Should take nitroglycerin
QUESTION: TIA-transient inschemic attack; what is false? Better chance to get stroke-true, patient
should take nitroglycerin FALSE-give for angina to prevent heart attacks.
Lungs:
QUESTION: Asthma causes constriction on bronchioles and inflammation true: Beta 2 receptors for
the lungs
QUESTION: asthma causes constriction of bronchioles and inflammation, constriction of smooth

muscle
QUESTION: What does asthma do? Causes constriction of smooth muscle T and inflammation of
bronchioles? T
BETA 2 RECEPTOR FOR LUNGS
BETA 1 FOR HEART
QUESTION: What do asthmatic patients have problem with? – Wheezing Exhalation

QUESTION: Wheezing → exhale with high pitch
QUESTION: Wheezing sound: insp or exp
QUESTION: COPD vs Asthma? Asthma have problem breathing in,(but wheeze when exhaling), COPD
has problem exhaling
QUESTION: Most breathing problem in dental setting? – Asthma (other were hyperventilation, COPD,
etc)
QUESTION: Most common respiratory problem in dental office: COPD/asthma
QUESTION: most common respiratory condition you will encounter in office? COPD →
hyperventilation
QUESTION: Most common respiratory emergency in dental office: hyperventilation
QUESTION: Hyperventilation causes – tachycardia and tachypnea
QUESTION: What is the most common cause for breathing difficulty in the dental chair? asthma
QUESTION: Patient has palmar pits, something and something when he presents: either CHF or
emphysema
QUESTION: Soft tissue emphysema: endo

QUESTION: face swelling after air spray in perio pocket: soft tissue emphysema (sudden painless
swelling)
QUESTION: Perio surgery, air into sulcus. What occurs?- subcutaneous emphysema
QUESTION: Emphysema: constriction of air sacks
QUESTION: Pt has emphysema. What are his symptoms? Dyspnea, wheezing, cough, chest tightness. Air
sacks are all destroyed (narrowing of distal airways)
QUESTION: Crowing sound when breathing? Stridor??
• asthma attack
• COPD* I put this but I didn’t know what crowing sound means.. so not sure
• Pneumothorax
QUESTION: What causes a crowing sound? COPD (maybe)* laryngeal SPASMS
QUESTION: Stridor? Laryngospasm
QUESTION: Stridor- laryngospasm- blockage of UPPER resp. tract
QUESTION: Epi for laryngiospasm what does it do? (multiple answers- multiple choice with 3 answers
each)- brochodilater, increase HR, increase BP
QUESTION: Theo-phylline
Theophylline is used to prevent and treat wheezing, shortness of breath, and difficulty breathing
caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air
passages in the lungs, making it easier to breathe.
QUESTION: Theophylline – drug used for asthma sometimes. Particularly for wheezing,
shortness of breath, chronic bronchitis, emphysema.
QUESTION: Which drugs for ***asthma?
Albuterol was not in it, levabuterol(xopenex), ipratropium(atrovent), Combivent, Advair,

Smbicort, Spiriva, Budenoside
QUESTION: Most effective during acute asthma attack: albuterol- generic name is Salbutamol
QUESTION: asthma attack – albuterol this is a beta 2 agonist causes bronchodialation
QUESTION: medication for severe asthma attack :→ aminophiline.

QUESTION: Singulair(montelukast) action? Block action of leukotrienes, is a leukotriene
receptor antagonist.used for asthma tx and seasonal allergies
QUESTION: leukasts block leukotrienes
QUESTION: M.O.A of Albuterol: Give for severe asthma. It’s a bronchodilator
QUESTION: Albuterol question, does not help asthma what do you give next,. Epinephrine
• epinephrine
• atropine
• something else…
QUESTION: A child treated with albuterol. Why? I put asthma
QUESTION: What drug cause asthma? Aspirin
QUESTION: Which of the following drugs is can trigger asthma? a) narcotic

analgesic b) NSAID c) corticosteriod d) sympatolytic amine.
QUESTION: Asthmatic only use Tylenol (not aspirin bc of hypervent)→ Bronchiospasms

QUESTION: What is used for a severe bronchial asthma attack? Albuterol, corticosteroids,
aminophylline
QUESTION: Patient begins to wheeze what do you not do?
o Beta2 blocker inhaler, sit pt more comfortable, corticosteroid inhaler

o Give oxygen
QUESTION: If patient starts wheezing? Don’t give oxygen; last thing you would do; other options
give beta 2 blocker inhaler, corticosteroid inhaler, make patient more comfortable
QUESTION: asthma patient, most important thing NOT to give: O2 (rest was inhaler, albuterol, etc.) - i
got it wrong
QUESTION: What cause dry mouth?Albuterol
QUESTION: Pt goes home from elective orthognathic sx and in 24hrs, without sign of inflam or edema,
but a fever of 102oF- Atelectasia (or pneumotosis – depending on answers. Atelectasia and pneumotosis =
most common cause of fever within 24 hour of GA)
Syncope:
QUESTION: Pregnant women with syncope – what hip should they lay on? Right or left (pretty sure
not trendelenburg) --- and why do you do that? To avoid compression of vena cava I think
QUESTION: 5 mo pregnant patient with syncope, what position would u put her in? supine with
legs raised, reverse trendelburg, on her left,
prego – CO increases 30-50%. Gradual increase in BP. 2nd and 3rd trimester- decrease in BP and CO
can occur while pt in supine position. =decrease in Venous return to heart due to compression of
inferior vena cava. =supine hypotensive syndrome. = light headed, hypotension, tachycardia,
syncope. Roll pt onto left side to lift uterus off vena cava. To avoid, prego pt positioned in semi-
reclining position. = elevate right butt and hip 15 degrees.
QUESTION: If a 3rd trimester pt all of a sudden feels a drop in BP what do you do?- Have pt lay on left
side.
QUESTION: Prego question – syncope, which side you put pt? Raise right hip.
QUESTION: Pregnant woman - put her right hip up if she not comfortable in chair or experiences
loss syncope, etc..
QUESTION: pregnant women, with syncope. turn them chicks on the left bc it won't compress the
inferior vena cava.
QUESTION: 2 questions on prego
a. Baby crushing IVC

b. Lay on left hip, Right hip UP
QUESTION: Pregnant women should lay in which direction (Trendelenberg, right hip up, left hip up?)
More proned to what medical emergency?
QUESTION: What causes pregnant woman to syncope – pressure on inferior vena ceva
QUESTION: Pregnant in supine position, what gets too much pressure? – I said Fetus (other choices were,
placenta, inferior vena cava, superior vena cava) ( inferior vena cava…)
→orthostatic hypotension (colloquially as head rush or dizzy spell, is a form of hypotension in

which a person's blood pressure suddenly falls when standing up or stretching. Vs
→ vasovagal syncope (the most common type of fainting. is a malaise mediated by the vagus nerve.)
QUESTION: Most important thing to do when patient syncope – maintain airway, loosen up buttons,
place head below heart, supine
QUESTION: Crown disappears down patient’s throat, what position do you put them in? Supine, Upright,
Trendelberg
QUESTION: Place crown in mouth and it comes out and to back of throat, place patient – upright, prone,
supine, trendelburg
QUESTION: Want to determine patient physiologic rest position, place in – supine, upright/standing,
tredenlburg
QUESTION: Purpouse of the trendelberg position is to- maint circulation so that the most vital organs are
never hypoxic.
QUESTION: what position you place the Pt when is having syncope? (TRENDELENBURG
POSITION) (SUPINE WITH FEET ELEVATED SLIGHTLY), The most common early sign of
syncope is PALLOR (paleness).
QUESTION: U walk to office, pt is unconscious? Supine, tendenberg, upright
QUESTION: Trendelenburg position: (for anaphylaxis)

Position in which the patient is on an elevated and inclined plane, usually about 45°, with the
head down and legs and feet over the edge of the table. It is used in abdominal operations to push
abdominal organs towards the chest. This position is also usually used in treating shock, but if there is an
associated head injury, the head should not be kept lower than the trunk.
• Hypovolemia
• Decreased perfusion to tissue
• Sepsis
QUESTION: Vasovagal syncope: Common cause of transient loss of consciousness
QUESTION: Syncope? Inhale ammonia, irritates es trigeminal nerve sensory. 100% oxygen works,
except hyperventilation syndrome.
QUESTION: High-flow 100% 02 is indicated for treating each of the following types of syncope
A. Vasovagal
B. Neurogenic
C. Orthostatic
QUESTION: most Emergency in dental chair : syncope
QUESTION: Most common ER after use of local: syncope
QUESTION: What is the most likely emergency in the dental office? Syncope
QUESTION: After receiving one cartridge of a local anesthetic, a healthy adult patient became
unconscious in the dental chair. The occurrence of a brief convulsion is
QUESTION: signs of epi overdose: blood pressure and heart rate rises
QUESTION: Carpopedal spasm seen in? asthmatic attack, hyperventilation,
Seizures:
QUESTION: grand mal seizure – give Dilantin *phenytoin*
QUESTION: Which of these is indicated for grand mal seizure? DILANTIN phenytoin
QUESTION: Most common seizure in children – grand mal
Febrile seizures, which occur in young children and are provoked by fever, are the
most common type of provoked seizures in childhood. Then generalized tonic-clonic
(grand mal)
**** Diazepam is for status epilepticus******

QUESTION: Status epilepticus – give what drug? Diazepam
QUESTION: Drug of choice of status epilepticus (seizure that last for long period)? `1. Valium
(diazapams) (answer) – look up how much too, 5ml?---***5-10 mg IV / per minute
QUESTION: Grand mal seizure : Phenytoin Status epilecticus : Valium
DIAZEPAM CONTRAINDICATIONS: Pregnant, myasthenia gravis, acute narrow glaucoma
QUESTION: Diazepam is contraindicated in the following pt? Asthma**

QUESTION: contraindication of diazepam : Pregnacy
QUESTION: What drug for patient with petit mal seizures in dental office?
Only 2 drugs for absence seizures (petit mal): ethosuximide (Zarontin) – only treats petit mal-
and valproic acid (Depakene, Depacon) – treats grand mal, petit, and myoclonic seizures.
QUESTION: What is best to give for petit mal seizure? I chose phenytoin. They also had diazepam
QUESTION: What may induce seizures? Hyponatremia, hypernatremia, hyperkalemia
QUESTION: cause seizure? Hypoglycemia, hypokalemic…can’t remember the rest, hyponatremia
QUESTION: convulsions where : a) hypoglycemia b) hypokalemia c) hyponatremia

QUESTION: Seizures due to lack of what nutrient/vitamin/electrolyte (sodium)
QUESTION: What causes seizures?
a. Hypocalcemia
b. Hypophosphatasa
c. Hyponantremia
d. Hypernantremia.
QUESTION: Epileptic pt least likely to take
a. ethosuximide – petit mal seizures
b. diazepam
c. Lasix (furosemide)----? This is a loop diuretic…..
QUESTION: Which of the following drugs, when administered intravenously, is LEAST likely to
produce respiratory depression?
A. Fentanyl
B. Diazepam
C. Thiopental
D. Meperidine
E.Pentobarbital
E.Chlordiazepoxide (Librium®)
QUESTION: Each of the following is an advantage of midazolam over diazepam EXCEPT one. Which
QUESTION: The clinical activity of a single intravenous dose (10 mg) of diazepam is most
dependent on which of the following?
A. Alpha half-life
B. Betahalf-life
C. Renalexcretion
QUESTION: Each of the following are narcotics used in outpatient anesthesia EXCEPT one. Which
A. Fentanyl
B. Sufentanil
C. Meperidine
D. Diazepam
E. Morphine
QUESTION: Which of the following describes the titration of diazepam to Verrill's sign for IV
conscious sedation?
A. It is recommended as an end-point.
Epinephrine (EpiPen ̈) Naloxone (Narcan ̈) Diazepam (Valium )̈ Flumazenil (Romazicon ̈)
Succinylcholine (Anectine ̈)
QUESTION Which of these opioid analgesics is associated with a serious life threatening drug interaction
when administered with an MAO inhibitor? Meperidine morphine fentanyl propoxyphene codeine
Can cause life-threatening hyperpyrexic reactions
QUESTION: Drug-drug interaction with MAOI(Hydralazine) and Meperidine.(opioid)
QUESTION: MAOI contraindication? Meperdine

QUESTION: No opioids for patient taking MAOIs )in case of head injury)
QUESTION: Opiate contraindicated in – severe head injury cases
QUESTION: An opiate type MAA with both agonist and antagonist properties is- pantazocin
QUESTION: Absolute Contraindications to Opioid Prescribing: Allergy to

Codeine/Oxycodone/Hydrocodone give Methadone or Meperidine or Tramadol..
QUESTION: Which of the following narcotics/opioids is synthetic? Meperidine (Demerol) or

propoxyphene
QUESTION: Use for sedation of children- Secobarbitol or pentobarbital (good for pre-op/anxious kids)
Ketamine is used in emergency situations (good anxiolytic and analgesic at low doses) Meperidine should
not be used in kids
QUESTION: Which is not done by opiates

o Constipation
o Bronchiolar constrction
o Vomiting
QUESTION: opioids do NOT do what? Peripheral pain block

o they do: constipation, respiratory depression, somnolence
QUESTION: opioid side effect – constipation
QUESTION: Opiate overdose--> miosis

QUESTION: Opoid overdose side effect (from cocaine) – constipation, respiratory depression,
euphoria, miosis, coma
QUESTION: opioid OD symptoms – answer was hypotension. Other options were irritability
(restlessness), hypertension, insomnia = withdrawl symptoms.
QUESTION: Symptom seen in oral opioid overdose: hypothermia, headache, insomnia, irritability
(rest are withdrawal sympotms)
QUESTION: Symptoms if too much codeine? Cold and clammy skin √
QUESTION: Opioid usage all except: xerostomia, chronic cough, diarrhea, miosis (for sure get
constipation)
QUESTION: adverse effect most severe of opioids: →respiratory depression.
QUESTION: What is the most significant side effect of morphine: →respiratory depression
A. Comatose sleep
B. Pin-point pupils
QUESTION: Opioids : opioids receptors in GI tract, CNS and adrenal medulla
QUESTION: Opioid Receptors- brain, and are found in the spinal cord and digestive tract.
QUESTION: opioid stomach upset - act in the brain, not in stomach receptors (I got this wrong!)
QUESTION: Opioid agonists act by…

QUESTION: Naloxone: use for Opioid overdose. Used Meperidine (Demerol) to decrease
withdrawl symptoms
QUESTION: Opioid (Fentanyl, Morphine, Meperidine, Methadone, Sulfentanil, Codeine, Heroin,

Dextromethorphan) reversal drug? Naloxone.
QUESTION: antidote for Percodone overdose (Oxycodone+aspirin)? all opiate antidote is
Nalaxone
QUESTION: True opioid antagonist should have-high affinity and no intrinsic effect

QUESTION: Antagonist: Binds to receptor but lacks intrinsic activity
QUESTION: Fentanyl is the opioid analgesic given trans dermally

QUESTION: TRANSDERMAL patch- Fentanyl (opoid)
QUESTION: Which opiate is part of intradermal system? Fentanyl

QUESTION: If you give too much of an opioid (but its not an overdose!), what’s the first sign you
would see?
a. Irritation
b. Headache
c. I don’t remember the other two…I put headache..? I really think it has something to
do with pin point pupils and respiratory depression → constricted pupils and
absent/slow breathing
QUESTION: Methadone? Helps alleviate withdrawl from heroine (opiates). ***Buprenorphine and
Methadone is for opioid addiction. Naloxene is an opioid antagonist for OVERDOSE***
QUESTION: why use methadone: long half life- extra info give to heroine addicts? 􀃆 to decrease
withdrawl symptoms
QUESTION: Methadone for detoxification of opioid addicts
(Methadone is a synthetic opiod, analgesic, antitussive, antiaddictive, acts on MU receptors so produces

similar effects of opioids…without addictive qualities…receptor antagonist to glutamate)
QUESTION: Why is nalbuphine contraindicated in previous heroin addict: A mixed agonist-
antagonist which may potentiate withdrawal symptoms
QUESTION: Nalbuphine (NUBAIN) (opioid agonist and antagonist) answer was increase
withdrawal symptoms.
QUESTION: pt is addicted to oxycodone which contra indi--- codeine, pentozocaine 
QUESTION: Sedative drug such as hydroxyzine, meperidine and diazepam are carried in the blood in…
a. serum
c. red blood cells
d. hemoglobin
QUESTION: where do opioids act? Medulla (bind to opiod receptors in CNS)

Morphine, codeine, as well as oxycodone, and hydrocodone all belong to the phenanthrenes
class
QUESTION: where are mu receptors?
Medulla
Periphery
QUESTION: The codeine produces nausea because?
Activates vasodialator blah blah blah
QUESTION: How codeine causes nausea: CHEMOTACTIC RECEPTOR ZONE (CRZ)
QUESTION Mechanism of how codeine causing nausea? Chemotactic receptor zone CRZ
QUESTION: How does morphine cause emesis in the body: know the pathway – via central action
QUESTION: Had a question about codeine—and what effects are—like it being antitussive, antidiarrheal
and analgesics, sedatives and preanesthetic meds
CODEINE: analgesic, antitussive, antidiarrheal, antihypertensive, anxiolytic, antidepressant, sedative and
hypnotic properties. IS ADDICTIVE
QUESTION: Allergy to codeine: what do you take for pain – random opioids, tylenol #3, hydrocodone,
acetominophin with aspirin I think
ALLERGY TO CODEINE: can prescribe another opioid from different class: Meperidine or
fentanyl for moderate to severe pain or acetaminophen or NSAID for mild pain.
QUESTION: What give to pt allergy to codein? Propoxyphene
QUESTION: Patient allergic to codeine what do you give?? Naproxen
QUESTION: Patient is allergic to codeine when you look at their medical history tab, (this is the trick
about the exam, look up stuff before you answer questions), what do you prescribe him for pain?
Hydrocodone with Acetominaphen (Other choices were Tylenol 3, Hydrocodone with Aspirin)
Acetaminophen + aspirin
QUESTION: Codeine allergy, pain killer option? - for pts with opioid allergy → use synthetic opioids
(meperidine, tramadol)
QUESTION: Allergic to Codeine what can you give? Demerol(meperidine), Pentazocine

• Vicodine
• Naproxen *
• Hydrocodone
• Group 1 (aka opiates) - Naturally occurring agents derived from the opium plant
• Group 2 - Semi-synthetics
o Hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine (heroin is also in this
group)
• Group 3 - Synthetics
All of the group 1 and 2 agents are structurally very similar to each other and should not be given if a true
allergy exists to any other natural or semi-synthetic derivative. Group 3 agents have structures different
enough that they can be given to a patient intolerant to the natural or semi-synthetics without fear of cross
reactivity. They are also very different from others in this same group.
histamine is bronchospastic and vasodilator
QUESTION: what is not true about histamine?…it is released by histamine
QUESTION: Benadryl (diphenhydramine) both are H1 blockers
QUESTION: What is used for motion sickness? Diphenadryin (Benadryl)----I think this is scopolamine
QUESTION: What does diphenhydramine (Benadryl) cause? Xerostomia (anticholinergic,
antihistamine, sedative)
QUESTION: What property of topical diphenhydramine would alleviate pruritus (itching)? I put
anti-cholinergic NO → antihistamine
The antihistamine relieves itchy/watery eyes and itchy throat by blocking a substance
(histamine) released by allergies. The anticholinergic dries up a runny nose and the fluid that
runs down your throat causing itching/irritation.
QUESTION: what antihistaminic cause less drowsiness : H1 blocker 2nd generation zyrtec, allegra,
Claritin (loratidine), Clarinex (Desloratidine) Certizine (Zyrtec) because they don’t cross BBB,
poor CNS penetration
QUESTION: what antihistaminic cause less drowsiness : H1 blocker 2nd generation zyrtec,allegra,
Claritin because they don’t cross BBB
QUESTION: Which one of these has the least sedative effect? (2nd generation H1 blocker)
chlorpheniramine- (LEAST)
Tripelennamine
QUESTION: Least sedating anti-histamine? (2nd generation H1 blocker)

QUESTION: Which antihistamine is least likely to cause drowsiness – Loratidine
QUESTION: WHAT DO YOU GIVE SOMEONE WHO IS ALLERGIC TO ESTERS AND AMIDES?
DIPHENHYDRAMINE (BENADRYL)
QUESTION: Which of the following (from a list of H1 blockers) would have slowest onset after IV
administration? Diphenyhydramine, loratadine.. didn’t recognize other options. IDK
Levocetirizine is listed as having an onset of action of one hour with duration of
greater than 24 hours, whereas loratadine has an onset of action within two hours
with duration of action of 24 hours. Hydroxyzine, a first generation antihistamine,
has an onset of action of two hours with duration of action of 24 hours.

QUESTION: How does antihistamin work? – I put “competitively block histamine receptor”
QUESTION: actions of H1 antagonist. Blocks H1 receptors. Block vasodilation,
bronchconstriction, and capillary permeability. →Vasoconstriction, bronchodilation, and
decrease capillary permeability

a. Anticholinergic
b. Antihistaminic
c. Antimuscarinic
QUESTION: Diphenhydramine/benadryl use results in xerostomia due to its anticholinergic activity.
Side effects of Benadryl – dry mouth and throat, increased heart rate, pupil dilation (mydriasis),
urinary retention, constipation – anticholinergic
QUESTION: H2 antihistamine → Cimetidine – decrease ulcers H2 antihisamine ratidine****** that’s
answer
QUESTION: Histamine 2 blocker meds - for gastric reflux Cimetidine all the drugs with “dine”
are histamine 2 blockers
QUESTION: H2 drug. What is it best used for? Gastric ulcer
QUESTION: Histamine 2 blocker meds - for gastric reflux (block the action of histamine on parietal cells
in the stomach…ie. Cimetidine, ranitidine, famotidine, nizatidine…Xtina)
QUESTION: when would you use H2 blocker (they only gave the name cimetidine)- H2 Blocker
(reduce the acid secretion) for GERD (gastro esophageal reflux disease)
QUESTION: H2 antihistamines for (cimetidine ie tagamet) (ZANTAC = RANTIDINE) : gastric ulcers

QUESTION: Detailed mechanism questions on H1 (histamine) → compete with histamine to bind at H1
receptor sites.
QUESTION: effects of H1 blocker EXCEPT: (causes CNS depression)
a. CNS increase
b. CNS decrease
d. resp depression
e. local anesthesia
QUESTION: Pt is allergic to aspirin? Wat can u give, Tylenol #3 is acetomenophen and codeine. Just
tylenol
QUESTION: Wat does acetametaphine do with codeine? Increase its activity, increase how long its around
due to clearance,...
QUESTION: Why opioid analgesic containing both acetaminophen and hydrocodone so effective?
• acetaminophen and hydrocodone works differently, and combining these effects
makes it stronger* I put this, but not sure.
• acetaminophen blocks the binding of protein with hydrocodone, so hydrocodone
level in blood is high, so it is strong
Narcotics work in brain (CNS) while NSAIDS/acetomenophen work in peripheral tissues (PNS) –
2 diff mechanisms compliment each other for effective pain reduction
QUESTION: How do you treat acetaminophen overdose? I put n-acetylcysteine

QUESTION: What to give when there is overdose of acetaminophen, opioid analgesics? N-
acetylcysteine
QUESTION: Reversal of acethaminophen: NAC , N-acethylcysteine-liposome.
QUESTION: Tylenol- liver toxicity
QUESTION: Pt has hepatic dysfunction which pain medication can prescribe?
a-Oxycodone b. naproxen c-acetaminophen
QUESTION: what is relationship bet Tylenol and aspirin – anti pyretic and analagesic
QUESTION: Another Q: Difference: asprin is antimflammatory common: anti pyretic
QUESTION: Which of the following does not have anti-inflammatory action: →Acetaminophen
QUESTION: Tylenol and acetaminophen: analgestic and antipyretic
QUESTION: Ibuprofen doesn’t cause as much GI upset as aspirin
QUESTION: Tylenol vs. NSAID: Apirin- reyes fever and adults GI, If liver problems give aspirin
QUESTION: NSAIDs--> stimulate asthma attack-->COX inhibitor
QUESTION: NSAIDs – inhibit cyclooxygenase

QUESTION: NSAIDS are....
options included aspirin, Advil, tylenol
they are both irreversible and reversible
go with irreversible (aspirin)
(NSAIDs are a mix of the two…) ->advil = reversible
QUESTION: NSAID→ irreversible affect platelets
QUESTION: NSAIDS? Suppress inflammatory response (antiinflam, analgesic, antipyretic not

immunosupp)
QUESTION: NSAIDs – mech of action of suppressing platelets – inactivate cyclooxygenase → decreased

prostaglandin synthesis
QUESTION: Asprin stops pain by:
a. stopping the unpward transduction of pain signal in the spinal cord
b.intefere wiht signal intrepretation in the CNS
c. stopping the local signal produtction and transduction
d.stopping the signal transduction in the cortex  
QUESTION: what does NSAID do? Irreversibly block platelets, reversibly, inhibit instric, extrinsic
pathways..
QUESTION: NSAIDS...irreversible or reversible (question which of the following true about

NSAIDS)…answer 1 irreversibly binds answer 2 reversibily answer 3 somethong about bleeding
time answer 4 something about platelets
Cox 2 does not increase bleeding time and less platelet adhesion.
QUESTION: Nsaid least likely to effect stomach –(Rofecoxib…aka Vioxx...however taken off the market)
Cox 2 inhibitor CELEBREX
QUESTION: Dyspepsia =upset stomach what drug can cause it – Less likely to be acetaminophen,
ibuprofen (less GI upset than other nsaids).
QUESTION: Aspirin→ inhibits platelet aggregation
QUESTION: Plavix and aspirin: alter platelet function

QUESTION: What affect does Plavix has? Inhibits platelet aggregation.(Given to patients allergic to
aspirin) →no ulcer side affect, give to patients with past ulcer history
QUESTION: Clopidogrel (Plavix) inhibits platelet aggregation irreversibly
QUESTION: Patient is taking baby aspirin.
a)how long before should you stop before surgery?
b)is it necessary to stop?
c) for long will the platelets be inhibited? 5-7days
QUESTION: aspirin stays in body for 7 days
QUESTION: For how long a single dose of aspirin will have effect on the platelets? 2h, 12h, 1 day, 10
days, 1 month – 10 days
QUESTION: After one effective dose of aspirin how long must you wait before there is not effect on
bleeding time (I said 1 week, I think it was an old exam q)
QUESTION: apirin - single dose - how much time- 4 hours, 1 day for baby aspirin (81mg, day)
aspirin is 325mg (to 650mg) q 4-6 hrs (max dose is 4000) 
QUESTION: aspirin is irreversible

QUESTION: Aspirin works on which pathway for pain?- Cyclo-ox pathway
QUESTION: Aspirin works how to inhibit bleeding?- Thrombox A2
QUESTION: Bleeding time: Inhibits thromboxane A2 preventings platelet synthesis
QUESTION: Differences between Bleeding time, PPT, which one it is affected by aspirin(BT)
QUESTION: Patient is on 3-5 grams acetylsylic acid per day for 3 months what is the most likely to see in
this patient?
Choices were
Acidosis and increased bleeding time (I am not sure if the second part of this choice was bleeding time
but I rememberly I instantly picked this as soon as I saw acidosis, since acetylsyllic acid is aspirin and its
an acid and 3g daily is a lot!!!!
QUESTION: Pt. on saw palmetto what do u want to avoid? Aspirin
QUESTION: Saw palmetto enhances anticoagulants
QUESTION: which effects (that heighten, I think) anticoagulants...St. John’s wart, cammomile, saw
palmette, licorice(antiviral )
QUESTION: HERBAL supplement that potentiates anti-coagulation (CHAMOMILE DIRECT EFFECT)
a. St. John’s Wort

b. Saw Palmetto (this is what I put)
QUESTION: **Which herb complicates in someone on anticoagulants: st johns wort-dec immunity

in hiv pt on heart mehs and antidepressant, chamomile, ginko, ginseng-anti-platelet (at least 2
questions)
a. Chamomile→ not ot be had with anti-coagulats
QUESTION: Which one has anticoagulant properties? – St John’s Wort – nope. it’s the saw palmetto
QUESTION: Which one has anticoagulant properties? – Saw palmetto
QUESTION: ibuprofen allergy, dont give aspirin
QUESTION: similar question: Pt has reaction to aspirin, cannot give what else? Ibuprofen (only nsaid in
the answers)
One very important point is that most NSAID's (or Non-steroidal anti-inflammartory drugs) cross-react
with aspirin - meaning that they can cause the same types of reactions in aspirin sensitive people
QUESTION: If someone can’t take ibuprofen what can u give them?
a. aspirin
b. demerol narcotic w/out aspirin
c. pentazocaine - narcotic w/aspirin
• safe to use for pt w/
QUESTION: Methotrexate toxicity increases with use of nsaids or penicillin
QUESTION: No NSAIDs for asthmatic patient
QUESTION: in asthmatic patient===nsaid contraindications - NSAIDS cause bronchospasm.


QUESTION: What doesn’t affect platelets of list of NSAIDS: Celebrex
QUESTION: Celebrex- Cox 2!!!
QUESTION: Does NOT have an affect on platelets (from list of NSAIDS): Celebrex/celecoxib is a
NSAID
QUESTION: Something about arachidonic acid breakdown….Prostaglandin? Bradykinin?
QUESTION: Oral Ketorolac: NSAID,usually used after IV dose of Ketorolac after surgery
Ketorolac (toradol) can be given orally or IM. Ketorolac is used to relieve moderately
severe pain, usually pain that occurs after an operation or other painful procedure.
The speed of absorption is faster for intramuscular injection compared to

subcutaneous injection. This is because the muscle tissue has a greater blood
supply than the area just under the skin. Muscle tissue may also hold a larger
volume of medication than subcutaneous tissue.
QUESTION: Ketoralac is an NSAID that inhibits prostoglandin synthesis (competitive non-selective

cox inhib)
QUESTION: What med to give for moderate post-op extraction pain? Ibuprofen, Acetaminophen, NSAID,
opioid
QUESTION: pt has mild pain from ortho. What med NOT to give?
• Aspirin
• Ibuprofen
• Hydrocodone *
• Naproxen
a.acetaminophen (the other drugs are nsaids and they affect the kidney in a more negative way. This
drug affects the liver and causes liver toxicity.)
b.aspirin
c.ketorolac
d.ibuprofen
QUESTION: Tylenol – non-narcotic analgesic of choice for pt taking anti-coagulants – no anti-inflamm.

Properties
QUESTION: For pregnant- only give Tylenol- NOTHING WITH CODEINE
QUESTION: Pregnant patient (third trimester) needs pain medication – options: Tylenol 325mg,
Tylenol 3m aspirin, or ibuprofen 600mg?
QUESTION: Pateint is pregnant and needs 2 teeth extracted, needs postop analgesic what do you rx:
ibuprofen vs aspirin vs Tylenol 3 vs regular Tylenol (I said acetaminophen)
QUESTION: Patient pregnant, what NSAID-Acetametaphin

QUESTION: What is a safe pain killer to give a woman who is pregnant? Tylenol (answer)
QUESTION: Breastfeeding mother don’t give her What? I was expecting tetracycline but it wasn’t there
so I put Propoxyphene because it has aspirin. Maybe could cause Reyes
QUESTION: do not give which medication to lactating female? codiene (yes)
FDA pregnancy category C. This medication may be harmful to an unborn baby, and could
cause breathing problems or addiction/withdrawal symptoms in a newborn.
QUESTION: Kid has pain – acetominophen
QUESTION: What would you give to 5 year old for pain: Give Tylenol

QUESTION: Asthmatic only use Tylenol (not aspirin bc of hypervent)
QUESTION: Kids w fever- tylenol
QUESTION: 5 year old patient with fever and pain
• Codeine
• Tylenol
• Asprin
• NSAID
QUESTION: DEA schedules there drugs by their toxicity ABUSE POTENTIAL or dependency
potential
QUESTION: DEA – classifies drugs on addiction
QUESTION: DEA number required for prescribing opioids/narcotics, like codeine, oxycodeine, etc
QUESTION: dentist cant write prescription for schedule class 2 for back pain.
QUESTION: What is not true of drugs? Schedule II drugs cannot get refill without script . the
following are true:
o Schedule 3, 4, 5 drugs CAN be filled over the phone.
o Scripts must have patients name and address
o DEA number must be on each script
QUESTION: Oxycodone, Hydrocodone: schedule 2

QUESTION: What can be combined with tylenol to make it a level 2…oxycodone, codeine etc.
Tylenol 1 = 8mg codeine ; Tylenol 2 = 15mg codeine ; Tylenol 3 = 30 mg Codeine ; Tylenol 4 =
60mg Codeine
QUESTION Which one is a class 2 narcotic? Vicodin, percoset, hydrocodone
QUESTION Vicodin schedule?: 2 acetaminophen + Hydrocodone

QUESTION Percocet schedule: 2 acetaminophen + Oxycodone
QUESTION LESS than 15 mg of hydrocodone per dosage unit is schedule 2
QUESTION schedule 2: combination products containing less than 15 milligrams of hydrocodone

per dosage unit (Vicodin®)
QUESTION Schedule 3: products containing less than 90 milligrams of codeine per dosage unit
(Tylenol – acetaminophen- with codeine®).
QUESTION schedule 4 narcotic is propoxyphene (Darvon® and Darvocet-N 100®). alprazolam
(Xanax®), clonazepam (Klonopin®), clorazepate (Tranxene®), diazepam (Valium®), lorazepam
(Ativan®), midazolam (Versed®), temazepam (Restoril®), and triazolam (Halcion®).
QUESTION: Drug schedules II or III – they are all acetaminophen with opioid except for one that
was hydrocodene with nsaid (vicoprofen)
QUESTION: Schedule II drug- Percocet (it didn’t say oxycodone so know that Percocet is oxycodone
and Tylenol)
QUESTION: Schedule II narcotic and antipsychotic →neuroleptic analgesia
QUESTION: if a guy wants to relieve his pain for 8 hours- ibuprofen, naproxen, Tylenol, aspirin
QUESTION: If a patient had some teeth extracted and asked what drug he can take that’ll provide at
least 8 hours of relief
a. Tylenol
b. Ibuprofen
c. NAPROXEN- this is what I put
QUESTION: Naproxen 8hr nsaid

QUESTION: Pt. has pain and wants to sleep for eight hours? Naproxen --- a nonselective cox inhibitor—
nsaid
QUESTION: What are you worried about when a patient is on Naproxin? (DDI w/ aspirin antiplatelet
activity)
QUESTION: Which of the following has least effect on platlets/bleeding?
• Aspirin
• Ibuprofen
• Naproxin
Biopsy:
QUESTION: White patch on buccal mucusa? Whats best way to get biopsy?? Smear**
QUESTION: You have a lesion in mouth, you tried to treat it, still looks the same after 2 weeks –
Take biopsy
QUESTION: You have a lesion in mouth, you tried to treat it, still looks the same after 2 weeks – Take
biopsy
QUESTION: Patient comes in with preliminary diagnosis of candidiasis on ventral tongue and floor of
mouth, white lesion rough and firmly attached. What do you do? Incisional biopsy, Do cultural testing
and confirm that it is/is not candidiasis
➢ I chose confirm/deny with cultural test because leukoplakia is when you have no other
differential but idk cuz you have to biopsy leukoplakia and the lesion looked like it.
QUESTION: Oral candidiasis biopsy of choice is – incisional biopsy, excisional biopsy, brush biopsy
(collects the cells for cytological smear), cytomologic smear
QUESTION: When do u have to do a biopsy- I wrote if can’t treat in 10-14days**about 2 weeks—any red
or white lesion that doesn’t resolve itself in two weeks – BIOPSY THAT SHIT
QUESTION: When to do biopsy? whenever there is a progressive metasis even though antibiotics are rx
QUESTION: White lesion 2x3x2 cm – excisional biopsy, incisional biopsy, smear
QUESTION: What should you not do initially with a patient with desquamative gingivitis--> BIOPSY,
topical corticosteroids (other choices were, encourage OH)
QUESTION: When you do biopsy, how do you store the specimen before it gets to oral pathologist? 1.
Formalin (answer)
QUESTION: Patient has a sore, shiny red area that when you blow air on it, a white membrane
comes off and the sore starts bleeding. What should you do? Culture and Medical
management (Or biopsy + Med Man)
QUESTION: To test for malignancy what test? Cytology, brush biopsy, etc? Incisional biopsy
QUESTION: Difference between incisional and excisional biopsy
Notes:
Incisional biopsy is a technique used when a lesion is large >1 cm, polymorphic suscpicious for
malignancy, or in an anatomic area with high morbidity,
Excisional biopsy is used on smaller lesions <1cm that appear benign and on small vascular and
pigmented lesions. It entails the removal of the entire lesion and a perimeter of surrounding
uninvolved tissue margin.
Implant:
QUESTION: Diff btween 1 stage and 2 stage, immediate loading vs traditional way
QUESTION: What kind of bacteria is under implants? At the apex of root canal?
Gram negative, Gram positive, Cocci, filament, rods. Know each.
Gram (-), rods and filaments anaerobic
Strict anaerobes are predominate in endo
QUESTION: What bacteria is responsible for implant falure?- gram – anaerobics
QUESTION: Bacteria around failing implants? Gram negative,motile, strictly anaerobics

QUESTION: best area to place implant? Anterior mand or posterior mand wasn’t sure
QUESTION: best bone to implant in --- apparently ant md? WORST: post mx
QUESTION: when an implant placement where in the least success: MAXILLARY POSTERIOR
QUESTION: Implants osteointergrate best in ? anterior mandible

QUESTION: Best area to place implants? – Anterior Mandible
QUESTION: best reasoning for implant in max lateral
a. no rest on central & canine
QUESTION: what is the least important factor when evaluating for implant: ( concavity of mandible,
bone density , distance to mandibalr cancal, bone width)
QUESTION: Bone should not reach temperatures above? (temperature in Celsius) 47 for 1 min 40
for 7 mins
QUESTION: What is the limit before bone dies in implant procedure (in Celcius!): 47 for 1-5 minutes
QUESTION: Max temperature for bone in implants 47*C
QUESTION: Temperature you don’t want to exceed during implant placement? They had 26, 36, 56. No
47. I chose 56
QUESTION: implant to implant – 3mm
QUESTION: Distance between adjacent implants minimum? 3 mm
QUESTION: Distance between two implants: 3mm
QUESTION: Space between 2 adjacent implants 3mm. 1.5mm teeth
QUESTION: How much space between implant and tooth? Answers were 1.5, 2, 3.5 3,
QUESTION: space from implant to nerve needed…2 mm
QUESTION: Minimum width (bucco-lingually) bone should be for 4mm diameter implant
Choices were 5mm and 7mm → I put 7mm (4 for diameter + 1mm each side = 6)
QUESTION: Minimum ridge width for 4mm implant is?

a. 6mm
b. 8mm
c. 4mm
d. 10mm
QUESTION: if implant with width of 4 is used what should be the bucolingual width of the ridge----6
Need 1mm bone on each side (facial and lingual)
minimum Vertical height of bone to place implant - 10mm (according to decks)
minimum Width of bone is 6mm
minimum distance of apex of implant From nerve - 2mm

platform of implant from adjacent CEJ - 2-3 mm
between implants 3mm
between implant and tooth (height of coutour) is 1mm
Mini implant is 2.4mm
QUESTION: When there is FPD from natural tooth to implant, the max stress is concentrated on the
SUPERIOR PORTION OF THE IMPLANT.
QUESTION: If implant and bridge are done with natural tooth, what is the complication?, there is a
lot of force on crown of implant and cause fracture. → diff mobility
QUESTION: how does fibers grow from crest of bone to implant?

Perpendicular with implant, parallel with implant, other options that didn’t make sense
QUESTION: How does gingival fibers orient next to implant – parallel to implant with no insertion,
perpendicular with insertion, parallel with cuff, perpendicular with cuff.
QUESTION: Tissue around implant? PARALLELL WITH CUFF LIKE
QUESTION: How does gingival fibers orient next to implant – parallel with cuff, (Parallel and/or circular
to implant surface)
Periodontium surrounding the implant: no periodontium, bone and implant.(false)
You have long JE and ct (parallel and circular only)
Periodontium = gingival, pdl, cementum, and bone
QUESTION: CASE: Case shows a picture of a bridge, when you look at it closely it resembles a
Maryland bridge because lateral is intact. What to do if Maryland is removed?
-regular bridge
-implant- she answered this because lateral was intact.
QUESTION: know implants CI:

uncontrolled diabetes
immunocompromised patients
volume and height of bone(anatomic considerations)
bisphosphonate therary
bruxism
tobacco(relative)
cleft palate
young kids
QUESTION: Contraindications to implant placement? Adolescents should not get implants.

QUESTION: never place implants in a patient that had cleft palate
QUESTION: Bruxism is implant CI
QUESTION: Old people can get implants
QUESTION: All affect implant placement EXCEPT – smoking 1 pack a day, cardiovascular disease,
uncontrolled diabetes, radiation of 60 Gy
QUESTION: Does not affect implant success? Age
QUESTION: All these are contributing factors for why implant wud fail in this pt except: smoking,
diabetes, AGE, etc. (AGE)
QUESTION: Implant treatment better option for smoker than perio surgery because perio surgery
in smoker doesn’t work as well as non-smoker.
QUESTION: When getting crown for implant, what occlusal scheme is preferred? metal occlusal is
preferred
QUESTION: When you use screw over cement retained? when you don't have space occlusally,
use screw
→ need more interocclusal space for cemented
QUESTION: What is the purpose of hex screw? Antirotational
QUESTION: External hex function: anti-rotation
QUESTION: Hex screw implant – prevent rotation of the crown
QUESTION: A lot of implants have external hex-what is it used for?

• For cementation
QUESTION: What is the component of the implant that replicates implant in cast? ---analogue
QUESTION: What is most important for osteointegration in implant procedures? – How well the surgical
procedure is managed.
QUESTION: Osteointegration of implants should be assessed:
prior to placement of restorative abutment- That’s why you torque before restoration.
QUESTION: At what appointment do you first check osseointegration-2nd stage surgery I think
QUESTION: When do you check osteointegration? Before place of abutment

QUESTION: when can you tell the an implant is osseointegrated : a)before taking the final
impression. B)before placing the abutment c) before cementing the crown
QUESTION: All of the following are true about Surgical stents, except? – It tells you the number of
implants you can place. (Other choices were, angulation of implant, location implant, thickness of
implant. I think number of implants to be placed is decided before the stent at the time of CT xray or
during a consult)
QUESTION: why do you use a stent? – make sure implants are aligned properly
QUESTION: Implant question: surgical template for angulation of bur for implant placement
QUESTION: implant guides and what info it relates to the surgeon: location, angulation, size,
number of implants
QUESTION: What will you do when implant is inclined too buccally and you don’t want the screw to
be seen on the buccal surface of crown? Angled abutment
QUESTION: implant placed in facial angulation, what do you do to prevent facial access for screw
abutment? I said place an angled abutment and cement it down; other options is correct implant
placement or put composite where facial access for screw will be
QUESTION: Implant placed at angle where screw hole will be on buccal surface. What do you do so
that you can’t see screw on buccal?
Cover with composite?
Angled abutment cemented?
Remove implant?
QUESTION: implant is angled to facial, use custom abutment

a. torque
b. compressive
A compressive force presses the components of the system together and normally does not
introduce any mechanical problems in the anchorage unit itself. On the other hand, tensile loading
refers to a force that tends to separate components
QUESTION: What is the problem with preloading a screw implant? Low loading can make it loose, high
loading can make it loose, low loading can lead to implant creep or something, high loading can lead to
implant creep (wtf)
High frictional forces between components decrease as a result of Creep leads to a decrease in preload
QUESTION: In an appointment for the impression of implant what do you do first? put the coping
first
QUESTION: What do you want to do first when taking an impression of the implant and abutment
splinting the 3 implants with a bar?- Make sure the abut is attached right when the pt comes in others
were check fit of custom tray, incert impression coaping, insert imp coaping with acrylic.

Advantage to open tray technique: Reduce effect of implant angulation
QUESTION: open technique impression for implant: to transfer the exact angle of implant to the lab
Open tray: pick up, reduces effect of implant angulation, don’t have to put coping back into
impression, impression material not deformed. Open tray is more accurate
Closed tray: transfer, easier, better for shorter interarch distance, more accurate, not
suitable for deep implants, don’t work for nonparallel implants
QUESTION: Mobility in implants is failure, remove and greft

QUESTION: Implant success is determined by what? – Mobility
QUESTION: During uncovering, you realized implant is mobile and there is bone loss - failed
implant, take it out!
QUESTION: What main reason implants fail? Surgical error , Lack of early loading , Inadequate
occlusal design
QUESTION: Most common implant failure due to Screw loosening, occulsal loading, Does not
osseointegrate
QUESTION: Most common complication for crown? screw loosening
QUESTION: 10-year success rate: -I think its 80 for 10yrs and 85 for 5yrs; what is most common
reason of failure
QUESTION: Most important thing about implant success (in the procedure the things are most important
for osseointegration)
QUESTION: Major mechanisms for the destruction of osseointegration are
o Similar to those of natural teeth
related to implant material
related to nutrition
QUESTION: Why implant fails: no osseointegration
QUESTION: What causes the greatest incidence of implant failure? Overheating not smoking.
QUESTION: What is the worst type of force for an implant? Horizontal.
QUESTION: When you place a implant, widening of crestal bone is seen because of which force?
horizontal
QUESTION: What main reason implants fail

Surgical error
QUESTION: Most likely to cause implant to fail?

Smoking
Hypotension
QUESTION: What is the strongest from lateral force…2, 5mm implants splinted together, 1 single 4 mm
wide implant, etc,
QUESTION: What causes the least buccal-lingual resistance to lateral forces?
CHOICES WERE:
2-4 mm below cej of adj tooth… I chose this
CHOICES WERE:
2-4 mm below CEJ of adj tooth…I chose this
ANSWER IS 2-3mm below CEJ
QUESTION: Implant…BELOW the gingiva (for better esthetics)

QUESTION: implants placed 2-3mm below adjacent tooth
QUESTION: where should you put implant platform in esthetic area (at level of alv.crest/ below
opposing tooth gingiva, etc.) I didn’t know answer, just went with whatever put it subg
a. 1mm subgingival to adjacent teeth CEJ
QUESTION: To obtain ideal emergence profile, where should the Implant head be in relation to
adjacent gingival margin? 1-2mm above, 3-5 mm above, same level, 1-2 mm apical
QUESTION: If you want the most natural emergence profile for an implant, how far should the
head be from the gingival? I put 2-3 mm apical
QUESTION: Cervical position while placing an implant-How much below CEJ? (3mm…Xtina) **Rest
platforms placed 2-3 mm below adjacent CEJ. Implant 5 mm from mental foramen, because nerve loops
out 4 mm. Implant 2 mm from vital structures. At least 1 mm of bone all around implant. 1.5 mm of bone
between implant and adjacent tooth. 3 mm of space between adjacent implants.
QUESTION: how far up or down from tissue should the implant be placed in relation to adjacent CEJ
***implant platform should be 2-3 mm below adjacent CEJ
QUESTION: Where should implant / abutment interface ideally be?
A: At height of alveolar crest
QUESTION: Trauma from occlusion in implants – no gingivitis
QUESTION: All are symptoms of TFO (trauma from occlusion) on an implant except. Gingivitis, pain,
loosening of implant, breakage of abutment screw.
QUESTION: What evidence is not seen in failed implants: something about gingivitis
QUESTION: 1mm crestal bone remains around implant after 1 year, why? inflammation, heavy occlusal
load,
QUESTION: Which of these show clinically acceptable results of implant placement? ;Periimplant
pathoses, implant mobility, .ans. bone loss less than .1mm per yr or
QUESTION: Implant success criteria--- I think choices included mobility,
(ONLINE) The basic criteria for implant success are?
immobility, absence of peri-implant radiolucency, adequate width of the attached gingiva,
absence of infection
Average bone loss of 0.2mm for the first year is acceptable
QUESTION: Whats the worst thing you can do to a tooth you plan to re-implant right before you do so?-
Scrape the tooth with a curret.
QUESTION: How does titanium of an implant help in osseointegration? Forms titanium oxide
layer
QUESTION: If doing implant for that area where supposed radiopacity? What are your
considerations; interocclusal height or width; would you excise lesion? NO
QUESTION: Check to see when your placing implants, whether or not radiopaque lesions are of
concerns?
QUESTION: Which of the following is bad for placing implants except…radiopaque
QUESTION: When placing implant mandibular posterior how do you ensure you don’t hit IAN? Look
at panorex and measure with mm caliper, look at PA and put some screen over to measure,
QUESTION: implant supported bridges and one doesn’t fit.
Section and index
QUESTION: At the time of delivery of an implant supported prosthesis, only 2 of the 3 implants
seat. What do you do next? I put separate the prosthesis and re-index it
QUESTION: Implant retained fixed prosthesis, doctor took radiograph and it showed 2 out of 3 implants
seat positively with good margin. What should doctor do after?
• section and index* This is what I put but not sure
• tighten screw
QUESTION: Which one is true about implant placement? – High Torque (other choices were high speed,
etc) **handpieces for implants are low speed and high torque
QUESTION: what speed and torque for implant is used: High Torque, slow speed
QUESTION: use high torque for implant: Implant handpiece = High torque, low speed
QUESTION: Which one is true about implant placement? – High Torque low speed
QUESTION: Which of these is not a consideration for replacing patients lower molars with implants?
Bone quality in the area? (I don’t think that’s the answer, cuz it is but he says in mandibular it should
always be good)
QUESTION: Pano given, sinus very low, what should be done prior to implant? Bone graft should be
done
QUESTION: Max sinus lift implants
QUESTION: In implant preparation, which of the following can be used? A) hydroxyapatite irrigation b)
High Speed Hand Piece c) Low torque Drill d)Air Coolant. IT SAYS COOLING SALINE SPRAY IN
FIRST AID
QUESTION: water is used when implant placement- cooling

QUESTION: Why you use irrigation in implant surgery? – To prevent bone from over heating. (other
options were to keep it clean, etc)
QUESTION: Why you use irrigation in implant surgery? – To prevent bone from over heating.
QUESTION: Why do you irrigate while preparing osteotomy for implant: keep bone cool (but clear
blood to visualize and remove debris make sense)
QUESTION: When doing an osteotomy for implant placement why do you use saline: to help cool
down the bone
QUESTION: When placing an implant, you keep the temperature of the bone below 56 degrees C how?
→Alkaline irrigation,
QUESTION: Percent of implants that are successful after 10 years: think its 80%.
QUESTION: What is the success rate of implants in 10 years? I put 90% (80)
QUESTION: % of implant success after 10 years : 95 %
QUESTION: When not to immediately load an implant
• Bone grafting with GTR: ans
QUESTION: Implant supported RPD, where to put occlusal rests→ None
QUESTION: where do you put occlusal rests for implant abutment rpd? NONE!!!!
QUESTION: I believe u can place implant in patient who has INR less than 2.5 *uhhh normal INR =
1…and higher INRO leads to a higher chance of bleeding.. People on anticoags INR range is around 2-3
or on higher doses 2.5-3.5
QUESTION: 13y/o present for implants : wait until 18-20 y/o
QUESTION: how to clean implants (os decks) ** Plastic scaler
QUESTION: implants, which instrument is ok to use for perio? plastic perio probe
QUESTION: Do we probe like normal for an implant?

A. No because you will disturb the epithelial attachment
B. I put yes. It didn’t say anything about a plastic probe being available but it seems like we still
would have to probe.
QUESTION: How to clean implant- prophy cup, plastic, not stainless steel!
QUESTION: indications for implants vs fixed partials
QUESTION: type of epithelial and connective tissue attachment to implants

QUESTION: Implant interface- how does CT and epithelium react? Like normal or not (for each)
QUESTION: Pt has an implant. Do the connective tissue and epithelium attach the same as they do to
natural tooth, meaning biological width?
QUESTION: Epithelial attachment for implat?
• Hemidesmosome* (epithelial attachment to tooth structure and implant are the
same)
• fibronectin
QUESTION: You are considering the placement of an upper and lower important retained complete
denture. How many implants will you place in the anterior region?

a. avoid wearing anything for 2 weeks
QUESTION: esthetics of a max central anterior implant replacement determined

• adjacent tissue
• perio of other maxillary central
• wax up to full contour (did not understand this question)
QUESTION: When palciing implant in max central, most important thing to consider in esthetics:
emergence proifile, perio health of adjacent tissues
Extraction:
QUESTION: 13 year old had 2 bombed out molars, asked what treatment is best: extractions,
extractions followed by implants, extractions followed by RPD, Root Canal and Crown
QUESTION: extracting upper posterior molars…order of extraction and reason? First, second then
third molar for visualization, 3rd,2nd,1st to prevent fracture of tuberosity, then the other
options didn’t make sense.
QUESTION: order of tooth extraction…1st molar, 2nd then 3rd for visualization or 3rd then 2nd then 1st to
spare tuberosity MAXILLARY Teeth first and MOST POSTERIOR TEETH FIRST
QUESTION: Same old question of where is the max 3rd molar most likely to be displaced?
A. infratemporal fossa**
B. maxillary sinus
QUESTION: When extracting 3rd molar, which space is it most likely to become dislodged in
QUESTION: What is the most common impacted tooth? Maxillary K-9. (after 3rdmolars? Xtina)
QUESTION: The most frequently IMPACTED teeth are MANDIBULAR 3rd MOLARS (followed by
maxillary 3rd molars and maxillary canines).
QUESTION: Most common impacted tooth? (3rd molars not an option) – max canines
QUESTION: Most impacted tooth? →Maxillary canines
QUESTION: Which tooth is least likely to be missing – I said canine (other options are 2nd pm, lat
inc, and 3rd molar)
QUESTION: What is least missing tooth congenitally? – canines, premolars, 3rd molars, lateral incisors
QUESTION: What is least missing tooth congenitally? –(others were 3rd molars, lateral incisors,
canines) nope. canine is the best option. of all 32 teeth the 2nd mand premolar is the 3rd MOST
congenitally missing. #1: 3rd molars, #2 max lateral.
QUESTION: Least congenital missing tooth (most 3rd molars, mand 2nd premolars, lateral incisors,
max 2nd premolars)

extraction of molars with divergent roots :hemisection
QUESTION: Easy to extract impaction in max tooth:
-Distoangular, Maxillary: maxillary 3rd molars, mesioangular impactions are the most
difficult to remove, while vertical and distoangular impactions
are the easiest to remove.
-Mesioangular: Mandibular
QUESTION: In which direction do you luxate distoangular max third molar? distal palatal,
distobuccal ,palatal, mesial
QUESTION: #32 - Complete bony impaction, horizontal…main concern? Excessive bleeding,

damage to nerve, etc. (he put damage to nerve)
QUESTION: #16 - half in bone, half in gum → most common kind of impaction & easiest to take out
(both FALSE)
QUESTION: FMX, question about right side of patient, #1 and #32 were both impacted, how would you
describe these impacted teeth? - #1 disto-angular impaction, #32 horizontal impaction (other choices had
other angulations, but with FMX, it should be straightforward to guess them right)
QUESTION: most important in eruption: sequence
QUESTION: RL under the furcation in primary teeth?
1. Diagnosis is pulpal necrosis
2. Treatment: EXTRACTION
QUESTION: ectopic eruption of mand 1st molar in relation to primary mand 2nd molar cause some
resorption –management: extraction of 2nd molar, separation, disking of 2nd molar
QUESTION: When you extract 3rd molar, inform possible damage. Extraction of lower 3/2 molar dmg to
lingual nerve
QUESTION: Greatest risk to injure IA nerve on extraction of third:
Forgot last option
QUESTION: Most likely to cause nerve damage during extraction? Nerve canal overlaps apices?,
nerve canal narrows
QUESTION: where is most likely to damage a nerve in vertical realese of flap : lingual, wharton’s
duct and the sublingual gland ( avoid vertical insicions in lingual and palatal )
QUESTION: Doing flap surgery on mandible, what structure do you watch for? I put
mental nerve (If 3rd molar TE= Lingual)
QUESTION: Doing flap surgery on mandible, what structure do you watch for? mental nerve mentalis
attachment
QUESTION: Where does man branch of trigeminal nerve come thru? Ovale
QUESTION: Old guy with impacted 3rd molar, whats indication for extraction?
QUESTION: Indication to extract third—choices were making space for ortho, prevent crowding, pt has
pain during eruption, there’s an infection
QUESTION: 65 yo has hypertension and congestive heart disease, referred to you to TE impacted molar,
absolute indication to do the TE is when – radiograph shows bone pathology prevent distal pocket of
2nd molar, prevent jaw fracture, prevent distal caries for 2nd molar
QUESTION: Old patient, medically compromised with impacted molar extraction, only reason to extract
them is? if you notice pathology
QUESTION: Patient has pain, trismus, inflammation for 3rd molar – TE
QUESTION: Know pericorinitis treatment, question had nothing to do with surgery though.
Wout surgery…clean and antibiotics
With surgery…. Before surgery..control infection. IND, irrigate drain, antibiotics, then remove the 3rd
molar
QUESTION: MOST common complication of extracdtion? Hemorge, infection, root fracture?
QUESTION: Radiograph of mandibular molar extraction sight. Patient came back having pain and
puss in that area: did not have dry socket as a choice??? Infection? osteomyletits
QUESTION: A picture of Occlusal radiograph with a lot of bone resorption - patient has pain and
something was draining after few weeks of EXT – Osteomylitis (other were radicular cyst, lateral cyst,
etc) Osteomyelitis common following tooth extraction -- bone infx
QUESTION: Xray of Older woman tooth extract 3 years ago, still hurts and exudate, shows (cotton-wool
radiograph, "prob wrong") what is it? Residual cyst, osteomyelitis, 2 other lesions that are radiolucent
QUESTION: X ray: pt had tooth extraction 3 years ago at site, now site has draining tract and painful, x-
ray shows a radiolucent area over ridge no teeth around area—forgot the answer choices
QUESTION: You got patient with Osteomylitis, after EXT, what do you do? you clean the walls of the
socket to remove infection)
QUESTION: patient w/ Osteomyelitis, after EXT, what do you do? I said put dressing in hole (wrong,
you curretage the walls of the socket to remove infection) (Mosby says…for acute treat with appropriate
antibiotic and drainage of lesion…for chronic treat with antibiotics and sequestrectomy…Xtina)
QUESTION: Premolar with huge MO amalgam and recurrent caries and if needing saving needed CL,
endo and crown-didn’t have all there options so i put extraction because C:R ratio would have been
bad
QUESTION: Extraction #30 which way would you section? B-L

QUESTION: Extraction of #30 which way do you section: Buccal- lingual
QUESTION: After fx a mesial root tip on a molar extraction whats the first thing you do?- get hemostasis
and visualive the root. Others, take an xray, pick at it with root pick, surgical retrieval
QUESTION: resorption of bone takes place in which direction after extraction----
downward/inward,downward outward,forward inward (something)
QUESTION: Aderall 5 yr old kid on prescription. needs an extraction. do u higher the dose? lower
the dose? no change?
QUESTION: which direction do you luxate the tooth --**Children: Palatally, bc molars are positioned
more palatally and palatal root strongest. Adults: bucally!!!
QUESTION: Patient is about to undergo radiotherapy, what do you? – EXT all questionable teeth before
radiation. (another answer said, EXT all teeth before radiation)
QUESTION: Patient is taking IV bisphosphanates and need TE – RCT then coronotomy and seal,
hyperbaric oxygen followed by TE, antibiotics and TE, Bisphoshanates.
QUESTION: A patient has begun radiation therapy in the mandible and needs teeth extracted. What do
you do?
DO endo, and amputate the crown without any trauma to soft tissue or bone
QUESTION: A patient received radiation therapy and requires extraction,what should the treatment
be? Extraction, extraction with alveoloplasty and sutures, extraction with alveoloplasty of basal
bone and suture, pre-extraction and post-extraction hyperbaric oxygen
QUESTION: Best tx for bisphosphonate iv patient? 1. Best tx is do rct and section crown off (as oppose to
ext) (answer), 2. Atraumatic ext, 3. Ext under hyperbaric oxygen. The answer was confirm by oral
surgeon.
QUESTION: It pt has been on IV bisphosphonates for two eyars? Do root canals and keep roots,
no exts
QUESTION: Look up side effects of bisphosphonates. Contraindicated except? → RCT is ok!!!!!!!
QUESTION: All of the following are contraindicated for bisphosphonates, except? – Do RCT (other
choices were invasive procedures)
QUESTION: Pt on IV bisphosphonates for 6 months needs tooth extracted what do you do? Atraumatic
extraction, hyperbaric oxygen and then extract, try to do RCT or some other form of restoration
QUESTION: Patient taking bisphosphonates for 6 months, but now needs extractions. Nontraumatic
extraction? Or hyperbaric oxygen and then extraction
QUESTION: Patient is on 6 months of bosphophanate therapy what do u do? Hypo dives and extract,
atraumatic extraction, or endo with crownectomy and place sealants
QUESTION: Pt on IV bisphosphonates for 6 months needs tooth extracted what do you do?
Atraumatic extraction, hyperbaric oxygen and then extract, try to do RCT or some other form of
restoration
QUESTION: if Pt takin biphosphonates for 3 years and tooth non restorable what is the Tx : a) endo
of remaning root b) extraction …. Etc Extract + Abx
QUESTION: pt has history of osteonecrosis and need to do extraction: can do under hyperbaric o2
QUESTION: pat has history of osteonecrosis and need to do extraction: give hyperbaric o2
QUESTION: Iv bisphosphonates and extractions are needed-what do you do? (hyperbaric O2 dives)
QUESTION: Patient has bronj and bone is exposed, what is treatment? hyperbaric oxygen, sc/rp,
chlorhexidine rinse (antibacterial rinse, and oral antibiotics)
QUESTION: Osteoradionecrosis: Swelling, degeneration and necrosis of the blood vessels with
resulting thickening of the vessel wall. Use hyperbaric for angiogenesis
QUESTION: when do you do serial extraction?
space deficency in the max ant region
b. space deficiency in the max posterior region
c. space deficiency in man ant region
d. space deficiency in man post region
b. for space deficieny in mandibular posterior region
#9 Periosteal elevator
#23 Mandibular cowhorn
#74 ash forceps (mand PM)
#151A (premolars)
#65 Bayonet-shaped forceps – Max incisors or roots
Cryer elevator: best for single retained root of extracted mandibular molar
Upper cowhorn forcep is #88 right and left for upper molars
Lower cowhorn forcep is #23 for lower molars
#151A is modification of #151, and it’s for mandibular premolars only
#17 is for mandibular molar but not fused root
#222 is for mandibular molar but fused root
QUESTION: What forcep used for mandibular premolars? 151 or 151A
QUESTION: What number forceps to use when extracting mand premolars: 151A or 74 (ash)
QUESTION: What forceps are best for a mandibular premolar extraction? #17, #23, #151, #150
(whichever is ash forceps)
ASH IS #74!!
Max Molar 150
Mand Molar 151
QUESTION: extraction a mandibular molar and all of a sudden mesial root break:what instrument
u use? crayer forcep
QUESTION: what does Medicaid cover? Extraction, 1 denture , children until 18
QUESTION: What cover Medicaid? Extractions, one time denture, children until 18.
QUESTION: Biggest risk with extracting remaining max molar? Fracturing tuberosity
QUESTION: When ext erupt max molar what is most like cause of complication (I said It was high
chance of max sinusitis, other is that you can have broken tuberosity/sinus floor, or high chance
of dry socket because low circulation)
QUESTION: Lone molar beware cuz tubersotiy fracture

QUESTION: removing a single lone max molar: worry about tuberosity fracture and sinus
involvement due to pneumatization
QUESTION: Lone molar ex most likely to fracture maxillary tuberocity (“beware of lone molar”…Xtina)
QUESTION: Can tell its ankylosed if submerged (there was an answer different sound but I think that’s
wrong) **Decks state that an akylosed tooth emits an “atypical sharp sound on percussion” soooo I think
different sound is right. Also “Beware of the LONE molar” → they are usually ankylosed.
QUESTION: Oro-antral communication 2mm- do nothing
QUESTION: You see sinus is open by 2mm with ext what do you do: don’t do anything and
observe
QUESTION: Oro-antral communication of 4mm, what do you do? Observe, buccal flap, palatal flap?
FIGURE 8 SUTURE
QUESTION: Oroantral communication best Tx? DEPENDS: <2 DO NOTHING, 2-6mm AB, nasal
deconjest+ figure 8 suture, more than 6 = flap surgery
QUESTION: If you have 3mm unifected root into sinus, what you do? You do one an attempt, and if
unsuccessful, leave it alone, no surgery.
QUESTION: What is the Caudwell lock technique? Removal of root tip from max sinus, incision over
canine fossa.
Suture:
QUESTION: What kind of suture do you use if you are only removing on one side of tooth…sling,
continuous, interrupted
QUESTION: What suture when only buccal tissue is displaced? I put interrupted
QUESTION: What suture do you place when you only displace facial of mandibular teeth? I put
interrupted; mattress, continuous, etc were other options.
QUESTION: best way to suture an incision? interrupted suture

c. immobilize the flap
QUESTION: what suture allows bacteria to invade – gut, silk, nylon
QUESTION: What suture contains wicks(?) that allows bacteria to enter extraction site?
Gut
Silk
Nylon
QUESTION: suture -movable to non movable

QUESTION: Incision on the corner of lip, where do you put suture: movable to fixed (Most important is
the vermilion border)
QUESTION: If 2cm laceration on lip how do u stich- continous, in middle and work both ways, reconnect
orbicularis oris first, reconnect vermillion border first, continous
Incisions/Flaps:
QUESTION: Types of Periodontal Flaps? Just 3... Modified Widman flap, Undisplaced Flap, Apical
Flap
Modified widman flap: Instrumentation for root therapy, not pocket depth reduction but removes
pocket lining→ pocket shrinkage bc healing. Internal bevel incision.
Undisplaced flap: PD reduction. Excisional procedure of gingiva = gingivectomy. internal bevel

gingivectomy. But also reverse bevel. Final placement of flap determined by first incision
Apical positioned flap: pocket elimination (by apical position) and/or increases width of attached
gingiva. Best position is 2mm apical to alveolar crest. Internal bevel incision.
Periodontal flap preferred for mandibular anteriors. Lateral repositioning is done for gingival
recession.
QUESTION: Least desirable place to place graft: mandibular 1st premolar space
QUESTION: Careful with mandibular flap: a. mental nerve, chin, vestibule
QUESTION: Location apical position flap contraindicated: max palatal
QUESTION: Extrusion of canine what flap technique is used except 1)Envelope flap 2) Semilunar
flap 3) Apical repositioning flap
QUESTION: modified widman flap can be characterize by all BUT – internal bevel incision, replaced flap,
QUESTION: know actual procedure of modified widmam flap, (Internal or external bevel, is it apically
repositioning? Etc) It is internal bevel and replaced/nonrepositioned flap.
QUESTION: I had many modified widman flap qs, where do you make incision to? (T/F: to the base
of pocket. I put false, not sure tho)
Another side note: Flap reflection with the MWF approach is only 2 to 3 mm beyond the alveolar crest
and not beyond the mucogingival junction. al, Rose et. Periodontics: Medicine, Surgery and Implants.
Mosby, 072004.
QUESTION: Indications for modified widman flap :

QUESTION: modified widman flap can be characterize by all BUT – interal bevel incision, replaced flap
Reflected beyond mucogingival line (which would be false)
QUESTION: With a modified Widman flap you mostly reduce bone if…
a. adapt the flap margin
QUESTION: What type of incision for palatal tuberosity reduction- T, Y **not sure but all I found was that
an “elliptical” incision is made so that from cross section the cut is oblique—and diverges towards the bone.
A. The most optimal flap uses a midline incision which courses from the papilla between teeth #8 and 9
posteriorly to the junction of the hard and soft palates.
B. The most optimal flap is a reflection of the entire hard palate mucoperiosteum back to a line between the
2 first molar teeth.
C. The most optimal flap uses a midpalatal incision that courses from the palatal aspect of tooth #3 across
to the palatal aspect of tooth #14
D. The most optimal flap is shaped like a "double-Y", with a midline incision and anterior and
posterior side arms extending bilaterally from the ends of the midline incision.
QUESTION: Y shaped palatal incision. Maxillary tori removal

QUESTION: where don't you do an apical flap? - maxillary palatal area
c. maxillary facial
QUESTION: Where can you not do a apical positioning flap:Max palatal area
QUESTION: Where can you not do apical flap: lingual of maxillary molars
QUESTION: Distal wedge contraindication? On 3rd molars without attach gingiva
QUESTION: CI when using distal wedge technique: Not enough keratinized tissue.
• Mental nerve
QUESTION: how to fix gingival recession in anterior region: pedicle graft (laterally repositioned
flap) (never lost blood supply)
QUESTION: bleeding points – used for incisional area location
QUESTION: What is purpose of “bleeding incisions” in gingivectomy? No idea what that is: choices
were like: location of dehiscence, location of alveolar defects, guide for incision
QUESTION: Function of bleeding points in gingivectomy: to guide incisions,
QUESTION: Bleeding spots established in gingevectomy to? I think outline incision line.
QUESTION: Gingivectomy indications/contraindications
QUESTION: Gingivectomy is for? supra bony pocket
QUESTION: gingivectomy done for hyperplastic gingiva
QUESTION: Indications for gingivectomy – gingival hyperplasia,
QUESTION: Few questions on when to do and not to do gingivectomy? infrabony pkts, gingival
hyperplasia, little attached gingiva, high smile line…
You do gingivectomy to: eliminate supra bony pockets, eliminate gingival enlagements or eliminate
suprabony periodontal abcess
You DONOT do gingivectomy if osseous recontouring is needed, if the bottom of the pocket is
apical to the mucogingival junction, if there is inadequate attached gingivaa, or if aesthetic is
concerned.
QUESTION: Which is contraindicated in 2nd molar region to reduce deep pocket with limited
attached gingiva? Gingivectomy
QUESTION: If little attached gingiva is present and have deep pockets, what will you NOT do to get
rid of them
o Gingivectomy
o Cannot graft
QUESTION: Gingivectomy is contraindicated in: when the sulcus is apical to gingival groove, sulcus is
apical to convexity of tooth, sulcus is apical to the crest of alveolar bone.
QUESTION: CI of gingivectomy-not enough keratinized tissue
QUESTION: Patient has very little keratinized gingiva which of the following flaps should u not do:
gingivectomy
QUESTION: mandibular molar minimum keratinized gingiva with pocket depth? Which of the
following way is not acceptable is a way to minimize pocket depth? Gingictomy
QUESTION: Patient has crown #18 w/ minimal attached gingival. Which do you NOT do to
expose the finish line? don’t do gingivectomy
QUESTION: gingivectomy is contraindicated with? minimum attached gingiva
QUESTION: Contradiction to do gingevectomy is when ? when there is infra bony pocket – when there
is a defect!!!
QUESTION: When do you not do gingivectomy – apical to the alveolar crest
QUESTION: Gingivectomy is contraindicated when bottom of the pocket is apical to alveolar crest
(infrabony)
QUESTION: Which of these is a contraindication to a gingivectomy? I put if the pocket extends

beyond the mucogingival junction (also infrabony pockets present)
QUESTION: Intrabony bone defect?

Same as infrabony, Vertical bone loss.
QUESTION: What should be considered for gingivectomy? level of attached gingiva*, degree of
attachment loss
QUESTION: Gingivectomy type of Bevel used? , external bevel incision ??
QUESTION: gingivectomy - is it incisional (reverse) or excisional
QUESTION: When doing gingivectomy, which is NOT right about internal and external bevel?
QUESTION: Epithelium over connective tissue, how fast per day in mm? 0.5-1mm (RELATED TO
GINGIVECTOMY)
QUESTION: How many mm a day does epithelium grow over connective tissue? 0.5-1, 1-2. 2-3 NO
CLUE
QUESTION: How does external bevel gingivectomy heal? Primary intention, secondary, tertiary, granular
tissue formation
QUESTION: How does external bevel gingivectomy heal? Primary intention, secondary, tertiary,
granular tissue formation
Primary healing=flap
Secondary healing is for sc/rp and regular gingivectomy
Tertiarty healing: Tissue grafts
QUESTION: After a gingivectomy how does the site heal?

QUESTION: How does site heal after gingivectomy? Long junctional epithelium
QUESTION: After lay a flap: how does wound healing work: long JE, new ct attachment?
QUESTION: Following flap surgery, new junctional epithelium can form on either cementum or
dentin, junctional epithelium is reestablished as early as one week.. First is False, Second is true.
QUESTION: Following flap surgery, new junctional epithelium can form on either cementum or dentin.
Junctional epithelium is reestablished as early as one week. BOTH ARE TRUE
QUESTION: after you perform a flap where you see regeneration : →ephitelial attachement via
long junctional epithelium and connective tissue adhesion.
QUESTION: Healing of flaps surgeries: something about its Long junctional epithelium
QUESTION: What do u want from perio flap: want regeneration of PDL cementum and bone
QUESTION: The soft tissue-tooth interface that forms most frequently after flap surgery in an area
previously denuded by inflammatory disease is a
E. collagen adhesion.  
F. reattachment by scar.  
G. long junctional epithelium.  
H. connective tissue attachment.  
QUESTION: type of healing in SRP and free gingival graft : LJE and CT
QUESTION: Gingivoplasty is? a reshaping of the gingiva to create physiologic gingival contours,
with the sole purpose of recontouring the gingiva in the absence of pockets.
QUESTION: Gingivectomy means? excision of the gingiva. By removing the pocket wall,
gingivectomy provides visibility and accessibility for complete calculus removal and thorough
smoothing of the roots, creating a favorable environment for gingival healing and restoration of a
physiologic gingival contour.
QUESTION: external bevel incision where is it made? Attached gingiva?

QUESTION: External bevel, ginviectomy: apical to epithelial tissue, vascular bundle(where to you
make incisision) Junctional epithelium (apical to base of pocket (epithelial attachment)
QUESTION: External bevel is put to tooth apical to what? Crest of bone, JE, CT. Junctional
epithelium I think
Starts at top of junctional epithelium
QUESTION: What direction reverse bevel (internal bevel): axial toward bone
QUESTION: How to make inverse bevel incision?
A: Start at crest of gingival margin or step back .5-2 mm and make incision to crestal bone
→Gingivectomy→ base of sulcus
QUESTION: What causes wound healing after Perio flap? I put Long JE but the others were new CT
attachment, CT adhesion and something else
QUESTION: Periodontal regeneration involves - Sharpeys Fibers, Cementum and Alveolar Bone
QUESTION: What is involved in periodontal regeneration? I think pdl, cementum, alveolar bone maybe
one other thing in there. Pdl & bone cells
QUESTION: Perio Surgery. Know what is regenerating? bone, cementum, and more was listed.
Regeneration is defined as the type of healing which completely replicates the original architecture and
function of a part. It involves the formation of a new cementum, periodontal ligament, and alveolar bone.
Repair, on the other hand, is merely a replacement of loss apparatus with scar tissue which does not
completely restore the architecture or the function of the part replaced. The end product of repair is the
establisment of long junctional epithelium attachment at the tooth-tissue interface.
QUESTION: Regeneration vs repair in perio attachment

• REGENERATION: new PDL/cementum made (bone and gingiva too)
• REPAIR: long jxnal epi formed
QUESTION: Know about internal bevel incision and where to cut: I think apical to the base of the
periodontal pockets, but coronal to the MGJ.
QUESTION: Doing flap surgery on mandible, what structure do you watch for? I put mental
nerve (If 3rd molar TE= Lingual)
QUESTION: A tooth had epithelium above cej what flap would you use? Undisplaced/Replaced flap
QUESTION: Long jxn epith was coronal to CEJ and margin was around cej,
apical position flap, widman flap, replace flap
QUESTION: Extrusion of canine what flap technique is used except:
1)Envelope flap 2) Semilunar flap 3) Apically repositioning flap
QUESTION: Crown lengthening procedure what would u do

Choices were
Modified woodman flap
Apical repositioned flap w/ osteotomy and ostectomy (I chose this)
QUESTION: Rct, getting post and core and crwon lenghteningin, why do crown lengthing:
feral effect, adequate crown length
QUESTION: Crown that came falling off? Inadequate ferrule!!!! or inadequate post
QUESTION: Sliding flap? What do you do it for?

a. envelope flap
b. y incision
c. Z incision
QUESTION: To expose a mandibular lingual torus of a patient who has a full complement of teeth, the
incision should be…
a. Semilunar
b. Paragingival
QUESTION: If removal of torus must be performed to a patient with full-mouth dentition, where
shouldthe incision be made?

a. initial incision
c. post op oral hygiene
QUESTION: Whats contraindicated for pt post mand radio tx.?- flap apico on pt.
QUESTION: During maintenance therapy pt has recurrent 6mm pocket on M of #4 and D of #20 what is
1st tx option: flap surgery, scaling root planning with local microbial administration
QUESTION: Pockets are still the same and oral health care is excellent? Flap and clean out
QUESTION: To prevent exposure of a dehiscence or fenestration what kind of flap? partial or split
thickness flap
QUESTION: Split thickness flap involves what tissues? Mucosa (only) or submucosa or they can say
epithelium and ct (submucosa)
surface mucosa (consisting of epithelium, basement mem brane, and connective tissue lamina
propria
QUESTION: In a partial thickness flap, what do you cut through? I put epithelium, connective
tissue, but NOT periosteum
QUESTION: Perio flap- expose bone?? - Full thickness
QUESTION: Full thickness flap will result in bone atrophy (or loss) in: thin periradicular bone (do
partial-thickness flap for this), thick periradicular bone, thick interproximal bone, thin
interproximal bone
QUESTION: Know about difference between regenerative surgery and flap surgery?
regenerative surgery - for regeneration with bone graft
flap surgery - to get acess for better srp
Grafts:
QUESTION: epithilium of free ging graft----degenerate
QUESTION: Free gingival graft gets blood from base first,
QUESTION: Free gingival graft: Which area can be affected
▪ Greater palatine nerve bundle

▪ Nasopalatine nerve bundle
▪ Nasopalatine artery
▪ Greater palatine artery
QUESTION: Most likely damage when you take tissue from gingival graft: damage to greater
palatine neurovascular bundle
QUESTION: Donor site complication when free gingiva graft (taken from palate) performed:
cutting the major palatine bundle.
QUESTION: mucosal graft what nerve would u damage ? greater palatine

QUESTION: What nerve is most likely injured when transferring donor tissue to area of free gingival
graft? Greater palatine
QUESTION: mucosal graft epithelization by---connect tissue from underlying tissue (recipient site)
QUESTION: Where does the epithelial for a graft come from?
a. Donor epithelium
QUESTION: What effects the epithelial cells from gingival graft? epi cells from donor, epi cells from
recipient, connective tissue cells or donor or recipient
c. donor CT
d. recipient CT
QUESTION: You only have 4 mm of bone above max sinus, how do you do bone graft (weird
question)…fill towards sinus, fill towards alveolar ridge (I put this, didn’t really get it), fill graft towards
mesial
QUESTION: If question is saying that you currently have 4mm of bone *alveolar ridge*..You can not add
to alveolar ridge, its not gonna integrate. So you FILL TOWARDS SINUS..
QUESTION: Only 4mm of bone below ridge and sinus where do you place graft? Floor of sinus (NOT
Top of ridge)
QUESTION: What graft is best for sinus lift? Autogenous and alloplastic
QUESTION: Sinus lift best to use? Answers are in pairs: Autogenous, alloplastic?
QUESTION: Your patient was referred to an oral and maxillofacial surgeon for an implant, and you were
advised that she was going to need a sinus lift procedure with placement of an autogenous bone graft.
What is the definition of that graft?

QUESTION: Which is the most predictable when restoring an edentulous mandibular ridge? I put
autograft
QUESTION: Which is the best graft: autograft
QUESTION: how you call a graft from a different species : Xenograft
QUESTION: bone graft : iliac crest
QUESTION: How to replace large chunks of mandible? Freeze dried bone; autogenous
QUESTION: What is the most osteogenic? (Choices: alloplast, autograft, etc) ONLY autograft
•
QUESTION: Know what an allograft is (b/w members of the same species)

QUESTION: Freezed dried cadaver bone is a type of? Allograft
QUESTION: Decalcified freeze dried bone allograft: has bone morphogenetic proteins
QUESTION: Freeze dried graft – allograft

QUESTION: best allograft material: dried freezed bone
QUESTION: Freeze dried bone has the advantage of having which protein: bmp/pdgf
QUESTION: Which hormone is used to bone graft? BMP, GH...

QUESTION: Dfdg- bone morphologic protein
QUESTION: Which type of grafts causes bone growth?: • Osteoinductive •Osteoconductive

QUESTION: Which type of grafts causes bone growth?:
• OsteoINDuctive→Allograph, autograph
QUESTION: Maxillary canine is contraindicated in a grafting procedure
QUESTION: least likely to need bone graft – one wall, two wall, three wall wide, three wall narrow
QUESTION: What is not going to need a bone graft to improve – 1, 2, wide 3, or narrow 3 walled defect –
narrow 3
Wide and deep 3 walled → GTR
Narrow 3 walled → bone graft regeneration
QUESTION: Purpose of lateral graft (Peddicle graft)...For gingival recession
QUESTION: how to fix gingival recession in anterior region : pedicle graft ( never lost blood supply )
QUESTION: 8 year old with anterior crossbite – recession
a. chlorhexadine
c. pedicle graft
QUESTION: Max canine is contraindicated in a grafting procedure
QUESTION: Facial recession on mandibular canine of 14 year old → graft not indicated? Reposition
with ortho?
QUESTION: You take a graft from a patient to another patient, what is this called? – Allograft
(alloplast was a choice, but that’s synthetic)
QUESTION: Which is least likely to be successful facial soft tissue graft? – Lower 1st premolars (no canine
in the choices) →?
QUESTION: Guided grafts- better for max
QUESTION: Best prognosis for a guided tissue regeneration? →three walled defect,
QUESTION: GTR in Class II furcations is most effective
QUESTION: Tx for ClassII furcation involvement (called cul-de-sac)? GTR
QUESTION: Furcations distal class II and GTR: better than furcation I and III
QUESTION: Class III furcations are least successful in GTR procedures.
QUESTION: Class 3 furcation which not an option? GTR
Guided tissue regeneration (GTR) is a surgical procedure used by dentists to promote the new
growth of tissue in areas
QUESTION: The purpose of GTR is to prevent: Long J.E, migration of PDL cells Migration of CT cells.
Decks: Guided tissue regeneration is a procedure that blocks the re-population of the root surface by long
junctional epithelium and gingival connective tissue to allow cells from the periodontal ligament and bone
to re-populate the periodontal defect.
QUESTION: In guided tissue regeneration, inserted material is preventing which of the following attached
to tooth structure?
• epithelial
• connective tissue (hinder the migration of fibrous connective tissue while
supporting the growth of bone: Xtina, First Aid)
• gingival
QUESTION: The purpose of a barrier: .Apical movement of PDl cells, coronal movement of
cells
QUESTION: 3 things u need when doing GTR: bone, sharpey’s fibers, & cementum
GTR excludes gingival epithelial cells allows progenitor cells to close the wound. Gingival
epithelium and connective tissue are excluded by the membrane. Progenitor cells form
cementocytes and fibroblasts which form new cementum and PDL fibers. This gives you
regeneration of the attachment apparatus and not long junctional epithelium. LJE is not as
strong as the original attachment apparatus (which is lost by debridement).
QUESTION: In gtr, you get new CT.??? PDL & sharpeys fibers are CT.
QUESTION: which tx is best for type III furcation
b. apical flap
HEMISECTION
QUESTION: In a through and through furcation lesion, which is the least appropriate treatment? I
put GTR
QUESTION: contraindication for max molar with class 2 furcation? hemisection w/ crown
hemisection = mand molar. Mandibular molars to treat Class II or III furcation invasions
For max molar - we do root amputation
QUESTION: Tx plan for furcal involvement ? GTR, Hemisection, Root amputation,
logical was hemisection and place 2 crowns to act as 2 premolars. Root amputation is for
maxillary teeth
QUESTION: Hemisection of maxillary molar which has best prognosis

• Furction that is more coronal or apical
QUESTION: Bony area between two premolars has no mesial, facial and lingual wall, what is it
called? Hemiseptum
QUESTION: Class 3 furcation tooth already had RCT, best tx, ext not option? split and tx as two
premolars
Healing (bone & wound):

QUESTION: For Perio; Why do you put a surgical dressing over a wound?
QUESTION: What do you want to see healing after perio surgery? PDL, bone, etc.
Restore/regen: PDL Bone Cement. Repair: Long junctional epi and CT.
QUESTION: Where does the epithelial for a graft come from after you place it and its healing?
a. Donor epithelium
c. Recipient epithelium and surviving basal cells of donor epithelium are what supply
for new epithelium

QUESTION: 2 questions on Dry socket...pt comes in 3 days after mand extraction with pain and bad
taste, what is it..also question on how to treat
QUESTION: most common complication after extraction : dry socket.
QUESTION: What is pt more at risk of getting after ext (pt hx said she was a smoker)? dry socket
QUESTION: What’s the most common complication after EXT? dry socket
QUESTION: Most common complication in extraction: dry socket (alveolar osteitis)
The most common soft tissue injury during oral surgery is the tearing of the mucosal flap during
surgical extraction of a tooth. Hupp. The second soft tissue injury that occurs with some frequency
is inadvertent puncturing of the soft tissue. The most common problem associated with the tooth
being extracted is fracture of its roots. Hupp. Contemporary Oral and Maxillofacial Surgery, 5th
QUESTION: pathophysiology of dry socket

QUESTION: how do dry sockets develop? Blood clots not forming
QUESTION: Dry socket: Loss of healing blood clot
QUESTION: Dry socket: fibrinolysis of clot

QUESTION: What causes alveolar osteitis? Active dislodgement of blood clot - I chose this one?
(fibrinolysis of the clot)
QUESTION: What causes alveolar osteitis? Lack of blood clot because lack of bleeding
Active dislodgement of blood clot - I chose this one? (I think the wording was fibrinolysis of the clot)
QUESTION: Main cause of alveolar osteitis (dry socket)? blood clot diminished and fell out
QUESTION: dry socket why

blood clot not produced
blood clot broke
QUESTION: MAIN CAUSE OF ALVEOLAR OSTEITIS (DRY SOCKET)? BLOCK CLOT
DIMINISHED AND FELL OUT
QUESTION: Don’t forget with dry socket = NO ANTIBIOTICS NEEDED! Just medicinal dressing.
QUESTION: Alveolar osteitis → place dressing; don’t need antibiotics and no curettage
QUESTION: Alveolar osteitis tx? Medicated dressing
QUESTION: acute osteitis = dry socket. How to take care of it? Gentle irrigation and Medicated
dressing
QUESTION: Treat dry socket with dressing
QUESTION: Ways to tx dry socket except
c. sedative dressing
QUESTION: Dry socket (except Q)- need for oral antibiotics
QUESTION: What is the treatment for dry socket? sedative dressing
QUESTION: Most common negative outcome of routine TE: alveolar osteotitis, hemorrhage, infection
QUESTION: Multiple questions about when you would not give antibiotics: all the answers were
alveolar osteitis (all the others had a systemic infection ie cellulitis), other questions about osteitis
is how would/wouldn’t you treat alveolar osteitis
Fractures:
QUESTION: most common trauma: avulsion, intrusion, lateral luxation, fracture
QUESTION: Mand fracture sign? Occlusal discrepency

QUESTION: Key sign of Mand fracture? change in occlusion
QUESTION: Inform about mental nerve damage and fracture of mandible
QUESTION: Patient has a condylar fracture, what happens when mandible grows – asymmetric growth
with damaged side lagging
QUESTION: Fracture near condyle, what happens to growth of mandible? I chose injured side lags behind.
QUESTION: Patient fractures one condyle, what is the expected growth? The fractured side will lag. The
unaffected will continue growth.
QUESTION: What child has mandibular trauma, what do they have later? Midline asymmetry
QUESTION: most common trauma on children what happens to mandible? Asymmetry of face
QUESTION: Retarded growth due to unilateral sub-condylar fracture on child → I think it’s
ipsilateral?
QUESTION: what is primary consequsence of trauma to jaw in kids (normal def of jaw, vs retarded
growth vs hypertrophic growth on one side, etc): retards growth
QUESTION: Fracture 1 condyle the other lags behind: Malocclusion

QUESTION: if kid had a problem with fractures in mand.. later they will have TMJ disfunction
QUESTION: most common area of fracture in children---symphysis, condyle, coronoid
QUESTION: Ankylosis of condyle most likely due to? Trauma? Fracture (looked this one up)
QUESTION: Splinting closed bone fracture – 6 weeks
QUESTION: Fractured mandible. Keep it in closed reduction for how long?? 6 weeks
QUESTION: Splinting closed bone fracture – I said 12 weeks (not sure) →? 6
QUESTION: Closed reduction, immobilize mandible for how long?, 6 weeks,

The standard length of maxillomandibular fixation (MMF) is 4-6 weeks.
QUESTION: Paresthesis occurs most commonly in what type of mandibular fracture? Angle
QUESTION: Lower lip numbness is seen in what kind of mandibular fracture: Body or angle fracture
QUESTION: angle of mandible fracture increases chance of IAN paresthesia and numbness
QUESTION: Fracture of what cause Paresthesia of the lower lip? evident with mandible
fractures distal to the mandibular foramen (in the distribution of the inferior alveolar nerve).
QUESTION: lefort frac 1 associated with- what fracture--nasoethmoidal air cell,frontal sinus,max
sinus,mastoid air cell
QUESTION: Lefort I fracture→ maxillary sinus
QUESTION: Le fort 1: maxillary

QUESTION: Guerin sign is a feature of Le Fort 1/2/3? Guerin’s sign: ecchymosis in the region of
greater palatine vessels.
QUESTION: The LeFort I tx of? brings the lower midface forward, from the level of the upper
teeth, to just above the nostrils.
QUESTION: Lefort I fracture: "floating palate", Disturbed occlusion, palpable crepitation in upper
buccal sulcus
QUESTION: The LeFort III brings the entire midface forward, from the upper teeth to just above
the cheekbones.
QUESTION: LeFort II: separation and mobility of the midface, Gagging on posterior teeth, Anterior
open bite, Pathongnomonic sign is? Periorbital ecchymosis/hematoma, diplopia and /or
subconjunctival hemorrhage , Infra-orbital nerve damage
Le Fort III - Nasoethmoidal complex, the zygomas, and the maxilla from the cranial base which results in
craniofacial separation
QUESTION: Lefort II most common injured nerve: infraorbital

QUESTION: subconjuctival hemorrhage seen in what fracture? Lefort 1 , nasal, frontal sinus,
zygomaticomaxillary complex
QUESTION: A patient experiences numbness of the left upper lip, cheek, and the left side of the nose
following a fracture of his midface. This symptom follows a fracture through the
A. nasal bone.
B. zygomatic arch.
C. maxillary sinus.
QUESTION: What was the most common fracture in the face? Zygomcomplex fracture. Nasal bone
fractures = 1st, zygomatic = 2nd (but first common midfacial fracture)
QUESTION: Which radiograph would you use to view a fracture of the mandibular symphisis? (A-P?)
QUESTION: What age does mandibular symphysis fuse? I think 6 months 6-9 months
QUESTION: What age does the mandibular symphisis close: birth, 3, 6-9 months
QUESTION: Fracture of which part of the face would compromise pt respiration?

• *Fracture through the body of mand (bilateral)
QUESTION: if there is a fracture in the left body of the mandible where will the other fracture most likely
be? Right Condyle
• Most COMMON = condyle (29%) 2nd most (angle of mandible 24.5%)
• LEAST COMMON: coronoid (1.3%) 2nd least (ramus of mandible 1.7%)
QUESTION: if hit on the right side of the jaw, what will get broken
• left condyle
• right condyle
• both
• right mandible
QUESTION: you hit a guy in the right body of mandible and fracture where is other site of fracture
(opposite side condyle)
QUESTION: punched on lower right and broken jaw. What else to worry about? Contralateral
conylar fracture
QUESTION: When pulling out tooth and jaw fractures what do you do? Open flap to see all of the
fracture, remove all the fractured pieces, remove all the fractured pieces that are not attached to
periosteum
QUESTION: What xrays do you take to confirm horizontal fracture? 3 xrays moving horizontally, 3
xrays moving vertically,, ...
QUESTION: Horizontal fracture easily seen with – multiple vertical angulated xrays
QUESTION: What is best view to see zygomatic process?

(other is submentovertex, SMV for zygomatic arch)
QUESTION: Max sinus: waters
QUESTION: Pano >>>> best for mandible fracture
QUESTION: Reverse towne‟s>>>> for condyle fracture
QUESTION: Submentovertex>>>>for zygomatic fracture
QUESTION: What causes Trauma in the US? By auto-accidents! (in 3rd world is knife fights)
QUESTION: Pan showing lucency going inferior over the body of mandible close to the angle. Informed
the patient was involved in an accident. Identify the lucency a.pharyngeal
airspace b.fracture c.artifact-retake radiograph 
Frenectomy:
QUESTION: thick upper buccal frenum with diastema. Yound kid…wait til upper permanent
canines erupt, frenectomy, use elastics…(a repeat I saw on old exam-answer was wait til max
canines erupt).
QUESTION: Kid has a diastema b/w 8 and 9 at age 10, how do you treat?: wait till permanent
canines have erupted, then do frenectomy
QUESTION: frenun centrals. What age do frenectomy
-when canines have erupted
QUESTION: If diastema is caused by a frenum, you don’t do a frenectomy until the canines have
erupted
QUESTION: sequence to close diastema in a child with low labial frenum:

1)wait for the canines to erupt,
2)close the diastema with ortho and at the end
3)perform the frenum surgery
QUESTION: What do you do for an 8 year old with a fibrous frenum and a large diastema? I put wait till
all ant teeth are in and then fix diast and frenum. (wait for canines..ortho before frenectomy…Xtina)
QUESTION: All of the following are risk for ortho treatment except ? – Frenal displacement (other
choices, were plaque management, bone loss, resorption)
QUESTION: Which of the following explains why the Z-plasty technique used in modifying a labial
frenum is considered to be superior to the diamond technique?
d. it decreases the effects of scar contracture (I believe this is it…because improves the appearance of
scars and porpose is to relax the frenum pull → less contracture)
Orthognathic surgery:
QUESTION: Most commonly used surgery for mand augmentation?- bilateral sagital osteotomy
QUESTION: BSSO = Vertical Osteotomy (when used) push mand. Forward or back for class III.
QUESTION: How would you repair a Class II malocclusion?- BSSO (bilateral sagital split osteotomy)
QUESTION: Class II patient needs sx – saggital split
QUESTION: Bilateral sagital split osteotomy : The BSSO is the most commonly used osteotomy for
mandibular advancement.
QUESTION: Worst complication of BSSO: Damage to IAN BSSO = Bilateral sagittal split osteotomy
QUESTION: whats the main thing you have to be careful with BSSO: INFA
QUESTION: Biggest disadvantage of BSSO?parasthesia
QUESTION: most complication of sagital osteotomy: IAN loss of sensitivity
QUESTION: During which surgery do you have most chance of paresthesia? BSSO, vertical ramus
osteotomy, etc. (don’t know)
QUESTION: Which osteotomy most likely to cause parestesia to lip and tongue: sagital split or
inverted L, vertical
QUESTION: Bsso indications:

• Mandibular advancement or retraction
QUESTION: Correction of severe class II
• BSSO
QUESTION: Patient wants to fix Class 3, what you going to do – lefort 1 with BSSO, lefort 1, BSSO,
max palatal expansion with BSSO
QUESTION: What surgery for class III? Le fort I, BSSO, rapid expansion?
QUESTION: Class III, what kind of surgery? Options include rapid palatal expansion, le forts, BSSO
QUESTION: 16 y.o. girl need to do lefort + BSSO – cant do RPE because she’s too old
QUESTION: Main disadvantage of BSSO – damage to the IA nerve

QUESTION: how long do you splint mandibular BSSO: You don’t do MMF, as there is internal plate.
Use an occlusal splint to help with occlusion but not wired shut. Keep splint on 4-6 week.
QUESTION: If a patient has vertical maxillary excess, how would you fix it? I put Le Forte 1
(other choices were mandibular and didn’t make sense)
QUESTION: Which of the following is the MOST common postoperative problem associated with
mandibular sagittal-split osteotomies?
a. infection
b. TMJ pain
QUESTION: A patient has a skeletal deformity with a Class III malocclusion. This deformity is the
result of a maxillary deficiency. The treatment-of -choice is
A. orthodontics.
E.surgical repositioning of the mandible.
QUESTION: whats the main difference between distraction osteogensis and a regular osteotomy :
DO has less relapse or DO cant move the mandible posterior …. Dunno
QUESTION: Distraction Osteogenesis over traditional osteosurgery: I put more stability during wide
span of movements, (not sure tho, another option was about patient compliance)
QUESTION: Distraction osseogenisis: when to use over convetnial: bigger stable movements
QUESTION: Advantage of distraction osteogenesis is that you can do bigger movements because
muscles can react over time
QUESTION: complication following distraction osteogenesis : Long term follow up
QUESTION: What is the difference btw distraction osteogenesis Max and BSSO Man?
QUESTION: distractive osteogenesis differs from osteotomy by..???
DO = benefit of simultaneously increasing bone length and the volume of surrounding soft tissues.
easier in children, shows less relapse. 2 surgical procedures, hospitalization time is less, more discomfort.
Compliance of patient and parent is a difficulty in DO
distractive osteogenesis is a surgical process used to reconstruct skeletal deformities and lengthen the
long bones of the body.
BSSO = stable for normal/decreased facial height, high relapse in patient with high mandibular plane
angle
An osteotomy is a surgical operation whereby a bone is cut to shorten, lengthen, or change its alignment
Orthodontics:
QUESTION: Dolycocephalic – long narrow face
QUESTION: Which is correct: Growth of Mandible is both intramembranous and endocondral
QUESTION: Scammon Growth curve: Neural tissue grows until what age? 5 (this was the number
on the test, but on book it is about 6-7)
QUESTION: Which tissue show most growth in first 6 years and then plateaus? lymph, neural,
genital
QUESTION: which is most fully developed at birth

e. muscle system
f. neural system **
gonadal system
QUESTION: Which grows faster, maxilla or mandible? Maxilla grows earlier and faster bc it is
closer to brain
→ closer to brain, grow faster
QUESTION: What is the best revealing issue for prediction about ossification ? wrist hand
radiograph
QUESTION: Majority of the tissues in FACE are derived from? A) ectoderm, b)mesoderm,
c)ectoderm and mesoderm
→ Ectoderm= Afractoderm
QUESTION: Eruption sequence of peds? ABDCE
Order: Central-Central, Lateral-Lateral, 1M-1M, Canine-Canine, 2M-2M
QUESTION: Curve of spee and curve of Wilson? Sagital is curve of spee, frontal curve of Wilson
→Sagital: curve of SPEE→ Anterior-posterior
→ Frontal: corve of Wilson→ Left and right
QUESTION: Overjet in permanent teeth should be ? 2-3mm
QUESTION: What do you do to camouflage class 2? you extract upper premolar
QUESTION: Based on Frank behavioral rating scale, what is the rate that indicates positive rapport
with dentist? rating 4
QUESTION: Tell-show-do? most appropriate
QUESTION: Figure 5.23 (pg 175) which one more stable and which one is problematic
Occlusion:
QUESTION: facial profile of class 2 malocclusion---convex, Class III is concave
QUESTION: MB max cusp in mandibular first molar: class 1

QUESTION: MB cusp in buccal groove: class I (in pic)
QUESTION: Normal class1 occlusion has mb cusp in buccal groove of mnd molar
QUESTION: Little girls, ortho casts were taken, what class is she? – Class 1 (her 1st permanent molars
were out, mesiobuccal cusp of upper 1st molars on buccal-lingual groove on lower 1st molars.
QUESTION: What occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st molar
CLASS III
QUESTION: What occlusion when MB cusp of max 1st molar is distal to buccal groove of mand 1st
molar Class III
QUESTION: Diatalized occlusion w/ uprght cental anterior and deep bite: class II div II
QUESTION: Pt is in Mixed dentition and they are end on, what type of occlusion will this result in
permanent dentition? Class I**, Class II, Class III
QUESTION: What's the difference btw primary class II and permanent class II? Shallow grooves,
broad contacts
QUESTION: What ethnicity with most class 3?

QUESTION: Class 3 is due to what? Max retrusin, mand protrusion
QUESTION: Most common type of occlusion in primary teeth: flush terminal plane
QUESTION: Most common malocclusion- ***CLASS 1***--
QUESTION: highest percentage of malocclusion in the US: class I, class II, class III?
QUESTION: What Percentage of population have class I normal occlusion? 30 %
QUESTION: What Class Occlusion gets most ant tooth fx?- Class II Div. 1
QUESTION: most common patients to have anterior tooth fractures : class II div I
QUESTION: Which class is susceptible to trauma? –as(class II division 1)
QUESTION: Most likely to cause fracture in children: class II division 1
QUESTION: in a cl III patient, which of the following is not helpful in establishing whether pt has
retrognathic maxilla or prognathic mandible? photographs, study models, ceph analysis,
clinical exam
QUESTION: A child who has a distal step in the primary dentition generally develops which of the
following molar relationships in the permanent dentition?
A. Class I
B. Class II
C. Class III
QUESTION: What happens to the permanent molar occlusion in the presence of a flush (straight)
terminal plane and mandibular primate spaces?
QUESTION: primate spaces **MAX: between LATERAL and CANINE; MAND: between CANINE and
1st MOLAR
QUESTION: What makes space for mand teeth when they erupt- primate space
QUESTION: Where are the primate spaces?
Max—b/w lateral and canine Man: b/w Canine and
Primary 1st molar
QUESTION: Primate space tested for maxillary and mandible
a. Max LI-C, Man C-M1
QUESTION: What is the purpose of primary teeth – said it was space holder of permanent teeth
QUESTION: Premature loss of which tooth will cause mesial drift of permanent tooth – primary 2nd
molar
Leeway space = Sum of primary tooth widths is greater than sum of permenant successors.
When primary teeth fall out, there is extra space to help relieve crowding. If nothing done,
then first molars drift forward.
QUESTION: How to create space for mand incisors: increase intercanine distance with primate
space?
a. Either the flaring of the max incisors

b. Primate space!! Because this is the space between the canines and the central
incisors
c. Either the flaring of the max incisors

d. Primate space (but decks says this extra space is most frequently due to growth of
the alveolar dental arches)??
QUESTION: allow more space for eruption of secondary lower incisors? Allow them to protrude
buccally, use primate space, use early mesial shift (which actually is primate space), or Leeway
space (aka late mesial shift…I picked this one).
QUESTION: Leeway space → enough room for mandibular teeth to erupt?
Leeway space helps with spacing for the molars
QUESTION: Class II is formed with distal step
QUESTION: Class I can be formed with edge to edge or mesial step
QUESTION: Primary teeth edge to edge molars...class 1 in perm. teeth w/ mesial shift of perm
molar
QUESTION: When ortho is end to end? Shifts to mesial, turns to class 1. If it remains, class 2.
QUESTION: Distal step and mesial step CLASS II/III
QUESTION: Which of the following will most likely lead to a class 2 malocclusion on a patient (I said
distal step, vs. terminal flush plane, vs mesial step, etc)
QUESTION: What head gear would you use to correct a class III? Reverse pull headgear
QUESTION: What ortho appliance to pull maxilla forward to correct class III? front facing head gear***
its reverse pull headgear****
QUESTION: What head gear would you use to correct a class III Reverse pull headgear/ protraction
headgear or facemask
QUESTION: Which headgear is used for pt who needs to bring maxilla towards protrusive? reverse
pull/facemask (protection headgear)
QUESTION: A dentist will perform a Moyers' mixed dentition analysis. Which of the following teeth
will be measured to predict the size of the unerupted canines and premolars?
QUESTION: Moyers predict MD canine & premolars using a table, with the sum of all 4 primary
lower incisors
QUESTION: Tanaka predict canine & premolars MD width using 1/2 of sum of all 4 lower incisors
QUESTION: The late mesial shift of a permanent first molar is primarily the result of closure of
which of the following spaces?
A. Canine
B. Leeway
C. Primate
D. Extraction
QUESTION: Ugly duckling stage: maxillary central incisors
• → Ugly duckling stage = when 2 maxillary centrals erupt, move labially and have
diastema→ perm canines erupt & move mesially to close diastema
QUESTION: ugly duckling tage: diastema between 8 and 9 no canines

QUESTION: The duckling phase refers to? mixed dentition
QUESTION: “ugly duckling” stage – maxillary centrals
→The maxillary central incisors can also be quite distally inclined when they first erupt
QUESTION: Ugly duckling stage definition: Wait for canines before doing ortho on centrals
QUESTION: If patient has their nose always stuffed and they breathe through their mouth what happens? I
said anterior open bite, some of the other choices posterior open bite, constriction on archesOrtho decks:
Mouth breathing causes “long face syndrome,” which is “SKELETAL OPEN BITE.”
QUESTION: Patient with airway obstructions often have an open anterior bite
QUESTION: Chronic nasal congestion in kid…..open bite (mouth breather)
most posterior cross-bites appear to be unilateral, they are usually the result of a bilaterally
underdeveloped maxilla with a shifting of the mandible to one side during closure.
QUESTION: a patient with maxillary arch constriction of 3mm and a posterior crossbite what will you
see? Normal midline, midline shift towards the unaffected side, midline shift toward the affected side
QUESTION: Maxillary constricted 3mm – pt is closing down
• Which way does the pt attempt to correct.
• To the crossbite side
QUESTION: patient has 3mm palatal constrict what is most likely complication: bilateral crossbite
QUESTION: 3mm max constriction--> Bilateral crossbite
QUESTION: cross bite unilateral and appliance of choice=bilateral expansor

QUESTION: why is the reason for that cross bite unilateral =mandibular shift
QUESTION: Unilateral posterior crossbites in kids are usually due to a MANDIBULAR SHIFT; treat
w/ MAXILLARY EXPANSION
▪ True unilateral maxillary constriction & functional crossbite

▪ Mandibular shift
▪ Bilateral constriction
QUESTION: How would you fix?
▪ Rapid Palatal expansion

▪ Nance
If true unilateral maxillary contriction → use unequal W arch or asymettrical maxillary expansion
QUESTION: What is indicated for the tx of unilateral cross bite? Elastics from Lingual of max mol to
Buccal of mand mol,
QUESTION: Hawley appliance for skeletal or non-skeletal deformities? Correction of skeletal crossbites
QUESTION: How do you fix a posterior cross bite? Quad helix, RAPID palatal expansion.
QUESTION: When to fix cross bite-ASAP
QUESTION: cross bite in child : correct immediately
QUESTION: most likely crossbite- maxillary lateral
QUESTION: Anterior permanent tooth most commonly erupts in cross-bite? Max laterals
QUESTION: what kind of appliance for posterior cross bite and when? Quad Helix (with digit sucking) or
Palatal Expander
QUESTION: Most common cause of anterio crossbite: thumbsucking, lack of interdental arch
space,
QUESTION: ant crossbite is done by all except: functional shift vs lower third of face is
hypertrophied
QUESTION: ant crossbite is done by all except: functional shift
QUESTION: Leveling of oclusal plane when? if open bite

QUESTION: Leveling of mandibular teeth→ OPEN BITE (treats the overbite)
QUESTION: Leveling of mandibular teeth → open bite

QUESTION: In an 8 year old child, there is a recession in a mandibular incisor with posterior crossbite,
which of the following treatment options is the least acceptable?
b. graft
d. observation
QUESTION: Case: Black,Girl around 7 years old. Presents with unilateral cross bite; she had a cleft
palate that was fixed. Palate in picture looks like a triagle and laterals are towards the palate.
A)What is the pigmentation?-racial pigmentation
B)what is the most likely cause of the crossbite?
-early loss of laterals
-due to cleft palate
QUESTION: 10 year old loses primary first molar, space maintenance? None, since premolar about
to erupt
QUESTION: A 10yo loses a primary M1, what should you do: nothing, band and loop
a. Nothing – the PM1 should be erupting at this age
QUESTION: Patient is has crown on first primary molar and second primary molar is going to be
extracted due to caries. What should be done in order to maintain space?
b. -nothing- because premolar is about to erupt
c. -band loop
d. -distal shoe
QUESTION: For child w avulsed 4 yr old mand incisor- what would you do? Leave out?
QUESTION: Can tx all with appliances except- crepetis
QUESTION: Loss of a primary right molar in a 3 year old child requires placement of a…
a. band and loop
b. distal shoe
QUESTION: Lower 1st molar come out too early, what do you do? – Band and Loop
QUESTION: child lost primary 2nd molar : distal shoe

QUESTION: Most common space maintainer- band and loop.
QUESTION: Patient has a Stainless Steel Crown on tooth #L, it’s going to before EXT, but what else will
be needed? – Do band-and-loop for space maintenance.
QUESTION: What does band and loop not have- occlusal stop for tooth above?
QUESTION: characteristics of a band and loop space maintainer include all of the following except?
QUESTION: Cementation of band and loop - common outcome
• All of the above except
• Creates space
• If leakage from cement – recurrent decay
• Prevents tooth from super erupting with opposing
QUESTION: What primary reason for restoring primary teeth
a. To maintain arch space
QUESTION: What is the most common tooth that involves space management in primary teeth? – 2nd
molar, 1st molars

resorbed and when canine is shed, midline will shift in the direction of the lost tooth.

resorbed and when canine is shed, midline will shift in the direction of the lost tooth
QUESTION: Child lost both his primary mandibular canines prematurely – why? Lack of arch space
QUESTION: Primary tooth lost prematurely, what does that do to perm tooth? Delayed eruption of
perm
**IF the kids’s primary molar is lost, the eruption is delayed. If the pt loses primary after age
7, eruption is accelerated
QUESTION: How do you determine arch perimeter?
Answer: Distal of primary second molar OR Mesial of permanent 1st molar

QUESTION: How to do measure the projected arch length space for permanent teeth? Incisors, Canine to
canine,
***→Arch length: Distal p2 to distal p2 or Mesial M1 to Mesial of M1

→Arch width: inter-canine space
QUESTION: What tooth erupting FIRST would cause some sort of arch discrepancy? Man 2nd perm
molar erupting before the 1/2nd man perm premolar
determine when the premolar will come in? – How fast roots of 1st primary molar resorbs (other choices
were age, how much of root of premolar is formed, etc) (not sure…usually would think how much of a
root of the permanent tooth is formed…about 2/3 formation…Xtina)
determine when the premolar will come in? – How fast roots of 1st primary molar resorbs, how
much of root of premolar is formed, etc
QUESTION: Post emergence eruption is mostly result of: root develompent, bone growth,
QUESTION: The primary tooth is missing/extracted. The perm tooth root is 1/3 formed. What is
driving the eruption of the perm tooth?
a. Either something about vascular supply to the tooth or the fact that the root is 1/3
formed.
QUESTION: When does tooth start to emerge in the oral cavity?
b. When root starts to form

c. Only after crown has been formed WHEN DONE CALCIFYING
d. After complete root formation
e. After ¾ root has been formed (through gingival) (2/3 erupts through bone!)
QUESTION: ¾ root formed-when crown erupts
QUESTION: Root formation (teeth start to erupt) which is associated when teeth are about to erupt?
b. 2/3 root formation when teeth erupt (3/4)
c. crown formation answer choices
QUESTION: teeth erupt when root form is ¾ of root I think (not when root just started I don’t think)
a. erupt through bone when 2/3, erupt through gingiva when 3/4
QUESTION: how long for the root take to complete after eruption? 2.5- to 3.5 was the choice
QUESTION: Apical root closes---21/2-31/2 years after eruption,
QUESTION: Takes 2.5-3.5years for root formation to happen after eruption
QUESTION: What race has most deep bites? White? Black? Hispanics? Asians?
Severe deep bite is nearly twice as prevalent in whites as blacks or Hispanics (p < .001), while open bite
>2 mm is five times more prevalent in blacks than in whites or Hispanics
QUESTION: The best age to correct a thumb sucking habit is…
a. The primary dentition. Kids are easier to desensitize (5-6 years)
“Mild displacement of the primary incisor teeth is often noted in a 3- or 4-year-old thumbsucker,
but if sucking stops at this stage, normal lip and cheek pressures soon restore the teeth to their
usual positions. If the habit persists after the permanent incisors begin to erupt, orthodontic
treatment may be necessary to overcome the resulting tooth displacements.” Proffit, William R..
Contemporary Orthodontics, 4th Edition. C.V. Mosby.
QUESTION: The space for the eruption of permanent mandibular second and third molars is created
by the
QUESTION: Edgewise bracket- for intrusion motion

QUESTION: ORTHo- finger springs??? (on removable to move a tooth via tipping)For what-tipping
of anterior mand and maxillary teeth
QUESTION: Labial bow- tipping teeth? (Passive labial bow - treats overjet) (Active labial bow – for
incisor retraction)
QUESTION: Patient needs ortho with partially erupted #17 and #32. Radiographically, both teeth had
crowns with distal area that are susceptible pericornitis. What do you do? – EXT both teeth surgically.
QUESTION: Patient with 16mm overjet → surgical and ortho combo
QUESTION: How to Tx 16mm of overjet: Ortho w/ surgery, premolar extraction route
QUESTION: ortho for kid with very poor oral hygene what treatment to do? Removable
QUESTION: Best time to fix lingaual inclined incisors- when canines erupt.
QUESTION: When to do ortho movement if max central is erupting lingually? During eruption, after
fully erupted?
QUESTION: Primary anterior tooth intruded 5mm-How would you treat it?
• Extract
• Splint
• Ortho-bring it down
QUESTION: Ortho uprighting of molar-what is the problem-what should you do?
• Occlusal interferences-need to adjust occlusion
QUESTION: How do you prevent rotation in ortho?
• Anti-rotational clasp
QUESTION: Ortho Treatment sequence question. (prophy, restorative, etc). be able to rank
QUESTION: Ortho sequencing questions
• level and align (light round wire)
• corrects vertical discrepancies (working arch wires) square/rectangular wires
• Finishing arch wires (finishing touches) light round wirest
QUESTION: Perio after the ortho b/c bone will change
QUESTION: Y would u move a tooth before doing perio? I wrote bec more likely to get bone loss after
perio surgery, other choices bec it easier to move now, stable teeth are harder to access...
QUESTION: Why do you restore primary teeth?
1. SPACE MAINTENANCE
QUESTION: Light ortho pressure-direct resorption
QUESTION: Ortho - Light movement causes what type of bone resorption (indirect (I picked) vs
direct): direct
a. intermittent
b. direct
c. continuous
d. indirect
QUESTION: Which one of the following doesn’t happen in PDL during ortho movement? – Chemical
change (Don’t think it chemical change because there is a release of chemical messengers in the
pression-tension theory…but not sure what the right answer would be…Xtina)
QUESTION: When moving with ortho what does not happen? Chemical change in pdl, pressure on one
side and release on the other...
QUESTION: Orthodontic movement- widened pdl due to decalcification? Due to tension
Compression (where tooth is moving toward) and tension side (where tooth is moving away from). First,
widened PDL occurs on tension side in presence of light prolonged orthodontic forces, indicating tooth
movement is soon to begin.
Compression side: osteoclasts are removing lamina dura
Tension side: Osteoblasts are laying down new bone
QUESTION: Which of the following soft tissue elements (fibers) are commonly associated with relapse
following orthodontic rotation of teeth: Supracrestal
QUESTION: What causes rotation of a tooth after ortho therapy: transeptal fibers
QUESTION: What fibers cause reversement of a rotated tooth after ortho treatment? →Transseptal
QUESTION: During orthodontic relapse, which fibers are primarily responsible for the relapse? – Oblique
(I can’t remember if circular was on there, but I think I got this wrong!) (should be something to do with
supracrestal fibers…Xtina) **The supracrestal fibers, in particular Transseptal fibers, have been
implicated as a major cause of postretention relapse of ortho treatment.
QUESTION: 2 ortho cases:
a. 14 yr old kid w/ pano; all PM’s congenitally missing except #28 (missing 7 of them);
retained primary molar crowns over congenital missing PM’s
ii. Using a ceph, you gotta tell if facial profile is convex, straight, or concave →
all 3 were CONVEX
iv. Given ANB = 6 & ask wut class it is → its Class II
v. Other ortho pt: explorer catches in 1 pit of #19? Wut wud you do? → PRR
b. Upper & lower canines are ectopically erupted out of the arch; besides that
everything else was normal in this case (15 yr old?)
i. How do u treat?
1. Extract 1st PM’s & bring canines into arch OR
2. Take out 4 canines & keep PM’s
a. (agu put take out canines)
3. if you’re gonna extract 1st PM’s wut would you NOT use: 150, 151, 3_,
2_ _ (answer must be 1 of the last 2; look em up)
iii. Ortho pt: has never had a restoration? Wut wud you do? → sealants, do
nothing, etc. (agu put: do nothing)
QUESTION: Ectopic eruption of maxillary first molar? Most likely needs ortho? 50% self resolves?
(66% self correct)
QUESTION: Permanent 1st molar ectopically erupting with slight resorption of primary –
separating device (Can use elastic seperators)
QUESTION: # of vertical planes in the face? 5
Esthetic analysis, face divided:
QUESTION: Vertically by 5 (4 planes)
QUESTION: Horizontally - 3 (2 planes) 
ANB = SNA - SNB.

• A positive ANB angle indicates that the maxilla is positioned anteriorly relatively to the
mandible (Class I or Class II malocclusion cases).
• A negative ANB angle indicates that the maxilla is positioned posteriorly relative to the
mandible (Class III malocclusion cases).
The normal range is 1-5.
>5 indicates a Class II skeletal jaw relationship, protrusive maxilla or retrognathic mandible.
<1 indicates a Class III skeletal jaw relationship, deficient maxilla or prognathic mandible.
Normal ANB is 2 degrees
QUESTION: SNA measures maxilla
QUESTION: Bigger SNA means? Maxilla is more protrusive
→SNA-SNB=ANB→ maxilla to mandible relationship
QUESTION: ANB 6, what skeletal classification? Class 2
QUESTION: angle ANB: 6. type of occlusion: class 2

QUESTION: Girl class II, ANB WAS 6(class 2)
QUESTION: ANB -4: class III

QUESTION: ANB is -6 degrees? Whats the facial profile? Class III
QUESTION: With ANB value being -6 what is the patient class/malocclusion: Class III
QUESTION: Ceph- ANB of -6: Class III

QUESTION: SNA 76 AND SNB 78=-2 = class 3
QUESTION: Know snb vs SNA (SNA = 82, SNB = 80)
QUESTION: ANB -2 --> negative ANB so class 3
QUESTION: Frankfort’s horizontal plane = porion (upper external auditory meatus) to orbitale
(inferior border of orbit)
Fox plane is parallel to campers line (alar of nose – mid tragus line) – for anterior-posterior
plane
Fox plane is parallel to interpuppillary line – for anterior plane

• Lower alla upper tragus and interpuplar distance.
QUESTION: cleft lip and palate? 6-9 weeks in utero

QUESTION: with cleft lip and palate what occlusion is mostly seen? class III malocclusion
QUESTION: Patients with cleft palate, what class will they present? – Class 3.
QUESTION: cleft lip more common in boys cleft palate more common in girls
QUESTION: Pt had cleft lip and palate. Later in life during ortho analysis what do you see?
• *Deficient maxilla
• Normal mand

QUESTION: Most prevalence: cleft lip and palate
o Cleft lip and palate (I chose this option)
QUESTION: What is cleft palate class 3: soft and hard palate plus alveolar process
QUESTION: What mostly gives cleft palate? Genetic or environmental

QUESTION: Cleft palate and lip is: autosomoal dominant ,
QUESTION: Cleft lip/palate is caused by: autosomal dominat, multifactorial, autosomal recessive?
QUESTION: Cleft palate
o Environmental
o Genetic
o MULTI-FACTORIAL!!
QUESTION: What are the reasons for closing a cleft lip except?- Support the premax on a unilat cleft, felp
speech, and the not is to support the ala of the nose.
QUESTION: Speech impediments from cleft palate are due to? tongue being unable to close
nasopharynx
QUESTION: Speech problems associated with cleft lip and palate are usually the result of: the inability of
soft palate to close air flow into the nasal area.
QUESTION: Why do people with cleft palate have a hard time talking?
because they cannot close the air space between the nose and the soft palate
QUESTION: A cleft lip occurs following the failure of permanent union between which of the
following?
QUESTION: Age when repair cleft palate for normal canine eruption: When canine tooth is ¾
formed (8-9years old)

• Closing plate
• Suturing lip
Alveolar augmentation (phase 2)
• Suturing lip
QUESTION: percentage of cleft lip and cleft palate in Caucasians? 1/750, 1/1100, 1/1500…from
OS lecture caucasin=1/1000, blacks=1/2000, Asians=1/500
QUESTION: Cleft palate and lip is seen in how many americans? 1/300. 1/700. 1/1100, 1/1500
QUESTION: Cleft palate prevalence in caucasion? 1/1000 (cleft lip in caucasion 1/800 (Asians
have it the most common)
QUESTION: Caucasions cleft lip and palate: 1:700
QUESTION: incident of cleft palate / Cleft lip in US - 1 in 700

QUESTION: Cleft lip/palate: 1:700
But be careful. It can ask for just cleft lip in White: 1:1000 or cleft palate 1:2000
Cleft PALATE with out cleft lip 1in2,000. (CDC2012)
Cleft LIP with and without cleft palate 1 in 1000. (CDC 2012)
QUESTION: Patient was class I according to molar relationship but skeletal she was class III because
of ANB and cleft palate
QUESTION: Angle class I but skeletal is CL 3 bc it tells you ANB and cleft palate
QUESTION: What surgery will a pt with cleft palate most likely need…move maxilla up or move
mandible back…(mandibular set back)
QUESTION: At 3 months they get the cleft palate and cleft lip surgery. Usually this causes future Class III
issues. So at later age they will need to move back the mandible to correct the class III. This is
called MANDIBULAR SETBACK
QUESTION: Chronic nasal stuffiness assoc with what occlusion? Class III????
QUESTION: What happens to cause class one from edge to edge- both mesial shift, only mand shift, only
max shift**?? I think only mandible—that is the only way it makes sense.
QUESTION: If lose primary max second molar early what happens? Class 2 or class 3 occlusion?
QUESTION: Crowding - will displace centrals…something about how are u gonna fix the anterior mand
crowding, answer was you’ll have to do stripping
QUESTION: WHAT IS A MODERATE Crowding ? less than 4mm is moderate
>4mm severe crowding

QUESTION: Ortho take out pre-molar for crowding, not sure which it was.
QUESTION: If a child has 3mm crowding on the lower and permanent canines haven’t erupted,
what do you do? I put nothing
QUESTION: 9 year old boy, 5 mandibular incisors, primary canines still present, already
crowding, permanent canines still have a long way to come. What would you do
to treat this anamoly: remove one of middle three, remove end, remove primary
canines.
QUESTION: anterior crowding : mixed dentition analysis.

a. increased
b. decreased
QUESTION: What does the moyers probability chart predict when a transitional dentition analysis is
performed?
Pharmacology:
QUESTION: alpha 1 - leads to vasoconstriction

QUESTION: What does Alpha-1 do? A.Vasoconstriction of peripheral vessels
QUESTION: When you stimulate alpha 1 receptors what happens? 
a. Vasoconstriction  b. Hypertension 
QUESTION: what does alpha 1 receptors do in the heart ?Vasoconstriction, increase blood pressure,
increase peripheral resistance, MYDRIASIS and urinary retention
QUESTION: Patients BP spike after EPI, what receptor? A1

QUESTION: Heart has beta 1 receptors
QUESTION: Vasoconstriction of the veins – Alpha-1 or Alpha-2 receptors?
QUESTION: slow infusion of epinephrine will cause which of the following and know which receptor is
responsible also. Alpha 1,2, beta 1,2, a rapid increase in heart rate and pressure, decrease in heart rate,
decrease in blood pressure, etc
Alpha 1 (Vasoconstriction during anaphylaxis), Beta 1 (Increases cardiac output), Beta 2
(bronchodilation)
QUESTION: hemostatic agents in retraction cord target
• a1 (alpha1 vasoconstriction)
• b1
• b2
• gaba
QUESTION: retraction cord what can cause : →with epi increase HR, BP, do not use in
hyperthyroid or cardiac disease.
QUESTION: Why do have to dry the sulcus before putting retraction cord? A. so hemo is
diluted.
QUESTION: After using a gingival retraction cord, tissue reacts by recession. Where do you see this
the most? Lingual, buccal, interproximal.
QUESTION: Amphetamines – lead to NE release in brain (increase neurotransmitter activity of NE &
Dopa)
QUESTION: ADHD; diagnosis boys=girls, boys > girls, girls < boys?
QUESTION: Know Methylphenidate =Ritalin, Amphetamine = Adderal.
Methylphenidate exerts many of its effects through dopamine uptake blockade of central
adrenergic neurons, in contrast to the amphetamines and cocaine that increase catecholamine
NE SERETONIN DOPAMINE release as a primary mechanism.
QUESTION: Patient is very anxious what do you do? – Tell him to stop taking amphetamine on the day
appointment (Amphetamine can induce anxiety, and are contraindicated for patients who are very
nervous)
QUESTION: Amphetamines- what are symptoms of it- increased heart rate and excitability
QUESTION: Kid is taking adderall (amphetamine), what should you do before the appointment? I
think you tell them not to take it that morning so that there is no adverse reaction with the
epinephrine in anesthesia (or you could just give an injection w/out epinephrine, but that wasn’t an
answer choice)
QUESTION: Insomnia and loss of appatite?
Adderall : psychostimulant medication composed of amphetamine and dextroamphetamine, which is
thought to work by increasing the amount of dopamine and norepinephrine in the brain
QUESTION: Amphetamine - Indirect-acting symphathomimetics
QUESTION: ADHD : most common in boys

QUESTION: ADHD is most common in boys
QUESTION: Which one is true about ADHD? – It’s more common in girls than boys (wrong, boys more
than girls. Other choices were they are both same, etc) **10X MORE IN BOYS
QUESTION: Pediatric pt taking amphetamine. What can be observed in pt’s health history? ADHD*
QUESTION: Which of the following is incorrect? The kid has ADHD, know the medication for ADHD.
Methylphenidate was one of the medications they asked , but don't remember the question
completely

a. prazosin (I think this one…alpha 1 blocker…allows relaxation of vascular smooth muscle..to lower
BP..)
c. theophylline (treat asthma, COPD…it relaxes bronchial smooth muscle…so I guess it does do smooth
muscle…)
QUESTION: Which of the following combinations of agents would be necessary to block the
cardiovascular effects produced by the injection of a sympathomimetic drug?
Atropine and prazosin  
Atropine and propranolol  
Prazosin and propranolol  
Phenoxybenzamine and curare  
QUESTION: Each of the following drugs produces vasoconstriction of vessels if injected into the gingiva
Phenylephrine (Neo-Synephrine®) Norepinephrine (Levophed®)
QUESTION: Epinephrine + Propanolol: Propranolol is a nonselective beta blocker. So epi acts

at only alpha receptors, which in the periphery are mainly alpha-1. So you get marked
vasoconstriction, which leads to reflex bradycardia. Increased ⬆ BP --> increased firing and aortic
and carotid sinuses --> increased vagal activity on the heart --> decreased ❤ ⬇ HR.
QUESTION: Epi and propranolol- increase BP dec HR
QUESTION: epi plus propanol: increases BP, decreases HR

QUESTION: Epi and propranolol-increase BP, decrease HR-patient taking propranolol in history;
QUESTION: If you inject a pt that is taking propranolol directly into their vein what will happen. Increase
BP and HR?
QUESTION: propanolol+ epi. bad reaction due to: Drug interaction, anxiety, allergy,...
-alpha 1
-alpha 2
-beta 1
-beta 2
If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, however, the beta-
blocker prevents the vasodilation, leaving unopposed alpha vasoconstriction. (alpha-1)
QUESTION: What is the effect seen when propranolol and epinephrine are injected simultaneously - in
cases of mild reactions it causes hypotension; in severe reaction it is malignant hypertension
QUESTION: Change propanolol for ? Metoprolol ... little change on HR, but no marked increase in
BP. METOPROLOL = selective B blocker and is ok to use with EPI!!
QUESTION: Proponolol mechanism..beta-adenergic blockers
QUESTION: Patient got LA injection and started to feel nervous, tachycardia etc: choices were CNS
effect of epi, direct cardiac effect of LA.
QUESTION: After injection of LA, pt experiences tachycardia, nausea, and nervousness: alpha blockade
of the CNS (reaction of epi), cardiac response to lido, →cardio vascular peripheral response to epi
QUESTION: Main prophylactic treatment for angina? propanolol
QUESTION: Nitroglycerin, prop3onolol, and something else are all used for- cardiac arythmias, angina
QUESTION: Which is not used in tx of angina? Nitroglycerin, Ca blocker, propranolol, thiazide
(thiazides are usually diuretics)
QUESTION: All these drugs alter ionic movement except- Propanolol, others were CCB, HCTZ, and
Digoxin
QUESTION: A patient recieving propanolol has an acute asthmatic attack while undergoing dental
treatment. The most useful agent for management to the condition is?
a. Morphine
b. Epinephrine
c. Phentolamine
d. Aminophylline
e. Norepinephrine
QUESTION: The drug-of-choice for the treatment of adrenergically-induced arrhythmias is
quinidine.  
lidocaine.  
phenytoin.  
propranolol.  
QUESTION: direct alpha symphatomimetic: clonidine (alpha2), gueanethidine (indirect→ acts on

neurons to inhibit NE release), methyldopa (alpha2).
QUESTION: Epinephrine Reversal with ? Alpha adrenoceptor blockers, like phenoxybenzamine,
inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP
instead of high BP
QUESTION: Epinephrine reversal: what drugs can do this? after giving a patient epinephrine, following
hypertension, which of these drugs would cause a drop in BP? Phenoxybenzamine
Anticholinergic properties
dry mouth and throat, increased heart rate, pupil dilation (mydriasis), urinary retention,
constipation, and, at high doses, hallucinations or delirium. Other side effects include motor
impairment (ataxia), flushed skin, blurred vision at nearpoint owing to lack of accommodation
(cycloplegia), abnormal sensitivity to bright light (photophobia), sedation, difficulty concentrating,
short-term memory loss, visual disturbances, irregular breathing, dizziness, irritability, itchy skin,
confusion, increased body temperature (in general, in the hands and/or feet), temporary erectile
dysfunction, and excitability, and although it can be used to treat nausea, higher doses may cause
vomiting- anticholinenergic
Salivary secretion increases with use of Pilocarpine, Neostigmine (cholinergic agonists)

Salivary secretion DECREASES with use of atropine and scopolamine (anti-cholinergics)
Scopolamine-commonly used for motion sickness Anticholinergic drug The drug is used in eye drops to
induce mydriasis (pupillary dilation)
Remember>ANTIHISTAMINE IS ALSO USED FOR MOTION SICKNESS!
QUESTION: What is used for motion sickness? Diphenadryin (Benadryl)----I think this is
scopolamine
Neostigmine (Increases Salivation)

Neostigmine, etc. cause salivation. **CHOLINERGIC effects: increase salivation, increase urination,
bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation
Know which drugs mimic parasympathetics (cholinergics), be able to pick from a list which does
not belong (Acetylcholine, Atropine, d-tubocurarine, neostigmine, Nicotine, Physostigmine,
Pilocarpine)
Effects of cholinergic drugs – slow heart, constrict pupils, stimulate GI smooth musc, stim sweat, saliva,
Belladonna derivatives – anticholinergic
Neostigmine: Acetylcholinesterase inhibitor, doesn’t penetrate BBB, tx of M. gravis
Physostigmine: used for atropine, scopolamine overdose, tx of glaucoma, acetylcholinesterase
inhibitor
Atropine: Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides
Pilocarpine: Muscarinic agonist, for glaucoma and xerostomia
Scopolamine: anticholinergic agent,
QUESTION: Neostigmine and pilocarpine increase? Salivation. are parasympathomimetic that

acts as a reversible acetylcholinesterase inhibitor.
QUESTION: Glycopyrrolate effect? reduce salivary (is a muscarinic anticholinergic), as well as the
acidity of gastric secretion.
QUESTION: Atropine: is sympotatic decrease salivation
QUESTION: what meds to decrease saliva? Should be atropine, scopolamine, etc. Pilocarpine,
methacholine, neostigmine, etc. cause salivation. **Muscarinic effects: increase salivation, increase
urination, bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation
QUESTION: Atropine-anti cholinergic-what does it not cause/cause? Don’t give if patient has
xerostomia
QUESTION: If patient has xerostomia what wont you give---Atropine- anticholinergic
QUESTION: What drug does not cause miosis of the eyes?- atropine
QUESTION: Insufficient cholinesterase leads to hypotension? (bradycardia)

Other answers: tachycardia, restlessness, …
QUESTION: bradycardia: atrophine

***I think the question must have been something like pt have bradychardia what should we give him?
And answer is atrophine. Because atrophine will increase heartrate causing tachychardia.
QUESTION: Drug to decrease saliva because you want to take an impression- ATROPINE (DECREASES)
, Prilocarpine (INCREASES), Neostigmine (INCREASES)

QUESTION: Xerostomic pt, give pilocarpaine! Or cevimeline.
QUESTION: Cimeviline just like pilocarpine to increase salivation in xerostomia
QUESTION: Pilocarpine used for? Is a parasympathomimetic alkaloid, for tx of glaucoma and
xerostomia.
QUESTION: What is the side effect of pilocarpine (Tx of dry mouth)in toxic dose?
Apnea
Cardiac shock
Note: nontoxic side effects>>> excess sweating and salivation, bronchospasm
QUESTION: Propantheline bromide (pro-Banthine) is? anti-cholinergic (anti-muscarinic), relieve

cramps or spasms of the stomach, intestines, and bladder.
QUESTION: Which of the following groups of drugs is contraindicated for patients who have glaucoma?
Adrenergic, Cholinergic, Anticholinergic Adrenergic blocking
QUESTION: Which of the following drug groups increases intraocular pressure and is, therefore,
contraindicated in patients with glaucoma?
A. Catecholamines
QUESTION: A patient has a deficiency in acetyhcholinesterase. After giving her this drug, action
is prolonged. I put d-tubocurarine (inhibits acetylcholine receptor→weakness of skeletal
muscles)
QUESTION: Decrease of pseudocholinesterase would lead to increase in? Succinylcholine or

tubocurare
QUESTION: Administration of succinylcholine to patient deficient in serum cholinesterase would casue…

a. convulsions
b. Hypertension
c. prolonged apnea
QUESTION: Only LA that is a vasoconstrictor? Cocaine
QUESTION: 2-3 questions on miosis (opioids + cholinergics) vs mydriasis (anticholinergics +

increase serotonin) and which drugs or conditions cause which?
QUESTION: Pt taking narcotic for long term what causes: headache due to increase intracranial
pressure.
Adrenergics:
QUESTION: End plate of adrenergic neuron how is it terminated?
-reuptake of NE? followed by MAO degradation in the neuron
-MAO degrades NE
QUESTION: What receptor or signaling pathway is linked most directly to α2-adrenoceptor

stimulation? Inhibition of 🚫 adenylyl cyclase through Gi, resulting from stimulation of α2-
adrenergic receptor, leads to intracellular ⬇ cAMP
QUESTION: A patient who has Parkinson’s disease is being treated with levodopa. Which of the
following characterizes this drug’s central mechanism of action?
QUESTION: why do you need to take carbidopa with levodopa: prevents breakdown of levodopa before it
crosses the blood brain barrier **L-dopa is a precursor to neurotransmitters like dopamine, norepi, and
epi. It is used in tx of parkinson’s. In parkinson’s you want to raise dopamine levels.
QUESTION: How does carbidopa tx Parkinsons? I put potentiates effects of dopamine
QUESTION: Carbidopa - Use in conjunction with levodopa
QUESTION: Levodopa used to treat Parkinson’s disease
QUESTION: Levdopa is used in parkinsons in order to do what?- increase dopamine in the CNS
Carbidopa-a drug used to treat PARKINSON'S DISEASE, but only works when combined with
LEVODOPA (treats Parkinson's Disease to replenish the brain's supply of dopamine, which is the
deficient neurotransmitter in Parkinson's.
QUESTION: Parkinsons is def of dopamine
QUESTION: Cause of Parkinson? Dopamine deficiency, give them methyldopa (levadopa)
Methyldopa competively inhibits DOPA decarboxylase →decrease in dopamine and NE/EPI. Its an
anti-hypertensive, acts on A2 adrenergic as well.
QUESTION: Theraputic Index LD/ED is a measure of : safety of drug
potency - response to a drug over a given range of concentrations. Potent = depend on dose of drug-
less mg for same efficacy has more potency
efficacy - effect of a drug -efficacy is the max effect of the drug. Max effect is also called as intrinsic
activity. (antagonists are not efficient/no intrinsic activity)
Therapeutic index - is an estimate of the margin of safety of a drug.
TI = Lethal dose 50/Effective dose 50
QUESTION: LD50 means that •At this does 50% of the test animals died
QUESTION: What is bioavailability of a drug? amount of drug that is available is blood. (plasma)
QUESTION: How is bioavailability measured?
How much drug is absorbed in the circulation  
Blood to urine ratio  
Note: efficacy of drug: level of binding a drug to its receptor
QUESTION: what pharmacokinetic factor influences the need for multiple doses in a day (dose
rate): I said half life; other option is bioavailability (maybe should have goe with this), or clearance
Elimination rate of a drug influences its half life → that determines the frequency of dosing
required to maintain therapeutic plasma drug levels.
Bioavailability: Highly absorbed drug (high bioavail.) requires a lower dose that poorly absorbed.
Most important determinant of drug dose is POTENCY of drug.
QUESTION: drug dosing has to do with: half life

QUESTION: two different drugs with same dosages bind to the same receptor and cause same intrinsic
affect however they have different affinities for the receptor: In which aspect these 2 drugs are similar?
Efficacy bc they can both produce the same maximal response if enough is given
ED50
Potency is how much they can get response with just a little
QUESTION: There are two drugs that with the same dosages bind to the same receptor and have same
intrinsic affect however different affinities for the receptor: How are these two drugs the same? 
a. ED50
b.  LD50
c. Potency
d. Efficacy
QUESTION: both drug have same intrinsic effect and different receptor affinity---same potency, same
efficacy
receptors)
receptors)* depends on the answer choices…. I think this person if referring to POTENCY. Potency =
relative concentrations of two drugs that produce the same effect. So a drug that produces the same effect
as another drug but at a lower dosage.. is MORE POTENT. EFFICACY deals with RECEPTORS.
EFFICACY = NUMBER OF RECEPTORS that must be ACTIVATED to yield maximal response.
Higher efficacy = activates less receptors to produce this response.
**in the Tufts packet—“Drug A had greater efficacy than drug B, so Drug A” – is capable of producing a
greater maximum effect than drug B.
QUESTION: Drug A vs Drug B question: less of drug A to produce a response than B (know efficacy,
potency, theurapeutic index)
QUESTION: Fixed dose drug A w/ low dose of Drug B increase drug B effect when same dose of drug
a is give w/ increased does of drug B: competitive antagonist, synergism , partial agonist
QUESTION: Three carpules (2 ml carpules, 40 mg/ml) of local anesthetic X are required to obtain
adequate local anesthesia. To obtain the same degree of anesthesia with local anesthetic Y, five carpules
(2 ml carpules, 40 mg/ml) are required. If no other information about the two drugs is available, then it is
accurate to say that drug X
0
X&Y are = in potency & efficacy.
A. agonism.
B. potency.
C. efficacy.
D. specificity.
General Anesthesia:
QUESTION: A 26 month old child w/ 12 carious teeth. How to treat? General Anesthesia
QUESTION: What would you do with a 26 month year old child and multiple decays on teeth
o General anesthesia
o Oral sedation
o Nitrous oxide
QUESTION: 26 mo old child with 12 carious teeth, how would u treat'? nitrous and local anesthesia,
oral sedative and local in one visit. GENERAL ANESTHESIA !!
QUESTION: 2 year old with 12 fillings that are deeply decayed, how do you tx patient? Under
general anesthesia
QUESTION: Benzodiazepines which one is used for depression and anxiety for compulsive disorder
(Xanax= Alprazolam - used for anxiety panic disorder not depression)Out of the Benzodiazepines
the only one that has OCD is Xanax-Alprazolam but does not include depression—only
QUESTION: Diazepam: Anticonvulsant & Sedative
QUESTION: Valium causes orofacial clefting  DOES NOT!
QUESTION: Anticonconvulsants can cause cleft palate (teratogenic effect)

QUESTION: valium is used for all of following except: I picked emesis/ other option was insomnia
but im pretty sure its emesis
QUESTION: Diazepam action in GABA: antianxiety and anticonvulsant
QUESTION: hypnosis affects what? voluntary muscles, involuntary muscles, both voluntary
and involuntary muscles, glands
QUESTION: What’s the action of the Benzodiazepines?

A.Facilitates GABA receptor binding by Increasing the frequency of chloride channel opening.*
QUESTION: Mechanism of action of on GABA receptors:
increasing the frequency of chloride channels by Benzodiazepines
Barbiturates increase the duration of chloride channel opening
QUESTION: Benzodiazepines act on: I put GABA receptors

QUESTION: benzodiazepines, anxiolytics how do they work? GABA!
QUESTION: Which of the benzodiazepine you don’t give to seniors? Long acting one (like diazepam,
look up)
Short to intermediate-acting benzodiazepines are preferred in the elderly such as oxazepam and
temazepam, midazolam.
QUESTION: Benzos are great for dentistry due to an action of- amnesia and little memory of the event.
QUESTION: Best benzo for iv sedation-MIDAZOLAM.

QUESTION: Best benzodiazepine for pt with liver cirrhosis -oxazepam
Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)
LOT:
Lorazepam
Oxazepam
Temazepam
QUESTION: Flumazenil: Benzodiazepine antagonist ; competive GABA receptor.

QUESTION: Which drug best reverses the effect of benzodiazepines?
Flumazenil Benzo flu away
QUESTION: Flumazinil - reversal for benzo
QUESTION: contraindication of lorazepam: a)pregnancy b)diabetes ?
QUESTION: diazepam is contraindicated in pregnant lady (ALL BENZOS)
QUESTION: Who cannot take Valium (diazepam)? Pregnant women
QUESTION: Pregnancey, don’t take? diazepam
QUESTION: Reversal for valium (diazepam)- flumazenil

QUESTION: Why do you use benzos or a barb for antianxiety? Reduced depression, does not
propentiate depressents. (less respiratory depression)
QUESTION: How benzos are anxiolytic – rebound sedation or amnesia?
QUESTION: How benzos are anxiolytic: moderate doses ANTIANXIOLYTIC and high doses is
SEDATIVE
QUESTION: Sedative rebound (or something like that) a. Antipsychotic
QUESTION: Sedative rebound (or something like that)

a. Antiphysicotic
→ PART OF WITHDRAWL
QUESTION: Which of the following barbiturates MOST readily penetrates the blood-brain barrier?
Thiopental
QUESTION: Sodium Thiopental → rapid-onset short ultra acting barbiturate(IV) for general
anesthesia- for Desensation
QUESTION: A patient has appointment next morning, he is anxious, and the night before he had hard time
sleeping, which of the following tx would you prescribe? Ambien! (sedative and makes patient sleep).
QUESTION: Check what is Ambien (Zolpidem) !!

(Ambien is a nonbenzodiazpine hypnotic…used for insomnia..so not a benzodiazepine but acts
accordingly… anticonvulsant and muscle relaxant but too strong for these purposes…also reversed by
flumazenil just like BDZs…potentiates GABA receptors…short half life…negative side efx: hallucinations
and amnesia…Xtina)
a. oxidation (occurs in the liver…Xtina)
b. reduction.
QUESTION: why are ultrashort acting(gave me an actual name of a barbiturate) barbituates so fast?
•Redistribution (right answer according to previous test)
redistribution.

A. Narcon
B. Flumazenil**
• Respiration
• *Electo cardiogram
• Skin and oral mucosa color (cyanosis?)
QUESTION: #1 cause for problems during IV sedation?—hypoxia
QUESTION: A 77 years old female 110 lbs weight requires removal of mandibular teeth under local
anesthesia. She is apprehensive. The appropriate dose of i/v diazepam to sedate her?
a. 5 mg
b. 10 mg
c. 15 mg
d. 20 mg
QUESTION: Drug for seizures? Dilantin (or diazepam)

QUESTION: Flumazenil combats benzos (naloxone combats opioids), disulfuriam is for alcoholics
QUESTION: Buspirone - Psychotropic w. anxiolytic; low CNS depression, low psychomotor skill
impairment ***Buspar—different from benzodiazepines because it does NOT cause, CNS depression,
muscle relaxant, or anti-convulsant!!!!!** UNIQUE!!! Anxiolytic and antidepressant
QUESTION: Know drugs used for conscious sedation → SSRIs/BDZ Diazepam and
Prozac(fluoexitine)
QUESTION: 25 yo female breast feeding 12m old child and currently pregnant-which sedative would you
give?
• Halcion
• Promethazine
• Nitrous
• Diazepam
• Phenobarbital
QUESTION: What anxiolytic to use for anxious 25 year old pregnant woman who is breastfeeding?
Chloral hydrate (avoid), nitrous (avoid), benzo (avoid)
QUESTION: 25 yo female breast feeding 12m old child and currently pregnant-which sedative
would you give?
• Promethazine
*promethazine OK for pregnancy
QUESTION: -If youre breast feeding what drug should you not take? Something prohibited in the states.
QUESTION: What drug NOT to give to lactating breast feeding mother
QUESTION: Prozac - acts on serotonin

QUESTION: Prozac (fluoxetine) - acts on serotonin SSRI “selective serotonin receptor
inhibitor” this is an antidepressant
QUESTION: Fluoxetine (prozac ) Mechanism of action: SSRI
QUESTION: Patient is in her 70’s, she lives alone, what could she be suffering from? – Depression
QUESTION: Most common psychological problem in elderly? A: Depression
QUESTION: Geriatric population- problem with dementia or depression
QUESTION: What is assoc with depression; age, econ stat, prof status..
QUESTION: Most common mental illness among elderly? dementia, depression..
QUESTION: which one of the things can be seen with TMP pt in elders: Depression
QUESTION: main sign of dementia (I think it should be MEMORY LOSS, dunno short or long)
a. confusion
b. short term memory loss—I think this is the answer.. if they are asking for the first main sign.
Long term loss occurs later.
c. long term memeory loss
QUESTION: 1st sign of dementia
short term memory loss
long term memory loss
QUESTION: main sign of dementia -People with dementia often forget things, but they never
remember them later
confusion **
QUESTION: Dementia: which is not a sign of dementia: long-term memory loss
QUESTION: Substance in the brain where antidepressants works :→decrese amine mediated
neurotranmision in the brain
QUESTION: TCA mechanism of action: inhibit reuptake of NE and 5-HT (serotonin)
QUESTION: TCA 2nd generation- Nortriptyline (Pamelor, Aventyl)
Desipramine (Norpramin)
Protriptyline (Vivactil)
QUESTION: know the mechanism of action of TCA.? it decreases the re uptake of Norepinephrine
QUESTION: How do tricyclics work?- by not allowing reuptake of neurotransm.
QUESTION: What catecholamine do tricyclic antidepressants affect? Dopamne, serotonin,
acetylcholine
QUESTION: patient is taking TCA antidepressants what do you take into consideration? Limit
duration of procedures, keep in mind the epinephrine limit ….
QUESTION: Side effect of having TCA and epi : HTN, hypotension, hyperglycemia,
hypoglycemia

QUESTION: IF someone has a history of depression, what do you give? Zyban (Bupropion), not Chantix
(smoke cessation)
QUESTION: Amitrriptyline – most common tricyclic antidepressant, inhibits reuptake of NE and
serotonin
QUESTION: Tricyclic antidepressant- didn’t remember what the question was: SSRI- prevent uptake of
serotonin
QUESTION: Zoloft works on what receptor?Presynaptic monoamine transporters (inhibit reuptake
of 5-ht)
Sertraline hydrochloride (trade names Zoloft and Lustral, among others) is an antidepressant of
the selective serotonin reuptake inhibitor (SSRI) class.
QUESTION: Most common mood disorder?generalized anxiety or depression?
QUESTION: Depression causes- eating, lonliness, and something else
QUESTION: Depression-st johns wort
QUESTION: St johns wort- is for depression
QUESTION: St. John’s Wart: (-) serotonin yeah because is for depression
QUESTION: What does St. John's Wort do? Decrease the body immunity
Note: there is no option “anti depressant” in choices. in Pt with HIV it interact with anti HIV drugs such
as Indinavir(increase immunity) and reduces their function so the immunity decreases
QUESTION: St johns wart- used for? · depression→not with benz and HIV medication
Antipsychotics
o Phenothiazines: Block DA receptors

▪ Act on the extrapyramidal pathway
o Side effects
▪ Tardive dyskinesia
QUESTION: antipsych drug does what?–DA (dopamine)
QUESTION: Substance in the brain where antipsychotics works : blocking the absorption of
dopamine
QUESTION: What catecholamine does Phenothiazine (antipsychotic) affect? Dopamine, serotonin,
acetylcholine
QUESTION: Phenothiazine (anti-psychotics): SE Tardive Dyskinesia
QUESTION: tardive dyskinesia-psychosis
QUESTION: Tardigive dyskaenesia – antiphyschotic (irreversible)

QUESTION: antipsychotic meds - act on dopamine
QUESTION: What acts on extrapyramidals? Phenothiazines (chlorpromazine)
QUESTION: what is the most common psych disorder? (anxiety, depression, ADD,
schizophrenia)
QUESTION: lithium is used for? Manic phase of bipolar disorder
QUESTION: Lithium- bipolar disorders
QUESTION: a patient on Lithium is indicative of what? Severe depression? BIPOLAR
Anti-inflammatory/Corticosteroids: Side effect profile: gastric ulcers,immunosuppression, acute
adrenal insufissiency, osteoporosis, hyperglycemia, redistribution of body fat.
QUESTION: Strongest glucocorticoid/Long acting Corticosteroid? Dexamethasone,

QUESTION: Stomach ulcers? Excess ..corticosteroids
QUESTION: GI with corticosteroids: Ulcers. Long term effect- osteoporosis
QUESTION: GI effect WITH CORTICOSTEROIDS-ULCERS

QUESTION: Long term side effect of corticosteroids-osteoporosis and hyperglycimea
QUESTION: What is the side effect of prolonged corticosteroid therapy?
o Osteoporosis
o Know the other side effects just in case
QUESTION: patient with long term therary corticosteroid will show?

Hyperglycemia
QUESTION: patient with long term therapy corticosteroid will show?
Osteoporosis
QUESTION: long term glucocorticoids use- shows all of following except? hypoglycemia
does lead to: osteoporosis, hyperglycemia, immunosupp.,
QUESTION: Where do you see moon facies: steroid treatment
QUESTION: Where do you see moon facies: increased steroid treatment

QUESTION: Containdation use corticosteroid-diabetes (also: HIV, TUBERCULOSIS, CADIDIASIS,
PEPTIC ULCER)
QUESTION: Aspirin contraindicated with: corticosteroid use
QUESTION: Corticosteroid: 20 mg 2 wks
QUESTION: How much and how long of steroid insufficiency: 200mg/two weeks in last 2 years, 20
mg 2 weeks in last 2 years, 10 mg or 1 mg….no idea
QUESTION: Critical dose of steroids for adrenal insuficience- 20 mg of cortisone or its equivalent
daily, for 2 weeks within 2 years of dental treatment
QUESTION: Pt taking corticosteroid with rheumatoid arthritis, pt needs TE, why would you consult with
physician: full blood panel, assess for adrenal insufficiency (want to make sure pt can produce enough
coricosteroid with addition to what they are taking so you won’t have over inflammatory response from
TE)
QUESTION: Pt on 3mo tx of steroids needs what?- no tx and consult gp for dose rase
QUESTION: if a pt. has been using 10 mg of corticosteroid for 10 years, what would you do for pt.
before any tx? Have pt continue and increase the dose
QUESTION: cortisone exerts its action on…(it’s a steroid hormone, so binds to intracellular receptor) -
receptors on membrane, proteins in plasma…etc.
(Enter cell and bind to cytosolic receptor migrate to nucleus gene expression or With plasma membrane
on target cells)
QUESTION: if pt doesn’t get steroid tx in time for their temporal vasculitis what will happened
• hearling loss
• vision loss

QUESTION: Asthma – why use corticosteroids – decrease inflammation
Inhaled corticosteroids are the most effective medications to reduce airway inflammation and
mucus production.
QUESTION: what Addison disease causes :→pigmentation of the mucosa

chronic endocrine disorder in which the adrenal glands do not produce sufficient steroid
hormones (glucocorticoids and often mineralocorticoids)
*Addison= lower steroid hormones…pigmentation of mucosa
QUESTION: Addisons shows what in oral cavity: pigmentation on buccal mucosa
QUESTION: what Addison disease causes : a)bone loss b)pigmentation of the mucosa
QUESTION: What clinical symptoms in the mouth would you see for Addison’s disease?
a. Hyperpigmentation
QUESTION: Addison’s Disease

tan skin(J.F.K.)
Tx: give cortisol
QUESTION: Nitrous oxide – in blue cylinder (oxygen in green)

QUESTION: Nitrous oxide oxidizes the cobalt in vitamin B12, resulting in the inhibition of
methionine synthase. Nitrous oxide has greater analgesic potency than other inhaled anesthetics
QUESTION: Dreaming on nitrous, what is it? Overdose, normal
QUESTION: How do u check to see if the oxygen (reserve) bag is ok: It shouldn't be that full or
that collapsed
QUESTION: Contradictions of nitrous, which patient can get nitrous? Hypertention, pregnancy
QUESTION: What is an absolute contra-indication for the use of Nitrous Oxide? Sickle cell anemia
or nasal congestion?
QUESTION: Fear anxiety, which option is better? First we administer Nitrous, then papous , then
anesthesia
QUESTION: devise used in evaluation of N20 : Pulse oximeter

(CORRECT—used to measure amount of oxygen in blood)
QUESTION: The correct total liter flow of nitrous oxide-oxygen is determined by the amount
necessary to keep the reservoir bag 1/3 to 2/3 full.
QUESTION: Nitrous to pedo at 50%-what we do? We stop giving it.

a. 40 %
b. 50%
c. 70% Adult
QUESTION: Safety on nitrous tank – 70%
QUESTION: A questions about the percent nitrous can NOT increase because of a safety?: 30, 70,
QUESTION: safety valve in nitrous tank no more than : a)50 % b)80% c)90%
QUESTION: Why is nitrous oxide used on children? alleviate anxiety
QUESTION: What is an adverse effect of nitrous? Nausea,
QUESTION: If patient does not have 100% oxygen after nitrous oxide: Diffusion hypoxia
QUESTION: NO2 contraindicated in I put nasal congestion, it is ok for asthma **contraindications for
NO2 include—COPD, resp infx, pneumothorax/collapsed lung, 1st trim of pregnancy, hard to
communicate with pt, contagious disease, middle ear or sinus infx, bowel obstruction, head injury
QUESTION: Nitrous oxide and preg pt, which trimester to avoid? 1, 2, 3, all trimensters
QUESTION: Nitrous should not be given in 1st trimester of pregnancy
QUESTION: When is nitrous contraindicated for a child? I put upper respiratory tract infection
QUESTION: Contraindication to nitrous- breathing disorder
QUESTION: When is nitrous contraindicated? Asthma/COPD
QUESTION: What is an absolute contra-indication for the use of Nitrous Oxide? Sickle cell anemia or
nasal congestion?**I think it is nasal congestion. Website states Nitrous is ok for sickle cell anemia, and
relaxing effects can lower chances of a crisis.
QUESTION: Why give hydralazine with chloral hydrate? Decreases nausea

QUESTION: hydroxizyne is used with chloral hydrate because decrease nausea is a first-generation
antihistamine of the piperazine class that is an H1 receptor antagonist. It was synthesized in the
early 1950s. It is used primarily as an antihistamine for the treatment of itches and irritations, an
antiemetic for the reduction of nausea, as a weak analgesic by itself and as an opioid potentiator,
and as an anxiolytic for the treatment of anxiety
QUESTION: hydroxizyne is used with chloral hydrate because →decrease nausea
Local Anesthesia:
Lipophilic ring (aromatic) + intermediate chain (ester or amide link) + hydrophilic amino terminus
Esters are more prone to hydrolysis = shorter duration of action
Esters = no I before –caine Amide = “I” before –caine
Amides: metabolized in liver

Esters: Metabolized by plasma esterase
QUESTION: Know where L.A. metabolized? Amide (2 I’s) met. in P450 enzyme of Liver. Esters (1 i)
met. in pseudocholinesterase of plasma.
QUESTION: How does anesthetic work? Decrease sodium influx
QUESTION: Mech of action of local anes on nerve axon – decreases sodium uptake through sodium
channels of axon
QUESTION: What is the primary reason for putting epi in LA?- to slow its removal from the site.
PROLONG DURATION OF ACTION
QUESTION: adding a vasoconstrictor like epinephrine decreases its rate of absorption, thus
increasing the duration of action, minimizing systemic toxicity, and helps with hemostasis

d. all of above
QUESTION: Anesthetics broken down by what: biotransformation
→***thiopental= redistribution
QUESTION: Biotransformation, what is tendency of molecules, chemical similarities: more polar and
more ionized and less lipid soluble
QUESTION: Which best describes biotransformation: increase/decrease in polarity and water
soluble
Whatever helps its excretion – polar and more water soluble
QUESTION: Conjugating the drug does what ? something about crossing brain barrio more or
other things conjugation reaction = are the Phase 2 reaction of drug biotransformation that occurs in the
liver. metabolizing to a soluble form
QUESTION: In relation to their parent drug, conjugated metabolites do what –more ionized in plasma
(more water soluble)
QUESTION: What happens to a drug after conjugation- more ionic, more hydrophilic, more active...
QUESTION: What do you use sodium bicarbonate for? All drugs or alcohol (phenol barbitals)
Excretion of acidic drugs is accelerated with Sodium Bicarbonate

QUESTION: Excretion of an acidic drug will be enhanced if the patient is given which of the
following? Sodium bicarbonate
QUESTION: First pass metabolism? Concentration will decrease exponentially. Drug eliminated in
proportional fashion.
QUESTION: First pass effect- metabolized in liver
QUESTION: First pass metabolism:
- enzymatic degradation in the liver prior to drug reaching its site of action
QUESTION: oral meds - first pass effect on liver

QUESTION: First pass effect best describes: passing through hepatic, entering the entero-
something
QUESTION: First pass refers to: enterohepatic circulation, metabolism in liver enterohepatic
goes from bile to liver and metabolism is not decreased.
1. Enterohepatic circulation
Substances that undergo enterohepatic circulation are metabolized in the liver (usually by
conjugation), excreted in the bile, and passed into the intestinal lumen (where the intestinal
bacteria break some of the conjugated drug, releasing the unmetabolized drug again) where
they are reabsorbed across the intestinal mucosa (thus returns to systemic circulation
again) and returned to the liver via the portal circulation. Drugs may remain in the
enterohepatic circulation for a prolonged period of time as a result of this recycling process.
thus increase in their halflives.
First pass effect:

After a drug is swallowed, it is absorbed by the digestive system and enters the portal
circulation. The absorbed drug is carried through the portal vein into the liver. The liver is
responsible for metabolizing many drugs. Some drugs are so extensively metabolized by the
liver that only a small amount of unchanged drug may enter the systemic circulation, so the
bioavailability of the drug is reduced. Alternative routes of administration (e.g., intravenous,
intramuscular, sublingual) avoid the first-pass effect.
QUESTION: Oral drugs – undergo first pass metabolism in liver
QUESTION: what is used to determine whether a drug will cross glomerulus: I said whether its
attached to a protein or not; other option is whether the drug is acid or base; other is if its
positive or negatively charged

Weak acid,
Weak base
Liposoluble-NON ionized drugs are soluble in lipid.
Hydrophobic
Hydrophilic-
QUESTION: When a drug does not exert its maximum effect is because its bound to ?
albumin-drugs highly bound to plasma proteins will not enter liver to be metabolized,
resulting in longer half life.
gamma
betasomething
alpha
QUESTION: what protein is used to attach to medication: alpha or beta or gabba globulin, albumin
was also choice: albumin
QUESTION: Which of the following best explains why drugs that are highly ionized tend to be more
rapidly excreted than those that are less ionized? The highly ionized are
QUESTION: Patient got LA, their breathing fast, hands and finger are moving, heart rate is up – You
injected into a blood vessel
QUESTION: Patient get LA injection, he started to breathe a lot, HR goes up, due to what? I said due to
vasoconstrictor acting on CNS (correct answer cardiovascular response to vasoconstrictor)
QUESTION: HTN pt. just gave 4 carpules of 2% xylocaine with 1:100k epi. BP went up to 200/100.
what’s possible mechanism/cause?
QUESTION: Patient receives local anesthesia, bp goes up to 200/100, reason? Injection of

epinephrine into circulation
QUESTION: LA does not work when there is inflammation as the pH has decreased
QUESTION: Infection around a tooth but can't numb patient, why? - Infection reduces the free base
amount of anesthetic
QUESTION: Where do you inject if infiltration in the area will not be able to avoid the infection?- Block
QUESTION: Why doesn’t anesthesia work when you have an infection? Decreased pH (acidic
environment) leads to more ionized form (less nonionized)
QUESTION: Abscess, give LA, decreased in effect why? LA is unstable in low pH, LA is in ionized
form, needs to be in free base form or unionized form to cross membranes
QUESTION: L.A. in inflamed tissue? Not enough free base to be effective.
QUESTION: As LA becomes more ionized, becomes more water soluble

QUESTION What tooth and what condition makes it most difficult to properly anesthetize the tooth:
irreversible pulpitis/necrotic pulp in mandibular/maxillary first molar
QUESTION: the pKA of an anesthetic will affect what. Metabolism, potency, peak effect? ONSET
QUESTION: When do you know that is it a non-odontogenic pain: When pain is not relieved with LA
QUESTION: Lidocaine calculation: a cartridge that contains 1.8 ml of solution at a 2% (20mg/ml)

concentration, how much drug? 36 mg/ml of drug (20 mg/ml X 1.8 ml/cart. = 36 mg/ml)
QUESTION: Calc of anesthetic. 2% lodicaine or 1:100,000. how much anesthetic in it? 1. 36mg (answer)
QUESTION: Know max dosage of lidocaine for a kid in mg/kg 4.4 mg/kg
QUESTION: Numb the kid, how many hours is the soft tissue numb? 3 hrs
QUESTION: When you numb IA nerve, which roots of primary teeth are numb, (2.3, section C),
Could not find!!
QUESTION: Kids have higher pulse, basal metabolic activity and higher respiratory rate , but lower
BP
QUESTION: Typical pulse for a 4 year old is 110 (12 yr old is 75, adult is 70)
QUESTION: 20 kg child how many mg of lidocaine: 88mg
MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI 7mg/kg) for adult’s 4.4mg/Kg for
Pedo
QUESTION: Kid is 16kg* 4.4 mg/kg max amount of lidocaine? 70mg
QUESTION: 88 lbs (40kg) patient is given 2 cartridges 1.8 ml each of 2% lidocaine with 1:100,000
epinephrine. Approximate what % of maximum dosage allowed for this patient was administered ?
a. 10%
c. 40%
d. 60%
88lbs*2.2 kg/lb = 40 kg. 40kg*4.4mg/kg (max dose for lido) = 176mg = max dose for this patient
72mg injected/176mg = 40%
QUESTION: 50 lb patient given 5 carps of 2% lido with 1:100k epi, during procedure he convulses, why –
overdose of lidocaine, overdose of the epi, allergic
→Lido: convulsions
→ EPI: HTN
QUESTION: know the dosage of both anesthetics (4.4kg/ml) and epi(???) for child. This xxkg boy got
5 x 2% Lido with 100,000 epi, and 20 min later, started twitching his arms and legs and went
unconscious. What’s wrong? I did calculation for anesthetics, but he wasn’t overdosed by
anesthetics but might be by epi, so know the pediatric dosage of epi. If it’s not overdosed, you can
pick other choice.
Choices were 1) this kid is overdosed with anesthetics. 2) by epi 3) some other answers I don’t
remember
QUESTION: Maximum recommended dosage of lidocaine HCl injected subcutaneously ( not i/v) when
combined with 1:1,00,000 epinephrine is?
a. 100 mg
b. 300 mg
c. 500 mg
d. 1 gram[/QUOTE]
QUESTION: What slows metab of lidocaine?- propanalol (stays in system longer because propranolol
slows down heart → blood delivery to liver is slowed →metabolism of lidocaine is slower→stays in system
longer)
QUESTION: How much epi for a cardio pt? 0.04mg
QUESTION: Max dose of epi for cardio pt----- 0.04mg, Two carps 1:100.000 (epi 1:50.000
max=1carp.; 1:200.000 max=4carps)
Max dose of epi for healthy pt---- 0.2 mg, Eight carps
QUESTION: Lidocaine-not metabolized in plasma

QUESTION: Lidocaine toxicity is due to - overdose - increased vasoconstrictor, due to preservative
(EPI)
QUESTION: which of the following anesthetic can be used as topical? benzocaine, butamben,
dibucaine, lidocaine, oxybuprocaine, pramoxine, proparacaine, proxymetacaine, and tetracaine
QUESTION: Topical anesthetic- lidocaine
QUESTION: Which pair of anesthetics is most likely to cause cross allergy? 1. Lidocaine and
mepivocaine (answer)
QUESTION: What do you give IV for ventricular arrhythmia?
a. Quinidine
b. Lidocaine
QUESTION: Muscle dystrophy after local anesthetic more likely to? Lidocaine toxicity?) Increase
duration of action? Increase onset? Cant they be supine?
QUESTION: Muscle dystrophy and oral surgery-lidocaine toxicity, duration of action, onset of
action, can they be supine
QUESTION: Pt with muscle dystrophy what can happen in concern with Local Anesthetic? Increase risk
of LA toxicity, need more dosage of LA, LA doesn’t last as much , duration, onset?
Muscular dystrophy: muscle weakness, “long face” which is characterized by a lower vertical facial
height and open bite

QUESTION: What can be seen on a patient with muscle weakness of the face? Cross bite, buccal tilting of
molars.. long upper face??
QUESTION: Muscle dystrophy , lower face with open bite.
QUESTION: Considerations for muscular dystrophy: increase in dental disease if OHI is

neglected, weakness of muscles of mastication→ decrease biting force, open mouth
breathing
QUESTION: Low occlusal plane leads to what? I put decreased biting force, other options were
tongue biting, excessive bite force
QUESTION: Cocaine overdose symptoms? pinpoint pupils, mydriasis

Vs Opiate overdose symptoms and signs include: decreased level of consciousness and pinpoint
pupils.[2] Heart rate and breathing slow down, sometimes to a stop. Blue lips and nails are caused
by insufficient oxygen in the blood. Other symptoms include seizures and muscle spasms.
*Cocaine OD—mydriasis
*Opiate OD—pinpoint pupil
QUESTION: Cocaine OD will cause? Mydriasis, pint point pupils.. (cocaine cause vasoconstriction to
heart so it will do Mydriasis to pupils)
QUESTION: Cocaine -Intrinsic vasocontrictive activity
QUESTION: Cocaine- is a natural drug
QUESTION: Reversal of cocaine overdose?
QUESTION: Pt is on rehab of cocaine. what you prescribe for pain? advil
QUESTION: Prilocaine given. Symptoms of methemoglobinemia (cyanosis, headache, confusion,

weakness, chest pain)- methemoglobinemia
QUESTION: Methemoglobinemia is caused by oexcessive doses of lido, benzocaine, but ESP
prilocaine

QUESTION: Prilocaine causes methemoglobinemia. (can be treated with methylene blue…Xtina)
QUESTION: 3.6ml of prilocaine contain how much anesthesia
a. 72mg
b. 80,
c.144
d. 36
QUESTION: 3.6 ml solution of 4% prilocaine contains how many mg?
3.6 36 72 144 360
QUESTION: Levonordefrin is added to certain cartridges containing mepivacaine: To increase
vasoconstriction.
QUESTION: pt has heart problem? Mepivocaine→ NO EPI
QUESTION: How many carps of 4% [X] anesthetic should be given if maximum amount that you want to
give is 600mg of drug? - approximately 8 carps (go over calculation)
QUESTION: The maximum allowable adult dose of mepivacaine is 300 mg. How many milliliters of 2%
mepivacaine should be injected to attain the maximal dosage in an adult patient?
a. 5
b. 10
c. 15
d. 20
e. 25
2% mepivicaine = 20mg/ml. 300mg/20 mg/ml = 15
QUESTION: calculation of 2% mepivacaine max amnt (I think it’s 5 cartridges for adults…and 3mg/lb in
children
QUESTION: best LA to use w/o vasoconstrictor
a. pro
b. benzo
c. lido
d. articaine
Note: 400mg for prilocaine,300mg for lidocaine without epi,300mg for lidocaine with epi,90mg for
bupivacaine
QUESTION: 3 carps of 1.8cc of .5% bupivacaine 1:200000 epi – total dose

QUESTION: Bupivicaine calc in 3 cartidges- epi and bup
QUESTION: Articaine(septocaine): metabolized in blood .**unique bc it is an Amide, but has
an ester group, and is metabolized in the bloodstream
QUESTION: Articaine - conjugated at liver 1st? (unlike other amides, it metabolized in blood stream).
QUESTION: Articaine - conjugated at liver 1st? Blood Stream, Liver. (unlike other amides, it
metabolized in blood stream).
QUESTION: Know that Articaine is metabolized by esterase in plasma.
QUESTION: Articaine - conjugated at liver 1st? unlike other amides, it metabolized in blood stream
QUESTION: Articaine (septocaine) has an ester group, unlike other amides it is metabolized in blood
stream.
QUESTION: A recently-introduced local anesthetic agent is claimed by the manufacturer to be several
times as potent as procaine. The product is available in 0.05% buffered aqueous solution in 1.8 ml.
cartridge. The maximum amount recommended for dental anesthesia over a 4-hour period is 30 mg. This
amount is contained in approximately how many cartridges?
a. 1-9
b. 10-18
c. 19-27
d. 28-36 (approx 33 cartridges)
e. Greater than 36
QUESTION: anesthesia of facial nerve will cause all but
a. epinephrine
b. procaine
c. bisulfite
d. lidocaine
QUESTION: Pt taking MAO inhibitors what you CAN NOT give him: epinephrine, opioids
Local anesthetics containing EPI are contraindicated in patients taking MAO inhibitors.
QUESTION: Mix MAOI and epi get? –HTN
QUESTION: what determines max. dose for anesthetic for a child? 1. Weight (answer)
TABLE 3-5 Recommended Maximum Dosages of Epinephrine
QUESTION: What is the best indicator for success of intra-pulpal anesthesia? I put something
about backward pressure,
Back pressure
Type of anesthetic
QUESTION: Intrapulpal anesthesia does what – back pressure anesthesia stops hemorrhage, anesthesia
after 30 sec, patient doesn’t feel it
QUESTION: What is a good indication success of intrapulpal anesthesia – feel the back pressure during
injection
QUESTION: Which order will sensation disappear? 1. pain, 2.temp, 3.touch, 4.pressure
QUESTION: muscles elevating the jaw : masseter,temporal,medial pterigoid
QUESTION: Trismus includes what muscle: medial pterygoid
QUESTION: The dentist is performing a block of the maxillary division of the trigeminal nerve into which
anatomical area must the local anesthetic solution be deposited or diffused?
e. canine space
Pre-Medication:
Premedicate these conditions → artificial heart valve, previous IE, congenital heart
(valvular) defect, total joint replacement

2. a history of infective endocarditis
3. certain specific, serious congenital (present from birth) heart conditions, including
o unrepaired or incompletely repaired cyanotic congenital heart disease, including those
with palliative shunts and conduits
o a completely repaired congenital heart defect with prosthetic material or device, whether
placed by surgery or by catheter intervention, during the first six months after the
procedure
o any repaired congenital heart defect with residual defect at the site or adjacent to the site
of a prosthetic patch or a prosthetic device
4. a cardiac transplant that develops a problem in a heart valve.
Pre med with odontogenic infection:

• Tetracycline for periodontal infections
QUESTION: Total joint replacement knee? Pre-medicate ??? YES or no**
QUESTION: What if someone has joint replacement or high risk procedures? 1. Life time prophylaxis
before dental tx (answer) (not anymore…for joint replacements…within 2 years…Xtina)

o Cardiac pacemaker
QUESTION: Need premedication for… prosthetic heart valve,
QUESTION: Prophylactic treatment for Prosthetic heart valves – premedication required
QUESTION: In what situation would a pt need to premedicate? prosthetic heart valve
QUESTION: One of his patients has a pacemaker, but don’t premedicate either? Just stay away from
ultrasonic and electric testing and such.
QUESTION: What precaution you need to take for patient who has cardiac pacemaker?
a. antibiotic prophylaxis
b. avoid electrocautery
QUESTION: (Again with different options) need premedication for… congenital heart defect with severe
problems
QUESTION: when to give prophylaxis: congenital heart disease
3 different cases with it asking what’s the premedication regimen and on all three I wrote you don’t need
to premedicate because the problem was a triple bypass or angioplasty or other stuff that didn’t require
prophylaxis
QUESTION: Cyanotic heart valves you must premedicate. Kid had unrepaired cyanotic something valves,
cyanotic congenital heart disease. Premedicate with amoxicillin and you need to know the dosage so that
you pick the right dosage 60 lb kid. 50mg/kg dosage.
QUESTION: premedication for child 44 lbs : 1 gram amoxicillin 1 hour prior Tx.
Amoxicillin: Clindamycin:
• Adults: 2g orally 1hr prior to appointment • Adults: 600mg orally 1hr prior to appointment
• Children: 5Omg/kg (not to exceed adult • Children: 20mg/kg orally 1hr prior to appointment
dose) orally 1hr prior to appointment
44 lbs = 20KgX 50mg/Kg= 1000mg = 1g Amoxicillin
QUESTION: Pt w/ MVP w/ regurgitation – don’t premedicate
QUESTION: Antibiotic prophylaxis for mitrall valve prolapsed with regurgitation- NO

QUESTION: (Patient’s medical tab say he is allergic to Amoxicillin), He needs to be premedicated, what
do you prescribe? – Clindomycin, 600mg 1hr before the dude shows up for the appointment.
QUESTION: If patient is allergic to ampicillin, then what antibiotic should be given? Clindamycin, but
should be 600 mg and the answer choice was wrong since they said 2 g so he picked cephalomycin. Fixin
(I doubt its cephalomycin…because similar to cephalosporin and those are cross allergenic with
penicillin…Xtina) --**I think he meant cephamycin, but yea similar to cephlasporin. **CEPHALEXIN
probably the answer… if allergic to pen give 2 g of it.
QUESTION: one of them pt was taking penicillin everyday so I prescribed Clindamycin to avoid side
intxn
QUESTION: Man has accident and pin placed in arm. What antibiotic prophylaxis does he need?
A: None
QUESTION: Pt w/ total knee replacement but was taking Amoxicillin for a while; how do you
premedicate? (give Clindamycin b/c bacteria are probably already resistant to amox by now)
QUESTION: Prophylax and pt is taking penicillin already what do u give him? clindamycin
QUESTION: What is recommended prophylaxis for pt that can’t take penicillin…clindamycin

QUESTION: IE pre-medications definition? – For patients who has cardiovascular problems and are
at risk of infection over their lifetime. (other choices were wrong). Mine had the option of “benefits
of premedication outweigh potential harm associated with pennicillin”- which sounds pretty right
to me.
QUESTION: definition of endocarditis : is an inflammation of the inner layer of the heart, the
endocardium. It usually involves the heart valves (native or prosthetic valves)
QUESTION: Infectious Endocarditis pre-medications definition? – For patients who has cardiovascular
problems and are at risk of infection over their lifetime. (other choices were wrong)
QUESTION: when is it appropriate to prescribe antibiotic prophylaxis in patient with previous

infective endocarditis: if consequence of potential infection is dentrimental to life

• RCT
• Some sort of surgery *
• IA injection
QUESTION: Guideline of antibiotic prophylaxis, specially for kids. ie 2g of amoxicillin, 600mg of
clindomycin. ***for kids Amox is 50mg/kg and Clinda is 20 mg/kg
QUESTION: What is AHA recommended antibiotic prophylaxis conditions?
QUESTION: What are the reasons a dentist needs to pre-medicate?
QUESTION: Know antibiotic classes pretty good, how much to pre-med, what adverse side effects they
can have
Lots of prophylaxis qs on 2nd day, about what to prescribe, amount, mitral valve prolapse with
regurgitation,
Antibiotics:
QUESTION: Most bacteriastatic ab, how does it work ? affects protein synthesis
QUESTION: broad spectrum antibiotics : increase superinfection and resistance.
***TETRACYCLINE ARE BROAD SPECTRUM***
QUESTION: If you increase spectrum of bacteria - leads to more infections
QUESTION: antibiotics least useful: LAP, NUG, chronic periodontitis
QUESTION: Why not use broad-spec or overuse antibiots?- bacterial mutations

QUESTION: Why don’t we use broad spectrum antibiotics? Produce resistant bugs
QUESTION: Antibiotic metabolism affected by chronic tx with what drugs? Benzos, barbs, ssri, TCA
QUESTION: which antibiotics will not work well on someone taking prolonged drug for awhile. He put
TCA down.
QUESTION: pt taking antibiotic which is metabolized in the liver. Metabolism of antibiotic decreased by
which drug.
a. TCA
b. SSRI
c. phenothiazine
d. diazepam
QUESTION: Antibiotic decrease effect if pt taking? Barbiturates
QUESTION: Doxycyclone - act on 50S ribosome (there were no 30S choice, but google search
says both) (doxycyclone is a derivative of tetracycline which acts upon 30S…however after
searching it says doxy binds to 30S and also possibly 50S…not sure though)
QUESTION: doxycycline - 30S is a kind of tetracycline treats malaria!
QUESTION: 20mg doxycycline works how
a. Anti-collagenase
QUESTION: Something about periodontal dressing and that it has 20mg of Doxycycline and asks
about its mechanism: there was nothing about bacteriostatic or inhibits 30S ribosome????
a. 20 mg = no antibacterial effects
b. It inhibits collagenase
QUESTION: which antibiotic is antimicrobial and anticollagenlyctic: clindamycin, doxycycline,

metronidazole, amoxicillin
QUESTION: You give antibiotics through IV, patient experience sudden allergic reaction, what’s the
FIRST thing you do? – Remove the IV line. (others were clear airway, give oxygen, etc)
QUESTION: Penicillin- Why is this so good to give as an antibiotic? Low toxicity
QUESTION: If not penicillin allergic what’s the adv of pen? It is not toxic, Cheap,
Gram negative anerobe rods

QUESTION: mechanism of action of pen is closely related to ? keflex ( cephalaxin )
QUESTION: What is the effect of Penicillin and Cephalosporins (cell wall synthesis) via beta
lactam ring
QUESTION: Tanspeptidase, enzyme is inhibit by penicillin. Causing effect on cell wall
QUESTION: Which of the following penicillins would be used to treat a Pseudomonas infection? Nafcillin
(Unipen) ,Amoxicillin (Amoxil), Benzathine penicillin (Bicillin), Phenoxymethyl penicillin (Pen-Vee
K), Ticarcillin (Thar)
QUESTION: why do penicillins have decreased effectivness in abscess -hyaluronidase, pen unable to
reach organism…
QUESTION: Cyst-why doesn’t penicillin work well?—b/c can’t penetrate cyst barrier
QUESTION: For an infection: give PenVK 500mg → give 1g at once and then 500 mg every 6 hours
(7 days)
QUESTION: Know the doses for someone that is allergic to penicillin, What you can give them. I put
clarithromycin 500mg but not sure if its right. THAT IS CORRECT. Geez.
QUESTION: All are true except- Cephalosporin has a broader spec then Penecillins (cephalosporin is a
beta lactam antibiotic, bactericidal, first generation more concentrated on gram positive
organisms…more resistant to penicillinase…Xtina)
QUESTION: If a patient is allergic to Ampicillin, what else can you premedicate with? Clindamycin
600mg 1-hr before, Cephalexinn2000, Azithromycin 500, or Clarithromycin 500 (look at specific doses!)
all 1-hr before.
QUESTION: Whats an adverse effect of a drug that you cant mix with antibiotics? Methotrexate because it
wont clear out of the system specifically with amoxicillin.
QUESTION: Tetracycline- SUPERINFECTION
QUESTION: tetracycline mechanism of action : protein synthesis inhibitor (30s)
QUESTION: how does tetracycline work? Block activity of collagenase, bind to 30S (block AA linked
tRNA)
QUESTION: Tetracycline is usually not used because they cause yeast infections, as well opportunistic
infect.
QUESTION: Tetracycline does not do one of the following (reduce host response, reduce bacterial
infection, reduce host collagenase; I said increase gingival crevicular fluid flow)
QUESTION: Tetracycline – interferes w protein synth/bacteriostatic
QUESTION: which drug would inactivate the latter?
a. Antacids- Tetracycline
note: Do not take iron supplements, multivitamins, calcium supplements, antacids, or
laxatives within 2 hours before or after taking tetracycline. Antacids and milk reduce the
absorption of tetracyclines.
QUESTION: Tetracycline is bacteriostatic

QUESTION: Pt. has dark permanent lateral incisor. What is the cause?
A: Tetracycline, damage to primary tooth at age five, damage to permanent lateral*
QUESTION: What affects tetracycline?
-enamel
-dentin-intrinsic stain.
QUESTION: Questions about hypoplasia and integration of tetracycline into matrix: couple
questions on what age most likely get infection that resulted in enamel hypoplasia or tetracycline
staining (before 4mon in utero for primary; birth for permanent) → calcification
QUESTION: Tetracycline not do: dec cervicular fluid

QUESTION: Minocycline & Doxcycline; all of the following are true except: (both increase GCF
secretion, both released in GCF, etc.) – don’t kno answer (side fact: tetracyclines are more
concentrated in GCF more than in blood)
QUESTION: which one of the following drug is chelated with C++? Tetracycline
QUESTION: X-allergenic with Pen: Cephalosporines (Cephaloxin)
QUESTION: cross allergenicity with penicillin :→ cephalosporin.

QUESTION: cross allergenicity with penicillin : cephalosporin.
QUESTION: Pt allergic to penicillin, what could be cross-reactive? → Cephatriaxone (3rd gen
cephalosporin)
QUESTION: What drug has cross allerginicity with Penicillin? Cephalosporin- both have Beta
lactamase ring. If pt has allergic to penicllin then pt has allergy to cephalosporin
→ SO is ampicillin
QUESTION: Child comes in with an oral infection and is NOT allergic to Pen. What do you
prescribe?
a. Penicillin
b. Amoxicillin → mosy (-)
c. Tetracyclin
QUESTION: Pt is taking tetracycline. Which of the following drugs would be contraindicated?Penicillin

QUESTION: Tetracycline-penicillin contraindication
QUESTION: Penicillin is ineffective when you give tetracycline why?

• b/c it causes penicillin to be excreted in kidney (or renal reabsorption)
• less penicillin absorbed in intestines
• metabolized more rapidly
QUESTION: Tetracylcine interacts with? Penicillin
QUESTION: tetracycline will interefere with…answer is penicillin. Look thru tufts pharm
QUESTION: what tetracycline does to penicillin :

Tetracline is bacteriostatic whereas penicillin is bacteriocidal… therefore Tetracycline will
decrease the efficacy of Penicillin.
QUESTION: What happens when you have penicillin and decide to prescribe tetracycline with it?
a. Don’t do it. The two mechanisms of action (CIDAL+STATIC) cancel each other out
because when you need bacterial growth to actually use penicillin, but you don’t
have that growth when you prescribe Tetracycline. ANTAGONISTS
QUESTION: penicillin and erythromycin taken together cause (cidal vs static)

•summation
•potentiation
•antagonists
**Erythromycin (Azithromycin and Clarithromycin) are macrolides. They are –static and bind to 50S
ribosomal unit to inhibit protein synthesis). Penicillin is –cidal and inhibits peptidoglycan cell wall by
binding to transpeptidase-CK
QUESTION: Penicillin’s can decrease elimination of methotrexate (cancer drug), increasing risk of
methotrexate toxicity. Methotrexate neurotoxicity can cause seizures and can be caused by
antiepileptic drugs. Methotrexate toxicity effects can be reversed by folinic acid (leukovorin) in a
process known as leukovorin rescue
QUESTION: If you have maxillary sinusitis…what antibiotic would you give: Amoxicillin with clav.
Acid (the clav. Acid prevents the b-lactamase from breaking down)
QUESTION: what the clavulanic acid do when is mixed with amoxixillin ( augmentin) →decrease
sensitivity from b-lactamase
QUESTION: clavulanic acid in amoxcillin - prevents beta lactam degradation by beta lactamase producing
bacteria
QUESTION: calvonic acid in amoxcillin - prevenst beta lactam degradation
QUESTION: Augmentin: blocks the action of penicillinase: Penicillinase resistant
QUESTION: sinusitis tract: augmentin
QUESTION: Penicillinase resistant penicillins – COMN [clox, ox, methi, naf] b/c of clavulanic acid---
D.COMN—Dicloxacillin, Cloxacillin, Meticillin, Nafcillin!!!!!
QUESTION: what antibiotic used for endo? PEN VK (yes it actually say VK together)
QUESTION: drug of choice for pulpal involvement? Pen V
QUESTION: antibiotic used in perio: Metronidazole
QUESTION: antibiotic used in perio : Metronidazole
QUESTION: Metronidazole is commonly prescribed in necrotizing ulcerative gingivitis;

metronidazole is contraindicated in patients on alcohol causing disulfiram type of reaction and has
red urine
a. Both are true
QUESTION: Metro…given for aggressive periodontitis. Makes your pee a different color? T/F
QUESTION: antibiotic against only anaerobes ab parasites (protozoa): metronidazole

QUESTION: Which med kills only anaerobic and parasites: metronidazole (Only parasites and
anaerobes on the metro)
QUESTION: Clostridium dificile is treated with metronidazole. Unless pt is pregnant or

breastfeeding, then use vancomycin

QUESTION: best treatment of localized aggressive periodontitis: tetracycline, Doxycicline
QUESTION: In Lethal doses of erythromycin, what do you see?

e. Hepatocellular GI damage**
QUESTION: Myasthenia gravis patient, what cant you give them? Erythromycin, clarithromycin,
penicillin or Impemene
QUESTION: All of these effect the protein synthesis except: azithromycin

• amoxicillin
• vancomycin
• azithromycin** (this inhibits protein synthesis)
QUESTION: Gentamycin- May cause auditory nerve deafness
QUESTION: aminoglycosides : →ototoxicity and nephro toxicity
QUESTION: aminoglycosides : oto toxicity and nepho toxicity
QUESTION: MRSA- What do you give for this?  ○Vancomycin
QUESTION: Medicine which helps with MRSA -- vancomycin
QUESTION: Pseudomonas colitis: c.difficile and clindamycin
QUESTION: Which of the following describes clindamycin?

inhibits cell wall synthesis
QUESTION: mechanism of action of Minocycline in the Arestin :

→decrease collagenases activity Minocycline, another tetracycline antibiotic, has also been
shown to inhibit MMP activity.
QUESTION: mechanism of action of minociclyn in the arrestin : broad spectrum Bacteriostatic;
Inhibits Protein Synthesis (binds to 30s ribosomal subunit)
*MINOCYCLINE(TCA)—decreases collagenase activity & inhibit MMP
QUESTION: Methotrexate MTX is an? . antimetabolite and antifolate drug. tx of cancer,

autoimmune diseases, ectopic pregnancy, and for the induction of abortions. inhibiting the
metabolism of folic acid.
QUESTION: Which drug will be used to treat an overdose of methotrexate→ Leucovorin is

indicated to diminish the toxicity and counteract the effect of inadvertently administered
overdosages of methotrexate
***OD Methotrexate—give LEUCOVORIN
QUESTION: drug agonist of folic acid : ? →Sulfa, Trimethoprin, Methotrexate

production: methotrexate
QUESTION: Methodextrate- inhibits folic acid in bacteria
production: ***methotrexate
QUESTION: Methotrexate is an anticancer drug that inhibits folate reductase

QUESTION: Anticancer-Methatrexte- folate antagonist which one? Folate reductase
QUESTION: Anticancer drug (Mechlorethamine), that was an alkylating agent what was its affect:
neurotoxic
QUESTION: Alkalizing anti-cancer drug called procarbazine causes HEPATOXITY
QUESTION: Alkalizing anti-cancer drug called procarbazine causes : Hepatotoxicity

When combined with ethanol, procarbazine may cause a disulfiram-like reaction in some
patients. It also inhibits the liver's CYP450 microsomal system, which leads to an
increased effect of barbiturates, phenothiazenes, and narcotics normally
metabolized by the CYP450 enzymes. Has monamine oxidase inhibition properties
(MAOI), and should not be taken with most antidepressants and certain migraine
medications.
Inhibits MAO in the gastrointestinal system thus can cause hypertensive crises if
associated with the ingestion of tyramine-rich foods such as aged cheeses.
QUESTION: Nonalkylating anti cancer med side effect – myelosuppression (?) BONE MARROW
SUPPRESSION
QUESTION: What race most likely to get orpharyngeal cancer: black
QUESTION: What disease is more predominate in males (hemophilia)

QUESTION: What percentage gets oral cancer? 3% of new cancers among males and 1.6% of
new cancer among females
QUESTION: 1 risk factor for oral cancer Tobacco

QUESTION: What population has the worst survival rate for SCC? (whites, blacks, native Americans…)
QUESTION: Lowest 5 year oral cancer survival rate- black people
QUESTION: Radiation for cancer, which cell is more effected?
Nerve, muscle, bone marrow

QUESTION: Mobile mass initially but is now sessile: indicative of malignancy
QUESTION: Discrete, non-tender, soft tissue swelling, what is it – malignancy, benign tumor, bone
cancer
Anti-viral:
know antivirals:
amantadine-influenza A
ribavirin-hep C and resp syncytial virus
oseltamivi and zanamivir-influenza A and b
gancyclovir: CMV
AZT,Didanosine,Zalcitabine,Abacavir-HIV
Ritonavir,saquinavir,nelfinavir,amprenair-HIV
QUESTION: Picture of lesion at corner of mouth, patient says it comes and goes now and then, what type
of infection would you suspect? – Viral (other choices were Bacterial, etc)
QUESTION: What to use for a viral drug? Don’t remember the answers but there were a couple ending
with azole and that not the answer (that’s for fungus)
QUESTION: Amantadine is an anti-viral and anti-parkinosonian or anti-TB and its anti-viral.
QUESTION: Amantadine is an anti-viral and anti-parkinsonian
QUESTION: How do you tx Infuenza A?- amantadine (Symmetrel)
QUESTION: amantadine -Tx influenza (anti-viral)
QUESTION: Which one is an antiviral agent? Amantadine**
QUESTION: What anti-viral is used to for all the above: HSV, VZV, CMV: Valacyclovir
QUESTION: What virus causes postherpatic neuralgia: VZV (not HSV)
QUESTION: Garlic : lots of uses, usually assoc with CVD: CI: contraceptives and anti-virals
(HIV), caution with bleeding
QUESTION: Acyclovir selective toxicity mechanism of action:

inhibits viral mRNA, inhibits cellular mRNA in infected cells, only phosphorylated and activated
in infected cells
QUESTION: Acyclovir-inhib mRNA?-phosphorylated---can’t make RNA
○only phosphorylated in infected cells and inhibits viral mRNA
○does NOT work on DNA 

QUESTION: HIV patient with sinusitis due to what?murcomycosis
QUESTION: Cd4 count and t cell count for HIV symptoms: I put the pt had HIV
// CD4 less than 200
QUESTION: Pt has viral load of 100000 : pt has high virus load and prone to infection
QUESTION: Pt’s viral load was 100,000, and T cell count was 50. What is the right sentence?
• Pt’s T cell count is too low**
QUESTION: Know what a healthy T cell count is. 500-1500units/ml
QUESTION: Need transfusion of platelets? 20,000?
QUESTION: Minimum platelet count for oral surgery?

A: Routine ok w/ 50,000 (emergency can be done w/ as little as 30,000 if work w/
hematologist and use excellent tissue management technique)
QUESTION: Least likely to get oral cancer?
a. Tobacco
b. Alcohol
c. HPV
d. HIV

amantadine (Parkinson’s)
e. isoniazid (TB)
QUESTION: Which of the following is not properly matching the antiviral med with the virus that
caused the disease: answer was retrovir was matched with coxsackie or something (retrovir is
used for hiv/aids)
QUESTION: Give drugs and paired it with the disease. Choose the wrong pair
o Retrovir with varicella zoster WRONG!!

▪ Retrovir is for HIV- right
QUESTION: What oral manifestation is seen in children with HIV? A* Candidiasis #1

QUESTION: HIV pt with fungi infection systemic med- Fluconazole- diflucan
QUESTION: Candisiiasis, and HIV what do you give: systemic or topical?????? Niastatin → AIDS PT
likely to have candida
QUESTION: Once a year, you have to check for one of the following
HIV
HEP B
HEP C
QUESTION: worker didn’t get hep b vaccine because more concern about HIV? A. tell he its easier to get
hep B → must sign that they legally don’t want
QUESTION: workers that are at least risk for HEP B : a) food servers
QUESTION: workers that are at least risk for HEP B : a) food servers b) down syndrome c) drugs
addicts
QUESTION: Patient has HEB B antigens in surface. What state is patient? HBsAg
-chronic?
-acute hepatitis contagious
-acute hepatitis not contagious
QUESTION: If pt has ABsAb, means that he was either vaccinated or recovered form infection
QUESTION: pATIENT tests POSITIVE HEP B ANTIBODY? All of his organs will be affect except..
Pancrease
Kidney
GI
thyroid**??
QUESTION: pt gets Hep B
a. carriers for life?—5-10% become carriers
b. gets active hepatitis
QUESTION: Hepatitis D through B
vaccine
Fungal:
QUESTION: Know which ones are systemic and which ones are topical
• Mycelex, nystatin, ketoconazol,Nastatin rinse and Clotrinzol-troch are topical,
• Systemic Ketoconazole, Amphoteracin B.
QUESTION: Easy question on Nyastatin: “swish & swallow”
QUESTION: Systemic antifungal: Fluconazole
QUESTION: Which systemic antifungal would u use? Nysastin, methazole *TOPICAL: Nystatin,
Clotrimazole (dissolve and swallow) Amp B, Ketocanozole, Nystatin (Creams); SYSTEMIC: “FAK”
Flucanazole, Amphotericin-B, Ketocanzole
QUESTION: medication for angular chelitis: nystatin
QUESTION: Oral antifungal infection – Nystatin
QUESTION: Anti fungal for oral candidiasis- no mycelex option → Clotrimazole( Mycelex) and
Nystatin are oral anti-fungals
QUESTION: Griseofulvin: used for athletes foot.
QUESTION: action of clotrimazole: Alter the enzyme for synthesis of ergosterol, alters cell memb.
Permeability
QUESTION: mechanism miconazole (antifungal) : inhibis the synthesis of ergosterol a critical component
of the cell membrane
Azoles : inhibit lanosterol conversion to ergosterol.
Polyenes : bind to ergosterol on cell membrane and create a pore.
Perio:
QUESTION: Which one is predominant in sulcular fluid? – PMN’s
QUESTION: First cells to appear in gingivitis – PMN was NOT an option
QUESTION: Established gingivitis- macrophages or plasma cells?
Initial = PMN, early = lymphocytes, establish – plasma cells
QUESTION: Which of the following species is a usual constituent of floras that are associated with
periodontal health?
A. Streptococcus gordonii
QUESTION: What bacterial species not associated with periodontal disease
B. P. gingivalis
C. Capnocytophaga
QUESTION: Bacteria that is not in chronic perio – answer is actinomyces viscosus (it’s a fungus..
NO) the other options were c. rectus, t forsytiaas and p. gingivalis

QUESTION: What the initiator of decay- plaque
QUESTION: What is the first step in bacterial plaque formation on a tooth? Pellicle formation, etc..
QUESTION: What is the first step in plaque formation? Pellicle formation (glycoproteins, enzymes,
proteins, phosphoproteins). Second step is adhesion and attachment of bacteria. Third step is
colonialization and plaque maturation
QUESTION: What does plaque depend on? Bacterial interactions and bacterial polymers. Does NOT
depend on host antigen
QUESTION: Which is not part of plaque formation? Host anigten, extracellular bacterial polymers

QUESTION: Gingival recession other than plaque is related to – age, tobacco, etc?
QUESTION: Periodontal risk factor ?which one is not? Smoking, OH, malnutrition, diabetic
- between all these, malnutrition is the most correct answer for not being risk factor
QUESTION: Risk factors of periodontitis except. Nutritional, diabetes,,smoking. Oral hygiene
QUESTION: Which of the following things are associated w/ periodontal dz (all answers include list
of 3 things)?
- A: Atheroschlerosis, Diabetes Mellitus, Low birth weight of babies
QUESTION: Difference between primary and secondary occlusal trauma? I put periodontal
support
QUESTION: Difference between primary and secondary occlusal trauma? periodontal support/healthy
peridontium
QUESTION: Healthy patient, probing shows bleeding, what could this be due to? – Gingivitis
QUESTION: Which is least likely to occur with occlusal trauma? gingivitis
QUESTION: Plaque index is used for what – gingivitis progression and disease activity are options
but I picked patient motivation
QUESTION: Plaque index done for…pt motivation, to track process of disease, to know plaque amt,
QUESTION: Plaque index is used for what – gingivitis progression, disease activity, patient
motivation
I think the q is asking periodontal index, not plaque index: in that case, it should be disease acitivty
QUESTION: plaque index-ordinal

QUESTION: Gingival index/perio index. Know their flaws: →Perio index flaws are that the
gingival recession was not taken into account
QUESTION: Gingival index 1= mild, 2 = moderate, ordinal

QUESTION: What is Gingival Plaque Index? ordinal
c. Interval like Celcius degree
d. Ratio e.g Kelvin degree, or BP measurement(can not be zero), length(can not be negative),weight
QUESTION: Your office uses perio scale 1=gingivitis 2=mild perio 3=moderate/severe etc, what
type is this? Nominal, ordinal, ratio, cardinal
QUESTION: gingival index is what: ordinal, nominal, ratio, interval (where 0-normal and 3-tendency
toward spontaneous bleeding) 
QUESTION: Gingivitis, nominal and ordinal?

a. ratio
b. nominal
c. interval
QUESTION: What is the CTI?- perio incidence index

QUESTION: CPITN: Community Periodontal Index of Treatment Needs
QUESTION: What is predominant in plaque 2 days after prophy: cocci and rods
QUESTION: bacterias present in gingivitis : gram + cocci and rods

gram + cocci and rods normally present, gingivitis transition includes Gram – rods and fillaments
followed by spirochetal and motile organisms.
d. spirochetes.
QUESTION: After you clean mouth, 2 days later, what bacteria is found? – Rods and Cocci
QUESTION: What kind of bacteria do you have when you have two day old plaque
a. Gram positive, gram negative, cocci, filament

b. (According to decks, its gram negative rods?)
QUESTION: Supra gingival calculus: main crystals are hydroxyl appetite 58%
QUESTION: Chronic periodontitis: has G – anaerobes
QUESTION: 2.04mm is bio width
QUESTION: The biological width is. 2mm
QUESTION: Biological width: from the crest of the alveolar bone to the base of the sulcus. a.gingival
sulcus, b.epithelial attachment. c.connective tissue,
QUESTION: Biologic width definition: junctional epithelium and connective tissue attachment to
the tooth above the alveolar crest (at least 2mm)
QUESTION: measure bio width from what 2 point: base of sulcus to alv crest
QUESTION: How to determine attachemtn level? CEJ to depth of pocket
QUESTION: attach loss is from CEJ to sulcus
QUESTION: Which of the following factor is most critical in determining the prognosis of periodontal
disease? 1. Probing depth, 2. Mobility, 3. Class 3 furcation, 4. Attachment loss (answer)
QUESTION: Attachment loss: loss of conective attachment. Apical migration of the JE away
from the CEJ
QUESTION: When is the prognosis that there is no hope- class 2 mobility or deep class 2 furcation, deep
probings with suparation**Perio prognosis—MOBILITY and Attachment LOSS---poor and questionable
involve class I and II furcations.
QUESTION: which has the worst prognosis? deep probing with suppuration, class II furcation or
class II mobility. ***Deep probing with suppuration= Vertical fracture
QUESTION: Class 2 furcation can treat with all but- GBR, take of enamel of root to make shallow class
2, hemisection and restore
QUESTION: Which tooth long run perio tx u will end up extracting: max pm max molar man molar
logical was hemisection and place 2 crowns to act as 2 premolars. Root amputation is for maxillary
teeth
QUESTION: If you have a through-and-through furcation involvement on a tooth, what do you do? –
Extract the tooth. (preferred treatment)
QUESTION: Molar with a III furcation with 5 mm root left in bone what do you do? Splint, extract
place implant?
QUESTION: Patient with class III furcation and 3mm exposure
• Extract
a. Section it and crown both as PFMs,

c. GTR (this is the answer)
QUESTION: Tx option is class 2 almost class 3 furcation? Main goal of tx on class 2 is converted to
class 1 furcation by doing GTR
QUESTION: treatment of a class 2 that is nearly a class III
-convert class ii to a class i(GTR)
-tunelling
-extraction
QUESTION: class 2 and 3, all of the following would be a part of tx plan except? gtr, tunnel prep,
odontoplasty the class 2 to a class 1 furc, extract + place implant, hemisection
QUESTION: Most likely shape of furcation is?- wide but still not very accessible to dental tools, others
used variations of that.

b. It’s wide enough and the currette is too big to clean it
c. It’s narrow enough and you cant clean it
e. Wtf something like that. I would assume the currete head is too big to get to the furcation but
then I dunno
QUESTION: Furcation: Usually wide but cannot insert hand instrument
QUESTION: Root amputation of MB root – cut at furcation and smooth for patient to keep clean
QUESTION: Probing furcation from facial is best. Better accesss to facio mesial furcation from facial.
QUESTION: Best way to detect furcation – curve perio probe(naber probe), curette, straight perio probe
QUESTION: The normal recall appointment between periodontal treatment. 3 months,
QUESTION: best time for supportive periodontal therapy? 1, 3, 6, 9, months post srp
QUESTION: how do you treat gingivitis in puberty : →debridement and OHI
QUESTION: What is not the initial treatment for gingivitis?- srp, OHI, corticosteroids
QUESTION: Common in school kids - Marginal gingivitis
QUESTION: What is most common periodontitis in school-aged children: aggressive PD, ANUG,
marginal gingivitis – I picked this even though its not technically periodontal disease…
QUESTION: Black ppl hav most perio dz

QUESTION: highest incidence of chronic perio? Black males
QUESTION: Which ethnic group has the most periodontitis? Black male
QUESTION: In the US, perio dz seen more in : African american males
QUESTION: most likely to have perio disease? Black males, black females, white males, white females
QUESTION: Black males have the highest incidence of chronic perio
QUESTION: Best for interproximal plaque removal in teeth without contacts: floss, waterpick,
interproximal brush?
QUESTION: What would you use to remove interproximal plaque from a wide embrasure after perio
surgery? →interproximal brush
QUESTION: Patient has big embrassure - I said use interproximal brush (other choices, floss, toothpick,
etc)
QUESTION: How do you clean wide interproximal spaces with history of recession (I said
interproximal brushes, but they also had plaque and a waterpik)
QUESTION: Best brushing technique: Sulcular (bass)
QUESTION: Best brushing technique to clean periodontal pockets (charters was an option, sulcular
was an option (they didn’t have bass written, and whitmans was another option and side by side
was another option) – I wrote sulcular(google says its another name for modified bass and is good
for perio pockets/mainteneance)
QUESTION: least effective for crevicular plaque: water irrigating device

QUESTION: What is not good at removing plaque? Waterpik, nylon, toothbrush
QUESTION: Whats not useful for removing plaque?-water pick

QUESTION: Water irrigation removes debirs (not plaque)
QUESTION: Class 2 furcation, what is worst at keeping area clean? tooth brush, floss, waterpik,
rubber stimulating tip
QUESTION: Brush and floss how much can reach in perio pocket (choose one for brush and one for floss
(1mm and 2-3mm)
QUESTION: Max depth of toothbrush and floss going subgingival?
Toothbrush 0mm, floss 2-3 mm Toothbrush 2-3 mm, floss 0mm Tooth brush 1mm, floss 2-3 mm
QUESTION: Ultrasonic: The type of the stroke, know the magnetostrictive and piezoelectric
ultrasonics
QUESTION: Which disease would you NOT have success using antibiotics for? I put chronic
periodontitis
QUESTION: Which therapy in adding an Ab + debridement have minimal effect for: anug, Localized
aggressive, chronic perio
QUESTION: SRP removes diseased cementum
QUESTION: Pt. just had SRP. Best way to prevent sensitivity of newly exposed root surface?
A: Keep it free of plaque
QUESTION: Have done SRP on pt w/ recession. Best way to prevent sensitivity to newly exposed
root surface?
A: Keep root surface free of plaque
QUESTION: After you do ScRP, how does new attachment form? long junctional epithelium
QUESTION: What happens after you do ScRP therapy? Don’t remember details but it was about
HOW the reattachment occurs SECONDARY INTENSION
QUESTION: Direction of root planning?—from base of pocket to CEJ
QUESTION: most benefits from SRP : →more edematosous is the gingival will be more benefitial.
QUESTION: What do you do if after SRP there are 2 probing sites of 6mm: surgery
QUESTION: SRP and they came back for maintenance but still 5-6 mm pocket. What to do? Open
debridement
QUESTION: If you did intial SRP and depth pocket r same what do you do? Perio surgery
QUESTION: why check occlusion in perio abscess
g. cus many perio lesions are caused by occlusion
h. cus edema can cause teeth to supra erupt **
i. some other choices were pretty good to, but I cant remember what they were
QUESTION: What’s the FIRST thing you do in maintenance appointment (recall)? – Update medical
history (other choice were address patient’s pain, prophy, etc)
QUESTION: What do you not do at the perio maintenance apt.?- S&P pockets of 1-3mm
QUESTION: What do you NOT do at the re-eval appointment? I put root plane 1-3 mm pockets
QUESTION: What happens after the periodontal re-eval? I put that the recall interval is set but
may be changed if the patietn’s situation changes
QUESTION: What happens after the periodontal re-eval? the recall interval is set but may be changed if
the patient’s situation changes, should be less to motivate pt, more to motivate pt
QUESTION: Pt is on a periodontal recall system. What best denotes good long term prognosis:-BOP,
Plaque, Deep pockets (BOP probable answer)
QUESTION: BOP most indicative of what?
A: Inflammation
QUESTION: How long does it take to form mature plaque (I wrote 5- 10 hrs), some others included 24-
36hrs, 1hr
QUESTION: how long for plaque to mature after removed: 24-36 hours
QUESTION: mature plaque in

• 1-2 hrs
• 6-8
• 10-12
• 24-48hrs
QUESTION: How many hours until plaque accumulation (after brushing or eating?): 1 hour
QUESTION: Percentage to be considered generalized perio-- *>30%
QUESTION: 40 year old fem generalized bone loss and localized vertical bone defect, gross calcium, dx?
Chronic periodontitis
QUESTION: Fusobacteria nuceatum has what specific characteristic? Bridging microorganism
between early and late colonizers
→Fusobacterium nucleatum—important bridging microorganism btwn early and late

colonizers of dental plaque
QUESTION: where perio Tx is more difficult : maxillary molars due to trifurcations.
QUESTION: Whch tooth is most commonly lost due to long term care in perio patients: max molar,
max pm, man molar, man pm
QUESTION: Where are the most teeth lost in local aggressive periodontitis? Max molars.
QUESTION: What kind of bone loss in aggressive perio? Vertical. Others, horizontal, mesial distal,
interprox.
QUESTION: Reason pts get aggressive perio- host cant fight off
QUESTION: localized or generalized aggressive perio : no too much gingival inflammation.
QUESTION: What are two things common among generalized aggressive periodontitis and chronic
periodontitis
→distribution among the teeth
QUESTION: Aggressive periodontitis localized: AA . First molar & incisors, circumpubertal onset,
robust serum antibody response to infective agents: the dominant serotype antibody is IgG2
QUESTION: where you find localized aggressive periodontitis →localized aggressive periodontitis in
perm dentition
o AA bacteria
o Most common in African americans
Tx: surgery, metronidazole with amoxicillin, tetracycline
→incisors and first molars

→Localized aggressive perio= AA
QUESTION: Know about Aggressive periodontitis: AA bacteria
QUESTION: What causes Localized Aggressive Periodontitis- AA and capnocytophaga

QUESTION: classical sign of aggressive perio ---> something about mobility (tooth mobility and deep
pockets with lack of inflammation are initial signs of LAP)
QUESTION: Which of the following is not associated w/ Localized Aggressive Periodontitis?
local factors (i.e. inflammation, plaque, calculus) consistent w/ bone loss*
QUESTION: localized aggressive periodontitis show – bone loss on first molars and incisor
QUESTION: What is not associated with LAP(Localized aggressive periodontitis): calculus

QUESTION: Do you use antibiotics with local aggressive periodontitis? Yes
f. Sc/RP
g. AB’s
h. Sc/RP and AB’s **
i. AB’s for 1 week and then Sc/RP
QUESTION: How do you treat localized aggressive periodontitis? – Sc/Rp and ABX
QUESTION: best to use w/ localized aggressive periodontitis
a. chlorhexidine
b. H2O2 rinse
QUESTION: 18 year old fem > 5 mm pocket on central and first molars? Localized aggressive Perio
LAP – AA and capnocytophaga; generalized periodontitis involves prevotella and eikenella (know
if spirochete/cocci, etc)
Know well about Localized aggressive periodontitis and ANUG.**LAP: high ab response to infecting
agents; disease on 1st M or I, with attachment loss on at least 2 teeth (one of which is a 1st M). Remmeber
that chronic includes attachment loss on at least 3 teeth (other than M or I) and there is low ab response to
infecting agents.
Aggressive periodontitis generalized: patients under 30 years of age, poor serum antibody
response,of Aggregatibacter actinomycetemcomitans, and in some cases, of Porphyromonas
gingivalis
QUESTION: Which of the following pdl disease causes rapid destruction of alveolar bone? 1. Periodontal
abcess (answer), 2. ANUG, 3. Chronic periodontitis.
QUESTION: 3 questions about ANUG: how to tx(srp/rinse/if systemic ab, if not systemic no ab
needed), Bacteria involved (Spirochetes)
QUESTION: bacterias present in ANUG: →fusiform, spirochetes and prevotella intermedia
QUESTION: Which NUG or ANUG, which microorganisms predominate? – Spirochetes
QUESTION: Which NUG or ANUG, which microorganisms predominate? 1. Spirochetes (answer)

QUESTION: Bacteria for anug – spirocytes –(fusoform, spirocytes, pervertoa intermedia)
(intermiated spirocytes- treponema denticola)
QUESTION: ANUG? Usually 15-35 years old, aka Vincent’s infection and trench mouth, punched out
papilla, fetid odor, prevotella intermedia.
QUESTION: Electron microscopic examination of the bacterial flora of necrotizing ulcerative
gingivitis indicates the presence of microorganisms within non-necrotic tissues in advance of other
bacteria. The organisms involved are
A. spirochetes.
→ Also P.intermedia and Fuso
QUESTION: Patient comes in with gingivitis, no pocketing, pseudomembranous coating gray on gingiva:
anug
QUESTION: ANUG: Interproximal necrosis
QUESTION: Patient has interpapilla damage periodontal condition, what could this be due to? –
ANUG
QUESTION: Patient has interpapilla damage periodontal condition, what could this be due to? – ANUG
QUESTION: Cratered gingival = ANUG (NUG)

QUESTION: Acute ulcertaive gingivitis what could be indicated: host overreacting to infection. Bacteria is
releasing deadly toxins (no toxin in acute periodontitis or is not main reason) and the answer was normal
bacterial flora is what youd find in acute ulcerative gingivitis.
QUESTION: Which of the following is the most appropriate initial treatment for a patient with HIV-
associated necrotizing ulcerative gingivo-periodontitis?
A. Debridement and antimicrobial rinses
B. Definitive root planing and curettage
QUESTION: Normally, you don’t give antibiotic. You only do debridement, rinse, and oral hygiene.
But if the patient has a fever or systemic indications like HIV, give Metroniadozle.
QUESTION: Metronidazole: given to someone to treat ANUG

QUESTION: Localized aggressive perio, treat with-tetracycline
QUESTION: How do you treat ANUG? Debriement, H2O2, Chlo

QUESTION: begin tx of ANUG pt w/
a. H2O2 rinse
b. debride & instrument
c. antibiotics
QUESTION: Red complex has 3 bacterias: P. Gingivalis, Tannerella forsythia, Treponema
denticola
→red complex = P. gingivalis, Tannerella forsythia, treponema denticola

i. BOP & deep pockets
→Orange complex = fusobacterium, prevotella, campylobacter
j. Precedes red complex
k. Plaque formation and maturation
QUESTION: Least associated w/ perio disease? Hypophosphatism (related), acrodynia (related)
QUESTION: all associated w/ perio problems accept

a. stevens-johnson syndrome (target lesions, eye, mouth, skin)
b. pap-lefev syndrome (palmoplantar keratoderma with periodontitis)
QUESTION: Least cause of bone loss around primary teeth? Hypophosphatsia, leukemia, plaque,
one other one I didn’t know, I put plaque
QUESTION: The depth of sulcus is 5mm, the distance between CEJ and the base of sulcus is 2mm.what is
the attachment loss: 2mm
QUESTION: Probing depth on pt. is 7mm. Your probe passes 2mm past the CEJ. What is the CAL?
2mm
QUESTION: If recession is 2mm and probing is 1mm how much attachment loss? 0,1,2,3
QUESTION: Pocket depth of 5mm and 2mm from CEJ and gingival margin: 2mm attachment loss
QUESTION: If you have 1mm recession and can probe 3mm, how much attachment loss is
there? I put 4mm
QUESTION: Best angle to place curette on root is 45-90 (repeat)
QUESTION: Perio instrument is held at what angle on the tooth
o 45-90 degrees
o the blade is opened 45 to 90 degrees for working strokes
QUESTION: What edge of curette do u want to be in contact at line angle? Lower 1/3
QUESTION: Curette, which third adapts tooth? – Apical Third, Middle Third
QUESTION: Curette, which third adapts tooth? – (I think correct one was apical) --*lower third of blade??
QUESTION: Which part of instrument do you place on line angle of tooth: middle third, third
including tip, third closest to handle or entire edge
QUESTION: Periostat- twice daily 20 mg has doxycycline which works by inhibiting collegenase/protein
synthesis (30s subunit not an option) Jon put perio chip…Periochip is 2.5mg of chlorohexidine gluconate
though.
QUESTION: Periostat’s mechanism of action: inhibits collagenase, inhibits ribosome 50s (I put
collagenase because it says so in Mosby’s)
QUESTION: Periostat mechanism of action ---- 1mg minocycline local
Reduces elevated collagenase activity in gingival crevicular fluid of patients with adult
periodontitis; no antibacterial effect reported at this dose
QUESTION: Doxycyclin use? intramicobial which inhibits MMP: matrix metaloprometase
• → Subantimicrobial dose doxycycline (SDD, periostat) inhibits matrix metalloproteinase
(MMP)
QUESTION: •How does Listerine act? Stops cells from binding, (some other choices... this is not the one I
chose) The mechanism of action of Listerine involves bacterial cell wall destruction, bacterial
enzymatic inhibition, and extraction of bacterial lipopolysaccharides.
QUESTION: Action of Listerine?
it disrupts adhesion of bacteria to plaque
is a phenolic compound
QUESTION: What type of agent is Listerine – charged or noncharged?? (according to
google…uncharged…Xtina)
QUESTION: LISTERINE :Antiseptic mouthrinse is a broad-spectrum antimicrobial, and it kills
bacteria associated with plaque and gingivitis by disrupting the bacterial cell wall.
QUESTION: What daily oral rinse would you give to a medically compromised child for plaque control?
(choices were CHX, Listerine, Nystatin, stannous fluoride, sodium fluoride)
QUESTION: What does sodium pyrophosphate do? -Plaque removal-something about removing
crystals of Ca and magnesium, inhibits mineralization of biofilm (inhibits calcium phosphate from
biding)
QUESTION: why are inorganic pyrophasphates in anti-tartar toothpaste: In toothpaste, sodium
pyrophosphate acts as a tartar control agent, serving to remove calcium and magnesium from saliva and
thus preventing them from being deposited on teeth
a. prevent bacterial colonization
b. prevent phosphate…
QUESTION: Why is inorganic pyrophosphate in tooth paste: prevent calcium phosphate crystals,
decrease number of bacteria growth
pyrophosphate, has a higher RDA and, additionally, prevents stain buildup by means of chelation
as well as abrasion.
QUESTION: Action of chlorhexidine: binds to cell wall→ cell membrane disruption/rupture→fluid

leaks out, cell lysis (CHX bursts membrames)
QUESTION: The use of chlorhexidine → reduce plaque accumulation (broad spectrum against gram
positive and negative bacteria and fungi – Positively charged)
QUESTION: Chlorhexidine :The mechanism of action is membrane disruption
QUESTION: Each of the following is a mode of action of an ultrasonic instrument EXCEPT one.
A. Lavage
B. Vibration
C. Cavitation
QUESTION: Ultrasonic Instruments: active portion is the tip, 20-45k cycles/seconds
o Magnetostrictive: elliptical vibration pattern, all sides of tip are active (4 sides total)
o Piezoelectric: linear vibration pattern, 2 sides are more active (sides are only active)
o CONTRAINDICATED in patients with Pacemaker, communicable diseases, titanium implants (use

plastic tip)
QUESTION: Mode of action of ultrasonics. ANS. Vibration in elliptical (magnetostrictive) , sonics

is linear
QUESTION: Why don’t u use Acidulated Fluoridated Toothpaste? Ruins Polish of Crown
QUESTION: Why you do perio before ortho: b/c perio you have gingival and osseous changes
QUESTION: Old and young person w/ same perio. Which has better prog?
• Older (b/c younger pt had shorter time frame to get to the same condition so more aggressive in
nature)
periodontitis, etc? – I said young (apparently old people!) **WTF???
periodontitis, etc? –old people have better prognosis
QUESTION: which tooth most likely to lose from perio dz? mx molars, mx anteriors, md molars,
md anteriors
QUESTION: Lots of questions on cerebral palsy (something about whether or not it is a
developmental disorder) (2nd after autism)
s neither genetic nor a disease, and it is also understood that the vast majority of cases
are congenital, coming at or about the time of birth, and/or are diagnosed at a very
young age rather than during adolescence or adulthood. It can be defined as a central
motor dysfunction affecting muscle tone, posture and movement resulting from a
permanent, non-progressive defect or lesion of the immature brain.
QUESTION: CP patient - which is not true?

b. all brux
QUESTION: Cerebral palsy – patient will have spastic oral mucosa during treatment
QUESTION: Pt has involuntary uncoordinated movements with larynx problem? ANS. Cerebral palsy
QUESTION: Common finding in a patient with cerebral athetoid palsy. ANS. Anterior Teeth fracture
QUESTION: What condition would benefit most from sc/rp. A) edematous gingiva desquamous ging b)

QUESTION: most benefits from SRP : →more edematosous is the gingival will be more benefitial.
QUESTION: Which of the following is NOT a sign of periodontal inflamm: color,consistency, bop, and
attachment

a. C3a, C5a
b. Endotoxin
c. Interleukin
d. B glucorinidase
QUESTION: What cytokine responsible for osteoclasts – IL-1, IL-8,IL-5, IL-3
QUESTION: Root surface tx with what agents? use citric acid, fibronectin and tetracyclin
QUESTION: Which part of dental anatomy on a central collects the most plaque? Facial surface, lingual
surface, cingulum, mamelon, gingivopalatal groove
-Perio: reverse architecture (papilla is supposed to be a mound not a volcano) what is diference between
open bevel and cloesd bevel: both of them would cause the same amount of recovery pain.
QUESTION: Define reverse architecture? When interdental bone is apical to crestal bone
QUESTION: After periodontal surgery, the dentist leaves interproximal bone apical to radicular
bone.What is this called: negative architecture.
QUESTION: What can make teeth green? Bacteria, gingival hemorrhage, medications or
hyperbilirubinemia
QUESTION: What can make teeth orange? Bacteria
QUESTION: What causes green and orange stain on teeth: Poor ohi I said that, other option are
meds and genetics
A. drugs.
B. diet.
QUESTION: What are proper ways to reinforce OHI: written and verbal, →verbal and in the dental
office
QUESTION: OHI should be? written and oral, Oral in office, written, video tape,
• pit and fissure
QUESTION: Rapid tooth mobility is due to advanced perio or periapical pathology??
QUESTION: Most common to cause mobility- trauma or perio
• Tooth mobility *
• Bone resorption
• Crestal bone
QUESTION: Which one the following is reversible? – Tooth Mobility (other were, bone loss, gingival
recession, and attachment loss)
QUESTION: Pregnant gingivitis: estrogen, estradiol, progesterone
QUESTION: Pregnant women more gingivitis why- hormones

QUESTION: Pregnancy induced hyperplasia: Progesterone induced
QUESTION: Pregnancy gingivitis has altered metabolism of progesterone
QUESTION: Which one of these bacteria are associated with pregnancy
P. intermedia
QUESTION: Pregnancy gingivitis caused by? hormones (progestrone) and P intermedia
QUESTION: Person who is pregnant,you should not give meds in the section e of page 250 .
Tetracyclin, metronidazole, gentamicin and vancomycin should be avoided
QUESTION: Puberty bacteria? P-Intermedia
QUESTION: patient inter-papilla givgiva is swollen - anticonvulsant meds (dilantin)

QUESTION: Whats the #1 cause of med induced ging hyperplasia?- dylantin-30% of all drug induced, this
was a perio test question.
QUESTION: What does NOT cause gingival hyperplasia?
a. phenytoin
b. cyclosporin
c. nifedipine
d. digoxin** (first three causes gingival hyperplasia)
QUESTION: Verapamil – calcium channel blocker, hypertension

QUESTION: Does not cause gingival hyperplasia?
Cyclosporine A, phenytoin, dilti, nifedipine all cause gingival hyperplasia
NEFEDIPINE doesn’t. the answer was nEfedipine instead of nIfedipine
QUESTION: All of the following drugs cause gingival hyperplasia except? Verapamil,
diltiazem(CALCIUM CHANNEL BLOCKER), phenytoin (dilantin), nifedipine and cyclosporine—
all do.
QUESTION: All the following drugs cause gingival enlargement (hyperplasia) except?
-DIGOXIN
QUESTION: Which does not cause gingival hyperplasia
o Phenytoin
o Digoxin
o Nifedipine
QUESTION: Gingival hyperplasia with which drugs? None of the answers were obvious like
phenytoin.. one of them was probably an obscure calcium channel blocker
QUESTION: which of these does not cause gingival hyperplasia: digoxin
a. CCb (vermipril), phenytoin, cyclosporine
QUESTION: All of the following drugs cause gingival hyperplasia except? I forgot what the
answer was but it was an easy question. They listed phenytoin, dylantin, nifedipine and
cyclosporine, which all cause hyperplasia. The answer was whichever I did not list above.
QUESTION: Easy picture of Gingival Hyperplasia due to patient taking drugs that causes this
QUESTION: Know drugs that cause gingival hyperplasia: Cyclosporines, phenytoin, calcium
channel blockers
QUESTION: Patient is on calcium blockers, picture show gingival hyperplasia, what do you do? –
Tell them to see their doctor to switch meds
QUESTION: Patient is on calcium blockers, picture show gingival hyperplasia, what do you do? – Tell
them to see their doctor to switch meds
overgrowth and hyperplasia.
overgrowth and hyperplasia. → cyclosporine will lead to gingival hyperplasia
QUESTION: Picture of gingival hyperplasia on 14-year old girl –hormonal induced,
QUESTION: Stress long term cause problem in periodontium bc it increases cortisone and
cortisone and brings immune system down
Dentures:
1. Retentive clasp: engages undercut below height of contour
2. Reciprocal clasp: passively touches above the height of contour
3. if you don’t have good indirect retention, it lifts off the soft tissue
4. SUPPORT (rigidity): Denture base, major connector, and rests
5. STABILITY: minor connector (lingual plates, guide planes, etc)
6. RETENTION: indirect and direct retainers
QUESTION: Main purpose of major connector? support retention,

QUESTION: 2 main purposes of major connector: Rigidity and stability?
QUESTION: Purpose of Major Connector – Stability and Rigidity, Stability and Retention, Retention and
Rigidity, Rigidity and Esthetics
QUESTION: Requirement of a major connector? Rigidity

QUESTION: Reciprocating arm of clasp? Stabilization
QUESTION: Reciprocating arm Counteracts the effects of direct retainer
QUESTION: Purpose of reciprocal clasp: Stabilization
QUESTION: What does the reciprocal clasp do? Indirect retainer
QUESTION: what does the reciprocal brace do? Counteract retentive clasp, stabalize the tooth, indirect
retainer
QUESTION: Reciprocal clasp is placed on or above the height of contour
QUESTION: Where does the retentive clasp engage on abutment: passively on the suprabulge,
**Retentive clasp-- gingival third of the crown w/I the undercut (suprabulge)
**Reciprocal Clasp-- middle third of the crown
QUESTION: Retentive clasp is not base metal alloy
QUESTION: Where does the retenetive clasp engage on abutment: passively on the suprabulge? It
exerts a positive direction movement; sits on the height of contour and another was not touch the
tooth at all (engage in undercut to resist removal of prosthesis and to help prevent dislodgement)
QUESTION: What is function of Rest? Support
QUESTION: What is the primary func of rest seats? To resist vertical tissue force (to provide vertical
support for RPD)
QUESTION: the purpose of the rest seat is: prevent displacement
QUESTION: Whats the purpouse of an indirect retainer?-to prevent distal extention from lifting up
QUESTION: What is the purpose of an indirect retainer? It is located on the opposite side of the
fulcrum line . assists direct retainer to prevent displacement of denture base in an offlucsal
direction. Consists of one or more rests, their minor connectors, and proximal plates adjacent to
edentulous areas. Should always be placed as far as possible from the distal extension base.
QUESTION: Function of minor connector? Stability
QUESTION: Main purpose of buccal flange of Mx denture?

A: Stability,
QUESTION: What does not have an effect on clasp flexibility? Undercut
(former)
(former)
QUESTION: The peripheral seal is the most important part of the denture for proper retention
→- Primary support area = buccal shelf
QUESTION: Primary retention for mand CD? Buccal shelf
QUESTION: Primary stress bearing area in mandible: buccal shelf --
and incase the residual ridge is in good shape it also contributes to primary support.
QUESTION: Primary support for denture – Mand: buccal shelf Max: ridge
QUESTION: What is main area of support for distal extension RPD? Ridge, buccal shelf, external
oblique ridge…
QUESTION: Primary support for denture – max: ridge, 2nd-rugae
QUESTION: mand: buccal shelf, 2nd-anterior lingual border

QUESTION: Primary stability for an edentulous CD on maxillary? Palate and residual ridges.
QUESTION: Combination clasp: ww and cast → Wrout wire, cast wire
QUESTION: What connects major connector with rest seats- Minor connector
QUESTION: What connects an occlusal rest and major connector? -->Minor connector
QUESTION: For bilateral distal extension - indirect retention because it is supported by tissue
QUESTION: How far do we extend a CD: Hamular notch
QUESTION: post extension of post palatal seal is vibrating line: 2mm past vibrating line (fovea
palatini) anterior is distal of hard palate (blow line)
QUESTION: Post extension of post palatal seal is 2mm beyond vibrating line (fovea palatini)
QUESTION: What should you consider when placing peripheral seal?
Tuberosity, throat form, …

I eliminated the answer choices that included age of patient?
QUESTION: What does dentist look at before placing palatal seal – vibrating line, throat configuration,
tension of tissue throat form, tissue type and fovea location.
QUESTION: Which 3 things determine the posterior palatal seal? throat form, tissue type and fovea
location
QUESTION: Which 3 things determine the posterior palatal seal? I put throat form, tissue type
and fovea location.
QUESTION: Which of the following best explains why the dentist should provide a postpalatal seal
in a complete maxillary denture? The seal will compensate for

QUESTION: if the palatal vault is too deep : →vibrating line is more pronounced and forward
QUESTION: if the palatal vault is to deep : vibrating line is more pronounced and forward → The
higher the vault, the more abrupt and forward is the vibrating line.
More pronounced
Forward
Backward
*From Dr. Nasr’s lecture: In the class III variation (of palate forms), there is a high vault in
the hard palate. Soft palate has an acute drop and a wide range of movement. The vibrating
line is much more anterior and closer to the hard palate. This gives a narrow posterior
palatal seal area.
QUESTION: When do you remove palatin torus: Prevents seating of denture and formation of
posterior seal
QUESTION: tori patient without peripheral seal what to do? Remove tori
QUESTION: Patient is going to get dentures and he has palatine tori, why should it be removed? To
increase peripheral seal, Because the mucosa is too small and it will hurt him
QUESTION: Indication for removeing max tori: interferes w/ posterior palatal seal
QUESTION: Palatal tori-when should it be removed?

• If posterior to vibrating line-interferes with posterior palatal seal
• 3mm anterior to vibrating line
QUESTION: Pt has bilateral max tori. Need to make an upper and lower cd. Tori extends to posterior
palatal seal. What should you do?
-make a post palatal strap
• make cd around tori, remove tori and allow to heal, reline denture
• *remove tori than make cd
QUESTION: major connector design for large inoperable palatal torus
a. horseshoe
QUESTION: Guy has no upper teeth and palatal tori that extends to soft palate what type of major
connector to use? Horshoe, AP, Palatal strap (unless option to remove)
QUESTION: Reason for splint in palatal torus removal (prevent infxn, flap necrosis, hematoma
formation)
QUESTION: Palatal tori removal....after surgery u splint because helps stop HEMATOMA
QUESTION: Mandibular tori in first premolar and canine
If you were to remove the tori would you have the patient sign an informed consent of lingual nerve
injury
QUESTION: Hinge axis : Face-bow
QUESTION: What does the facebow do? I put translates the relationship of the maxilla to the
terminal hinge axis using a 3rd point of reference
QUESTION: Primary purpose of plaster index of occlusal surface of max denture before removing
the denture from the articulator and cast: Preserve face-bow transfer
QUESTION: what is the plaster index for? preserve facebow record
QUESTION: Why do you use plaster index on mounting for facebow: Preserve face-bow transfer
QUESTION: Why take plaster index? Teeth are then put back exactly in their original position aided
by plaster key
QUESTION: Delivered CD/CD. Why do you take impression of max denture and mount it to
articulator?(clinical remount): so you don’t have to take face bow registration again (preserve
facebow)
QUESTION: lab and patient remount? Why are they done- establish and maintain VDO
QUESTION: Why is the WW clasp placed far away from its minor connector?
To have room to solder it on
More retention
QUESTION: What is reason for the altered cast technique when doing an distal extension rpd : I said
it was support but not sure (others were retention, esthetics, etc)
QUESTION: Altered cast technique. The reason for doing this procedure..
“The altered cast method of impression making is most commonly used for the mandibular distal
extension partially edentulous arch (Kennedy Class I and Class II arch forms). A common clinical
finding in these situations is greater variation in tissue mobility and tissue distortion or
displaceability, which requires some selective tissue placement to obtain the desired support from
these tissues. This variability in tissue mobility is probably related to the pattern of mandibular
residual ridge resorption. Altered cast impression methods are seldom used in the maxillary arch
because of the nature of the masticatory mucosa and the amount of firm palatal tissue present to
provide soft tissue support. These tissues seldom require placement to provide the required
support. If excessive tissue mobility is present, it is often best managed by surgical resection, as this
is a primary supporting area.” Carr, Brown. McCracken's Removable Partial Prosthodontics, 12th
QUESTION: SIBILANT allow maxillary incisors to nearly touch the mandibular incisors,
QUESTION: fricative sounds are made by allowing the maxillary incisors to nearly touch the
slightly inverted lower lip.
QUESTION: If doing a denture try-in: where wud teeth touch compared to vermilion border when
saying “F” sound → they would just touch ->wet/dry lip line
teeth? F and V
QUESTION: What do you use to check if VDO and anterior teeth are set correctly for denture teeth?
- F and V
QUESTION: What do you use to check if VDO and anterior teeth are set correctly for denture teeth? - F
and V ** all these file answers say F and V, but when I checked Mosbys it says to evaluate VDO you
make the sound S
QUESTION: Asked about what sound will determine VDO **S sound. This will bring teeth slightly
together with 1-1.5 mm separation. This is the “closest speaking space”
QUESTION: S, z, and ch sounds the teeth must be…close together, far apart
QUESTION: s/ch/z sounds formed by putting tongue between mx and mnd incisors: th
QUESTION: Denture wearer say’s “S” sounds and the post teeth are touching….why? excessive vertical
QUESTION: S, ch, sounds are made: When max and mand ant teeth barely touch… Increase VDO,
decrease freeway/interocclusal space, Decrease VDO, increase freeway/interocclusal space

QUESTION: Have large incisors, difficulty with F sounds
teeth? **Decks say that placing anterior teeth too far superior and anteriorly make it hard to say F and
V!!!
QUESTION: If the maxillary incisors are placed too far superior and anterior, what is affected? →D
and T sounds (D & T are for labial and lingual)
QUESTION: Maxillary anterior teeth too far superior and anterior: F and V sounds
QUESTION: After a couple of months of delivery of upper and lower complete, patient complains of
burning of lower lip: Canidida or impingness of mental nerve.
QUESTION: Burning sensation lower denture? impingement of mental nerve
QUESTION: Which denture base is not light cured?? A really weird question. Never seen it before.
And none of the answers were a 100%
a. Pressure formed
d. Pour or fluid resin technique
QUESTION: Why don’t you set denture teeth on the incline up towards the retromolar pad? You’re
impinging on it or because it dislodges the denture
QUESTION: Which of the following explains why mandibular molars should NOT be placed over the
ascending area of the mandible?
E. The occlusal forces over the inclined ramus would dislodge the mandibular
denture.
QUESTION: Why don’t put posterior tooth on inclination of ramus? Occlusal forces dislodge
QUESTION: You give patient maxillary denture and they come back with generalized soreness under the
denture. no sore spots or anything visible clinically, what's causing this? allergy, significant
malocclusion(gross occlusal misalignment)

QUESTION: Pt has general soreness along ridges from complete denture…what should you do…reline,
adjust occlusion
QUESTION: Generalized maxillary soreness over ridge of a patient that just got a new denture what
is it due to? The options did not help… Like excessive interocclusal space, decrease VOD, lack of
interocclusal space
QUESTION: If there is a lesion under a denture, relieve the denture and do a follow up
QUESTION: A 6x3 mm white lesion seen under old man wearing a denture for 19 years. Its
aymptomatic. What is first thing done at initial treatment? –adjust and check in one week
adjust denture and the observe ,Incision,excision, cytologic Relieve any trauma from
intaglio, watch for 2 weeks, then biopsy, when you biopsy, you can do incisional
QUESTION: you tell patient who has dentures to take off at night - to relieve the bone
QUESTION: you tell patient who has dentures to take off at night - to hydrate denture in water (it should
be to rest gum/bone?)
QUESTION: Patient is edentulous and has red upper palate - allergic to denture (it should be don’t take it
off when they go to bed)
QUESTION: When tx planning an RPD for a pt what is the first attachment placed on the serveyor?-
analyzing rpd
QUESTION: When tx planning an RPD for a pt what’s the first thing you do?- Mount casts. Others, find
undercuts, find abutments, extract hopeless and perio teeth.
QUESTION: best way to eval available space for rests-mounted casts
QUESTION: patient has mobile upper anterior maxillary tissue that is inflamed. Before making
new denture you do what? A) gingivectomy, B) apply conditioner to existing denture, C) make
new denture that will immobilze the existing tissue D) something else
QUESTION: pt's max denture made her tissue inflamed and weird, you decide to make her a new
denture after?
a. you place tissue conditioning material in her old denture
QUESTION: Pt. with inflamed abused tissue and needs new cd, what do u do? Tissue conditioning
QUESTION: What appointment do you check for sibbilings sounds? – When verifying VDO
(basically at intermaxillary records appointment, another choice was tooth try-in) →?
QUESTION: At what point do you check the proper placement of teeth: At the wax-try in phase
QUESTION: when do you check for syllabus sounds: at the Wax rim try-in appt.
QUESTION: when do you check for silabount sounds : at the try-in appt.
QUESTION: What appointment do you check for sibilant sounds? – When verifying VDO (basically at
intermaxillary records appointment, another choice was tooth try-in)
QUESTION: During try-in of denture, check for tongue to do all movements: all working movements
QUESTION: Lingual of a denture, how do u know if its good? want to have a full movement of the
tongue
QUESTION: If teeth on the wax tryin don’t occlude like they did on the articulator what do you do?-
Remount, redo teeth and retry!!
QUESTION: A denture tooth falls of y is that? She put down there was some wax that was not removed
QUESTION: Which one of the following is usually an issue for denture patients? – Lower denture
(other were maxillary dentures, and some other things)
QUESTION: Saliva and denture, which one is correct? – (thin watery)

QUESTION: Retention of denture is impacted by saliva flow
QUESTION: Saliva and denture, which one is correct? – Relationship that leads to denture and tissue
adhesion, no relationship
QUESTION: Saliva and denture, which one is correct? – No relationship (Of course I’m wrong, there is a
relationship that leads to denture and tissue adhesion) **THIN saliva is better and aids in adhesion
QUESTION: Full denture- a lot of saliva better for retention/ worse? Less saliva worse?
QUESTION: Physiologic rest position: When mandible and all of supporting muscles are in their
resting posture, Muscle guided position
QUESTION: no posterior teeth and incisal wear on the anterior-because of absence of posterior
teeth
QUESTION: No posterior teeth and anterior incisal edge why? Abcense of posterior teeth
QUESTION: Patient feels fullness of upper lip after delivery of complete denture: Overextended
labial flange
QUESTION: RPD modification- to remove indirect retainer or add lingual palatoplate? It was an
palatal strap and missing some molars and premolars bilateral with circumferential clasps
QUESTION: VDR-Freeway Space=VDO
QUESTION: what happens when Vertical is lost-signs that is reduced VDO
QUESTION: Which position depends on patient’s posture? I put VDR
QUESTION: what changes with patient posture (sitting up vs laying down) : VDR (other options are
centric relation or vdo and someone else)
QUESTION: What problem causes bilateral angular cheliits: high vertical dimension, low
interocclusal space, high occlusal distance: Low VDO
QUESTION: Angular chielitis – unbalanced Centric occlusion, or unilateral… decrease VDO

QUESTION: Angular chelitis- increase interocclusal space **angular chelitis associated with overclosure
a. Fungal infection
d. Other options
QUESTION: Patient has short lower face and sagging lips. What should you do? I put increase
VDO
QUESTION: Patient has clicking with dentures – instead of saying vertical dimension too high, the
answer choice said something about inadequate resting space
QUESTION: clicking of denture teeth → excessive VDO- teeth
QUESTION: Teeth clicking in dentures: excessive vertical dimension
QUESTION: If you hear clicking in denture patient it is due to? excess VDO =too little VDR
QUESTION: Reason for cheekbiting with dentures? inadequate horizontal overjet
QUESTION: Pt wearing a complete dentures… pt is cheek biting: →posterior teeth set up with no
horizontal overlap.
QUESTION: cheek biting → not enough horizontal overlap of posterior teeth, insufficient OVD
QUESTION: You fit new completed denture and the patient complains of cheek bite, what will
you do?
• Open VDO
QUESTION: An examination of a complete denture patient reveals that the retromolar pad contacts
the maxillary tuberosity at the occlusal vertical dimension. To remedy this situation, which of the
following should be performed?
Reduce the maxillary tuberosity by surgery.
Cover the tuberosity with a metal base.
Increase the occlusal vertical dimension.
Reduce the retromolar pad by surgery.
Omit coverage of the retromolar pad by the mandibular denture.
QUESTION: Immediate denture and has undercuts and tuberosity, what do you do? Remove
tuberosity, remove both don’t remove any?
QUESTION: A patient who has a moderate bony undercut on the facial from canine-to-canine needs
an immediate maxillary denture. There is also a tuberosity that is severely undercut. This patient is
best treated by
QUESTION: an examination of a complete denture patient reveals that the retromolar pad
contacts the maxillary tuberosity at the occlusal vertical dimension. To remedy this situation,
which of the following should be performed
b. cover the tuberosity with a metal base
c. increase the occlusal vertical dimension
d. reduce the retromolar pad by surgery
QUESTION: When making a denture base, the hamulus is too close to the retromolar pad ? Surgery, don't
put base on hamulus don't put base on retromolar pad or increase vd?
QUESTION: When taking impression and patient is open what can interfere with fully seating- coronoid
QUESTION: coronoid process displace upper denture if : too bulky at max distobuccal
QUESTION: Coronoid – when open mouth can dislodge denture (mand denture=masseter)
QUESTION: Open mouth while maxillary border molding- Coronoid process will block buccal
extension
QUESTION: best way to prevent speech problems in complete dentures keep teeth in same position
QUESTION: Dentist mounted maxillary cast without using facebow, but now wants to increase
vertical dimension 4mm: open articulator 4mm, get new CR, take new facebow, lateral movements
QUESTION: If you want to increase patient’s VDO by 4mm, what do you do? - I said take new CR (other
choices were take new facebow, adjust articulator, etc)
QUESTION: Need to increase vertical dimension by 4mm in denture patient. How do you do it?
Increase VDR, retake CR, change condylar angulation
QUESTION: new CR if you raise a pin if 4mm

QUESTION: Cd/cd and want to open bite 4mm? take new centric relation
QUESTION: What to do if you increase VDO after mounting? New bite registration and remount
QUESTION: Made pt denture which shows to much of max teeth. There are 3 mm of freeway space.
What would you do?
lift up occlusal table
*?decrease VDO (not sure about this…because the freeway space doesn’t seem excessive…would seem
like the only solution is remake the CD…Xtina)
QUESTION: you are correcting the VDO of a patient, your articulator emminentia is set at 20 degrees, you
later correct it to 45 degrees. What do you do next? Adjust bennet angle, new centric relation record,
increase the VDO, others? Decrease incisal guidance, or increase compensating curve. Bennet angle
is calculated using condylar incline so you can adjust bennet angle too
QUESTION: if denture teeth were set to a 20 degree condylar setting when the teeth need to be at 45
degrees, what will need to be changed?
• Incisal guidance increased??
DECREASE INCISAL GUIDANCE (to compensate for increase in condylar guidance)
(Steep condylar path requires steep compensating curve, and decreased incisal guidance)
QUESTION: The condylar guidance is increased from 20 to 45 degrees,what do you do.
􏱒Increase the compensatory curve
the curvature of alignment of the occlusal surfaces of the teeth that is developed to compensate for
the paths of the condyles as the mandible moves from centric to eccentric positions.
A means of maintaining posterior tooth contacts on the molar teeth and providing balancing
contacts on dentures when the mandible is protruded.
Corresponds to the curve of Spee of natural teeth.
QUESTION: Setting condylar inclination on articular using protrusive , what do with the pin?
Remove the pin (lift up)
QUESTION: incisal guide pin position while checking protrusive,why (determine condyle guidance)
QUESTION: purpose of incisal guidance,mount casts..? adjust condylar guidance ..begin prep
QUESTION: Reason for Incisive guide table?. Anterior guidance

QUESTION: When making a guide table….Lift the pin up about 2 mm
QUESTION: What is the best way to preserve the anterior guidance? translating the horizontal and
vertical relationship onto the incisal table
QUESTION: What is the best way to preserve the anterior guidance? I put something about
translating the horizontal and vertical relationship onto the incisal table
QUESTION: How to determine the angle of the incisal table? By the horizontal plane (occlusal plane)
of occlusion and a line in the sagittal plane between incisal edges between maxillary and
mandibular central incisiors.
QUESTION: Which plane is most important on anterior guidance.: Horizontal/occlusal
QUESTION: pt with class III will lhave the mandibular incisal angle? Increased, decreased
QUESTION: Another case, lower natural anterior teeth, upper PFM anterior teeth. Lowers had incisal wear
facts, what do you think this is due to? – Heavy incisal guidance (this was the most logical answer, as
PFM vs natural teeth, natural teeth wear off)
QUESTION: Same patient from #56, a picture of him doing incisal guidance, what is this patient doing? –
Incisal guidance (lower teeth and upper teeth were at edge to edge position)
QUESTION: Same patient as question 56 and 57, when he does anterior guidance, what is happening to
the TMJ? – Rotational (I was wrong, it’s translation!)
*anterior guidance…TMJ TRANSLATES!
QUESTION: A patient presents for try-in evaluation of balanced occlusion of complete maxillary and
mandibular dentures. A dentist notes that protrusive excursion results in separation of posterior
teeth. This dentist can best correct this problem by
QUESTION: Protrustion denture causes dislodging. Change condylar inclination increase

compensating curve!!
QUESTION: First step in religning a distal extention denture you must first- try in the framework
QUESTION: In Max CD opposing Mand bilateral distal extension (Kennedy class 1) why is the
anterior of the wax rim beveled? I put because the length is good esthetically but there is not
enough interocclusal space @ that length.
QUESTION: Beveling on upper occlusan rim due to? length is adequete for esthetics but inadequete
interach space
QUESTION: Patient has occlusal rims prepared and bevels the max,why?
-VDO and lenght of max occ rim was adequate
-Lengh of occ rim as adequate but vdo was wrong
QUESTION: Which one of the following is usually an issue for denture patients? – Lower denture (other
were maxillary dentures, and some other things)
QUESTION: what is the best way to treat a tooth supported lower denture? Use metal copings to
cover teeth
QUESTION: Denture border sitting on what muscle due to its orientation of its fiber: I think its
masseter.
QUESTION: Posterior buccal extention of a mandibular complete denture is limited by : Masseter

muscle
QUESTION: Posterior buccal extention of a mandibular complete denture is limited by: →Masseter
muscle
QUESTION: What muscle can u impinge on with denture- maseteer, medial pterygoid, or lateral pterygoid
a. Medial pterygoid
c. Masseter
d. Buccinator
a. Medial pterygoid
c. Masseter
QUESTION: what muscle covers dentures flanges and no affect stability : Buccinator- the
buccinators does not affect stability!!
• Buccinator
• Masseter
QUESTION: lower denture impression lingual area muscle – mylohyoid
QUESTION: Which muscle helps border bold in the posterior lingual flange? Mylohyoid was the
answer. Other muscles that help are: palatoglossus, superior pharyngeal constrictor, genioglossus
(lingual border of mandibular impression)
QUESTION: lingual flange on lower complete is around which muscle? Geniglossus, medial
pterygoid, lateral pterygoid, mylohyoid.
QUESTION: man. Lingual flanges are affected by

• geniglossal
• mylohyoid
QUESTION: Mand CD interfere with what muscle in lingual side?
• Mylohyoid.
QUESTION: What determines lingual border of Mandibular impression? BOTH Superior Pharyngeal
Constrictor/mylohyoid muscle and buccal is masseter.
QUESTION: lower denture impression lingual area muscle – mylohyoid / superior pharyngeal
constrictor / palatoglossus, genioglossus
QUESTION: What muscles help in retention of lower complete denture : palatoglossus , superior
pharyngeal constrictor, mylohyoid and genioglossus.
QUESTION: Denture outline in border molding affected on the lingual of mandible by what?
Superior constrictor, palatoglossis, genioglossis, mylohyoid
QUESTION: Border molding of lingual mandibular portion done by what movement? Wetting of lips
with tongue
QUESTION: you would relieve a mandibular denture in the area of the buccal frenum to allow which
muscle to function properly? Buccinator? Orbicularis oris
QUESTION: pt presents with a restricted floor of the mouth, only 6 mandiblar anterior teeth and
diastama b/w several teeth, which of the following major connector is appropriate for this pt: a
lingual plate with interruptions In the palate at the diastemas
QUESTION: RPD rocks when you apply pressure on either side of fulcrum line, why? Indirect
retainer
QUESTION: RPD pops off when press on one side – inadequate indirect retainer
QUESTION: Insufficient indirect retention on RPD when what happens?

A: Distal extensions lift away from mucosa
QUESTION: Edentulous bilateral and rocking of denture- inadequate seating of denture or
inadequate indirect retainers.
QUESTION: What happens when no indirect retainer on distal extension: see distal extention pop
up off of tissue
QUESTION: With mandibular bilateral distal extension RPD, when you place pressure on one sides the
opposite side lifts and vice versa, what is the problem?
b. rests do not fit
QUESTION: Why is there a tissue stop under distal extension rpd – acrylic resin
QUESTION: Pt complains “it feels loose” from a new bilateral distal extension RPD. Why? I put retainers
are passive on the abutments they should fit passive .Thin flanges bases, Occlusion , Indirect retainer
QUESTION: Pt comes in w/ new bilateral distal extension RPD that’s loose. Why? I put retainers
are passive on the abutments. (retainers are supposed to be passive)
QUESTION: Pt comes in w/ new bilateral distal extension RPD that’s loose. Why? Deflective
Occlusal contacts
QUESTION: Lower denture is loose whats wrong with it? (over extended, under extended????
QUESTION: Distal extention lower rpd u push on that area and the indirect retainer rest comes up….how
do u tx?
Reline (if its excessive →altered cast)
Tighten clasps
QUESTION: multiple failures in FPD : →poor framework design.
QUESTION: Breaking clasp? Poorly designed something

QUESTION: The main reason of breaking of RPD clasp?
High Mudule of Elastisity
work Work Hardening
QUESTION: What property of rpd framework will limit adjustments of clasps?
a. Yield strength?
b. Ductility
c. Stiffness
QUESTION: What mechanical property effects permanent composition for RPD clasps – yield strength
QUESTION: Why do you use canine for incisal rest: esthetics, surface area, cingulum
QUESTION: Base metal: Long span bridge
QUESTION: Pt comes in w/ interim; if u fabricate cast partial, how is it gonna be different?

Aesthetics of teeth, retention, resistance to occlusal loading, etc. (agu’s answer: resistance to
occlusal loading – cuz interim doesn’t have rest seats)
QUESTION: Which of the following explains why a properly designed rest on the lingual surface of a
canine is preferred to a properly designed rest on the incisal surface?
QUESTION: How do you protect roots under an overdenture – RCT with cast copings,
QUESTION: What is not important for over denture? clinical crown size
QUESTION: Which teeth roots to retain under overdentures? PICK roots from dense bone areas.. Such as
Mandibular Canine
QUESTION: Overdenture…how do you choose which teeth to retain?...which is most important…no freaking
clue…based on crown, # roots, location etc… Pref = canine → premolars → incisors →molars
Bilateral, symetrrical, with healthy attached gingiva, adequate perio support (>1/2 root in bone), limited/no mobility
QUESTION: A patient has acromegaly and needs dentures. Which denture will not fit?
Maxillary
Mandibular
QUESTION: which of the following is the endocrine involvement that is related to jaw deformity:
Acromegaly
a. acromegaly
b. cherubism
c. Albrights
d. pagets
QUESTION: Denture patient with a big ball around canine and premolar
neurofibroma
QUESTION: First sign of increased (we think in reference to VD) occlusion? TMJ, myofascial,
attrition, abfraction
QUESTION: After surveying and designing which is the first step to do? reduction the axial for
proximal plate
QUESTION: In which is a direct retainer very important? Kennedy class 2

QUESTION: Describes a denture with bilateral edentulous space anterior to natural teeth. Kennedy
class 4
QUESTION: Which type of kennedy classification doesn’t have a modification? Kennedy Class IV**
QUESTION: which kennedy class has no modification-Class IV
QUESTION: RPD denture frame what metal causes allergy, nickel, chromium , cobolt and copper
QUESTION: Allergy mostly to nickel
QUESTION: Metal most likely to cause allergic reaction → NICKEL
QUESTION: Which metal is responsible for allergic reaction? Nickel or cobalt? I THINK NICKEL
QUESTION: KELLY Syndrome=Combination syndrome (CS). pt with completely edentulous

maxilla and partially edentulous mandible with preserved anterior teeth, consists of severe anterior
maxillary resorption combined with hypertrophic and atrophic changes in different quadrants of
maxilla and mandible.
(class I mandibular RPD vs. Max CD, bone loss in anterior maxilla, overgrowth in max tuberosities,
papillary hyperplasia of hard palate, supraeruption of mandibular teeth, bone loss beneath distal
extensions: Xtina, First AID)
ultimate goal when you make his cd upper and rpd lower: balanced occlusion on both anterior
and posterior teeth of mouth during centric relation;
ultimate gola when you make his cd upper and rpd lower: I said you want balanced occlusion on
both anterior and posteror teeth of mouth during centric relation; (other option was wanting
balanced occlusion (didn’t mention ant vs post teeth, during excursive movement)
QUESTION: Combination syndrome = Kelly syndrome : Pt with maxillary complete denture –

retained mandibular anteriors and not lower RPD . Pt shows : denture anteriors teeth doesn’t show
, flabby anterior ridge , tuberosities flabby and enlarged, lower anterior teeth extruded above plane
of occlusion and atrophy of lower posterior ridge.
QUESTION: Pt has flabby anterior tissue

• Caused by combination syndrome
• Causes decreased VDO
QUESTION: Combination syndrome = Kelly syndrome
1)denture anteriors teeth doesn’t show ,
2)flabby anterior ridge ,
3)tuberosities flabby and enlarged,
4)lower anterior teeth extruded above plane of occlusion and
5)atrophy of lower posterior ridge.
QUESTION: A flabby, maxillary anterior ridge under a complete denture is frequently associated
with
A. V shaped ridges.
C. osteoporosis.
Down Syndrome/Birth Problems:

QUESTION: Down syndrome patients have small maxillas and midface deficiency
QUESTION: DOWN syndrome:
they don’t have more caries
QUESTION: Trisomy 21 face: Low Caries Risk
QUESTION: Trisomy 21
o Down syndrome
o Class III profile
QUESTION: Down syndrome : midfacial hypoplasia

QUESTION: Downssyndrome: trisomy 21, which is a description ? small mandible Mid Facial
discrepency
QUESTION: Trisomy 21 (Down syndome)

Manifestations
Mid-face deficiency, Class III
Delayed eruption
Super-numerary teeth
Does not have a higher chance of caries
HIGHER chance of periodontal disease
QUESTION: What orthomanifcastion does Turner syndrome and trisomy 21 associated with? short
midface
QUESTION: What is telurism- eyes wide apart--- example Crouzan’s Disease (gorlin and down
syndrome for extra info)
QUESTION: What is hypertelorism-
Wide-set eyes (seen in Crouzon, Cleidocranial dysostotosis, GOrlin Sydrome,)
QUESTION: asked of definition of hypertolerism – increased distance between eyes.
(crouzon’s)
QUESTION: Which does NOT result in delayed development:

Trisomy 21, Trisomy 18, Hurler Syndrom (mucopolysaccharides), Cru di Chat
QUESTION: which one doesn’t show late development trisomy 18(Edward syndrome),
Edwards syndrome (also known as Trisomy 18 [T18]) is a genetic disorder caused by the presence of
all or part of an extra 18th chromosome.
Cri du chat syndrome, also known as chromosome 5p deletion syndrome, 5p- (said minus)
syndrome or Lejeune’s syndrome, is a rare genetic disorder due to a missing part (deletion) of
chromosome 5.
QUESTION: Fetal alcohol syndrome

anencephaly, mid face deficiency, cleft lip
QUESTION: How it looks in a kid fetal alcohol syndrome? -midface deficiency
QUESTION: Fetal alcohol syndrome causes – cleft lip
QUESTION: Teratogen definition: anything that messes with the fetal development
QUESTION: What causes problems in babies in emryo? Teratogens (Any agent that can disturb
the development of an embryo or fetus) Carcinogen
QUESTION: teratogenic definition - cause deformity / birth defects
QUESTION: Definition of teratogen: Any agent that can disturb the development of an embryo or
fetus. Teratogens may cause a birth defect in the child. Or a teratogen may halt the pregnancy outright.
Bone & Sutures:

QUESTION: Epiphyseal plate is most like a synchondrosis
QUESTION: what resembles epi plate: synchondrosis
QUESTION: What age does the mandibular symphisis close: 6-9 months
QUESTION: Sphenooccipital synchondrosis: cartilage*
QUESTION: Sphenooccipital closure…what kind of tissue fills it in – its cartiledge

Interstitial growth – occurs by the mitotic division and deposition of more matrix around chondrocytes
already established in the cartilage.
Ex – CONDYLE, nasal septum, and spheno-occipital snychondrosis
QUESTION: Sphenooccipital synchondrosis: cartilage* or bone
QUESTION: which of these undergo suture closure latest?

• sphenoethmoidal
• Sphenoccipital
• Intrasphenoid
• Intraoccipital
QUESTION: What is synostosis? ABNORMAL FUSION OF BONES
QUESTION: synostosis definition:
(abnormal fusion of neighbor bones…wiki…Xtina)
QUESTION: What is craniosynostosis? Early closure of suture

• Abnormal fusion of two bones. Craniosynostosis is early closure of a suture between
bones.
• Abnormal development of a joint.
QUESTION: Synostosis (fusion of 2 bones)- CROUZON

QUESTION: Patient w/ deficient synostosis mid-face, proptosis,? Crouzon syndrome
Synostosis means fusion of two bones…proptosis) - a bulging of the eye anteriorly out of the orbit
QUESTION: Patient w/ deficient mid-face, proptosis, etc? I put Crouzon syndrome, Could also
be Apert Syndrome
QUESTION: Ocular proptosis, max hypoplasia, premature suture closing? treacher-collins, crouzon,
Pierre robin, cleido cranial
BEATEN METAL SKULL
→ The most notable characteristic of Crouzon syndrome is cranial synostosis, as described
above, but it usually presents as brachycephaly, which results in the appearance of a short and
broad head. Exophthalmos (bulging eyes due to shallow eye sockets after early fusion of
surrounding bones), hypertelorism (greater than normal distance between the eyes), and
psittichorhina (beak-like nose) are also symptoms. Additionally, a common occurrence is
external strabismus, which can be thought of as opposite from the eye position found in Down
syndrome
→mucopolysaccaridosis- build up of GAGs
HURLER SYNDROME = also known as mucopolysaccharidosis type I (MPS I), Hurler's disease, also
gargoylism, is a genetic disorder that results in the buildup of glycosaminoglycans (formerly known as
mucopolysaccharides) due to a deficiency of alpha-L iduronidase, an enzyme responsible for the
degradation of mucopolysaccharides in lysosomes
HUNTERS SYNDROME = It is a result of a defect in anchoring between the epidermis and dermis,
resulting in friction and skin fragility
Both are lysosomal storage diseases
→mucopolysaccaridosis- build up of GAGs
QUESTION: Hunter-hurler syndrome, mucopolysaccaridosis is buildup of glycosaminoglycans

QUESTION: Hunter-Hurler is mucopolysacchrides
QUESTION: Hunter syndrome has what?

Lysosome storage disease. Get abdominal hernias, ear infections, colds, prominent forehead, enlarged
tongue, mental retardation.
Type of MCUOPOLYSACCHARIDOSIS
X-linked, appears @ 1-2 yrs of age, clear corneas, growth retardation, stiff joints, mental retard
QUESTION: hunter syndrome : build up of glycosaminoglycan due to lack of an enzyme : enzyme
iduronate-2-sulfatase (I2S).
QUESTION: Hurlers Syndrome? genetic disorder that results in the buildup of mucopolysaccharides due
to a deficiency of alpha-L iduronidase, an enzyme responsible for the degradation of
mucopolysaccharides in lysosomes. Without this enzyme, a buildup of heparin sulfate and dermatan
sulfate occurs in the body.
QUESTION: 15 yr old edentulous and keratosis on hands and feet.

Papillon Lefevre syndrome ***Think PERIO + PALMOPLANTAR KERATODERMA********* ugly
pic of thick soled FOOT GROSS!—wiki it
QUESTION: What is Papillon–Lefèvre syndrome? You get periodontitis, keratosis on hands and soles, and
premature loss of primary teeth.
QUESTION: Hyperkeratosis in hands and feet – Papillon Le-Favre Syndrome this also cause
severe periodontal disease which cause primary tooth loss by the age of 4 and permanent
tooth loss by the age of 14
QUESTION: Papillon-Lefevre syndrome -basic question on hand and feet derm
Pierre Robin Syndrome = micrognathia, occurring in association with glossoptosis, cleft palate, and
absent gag reflex.
QUESTION: Pt. has glosoptossis (downward displacement or retraction of tongue), Mn
micrognathia, and cleft palate?
A: Pierre-Robin Syndrome
QUESTION: triad of glossoptosis, mand. Retrognathia, and cleft palate? Pierre Robins?
QUESTION: Glossoptosis = refers to the downward displacement or retraction of the tongue
QUESTION: Glossoptosis – micrognathia - cleft palate? Pierre,Robin syndrome
QUESTION: Triad of cleft palate, glossoptosis and absent gag reflex. What is it? Pierre-Robin
Syndrome
QUESTION: Sturge-Weber syndrome? vascular malformation, eye and hemangioma → Port-

wine stain
QUESTION: Sturger webber syndrome : Port Wine Stain.

*Sturger Webber—Port Wine stain
QUESTION: alveolar bone is open over root, this is: fenestration, dehiscence ( I put fenestration, b/c
dehiscence refers to wounds according to wiki)
QUESTION: Dehisense defined as? The loss of buccal or lingual bone overlying a tooth root.
QUESTION: Dehiscence? The loss of the buccal or lingual bone overlaying the root portion of a tooth,
leaving the area covered by soft tissue only.
QUESTION: Dehiscence - dehiscence is loss of alveolar bone on the facial (rarely lingual) aspect of a
tooth that leaves a characteristic oval
QUESTION: Each of the following osseous defects would be classified as infrabony EXCEPT one. Which
A. A trough
B. A dehiscence
C. A hemiseptum
Thyroid:
QUESTION: Which do you give a hypoparathyroid child for normal development of teeth: vit D →
Brings in Ca+
QUESTION: Give a kid Vitamin D or calcium for hypoparathyroidism
QUESTION: Thyrotoxocosis symptoms
a. DIAPHORESIS, fever and TACHYCARDIA
QUESTION: Thyrotoxic shock and its symptoms: fever, tachycardia, hypertension, and neurological
and GI abnormalities.
QUESTION: Thyrotoxic pt. manifestation? Tachycardia,

QUESTION: Characteristic of excess thyroid?
A: Hypotension, bradycardia, restlessness, sweating → probably due to heat intolerance
QUESTION: Thyroid crisis resembles….
Hyperthyroidism….thyroid storm (thyroid storm is a severe version of thyrotoxicosis)
QUESTION: Symptoms of hypothyroid

QUESTION: symptoms of hypothyroid attack: weight gain, bradycardia, cold, fatigue, constipation
QUESTION: Which endocrine system does thick hair become thin hair: thyroid – hypothyroidism
(cretinism in kids and myxoedema in adults)
QUESTION: loss of weight, sweating and fine hair : hyperthyroid
QUESTION: the decreased alkaline phosphatase is related to: →it’s hypophosphatasia
QUESTION: Hypophosphatasia leads to a Decrease in Alkp,
QUESTION: What disease causes decrease in alkaline phosphatase? Malnutrition,
hypophosphatasia, hypothyroidism, pernicious anemia
QUESTION: Central Giant Cell Granuloma is seen with pts with which condition? Hyperparathyrodisim
QUESTION: Thyroid drug, which doesn't let iodine bond to hormone? Radiated Iodide (for
hyperthyroidism)
QUESTION: Pheochromocytoma involves – thyroid,
QUESTION: Graves Disease (Hyperthyroidism) - exopthalmos
QUESTION: Thyroid hormone decrease, which drug do you give? Levothyroxine (for
hypothyroidism)
QUESTION: Pt has high cholesterol, hypertention and diabetes, metabolic problem, which does he
have: metabolic syndrome,
QUESTION: BMI of 36 what syndrome? Overweight always going to pee-; high lipids high
cholesterol; what syndrome? METABOLIC SYNDROME
QUESTION: What other organs would not be effected? Pancreas, colon, thyroid, kidney? THYROID
QUESTION: Blood tests back from together hematocrit, etc….hematocrit again
QUESTION: What is the normal %fat intake per day- 30

QUESTION: Recommended daily dose of fat: 30% of total calorie and saturated fat is 10% of daily calorie
intake
ETHICS & Patient Managament:

Beneficence- “Do good”.
Patient Autonomy- “Self governance”.
Nonmaleficence- “Do no harm”. Dentists are to keep skills and knowledge up-to-date and practice within
their limits in order to protect the pt from harm.
Justice- “Fairness”.
Veracity- “Truthfulness”.
LOTS OF ETHICS QUESTIONS: what to say what to do in these situations. If your patient is
looking around a lot at your masks and gloves, safety equipment, whats the most appropriate
response? Some of the answers are vague.
QUESTION: Dentist tells patient amalgam is hazardous – veracity
QUESTION: Know veracity: truthfulness: tell patient that he needs to take of amalgam fillings bc
they are not good for his health: not practicing veracity.
QUESTION: If a dentist tells the patient “I need to remove all your amalgams because they are
toxic” he is violating? I put Veracity
QUESTION: telling truth is veracity
QUESTION: What principle has to do with patient self-governance and privacy? I put autonomy
QUESTION: Informed consent – autonomy
QUESTION: Informed consent → autonomy

QUESTION: Definition of Autonomy - patient choose to sign consent
QUESTION: Dentist lets the patient sign informed consent-autonomy
QUESTION: What you do first before choosing informed consent: make sure patient can sign or has
guardian, consult physician, discuss options with relatives …
QUESTION: 82 y/o pt comes w/ younger person who hands dentist paper saying the pt has a
legal guardian. Now what? I put that you must have consent of this guardian before
treating the 82 y/o pt
QUESTION: 90 year old patient comes in with son who has a document mentioning the guardian of
the patient- must have consent from them to treat the patient
QUESTION: The 16 yr old can take the decisions for the elder pts if: If the elders are deaf and dumb,
if the boy makes thepayment, if the elders are over 60yrs, if the kid has the power of an
attorney
QUESTION: Consent- do not need to discuss the witness signature (I think)
QUESTION: When should patient sign informed consent forms for surgery? I put AFTER there
has been a discussion w/ the dentist about the surgery
QUESTION: inform consent most contain all except : cost of Tx.
QUESTION: Treatment without informed consent is battery

QUESTION: What happen when patient doesn't sign the consent? Battery, health care provider
commits a battery if the provider performs a procedure for which the patient has not given consent.
QUESTION: Dentist keeping up with new data – non-malfecence
QUESTION: Something about dentist needs to keep up to date with new technology and learn and
practice new procedures: Non-malfecience
QUESTION: Dentist keeps on current dental medicine to provide current standard of care. What part of
the ethical code does this relate to?
A: Nonmalefacence
QUESTION: Definition of non-malifacence - Knowing your limitations and referring patients out to
specialists
QUESTION: Dentist refers a difficult case to a speacialist-non malfiecence
QUESTION: Reason y we need to CE and know our limitation- forget the name the one where we do no
harm to patient (non-malfiecense)
QUESTION: Dentist keeps on current dental medicine to provide current standard of care. What
part of the ethical code does this relate to?
A: Nonmalefacence
QUESTION: Like if a child came with a history of aggressive behavior and is crying then should the
dentist show empathy or sympathy or control LOOK BACK **Apathy-indifferent; Empathy-to walk in
their shoes, share the emotional state they are feeling; Sympathy-to be concerned about someone, do not
have to share the same emotional state as them.
QUESTION: Rapport best with : empathy I put: other choices were sympathy, compassion
QUESTION: What best characterizes rapport? Understing patients feeling and talking with
patient
QUESTION: Definition of rapport? mutual openness / harmonious relationship*

Rapport = mutual sense of trust and openness between individuals that, if neglected, compromises
communication. 
QUESTION: A successful practice is built on- friendship COMMUNICATION? Good clinican-patient

relationship
QUESTION: what is the best to communicate with patient- apathy, empathy, or some other stuff
QUESTION: to show empathy you don’t need which of these? An imagination, understanding.... I don’t
remember what I put down though...
QUESTION: Empathy is not: shared personal experiences Imagination, understanding
QUESTION: which does not show empathy to the patient?
a. open-mindedness
QUESTION: Definition of Empathy – Patient wanted to give you paperwork, and you acknowledge
their concerns
QUESTION: to paraphrase a question you do not need to agree with it
QUESTION: When should the dentist NOT use paraphrasing? When trying to speak to a patient in his
second language, When the dentist is upset with what patient says, when giving factual values.
QUESTION: When should the dentist not use para-phrasing?
QUESTION: Which statement is NOT correct about “Paraphrasing”?
• to put in your own words – it’s correct meaning of paraphrasing
• there were a few other example, but can’t remember…
Paraphrasing=repeating, in one’s own words, what someone has said. This serves to confirm one’s
understanding, validate a patient’s feelings, convey interest in the patient’s experience (thereby building
rapport), and highlight important points.  
QUESTION: Patient complains of pain in relation to a particular tooth.So the best answer/reply of the
dentist would be:
QUESTION: While the dentist is preparing a large carious lesion in Tooth #30 for a restoration, a
pulp exposure occurs. The patient angrily shouts at the dentist, "You incompetent 'creep'- -you're
responsible for this problem!"- Of the following possible responses the dentist could make, which
one is the most emphatic?
C. I can see that you're very upset. You thought the tooth could be restored and
now this problem has occurred.
E.I'm sorry this happened, but we must get on with the procedure.
QUESTION: Patient comes in and they say “oh I hate the dentist, I hate being here”
• What would be your response
QUESTION: if the patient tell you why you fees are so high, what would be your response:??
QUESTION: Pt complains of high fees of dentist, how should the dentist answer? Fee is fine
according to the geographic area, it is fair and reasonable, I have to make a living too
QUESTION: Patient says, “I’ve been brushing like you showed me but I still have cavities.” What do
you do?
a. Go over OHI?
QUESTION: The closest a dentist should get to their patient is? 1. Tap their shoulder
QUESTION: Reason to not have parent in room with dentist and kid- communication barrier
between dentist and child, osha violation, hipaa violation,
QUESTION: Don’t have parent in room with child → disrupts relationship between child and dentist
QUESTION: Why a parent would be contraindicated from being in the room? barrier to
communication btwn dentist and child
A: Precontemplation*, contemplation, action, denial
o Positive reinforcement : u brush u get sticker
o Negative reinforcement: stop pain from toothache pt realizes he should brush)
o Positive punishment =Aversive Conditioning: everytime u don’t brush u have to
clean ur room
o Negative punishment= don’t brush no allowance
o Operant extinction= child cries don’t give attention
Positive reinforcement- Positive consequence that increases behavior

a. Negative reinforcement- Removal of negative consequence that increases behavior
b. Positive punishment- (adversive conditioning)- negative consequence that
decreases negative behavior
c. Negative punishment- (adversive)- Removal of positive stimulus in order to
decrease an undesirable behavior
d. Basically, know that reinforcement is more effective than punishment because in
punishment, you have resentment, you avoid the punisher, and you are not taught
positive behavior.
Systemic desensitization
a. Relaxing strategy like diaphragmatic breathing

b. Most important component of systematic desensitization is exposure to
fearful stimulus
QUESTION: MOST of the questions where of behavior modification techniques in children and
“what would you say” questions
a. Autistic kid, down syndrome
b. Kid that kicks and screams
c. Shy kid
QUESTION: During the child's first visit, the dentist requested that the parents wait in the reception
room. The child cried moderately, but tearfully, throughout the dental examination and
prophylaxis. The dentist "gave her permission" to cry while he/she worked and then took no notice
of her crying. Her crying diminished in intensity over time and then stopped. With respect ONLY to
the crying behavior, the dentist has)
QUESTION: Pt with manic depression disorder not willing to get treated for that is now getting dental
treatment from you. What do you see in this patient:
A) bipolar b)depression c)excitement
QUESTION: How to reduce Stress-dental anxiety? tell-show-do
QUESTION: Emancipated minor: if the kid is under 18, know exceptions of how they become
emancipated minor, page 230
- If he graduated from high schoo, has been married, has been pregnant, or
responsible for his or her own welfare and is living independently of parental control
and support.
QUESTION: How is FACT witness is different from expert specialist? fact witness just determines
the quote pg.231
QUESTION: Behavior shaping: providing positive reinforcement for approximation of behavior you
are desiring
QUESTION: Which describes a stage in Piaget’s model of congnitive development? I put
preoperational.
QUESTION: A behavior modification device (ie thumb sucking deterant) is an example of: choices
where things like positive or negative reinforcement and other conditioning terms POSITIVE
PUNISHMENT
considered? – Negative reinforcement (other choices were positive reinforcement, and some other
behavioral modification stuff. My thinking was, the lil dude was probably not going to listen to anyone
about his oral habits, so the appliance is used to modify his little addiction, so if the appliance is in the
way he has no choice but give it up, thus the desired behavior will be increased in the future, fo sho!).
POSITIVE PUNISHMENT
considered? – Negative reinforcement POSITIVE PUNISHMENT
QUESTION: 6 year old mentally retarded child.Treatment is recall. Would you give sedation,
antianxiolytic, voice control or positive reinforcement.--- with int. disabled—you want to be short and
brief, explain things, tell-show-do, and REWARD. So I would think positive reinforcement.
QUESTION: What is the best way to treat a developmentally disabled patient? I put consistency
QUESTION: Autistic kids have what characteristic. Repetitive behavior
QUESTION: Autistic behavior: ?? I put they have a desire for physical contact. There was no choice
that they are sensitive to loud noise.
QUESTION: Disable patient comes in and not cooperative, how should you act? Permissiveness
(give patient freedon and treat in the way patient feel comfortable)
QUESTION: Disabled pt, should be treated by flatterness, permissible, consistent

QUESTION: Mentally disabled, approach by dentist? Strict, freedom
QUESTION: patients with autism will usually show?

Children with autism are easily overwhelmed by sensory overload. This can cause “stimming”
(flapping of arms, rocking, screaming, etc). Autistic children are hypersensitive to loud noises,
sudden movement, and things that are felt.

QUESTION: Eye contact, smiling, and telling pt doing good job: social reinforcement
QUESTION: Praising, smiling and congratulating is what type? Social reinforcement
QUESTION: Child patient – you smile, tell him good job, and pat him on the shoulder. These
are examples of negative reinforcement, social reinforcement, token reinforcement.
QUESTION: If kid complained and whined in the beginning but at the end were very good: you
compliment how well they were at the end of the procedure
QUESTION: Voice control method used with children’s : Aversive conditioning= punishment to
deter unwanted behavior ex Hand over mouth
QUESTION: What is the purpouse of the voice control technique? Sets boundaries→ Aversive
conditioning
QUESTION: 8 year old patient, 1st time ever, scared of dentist? Whats the most likely answer?
d. Television
e. Parents
f. Tv
QUESTION: If pt is afraid, because of
g. Parents
h. Peers
i. Tv
QUESTION: If child is afraid: Allow the child to express fears
QUESTION: Desensitization works if the base of the behavior problem is Fear

QUESTION: How do you treat a fearful child- use sedation, let him watch another patient,
QUESTION: Patient is scared bec he has no control what to do- I said tell him to raise his hand if he needs
a break/ you to stop
QUESTION: Dental anxiety can be caused by Pt‟s helplessness. What would reduce it? Telling Pt
to raise her/his hand when feels pain
QUESTION: A kid is on recall appointment and is not cooperative. You should do voice control
followed by? Alternating appraisal
QUESTION: Patient is very young amd fearful first time you meet them – try to talk to them going down
at their height.
QUESTION: Patient is very young and fearful first time you meet them – try to talk to them going down
at their height.
QUESTION: Patient 2 yrs old and scared – ask parent to position patient for you (others were get assistant
to do it, you do it yourself, the point here is knee-to-knee position)
QUESTION: Patient 2 yrs old and scared – ask parent to position patient for you (others were get
assistant to do it, you do it yourself, the point here is knee-to-knee position)
QUESTION: The restraining of uncooperative 2 yr child should be done by.Dentist, Assistant, Parent
QUESTION: 2 year old kid, best technique?
Knee to knee with head on parents lap
QUESTION: Patient comes in with 1 year old child, how do you do exam? parent and dentist are
knee to knee, baby's head is in dentist's lap
QUESTION: 8 year old boy, when will he behave better?

Nobody inside
QUESTION: pediatric fears correlated with age
QUESTION: what is a 2 yr old most afraid of? 4 yr old?
• 1-3 yr old: SEPARATION
• 4-6 yr old: UNKNOWN
QUESTION: Uncooperative 2 year old- separation anxiety
QUESTION: 4-5 year child scared of? → unknown
QUESTION: Boy 4 yrs old: afraid of unknown.
QUESTION: You help a child help recognize what they are afraid of and make outward positive
connection:
- cognitive restructuring: is a psychotherapeutic process of learning to identify and dispute
irrational or maladaptive thoughts,
QUESTION: Modeling behavior is used when: when the kid is afraid and use a sibling or
someone older to show how they should behave
QUESTION: What is behavior modeling?
QUESTION: Patient had a flu shot done and she is afraid of dental needle even though she never had
one: what is term called (generelaization vs transference idk what answer was)
QUESTION: A patient is going to the dentist and has never had local anesthetic. He recently got a
vaccine and is now afraid of needles.The fear is due to what?
Location
Generalization?
Translation
QUESTION: When pt say I have anxiety to pain from needle… when flu needle fear is extended to dental
needle fear means general anxiety/specific anxiety
QUESTION: A 4 yr old child management-ANS .empathy and respect
QUESTION: Management of moderately apprehensive child
QUESTION: Replacing words like LA with sleepy juice is called as Euphamism (relabeling)
QUESTION: classic condition, which is an example? – pain (as in, you see dentist, you assume pain is
coming
QUESTION: classic condition, which is an example? – pain (as in, you see dentist, you assume pain
is coming
What is an example of stimuli in classical conditioning: DEntist (all others were responses)
QUESTION: What is an example of stimuli in classical conditioning: dental chair (all others were
responses)
(dentist)
a. Dental chair
c. Fear
d. Anxiety
Anxious patients: most difficult patients as they often cause the dentist to become anxious as
well.
QUESTION: Difference between fear and axiety- fear is on something anxiety is everythin (harder to treat)
Fear decreases pain and anxiety increases pain, fear is painful, anxiety is a disease, Fear is local,
anxiety is generalized
QUESTION: What do Freud and the other guy say about anxiety? I put something about how it’s
a part of personality that must be controlled to be socially acceptable. Probably wrong.
QUESTION: Define anxiety according to Freud and K- aversive inner state that people seek to
avoid or escape.
QUESTION: What do Freud and Erikson say about anxiety? I put something about how it’s a part of
personality that must be controlled to be socially acceptable. Probably wrong. Their inability to overcome
a conflict in a particular stage that will lead to anxiety. Inadequate resolution ->Anxiety
An inadequate resolution in this case would Indicate a child's insecurity and anxiety. An
Adequate Resolution would mean that a child was able to overcome the conflict in each stage and
develop properly. This applies similarly to the other 8 stages.
QUESTION: Freud anxiety concept
D. Kid overcomes it
QUESTION: what would most cause a man to have anxiety: traumatic past experience, or finances,
peers, unpleasent staff
QUESTION: constantly exposing the pt to get from the fear factor is---desensitation
QUESTION: Impending doom: panic attack, fear, anxiety, pain
QUESTION: Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear
of losing control.
QUESTION: Impinguing doom
panic attack
QUESTION: What is maturity: Environmentally dependent, environmentally independent
QUESTION: Pedo t 1st visit. Multiple carious teeth on anteriors. During anesthesia is well
cooperative and doesn’t cry or move. Once begin tx, begins to cry. What do.
• Keep working
• Voice control **
• More anesthesia **
• Oral sed
• N20
Included in ADA code of ethics and professional conduct:

Fees (discusses overbilling), Advertising & marketing, ethics (patient values & harm), credentials
(dentist cannot state they are certified in a speciality when they’re not)
QUESTION: what is not included in the ADA code of ethics?
• Advertising
• Issues concerning pt
• Fees
QUESTION: Each of these is covered in the ADA code of ethics except:, advertisement, patient
values…
QUESTION: Which one is not covered by ADA code of ethics – Advertising (fees)
QUESTION: All of these are included under the code of conduct except: harm, advertising, list of
credentials needed to be a dentist, fees
QUESTION: Something about the code of ethics and what it includes- it did not include snitching on other
dentists that use electronic advertising

a. Cost
b. Specialty (obvious…no?...Xtina)
QUESTION: A dentist has an ethical obligation to report a colleague is all situations ... except?

c. abusing patients
QUESTION: What do you not report to the ADA? Reporting an advertisement for a colleague or an
announcement for specialty practice? Principles of ethics and conducts does not cover and you have to
pick one
QUESTION: if you find problems, medical conditions occurring with a certain drug, who do you
contact? OSHA, FDA, EPA,
QUESTION: If there is an adverse reaction to a medication in the office, who do you notify? FDA
QUESTION: allergy to meds or dental instrument - report to FDA
QUESTION: toxic reaction to a medication the dentist most contact : a) FDA b) CDC c) HIPPA d)
OSHA e) EPA.
QUESTION: Asked which statement was correct for HIPPA? Must give privacy form to pt but you
don’t need confirmation of receipt, fax and email standard, etc.
QUESTION: Something about HIPAA. Something about a fax machine and who can pick up the
phone and if a patient receipt counts as something….I don’t know.
QUESTION: Which example is not discussed in the HIPAA ethical privacy manual??: Something
about providing privacy information to patient and document, sending information over email and
fax, idk
QUESTION: If you need a medical record from your patient’s physician, your patient needs to give
you a permission to do that. Based on which principal/policy?
I picked Medicaid/medicare bc the choices were CDC, OSHA, bloodborne, some random
nonsense. There wasn’t HIPAA
QUESTION: Where does the government spend all its dental money? I put Medicaid.
QUESTION: which insurance have dental coverage medicaid: Medicaid (poor people!!).
QUESTION: What sector of government provides funding for dental care? Medicaid, medicare,
grant, HMO
QUESTION: Who pays MedicAid: States and the federal government share in the cost of Medicaid,
States may pay health care providers directly on a fee-for-service basis or states may pay for
Medicaid services through prepaid, capitated payments to health plans or other entities. Within
federally imposed upper limits for certain services, each state has broad discretion to determine the
payment method and payment rate for services
QUESTION: Who pays for MediCare: federal program that pays for covered health services for
most people 65 years old and older and for most permanently disabled individuals under the
age of 65.
QUESTION: Government spends most of the money in Medicare. Medicaid, HMO
QUESTION: Medicare cover dental routine care? NO
QUESTION: Medicare is a federal thing that provide health care for elderly . It does not cover
dental. Answer: Both statements are true
QUESTION: Most aid for finance: Medicaid, medicare, and hmo
• Insurance pays a flat fee/patient pays the rest – co payment
• Provider is payed per patient not per procedure – capitation
QUESTION: Most of the dental payments are by?- cash for service-67%
QUESTION: Most dental procedures for the elderly are paid for by out of pocket cash
QUESTION: which of the following is the leading payer for dental treatment, Insurance or self pay?

a. government
b. insurance
c. cash (should be this one)
QUESTION: Majority of health service in USA : is private insurance.

QUESTION: Patient makes $23,000/year, 73yo woman, how should she receive dental care?
• Medicaide
• Medicare
QUESTION: A 65 yr old lady living on 40k pension per year, wants to get a treatment. She does not have
any other physical abnormality besides tooth pain in her molars. From where does the money covered for
her treatment come from?
a. Medicaid does not cover dental for adults
b. Medicare. - does not cover dental for elders
c. Private Insurance - private dental IF she has it
a. medicare wI dental coverage
b. medicare w/o dental coverage
c. medicaid wI dental coverage
d. medicaid w/o dental coverage
QUESTION: insurance question about adverse selection (adverse selection deals with the idea that those at
higher risk are more likely to buy an insurance policy. If the price for the policy is the same for non
smokers and smokers, it is more likely that smokers will buy the insurance, because it is more “worth it”
to them—because they are at higher risk for disease. This is adverse to the insurer. So the prices need to
be different.
• only take pt with low risk
• take both
• something about taking pt of all ages
QUESTION: Health care plan adverse beneficiary risk
-high risk-individuals that present a high risk for insur
-low risk
-equal
QUESTION: What is capitation? Cap off how much the dentist gets reimbursed per procedure.
QUESTION: Know about capitation: Dentist is paid a fixed fee to see patients enrolled in
program
QUESTION: Capitation= hmo
QUESTION: HMO = capitation dental plan
QUESTION: HMO’s – dentists are paid a fixed rate for each individual per month. Dentist is paid
regardless patient was seen or not. If value of services exceeds payments, dentists loss. If payment
exceeds value of services, dentists gain.
QUESTION: You work at a HMO office and the patient has used up all his yearly benefits, what can you
do?
QUESTION: Your office is fee schedule and pt needs new crown but pt used up all of her
allowance (or something like that)? what do you do?
C ha rg e her a higher fee Cannot treat her Negotiate a lower fee
C harge same fee
also you can go to a dentist of your preferance? – PPO, HMO
also you can go to a dentist of your preferance? – PPO
QUESTION: Which one is related to employee insurance, where you get a discount from the
insurance and also you can go to a dentist of your preferance? – PPO, at the same rate mine
didn’t say anything about the company recommending any list of providers who were in in their
“preferred plan” or not
QUESTION: Company offers dental insurance to its employees that can go to selected dentist, what
QUESTION: Which one is related to a dental insurance, that only allows you to go to a group of
dentists at a specific location? – Closed Panel (other choices were open panels and other things)
QUESTION: On a prepayment basis, dental patients receive care at specified facilities from a limited
number of dentists. This practice plan is classified as which of the following?
A. Closed panel
B. Open panel
C. Group practice
D. Solo practice
QUESTION: Which of the following represents a dental program in which eligible patients receive
services at specified facilities from a limited number of dentists?
A. An open-panel
B. A closed-panel
C. A capitation group
D. A prepaid group
QUESTION: DR is a self-funded group dental plan in which the employee is reimbursed based
on a percentage of dollars spent for dental care provided, and which allows employees to
seek treatment from the dentist of their choice.
1. If Direct Reimbursement is there-- Pick It
QUESTION: If you are an employer and you provide your employee with reimbursements for dental care
they received from a dentist of their choice it is called: →direct reimbursement,.
QUESTION: patient goes to the dentist and needs to pay something before seen
-copayment
-deductible
QUESTION: If patient agrees to pay certain percentage of treatment plan:
copayment (vs deductible?) another term
Unbundling of procedures as "the separating of a dental procedure into component parts with
each part having a charge so that the cumulative charge of the components is greater than the total
Bundling is the exact opposite of unbundling and can occur on the insurance carrier end.
Bundling is defined by the ADA as "the systematic combining of distinct dental procedures by
third-party payers that results in a reduced benefit for the patient/beneficiary."
Upcoding or overcoding is defined by the ADA as "reporting a more complex and/or higher cost
procedure than was actually performed."
Downcoding on the other hand is defined by the ADA as "a practice of third-party payers in which
the benefit code has been changed to a less complex and/or lower cost procedure than was
reported except where delineated in contract agreements."
QUESTION: Dentist did not accept a copay and did not report it to the 3rd party (why would any
dentist do this? Over Billing
QUESTION: If a dentist waives the copayment and doesn’t tell the third party, what is this called?
→OVERBILLING.
QUESTION: You let patient not pay copay but you tell insurance that you charged the pt
→overbilling
QUESTION: Dentist charge for crown $500. insurance only covers $400.Dentist waves copayment($100)
but still let insurance he charges $500 for crown. what this action called?
a.Down coding
b. Overbilling
c.Price fixing
d.Unbundling
QUESTION: Bill out for a core build up and crown and insurance says build up is only covered, what
is this? Bundling
QUESTION: The dentist charges separately for core build up and the crown but the insurance
company says that the core build up is part of crown.what is this called? bundling
Bundleing : many procedure to a crown they only pay u for one
QUESTION: What's downcoding—had example of a dds who did 2 2 surface composites and insurance
made it 1 1 surface comp
QUESTION: Dentist do the treatment for 2 crowns but the insurance company pay the money for one
crown what is it: downcoding
QUESTION: You performed a two surface restoration and coded it that way. Insurance came back with
coding it as only one surface restoration. What is this called…downcoding, upcoding
QUESTION: When you charge for multiple codes when you actually did one thing → unbundle
QUESTION: Doctor billed insurance couple of procedures, when actually there is a global procedure that
combines them all, what did he commit? – unbundling
QUESTION: One big procedure, but if you divide it to many sub procedures.. → unbundling
QUESTION: Unbundling → coding procedures

QUESTION: Bundling --- bundling of procedures: The systematic combining of distinct dental
procedure codes by third-party payers that results in a reduced benefit for the patient/beneficiary
QUESTION: What is it called when a patient charges several procedures instead of one?
a. upcoding
b. downcoding
c. unbundling
d. bundling
QUESTION: Pt asks u to change date of service on insurance claim, what is this called? Fraud
QUESTION: The patient retires and loses health benefits.the treatment is done on the next day.the pt
requests the dentist to enter the previous day date and the dentist does so.what is this called.ANS. Fraud
QUESTION: Whats not the reason for rising dental costs?- the number of dental students in dental schools.
QUESTION: When treating elderly patients what should be your concern?
• Health of patient
QUESTION: Whats true about abuse cases? You’ll see at least 2 a year
Child abuse sign
• multiple untreated injuries
• lag time bt injury and tx
• comminuted facial fractures
• parents with different stories
Most common in children under 3
QUESTION: It is required mandatory to report all except -child abuse, reaction to drug, one more
choice
Abuses that have to be reported to authorities - colleague practicing with chemical impairment,
colleague advertising on electronic media, child abuse, domestic violence, elderly abuse
QUESTION: You suspect child abuse. Who do you call? I put social services
QUESTION: If there is an old women in ur chair and u think there might be abuse what do you have to
do?- tell family or tell human health services
QUESTION: You suspect elder abuse. Who do you call? I put dept of health and human
services
QUESTION: Which is not true of elder abuse: Most of the elder abuse is at victims home, mostly it is by
victims relative, elder’s abuse is often over reported and exaggerated,
QUESTION: elderly people abuse question --under reported
QUESTION: which is not true of elder abuse? Most of the elder abuse is at victims home, mostly
it is by victims relative, elder‟s abuse is often over reported and exaggerated, un-authorized
use of ATM card is some times considered crime but not abuse
QUESTION: using ATM card of elder is not applicable but some suitation is not under consideration-
--both true,both false.1st true 2nd flase
QUESTION: Opening a dental practice – what makes it more successful: Better communication
QUESTION: Finding out wether a pt is listening: Eye contact
QUESTION: Dentist report most problems with-business/financial issues, staff training, fearful
patients
QUESTION: What do general dentists report as being their biggest issue? I put fearful patients
QUESTION: Pt was bothering the dentist, dentist got upset and assistant drop instruments in the
floor, the dentist was so piss that he had it out with the assistant : how you you call that reaction ?
transference
Transference is a phenomenon characterized by unconscious redirection of
feelings from one person to another
QUESTION: Most eye injury in practice happens to who: dentist, dental assistant, hygienist,
custodian
QUESTION: Personnel most at risk for eye injury-dentist
QUESTION: When do you most likely get a puncture wound: Cleaning up
QUESTION: When do most punctures occur? pre procedure, during, post-proceduring cleanup,
needle recapping
QUESTION: Dentist can diagnose which of the following? – Bellumia

QUESTION: if a pt presents with a problem reflexted in the mouth , how the dentist recongnize the
problem : anorexia, bulimia etc…
QUESTION: A patient comes in with rampant decay. What is the primary responsibility of the
dentist? I put figure out etiology of decay FIRST
QUESTION: Patient is in your office for a treatment plan, all of the following should be done when you
explain the proposed treatment to the patient, except? – Use professional terminology. (other choices were
the risk of not getting a procedure done, the fee of the procedure, etc)
QUESTION: New patient comes into office, not of record, what do you do 1st visit?
Full exam, record probing, med history, impressions.
QUESTION: First step before/in treatment planning: make sure patient doesn't need translator, consult
with physician about pre-existing medical conditions
QUESTION: Patient is ready to hear your treatment plan, all of the following are true except? – Guarantee
the success of treatment!
QUESTION: First step in tx planning is?- treat the initial pain and discomfort of the pt. others, see how
you can make a preventitive plan, treat all restorations.
QUESTION: Proper order for treatment planning – emergency care, disease control,
reevaluation, definitive treatment, maintenance care

• Med history of the patient (If the lab test was choose may be that)
• ESR lab results
you how you are the best dentist in the world. What mental condition is she suffering from? – Paranoia.
(the definition of this is baseless or excessive suspicion of the motives of others)
QUESTION: pt comes in saying she’s been to 5 different dentists the last 6 months. A few mins later
she’s telling you how great of a dentist you are and that she’ll refer all of her friends to you. This
example is…schizo, narcissistic, paranoid.
you how you are the best dentist in the world. What mental condition is she suffering from? –
Borderline, Paranoia.
QUESTION: a patient have been visiting several dentist in the past, the first time she see you she
tells you that she likes you and she will refer family and friends to your office, what type of attitude
is she showing ? borderline
QUESTION: Patient has been to multiple other dentists before you and says you are the best what
does her personality resemble: schizoid, borderline, paranoid, etc
QUESTION: Patient with bipolar disease comes in for dental care, choses not to take his medication
and states he is in the “manic phase,” what do you expect from treating this patient?: he will have
unpredictable reactions during the treatment, he is will be obsessed about is esthetics (not sure
if it means he is going to be continuously manic or just general bipolar disorder)
QUESTION: Trying to change person what is most importation : trying to determine whether they
are willing to change
QUESTION: Patient who has medical history but is not debilitating but will require medical
management and dental modifications – ASA 3
QUESTION: ASA2- mild systemic disease, ASA3-severe systemic disease

QUESTION: You have a test that is not accurate but gives consistent result: I said this means test is
reliable
QUESTION: Which of the following are necessary for a test to be accurate: Specificity, reliability,
validity
QUESTION: Something about nonverbal vs verbal communication – →nonverbal is not as reliable
QUESTION: What happened in 1997: SCHIP (state insureane health program)
QUESTION: SCHIP: The State Children's Health Insurance Program provides matching funds to
states for health insurance to families with children. cover uninsured children in families with
incomes that are modest but too high to qualify for Medicaid.
QUESTION: 1997 law passed that state must look after children that cannot afford healthcare - State
Children's Health Insurance Program (SCHIP) AKA Children's Health Insurance Program
(CHIP)
QUESTION: in 1997 there was a program which stated that all childrens needed dental coverage (
even with no insurance ) : how it this call ??? Children’s Health Insurance Program. medicaid
QUESTION: in 1997 there was a program which stated that all children needed dental coverage
(even with no insurance ): Children’s Health Insurance Program. Medicaid
QUESTION: Who is protected under Americans with disabilities act? AIDS pt. and accommodate the
handicapped.
QUESTION: Dentists have to have proper accommodations for disable people. Dentists have to treat
HIV people the same as others. Both statements are true
QUESTION: Disinfecting spray → let it sit for 10 minutes and then wipe
QUESTION: One patient left, and before getting another patient, how would you clean your
operatory?
-Gross cleaning, spray disinfectant for 10min, then wipe off

-disinfect every 10 min
-some other choices.. try to pick one that makes the most sense.
QUESTION: Disinfectants- kills mycobacterium (benchmark organism)

QUESTION: Disinfection? Destroy majority of microorganisms but not bacterial spores. Bacterial spores
= benchmark organism for sterilization
QUESTION: Definition of disinfectants – Innanimate objects
QUESTION: Definition of disinfectants – Innanimate objects non living
QUESTION: Asepsis – antiseptic…can be safely applied to tissues, but will kill most living organisms
QUESTION: Denaturation of the proteins - alcohol and autoclave; Coagulation of proteins - dry
heat
QUESTION: Dry heat, chemical sterilization , know about them. Autoclave, what are the exact
numbers?120 ce, 20 min, 15 Psi
QUESTION: Steam Autoclave: 20 minutes at 121C and 15 psi.

steam
dry heat-320
oxide pressure
QUESTION: Benchmark for sterilization: →=bacillus spores
(I think it is Clostriduim Botulinium) First aid page336)
QUESTION: OSHA
• Hep B vaccinated
• if employee does not want it need prrof that they didn’t get it
shit
QUESTION: OSHA rule on hepatitis B vaccination

QUESTION: OSHA is for inside the office to see how you handle stuff in the office. EPA is for the
outside.s OSHA IS NOT FOR BOTH INSIDE AND OUTSIDE
→ EPA is for transferring IN/OUT of the office
QUESTION: Whats not found on the OSHA poster?- How many days each employee is allowed to work
with that chemicals.
QUESTION: Which one applies to OSHA guideline? – Update it once a year!

QUESTION: What does OSHA mandate in regards to hep b?
• employers must take the vaccine
• *employees have to take vaccine that are in contact with pt (I don’t think so…all
employers are supposed to be offered the vaccine after education of Hep B within 10 days of
employment…Xtina)
• Front office employees must take the vaccine
QUESTION: OSHA does all except: material safety data sheet MSDS (by manufacterur)
QUESTION: Hazard Communication Standard: Created by OSHA to make sure employees know
about hazardous/toxic materials
a)OSHA
b) what does it control:
sharps
blood
amalgam
QUESTION: OSHA→ Bloodborne pathogen standard for dentistry→ HIV and HBV
QUESTION: OSHA-HIV, HBV; bloodborne pathogen standard
QUESTION: MSDS → manufacture directions
QUESTION: MSDS-responsible to make it-manufacture
QUESTION: Which is NOT a reason for dentist becoming addicted:

Reasons: easy access to and knowledge of drugs, feel the pressure to be perfect, feeling vulnerable
QUESTION: dentist and drug abuse. all are true except: high stress, perfectionist personality,
vulnerability, knowledge and access to drugs
QUESTION: which of the following is not a reason dentists become drug addicts? Stress level, strive for
perfection, access and knowledge of drugs, (some other off the wall answer)
a. Vulnerability
d. Stress
•What is t test? –used to compare whether the means of two groups are statistically different—assume
that standard deviation is unknown. Small sample size
•Z test—to see if the means of two groups are statistically different if the variances like standard deviation
are known. Large sample size.
•Know questions about Case control—RETROSPECT study. Study that compares people that have the
disease to people that do not have the disease. And also looks back to see how the risk for the disease is
compared to actually getting that disease.
Case-control (retrospective) studies - start with disease and look backwards for exposure
•Cohort study—study where there is more than one sample/cohort, and evaluations are done to see how
certain risk factors the groups have are related to developing a certain disease.
Cohort (prospective) studies - look forward from exposure to disease development
•Cross sectional study—study the entire population. Not like case control, that only studies a certain
group with a specific characteristic. Studies a population with certain characteristics.
Cross-sectional (epidemiological) studies - all variables measures simultaneously at one point in time
Example – It was observed that there was less caries in certain geographic areas. Higher fluoride
in water supplies was suspected as the probable cause
•Longitudinal study—studies a certain set of people (same people) over a long period of time.
Longitudinal Studies - Hypothesis Testing Observational Studies
Example – Hypothesis testing observational studies supported the explanation of increased
fluoride levels causing a reduced rate of caries
Clinical Trial - Use randomization and blinding to compare effects of treatment with non-treatment. This
is the Gold Standard for establishing cause and effect
Descriptive studies - time, place, person
• Correlation studies - measure linear relationship between two factors within
defined groups, no cause and effect established
Clinical trials: Trials to evaluate the effectiveness and safety of medications or medical devices by
monitoring their effects on large groups of people.
Clinical research trials may be conducted by government health agencies such as NIH, researchers
affiliated with a hospital or university medical program, independent researchers, or private industry.
Typically, government agencies approve or disapprove new treatments based on clinical trial results.
While important and highly effective in preventing obviously harmful treatments from coming to market,
clinical research trials are not always perfect in discovering all side effects, particularly effects associated
with long-term use and interactions between experimental drugs and other medications.
There are four possible outcomes from a clinical trial:
•Positive trial -- The clinical trial shows that the new treatment has a large beneficial
effect and is superior to standard treatment.
Non-inferior trial -- The clinical trial shows that that th
what is progressive relaxation

a. intermittent relax & tense (T/F)
b. something about visualized images or something… (T/F)
QUESTION: where would you look in an article for the Dependent and Independent Variables :
Methods.
QUESTION: If a dentist is reading an article, where should he look for the definition of dependent and
independent variables? method -introduction- discussion- results summary
QUESTION: Where would you look in a scientific journal to find the dependent and independent
variables
• Intro
• Materials
• Methods **
• Conclusion
• Summary
QUESTION: Introduction-where in article you find a summary (ABSTRACT)
QUESTION: double blind q, except - you need 2 controls (you don't)
QUESTION: double blind q, except - you need two controls (you don't)
QUESTION: What are the qualities of a double blind study except? I put everything EXCEPT 2
control groups.
QUESTION: Researcher wants to find incidence of oral cancer in nursing home what study
a. Cross-sectional
QUESTION: Research done to determine caries rate at a nursing home. What kind of study is this?
A: Cross-sectional
QUESTION: which type of study determines relative risk ratio: Cohort
QUESTION: Case control study = odds ratio
QUESTION: Efficacy, what study would u go? Cohort, longitudinal, multiple short ones, CASE
CONTROL
QUESTION: Study among smokers and nonsmokers in a period of 6 years (2000-2006) to develop
disease? Cohort, cross sectional
By: disease/non-disease: case control
QUESTION: study how do you find causation- analytical (cross-sectional, case-control, cohort)
QUESTION: Myestena Gravis patients are involved in a study. The doctor is conducting a study and
is trying to find out how many of these patients has periodontitis. What study is he conducting?
-Cohort
-Study case
-Cross sectional?
QUESTION: Doctor conducting a study on myasthenia gravis patients wants to know how many of
these patients have periodontitis. This is a study case, maybe cross sectional
QUESTION: The problem with this study is that you don’t know if the disease came from drinking or
not. What study is it?
Followed a group for 6 years → cohort
Gave patients survey about their treatment → cross sectional
QUESTION: Dentist is doing research on 5 unrelated patient with different background. He record data
……etc. Dentist is doing what kind of research?
a. clinical trial
b. cohort
c. sectional
QUESTION: Study group A and B give some agents for plaque control then compare which agent is
more effective. Which study is that? Clinical trial
QUESTION: A study is done to determine the affectiveness of a new antihistamine .To do this ,25
allergic pt‟s are assigned to one of the two groups ,the new drug (13 pt‟s) , placebo (12 pt‟s) . The
pt‟s are followed for 6 months . This study is called: Cohort, Cross-sectional, Case controlled,
historical cohort, clinical trial. ( assigned or give is the clue )
QUESTION: A study is designed to determine the relationship between emotional stress and ulcers.
To do this, the researchers used hospital records of pt's diagnosed with peptic ulcer disease and pt.
diagnosed with other disorders over the period of time from july 1988 to july 1998 . The amount of
emotional stress each pt. is exposed to was determined from these records. This study is:
A) Cohort B)Cross-sectional C)Case-study* D)Historical Cohort E)Clinical Trial
QUESTION: There are 4 people with a disease and guy wants to report/describe them: I said ti was
case report but idk

QUESTION: Means of caries risk assessment for 3 groups: white, black, Hispanic what test do u use to
compare? t-test A) chi square b) variance c)
QUESTION: How do you compare between 2 constant variables? I put regression analysis
QUESTION: How do you compare between 2 constant variables? CHI SQUARE regression analysis
QUESTION: 2 groups of 100 ppl, gave them different foods & asked how they felt afterwards; which
test to compare the 2 groups answers → chi squared test
QUESTION: Want to compare 2 groups of people, male and female for something, what test do you
look at? Multiple regression, Chi square Test, T -t est
QUESTION: Chi test, two common variables

QUESTION: What test measures 2 nonparametric data: Chi-square
QUESTION: Which of these tests are non-parametric? Chi square test
QUESTION: calculating for a non-paramater….what test would you use? Chi-square, normal
distrubition, spearman, wilcoxin, kruskal wallis
QUESTION: Chi test (tests correlation b/w two independent variables)
QUESTION: Two common VARIABLE..what statistical test would you use? Chi-test, T-test,
correlation analysis, or standard deviance
QUESTION: what test for variability variance, standard deviation
QUESTION: Given a case – what is the dependent variable? independent variable influences a
dependent variable, or variables. Ie: effect of Temperature on plant growth, temp = independent
and growth; height, weight, # of fruits = dependent
QUESTION: confounding variants? A confounding variable, also known as a third variable or a

mediator variable, can adversely affect the relation between the independent variable and
dependent variable. This may cause the researcher to analyze the results incorrectly. The results
may show a false correlation between the dependent and independent variables, leading to an
incorrect rejectionof the null hypothesis.
QUESTION: If you have a study of confounding variable? Controlled variables are used to reduce
the possibility of any other factor influencing changes in the dependent variable, known
as confounding variables.
QUESTION: If you have a study of confounding variable – minimize confounding variables by
randomizing. minimize confounding variables by randomizing groups, utilizing strict controls, and
sound operationalization practice all contribute to eliminating potential third variables.
QUESTION: Crossover study advantages? influence of confounding covariates is reduced

because each crossover patient serves as his or her own control and are statistically efficient and
so require fewer subjects than do non-crossover designs (even other repeated measures designs).
The null hypothesis (H0) is a hypothesis which the researcher tries to disprove, reject or nullify.
The 'null' often refers to the common view of something, while the alternative hypothesis is what
the researcher really thinks is the cause of a phenomenon.
QUESTION: Experiment wa done and error 0.05 was the goal but when completed it was 0.01. The
question asks what type of error was it?
-type I
-TYPE 2
-no error: Error of less or equal of 0.5 no statistical significance..
*If the observed probability is less than or equal to .05 (5%) the null hypothesis is rejected and
outcome is judged as “no effect”.in this case the alternative hypothesis is adopted
*If the observed probability is greated than 5% the decision is to accept the null hypothesis and the
results are called “not statistically significant.
QUESTION: P-significant value is equal to 0.01, your theory should be right, so you you will reject
null hypothesis
QUESTION: Type I – false rejection of null hypothesis (false negative/incorrect regection) = less
dangerous in terms of research and Type II – false acceptance of null hypothesis (false
positive/failure to regect) – less problematic bc no conclusion is made from a rejected null. But type
2 is more dangerous medically bc a patient is diagnosised as HEALTHY when they actually have the
HIV.
QUESTION: fail to reject, what null? TYPE II error

QUESTION: The power of a statistical analysis is ultimately to:
a. I put reject the null
Type I and Type II Null hypothesis.
Type I Error- rejecting the null hypothesis when it is true. This is an alpha error. Another way to say
this is, to reject a null that should be accepted.
Type II Error- accepting a false null hypothesis. This is a beta error. Another way to say this is, to
accept a null that should be rejected.

Sensitivity –correctly identifying those ppl who have dx
Specificity –correctly identifying dx free people
specificity, tn/tn+fp
Sensitivity – tp/tp+fn
FN= false negative
FP= false positive
TP=sensitive
TN=Specific
→sensitivity = percent of persons with the disease who are correctly classified as having the
disease
True Positive-Those that actually have it
False negative- Those that are misdiagnosed as not having it
→specificity = percent of persons without the disease who are correctly classified as not having
it
a. true negative, false positive
True Negative-Those who are ACTUALLY disease free
False positive- Those that are misdiagnosed as not as being disease free
QUESTION: dentist in his clinic notice new diseases this is ? incidence
Prevalence – all cases
QUESTION: What is the statistical measure for the total number of cases per population,
regardless of time of onset? I put prevalence
QUESTION: For a population, the research divides the number of disease cases by the number of people.
By so doing, this investigator will have calculated which of the following rates?
a. incidence
b. odds ratio
c. prevalence
d. specificity
QUESTION: Specificity? Proportion of truly nondiseased persons who are so identified by a screening test
(measures “how good a test is at correctly identifying nondiseased persons). Sensitivity tests identifying
diseased persons.
QUESTION: If a dentist was able to correctly ID disease free patients w/ the diagnostic study, it
has? I put high specificity.
QUESTION: investigator finds patients that don’t have a disease: specificity

QUESTION: You were looking for a disease in a study, disease was not present, what’s this called? –
Specificity!
QUESTION: “if test determines those who do not have the disease is…specificity, sensitivity,
validity.

QUESTION: Study says 95 out of 100 people had the disease what is lab value: I said 95%
sensitivity
QUESTION: sensitivity= sick people

QUESTION: Specificity (without disease) and sensitivity (with disease)
QUESTION: A study failed to report 5 cases of caries. What is this called? 1. True Positive, 2. True
Negative, 3. False Positive, 4. False Negative 
QUESTION: Biggest difference across cultures regarding pain… Variability in pain threshold rather
than pain tolerance, variability in pain tolerance rather than pain threshold, difference in stimulus
awareness rather than pain tolerance, difference in stimulus awareness rather than pain threshold
QUESTION: few questions about mean (average), median (middle number), mode (number that
shows up the most):
QUESTION: Which does not describe the spread of data? I put median.
QUESTION: Which does not describe the spread of data? median. Range. Variance, stand deviation,
standard error

QUESTION: Which of the following represents the variability about the mean-value of a group of
observations?
A. Sensitivity
C. t-Statistic
D. Specificity
QUESTION: What most common form of standard deviation? 1. 2 stand deviations (answer)
variance
QUESTION: Histogram → variance
variance
QUESTION: Outliers control…

a. mean
b. median
c. mode
QUESTION: An outlier has the biggest effect on which of the following?
a. Standard deviation **
QUESTION: Scale of 1, 2, 3, - is it ordinal, nominal, interval, rational. Answer is ordinal.

Nomial- categories. Just naming items.
Interval- is not constant. A constant interval but lacks true zero point.
Ratio- units of time, distance, weight.
QUESTION: BP and pulse Kelvin – ratio
QUESTION: BP, pulse- ratio; same as Kelvin

QUESTION: pulse n bp what kind of measurement - nominal, ordinal, interval, ratio 
➢ Categorical (nominal) is like black hair, blonde hair

➢ ORDINAL is like Low, medium, high…or highschool, college, graduate school
➢ Interval is like ordinal but the values are EQUALLY SPACED – 10,000, 15,000, 20,000
➢ Cardinal tells how many: 8 puppies, 14 friends
➢ Ordinal shows ranking – 3rd fastest, s
➢ Nominal names something. Jersey number 4.
1. Which is least complicating for OH? Fixed bridge, rheumatoid arthritis, open contact?
2. Mask metal, reduce porosity, make coefficients of expansion more similar
3. Growth in buccal vestibule by flange of mandibular RPD? Most likely traumatic neuroma,
neurilemma, or neurofibroma? -_-
4. Older woman tooth extract 3 years ago, still hurts and exudate, shows cotton-wool
radiograph what is it? Residual cyst, osteomyelitis, 2 other lesions that are radiolucent
5. Macroglossia seen in all EXCEPT?
6. All of the following are an indication for putting a temporary on a deep caries and restoring
at a later time except? Lack of time due to it being an emergency appt, weakened dentin
under cusps, to assess pulp condition
7. Edema (by eye) due to? Chemotaxis, hemorrhage, chymosis

8. Pt has pain lower right 3rd molar and can’t take intraoral xray, what kind of xray indicated?
Lateral oblique mandibular, reverse town’s, lateral ceph, anterioposterior
9. You have pano, what can’t you do without intraoral photos? I said space analysis…
10. Force put on crown, where is center of translation or rotation? Halfway down root, CEJ, past
apex
o Center of resistance – half the distance from alveolar crest to root apex (translation)
o Center of rotation: Apical to center of resistance (apical to halfway down root) –
during translation movements and tipping movements
o During rotation movements: center of rotation=center of resistance
o 1st: rotation, 2nd: tipping, 3rd: torque
Anti-retraction valves for what? I put prevent patient to patient cross-contamination
11. Best to use on infected oral wound? I put hydrogen peroxide, chlorhexidine
12. Initiation of first menstruation cycle is best indicative of what? Cognitive age, dental age,
skeletal age …
13. Menarche onset: before growth, during peak of growth, after peak of growth?
14. menarche begins at what point in growth spurt? Before, during, after, when completed.
15. Menarche definition:• At peak of puberty (AFTER PEAK GROWTH)
Neuropraxia definition:
• Neurapraxia describes nerve damage in which there is no disruption of the nerve or its sheath. In this
case there is an interruption in conduction of the impulse down the nerve fiber, and recovery takes place without
true regeneration, as Wallerian degeneration does not occur. This is the mildest form of nerve injury.
Axon damage most likely to cure on itself – neuropraxia …
Definition of Neuropraxia - interruption of axon, but not nerve all together (reversible nerve damage)
…neuropraxia is reversible
Neuropraxia: involves both perineurium and epineurium, only perineurium, only epineurium, none
of the above
a. None of the above? (temporary damage, nerve left intact) – asked in a strange way
Neuropraxia: It is a transient episode of motor paralysis with little or no sensory or autonomic

dysfunction
o Neurapraxia describes nerve damage in which there is no disruption of the nerve or its sheath
16. Tiny line noticed in an isthmus between an MO and DO amalgam. It is not a separation
between two different restorations. What tx? Re-do or leave and monitor
17. Which is more damaging to the PDL? Extrusion or intrusion, lateral luxation
18. Crazy question about a dentist putting an elastic around patient’s maxillary centrals to close
diastema.. I forgot options but I put: eventual loss of teeth? Due to the elastic traveling
upwards. No clue.
19. No obvious clinical caries in a child. Radiographically, interproximal caries on primary tooth
20. Extract a tooth and give Penicillin, the next day patient has high fever, swelling, dysphagia,
what do you do? Change to different antibiotic, refer to OMFS, add another drug to regimen
21. Which muscle mainly responsible for positioning and translating condyles? Lateral
pterygoids
22. Cracked tooth with no pulpal involvement, what is the treatment? Endo, extracoronal
restoration, occlusion reduction, amalgam with adhesive
23. When you smile what is the black space buccal of teeth and next to cheeks? Buccal corridor or
something?
27. Picture of ulcerated tumor on palate? SSC, salivary gland tumor, tori
28. advantage of rectangular orthodontic wires
What is Trephination? Hole is drilled or scraped into the human skull
Dentinogenesis Imperfecta
Lymphoid epithelial cyst – odontogenic origin
Cemetoblastoma – RO mass that replaces root; tooth is removed with lesion
Periapical Cemento-Osseous dysplasia – vital, lower anteriors, middle age women, RL then RO; no
symptoms
􏲁 Florid Osseous dysplasia involves entire jaw
Migratory glossitis
Nicotinic Stomatitis
Dentinogenesis imperfecta
Ameloblastoma
reverse polarization (follicular type), nucleous moves away
Calcifying Epithelial Odontogenic Tumor (pindburg tumor):
calcified intracellularbridge
Odontoma (complex)
Complex odontoma
zygomatic process of maxilla on PA

U, V, J radiopaque line
superior to maxillary first and second molars
Drug induced hyperplasia (cyclosporine)
Drug induced
Bells palsy
epilus fissuratum
Erythema multiforme
Vertical root fracture –J shaped radiolucency

NBDE PART2 RQs 10-11 may (RINA KELKAR)
1- sealants most beneficial on wch teeth? ANS-

mandibular premolars
2- wch represents initial consideration in the
treatment planning process?
a) Medical/systemic evaluation
b) B- Periodontal evaluation
c) C- Radiographic evaluation
d) D- Elimination of pain and discomfort had this questiom
Ans-A
3- RQ: What ASA classification: someone who has DM,

hepatitis C, hypertension, renal transplant 2 years ago.
A,ASA 3
B.ASA 4
C.ASA 5
D,ASA 6
4: To extract 4 upper anterior teeth you need to do

infiltration and greater palatine and block for
1- incisive
2-anterior palatine
3-superior anterior alveolar
4- greater palatine
5- A Patient who has been wearing a maxillary denture
for 15 years notices multiple, reddened, nodular lesions
on his palate. The lesions are soft and painless.
The most likely diagnosis is
A- Torus palatinus
6- When establishing a balanced occlusion, lingual cusp

of ,maxillary posterior teeth on the balancing side
should contact
a) Central fossa of mandibular posterior teeth
b) Facial inclines of the lingual cusp of mandibular
posterior teeth
c) Li inclines of the facial cusp of mandibular post teeth
d) Li incline of li cusp of mand post teeth
**** I marked C for this one please someone confirm
7- not true about MWF??

a)reverse bevel
b)sub marginal incision
c)replaced flap
DONT KNOW TH ANSWER
8- Position of mand foramen relative to occlusal plane

in kids?----i don't know what i marked...but i had read it
day before my exam fromDD----
9- drug for petit mal?

ans- ethosuximide
10- max 2nd molar less keratinized tissue, which graft

you will give?
i think i chose apically displaced for this one coz options
were modified widman, free connective tissue graft,
apically displaced and last one was i don't remember
11- i was given clinical features of CROHN DISEASE,

HYPERPARATHYROIDISM, TREACHER COLLINS
SYNDROME AND WAS ASKED to identify the disease
12- pt. has asthma and currently has cardiac disease

what drug will u give?
ans- theophylline
13- Epi works in which receptors?

A1
A2
B1
B2
DONT HAVE THE ANSWER
14- Recovering from alchoholism, which analgesic to be

given except-
ibuprofen,
Percocet,
vocodin,
tylenol3
i didn't have this straight forward question----it gave me
hydrocodone+ codeine option A, then
acetaminophen+codiene option B and so on...so it was
not that straight forward...
15- 22 yr old girl with fever , malaise,

lymphadenopathy, multiple ulcers on tongue, palate
with swollen gingiva-?
A)anug,
b)acute herpetic gingivostomatitis,
c)marginal gingivitis,
d)herpangina
16- Tooth with 2 pulp chambers?

A. Fusion
B. Germination
ans- fusion
17- Aspirin does not increase what?-

a)bleeding time,
b)prothrombin time,
c)acidosis,
d)renal prostaglandins
ans-D
18- Pat had mand incisors only. Needs upper denture

with lower rpd. What type of occlusion willprefered?
1. Balances in centric
2.balanced on working
3. Group function
4.canine protect
i chose 3—
19- How to differentiate incipient white on smooth

surface with remineralized caries?
Transilumination
Enamel illumination
Using explorer on surface
Better lighting and air drying
ans-D
20- Signs and symptoms of alveolar osteitis include all

of the following except:
a. pain commencing 2 - 5 days following the extraction
b. accompanied by a foul taste or smell
c. self limiting condition that will improve and resolve
with time
d. treat with antibiotics and pain medications
21- What do we write the consult for?

1.to gain certain inform
2. To gain clearance
3. To have better relationship with pt (picked 1 coz i
had asked my husband who is a doctor he said we do
consult to get information)
22- What is the best indicator of periodontal stability

over time for the patient on periodontal maintenance
therapy?
A- Plaque control
C- Probing depths
23- Which of the following would be the first step to

perform during a reevaluation appointment?
24- In removing a torus palatinus, the practioner

inadvertently removed the midportion of the palatine
process of the maxilla. One would expect to see:
A. The nasolacrimal duct
B. The inferior nasal concha
C. An opening into the nasal cavity
D. An opening into the maxillary sinus
25- What pathogenic microbiota is most likely

associated with a failing implant?
D- Gram-positive anaerobic rods (don’t know wat I
picked)
26- Which of the following is used primarily as filter
material in a dental X-ray machine?
A- Oil
B- Lead
C- Aluminum
D- Tungsten
E- Molybdenum
27- Which of the following is NOT true regarding

orthodontic tooth movement?
A- Blood flow within the PDL is altered after force
application
C- Chemical changes in the compressed PDL stimulate
cellular differentiation
D- Oxygen tension is increased in some areas of the PDL
and decreased in other areas
*** I chose D, DON’T know wats the right answer
28- Which of the following is NOT a clinical

presentation of oral Candidiasis?
D- Ulcerative patch
29- In arranging the patient’s maxillary anterior teeth,

the dentist should create a pleasant, natural-looking
smile line. This can be done by contouring the incisal
edge to follow the
**don’t know wats the answer
30- Dental waterline should be flushed at the beginning

of the day
30 sec
45 sec
60 sec i chose 30 sec
31- most common benign odontogenic

tumor....something like this its given in mango- answer
is ODONTOMA
32- Which material has the highest coefficient of

thermal expansion?
Gold
Amalgam
Filled Resin
Unfilled resin
****I chose unfilled resin I don’t know wats the right
answer
33- treatment of leukoplakia- I DONT REMEMBER THE

ANSWER
34- toxic and lethal dose of flouride...learn it
35- bur used to polish porcelain- DIAMOND
36- how to measure pocket depth?? They give u options

from where to where
37- Opiates do NOT produce which of the following

effects?
A- Diuresis
B- Euphoria
C- Mental clouding
38- The dentist places a MOD amalgam restoration on

tooth 30. The patient bites down immediately after
carving, and the marginal ridge fractures easily. Which
amalgam properties contributed to this failure?
A- Creep
B- Resilience
C- Edge strength
D- Setting time
39- T/t of gingivostomatitis and herpetic stomatitis
40- difficult to put matrix on wch tooth? max 1st PM

41- painkiller safe in pregnant women- acetaminohen
or tylenol 3
42- How do we determine arch length for primary?

Ans- Primary: Distal of 2nd Molar to distal of 2nd molar
43- most rapid loss in anteroposterior distance in an

arch is due to mesial tipping and rotation of which
tooth?
a: permanent 1st moar
b:permanent 2nd molar
c: 1st premolar
d: 2nd premolar
e: permanent canines
44- :In which of the following situations can topical

corticosteroids be used?
A. Angular cheilitis.
B. Candidiasis.
C. Herpes labialis.
D. Erosive lichen planus.
E. Necrotizing ulcerative gingivitis
45- What can't you change?

Hue, Chroma, or Value-
ANS-hue
46- delayed expansion from amalgam causes

a. aesthetic
b. shiny
c. decrease streghth
d. increase strength
47- dental matrix made of plaque made up of dextran
+_______ ? ans- LEVANS
48- when should the consent be done ? ANS-after

discussing the treatment planning and before the
procedure
49- space infection of mandibular PM 1 where to ?

SUBLINGUAL
50- MAX 3rd molar space infection where to ?

infratemporal
51- IAN block which space given ?—

PTERYGOMANDIBULAR
52- mandibular 3rd molars roots disappear into wch

space? SUBMANDIBULAR
53- 40 year old , 32 unrestored teeth only has deep

stained grooves on posterior teeth and grooves are
uncoalesced
a. PRR
b. observe
c. topical fl
d. pit and fissure sealants
54- aphthous stomatitis is associated with what ?
a. herpes
b. cmv
c. EBV
d. tomato allergy
e. human leukocyte count
55 : What lesions are not radiopaque?

AOT
Ameloblastic fibro odontoma
ameloblastic fibromA
PLEASE LOOK THIS ONE IN MANGO
56- why do you do triangular access on incisors (max

central incisor?)
57- What property of rpd framework will limit

adjustments of clasps?
a. Yield strength?
b. Ductility
c. Stiffness
d. Modulus of elasticity
58- Where are the majority of supernumerary teeth

located?
Posterior maxilla
Posterior mandible
Anterior mandible
Anterior maxilla
None of the above
59- warfarin wch test- PT
60- Alcoholic wch test- INR
61- symptoms of thyrotoxic crisis?

bradychardia
tachychardia
hypotension
62- network model- HMO
63- flouride in community what kind of prevention?

ans- PRIMARY
64- transillumination for what- i picked CRAZE line
65- caries are triangular at the DEJ what type of caries

are they? ans- chronic
66- Anterior teeth class 4 big composite done few

weeks ago. The filling is acceptable but
too light. What to do?
Re do
Observe
67- Bisphosphonates contraindicated in osteomyelitis
and multiple myeloma? T/F-----true
68- to motivate patient for proper OH u do al EXCEPT:

ANS- CARROT STICK
69- wch flouride best for handicapped kid? i picked NaF
70- Acc to WHO classification, avulsion in classified as

Dental hard tissue
Luxation
Soft tissue ***I chose luxation don’t know the answer
71- most abundant in gingival sulcus? ans- MAST CELL
72- most abundant in gingival sulcus? ans- IgG **** I

had both the versions….
73- The penetrating quality of x-ray beams is

influenced by which of the following?
A kilo voltage
B.Milliamperage
C.Exposure time
D.Focal- film distance
E Filament temperature
74- Each of the following is known to contribute to

orofacial clefting EXCEPT one.Which one is the
Exception?
A.Valium
B.Poor diet
C Acetaminophen
D Vitamin deficiency or excess
75- steps involved in placing veneer? Ans- microetch,
etch, silane, bonding
76- partner dentist and hygienist hurts patient, who

will be involved in law suit??
77- bilateral enlargement of the parotid glands

characterizes each of the following conditions EXCEPT
one. which one is the EXCEPTION:
a. malnutrition
b. sialolithiasis
c. Sjogren syndrome
d. benign lymphoepithelial lesion
e. acute epidemic parotitis
78- Tooth extraction, 3 days later starts to hemorrhage

what is the cause? Fibrinolysis t/f...I CHOSE ITS
true...100% dry socket starts happening after 3 days of
extraction sourced
79- :Pain associated with of the following mimic tooth

ache
1. Herpes
2.shingles
3. Maxillary sinusitis
ANS-herpers zoster
80- Which treatment has least successful long term
prognosis on deep caries on tooth #3
A DPC
B IPC
C pulpotomy
D RCT I CHOSE-DPC....check this one too
81- If implant with width of 4 mm is used ,what should

be the buccolingual width of the ridge?
A. 6 mm
B.8 mm
C. 4 mm
D. 10 mm ANS-A
82- Both cleft lip and cleft palate needs to be corrected

on baby---like how many months of weeks later after
birth
83- which stage of syphyllis most infectious? ans-

SECONDARY
84- which mandible fracture site is most common? ans-

condyle
85- drug for epinephrine reversal? ans-phentolamine

mesylate
86- drug for benzodiazepine reversal- FLUMAZENIL
87- radiographic feature of sickle cell anemia?

Ans- STEP LADDER TRABECULATIONS
88- while anterior teeth arrangement where should the

incisors touch---something like that----vermilion border
of lower lip
89- maximum dosage of acetaminophen in a day- ans-

4mg…(I chose 3mg..my bad)
90- most common medication accepted

SUBGINGIVALLY?
ANS- 2% doxycycline
91- slow set and fast set alginate what is the difference
in their compositions?
92- Most commonly used TCA drugs- ans

AMYTRIPTYLLINE AND _____ DON’T remember the
other one
93- perio t/T most unsuccessful in wch teeth?

Ans- maxillary molars
94- flossing difficult wch tooth- I chose maxillary molars

(due to trifurcations)??
95- calculation of the number of bifurcations and

trifurcations when 3rd molars are absent?? This one is
given in mango----14 or 16 I don’t remember NOW but
chose the one given in mango for the exam
96- posterior tooth has large carious lesion extending
subgingivally which of the following is the best initial
treatment?/
a) endo therapy
b) crown lengthening
c) caries excavation
d) crown fabrication
97- prostaglandins blocked which of the following

functions will not be performed
a) inflammatory
b) antipyretic
c) antiplatelets…something like these were the
options
****I chose antipyretic
98- activity worked on to work as ANTIPLATELETS??

Ans- block thromboxane A2
99- wear on mesio marginal ridge of MB of mand molar?

A) working interference
B) NW interference
C) Protrusive interference
D) Centric interference
*** I chose A
100- in wch teeth malocclusion teeth gets injured

most?
Ans- classII divI
101- Wch test to see if patient is maintaing his blood
sugar for past 2 years… something like that??
a) fasting plasma glucose
b) oral glucose tolerance
c) random plasma glucose
d) I don’t know this option
102-
soft tissue outline of

nose
103- perineural invasion seen in wch condition??

*** I chose warthins tumor, don’t know the options but I
think SCC was one of the options
104- flexure of the teeth seen in?? ABFRACTION?
105- my first question on screen- patient is taking IV

biphosphnate from 2 years has non restorable carious
tooth what should be the t/T?
ANS- endo of teeth
106- component of ADA accepted dentrifice?

Ans- KNO4
107- do D1-D2 endo file calculation- I had 1 question----
108- most commonly ectopic tooth?

Max 1st molar
109- congenitally missing primary tooth? Ans-

maxillary lateral incisor
110- “w” in the rubber dam clasp means what??

WINGLESS
111- narrowest zone of attached gingiva?

Mand premolar
112- radiation caries most common site- ? CERVICAL
113- Rheumatoid arthritis

A. Autoimmune
B. Auto dominant
C. Auto recessive
D. Other **** I picked auto dominant
114- Don't put instrument whith in steam sterilization

A. Plastic bag
B. Plastic & paper
C. Cloth
D. Heavy metal ** don’t know if its right
115- Sharp instrument NOT require

A. Upper lower lid
B. There should be Symbol of Hazards
C. Metal container
D. Plastic container with lid
116- 2ry hyperparathyroidism caused by : Renal failure
117- Two factors that will decide the placement of the

posterior composite Tech and pt selection
118- Acute Herpetic gingivostomatitis is common in 4

month
2 yrs
6 yrs
8 yrs
119-
2015/2014 RQ – blue
2016 RQ – green (Highlighted - V)

ENDODONTIC DIAGNOSIS
KNOW THIS!

QUESTION: Which teeth do you perform pulp evaluation on?
a. tooth only
b. tooth and neighboring tooth

QUESTION: When testing tooth for cold: test adjacent teeth, opposing teeth & contralateral teeth.
QUESTION: If an apical radiolucency is present for a long time with no symptoms and no sinus tract associated with necrotic pulp,
asymptomatic apical periodontitis, Asymp chronic periodontitis

QUESTION: You have a tooth, no pulp, but periapical radiolucency, you do access and find no canal, what do you do? - I said don’t try to be a
hero, refer to an endodontist

QUESTION: A molar is super-erupted, but has irreversible pulpitis, what do you do? – RCT & Crown (other choices were EXT, just do crown –
this was tricky because to answer the question, you have to look at the patient dental chart and findings)

QUESTION: Case: Patient with tooth that has sensitivity that lingers with thermal test, sinus tract, and positive to percussion, what does the
patient have? Irreversible pulpitis with acute periapical abscess (other choices were Irreversible pulpitis with no acute periapical abscess, and
2 other choices with reversible pulpitis in them).

QUESTION: Prolonged, unstimulated night pain suggests which of the following conditions of the pulp?
A. Pulp necrosis
B. Mild hyperemia Pulpal hyperemia = same as reversible pulpitis

QUESTION: Pulpal pain that only occur at night with no stimulation: pulpal necrosis


ENDO TESTS
Percussion- presence of inflammation in PDL or not
Palpation- spread of inflammation to periodontium from PDL or not
EPT- Pulp vitality, responsiveness (necrosis or not)
Thermal test (hot & cold)- pulp vitality. Hot (irrev), cold (rev)

- With irreversible pulpitis, the teeth that are most difficult to anesthetize are the mandibular molars, followed by the mandibular
premolars, the maxillary molars and premolars, and the mandibular anterior teeth. The fewest problems are in the maxillary anterior
teeth.
QUESTION: When heat is applied to the tooth, lingering pain for several minutes indicates: irreversible pulpitis

QUESTION: What is diagnosis for lingering pain to cold and sensitivity to percussion? Irreversible pulpitis & acute periapical abscess
- Usually periodontal abscess is sensitive to percussion, irreversible is usually positive to percussion

QUESTION: A tooth is not responsive to cold, not to percussion, and palpation is tender: necrotic pulp and chronic apical periodontitis. –
irreversible pulpitis and normal apex, there was not an item saying necrotic pulp and normal apex)

QUESTION: What is test to diagnose chronic periradicular periodontitis? Percussion

QUESTION: EPT test for pulpal: responsiveness (not health)
- EPT tests whether the tooth is responsive or nonresponsive that’s it (not pulpal necrosis or how vital the tooth is, etc.): Nerve
- Doesn’t tell you about vascularity of the pulp (pulpal diagnosis)

QUESTION: How does a tooth covered with crown react to pulp testing? Cold is a better test (thermal)
QUESTION: How do you differentiate between an endo/perio lesion? EPT Need to do pulp vitality tests and perio probing

QUESTION: Differential diagnosis of periodontal abcess & periradiculal abscess? Vitality

QUESTION: Best way to diagnose irreversible pulpitis? Cold/ thermal test


QUESTION: Tooth did not respond to thermal & EPT but response to palpation and percussion? Necrotic pulp

QUESTION: Most reliable way to test vitality of a tooth? Thermal test
- Mosby’s states that thermal tests must be done before a final diagnosis, because EPT can have may false readings

QUESTION: Which of the following is the least important factor in referring an endo case to specialist?
Dilacerations
Calcifications
Inability to obtain adequate anesthesia
Mesial inclination of a molar

QUESTION: Chronic endodontic lesion has what type of bacteria? Anaerobes

QUESTION: How do you test a tooth to differentiate between chronic perio and supperative perio?
a. Cold test
b. Percussion
c. EPT

ENDO/PERIO ABSCESSES & LESIONS

ENDO – PERIO LESIONS
st
Evaluate tooth: If tx is warranted, initiate endo therapy 1 . Perio treatment may be combined with periapical surgery, if needed. Prognosis is
poorest with perio lesions.
- If Endo lesion is draining through periodontal ligament space, complete RCT & wait several months to evaluate healing of periodontal
lesion.
o Endo-perio: Pulpal necrosis leading to a perio problem as pus drains from PDL.
- If Perio Lesion has spread to the periapical region, evaluate vitality of the pulp, institute periodontal treatment alone if vital (treatment
may devitalize pulp).
o Perio-endo: infection from pocket spreads to pulp causing pulpal necrosis.

QUESTION: What is initial treatment of a combination perio and endo lesion? Perform endo with RCT first, then perio Sc/RP
QUESTION: Periapical abscess, what do you do? DO NOT DO RCT FIRST, YOU ARE SUPPOSE TO INCISE AND DRAIN (incise & drain lesion first)
PRESCRIBE ANTIOBIOTCS AND WAIT TO DO RCT AT A LATER DATE
- Use gutta percha to find it
- Most important thing for acute apical abscess is drainage & cleaning the canal
QUESTION: Acute perio abscesses that require drainage are usual firm, localized lesion, fluctuant, local lesion; generalized firm lesion)

QUESTION: Difference between perio and endo periapical lesions, which one has the best prognosis? Perio started from endo or endo started
from perio?
QUESTION: Test performed to differentiate endo vs. perio lesions: Percussion

- Perio lesion are sensitive to lateral percussion.

QUESTION: Indications of perio lesion vs endo lesion: apical radiolucency and pain upon lateral pain pressure (not apical)

QUESTION: Which of following is not endodontic in origin: tooth with wide sulcular pocket not extending to apex

QUESTION: Which of the following conditions indicates that a periodontal, rather than an endodontic problem, exists?

QUESTION: Endo abscess w/ no sinus tract can pus drain through the PDL: True
- Do RCT and leave the sinus tract alone, will heal

QUESTION: What treatment is required with a tooth that has a draining sinus tract has been treated via RCT? No further treatment

QUESTION: Lateral periodontal abscess is best differentiated from the acute apical abscess by?
a. pulp testing (vitality tests)
b. radiographic appearance
c. probing patterns
d. percussion
e. palpation

QUESTION: Best way to diagnose acute periradicular periodontitis? – sensitive to percussion, cold

QUESTION: Radiographically, the acute apical abscess
b. may not be evident
c. has more diffuse margins than another lesion

QUESTION: When do you puncture an abscess?
Localized chronic fluctuant in palpation

QUESTION: A patient has a non-vital tooth & a fistula that is draining around the gingival sulcus. What kind of abcess is it?
perio and then endo
only endo
only perio

QUESTION: There usually is no lesion apparent radiographically in acute apical periodontitis. However, histologically bone destruction has been
noted.

QUESTION: Based solely on the sharp transient response of pulp to hot stimuli, what is the periradicular diagnosis?

d. Cyst formation.

QUESTION: A periradicular radiolucent lesion of endodontic origin on the radiograph may be any of these histological diagnoses except one.
Mark this exception.
a. A cyst
b. A granuloma
c. An abscess
d. Dentigerous cyst

QUESTION: What complete endodontic diagnosis could be completely asymptomatic but should require endodontic therapy?

QUESTION: A lesion of non-endodontic origin remains at the apex of the suspected tooth regardless of X-ray cone angulations.
a. True
b. False

QUESTION: After an RCT in maxillary molar, what Tx would you for sinus track? No treatment

PEDIATRIC ENDODONTICS

When to extract:
st
- If it’s a primary 1 w/ furcation involvement: EXT
nd
- If it's a primary 2 w/ furcation but restorable: PE (Pulpectomy, complete removal)
- If it’s any other primary tooth w/ no furcation: PO

QUESTION: CASE: 5 yrs old patient, he fell down 2 months ago, and hit his #E (central) when he fell down, the tooth is now discolored, what do
you suspect? Necrotic pulp
- A. There is a red swollen lesion on the gingiva of tooth #E, what is most likely be? Sinus tract (other choices, periapical cyst, periapical
granuloma, etc.)
- B. What do you recommend for this tooth? EXT!

QUESTION: What does radiolucency at furcation of primary M1 in 5 y/o usually indicate? erupting permanent PM1, necrotic pulp, normal
anatomy
st
- With furcartion involvement, TE when primary 1 molar, non-restorable, or root resorption present.

QUESTION: PA X-ray of #R/L of a primary teeth: Normal #R/L because permant tooth is erupting underneath

QUESTION: Lucency is seen in PA under the furcation of primary molar, what could this be due to? Necrotic pulp (other options were roots are
resorbing, permanent tooth caused it, etc.)

QUESTION: Primary tooth got necrosis, and the inflammation went down through furcation and affects permanent tooth. What is it going to
cause to permanent tooth? Can disturb ameloblastic layer of permanent successor or spread infection
QUESTION: In a primary tooth, apical infection on the radiograph is usually where? In the furcation

QUESTION: Calcium hydroxide is contraindicated in pulpotomy in a child (primary teeth) because it causes irritation, leading to resorption in
primary teeth.

nd
QUESTION: Little girl has ALL, had radiolucency in furcation of primary 2 molar. What is the treatment?
• Extraction
• Pulpotomy
• Pulpectomy

QUESTION: The best method to test newly erupted primary teeth – percussion (most reliable)

QUESTION: Least reliable test on primary teeth - Electric pulp test
- On primary teeth you don’t want to use EPT b/c thin enamel creates false results & after trauma, you don't want to use electronic pulp
tester.

st
QUESTION: 7 yr old boy has vital pulp exposure of 1 perm max molar. What do you do for treatment? Pulpotomy
st
QUESTION: Child had caries exposure on primary 1 molar…. what to do? Pulpotomy

QUESTION: A 7-year-old patient fractured the right central incisor 3 hours ago. A clinical examination reveals a 2-mm exposure of a "bleeding
pulp." The treatment-of-choice is

APEX ENDODONTICS
Apexification: tx of NONVITAL tooth w/ incomplete apex formation & pulp exposure using calcium hydroxide to achieve apical closure. Want to
create an apical barrier in a necrotic tooth with an open apex. (fill close to apex)
• Induce a calcified apical barrier by placing dense calcium hydroxide paste after instrumentation. Canals are obturated when barrier is
formed in 3–6 months.
• Placement of an artificial apical barrier, like MTA, prior to obturation. This method, can be completed in a day or 2, appropriate when
patient compliance or long-term follow-up care is questionable.

Apexogenesis: tx of VITAL tooth w/ an OPEN apex & pulp exposure using calcium hydroxide to preserve vitality and encourages the continued
development of the root. Vital pulp therapy performed to allow continued physiologic development and formation of the root. (fill coronal
portion)
• Place calcium hydroxide over the radicular pulp stump. Recall every 3 months to check for the pulpal status.
• RCT is indicated when the root development is completed.

Apicoectomy: Root-end resection/excision of apical portion of root.

Know when to do indirect pulp cap, pulpotomy, apexification (non vital teeth with MTA), and pulpectomy (ZOE if apex is not closed in primary
teeth) in pediatric patients.
QUESTION: You did a pulpotomy in a 7 yr old’s pulp exposed decayed tooth #30, why? To allow completion of root formation (apexogenesis)
QUESTION: During apexiogenesis, all of the above with the root except: root lengthening, root widening, root apex closure, root
revasulcatization
QUESTION: Why would you do a pulpotomy in a mandibular first molar of a 7-year-old? To continue physiologic root development
(apexogenesis)

QUESTION: Indications for apicoectomy: RCT can’t be done by conventional means, failed existing RCT that can’t be re-treated

QUESTION: Why you do apico surgery: when an apical portion of canal cannot be cleaned, persistent apical pathology after RCT, apical
fracture, overextension of material interferes with healing
QUESTION: If a tooth with previous endodontic treatment becomes reinfected, it is best to retreat it conventionally by removing the filling
material, debride the canals, and refill. However, if the tooth has been restored with a post, core, and crown, then apical curettage, then an
apicoectomy and retrofill should be performed.

QUESTION: Periapical lesion biopsied after apicoectomy of RCT treated tooth, tooth still sensitive tooth, with neutrophils, plasma cells,
nonkeratanized stratified epithelium (islands of), and fibrous connective tissue → abscess, granuloma, cyst (granuloma: a mass of granulation
tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance)

QUESTION: There is a study that shows there is extraradicular plaque in an infected tooth. What does this mean that the dentist might need to
do: mechanochemical irrigation and debridement of the canal vs doing surgical endo (apicoectomy)
QUESTION: Extraradicular biofilm theory recommends endo with: Crown down, debridement, Ca(OH)2 therapy? (irrigate and debride)

1. Apexification (Non vital)
2. Apexogenesis (vital)
3. Root Canal Treatment

QUESTION: Why you perform apexification (non-vital)? When you have necrosis on an open apex tooth

QUESTION: Definition of apexification: The process of induced root development or apical closure of the root by hard tissue deposition
(NONVITAL)

QUESTION: Tx for traumatic pulp exposure on max incisor that root has not completed formation? Apexogenesis

QUESTION: Irreversible pulpitis with open apex – apexification

QUESTION: Six months ago you did a RCT on central with an open apex (young pt). You place calcium hydroxide in canal and waited the 6
months. You open the canal but can still pass #70 file through the apex. What would you do?
Calcium hydroxide
Zinc oxide eugenol
Gutta percha

QUESTION: Pt is 13 years old and has a non-vital maxillary central. The apex is still open what do you do?
A. Apexogenesis
B. Apexification
C. Pulpectomy
D. Nothing

QUESTION: Pulp is vital, pt’s a 8 year old. Apex is open. What do you do?
A. Apexification
B. Apicoectomy
C. Pulpectomy
D. calcium hydroxide pulpotomy.

QUESTION: Why are traumatized primary incisors discolored? Pulpal Necrosis & Pulpal Bleeding
TOOTH AVULSION & INTRUSIONS

Tooth Avulsion: complete dislodgment of a tooth out of its socket by traumatic injury.
- Short extra-oral dry time & proper storage medium are key factors in offering favorable treatment outcome.
- To slow down osseous replacement of tooth, tx root surface w/ 2% NaF solution for 20 min.

Splint the tooth is for pt comfort
- Avulsion: 7-10 days non-rigid/flexibile splint, antibiotics
- Horizontal root fractures: Rigid splint, 3 months
- Extrusion: 2-3 weeks splint

QUESTION: Reason for failure of replantation of avulsed tooth: external resorption or internal resorption
QUESTION: Most important factor about avulsed tooth: Time (other options were like what you store it in, etc)

QUESTION Most crucial in replantation? Time management (< 2 hrs)

QUESTION: Why would an implanted avulsed tooth fail?
a) the dentist curettage the socket
b) too much extra oral time
c) the dentist clean the root surface
d) failure to place the tooth in the solution

QUESTION: Before 15 min, what is success rate of avulsed tooth? 90% success rate, by 30 minè success rate decreases to 50%

QUESTION: Splinting avulsed teeth for how many days? 7-10 days

QUESTION: What is best storage media for avulsed tooth? HANK (HBSS: Hank’s balanced salt solution, Na, K, Ca + glucose)

QUESTION: If tooth has a closed apex, immerse tooth in 2.4% sodium fluoride solution with what pH & for how many minutes? pH of 5.5 for 20
min

QUESTION: Avulsed tooth should be treated with what to reduce root resorption? 2% Sodium fluoride for 20 minutes.

QUESTION: Avulsed tooth, extraoral time was less than 60 mins, primary tooth, what you do? Don’t put it back.


QUESTION: CaOH tx for an avulsed tooth? Yes or NO?

QUESTION: Which is more damaging to the PDL? Extrusion, intrusion, lateral luxation, avulsion

QUESTION: Patient intrudes mature maxillary incisor. Permanent tooth trauma due to deep intrusion causes PULP NECROSIS & conventional
RCT is necessary.

QUESTION: Trauma to permanent central incisor, intruded 5 mm. What do you do? Pull to normal & splint


QUESTION: Intrusive trauma/ pulp necrosis, what percent is rate of pulp necrosis? 96%
QUESTION: Luxated tooth, negative EPT, why? disruption of nerves to tooth

QUESTION: Pt. has dark permanent lateral incisor. What is the cause? Tetracycline, damage to primary tooth at age five, damage to permanent
lateral

QUESTION: What’s the worst thing you can do to a tooth you plan to re-implant right before you do so? Scrape the tooth with a currette

ENDODONTIC MATERIALS

Chelating agents - bind with Ca+ and carry it out of the canal. It removes smear layer/inorganic layer in dentin to expose tubules for
penetration of endo sealer & exposing bacteria. Ex. EDTA
- Chelating agents are good for sclerotic canals. Substitute sodium ions & soften canal walls.

Sodium Hypochlorite: 5.25% irrigation solution, germicidal, dissolve organic material Does NOT remove smear layer
- Other irrigation solutions include urea peroxide (glycerol based) and 3% hydrogen peroxide.
NiTi rotary files remain better centered, produce less transportation, and instrument faster than stainless steel files due to their superior
flexibility & resistance to torsional fracture. They have 10x the stress resistances of stainless steel (stronger).

The advantageous properties of SS files include:
1. bulk strength as well as edge strength,
2. resistance to cyclic fatigue,
3. recording curves,
4. inexpensive manufacturing.

***Sodium hypochlorite (NaOCl) is NOT a chelator, (it dissolves organic tissue)

QUESTION: Sodium hypochlorite is not a chelating agent.

- Bleach is not a chelating agent



QUESTION: Which is a chelator/chelating agent for endo? EDTA, sodium hypochlorite, etc.
- EDTA is chelator, removes SMEAR LAYER and inorganic material.
- NaOCl (sodium hypochlorite) only dissolves organic material, only disinfects & is most common irrigant.
QUESTION: Percentage of EDTA: 17%
QUESTION: What is the function of EDTA? remove inorganic material & smear layer
QUESTION: Which one is false about NaOH? It’s a chelating agent, doesn’t remove smear layer
(typo: NaOCl)
QUESTION: Which one is correct about EDTA? It’s a chelating agent.

QUESTION: Contraidication for Ca(OH)2? Pulp symptomatic for last month

QUESTION: PARL seen on asymptomatic tooth. When opened, the canal is calcified. What do you do? do nothing, refer to endodontist, place
EDTA
QUESTION: Internal resorption left untreated can lead to? Pink tooth

QUESTION: Similar question: What causes “Pink Tooth of Mummery”? internal resorption

QUESTION: Treatment for internal resorption: RCT

QUESTION: Internal resorption shows all BUT:
radiograph is symmetrical with the pulp space
can resorb all the way to the PDL
a treatment option is observe until resorption stops
resorbed to create pink tooth

QUESTION: When a tooth is ankylosed, what type of resorption? replacement resorption

QUESTION When you replant teeth, what will happen? Ankylosis (will not say that) – replacement bone formation

QUESTION: The treatment-of-choice for an inflammatory external root resorption on a non-vital tooth is which of the following?
A. Extraction
B. Surgical curettage of the affected tissue
C. Pulpectomy and obturation with gutta-percha and sealer
D. Removal of the necrotic pulp and placement of calcium hydroxide
- Do Ca(OH)2 every 3 months until PDL is healthy, then complete RCT

QUESTION: When a reimplanted tooth presents external resorption, what is the treatment?: JUST (instrument) AND PLACE CaOH (other
options are RCT w/ gutta percha & extraction)

QUESTION: Which of the following is not a property of gutta-percha? radiopacity, Biocompatibility, Antibacterial, Adaptation
- Needs sealer to adapt to tooth well

QUESTION: Gutta percha has the following advantages EXCEPT:
1. easy manipulation
2. Adapts to tooth surface
3. Anti- microbial
4. Biocompatible

QUESTION: What is the NOT an advantage of stainless steel files?
1. More flexible
2. Less chance for breaking
3. Allows the file to be centered in canal
4. Aids depth penetration in the canal
QUESTION: All are advantages of using nickel titanium endo files over regular steel files except?
c. direction of the flutes (no)
QUESTION: What is the weakness of NiTi files vs regular SS files? strength, flexibility... and some other choices
b. flexibility,
c. resistance to fracture
ENDODONTIC FAILURES

Most common cause of RCT failure is inadequate disinfected canals (insufficient canal debridement)
nd
2 most common cause is poorly filled canals.

QUESTION: Which case has the best prognosis?
• perforation in internal resorption
QUESTION: Least likely to result in endo failure?
overfilling with gutta percha
inadequate either obturation or cleaning and shaping
lateral root resorption
perforating internal resorption

QUESTION: Cause of grey tooth
• Blood products in the dentinal tubules
• calcified canal

QUESTION: Elective endo due to:
• pulp exposure
• unrestorable tooth…endo contraindicated in: non restorable tooth

QUESTION: Biggest reason for failure of RCT – improper cleaning of the canals, proper obturation, etc

QUESTION: Root canal failed on upper canine b/c lack of seal


QUESTION: Pt comes in for a RCT on a non-vital tooth with 1 mm apical lucency. 5 mo later, comes back with 5 mm lucency, why?- Improperly
done endo, retx. Other choices are another canal present, osteosarcoma, carcinoma.

QUESTION: Incomplete removal of bacteria, pulp debris, and dentinal shavings is commonly caused by failure to irrigate thoroughly. Another
reason is failure to:
A. use broaches.

QUESTION: Least likely cause for failed RCT
a. GP beyond apex
- Causes of RCT failure are 1) insufficient canal debridement 2) insufficient obuturation/leakage

Bacterial infection

QUESTION: Endo file breaks when you are at 15 file, what do you do? Refer to endodontist. (retrieving it was not an option)

QUESTION: You separate an endo file 3mm from the apex and obturate above it... which case will show the best prognosis?
a. vital pulp w/ no periapical lesion (yes)
QUESTION: You being the best doctor in the world, you broke a 5mm dental instrument in a canal during RCT procedure, what’s the best thing
to do? Tell the patient what happened, and refer her to an endodontist. (Other choices were, take a picture and only tell patient if you see
the instrument in there, re-schedule patient to continue with RCT, Put a watch on it)

QUESTION: Which has worst prognosis? File fracture, transportation, perforation through furcation
QUESTION: During root canal you notice you left debris in the canal most likely due to lack of use of which? Gates burs, broaches, chelating
agents, irrigant, etc

ROOT FRACTURES

Vertical root fracture –J shaped radiolucency à à à
Most common cause of vertical rt fracture:
Horizontal Root Fracture: more common in anterior. Success and healing of horizontal root fractures requires
immediate reduction of the fractured segments & the immobilization of the coronal segment in 12 weeks.

QUESTION: Patient comes back few months after RCT & crown with pain upon biting, what happened? cracked tooth, hypersensitivity

QUESTION: Pt has pain 1 month after cementing a crown on a tooth with RCT + post. Pain has been present for several days esp during biting
and cold: vertical root fracture

QUESTION: Pt has crown cemented 2 weeks ago & is sensitive to pressure and cold, why? Occlusal trauma

- vertical root fracture = non-restorable tooth


QUESTION: Which teeth are more likely to have vertical fractures? Mandibular posterior teeth

nd
QUESTION: Most common tooth associated w/ cracked tooth syndrome: Mandibular 2 molars
st
- followed by mandibular 1 molars and maxillary PM are the most commonly affected teeth.

QUESTION: What teeth most likely to have crown/root fracture … max anteriors, mand anterior, max posteriors, mand posteriors
QUESTION: Which tooth is least likely to fracture: mx premolar, mx molar, md premolar, md molar?

QUESTION: Cracked tooth with no pulpal involvement, what is the treatment? Endo, extracoronal restoration, occlusion reduction, amalgam
with adhesive

QUESTION: What causes most vertical root fractures during RCT? Condensation of gutta percha

QUESTION: Best indicator of vertical root fracture - isolated deep pocket depth

QUESTION: Which allows the enitre tooth tooth to light up under transillumination? Craze lines, cracked tooth, crown & root fracture,
separated tooth, etc)
- TRANSILLUMINATION: shows cracks. Whole tooth = craze line

QUESTION: When does transillumiator show evenly through tooth: craze line, crack, fracture from crown to root: Craze line

Cracked tooth
Fractured cusp
Craze line

QUESTION: Vertical root fractures are also called cracked teeth. The prognosis of cracked teeth varies with extent and depth of crack.

QUESTION: If 2 cavities were thought to be two separate fillings but upon exam it was a crack through the isthmus. What do we tx this
symptomless crack with? Observe

QUESTION: Tooth w/ horizontal root fracture à Reduce & immobilize

Rct
Splint
CaOH

QUESTION: Apical horoziontal root fracture & no pain, what do you do? Rct, scaling, RCT if tested nonvital, monitor 1 year

rd
QUESTION: Boy has horizontal root fracture in apical 3 , no symptoms, no pain or mobility, what tx? Monitor, RCT, extract, pulpotomy, splint

QUESTION: A maxillary central incisor of an adult patient is traumatized in an accident. The tooth is slightly tender to percussion, is in good
alignment, and responds normally to pulp vitality tests. Radiographic examination shows a horizontal fracture of the apical third of the root.
The best treatment is which of the following?
C. Apexification
D. Apicoectomy to remove the fractured apical section of the root followed by root canal treatment

QUESTION: Worst prognosis for RCT – ledge formation, vertical fracture during obturation, instrument gets stuck in apical 1/3



QUESTION: Tooth #30 has huge MOD amalgam that is deep. It hurts pt when he eats french bread. What is the cause? Root fracture
QUESTION: Patient has a line of separation coronoapical, the tooth is asymptomatic and it only hurts when patient eats French bread. What
should you do? Ext only if moveable pieces. If asymptomatic & not moveable àfair prognosis àRCT
- separation of coronoapical means vertical fracture (they won’t say vertical fracture on the test)

QUESTION: Days after placed an MOD amalgam, pt present pain in biting and cold: check occlusion.

PULPAL ANATOMY & OTHER QUESTIONS

QUESTION: How many canals do you expect in primary M2? 4

st
QUESTION: What is the shape of the access of mandibular 1 molar?
A. Square
B. Trapezoid
QUESTION: Maxillary 1st molar access opening - triangular
QUESTION: Premolar most likely to have 3 canals? Max 1st
QUESTION: Pulpal anatomy dictates a triangular access cavity preparation in the MAXILLARY CENTRAL INCISOR.
QUESTION: Why do you do triangular access on incisors (ex. max central incisor?)
QUESTION: Most critical for pulpal protection is? Remaining dentin thickness (2mm)

QUESTION: Each of the following can occur as a result of successful RCT tx except what? formation of reparative dentin

QUESTION: Pt with an RCT in a molar tooth, after one year a cyst form, the tooth was extracted, after another year the cyst was bigger what
happened? Bad endo, the dentist did not curettage well when the extraction was done

QUESTION: Taurodontism has enlarged pulp chamber in which direction? apical, occlusal or apical AND occlusal **** know what tauradontism
looks like on x-ray****

- Taurodontism is a condition found in the molar teeth of humans whereby the body of the tooth and pulp chamber is enlarged
vertically at the expense of the roots

CARIES & BACTERIA

QUESTION: pH that enamel starts to demineralize – pH = 5.5 (critical pH of developing cavities)

QUESTION What can tell best thing to tell you about caries? Past caries history


QUESTION: 3 factors that affect caries initiation: substrate, bacteria, host susceptibity

A. Radiolucency

• Can live in plaque

QUESTION: Most Cariogenic? Sucrose
- S.mutans adheres to the biofilm on the tooth by converting sucrose into an extremely adhesive substance called dextran
polysaccharide.

QUESTION: How do cells first attach- dextran or lextran?
- S. Mutans converts sucrose à dextran like long chain polysaccharides (glucans/fructans) using enzyme glucosyltransferase.

QUESTION: What helps in carious progression but it is not the primary inititator for caries? Lactobacillus

Saliva pH
Refined sugar
Fluoride tx
saliva flow

QUESTION: Early childhood caries affects? Centrals and molars
QUESTION: What one of the following increasing in the US? Root caries
QUESTION: New data regarding caries shows:

a. increase in smooth surf caries - wrong
b. increase in pit/fissure caries - wrong
c. smooth surf caries and pit/fissure caries is same - wrong
d. increase in root caries

QUESTION: Best clinical determinant of root caries?
sensitivity to cold
soft spot on tooth - visual & tactile methods are used for detect caries
QUESTION: Remineralized teeth are stronger than regular enamel. True
QUESTION: For a lesion in enamel that has remineralized, what most likely is true?
1. The enamel has smaller hydroxyapatite crystals than the surrounding enamel
2. The remineralized enamel is softer than the surrounding enamel
3. The remineralized enamel is darker than the surrounding enamel
4. The remineralized enamel is rough and cavitated
QUESTION: What’s the characteristic of a remineralized tooth/arrested caries? Darker, harder, more resistant to acid or further decay/caries

black, dark, bright
black, dark, opaque

QUESTION: Leathery brown-white lesion? acute, chronic, arrested

QUESTION: Which of these is NOT an important reason for a clinician to be able to distinguish remineralization? I put color. I have no idea what
this was asking.

• pit and fissure


QUESTION: Most interproximal caries lesion happens where? Just under/below the contact

QUESTION: When do you restore a lesion?

When there is cavitation
When it’s half through enamel
When it passes CEJ
When you see it on x-ray

QUESTION: Tx of root surface caries, what kind of dentin should not be restored? Eburnated dentin (Sclerotic dentin)

A. interproximal
B. Pit and fissure (I saw this somewhere and it said smooth surfaces, pit and fissure is prr/sealant)
C. Smooth surfaces

QUESTION: Which of the following is a factor for smooth caries & sugar in-take? Consistency (others were volume, and other option.)
- Sticky consistency stays on the tooth longer, allowing bacteria to keep the pH lower longer

QUESTION: For occlusal caries, where is base & cone? Triangle point is at enamel and base to dentin, dentin base to tip at pulp. (apex to the
pulp)
QUESTION: What tooth is most likely to have occlusal caries? Mandibular molar

QUESTION: Caries in children depend most on amount, consistency, & time.

b. Two apexes are pointing toward pulp>>>> in smooth surface (proximal caries)
d. base of both triangles facing the DEJ
QUESTION: At the DEJ, diff btw smooth caries (conical), occlusal (apex at occlusal), interprox (apex at DEJ)

QUESTION: Conical shaped caries w/ broad base with apex towards pulp is commonly seen in?
a. root caries
b. smooth caries
c. pit/fissure caries
QUESTION: Most likely dx indicator of pit and fissure caries is what? Explorer catch. Others, xray, adjacent tooth decalcify, contralateral tooth
thingy
a. Watch & observe

b. sealant
c. composite
QUESTION: If a dentist seals a caries lesion on the tooth, what would be the most likely result?
1. Arrest caries
2. Extension caries
3. Discoloration of tooth
4. Micro-leakage
QUESTION: Radiographic decay most closely resemble which zone of carious enamel? Body zone, dark zone, translucent zone, surface zone
QUESTION: When looking at a radiograph, what zone of caries are you looking at? Body zone Demineralization
QUESTION: If you feed a person through a tube, then you decrease risk of caries.
QUESTION: Mechanism of caries indicator: enters the dentin & binds to the denatured collagen.
- A colored dye in an organic base adheres to the denatured collagen, which distinguishes between infected dentin & affected dentin
QUESTION: What does caries indicator do –only stains infected dentin
QUESTION: What type of caries detection is the Difoti used for? Class I Class II, Class III (detection of incipient, frank and recurrent caries)
demineralization

QUESTION: DaignoDent is Class I – ONLY OCCLUSAL CARIES (pit & fissure)


QUESTION: Most commonly accepted theory of dentin sensitivity? Hydrodynamic theory
- Postulates that the pain results from indirect innervation caused by dentinal fluid movement in the tubule that stimulates
mechanoreceptors near the predentin

DENTAL INDEX & EPIDEMIOLOGY

KNOW THIS!
- index with “E/extraction” = primary dentition only

QUESTION: Know what DMFS stands for decay missing fillied surface

QUESTION: DMFS is for surfaces includes 3rd molars

QUESTION: DMF indexà measures how permenant dentition is affected by caries

QUESTION: DMFT - measures the amount tooth decay
rd
QUESTION: DMFT is for permanent teeth (no 3 molars or primary teeth)

QUESTION: Which race has a higher F in DMFT index? White

QUESTION: Which ethiticity has most caries in kid population (highest caries incident)? Hispanics
QUESTION: Which population has the most number of UNRESTORED caries? Blacks

QUESTION: Which of the following acronyms is only used for kids? PI, DEFT, DMF, OHI-S, etc
- DEFT = for primary dentition (e=extraction)

DENTAL BURS & HAND INSTRUMENTS

QUESTION: Differences between 245 and 330 burs: All other dimensions the same except for
length. Other options were shape, what angle they form.
- 245 bur is 3mm in length while 330 is 1.5mm.

QUESTION: Which bur do you use for peds? A.245 bur B.18 C.51

QUESTION: Which is best for occlusal convergence in a prep? 245 (169 is better for occlusal)

QUESTION: Diameter of 245 bur? 0.8 mm

QUESTION: What bur use for amalagam retention in class II? 245 or 330

QUESTION: Example of pear shape bur: 329, 330, 245 (330L)
- 245 = 330L = pear and elongated bur (tip is a cone)

QUESTION: Bur used that converges F and L walls? #245, 7901, 169 (tapered bur, 0.9 diameter)
- If 169 is not thre, pick 245.

QUESTION: What bur do you use to shape convergent walls for amalgam à 169

QUESTION: Burs for smoothing out preps?
More flutes and shallow (this is what red burs are)
more flutes and deeper
less flutes and shallow
less flutes and deeper

QUESTION: More # of blades on carbide burs: SMOOTHER, DECREASED CUTTING EFFICIENCY
QUESTION: Which high speed bur gives a smoother surface? Plain cut fissure bur = best cross cut fissure have a higher cutting efficiency

QUESTION: Bur used for polishing – Carbide have more threads, STEEL FOR POLISH

QUESTION: What is the correct method of excavation of deep caries?
a. Large bur from periphery to the center
b. Large bur from center to periphery
c. Small bur from periphery to center
d. Small bur from center to the periphery
- use the largest bur that fits, and go around the periphery and then towards the deepest

QUESTION: Rotary high speed, how many round per min? 200,000 RPM
- slowspeed goes 20-30k average, endo = usually 800

QUESTION: Chisel vs spoon application: Chisels are intended primarily to cut enamels, but spoons remove caries & carve amalgams
QUESTION: What’s the difference between an enamel hatchet & gingival marginal trimmer? Both chisels but GMT has curved blade and angled
cutting edge while Enamel HA has cutting edge in plane of handle

QUESTION: Main difference and advantage of using GMT instead of Enamel hatchet?
QUESTION: What do you not use to bevel an inlay prep?

a. enamel hatchel
b. ging marg trimmer
c. flame diamond bur
d. carbide bur

- Causes enamel fracture

• 13, 8
• 15, 80 (GMT)
• 15, 95

QUESTION: What instrument would not be used to bevel the gingival margin of an MOD prep? Enamel Hatchet
QUESTION: Proper pulpal floor depth using Bur 245? 3mm, so half of it is 1.5 mm which is proper pulpal floor depth
QUESTION: You did a prep with high speed + diamond bur and tooth is sensitive, what is it about bur and handpiece that it caused sensitivity?
A) Desiccation
B) Traumatized dentin
C) Heat
QUESTION: What would cause displacement of odontoblastic processes?
Thermal
Dessication
Mechanical
Chemical

QUESTION: What causes displacement of odontoblastic nuclei in the dental tubules? Thermal, mechanical, chemical, caries, dessication
- related to hydrodynamic theory I think so I put thermal

AMALGAM

Pins in Amalgam: Pins should be 2mm into dentin, 2mm within amalgam, and 1 mm from the DEJ (to be safe) with no bends in the pins.

For amalgam:
st
- RESISTANCE: 1 = Flat floors, rounded angles (bevel in axiopulpal line angles)
st nd
- RETENTION: 1 = BL walls converge, 2 = retention grooves/Occlusal dovetail

QUESTION: Acute mercury toxicity for dentists or subacute mercury poisoning symptoms, the first signs is: nausea, other are muscle weakness
(hypotonia) and hair loss.

QUESTION: Mercury poisoning effects? Loss of hair was a choice (I looked it up, and I think that is the answer)

QUESTION: MOD amalgam with hole why? poor condensation
- condensation removes mercury (gamma mercury removed)

QUESTION: Most common reason for Amalgam fracture occuring in a primary tooth: Inadequate cavity prep (especially the isthmus area)
QUESTION: Most common reason for failed amalgam

improper prep design - not enough depth
improper titrutration
- most likely depth (first), than outline form
QUESTION: Patient had occlusal amalgam on tooth #30 few weeks ago, one day the dude went to Chinatown and was having lunch with his
hommies. He bit down on something and the amalgam broke off. He came back to your office demanding how could this happen with a new
filling. What should be crossing your mind? The prep was not deep enough.
QUESTION: When prepping the amalgam, which is incorrect? Cavo surfaces is greater than 90⁰
- Ideal cavo margin (margin between tooth and your prep) is 90 degree

QUESTION: Axial pulp should be? 0.2 - 0.5 into DEJ
QUESTION: How far do you extend the pulpal floor in class I amalgam cavity on primary dentition?
- 1mm into dentin
- Just into dentin
(total prep should 1.5 mm so 1 mm for enamel & ~ 0.5 mm for dentin
QUESTION: Greatest wear on enamel of the opposing tooth: amalgam, porcelain, microfill, hybrid composite, Porcelain (zirconia)
QUESTION: Picture of a deep amalgam w/ overhand: What is wrong with marginal ridge of DO amalgam of #29? All of the following except ?
Occlusal wear, over carving, wedge not placed right, OVERCARVED
to give an idea of the anatomy of the region: mesial on maxillary first molar b/c of the cusp of carabelli also
st
- mesial Of max 1 premolar (MOST DIFFICULT due to mesialdevelopmental grove, contact is harder) > Distal of max molar
st
QUESTION: How to account for mesial concavity on maxillary 1 premolar when restoring with amalgam:
custom wedge
acrylic within matrix
normal matrix
create overhang and recontour

st
QUESTION: Two class III lesions adjacent to each other (kissing lesion). Which one do you prep first & which will be filled first? Prep larger 1 ,
st
Restore smaller 1

QUESTION: More corrosion of amalgam is in which phase? Tin-mercury phase (gamma 2 phase)
- Noble metals (gold, pd, platinum) are CORROSION RESISTANT while silver & tin erode
- most common corrosion products found with conventional amalgam alloys are oxides and chlorides of tin
- silver tarnish but copper & tin corrode
QUESTION: Zinc in amalgam, what is used for? Decreases oxidation of other elements (deoxidizer)
- Zinc acts as a deoxidizer, which is an O2 scavenger that minimizes the oxides formation of other elements in the amalgam alloys during
melting.


QUESTION: For amalgam, the most toxic mercury is: Elemental mercery, ethyl mercury, methyl mercury (organic mercury)

QUESTION: Type of mercury most hazardous to dentist health: methyl mercury, ethylmercury, inorganic mercury, elemental mercury
QUESTION: What type of amalgam needs to be condensed more? Spherical

QUESTION: Material to use for best interproximal contact of a CLASS II is Admix Amalgam (others Spherical amalg., Composite w/ and w/o
filler)
- Admix materials = better for proximals contcts b/c of higher condensation forces

QUESTION: From pt images, which amalgam filling has the lowest Copper content? One that looks corroded.
QUESTION: Overtriturating amalgam? sets too fast, decreases setting expansion, increase compressive strength

QUESTION: Huge MOD in posterior à restore with amalgam

QUESTION: Placing pin in amalgam restoration, Amt in tooth/restoration/angulation = 2mm
- The optimal depth of the pinhole into dentin is 2mm.
- Threaded pins used in a dental amalgam restoration should be placed 2mm in depth at a position axial to the DEJ & parallel to the
external surface between the pulp and tooth surface.

QUESTION: What is wrong about retention pin? Better retention with bigger pin. other answer follows axial, 0.5mm in DEJ.

QUESTION: What happens to amalgam if it is contaminated with water/moisture? Decrease in strength

QUESTION: If there is water while you are condensing amalgam, what happens? Delayed expansion (other options were severe expansion,
corrosion and decreased compressive strength)

QUESTION: What happen to amalgam with moisture contamination? Delayed expansion

No marginal leakage
- b/c it gets filled with corrosion products

QUESTION: You have an amalgam that is deficient at the margin by 0.5mm (concavity) and no signs of recurrent decay. What do you do:
observe/monitor, remove and replace, repair with amalgam

QUESTION: Where is it acceptable to leave unsupported enamel? Occlusal wall of class V amalgam
- It’s not a bearing surface so you can leave unsupported enamel in class V

QUESTION: What do class I & class V amalgam ideal prep have in common?

QUESTION: What is the reason you would do MOD onlay vs an Amalgam: Better facial contour (more ideal contours) & less Microleakage
- cusp protection (onlay) vs amalgam

QUESTION: Is the isthmus the same for inlay and amalgamà NO

- isthmus is convergent for amalgam & divergent for inlay.

QUESTION: Resistance form for amalgam prep: bevel in the axiopulpal line angle to reduce stress and increase RESISTANCE form.
- resistance = keeping the restoration from fracturing, “ways to resist stress”
- smooth floor & line angles. Flat walls are right angles of tooth’s long axis.

• Retentive grooves (for proximal resistance)
• depth of prep

QUESTION: Proximal retention in class II box for amalgam? Retentive grooves, convergence of facial lingual walls, bevel on axiopulpal line
angle, all of the above, none of the above

QUESTION: BWX, Tooth #18 has mesial amalgam restoration with overhang and very light contact. What lead to this? A wedge was not placed
right or poor adaptation of matrix band
QUESTION: Position of incisal portion of matrix band? 1 mm above adjacent marginal ridge. other option 2 mm
QUESTION: Put wedge in after matrix

QUESTION: Restoration of class 2 for posterior with heavy occlusion – amalgam, composite, microfill
GOLD INLAY/ONLAYS

Malleability – deform (without fracture) under compressive strength; ability to form a thin sheet
- Greatest malleability to least: gold, silver, lead, copper, aluminum, tin, platinum, zinc, iron, and nickel

Ductility – deform (without fracture) under tensile strength; ability to stretch into wire
- greatest ductility to least: gold, silver, platinum, iron, nickel, copper, aluminum, zinc, tin, and lead.

Gold inlay/onlay Prep: divergent walls (2-5⁰ per wall), 30⁰ bevel margins for better fit, skirt – extend beyond line angle
- resistance/retention: 2-5⁰ of taper per wall as tall as possible.
- Primary retention is from wall height & taper.
- Secondary retention is from retention grooves, skirts, and groove extensions.

QUESTION: What is the hardest (most rigid) gold? Gold Type IV

QUESTION: When do use base metal opposed to gold? Long span bridges (FPD)
- need it be more rigid = more base metal

QUESTION: Ductility – gold’s ability to be worked into different shapes

QUESTION: Only advantage of porcelain over gold: esthetics.
QUESTION: Advantage of gold on occlusal surface, porcelain in facial surface: conserve tooth structure, minimal reduction?
- Gold is compatible in wear with natural tooth & is more conservative, porcelain gives esthetics.

QUESTION: Reduction dimension for functional/non-functional cusps in gold and PFM à Gold: functional = 1.5, non-function = 1. PFM:
functional = 2-2.5, non-functional = 1.5
QUESTION: Why do we bevel the edge of gold- finish margins better, marginal stability & better adaptation

QUESTION: Weakest part of the gold mod inlay is? cement layer (cement = weakest part of cast gold restoration)

- Zinc phosphate is used as a cement for gold & PFM (basically metals). Zirconia can’t bond to it so we use GI.

QUESTION: What is the most accurate pulpal test to determine vitality of a tooth with a full-gold crown?
Electric testing
Percussion test
Palpation test
Thermal test
QUESTION: Recently placed gold inlay on upper tooth is opposing lower amalgam, what is the most common reason for pain afterwards?
Galvanic shock
- Galvanic shock Sensitivity - choose this if only question says opposing dissimilar metal.

QUESTION: Gold casting wrong? Due to hygroscopic expansion or setting expansion
- Plaster expands during casting so gold casting will be smaller than expected

QUESTION: Effects burnishability in gold – yield strength

QUESTION: Main Disadvantage of gold inlay
a. deforms under load- since it is high noble gold and softer, it may have higher creep
b. wear opposing
c. cement is soluble (not soluble)

QUESTION: What is the reason to burnish gold to the margin? Acute angle of gold margin
QUESTION: Which is a characteristic of a gold inlay? Axial walls converge toward the pulpal floor (axial pulpal walls = divergent prep)
- From facial to lingual, the axiopulpal line angle of an onlay preparation is longer than the axiogingival line angle (if it were not, the
preparation would be undercut and the onlay would not seat). For an MOD onlay prep, the axial walls must converge from the gingival
walls to the pulpal wall (for the same reason, the onlay would not seat if they diverged).

INLAYS/ONLAYS

Removing cusp affects retention form
QUESTION: Isthmus of MOD prep extends over 1/3 of intercuspal dimension, how to treat? amalgam, crown, onlay, inlay crown
- Inlays when less than 1/3 intercuspal dimension is prepped

QUESTION: Removing cusp affects retention form

QUESTION: When is onlay indicated? when cuspal coverage is needed or when cusp is undermined by not enough dentin

QUESTION: Which is the only surface not beveled for an onlay? Pulpal

QUESTION: Dentist has to reduce a weak cusp during onlay preparation is to:
a) outline form
b) resistance form
c) retention form
- Cuspal coverage – retention form


QUESTION: Reason for using porcelain for posterior onlay (bond to dentin, to correct occlusion, etc)

QUESTION: Use of indium (tin & iron) with alloy is mainly to provide chemical bond with porcelain

QUESTION: Purpose of addition of tin and iron to metal ceramic allows: Chemical bond, covalent bond with porcelain

QUESTION: Cut onlay & find out margin of crown w/in 1 mm of interseptal bone
b. crown length surgery----impinges biologic width
c. use amalgam

QUESTION: When is the best case to use an inlay? Patient with low caries index
QUESTION: All of the following you can use inlay except high caries risk
QUESTION: Where is the MOD inlay hitting when it contacts early during seating? Interproximal
QUESTION: What causes most post-op sensitivity in direct inlay: Polymerization shrinkage
QUESTION: Patient receives a blow to the chin. He has a MOD inlay placed on the maxillary molar 3 months earlier. Now the patient has a
vague pain on biting, there are no other symptoms. Why? maxillary sinusitis, M-D fracture

QUESTION: Reasons of reduction of tooth for MOD inlay except: amt of enamel on teeth


QUESTION: Cement onlay & you see black lines few months later: MICROLEAKAGE

QUESTION: Coefficient of thermal expansion is most for which material? Tooth <gold (most) < amalgam< filled resin < unfilled resin (8x.
highest)
PORCELAIN/PFM/CVC

Porcelain Strength: (weakest) Feldspathic porcelain <Leucite-reinforced ceramic < Castable glass < Glass-infiltrated alumina (strongest)

QUESTION: 14-year-old with MOD restoration, decay interproximally and undermined enamel in all cusps.
- onlay
- inlay
- crown (b/c all cusp has undermined enamel)

QUESTION: MOD amalgam that exceeds 1/3 distance of cusp height, what would you do? MOD amalgam, MOD composite, MOD onlay, MOD
inlay

QUESTION: Common feature between porcelain veneer and all-ceramic crown preparation – rounded internal

QUESTION: What is the most important thing for retention? Surface area

QUESTION: Most lab complain that the tooth is under reduced.



QUESTION: What is the weakest porcelain? Feldspathic


QUESTION: Silver turns porcelain (PFM) what color? Green

- Silver (Ag) is not considered noble; it is reactive & improves castability but can cause porcelain “greening.”
QUESTION: What component makes a PFM green in the cervical 1/3? copper
- at the margin its copper, other places its silver

QUESTION: What parts of tooth prep can be managed by operator/dentist: parallelism, surface area, length, circumference
QUESTION: What is function of opaque porcelain EXCEPT:

to decrease contamination of additional porcelain with metal in ensuing firing and baking procedures

c. Margins

QUESTION: Where will you place the margins in an anterior PFM prep: Subgingival

QUESTION: Minimum incisal reduction in anterior PFM: 2 mm
- Mostly for esthetics & thickness of porcelain (translucency layer)

rd
QUESTION: Facial reduction for PFM at gingival 3 is 1.5mm
QUESTION: How much reduction would you do for a PFM crown on anterior? 1.5mm on facial incisal plane, not incisal angle

QUESTION: When you have a short crown for PFM, what do you do to increase retention of the crown? Place proximal boxes & vertical
grooves to increase retention.

QUESTION: What causes the most retention of crown? Axial taper, surface area, surface roughness, retention grooves

QUESTION: How do you make sure your all-ceramic restoration does not fracture? must have NOT LESS than 1.5mm porcelain @ occlusal


QUESTION: Why do a functional cusp bevel on a crown prep? To prevent cusp fracture & for proper casting/fabrication of the crown
- Bevel on functional cusp for extra room for porcelain. Ideal is 2 mm reduction.

QUESTION: In PFM, porcelain fractures because the junction should be? Right angle, not round
- Junction between tooth & metal = right angle
- Junction between metal & porcelain should be rounded
QUESTION: When you want to cement crown, what is the sequence? Look inside the crown (internal fit), contacts, then margin
QUESTION: Which of the following do you not do in cementation of a porcelain crown: etch enamel with hydrofluoric acid

QUESTION: What is NOT the reason why you use resin cement on all porcelain restorations? for added retention, to fill small openings at
margin
- All porcelain crowns use resin cement for increased retention (bonded)

QUESTION: You have a patient who wants an all porcelain on # 8 – the incisal edge keeps breaking off and you have to come in to repair, why
does it keep breaking off? Because the anterior guidance and the protrusive movements/clearance space was not properly
QUESTION: #10 PFM on a patient looks longer than #7. All of the following may be the reason why the crown looks like this except? Incorrect
shade. (Other choices; insufficient tooth prep (yes), too thick metal (yes), too thick porcelain (yes) – all of these could have caused it).

QUESTION: What didn’t cause the unaesthetic opacity of crown? shade selection; other choices were under-prepared tooth, too thick metal,
too thick base porcelain or something like that

QUESTION: What could the reason be if you see opaque white porcelain in the incisal 1/3 facial of the PFM crown: Inadequate reduction of the
inciso facial part of the tooth
QUESTION: If incisal edge of anterior PFM is opaque, it is because they had improper second plane of reduction

QUESTION: Lab overbulks porcelain, why? Not enough reduction on tooth, compensate for 20% shrinkage
QUESTION: All porcelain crown on #8 is too light but it is a good crown. What would u do and I put to whiten the other teeth. (vital tooth
bleaching)

QUESTION: ¾ gold crown advantageous except for? LESS retention than full crown

QUESTION: Resistance to lingual displacement of ¾ crown? Lingual wall (of groove), facial wall of groove, facial aspect of prep
PORCELAIN VENEERS

When preparing for a porcelain veneer:
- Gingival third: 0.3 mm veneer reduction
- Facial third: 0.5 mm veneer reduction

QUESTION: Advantage of a direct composite vs. a veneer? Direct
composite is only 1 appointment vs. veneer is at least 2

QUESTION: Pt had veneers cemented with light cured resin. Now, comes back few weeks later with brown staining at gingival margins. Why?
Microleakage, not enough cement, etc

QUESTION: Veneer after a month time has some brown stain: not enough cement at margin, Microleakage
QUESTION: The dentist cements the porcelain veneer with light cured resin and the patient returns with brownish discoloration at the margins,
why? not enough cement or microleakage (depends on duration of pt return)
QUESTION: How much tooth structure needs to be removed on the mid facial for a porcelain veneer? 0.5 mm
QUESTION: Patient has a veneer on incisal edge, small piece of porcelain chipped off and wants you to fix the chip only, what is the sequence of
events: microetch/micro abrasion, acid-etch, silanate, and bonding agent (MAS Bonding)
- Silane = porcelain tx to help it stick to bonding agent

QUESTION: Repairing porcelain veneer with composite à microetch, etch, silanate, resin

• Resin cement
• Polyacrylic acid (etchant for GI)

QUESTION: Opaque coming through on veneer, what’s the problem? Veneer under prepped
QUESTION: When will you bleach teeth in anterior veneer prep?
Before veneer prep, wait for 2-3 weeks
After prepping veneer and then bleach
After cementing veneer and bleach

QUESTION: Pt has veneers from 6-11, which fluoride do you use to not stain the veneer?
A. Stannous Fluoride (stains)
B. Sodium Fluoride**
C. Acid Fluoride
BLEACHING
QUESTION: In-home bleaching kit, what’s the percentage? 10% carbamide peroxide

QUESTION Material used for mouthguard vital bleaching - 10% carbamide peroxide
QUESTION: Home bleaching causes what? sensitivity


QUESTION: What is the most effective way of bleaching teeth? In-home vital bleaching
QUESTION: Non vital bleaching is with? 35% hydrogen peroxide, carbamide peroxide, and sodium perborate.

QUESTION: Difference b/t dentist and home bleaching - strength of peroxide

QUESTION: Best way to decrease gingival irritation w/ home bleaching? Well-fitting custom trays

QUESTION: Purpose of bleaching teeth except? getting past foramen to treat bone

QUESTION: Most common complication of internal bleaching: cervical root resorption

QUESTION: What is worse outcome of nonvital bleaching (internal bleach for endo)? internal root resorption /CERVICAL RESORPTION.

QUESTION: You are about to prep a tooth for PFM crown, patient also needs teeth bleached, how do you go about it? – Bleach first, wait 2
st
weeks, prep tooth, then restoration. (Other choices, Bleach and prep 1 , then wait 2 weeks, Bleach last after prep and crown).


QUESTION: Patient is complaining about a very light colored anterior PFM crown she had done sometime ago, there is nothing clinically wrong
with the crown. What do you do Doctor? Bleach natural teeth (other choices, re-do the crown, put a darker shade composite on crown, some
other stupid answers).

QUESTION: #8 PFM is too light but good margins and been there for 10 years – vital night guard bleaching

QUESTION: 45 yr. old woman. Anterior crown placed 10 years ago & color doesn’t match natural teeth now, appears clinically acceptable & has
good margins, what will you do?
a. vital bleaching
b. new crown


QUESTION: The office bleaching changes the shade through all except:
a. dehydration
b. etching tooth
d. surface demineralization

FIXED PARTIAL DENTURE (FPD)
Saddle Hygienic

Non-Rigid Connector: Key and keyway—for pontics and short span bridges where
you can’t get proper draw without a lot of tooth reduction. POI is parallel to
pathway of retainer.
Ante’s Law: Root surface of abutment teeth have to be greater than root surface of
pontic.
- The longer the FPD, the poorer the prognosis

QUESTION: Where do you attach a non-rigid retainer from a FPD? Distal of mesial abutment & mesial of the distal abutment
- Keyway = lock & key for non-ridge retainers, is located on the mesial of the distal abutment to prevent stress on the distal tooth (most
likely to fail)

QUESTION: Most immediate sign after high occlusion on a bridge? Myofacial pain
QUESTION: A fixed partial denture keeps breaking, why? POOR FRAMEWORK

QUESTION: Most common reason for PFM bridge breakage? Firing schedule, high contact, inadequate design

QUESTION: FPD seats during framework try-in but when come back for final cementation, the FPD holds up/doesn’t seat. Why? Interproximal
(porcelain over contoured)
- Check proximal contacts first when cast that fits on die cannot be seated on the teeth in the mouth.

QUESTION: All ceramic FPD should cover how much of abutment? 360 degrees

QUESTION: What is the basis for classification of different FPD pontics: Relation of the pontic to the supporting tissue
QUESTION: Modified ridge lap pontic has what kind of contact? Minimal contact w/ residual ridge
QUESTION: The modified pontic how should it touch the gum? Barely touch it

QUESTION: MOST esthetic pontic: Saddle, steins, sanitary, conical ridge lap, Modified ridge lap

QUESTION: Pontic of 3-unit FPD should rest gently on the soft tissue & should not blanch tissues.
QUESTION: Anterior teeth, which pontic is best? Ovate or modified ridge

QUESTION: Pontic length on a bridge, what’s most important? AP dimension, MD dimension

QUESTION: Strength of abutment connection to pontic which is more important? occlusogingival width
QUESTION: Most important dimension that ensures the metal connector between abutment and pontic is sufficient (in 3-unit fpd bridge)?
occlusal-gingival

QUESTION: A pontic in the bridge shows the metal, why?
Under-reduction
Framework was not done well (since is a pontic this is probably the answer)

QUESTION: Edentulous space is wider than adjacent anterior tooth, how to match them?
Make pontic line angles farther apart and deeper interproximal embrasures
Make pontic line angles closer and deeper interproximal embrasures
Make pontic line angles farther and shallower interproximal embrasure
Make pontic line angles closer and shallow interproximal embrasures

QUESTION: How do you decrease the width of an artificial tooth?
Deepen the facial line angle proximally and increase the interproximal embrasure
Deepen the facial line angle proximally and decrease interproximal embrasure
Take the facial line angle labially (closer together) and increase the interproximal embrasure
Take the facial line angle labially and decrease the interproximal embrasure.
QUESTION: How do you make a crown narrower? Move line angles more facially (closer together)
QUESTION: Ante’s law: 3 abutments, one being lateral, with 2 pontics, prognosis is good, poor, excellent?
QUESTION: Which of the following is not ideal abutment-pontic connection? Lateral Incisor-Central Incisor (other choices, Central Incisor-
Lateral Incisor, Canine-Lateral Incisor, etc)
- worst cantilever à lateral abutment with central pontic

QUESTION: Which cantilever bridge would be most destructive of the abutment tooth: lateral incisor as abutment with central incisor as
pontic (larger root surface of pontic than abutment, Ante’s Law)
QUESTION: The strength of soldered connector of FPD in enhanced by?

1. Using higher carat solder
2. Increasing height
3. Increasing width
4. Increasing gap

QUESTION: When soldering, what is the most important factor? Height
QUESTION: What system is best for soldering adjusted FPD framework? Oxygen something, use a torch

POST/CORE

Dowel post = cord build up + post in one that is cast, for retention of core & to prove support to crown
- Dowel = post, dowel core = vertical stop (ferrule)

Active screw (post) vs. inactive post?
- An active post is one that engages (screws into) the dentin in the canal space. Traditionally, the major
concern about active posts has been the potential for vertical fracture of the tooth during placement
of the post. Active posts are indicated when the canal length is insufficient to gain adequate retention
with a passive post.
- Inactive post = cement retained.

QUESTION: Keyhole for post /core is to prevent rotation
- post = key, hole = keyhole

QUESTION: Cast post and core - you put extra slit - what is that for? prevent rotation (keyway)

QUESTION: What is the advantage of a fiber post over a cast post? Fiber post has the same modulus of elasticity as dentin

QUESTION: How does a dowel post & core help prevent vertical fracture? Ferrule, Ventilating groove, bevel, vertical stop

QUESTION: What is the point of putting a dowel post on an RCT tooth? Retain core, metal set into root canal to provide support to crown

QUESTION: How should prep an RCT for cast post? Need at least 4 mm of GP to preserve apical seal
COLOR/SHADE

Hue = color
Value = black & white, brightness
Chroma = saturation
- Value is the most critical of the 3 parameters when
attempting to match an adjacent natural tooth; hue
is the least important.

Metamerism: visual effect in which a color appears differently under different light sources
Metamerism is when two colors that are not actually the same (they reflect different wavelengths of light) appear the same under certain lighting conditions ?

QUESTION: Most important when selecting shade? Value, translucency, chroma, hue, color

QUESTION: Least important in selecting shade? fluorescence, hue
- due to lack of variation in mouth

- Color value is 0 = black while 100 = white

QUESTION: A dentist adjusts the shade of a restoration using a complementary color. This procedure will result in
A. increased value.
B. decreased value.

QUESTION: Crown #9 and #10. One of the crowns looks very light (white). What did the dentist pick wrong?
Hue
Chroma
Value

QUESTION: What does staining do for ceramics? Decreases value. Alters chroma

QUESTION: What can’t occur with the addition of stain? Increase value, decrease value, increase chroma, increase hue, decrease chroma

QUESTION: What can’t you change? hue, increase value, decrease value, change chroma

QUESTION: When you add a different color to a resin, you increase what? Chroma

QUESTION: How to change hue? Add orange to it (some sources says it changes chroma)

QUESTION: How do you lower value in a restoration? STAIN w/ Complement color or orange
- when you add a complement color, the colors mix & turn grey, thus changing value

QUESTION: What complementary color to darken porcelain & decrease value? gray, orange, ochre, violet.

QUESTION: If you add a complementary color yellow, what happens to the hue? decrease red content of yellow red shade
- Side note: adding yellow stain = Inc chroma of basic yellow shade
- Pink purple makes yellow à yellow red

QUESTION: Which represents position on the spectral wavelength? Hue

QUESTION: Which color characteristic is dependent on spectral wavelength? Hue

QUESTION: What is best way to determine value:
Open eye as wide as you can

Half close eyes (squint) to increase sensitivity to better select value.
Arrange the shade guide in increasing value (from light to dark)
QUESTION: Which one can human eye see, hue vs value vs chroma?
- More rods than cones so eyes are more sensitive to value

QUESTION: How to prevent metamerism – look at shade under multiple light sources
- Porcelain, look at it with different light sources (metamerism)

QUESTION: The phenomenon whereby various light sources produce different perceptions of color is called
A. fluorescence.
B. incandescence.
C. opalescence.
D. translucency.
E. metamerism.

FUNCTIONAL/NON-FUNCTIONAL MOVEMENTS

Ø Balancingà LUBL Lingual Upper Buccal Lower (non-working)
Ø Workingà BULL Buccal of Upper, Lingual of Lower —> tells you which teeth to adjust to maintain centric stops
Ø Protrusiveà DUML Distal Upper Mesial Lower


QUESTION: Upper molar crown has a wear facet in porcelain on the MB inclination of MB cusp. Most likely associated with? Interference in
protrusion & working interference

QUESTION: #30 gold crown has wear located on the MB cusp of the MB incline, cause – protrusive and working side movement
QUESTION: Non-working movement, which one is true? Lingual cusps of upper molars hit lingual inclines of facial cusps of mandibular molars.

QUESTION: Non-working contacts: mand buccal cusp lingual incline

QUESTION: Contact on lingual portion of buccal cusp of mandibular molar, what kind of interference? Non-working, working, protrusive

QUESTION: Contact on buccal portion of lingual cusp of maxillary molar, what kind of interference? Non-working lateral, working, protrusive

QUESTION: Wear facets on lingual incline of maxillary lingual cusp & facial incline of mandibular facial cusp on left side? pt has: left nonworking
interference, protrusive interference, right nonworking interference, left working interference

QUESTION: Working side interferences are seen on what surfaces? palatal inclines of buccal cusp of upper and buccal incline of lingual cusp of
lower; (the nonworking cusps on the final side are interfering)
- In MIP or CO, the buccal incline of palatal cusp of upper and lingual incline of buccal cusp of lower.
- Balanced side interferences are buccal incline of palatal cusp of upper and lingual incline of buccal cusp of lower (it’s the working cusps
interfering)

QUESTION: Wear on buccal of maxillary premolars due to, due to mandibular movement working or nonworking?

QUESTION: When will the BULL rule be utilized with selective grinding? Working side

QUESTION: The mesiobuccal incline on the mesiobuccal cusp of mand molar (with stainless steel crown) has wear. This is because of movement
in which direction(s): working and protrusive movement
QUESTION: Max molar on mesial slope of mesial lingual cusp, where do you have wear on lower teeth? Mesial or distal incline of either mesial
facial or mid facial cusp? Distal incline of midfacial cusp
nd nd
QUESTION: The mesial angle of the ML of max 2 molar occludes with what on the man 2 molar
a. Mesial MB cusp
b. Distal MB cusp
c. Mesial DB cusp
d. Distal DB cusp

nd
QUESTION: Mesial angle of the L of maxillary second molar occludes with what on the mand 2 molar.? Distal of MB CUSP

QUESTION: Pt bites down after cementing down and deviates to the right #30: Lingual incline of the buccal cusp

QUESTION: Crown on number 30, pt tries to close, contact interference deviates to left, lingual incline of buccal cusp needs to be altered buccal
incline of the lingual cusp


QUESTION: In restoring a canine protected occlusion, with anterior overbite of about 2mm. The buccal cusps of posterior teeth should be flat,
BECAUSE they will guide the protrusion.
a. both are true
c. both are false
d. only the first statement is true

QUESTION: What kind of occlusion if in right lateral movement all posterior teeth are not in occlusion: canine guidance

QUESTION: Which of the following would result in inaccurate terminal hinge record? acutely apprehensive patient, severe skeletal cl III, tooth
contact, muscle pain, etc

QUESTION: IF you are making a crown but before you begin, when you do equilibration, what are you trying to achieve to get rid of the non-
working interference? Posterior dissocculusion??
QUESTION: You have a patient who wants an all porcelain on number 8 – the incisal edge keeps breaking off and u have to come in to repair,
why does it keep breaking off? Because the anterior guidance and the protrusive movements/clearance space was not properly

movement
b. it is the angle that is formed by the condyle and the horizontal plane during protrusive
movements.
c. It is a difference in condylar inclination between protrusive and lateral movements

QUESTION: Bennett shift mainly on: lateral movement or working side

TEMPOROMANDIBULAR (TMJ) DYSFUNCTION:

TMD = Most common form of internal TMJ derangement is anterior misalignment or displacement of the articular disk above the condyle.
Symptoms are localized joint pain & popping on jaw movement.
- Articular disk is pulled out of place anteriorly due to abnormal jaw mechanics; it may remain displaced (without reduction) or return (with
reduction).
- Disk displacement with reduction typically causes clicking and pain with chewing.
- Disk displacement without reduction does not cause clicking but reduces maximum jaw opening to ≤ 30 mm. Surrounding tissues may
become painfully inflamed (capsulitis).

Upper compartment – Translation
Lower compartment – Rotation

QUESTION: Where to the condyles go in CR? Superio-anterio-Medial

QUESTION: Which anatomical components are responsible for rotation of the mandible? Disc and condyle

QUESTION: If you both condyle break, what you get? Posterior open bite


QUESTION: Clicking in TMJ: internal derangement with reduction

QUESTION: Patient always had internal derangement with clicking. All of a sudden, no noise and open max 30 mm. What happened?
Myofascial pain, Lockjaw, Internal derangement w/o reduction

QUESTION: Which way is the articular most displaced? Anterior-medially

QUESTION: Which artery supplies the TMJ? Deep auricular, maxillary, superficial temporal…MADS (4 arteries, acronym)
- MADS: Middle meningeal from maxillary, ascending pharyngeal, deep auricular, superficial temporal

QUESTION: Best imaging for TMD (soft tissue, disc & condyle of TMJ): MRI
QUESTION: Best diagnostic eval for TMJ disc? MRI, CT, PA radiograph
QUESTION: Rotation involves what structures? Condyle, glenoid fossa, disc, TMJ

QUESTION: Which anatomical components are responsible for rotation of the mandible? Condyle & articulating disk
QUESTION: When TMJ is in rotational movement, rotation is in the lower compartment
QUESTION: What causes TMJ ankyloses? Trauma, Rheumatoid arthritis

QUESTION: Patient can’t speak English well, she doesn’t work, she has TMJ problems, she is on meds. Which one will not affect her oral
hygiene prognosis? TMJ problems
- Rationale here is; she may not be able to afford hygiene procedure, she might not understand doctor’s recommendations, and her meds
can contribute to hygiene issues. TMJ problem was not serious enough, as in she can open her mouth to clean her teeth.

QUESTION: Man comes in after years of TMD with reduction and is now only able to open 25mm w/ with muscle pain. What’s his disorder?
Myofacial pain syndrome
- myofacial pain syndrome (can cause clicking, limited opening, pain), internal derangement without reduction has no noises or clicking but
limited opening to < 30mm

QUESTION: High school football player wears a mouthguard. He has crepitation of left TMJ & trigger zone tenderness to palpation of left
temporalis area, stiffness upon wakening: Myofacial pain syndrome, TMJ dislodgement

QUESTION: Symptoms of pain & tenderness upon palpation of the TMJ are usually associated with which of the following?
c. flaccid paralysis of the non-painful side of the face
e. deviation of the jaw to the painful side upon opening the mouth

QUESTION: What branch off facial nerve gets damaged the most during TMJ surgery? Temporal
QUESTION: TMJ ligaments purpose is to – limit the movement of mandible, helps open mandible, helps closes mandible
QUESTION: Which muscle mainly responsible for positioning and translating condyles? Lateral pterygoids

QUESTION: Muscles elevating the jaw: masseter, temporal, medial pterygoid and SUPERIOR belly of lateral pterygoid
QUESTION: Trismus includes what muscle? Medial pterygoid

- Stress causes immune weakness which leads to disease and bruxism.

QUESTION: Main function of the occlusal guard:
• Distribute occlusal forces more evenly
• Bruxism
COMPOSITE
If patient has:
- Decay, microleakage à failure of composite
- Sensitivityà occlusion, debonding

Microfill composites are more color stable than hybrid. Microfill have the smoothest finish (smaller particle) compared to hybrid composite
resin (has microfill + bigger ones for better fill), which are rougher. Rougher will pick up stain easier.
- Has reduced physical properties (ex. thermal expansion, elasticity, strength, etc)
Flowable – less filler content

Component of composite: Bis-GMA + dimethacrylate monomer (TEGMA, UDMA, HDDMA) + filler (silica; for adhesion) + photoinhibitor
(camphorquinone) Typo-should be
photoinitiator
- Filler = wear resistance, translucency
- Photoinhibitor: begins polymerization when external energy (light) applied

QUESTION: What type of bond is composite on tooth structure?
a. chemical bond
c. organic coupling
d. adhesion

QUESTION: Two things that account for a successful posterior composite restoration? Type of resin and type of prep

QUESTION: Post-operative MOD composite pain, most likely due to? Hyper-occlusion

QUESTION: Few days after placement of composite restoration complains of pain especially with biting but relieved by cold: check occlusion

45-degree bevel cavosurface

QUESTION: When doing a class 1 composite, what is the requirement: contain to only pit and fissure caries
QUESTION: What determines composite class 2 prep? Extent of caries, Access
QUESTION: When do you replace class 2 composite? Recurrent decay
st
QUESTION: You are doing a composite slot on mesial and distal of 1 molar, you decide to connect the composites by crossing the oblique
ridge, why? Only answer that made sense was that when oblique ridge is less than 1.5mm so you involve it

QUESTION: Class II prep into cementum, how should you restore? GI, Hybrid, non-restorable

QUESTION: Small occlusal fillings need to be done on posterior, what do you use – amalgam, composite? (small lesion so don’t want to take
away too much with amalgam), GI
QUESTION: Large MOD composite, what’s disadvantage? Occlusal wear
QUESTION: What is not a class I cavity preparation? gingival 1/3 of #19, Lingual pit of #7, Lingual pit of #18
Amount of stress for composite depends on c factor: (# walls involved)

QUESTION: C factor in class 1 composites, which one is correct? less walls is lower C
factor
- for ex, class I composite: 5 bonded/1 unbonded: 5

QUESTION: C factor in class 1 composites, which one is correct? More walls, higher C
Factor

QUESTION: Which has the highest C factor or stress on it? Class 1 & class 5
Box shaped class V fills have C factor about 4
QUESTION: Which part of composite stains the most - gingival proximal, facial proximal,
lingual proximal, or occlusal

QUESTION: Secondary caries is most likely at gingival margin.
QUESTION: Trans illumination is useful in the diagnosis of Class 1, class 2, class5, Class III
QUESTION: What do you place on a 75 y/o patient with ~ 8 class V carious lesions? GI

QUESTION: 65 y/o pt shows several new caries in molars and premolars class V, what material would you use:
a) amalgam
b) composites
c) glass ionomer

QUESTION: #5 cervical lesion Class V onto root: Bevel enamel, 90 butt margin on cementum

a. sensitivity
b. esthetics
c. prevention of decay
d. prevention of further structure loss
QUESTION: Class IV composite, you notice it is too light two weeks later, how do you treat? Add composite tint or do direct facial composite in
new color

QUESTION: If a dentist notices that a large but acceptable composite is too light a few weeks after placing it, what should he do? Veneer with
composite

QUESTION: Class III that extends to facial. The restoration is stained but margins are perfectly sealed. However, they have bad color & pt wants
it fixed. What should you do? Remove 1 mm prep and add more composite

QUESTION: Recently placed a class III comp, pt isn’t happy with it and has a huge staining on margins what to do? Replace, remove on margins
and place composite, extract/implant, etc

QUESTION: After caries removal, sound tissue is in cementum. How do you restore? Build up with GI and place composite
QUESTION: If a Class III prep is subgingival? Restore with GI, followed by composite

QUESTION: Class III composite w/ radiolucency under it, this could result from all the following except? liner, recurrent caries, contraction from
shrinkage of curing, composite contraction

QUESTION: Main advantage of doing direct composite over composite onlay?
a. less Shrinkage-I’ve seen this in other tests
b. better marginal adaptation, seal - best answer among the options

QUESTION: Most important factor when placing a composite in posterior teeth? Case selection and technique

QUESTION: Sensitivity after placing composite restoration in posterior is mostly likely caused by? due to resin polymerization shrinkage in
margin, shrinkage floor.

QUESTION: You place a conservative composite on a posterior tooth and the patient returns due to sensitivity. What is the most likely reason?
Putting large amount of comp while filling, microleakage, trauma to dentin during preparation, etch causing pulpal pain, bacteria, gap, cuspal

QUESTION: Most common reason for replacing posterior composites: RECURRENT CARIES, inadequate margins, fracture of composite
- Two main causes of posterior composite restoration failure: secondary caries and fracture (restoration or tooth)

QUESTION: After placing a crown with composite resin 6 month ago, there is discoloration around the porcelain gingiva (brown color). What is
the cause? discoloration of resin
QUESTION: An anterior composite placed 10 years ago without caries, what is the most common reason to make a new one? color
change/staining
QUESTION: How long should you wait after bleaching to do a composite on an anterior tooth? 1 week at least
QUESTION: Why do you bevel when placing anterior composite? More surface area
QUESTION: Which one is not reason for post-op sensitivity Class I comp? cusp deformation due to shrinkage force
QUESTION: You have a pt. with a composite filling that complains of pain to cold during chewing, you ditch it out with a bur, no more pain.
What was the cause of the pain? Polymerization Shrinkage
Hyperocclusion?

QUESTION: Post-op sensitivity on MOD so removed a portion of the occlusal & placed more composite. What was cause: Fracture
Microleakage
Inadequate margins and water coming out of the tubules
Acid etch
Compression pulling on cusps
QUESTION: Post-op sensitivity from a recently placed Class I composite. Everything could be a reason for sensitivity EXCEPT:
1 etchant causes pulpal sensitivity
2 shrinkage causing gap for microleakage of bacteria
3 shrinkage causing gap for movement of fluid out of pulp

Same amount of time as if done with rubber dam
2 weeks later
2 months later

QUESTION: Class II composite done without rubber dam, how long until you see microleakage – 2-4 weeks, 4-6 weeks, same time as with
rubber dam on

QUESTION: Highest chance of leakage under rubber dam? Holes too wide, Holes too far apart, Holes too close (holes pull away from teeth causing leakage)
QUESTION: What is not an advantage of rubber dam when compared to not using it? Improved properties of materials, shortens operative
time, facilitates the use of water spray
QUESTION: Placement of rubber dam affect the color selection by à dehydration of tooth gives inaccurate tooth shade
QUESTION: “W” on the rubber dam clamp means it is? Wingless

QUESTION: Pt has composite restoration with severe pain with localized swelling, Tx is? Incision & Drainage
QUESTION: Pt had a bunch of little pits in #8 central incisor, how would you fix it? Composite over pits only, or over entire tooth, or veneer w/
porcelain, etc
QUESTION: Pt complains of a marginal stain on #8, what do you do? Polish it

QUESTION: Patient’s chief complaint is #8 and #9 don’t look right. Picture shows nothing is wrong with #9. #8 has extra enamel at the incisal-
distal aspect. What do you do? Shave the inciso-distal aspect of #8. (Other choices were stupid; like put composite on both teeth, put a crown
on #9, etc)

QUESTION: All of the following are an indication for putting a temporary on a deep caries and restoring at a later time except? Lack of time due
to it being an emergency appt, weakened dentin under cusps, to assess pulp condition

QUESTION: Photo initiator of resin composite? Camphoroquinone

QUESTION: Diketones activate by? Visible light
- Composite resins contain alpha diketones as photoinitiators. Blue light to produce slow reactions. Amines are added to accelerate
curing time. Crosslink reaction.

QUESTION: The most radiopaque in composite is: Barium (it is a metal)
QUESTION: Most radiopaque in porcelain:
b. silica
c. quartz

QUESTION: Heat-cured indirect composite (stronger) vs direct composite. Which is incorrect?
c. Heat composite is done indirectly so Less irritation to tooth due to less shrinkage
d. Heat indirect composite has better bonding to the dentin and enamel
QUESTION: Which composites have more color stability? light cure due to TEGDMA (Triethylene glycol dimethacrylate)
- HEAT CURED (light cured) RESINS HAVE SUPERIOR COLOR STABILITY

QUESTION: With TEDGDMA and HEMA: light cure to maintain proper shade

QUESTION: What is importance of light cured vs self-cured in terms of shade balance? less number of nitrates when you light cure
QUESTION: What is false about LED vs halogen curing lights?

a. blue light is 340-370
- Blue light is not 340-370, actually 450-750
- We use LED curing light b/c has more narrow spectrum, less heat generated, light bulb last longer & generally smaller.
QUESTION: Lasers and LED lights don’t cure all resins b/c some resins photoinitiatiors have require light sources is out of range: true and correct
logic.
QUESTION: Which of the following will be not be good against enamel? – Porcelain, Hybrid resins (other choices, enamel, amalgam and unfilled
resins
- Hybrids have silica filler, which increase hardness wear resistance & is the most abrasive.

QUESTION: Worse restorative material for canine restoration? gold, glass ionomer, composite, amalgam
- Worst will be Composite > GIC> Amalgam> Gold (according to dental decks composite not given for class 3 DL in canines)

QUESTION: For a class 3 on a canine, all are appropriate except: gold inlay, composite, amalgam, glass ionomer

CEMENT & MATERIALS

Acid etch technique: conserves tooth structure, reduces microleakage, improves esthetics and provides micromechanical retention. Etch does
improve marginal seal, helps in wetting enamel, cleans surface debris, created microspores (roughness of surface).
Micropores
Smear layer: debris that consist of hydroxyapatite + altered denature collagen that fills the dentinal tubules. Removed by etchant.
GI cement/GI restorative--**think GI joe! He leads a double life and can be both a cement and restorative material!
- As a cement---low pH can cause sensitivity, pulp irritation, least erosive (because GI joe is super strong you can’t beat him up).
- As a restorative material---releases F, low solubility, thermal ins, sim therm exp to tooth, chemical adhesion, biocompatible. However,
GI has less surface hardness, compressive strength, and tensile compared to COMmander COMposite! OMG guys, really? lol
- Components of GI CEMENT: alumina silicate and polycarboxylate
- GI is brittle = high compressive, low tensile strength

Compomer: GI and composite modified with polyacid groups, used in low-stress-bearing areas (less wear resistant than composite but releases
fluoride) Root caries and Class V. RMGI is better.
- RMGI = GI with added resin | Compomer = Composite resin with added GI components.

QUESTION: Beveling in acid etching composite: Increase surface area
QUESTION: Etchant cleans the tooth & creates micropores for micromechanical retention.
QUESTION: Etchant does all except: provide chemical bond

QUESTION: What does acid etching NOT do? Increase surface area, remove debris, increase wettability of enamel, or decrease irregularities at
cavosurface margin.

QUESTION: What does acid etching NOT cause? Acid-etching does not cause. Reduced leakage, better esthetics, increased strength of
composites

QUESTION: Acid-etching does not cause: Reduced leakage, better esthetics, increase composite strength
QUESTION: Etch removes the smear layer & exposed collagen fibers to form hybrid layer with resin

QUESTION: Hybrid layer - primer within intertubular dentin
QUESTION: If contamination occurs after etch, Re-etch
QUESTION: The most unreliable etch system? Self-etch (all in 1 system – etch, prime, bond)
QUESTION: Function of filler in resin—strength (reduces polymerized shrinkage & increases hardness)
QUESTION: Filler composites: Larger fillers have more strength, but do not polish as well (also stain more easily)

QUESTION: Dentist who work with HEMA (methacrylate, acrylic) can have what kind of complication?
HEMA usually found in 1-step adhesives
Contact dermatitis
Anaphylaxis
Immune mediation reaction
Arthus phenomena (Arthus = type III hypersensitivity, usually happens after given vaccination)
- Think acrylic allergy due to monomer

QUESTION: What acid is in GI cement? silicate glass powder & polyacrylic acid
QUESTION: Glass ionomer, what is the liquid made of? Powder = fluoroaluminosilicate glass; Liquid = polyacrylic acid

QUESTION: What is the acid in glass ionomer? Phosphoric acid, Polyacrylic acid

QUESTION: Why do you use a cool glass slab? More powder incorporated, less powder incorporated, decrease working time

QUESTION: Purpose of a cool glass slab when mixing cement is: to incorporate the most powder into liquid as possible.

QUESTION: Which indicated for high caries risk or multiple class Vs? Glass Ionomer

QUESTION: What is the most practical way to seat a casting at the time of cementation? Grind the inside away since the other answer choices
would be either impractical or not done at cementation

QUESTION: To make sure casting seats, do the following EXCEPT:
• Mix cement thin

QUESTION: If you have a bubble in an impression for a crown that is not visible, what is going to happen with the crown when comes from the
lab and you try to seated in the mouth? Crown does not seat

QUESTION: Small void in die, crown was processed, what will happen? Crown will seat in die, but not on tooth

- It won’t fit the tooth but will fit the cast.

QUESTION: You notice a void on occlusal of cast. Crown will:
c. Fit on both

QUESTION: What do you not do if your crown doesn't fit? Don’t change the cement ratio mixture
QUESTION: Why do we lute all ceramic crowns with composite/resin? Increase strength, color stability, sealing of margins, enhance retention
- Composite Resin - the luting material of choice to cement a ceramic crown and can provide the strongest bond.

QUESTION: Why don't you use GI resin cement in cementation of all ceramic restoration? Its expansion could cause cracking of porcelain.
(hygroscopic)
(RMGI cements)
QUESTION: Sensitivity of pulp in regards to cement, which is correct? Resin ionomer and glass ionomer cause highest pulp sensitivity.

QUESTION: Which cement is the easiest to remove after procedure? Zinc Phosphate cement
QUESTION: Zinc phosphate pH is 3.5, what is the significance of that? This might also cause pulp sensitivity
QUESTION: pH of ZOE (near 7), zinc phosphate: pH of 3.5—acidic irritates pulp
QUESTION: What component of cement contributes to adhesion? Polycarboxylic acid, benzoyl peroxide, others,
- Polyacrylic side group à chelation between carboxyl groups and calcium in tooth.

QUESTION: RMGI: What is the advantage beside fluoride release? Ionic bond btwn enamel and dentin
- GI forms ionic bonds

QUESTION: You place a CaOH on the tooth for a direct pulp cap, what else is needed? Placement of a liner

QUESTION: Pulp capping: Use CaOH & in order to protect the pulp, put 2mm thickness of liner/base above CaOH

QUESTION: How do you improve the success of calcium hydroxide on a direct pulp cap? Place GI liner over calcium hydroxide
QUESTION: Which procedure is most unsuccessful in primary tooth with deep caries? Direct pulp cap, indirect pulp cap, pulpectomy, partial
pulpectomy, pulpotomy
QUESTION: The strength of Zinc Oxide Eugenol (IRM) can be increased by adding what? Methylmethacrylate (MMA)
- Zinc oxide eugenol is IRM but there’s an extra component that makes it IRM which is the methylmethacrylate, which is an inactive
ingredient. PMMA = component of plaster, makes IRM set harder/stronger than ZOE

QUESTION: What is the material in reinforced IRM that give it strength?
A. amalgam powder
B. Zinc phosphate
C. Poly methyl methacrylate (PMMA)
D. Titanium powder

QUESTION: Zinc eugenol is a good temp filling: gives a good bacterial seal, high compressive strength, high tensile strength, good biological
seal.
QUESTION: The main component of any root sealers is? Zinc oxide

QUESTION: What do you use to fill a root canal on the primary tooth? ZOE w/out catalyst
- Lack of catalyst gives it adequate working time to fill canals

QUESTION: What do you fill a root canal with on a primary tooth?
• Gutta percha
• Sealer alone
• ZOE with accelerator
• ZOE without accelerator (zinc stearate = accelerator)

QUESTION: Zinc phosphate cement is used as luting agent. The initial acidity may elicit a traumatic response if:

A. a, c, & d
B. an or d
C. b only
D. all of the above

QUESTION: If you add BIS-GMA to PMMA (acrylic) à increases strength or results in the doughy texture to have more working time
QUESTION: Crosslinking factor of P-MMA? BIS-GMA, benzoyl peroxide

- Bis-GMMA- provides the CROSS LINK

QUESTION: Cross-linking in polymers leads to what? Better Strength
QUESTION: Addition of long cross-linking chains in PMMA is for what reason? increase strength, allow doughy consistency before set, allow for
addition of more powder without crazing, prevent shrinkage
QUESTION: By having excess amount of monomer in acrylic, it can create excessive amounts of what: shrinkage, expansion, thermal conduction
QUESTION: Adding more monomer increases:

a. Expansion
b. Shrinkage
c. Brittleness
d. Harness
IMPRESSION MATERIALS
QUESTION: What happens when you take an impression & lip immediately swells? Angioedema (allergy reaction)


QUESTION: Which of the following systems is thought to malfunction in the hereditary form of angioneurotic edema?
A. C-1 esterase
B. C-1q inhibitor
C. CH50 consumption
E. Complement synthetase

HYDROCOLLOID:
Alginate (irreversible hydrocolloid) Setting time:

- Increased water: powder ratio increases setting time & decreases expansion
- mixing faster & increase water temperature decreases setting time
■ Imbibition, which is the process of absorbing water leads to alginate expansion.
■ Syneresis, which is the exudation of the liquid component of a gel leads to alginate shrinkage.

QUESTION: If you decrease water temp (colder), you have more working time for an irreversible hydrocolloid
QUESTION: Alginate impression in 100% humidity, why will shrinkage occur? Imbibemnt, syneresis, historgysm
- syneresis = extraction or expulsion of a liquid from a gel àshrinkage The LEAST amount of shrinkage occurs when alginates are stored in 100% humidity,
but they can still lose moisture (syneresis)
QUESTION: Which is not recommended for final FPD cast impression?
• irreversible hydrocolloid
• PVS
• Polyether

o Polysulfide
o PVS
QUESTION: Syneresis & imbibition applies to which impression material? Reversible hydrocolloid. Irreversible is not an option
QUESTION: Tolerates moisture the most – hydrocolloid, polyether, addition silicone, polysulfide
QUESTION: Imbibition and syneresis affect which one the most
a. reversible hydrocolloid
c. polysulfide
d. silicone
- Imbibition is a special type of diffusion when water is absorbed by solids-colloids causing an enormous increase in volume

GYPSUM:

Gypsum bonded Setting Time:
- longer spatulation, increase water temperature, use of slurry water, less water: powder ratio = greater expansion, shorter setting time
- older investment = decrease expansion
- Increasing water: powder ratio – decrease expansion, longer setting time
QUESTION: Gypsum: If you increase water to powder ratio, you have decrease expansion.
QUESTION: Gypsum: If you have decrease spatula/mixing, you decrease expansion. If you have increase spatula/mixing, you increase expansion
QUESTION: Increased trituration time will increase compressive strength/decrease setting expansion
QUESTION: What decreases setting time of Gypsum: Decrease water: powder ratio
QUESTION: What happens if you increase water in gypsum stone? Less expansion and strength (b/c particles are farther apart)
QUESTION: Decrease setting time - increase spatulation time, increase water temperature, use of slurry water, decreases water: powder ratio
QUESTION: What happens when you increase water/powder ratio of an investment: increase thermal expansion, decrease thermal expansion,
increase setting expansion...?

IMPRESSION MATERIAL:
à Polysulfide (rubber base) is an elastomeric impression material that has an

- exothermic setting reaction with water as a by-product (see Table 3–4)
- ✍✍✍✍✍✍✍Advantages:
- long working time
- flexible and tear resistant
- ✍✍✍✍✍✍ Disadvantages:
- long setting time
- very unpleasant odor and taste
- highest permanent deformation
à Condensation silicone is an elastomeric impression material that sets in a

- cross-linking polymerization reaction and gives off the by-product ethanol
- (see Table 3–7).
- Disadvantages:
- Must be poured immediately
- Poor dimensional stability due to evaporation of ethanol
- Hydrophobic
- Low tear strength
àAddition silicone or PVS has become one of the most popular crown and
bridge impression material (see Table 3–8.). There are no by-products compared
to condensation silicones.
Advantages:
Excellent dimensional stability (up to 2 weeks)
Excellent surface detail
Low permanent deformation
Disadvantages:
Hydrophobic
Temperature sensitive
QUESTION: Most stable impression material or provides best dimensional quality: additional silicones (aka PVS)

QUESTION: When pouring gypsum material into an impression, which material will cause the least amount of bubbles? Polysulfide, polyether,
silicone, irreversible hydrocolloid

polysulfide (polyvinyl sulfide, the smelly one)
QUESTION: Polyvinyl siloxanes (PVS) gets affected by latex, sulfur in latex gloves retards the setting of PVS.

QUESTION: Polyether, disadvantage compared to other elastomeric? sticks to teeth/hard to remove from teeth, longer working time, less
accuracy
QUESTION: Which one most likely to get stuck in mouth? Polyether

QUESTION: Impressions, what’s wrong with polyether? It’s hard & engages undercuts.
QUESTION: When compared to other materials, which of the following is the main disadvantage of using polyether elastomeric impression
materials: is much stiffer
QUESTION: Most rigid impression material: Polyether

QUESTION: Which is hardest one to remove from the oral cavity (STIFFEST)? Polyether

QUESTION: What material would you not use for a single crown: a) polyether b) polysulfide c) PVS etc

QUESTION: Polysulfide gives out? water
QUESTION: Catalyst of POLYSULFIDE impression material- lead dioxide
QUESTION: Condensation silicone release – ethyl alcohol as by product

QUESTION: Addition silicones (PVS) releases? H2 (as secondary reaction) —> should wait an hour before pouring casts

a. polyether
b. additional silicone
c. condensation silicone
d. polysulfide

QUESTION: Which impression material is least distorted by water? Additional silicone (Condensation silicone better ans if available)

QUESTION: Property of interocclusal recording material? Low resistance to jaw closure
QUESTION: Why elastomer is not a good interocclusal record? Rebound when mounting
FLUROIDE
Fluoride BREAKSDOWN collagen, is bacteriocidal, fluoroapetite is more resistant to acid, decreases solubility of enamel, excreted by kidneys, &
helps remineralizes.
Hydroxyapatite + Fluoride à Flourapetite + Hydroxy
Fluoride ions replace the hydroxyl radicals of the hydroxyapatite crystals in the enamel, producing fluorapatite, which is less soluble in catabolic
acids produced by oral bacteria.
- Fluorapetite has a lower critical pH of 4.5 (pH of dental enamel as 5.5) = harder to dissolve

Fluoridation: know the primary/secondary/tertiary prevention differences.
- Primary: aims to prevent the disease before it occurs. Health education, community fluoridated water, sealants.
- Secondary: Eliminates or reduces disease after they occur. Composite filling
- Tertiary: Rehabilitates an individual in later stages to restore tissues after the failure of secondary prevention. Examples include
dentures and crown and bridge.

Fluoride Facts
■ Food and Nutrition Board recommends public water supplies be fluoridated when levels are significantly below 0.7 mg/L.
■ Fluorine intake of 20–40 mg/day can inhibit the important enzyme phosphatase.
■ Phosphatase is needed for calcium utilization/metabolism in tissues including the bones and teeth.
■ Fluorine intake of 40–70 mg/day can cause heartburn and pains in the extremities.
■ Just as fluoride will displace calcium in the body, calcium therapies are used to treat fluoride toxicity.
■ Topical fluoride does not cause fluorosis (occur in permanent and primary teeth).
■ School water fluoridation ≈ 4.5 times that of city water (≈1 ppm).
■ Fluoride deposit in calcified tissues over time.
■ Greatest concentration of fluoride at outermost layer of enamel.
■ Proximal and smooth surfaces benefit the most from fluoride.
■ Fluoride is excreted by the kidney (in form of urine and sweat, up to 3 mg/day).
■ U.S. Public Health set optimal fluoride = 0.7–1.2 ppm for public water.
■ Cariostatic effect of fluoride is at calcification stage of tooth development.
■ Fluoride converts hydroxyapatite to fluorapatite.
■ Fluoride ↓ solubility of enamel.
■ Toothpaste contain 1100 ppm of fluoride.

Fluoride Toxicity
■ Adult lethal dose = 4–5 g
■ Child lethal dose = 15 mg/kg Typical tube of toothpaste has about 285mg fluoride
■ Odontogenic manifestation = fluorosis

QUESTION: How many mg of fluoride in 1 L of water at 1 ppm: 1 mg
QUESTION: Patient has 1 ppm fluoride in water. What is that equal to in mg/L? 1mg/L
QUESTION: What ion gets replaced in hydroxyapatite by fluoride? Hydroxyl
QUESTION: least soluble - fluorapatite
QUESTION: ***Fluoride works in all these ways except: Increases strength of collagen***
- Fluoride BREAKSDOWN collagen, is bacteriocidal, fluoroapetite is more resistant to acid attack, decreases solubility of enamel,
excreted by kidneys, helps remineralize


QUESTION: Where does fluoride localize/accumulates? Outer enamel

QUESTION: Fluorosis does what? Inhibits remineralization

- Fluoride induces enamel hypoplasia (hypocalification), which is a characteristic of fluorosis that is caries resistant.

QUESTION: Fluoride spot makes enamel more resistant to future caries.

QUESTION: Fluoride does all the following, except? Direct action on plaque
- Higher the fluoride level, greater degree of enamel change

QUESTION: ADA recommends to apply in-office fluoride foam for how long? 4 minutes
QUESTION: How many minutes do you place neutral sodium fluoride tray on teeth? 4 minutes

QUESTION: Floride supplementation is effective in: everybody, only kids, anyone but most beneficial to children.
QUESTION: At what age should supplemental fluoride be started? 6 months
QUESTION: What age does fluoride get incorporate into primary dentition? 4 months in utero
QUESTION: At what age does fluorosis of anterior permanent teeth occur? 4-6mo (others options: 0-4mo, 1year, 2years and 6 years)
QUESTION: Fluoride is given to children in schools usually by rinse with what concentration? 0.05 daily, 0.2 daily, 0.05 weekly, 0.2 weekly

QUESTION: What happens when a kid with primary teeth ingests fluoride? It affects their permanent teeth.
QUESTION: The drinking water supply of a community has a natural F level of 0.6 ppm. The F level is raised by 0.4ppm. Tooth decay is expected
to decrease by what % after 7 years? 40%
QUESTION: The usual metabolic path of ingested fluoride primarily involves urinary excretion with remaining portion in? skeletal tissue
QUESTION: Where is the biggest storage of fluoride in tissues? Skeletal tissues Fluoride likes calcified things i.e. bones
A. interproximal
B. Pit and fissure (I saw this somewhere and it said smooth surfaces, pit and fissure is prr/sealant)
***WORKS BEST ON SMOOTH SURFACES***

c. Water with no fluoride
d. juice
QUESTION: Early Childhood Caries (ECC) are cause by all at night except?
- bottle feeding with formula with fluoridated water
- breast feeding
- sippy cup with OJ
- bottle feeding with processed water with no fluoride

QUESTION: ECC (early childhood caries) is usually in what location?
a. Max incisors and molars
b. Man incisor and molars
c. Max canine
d. Man canine and molar
- Primary max incisors (B&L), then primary molars, mandibular unaffected bc tongue blocks

QUESTION: What determines fluoride supplementation for a city - temperature

QUESTION: Usual/recommended water fluoridation- 0.7 ppm

QUESTION: The appropriate/optimal amount of fluoride in the community water: 0.75-1.2 ppm

QUESTION: Maximum allowed fluoride in the water by EPA (Environmental protection agency)? 4.0 mg/liter (4 ppm)

QUESTION: Percentage of fluoride water in US - should be about 65-70%

QUESTION: What percentage of Americans have public fluoride in water: 66%, 85%, other lower numbers
- CDC 2010 reports Americans have 79.6% water fluoridation


QUESTION: Fluoridation for water: effectiveness: early studies showed that it prevents 50%-70% of caries in permanent teeth, however
currently the effectiveness is 20%-40%
QUESTION: Effectiveness of Water fluoridation in the U.S. is 20%-40%
QUESTION: Pt has a white discoloration with no sensitivity near cervical region of #29, what do you do? fill, 5% fluoride, do nothing

TYPE OF FLUORIDE:
QUESTION: What type of fluoride is in water? fluorosilicic acid (hydrofluorosilicate) – most commonly used, sodium fluorosilicate, and sodium
fluoride
QUESTION: Types of Fluoride used in toothpaste: sodium fluoride, Stannous fluoride (most effective), sodium monofluorophosphate
- Stannous fluoride may stain.
QUESTION: What mouthwash is good for children with caries to rinse with? Sodium Fluoride (NaF)
QUESTION: What rinse is used at home for developmental disabled child to reduce of plaque? NaF, stannous fluoride, chlorohexidine

QUESTION: Which type of fluoride is not in toothpaste? Acidulated fluoride
QUESTION: What fluoride toothpaste should not be used in a patient with multiple porcelain crowns? Acidulated (takes the glaze off)

QUESTION: What’s the concentration of acidulated phosphate fluoride is used in the dental office? 1.23%

QUESTION: Dentist places sodium fluoride on patient with GI fillings rather than acidulated fluoride because – acid of fluoride will wear away
at GI. TRUE

QUESTION: What fluoride tx would you used in a pt with amalgams, PFM's, composite restorations, implants? 1.1% NaF

QUESTION: Pt has fillings and full porc. Crowns, but has decalcification on class V? 1.1 % NaF

QUESTION: Which one is not useful in managing caries in elderly? Use of 1.1% fluoride as a standard of care

FLUORIDE SUPPLEMENTS: Easiest way to remember supplemental fluoride is
“Rule of 6s”

1) Don’t give before 6 months
2) No need for supplemental fluoride (for any age)
if above 0.6ppm
3) No need for above 16 years old

QUESTION: A 2 y/o child has injested 20mg fluoride pill. What will likely happen? coma, nausea, renal failure, cardiac arrest
QUE
STION: How much fluoridation supplement would you give to a 5 y/o drinking 0.75ppm F in their water? 0 ppm
QUESTION: 3 y/o patient lives in area with 0.4 ppm fluoride. How much do you supplement? 0 ppm
QUESTION: 4 yrs old patient lives in community w/ 0.25 ppm fluoride intake, what do you give?
Give her systemic fluoride (0.5 mg/day)
Apply fluoride
Change diet to more fluoride intake
Prescription fluoride rinse

QUESTION: 4 y/o pt with 0.4 ppm fluoride Supplement? 0.25mg/day
QUESTION: 4.5 y/o child with 0.75ppm fluoride in their water requires how much fluoride to be supplement? 0 mg
QUESTION: 7-year-old patient has no fluoride in drinking water. What do you give them systemically…? 5 mg, 1 mg, 0.25 mg
QUESTION: 7-year-old child lives in area with 0.2 ppm fluoridated water, what do you supplement? 1.0 mg/day
QUESTION: Supplementation for 10-year-old with no other fluoride source? 1 mg/day or 1 mg/week?
SEALANTS
RECOMMEND AGE: Do sealant age 6-12
QUESTION: Sealants - mechanical microretention binding to tooth
QUESTION: Contraindication of sealant: when you have rampant or gross caries
QUESTION: A child with no decay but deep pits and fissures, what is the Tx plan? Sealants
QUESTION: Patient has deep grooves but no decay on permanent molars, what do you suggest? Sealants
QUESTION: Ortho pt: has never had a restoration? What would you do? sealants, do nothing, etc. (agu put: do nothing)
QUESTION: High caries risk patient, when is he indicated for sealants? Obvious clinical cavitation on the occlusal, deep fissures without caries
QUESTION: Pictures of molars in 16 y/o – does it need sealants, no treatment, Class I. Book says do sealant age 6-12, so no treatment most
likely unless caries visualized.
NORMAL ANATOMY
QUESTION: Patient has bilateral white lines @ occlusal plane, what is primary microscopic finding? Epithelial hyperkeratosis, frictional
keratosis, linea alba.
FORDYCE GRANULES:
Fordyce granules (Sebaceous Prominence) = small, raised, pale red, yellow-white or skin-colored
bumps/spots that appear on the penis shaft, labia, scrotum, or the vermilion border of the lips. No
pathology.
QUESTION: Fordyce granules is what? Ectopic sebaceous gland
• salivary gland
• sebaceous gland
• sweat gland

VARICIES:

QUESTION: Varicosities in ventral tongue commonly seen in? elderly
QUESTION: What causes varices on the tongue? Hypertension
QUESTION: Pt with bilateral asymptomatic blue stuff under tongue?
a. hemangioma
b. varices

STAFNE DEFECT (SALIVARY GLAND DEPRESSION DEFECT):

Stafne defect (lingual mandibular salivary gland depression, static bone cyst, stafne bone cyst) = depression of the mandible on the lingual
surface.
- normal anatomical variant, as the depression is created by ectopic salivary gland tissue associated with the submandibular gland &
does not represent a pathologic lesion.

QUESTION: Pano Radiograph of mandibular gland depression: Stafne defect (also called salivary bone cyst (another name for stafne bone cyst)
on PAN)
QUESTION: Very well-defined round radiolucency posterior mandible below inferior alveolar canal on a panoramic à static bone cyst (stafne
defect)
QUESTION: X-ray of Stafne defect, only option was salivary inclusion defect


Attrition is wearing away from natural dentition.

a. caries
b. candidiasis
c. dental attrition

QUESTION: Most attrition of enamel is against what? (porcelain not an option in the answer)
a) Enamel
b) Amalgam
c) Hybrid resin
d) Microfill resin?

a. prevents future erosion
c. esthetic

QUESTION: What causes erosion? Chemical, gastric reflux, & Bulimia

QUESTION: Which one is a chemical cause of tooth destruction? Erosion
- Type of wear from gastric acids: erosion

QUESTION: Abfraction (flexure of tooth) à If it’s not too deep, don’t touch it. If deeper, fill with glass ionomer cement? Compomers
(Composite with GI, or RMGI)

ORAL PATHOLOGY
LAB VALUES: http://www.aapd.org/media/Policies_Guidelines/RS_LabValues.pdf

QUESTION: Mobile mass initially but is now sessile (fixed): indicative of malignancy

QUESTION: Metastasis is most common to posterior mandible.

QUESTION: Discrete, non-tender, soft tissue swelling, what is it – malignancy, benign tumor, bone cancer

QUESTION: What is usually seen with affected hypertrophic filiform papillae? Hairy tongue
QUESTION: Causes of Hairy tongue? antibiotic, corticosteroid, hydrogen peroxide

- Mostly in heavy smokers, poor oral hygiene, general debilitation, hyposalivation, radiotherapy, fungal/bacterial overgrowth, certain
meds.

QUESTION: Which of the following is seen with hyperplastic (or was it associated with) foliate papilla: hairy tongue, Lingual tonsil hyperplasia,
median rhomboid glossitis, lymphadenopathy

c. Squamous cell carcinoma (?)
e. Prominent fungiform papillae. (foliate papillae, not fungiform papillae)

QUESTION: Loss of filliform papilla- vitamin B deficiency

QUESTION: Bilateral swelling of parotid cannot be caused by: Anorexia
- Bilateral usually caused by infections. Unilateral - sialoliths or obstruction.

QUESTION: Brush tongue to reduce odor. It removes biofilm, which can be associated with overgrowth of bacteria due to meds.
QUESTION: Transillumination of soft tissues is useful in detecting which of the following problems in a child? Sialolithiasis, Koplik’s spots, aortic
stenosis, sickle cell disease
QUESTION: Baby with nodules on the palatal, what is it?

• bone nodulus
• Epstein pearls
• bohn nodule (hard/soft palate)

- Epstein pearls are whitish-yellow cysts that form on the gums and roof
of the mouth in a newborn baby.

QUESTION: Neonate with numerous nodules on alveolar ridge. What is it?
• Eruption cyst
• Bohn’s nodule
• Congenital cyst of newborn
- Bohn’s nodule (keratin-filled cysts of salivary gland origin, on junction of
hard/soft palate + buccal/lingual of dental
ridges, away from midline)

SYPHILIS:

th
Congenital syphilis presentation consists of 3 phenomena (Hutchinson triad): interstitial keratitis (corneal scarring), Hutchinson incisors, and 8
nerve deafness.

QUESTION: Indents on incisal edge with narrowing at mesial and distal? Congenital syphilis (Hutchinson’s incisors and mullberry molars)

QUESTION: Syphilis: Hutchinson triad

QUESTION: Stages of syphilis that is most infectious: primary and secondary, primary, secondary, tertiary, primary secondary and tertiary
- In secondary syphilis, the bacteria have spread in the bloodstream and have reached their highest numbers.

SYSTEMIC LUPUS ERTHEMATOSUS:
Systemic Lupus Erythematosus - Collagen/CT multi-system disease. Unknown cause. Women 10x more frequently. Avg age = 31yo.
- Presents: Malar rash, kidney problems 50% of time & lead to organ failure. Pericarditis is a frequent complication
- Warty vegetation’s on valves = Libman-Sacks endocarditis. Oral lesions if evident- palate, B mucosa, gingiva.

Lupus is a chronic autoimmune disease in which the body's immune system becomes hyperactive and attacks normal, healthy tissue. This
results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys, blood, the heart, and lungs.
QUESTION: Which syndrome has rash on cheeks, ulcers, kidney, etc? Lupus
QUESTION: Which skin condition has endocarditis and glom-? lupus

CAVERNOUS SINUS THROMBOSIS:

Cavernous sinus thrombosis (CST) = blood clot formation w/in the CS at the base of the brain,
which drains deoxygenated blood from the brain back to the heart. Usually from an infection
from nose, sinuses, ears, teeth or Forunculo.
- Staphylococcus aureus and Streptococcus are often the associated.

- Symptoms include: decrease/loss of vision, chemosis (edema of eye conjunctiva),
st
exophthalmos (bulging eyes), ptosis, headaches (1 sign) and paralysis of the cranial
nerves that course through the cavernous sinus.
- This infection is life-threatening and requires immediate TX.
Infections in upper front teeth are within the area of the face known as the "dangerous
triangle". The dangerous triangle is visualized by imagining a triangle with the top point
about at the bridge of the nose and the two lower points on either corner of the mouth.
QUESTION: Cavernous sinus problem - due to infection of upper lip/canine space, infxn from max ant teeth
QUESTION: Most likely to cause cavernous sinus thrombosis: valve infected by endocarditis, soft tissue abscess in upper lip (veins of face don’t
have valves)

QUESTION: Which of the following causes cavernous sinus thrombosis:
A) Subcutaneous abscess of upper lip
B) Subcutaneous abscess of lower anterior region
- Infections in upper anterior teeth are within the "dangerous triangle" area, which is visualized by imagining a triangle with the top
point about at the bridge of the nose and the two lower points on either corner of the mouth.

QUESTION: Cavernous sinus infection would most likely come from, maxillary sinus, paranasal sinus, frontal sinus, anterior maxillary teeth
QUESTION: Site of infection most likely to enter cavernous sinus? Anterior triangle of face, naso-labial cyst

QUESTION: Why are you afraid of having infection in anterior triangle (i.e. upper lip)? Because there are valve-less veins that can send infection
back to the brain.

QUESTION: Danger zone of Cavernous Sinus thrombosis: What is the first signs/symptoms?
a. pre-orbital swelling (bulging eye)
b. loss vision
c. HEADACHE
- most common initial symptom of CST is a headache, which develops as a sharp pain located behind or around the eyes that steadily
gets worse over time.
- Symptoms often start w/ in 5- 10 days of developing an infection in the face or skull, such as sinusitis or a boil.
LUDWIG’S ANGINA:

Ludwig's angina = serious bilateral cellulitis (CT infection) of the floor of the mouth, usually occurring in adults with concomitant dental
infections & if left untreated, may obstruct the airways, necessitating tracheotomy.
- Symptoms: swelling, pain and raising of the tongue, swelling of the neck and the tissues of the submandibular & sublingual spaces,
malaise, fever, dysphagia (difficulty swallowing) and, in severe cases, stridor or difficulty breathing.

QUESTION: Which space is not involved/associated with Ludwig's angina?
Sublingual
Submandibular
Retropharyngeal
Submental

QUESTION: Cellulitis most of the time is unilateral. Ludwig's angina is bilateral & a complication is edema of GLOTTIS.

QUESTION: Patient has bilateral submandibular infection; tongue is elevated due infection - Ludwig's Angina
- Ludwig angina = bilateral cellulitis of submandibular & sublingual spaces.

QUESTION: What do you need to worry about the most with Ludwig’s Angina? edema of glottis
nd
QUESTION: Mandibular 2 molar infection spreads to what space? Submandibular space
QUESTION: Infection on the mandibular buccal side of premolars is most likely to go where? Submandibular space
nd
QUESTION: Infxn of mnd 2 pm goes into submandibular space
rd
QUESTION: You are extracting a mandibular 3 molar and the distal root disappears into which space? Submandibular space
nd
QUESTION: Which muscle separates 2 potential infection spaces from a maxillary 2 molar? Buccinator or Masseter
QUESTION: If you have an infection in the lateral pharyngeal space, what muscle is involved? Medial pterygoid
QUESTION: Inferior Alveolar Nerve tract infection involves what space? Pterygomandibular space

SCARLET FEVER:
Scarlet
fever = bacterial infection caused by group A Streptococcus. It begins with a fever & sore throat.
Sometimes, chills, vomiting, & abdominal pain. The tongue may have a whitish coating, appears
swollen, and have "strawberry"-like (red & bumpy) appearance. The throat and tonsils may be very red and
sore, and swallowing may be painful.
QUESTION: Strawberry tongue is seen in scarlet fever (Also, Kawasaki disease & toxic shock
syndrome)
TURNER’S TOOTH:
Turner's hypoplasia = abnormality found in teeth & presents as a portion of missing or diminished enamel on permanent teeth. Most likely
occurs when developing permanent tooth is damaged by periapical infection in overlying deciduous tooth, leading to enamel defect.

QUESTION: Most probable reason for Turner Tooth? Syphilis, Trauma at birth, Trauma when
young
QUESTION: Turners tooth – single tooth affected
QUESTION: Turner’s tooth is caused by: trauma or local infection
QUESTION: What gives you Turners incisors:
• Syphilis
• Trauma during delivery
• Trauma during pregnancy

RECURRENT APHTHOUS STOMATISIS:

Aphthous ulcers in non-keratinized tissue – herpes in keratinized tissue

Aphthous stomatitis = recurrent ulceration that are almost always painful. It occurs on freely movable mucosa that does not overlay bone.
- Aphthous can be differentiated since it usually does not occur over bone, doesn’t form vesicles, and isn’t accompanied by fever or
gingivitis.
QUESTION: Patient has ulcer at mucolabial fold, it goes away and comes back, what could it be? Aphthous
QUESTION: Pt has occasional sores on mucolabial fold on mandibular arch that healed without scarring after a week or so? Minor Aphthous
ulcer. Ulcer healing with scar tissue: major

QUESTION: Ulcer on tongue that repeats every 4 months? Apthous ulcer
QUESTION: A chancre due to Syphilis mostly resembles:

1) Cancer
2) Herpes Herpangina = coxsackie virus, vesicular lesions further back in mouth compared to primary
3) Herpangina herpes infections, both show fever/malaise, affects kids, assoc with sore throat/trouble swallowing
4) Apthous Ulcer

QUESTION: What don’t you treat aphthous ulcers with? Acyclovir
***LEUKOPLAKIA IS A PRE-MALIGNANT CONDITION
- Acyclovir: Anti-viral used to tx herpes
AND SHOULD ALWAYS BE LOOKED AT WITH SUSPICION

QUESTION: Bechets syndrome produces what type of mouth lesion?
Apthous Ulcers
Apthous stomatitis
Recurrent, herpes
- Behçet disease/syndrome is a rare immune-mediated small-vessel systemic vasculitis that often presents with mucous membrane
ulceration & ocular problems. Triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis.

DESQUAMATIVE GINGIVITIS DISEASES: lichen planus, mucous membrane pemphigoid (95%), and pemphigus

Dequamative gingivitis = band of red atrophic or eroded mucosa affecting the attached gingiva. Unlike plaque-induced inflammation, it is a
dusky red color & extends beyond the marginal gingiva, often to the full width of the attached gingiva and sometimes onto the alveolar
mucosa.

QUESTION: Lichen Planus and pemphigoid = sub epithelial, and pemphigus is suprabasilar vesicle.

QUESTION: Desquamative gingivitis is associated with which 2 conditions? Lichen planus & pemphigoid

QUESTION: Most likely to cause desquamative gingivitis: Lichen planus, Pemphigus vulgaris, Pemphigoid

PEMPHIGUS VULGARIS:
Pemphigus = autoimmune type II hypersensitivity reaction, has acanthylosis, & Tzanck cells. Antibodies are directed against the epithelium,
target the desmosomal Dsg3 and cause sloughing.
o Nikolsky’s sign is when the epithelium can just be rubbed off of an unaffected area HISTO: vesicles are suprabasilar and there
is presence of acanthylosis

Pemphigoid = autoimmune disorder where antibodies attack hemidesmosomes. Blisters and vesicles develop—BMMP—benign mucous
membrane pemphigoid.
o DIFFERENT than Pemphigus vulgaris because—less severe and HISTO:
vesicles are SUBepidermal and NO acanthylosis.
QUESTION: A patient has painful lesions on her buccal mucosa. A biopsy reveals
acantholysis and a suprabasilar vesicle. Which of the following represents the MOST likely
diagnosis?
A. Pemphigus
B. Psoriasis
E. Systemic lupus erythematosus

QUESTION: Pemphigus: which was a vesicular disease & which layer it effects? Lichen Planus and pemphigoid = sub epithelial, and pemphigus
is suprabasilar vesicular disease.
QUESTION: Immunofluorescence of antibodies: Pemphigus - intraepithelial, demosomes. Pemphigoid and pemphigus: which one comes apart
from connective tissue?

QUESTION: Immunofluorescence used for dx of: pemphigus or LP

QUESTION: Pic that looked like herpangia in back of palate. Question stated there are Nikoski signs, what is it? Pemphigus
- Erythema multiform & pemphigus vulgaris both show Nikolsky sign

QUESTION: White film w/ positive Nikolsky – pemphigus, tx w/ incisional biopsy
QUESTION: Sloughing of gingiva epithelium in maxillary and mandibular arches: pemphigus or pemphigoid

BENIGN MUCOUS MEMBRANE PEMPHIGOID:
Pemphigoid = D = DEEPER (sub epithelial separation) than pemphigus S = SURFACE (epithelial separation)
Pemphigoid = autoimmune disorder where antibodies attack epidermis. Blisters and vesicles develop
—BMMP—benign mucous membrane pemphigoid. This is DIFFERENT than pemphigus vulgaris
because—less severe and HISTO: vesicles are SUBepidermal and NO acanthylosis.
QUESTION: Subepithelial separation (separation of basement membrane) on immunofluorescence

indicates? benign mucous membrane pemphigoid


LICHEN PLANUS:
Lichen planus = autoimmune mucocutaneous disease
- T lymphocytes target/destroy basal keratinocytes (reason unknown)
- Basal zone vacuolation due to basal keratinocyte destruction
- Hyperkeratosis, lymphocyte infiltrate at the epithelial CT interface
- Epithelium may exhibit a “saw tooth” pattern (loss of rete peg)
- Bilateral on buccal mucosa*
- Reticular type: interlacing lines (Wickhams striae) – white lines
- Tx: corticosteroids

a. pemphigus
b. lichen planus
c. pemphigoid
d. syphilis
- Rete pegs are the epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes.
Development of a "saw-tooth" appearance of the rete pegs, which is much more common in non-oral forms of lichen planus.

QUESTION: Desquamative gingivitis is associated with which two conditions: Lichen planus and pemphigoid
QUESTION: Lichen planus: Target T lymphocyte
QUESTION: Pic of 55 yo woman with erosion: lichen planus (Erosive lichen planus – gingival is magenta to bright red)
QUESTION: Lichen planus more common in women.
QUESTION: Lichen planus, what do you treat with? Topical corticosteroids or anti-histamines
EPIDERMOLYSIS BULLOSA:
Epidermolysis bullosa (EB) = group of inherited connective tissue diseases that cause blisters in the skin &
mucosal membranes. It’s due to a defect in anchoring between the epidermis and dermis, resulting in friction
and skin fragility. Its severity ranges from mild to lethal., usually affects infants/children.

QUESTION: Young child/infant exhibits ulcerations of mouth - epidermolysis bullosa
QUESTION: A child is most likely to have which of these: pemphigus, pemphigoid, erythema multiform,
epidermolysis bullosa
QUESTION: Child formed blisters/ulcerations with minor lip irritation? Epidermolysis bullosa
QUESTION: Which pemphigoid like-lesion most often in infants?
Pemphigus vulgarius
Pemphigoid
Erythema multiform
Epidermolysis bullosa
- small blisters that develop from mild provocation over areas of stress—ie elbows and knees

CANDIDIASIS:

Candida forms – ulcer, erythema, white hyperplastic, white/curd
QUESTION: HIV patient with oropharyngeal candidiasis, what would you prescribe? fluconazole
QUESTION: Which oral medication would you give to tx vaginal candidiasis? Nystatin, griseofulvin, Monistat, Diflucan (fluconazole)
QUESTION: If pt undergoes radiotherapy for cancer, the most common oral infection that necessitates drug tx in this stage is? Candida albicans
QUESTION: Candidiasis in cancer patients due to- chemotherapy, radionecrosis
QUESTION: Pt has multiple white patches that can be scraped off à candidiasis
QUESTION: Oral cytology smears are MOST appropriately used for the diagnosis of which of the following? Pseudomembranous candidiasis
QUESTION: What oral manifestation is often seen in children with HIV? Candidiasis
QUESTION: Systemic medication for Candida: amphotericin B
QUESTION: Lesion in the middle of tongue also pt had it on palate before and pt is healthy? Kaposi, candidiasis, Syphilis
ACTINIC CHEILITIS:

QUESTION: How do you treat actinic cheilitis?

- According to wiki, its 5-fluorouracil or imquimide – block DNA synthesis, but I’m not sure if those were even answer choices.

QUESTION: Actinic Chelitis: lower lip shows epithelial atrophy and focal keratosis à same as Actinic Keratosis
A. Leukoedema
B. Lichen planus
- Actinic chelitis can lead to SCC

QUESTION: What problem causes bilateral angular cheliits?
high vertical dimension
low interocclusal space
high occlusal distance
Low VDO
QUESTION: Angular chelitis for dentures, you need to increase interocclusal space. It’s associated with overclosure.
a. Fungal infection
d. Other options

QUESTION: What problem causes bilateral angular cheliits? high vertical dimension, low interocclusal space, high occlusal distance, Low VDO

MEDIUM RHOMBOID GLOSSITIS:
Median rhomboid glossitis (MRG) = area of redness & loss of lingual papillae, situated on the dorsum of the
tongue in the midline immediately in front of the circumvallate papillae. MRG created by a chronic fungal
infection, and usually is a type of oral candidiasis.
QUESTION: Median rhomboid glossitis — smooth red area of tongue that lacks the lingual papillae
QUESTION: Healthy 36-year-old, red patch on palate, redness in middle of tongue:

- Kaposi sarcoma
- Syphilis
- Median rhomboid glossitis à Candidiasis
- Gonorrhea
HERPES:
st
Gingivostomatitis Herpetica: Initial presentation during the 1 (primary) herpes simplex infection is of greater severity than herpes labialis
(cold sores), which is often the subsequent presentation. It's the most common viral infection of the mouth, affects both the free & attached
mucosa.
- Aphthous ulcers in non-keratinized tissue – herpes in keratinized tissue

Acute (primary) herpetic gingivostomatitis arise between 6 months and 5 years, with peak
prevalence btwn 2-3 years of age. Development before 6 months is rare due to protection of
maternal anti-HSV antibodies.

Drugs that are used for Herpes: Acyclovir, valtrex (valacyclovir), docosanol (abreva), and
PENCICLOVIR

DRUG OF CHOICE:
Acyclovir or (valancyclovir – oral): herpes I, II, VZV, EBV
Ganciclovir (IV): CMV

- 65-90% worldwide; 80-85% USA
QUESTION: Kid with primary herpes infection. What is the age of infection? 2 y/o, 4 y/o, 8 y/o, 10 y/o

QUESTION: Young person w/ fever & oral vesicles: Fever = PRIMARY herpes stomatitis

QUESTION: Ways to treat kid w/ herpetic gingivostomatitis EXCEPT:
a. antibiotics
b. gives numbing anesthetic before eating
c. has pt rest and drink lots of water

QUESTION: Herpes zoster (VZV) – Valacyclovir treats herpes labialis

QUESTION: Patient gets recurrent herpetic lesions very often with gingivostomatitis. What should be done? (herpetic gingivostomatitis)
Acyclovir
Palliative tx
Systemic antibiotics
Steroids
- Treatment includes fluid intake, good oral hygiene and gentle debridement of the mouth. In healthy individuals, the lesions heal
spontaneously in 7–14 days without scarring.

QUESTION: Patient has all clinical signs of herpes (w/ lesion on corner of mouth that comes and goes) which medication do you recommend? –
The one that ended with a vir. (no acyclovir in the answer choices)

QUESTION: Herpes can be diagnosed by exfoliative cytology b/c a characteristic multinucleated cell appears in the smear of herpes infections.

QUESTION: Recurrent intraoral herpes occurs almost exclusively on mucosa overlying bone. The hard palate is the most common site.

QUESTION: best med for herpes, CMV = acyclovir

QUESTION: Secondary herpes? lip, gingival, and palate

QUESTION: Herpetic whitlow - Herpes on finger
- Herpetic whitlow is an intensely painful infection of the hand involving 1 or more fingers that typically affects the
terminal phalanx

QUESTION: Patient comes with recurrent herpetic stomatitis on the lips and history shows no signs of primary herpetic gingivostomatitis. Why?
Most primary infections are subclinical.

QUESTION: Herpetic gingivostomatitis – within 3 days of onset: treat with Acyclovir 15mg/kg 5 times per day for 7 days
- More than 3 days, just do palliative care (plaque removal, systemic NSAIDS, and topical anesthetics). 3 days = borderline.
- Contagious when vesicles are present
QUESTION: Primary herpetic stomatitis? Reactivation of the primary can cause recurrent herpes infection

QUESTION: Which disease is caused by the virus that causes acute herpetic gingivostomatitis? Herpes simplex 1

QUESTION: Herpes lesion intraorally, how do you treat? Palliative, acyclovir? Tx is supportive—topical before eating, analgesics, maintain
fluid/electrolyte balance, anti-viral agents. DO NOT GIVE CORTICOSTEROIDS.

QUESTION: How is Acyclovir selective toxicity mechanism of action? only phosphorylated in infected cells and inhibits viral mRNA
- Acyclovir is selective and low in cytotoxicity as the cellular thymidine kinase of normal, uninfected cells does not use acyclovir effectively
as a substrate.

QUESTION: Post-herpetic neuralgia cause by: (VZV) herpes zoster, HSV 1, HSV 2, CMV
- Complication of long term shingles infection

QUESTION: What does histoplasmosis oral lesion look like? Recurrent herpes
- Painful, ulcer with irregular borders, similar to cancer

QUESTION: Patient has upper denture, when he removes it, there is unilateral lesion on the palate. What could it be? – Herpes (other choices
were more serious pathological lesions).

QUESTION: Pic with half the tongue (left side) that looks like herpes lesion and other nothing on it- herpes zoster

QUESTION: Antivirals (wrong match)- azt with herpes zoster
QUESTION: Kaposi sarcoma by herpes 8 & most likely on hard palate

TRAUMATIC NEUROMA:

QUESTION: A patient has a RPD and a firm, swelling under the buccal flange midway between incisors and molars. What is it? Traumatic
neuroma

QUESTION: Mandibular Denture. Lump hurts & is anterior to posterior areas. What caused it? Traumatic neuroma

PYOGENIC GRANULOMA:
Pyogenic
granuloma is a relatively common, tumor like, exuberant tissue response to localized irritation or
trauma. It can occur anywhere in the oral cavity & develops rapidly.
- 2 lesions, peripheral ossifying fibroma & peripheral giant cell granuloma, are clinically identical to
the pyogenic granuloma when they occur on the gingiva. Peripheral ossifying fibroma & peripheral
giant cell granuloma only occur on the gingiva or alveolar mucosa.

QUESTION: Picture said: “erythematous, bleeding swelling” mandibular swelling right next to premolars on right side? pyogenic granuloma
st
QUESTION: Pink growth on palatal between canine and 1 PM? Papilloma, pyogenic granuloma, peripheral ossifying, irritation fibroma

• fibroma

QUESTION: Fastest growing tumor?
a. oncocytoma
*Peripheral giant cell granuloma EXCLUSIVELY found on gingiva, usually between first molars and incisors
-More likely to cause bone resorption than pyogenic granuloma

QUESTION: Patient is female and pregnant and is said to have this enlargement and picture has it on the corner of her mouth (vermillion
border) and she said it just developed; the picture had it shown as a boil and very red. It bleeds and is not painful – I went with pyogenic
granuloma (other option that could have made sense bc I didn’t know what it was a varix (dilated vein)
- Common in pregnancy & in normal condition

QUESTION: Fast growing Lesion on gingiva that blanches and bleeds easily when pressed? pyogenic granuloma

Giant Cell Granuloma – multilocular radiolucent benign jaw condition, most common in anterior max/man, & in younger people, especially
women. They are characterized by large lesion that expand the cortical plate & can resorb root + move teeth.

QUESTION: Where do you find giant cells? Hyperthyroidism, Hypothyroidism, Hyperparathyroidism, Hypoparathyroid

QUESTION: Giant cell lesion found in bone, what test would you run to help with diagnosis? Bence Jones (from multiple myeloma), calcium
levels, Complete blood count

QUESTION: Giant cell lesion is most like histology of congenital epulis of the newborn. NO! —Granular cell Myeloma

SQUAMOUS PAPILLOMA:

Squamous cell papilloma = caused by infection with the human papillomavirus (HPV). When
Text
the papilloma’s are found on the skin, they are more commonly referred to as warts or verrucas.
- most common benign neoplasm of EPITHELIAL TISSUE ORIGIN.
- It appears as apedunculated (foot-shaped), or sessile whitish cauliflower-like mass on the tongue
(posterior border), lips, gingiva, or soft palate.

QUESTION: Lesion on the palate that verrucous and pedunculated - Papilloma
QUESTION: The causes of Verrucous xanthoma? Human papilloma virus

- Xanthoma = fatty deposits under skin

QUESTION: Lesion in lip with cauliflower shape: Papilloma

QUESTION: The most common between five choices?
1- Papilloma
2- Rhabdomyoma
3- Leiomyoma
4- Lymphangioma
5- Neurofibromatosis

CONDYLOMA ACUMINATUM:
Condyloma acuminatum = epidermal manifestation attributed to the epidermotropic human

papillomavirus (HPV).
QUESTION: Condyloma acuminatum (genital/venereal wart) is caused by which virus? HPV

QUESTION: Which of the following does not have cauliflower-like, pebbly appearance? Verrucous carcinoma, fibroma, condyloma accuminata,
papilloma.

QUESTION: HPV know the subtypes, 6 & 11 for condyloma acumintam
- HPV types 6 & 11 are most frequently the cause of genital warts

FIBROMA:
Fibroma = benign tumors composed of fibrous/CT tissue.
Epilus Fissuratum = benign hyperplasia of fibrous CT, which develops as reactive lesion to chronic mechanical
irrigation produced by flange of poor fitting dentures.
QUESTION: Epulis fissuratum is most similar cellularly to: fibroma, granuloma cell tumor, etc
- Fibroma (and a question about how to treat a patient with old denture and epulis – usually make new denture or modify; don’t just
wear same denture)
QUESTION: There was a picture of fibroma but the term fibroma was not used instead they used another name: Focal Fibrous Hyperplasia
QUESTION: Fibromas are a result of what dysfunction? Neoplasia, dysplasia, hyperplasia

QUESTION: In most of the cases, localized fibromas are often: Dysplasia, metaplasia, anaplasia, hyperplasia
Granular cell tumor (Granular cell nerve sheath tumor, Granular cell schwannoma) = tumor that can develop on any skin or mucosal surface,
but occurs on the tongue 40% of the time. It’s pseudoepitheliomatus hyperplasia: resembles SCC & congenital epulis. It is seen in inflammatory
papillary hyperplasia, chronic hyperplastic candida, & blastomycosis.
QUESTION: Congenital epulis histological similar to: hemangioma, lymphangioma, granular cell myoblastoma

LEUKOPLAKIA:
QUESTION: If you have leukoplakia for biopsy, do you incise or excise for biopsy? Incision
- incise multiple areas w incisional biopsy

Erythroplakia:
QUESTION: In smoker’s soft palate, there are red points. What could it be? Erythroplakia, initial stages of SCC, nicotinic stomatitis (hard
palate), etc.

QUESTION: What presents with severe dysplasia? Erythroplakia, white sponge nevus
QUESTION: Lesion commonly with dysplasia and carcinoma in situ -- Erythroplakia
QUESTION: White ppl have least oral carcinoma. Black men have the worst rate of SCC.
QUESTION: Etiology of Squamous Cell Carcinoma, external factors and stress: Alcohol, tobacco, UV radiation,
certain HPV types, vitamin deficiency, immunocompromised, iron deficiency anemia – plummer Vinson
syndrome
- Xerostomia increases risk of SCC.
QUESTION: Lateral boarder of the tongue picture looked like squamous cell carcinoma.

QUESTION: Lesion that resembles SCC. 16 weeks and then disappears.
a. papilloma
b. keratoacanthoma
- skin tumor that can occur on sun-exposed areas

b. adenocarcinoma
c. osteosarcoma

QUESTION: SCC on tongue, what you do? Incisional
QUESTION: What is the #1 risk factor for oral cancer? Tobacco
QUESTION: Most likely site for SCC? Ventrolateral tongue (other choices were weird…palate (least)…)
QUESTION: Chewing Betel nut can lead to à SCC, xerostomia, gingival recession

QUESTION: Pt has been a smoker (60 pack yr. history) & has ulcer in lower lip. Ulcer is non-indurated; what’s the most probable diagnosis? SCC

e. adenoid cystic ca (second most common salivary gland carcinoma)
QUESTION: Most malignant cancer in oral cavity? Epidermoid carcinoma (SCC)
QUESTION: Which of these is the most likely to become malignant? low grade mucoepidermoid carcinoma

QUESTION: What race most likely to get oropharyngeal cancer? black

QUESTION: What percentage gets oral cancer? 3% of new cancers among males & 1.6% of new cancer among females


QUESTION: What population has the worst survival rate for SCC? Black

QUESTION: Lowest 5-year oral cancer survival rate? black people

VERRUCOUS CARCINOMA:
Verrucous carcinoma (VC, "Snuff dipper's cancer") is an uncommon variant of SCC. Usually seen in those who chew tobacco or use snuff orally.
Most patients with verrucous carcinoma have a good prognosis due to rarity of metastasis.
- large broad based exophytic papillary leukoplakic lesion
QUESTION: Which one has the best prognosis?

Verrucous carcinoma in vestibule
verrucous carcinoma floor of mouth
SCC floor of mouth
SCC in other areas
QUESTION: Smokeless tobacco: verrucous carcinoma
QUESTION: Verrucous leukoplakia - HPV 16 and 18
QUESTION: Most common most pathogenic location for verrucous carcinoma: buccal vestibule

QUESTION: Verrucous carcinoma presents with:
• warty lesion
• large warty mass- variant of SCC

LEUKOEDEMA:
QUESTION: Leukoedema – blue/grey/white mucosa that blanches. It disappears when stretching. Mostly
bilateral. No treatment.

QUESTION: A patient presents with a bilateral, grayish-white lesion of the buccal mucosa. This lesion disappears
when the mucosa is stretched. Which of the following is the MOST likely condition?
A. Leukoedema
B. Leukoplakia
C. Lichen planus

LEUKEMIA:

Lymphocytic leukemia - involves Lymphocytes.

Chronic lymphocytic leukemia runs a variable course (older patients may survive years even without treatment). Lymph node enlargement is
the main pathologic finding. May be complicated by autoimmune hemolytic anemia.

CML (Chronic myelogenous leukemia) – Philadelphia chromosome 22 (chromosomal translocation)

o 20 yr. old patient

QUESTION: Patient shows up with kid that has bleeding gums, problems healing & has discomfort – leukemia
QUESTION: Leukemia Picture: young person that is fatigued and has a jacked-up mouth, looks like multi pyrogenic granuloma, very inflamed
and red gums.
QUESTION: Most common type of leukemia in children? ALL (lymphoblastic)
QUESTION: Pt had erythematous and gingival enlargement over past 5 weeks. And increased report of bruising on body – cause is acute
leukemia: Specifically, AML
QUESTION: 6 years old patient has acute lymphatic leukemia (ALL). Her deciduous molar has a large carious lesion and furcation lucency. How
will you treat this person?
STIMULATED SALIVA FLOW:
a. pulpotomy
1.5-2mL/min = normal
b. pulpectomy < 0.7 mL/min = hyposalivation
c. extraction
d. nothing

SALIVARY GLAND TUMORS:

Salivary gland tumors: most are benign but the parotid glands still are where most malignant (cancerous) salivary gland tumors start. Classified
as:
- major salivary glands consist of the parotid, submandibular, and sublingual glands.
- minor glands include small mucus-secreting glands located throughout the palate, nasal and oral cavity.

Most common salivary gland benign major or minor: Pleomorphic adenoma (benign mixed tumor)
Most common malignant major: Mucoepidermoid carcinoma
Most common malignant minor: Adenoid cystic carcinoma
Adenoid cystic carcinoma: high grade salivary malignancy, most common malignancy
o “Swiss cheese” microscopic pattern
o spreads through perinueral spaces**

Necrotizing sialometaplasia - minor salivary gland disease presents on the palate which is most commonly confused with carcinomas due to the
ulcerated presentation. Heals without scarring.

QUESTION: Picture of an ulcerated tumor on palate? SCC, salivary gland tumor, tori

QUESTION: Adenoid cystic carcinoma – best prognosis of malignancy


QUESTION: Which of the salivary tumor glands has the best prognosis: Mixed Tumor (plemomorphic adenoma), Adenoid cystic carcinoma
(perineural spread), Mucoepidormoid Carcinoma (most common)
- Malig Mixed tumor & adenomatoid = worst
QUESTION: Peri-neural invasion is seen in: adenoid cystic carcinoma (ACC), Pleomorphic adenoma, low grade mucoepidermoid carcinoma, OKC
- ACC tumor has a marked tendency to invade nerves. Perineural invasion is seen in about 80% of all specimens.

QUESTION: Which has swish cheese appearance? Adenoid cystic carcinoma

WARTIN TUMOR:

Warthin tumor (adenolymphoma) = benign cystic tumor of the salivary glands containing abundant lymphocytes and germinal centers

QUESTION: Warthin tumor is most common in what gland? Parotid (don’t get mixed up with Wharton’s duct)

*Entirely odontogenic epithelium. The most aggressive
Ameloblastoma: odontogenic tumor.
Ameloblastoma is a most aggressive & the most common epithelial odontogenic tumor. Mostly in mandibular molar area. Solid, well-defined,
multicystic or polycystic (“soap bubble”) lesion – most aggressive kind and requires surgical excision

- Usually associated w/ impacted teeth
reverse polarization (follicular type), nucleus moves away
Ameloblastic fibroma and ameloblastic fibro-odontoma

kids about 12 years old (up to age 40)
QUESTION: Ameloblastoma histology: stellate reticulum in bell stage, epithelium in net flex pattern
- stellate reticulum is a group of cells located in the center of the enamel organ of a developing tooth.
QUESTION: Which one can lead to ameloblastoma? Dentigerous Cyst
QUESTION: Which describes ameloblastoma best? local invasion
QUESTION: What is the most definite way to distinguish ameloblastoma from OKC?
a. smear cytology
b. reactive light microscopy
c. reflective microscopy
QUESTION: Ameloblastoma: You get a picture, slow progressing, other false choices included dentigerous cyst.
QUESTION: X-ray: A painless, well-circumscribed radiolucency and radioopacity in the posterior mandible of 11 yrs old boy. What is the
differential diagnosis? Ameloblastic fibro – Odontoma
DENTIGEROUS CYST:

QUESTION: Which lesion can become ameloblastomic? dentigerous cyst, lymphedema, epidermoid

QUESTION: Radiographic picture: upside down molar with lucency around crown, what is it?
Dentigerous cyst
STARTS AT CEJ

a. dentigerous
b. residual
c. radicular

ODONTOMA:

Usually anterior jaws
Usually posterior jaws
Odontoma = benign tumor of odontogenic origin, commonly in mandible. It starts off lucent but develops small
calcification to be radiodense lesion, can give rise to dentigerous cyst, divided into 2 categories:
- Complex Odontoma – irregular calcified lesions w/ no distinct tooth components
- Compound Odontoma – identifiable tooth components
QUESTION: X-ray of compound Odontoma

- Compound odontoma - looks like a tooth more defined; complex odontoma – giant mass that is radiopaque but doesn’t look like a
tooth.
Text
QUESTION: Syndrome associated with multiple odontoma- Gardner’s syndrome Pindborg tumor = CEOT = likes molar ramus area , jaw expansion, >40 years old
QUESTION: Picture of multiple small teeth within a radiolucency around the canine: compound odontoma, pindborg tumor, calcifying
odontogenic
- Tumor of mixed (epithelial and mesenchymal) origin is the odontoma. These calcified lesions take 1-2 general configurations. They may
appear as multiple miniature or rudimentary teeth (compound odontoma).

ADENOMATOID ODONTOGENIC TUMOR (AOT): Females, anterior jaws

Adenomatoid odontogenic tumor arises from the enamel organ or dental lamina. It’s mostly young females,
maxillary, & usually associated w/ unerupted permanent tooth.
- 2/3 tumor: adenomatoid odontogenic tumor: 2/3 in maxilla, 2/3 in female, 2/3 in anterior jaw
QUESTION: AOT (Adenomatoid odontogenic tumor) radiograph picture (9Exact picture used)
QUESTION: Radiolucency at the end of a tooth that looks like there might be an AOT but the patient is having
symptoms (I wrote periapical cyst)

QUESTION: Radiolucent lesion Between maxillary canine-lateral with radiopacity inside: adenomatoid tumor (AOT)
- REMEMBER lesion goes to apex

QUESTION: Mixed density lesion in a young child: AOT

QUESTION: 16 y/o boy: x-ray showed maxillary anterior tooth with a radiolucency with “SPECKS” in it (yes that’s the word that was used) -
Adenomatoid Odontogenic Tumor

AMELOGENESIS IMPERFECTA:
Amelogenesis imperfecta = malfunction of the proteins in the enamel: ameloblastin, enamelin, tuftelin and amelogenin. People afflicted with
amelogenesis imperfecta have teeth with abnormal color (yellow, brown or grey) and have rapid attrition, excessive calculus deposition, and
gingival hyperplasia.

QUESTION: Amelogenesis imperfecta is autosomal dominant.
QUESTION: Pictures of teeth, premolars just erupted. Thick dentin, thin enamel, pulps not obliterated, and no
teeth contact – Amelogenesis imperfecta
- Amelogenesis imperfecta in X-ray shows open contacts

radiolucency, what another thing do you see? Amelogenesis imperfecta (tooth lacks enamel)

QUESTION: Know the Amelogenesis Imperfecta: Hypoplastic pitting enamel

CALCIFYING ODONTOGENIC CYST/GORLIN CYST:

QUESTION: “Ghost cells” - keratinized calcifying odontogenic cyst

REGIONAL ODONTODYSPLASIA:

QUESTION: When does enamel hypoplasia occur? Altered matrix formation (BELL STAGE)

c. regional odontodysplasia (or odontogenesis imperfecta)

QUESTION: Regional odontodysplasia: ghost teeth. (enamel, dentin and pulp are all affected. Non hereditary, eruption is delayed or doesn’t
occur)
DENTIOGENESIS IMPERFECTA vs DENTINAL DYSPLASIA:
Dentiogenesis Imperfecta: Crowns are short & bulbous, narrow roots, obliterated pulp
- DI Type 1 is with osteogenic imperfecta. DI Type 2 is not with OI. DI Type 3 is the bradywine type,
which occurs in absence of OI, exhibits multiple periapical radiolucency, shell-like appearance, &
large pulp chambers/exposures.
Dential Dysplasia: Clinically, the dental crowns appear normal while radiographically, the teeth are
characterized by pulpal obliteration, short blunted roots, & sometimes, PARL. The teeth are generally mobile, frequently abscess and can be
lost prematurely.
- DD Type 1 – radicular: shorter roots, obliterated pulp chamber.

- DD Type 2 – coronal: pulp enlarged, “thistle” tube appearance, primary dentition appears similar to DI type II.
QUESTION: X-ray: Dentiogenesis Imperfecta – obliterated pulp chamber
THIS PICTURE, KNOW IT WELL
QUESTION: What is seen with Osteogenesis Imperfecta? Dentinogenesis Imperfecta
QUESTION: Osteogenesis imperfecta is usually associated with/seen with?

a. Dentinogenesis Imperfecta (DI)
b. Amelogenesis imperfecta
c. hypercementosis

QUESTION: All of the following are differential diagnosis for Dentinogensis imperfecta except?
ectodermal dysplasia
amelogenesis imperfecta
enamel dysplasia
dentinal dysplasia
enamel hypoplasia (AI)

QUESTION: Which is not associated with dentogenesis imperfecta? Ectodermal dysplasia because the enamel is the ectoderm, dentin is
mesoderm I think

QUESTION: Dentinogenesis Imperfecta = poorly mineralized dentin, enamel frequently fractures from the teeth leading to rapid wear and
attrition of the teeth.

QUESTION: Dentinogenesis imperfect type I is a part of osteogenesis imperfect. Has BLUE SCLERA or it can be a separate inherited dominant
trait without OI (DI type II)

• Blue sclera (this is from osteogenesis imperfecta)
• hypodontia
- Other characteristics of this condition: opalescent teeth, affects both primary and permanent, teeth are bluish-brown and translucent,
enamel is lost early.
- Blue sclera seen in? Osteogenesis imperfecta
QUESTION: Radiographs of a patient's teeth reveal that the crowns are bulbous; the pulps, obliterated; and the roots, shortened. These
findings are associated with which of the following?
Porphyria

QUESTION: What is the most common? Dentinal dysplasia, amelogenesis imperfecta, dentinogenesis imperfecta, cleft lip (Cleft Lip/palate)

QUESTION: Dentin dysplasia looks like dentinogenesis imperfect WITH ONE DIFFERENCE? Dysplasia has radiolucency.

QUESTION: 12 y/o boy’s X-ray shows roots are short & open apex. Sister also has same condition. What condition is this?
DI - autosomal dominant
AI - autosomal recessive
Dentin dysplasia – autosomal dominant
QUESTION: Some teeth appear to be clinically normal, but exhibit (1) globular dentin, (2) very early pulpal obliteration, (3) defective root
formation, (4) periapical granulomas and cysts, and (5) premature exfoliation. The condition is known as which of the following?
A. Shell teeth
B. Dentin dysplasia
C. Regional odontodysplasia
D. Amelogenesis imperfect
E. Dentinogenesis imperfecta
ECTODERMAL DYSPLASIA:
Ectodermal dysplasia = X-linked conditions in which there are abnormalities of 2 or more ectodermal structures (ex. hair, teeth, nails, sweat
glands, salivary glands, cranial-facial structure, digits). During tooth bud development, it frequently results in congenitally absent teeth (in many
cases, a lack of a permanent set) and/or in the growth of teeth that are peg-shaped or pointed.
- Teeth develop abnormally causing anodontia or oligodontia (partial). Retained primary teeth. CONICAL shaped anterior teeth.
QUESTION: Ectodermal dysplasia expressed as? anodontia or hypodontia, with or without a cleft lip and palate.


QUESTION: Ectodermal dysplasia: which of the following is correct? It is X-linked, not autosomal dominant

QUESTION: Characteristic of Ectodermal Dysplasia is? Oligodontia (some missing teeth, > 6 teeth, not all teeth) and hypohidrotic (reduced
sweating) or anhidrosis (lack of sweating)

QUESTION: Ectodermal dysplasia: partial or complete anodontia

QUESTION: Hypohidrotic child à ectodermal dysplasia
- Sweating dysfunction, abnormal reduced of sweating due to heat

QUESTION: Having hypodontia will prevent/undermine formation of what? Alveolus (others were maxillary and mandibular arch but not
together)

1. max deficiency
2. man deficiency
- Less teeth à reduced alveolar ridge development so the vertical dimension of the lower face is reduced
Cherubim:
Cherubim - Autosomal dominant condition characterized by abnormal bone tissue in the lower part of the face. In early childhood, both the
mandible & maxilla become enlarged as bone is replaced with painless, cyst-like growths.
QUESTION: Cherubim: Bilateral jaw expansion

QUESTION: A kid presents for bilateral enlargement, painless, etc. (they are implying Cherubim), what is the Tx? No Tx required

FIBROUS DYSPLASIA:
Fibrous dysplasia = bone disorder where scar-like (fibrous) tissue develops in place of
normal bone. This can weaken the affected bone & cause it to deform or fracture.
**Mccune-Albright Syndrome — polyostotic fibrous dysplasia—areas of

radiolucent/radiopaque---potential for malignant transformation
*at risk for osteosarcoma
QUESTION: Fibrous Dysplasia – ground glass appearance, diffuse expansion of the

mandible (“orange peel”)

- fibrous dysplasia: it is diffuse radiopacity-vital tooth
- osseous fibroma: radiolucent vital tooth
- Cementous dysplasia

QUESTION: 35 yo female, picture of a couple of radiolucency lateral to lateral incisors, asymptomatic: fibrous dysplasia
- Monostotic fibrous dysplasia may be completely asymptomatic and is often an incidental finding on x-ray

QUESTION: Which of the following is frequently accompanied by melanin pigmentation (cafe-au- lait spots)?
A. Osteomalacia
D. Polyostotic fibrous dysplasia (Mccune-Albright Syndrome)

QUESTION: McCune Albright’s Syndrome – Café au lait spots (coast of Maine)—bone and skin disorder—brown spots!

CONDENSING OSTEITIS:
Condensing osteitis = periapical inflammatory disease that results from a reaction to a dental infection. It
causes more bone production rather than bone destruction in the area (most common site is near the root
apices of premolars and molars).
- appears as a radiopacity in the periapical area due to the sclerotic reaction.

QUESTION: X-ray, what is the cause of radioopacity on the apex of the infected tooth - condensing osteitis

QUESTION: All are lesion are radiolucent except? Condensing osteitis (radiopaque)

TRAMUATIC (SIMPLE) BONE CYST:
Traumatic bone cyst (simple bone cyst) = nothing inside, not a true cyst b/c not epithelial lined so pseudocyst
that heals by itself. It scallops around the roots of the tooth.

QUESTION: Picture said: “scalloped border, tooth is vital, patient is asymptomatic” traumatic bone cyst

QUESTION: Young patient with traumatic bone cyst, what tx?
None, spontaneous healing
Surgical exploration
curettage of the osseous socket and bony walls
intralesional steroid injections
PAGET’S DISEASE OF BONE:
Paget’s Disease (Osteitis Deformans) = chronic bone disorder where bones become enlarged &
deformed – dense but fragile. Seen in pts OLDER pts. Dentures stop fitting. Develops slowly.
COTTON WOOL appearance, hypercementosis, and loss of lamina dura.
- Labs – INCREASE serum ALKALINE phosphatase but normal serum phosphate and calcium.
Risk of osteosarcomas.

QUESTION: Pagets disease à increase serum alkaline phosphatase
QUESTION: Which one most likely has potential (high incidence) for malignant transformation?
osteomas, Paget’s disease

QUESTION: Which of the following has the potential for undergoing spontaneous malignant transformation?
A. Osteomalacia

QUESTION: Paget’s disease can lead to osteosarcoma (malignancy)

QUESTION: Denture does not fit anymore as a result of? Paget’s disease

LANGERHANS CELL HISTOCYTOSIS X:
Langerhans cell histiocytosis (LCH) = rare disease w/ clonal proliferation of Langerhans cells, abnormal cells
deriving from bone marrow and capable of migrating from skin to lymph nodes.
- Hand–Schüller–Christian disease is associated with multifocal Langerhans cell histiocytosis.
- Oral signs: bad breath, sore mouth, loose teeth. Lesion are sharply punched out radiolucency & teeth
appear as FLOATING IN AIR

QUESTION: Radiographic picture: Floating tooth not in bone, opacities in lesion, what is it?
• Whole jaw cyst
• Ameloblastoma
• Keratocyst
• Langerhans X

QUESTION: Hand-Schuller-Christian triad: Diabetes insipidus, exophthalmos, & lytic bone lesions (Langerhans dis).

NASOLABIAL CYST:
Nasolabial cyst (nasoalveolar cyst, Klestadt`s cyst) = rare non-odontogenic, soft-tissue,

developmental cyst occurring inferior to the nasal alar region. Derived from epithelial cells
retained in the mesenchyme after fusion of the medial & lateral nasal processes + maxillary
prominence or due to the persistence of epithelial remnants from the nasolacrimal duct
extending between the lateral nasal process and the maxillary prominence.
- Patient usually presents with a slowly enlarging asymptomatic swelling.
QUESTION: Not a bone cyst? Nasolabial cyst b/c it occurs outside of bone & is a soft-tissue cyst

QUESTION: Which one is soft tissue involvement, not bone? Nasolabial Cyst

QUESTION: A patient has a swelling under the upper lip that is by her lateral incisor and raises the ala of the nose from the outside. What is it?
Nasolabial cyst

QUESTION: Radiolucency radiating from root of central incisor toward midline, could be all of the below except: lateral periodontal cyst,
nasopalatine cyst, some sort of fibrous dysplasia, nasolabial cyst

QUESTION: Which one not seen radiographically? Nasolabial cyst
- Because this cyst is extra osseous, it is not likely to be seen on a radiograph.
QUESTION: Lining of nasolabial cyst - pseudostratified squamous

NASOPLATATINE CYST:
QUESTION: The most common non-odontogenic cyst:
a. dermoid
b. thyroglossal
c. lymphoepithelial
d. nasopalatine duct cyst

QUESTION: Nasopalatine X-ray- heart shaped near central incisors

QUESTION: Nasopalatine cyst treatment? Enucleation

QUESTION: Intraoral picture of nasopalatine cyst by incisive papilla on backside of #7 & 8. The foramen and nasopalatine canal is where the
incisive papilla is and if there’s a cyst there then what does it look like clinically? Soft tissue is swelling and discolored.

LYMPHOEPITHELIAL CYST:
- Usually an enlargement of the parotid or lacrimal gland
QUESTION: Round yellow-white bump underneath tongue? Lymphoepithilial cyst? Yellowish cyst on floor of mouth? Oral lymphoepithelial cyst

QUESTION: Patient (young child) w/ nodules on right side of tongue that are fluid filled the rest of the mouth is WNL, no other systemic signs
b. Lymphangioma *

ODONTOGENIC KERATOCYST:
Keratocystic odontogenic tumor (OKC) = rare benign but locally aggressive developmental cystic neoplasm. It
often affects the posterior mandible but can extend to maxillary. Usually, a lucent uniloclar lesions extending
along mandible, presents with swelling & pain, & has a high reoccurrence rate.
- Originates from epithelial cell rests (stratified squamous keratinizing epithelium).

- basal cell nevus syndrome (a.k.a. Gorlin’s syndrome, multiple OKC’s seen)
QUESTION: Which highest incidence of recurrence?

• Odontogenic keratocyst
- High recurrence, Intrabony, posterior mandible but anywhere; BCNS association

QUESTION: Initial treatment for OKC is enucleate or resect?
- Conservative treatment generally includes simple enucleation, with or without curettage

NEVOID BASAL CELL CARCINOMA:
Nevoid basal cell carcinoma (Gorlin syndrome) = commonly see multiple OKCs and palmar pitting, plantar keratosis (odontogenic keratin cyst,
KCOT)

QUESTION: Pt has calcified falx cerebri, multiple OKCs, bifid ribs. What syndrome does the patient have? Gorlin Goltz syndrome aka Basal cell
bifid rib syndrome.
QUESTION: What else most often seen with nevoid basal cell carcinoma? Odontogenic keratocyst
QUESTION: What does multiple OKC tell you? Gorlin-gotz syndrome (also called basal cell nevus syndrome)

QUESTION: Nevoid basal cell carcinoma causes – cyst in the jaws

QUESTION: Nevoid BCC and palmar melatonin indicative of: OKC

GARDNER’S SYNDROME:
Gardner syndrome, a variant of familial adenomatous polyposis (FAP), is an autosomal

dominant disease characterized by GI polyps, multiple osteomas, and skin/soft tissue
tumors. Cutaneous findings of Gardner syndrome include epidermoid cysts, desmoid
tumors, and other benign tumors.
QUESTION: Which syndrome includes multiple osteomas? Gardner’s (Multiple facial

osteomas & skin nodules)
QUESTION: Gardner’s syndrome has multiple osteoma, odontoma and intestinal polyps
QUESTION: What do Gardners and Peutz-Jeghers syndrome have in common? GI polyps

- GI polps in Gardner’s, Peutz-Jegher, Crohn’s

QUESTION: In Gardner’s Syndrome, there may be cancerous transform of what? polyps in intestine

PEUTZ-JEGHERS SYNDROME:

Peutz–Jeghers syndrome = autosomal dominant disorder characterized by the development of benign
hamartomatous polyps in the GI tract & hyp agonists for the insulin receptor, pigmented macules on the
lips and oral mucosa (melanosis)

QUESTION: Peutz Jeghers and Pierre showed up on my exam. They gave only description and you had to
diagnose.
QUESTION: Peutz Jeger syndrome? Not cafe au lait, but freckles on lips.
QUESTION: Peutz-Jeghers syndrome – multiple melanotic macules and gastrointestinal polyposis
QUESTION: Peut-jeghers syndrome: intraoral melanin pigmentation & multiple intestinal polyps

BELL’S PALSY:
Bell's palsy = unilateral facial paralysis with no known cause, except that there is a loss of excitability of the
involved facial nerve. The paralysis onset is abrupt & most symptoms reach their peak in 2 days. One theory of its
cause is that the facial nerve becomes inflamed within the temporal bone, possibly with a viral etiology.

QUESTION: Photo of a black person w/ unilateral eye & lip, unable to close. ID the condition? Bell’s Palsy

QUESTION: What causes bell’s palsy? idiopathic

th
QUESTION: Which cranial nerve affected bell’s palsy? Facial nerve (7 )

ERYTHEMA MULTIFORME:
Erythema multiforme = skin condition of unknown cause, possibly mediated by deposition of immune
complexes (mostly IgM) in the superficial microvasculature of the skin & oral mucous membrane that
usually follows an infection or drug exposure.
- Nikolsky sign - top layers of the skin slip away from the lower layers when slightly rubbed.
QUESTION: Steven-Johnson syndrome? conjunctiva and genital problems
- Stevens–Johnson syndrome, a form of toxic epidermal necrolysis, is a life-threatening skin
condition, in which cell death causes the epidermis to separate from the dermis
QUESTION: Blow cold air on mucosa causing a positive Nikosky sign a) erythema multiform b) herpes c) pemphigoid d) epidermolysis bullosa
NO PEMPHIGUS AS ANS CHOICE.

SCLERODERMA:

Scleroderma (systemic sclerosis) = chronic systemic autoimmune disease characterized by hardening (sclero) of the skin (derma) & CT. Blue
fingers, hair loss, skin hardness & skin that is abnormally dark/light.
- scleroderma - symmetrical widening of PDL and deposition of collagen in organs leads to organ failure.

QUESTION: Widening of PDL and loss of mandibular ramus: Scleroderma
QUESTION: CREST Syndrome = limited SCLERODERMA (usually only in lower arms & legs, sometimes face & throat)
GEOGRAPHIC TONGUE (ERYTHEMA MIGRANS):
Geographic tongue (benign migratory glossitis, erythema migrans) = inflammation of mucous membrane of tongue,
usually on dorsal surface.
- Characterized by areas of smooth, red depapillation (loss of lingual papillae) which migrate over time. Cause is
unknown but condition is benign.
QUESTION: Description of geographic tongue: burning sensation on the tongue, moves around

QUESTION: Migratory glossitis picture: red-white borders – Erythema migrans

QUESTION: Guy with lesions on his tongue that seem to move locations? Erythema migrans

QUESTION: Cause of geographic tongue: unknown

QUESTION: Lesion hurts after eating spicy food, has white lesions with red borders that move: Geographic tongue

BASAL CELL CARCINOMA:
BCCs =
abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest
layer of the epidermis.
QUESTION: Oral path picture of Basal Cell carcinoma: round bluish lesion on side of lip

MUCOCELE:

Mucocele = caused by ruptured salivary duct, commonly seen on the lower lip, & usually due to trauma.
- NEVER ON THE GINGIVA


QUESTION: Patient had SSC removed and now has a mucocele looking lesion on the lower lip, what is it? mucocele, other choices fibroma, SSC

QUESTION: You get mucocele due to? Rupture of salivary ducts (trauma related)

RANULA:

Ranula = noncancerous cyst-like swelling of CT consisting of collected mucus from a ruptured salivary gland caused by local trauma.
- Texture/consistency of dermoid cyst vs ranula: dermoid is doughy/rubbery consistency while ranula is more fluctuant, bluish

QUESTION: Ranula à blue mass under tongue, blue nodule on the floor of mouth, fluctuant

QUESTION: Lady presents w/ blue swelling under tongue? ranula

QUESTION: Ranula are due to?
sialolith
mucus plug
trauma
fibrous plug

• Mucocele
• Ranula

nQUESTION: How do you treat a ranula? excise (all of it)/excisional, incisional, aspiration

SIALOLITHIASIS + ANTRAL PSEUDOCYST

Sialodochitis (ductal sialadenitis) = inflammation of the duct system of a salivary gland. On sialography, it may appear as segments of duct
dilation & stenosis. This is sometimes termed the 'sausage link appearance'.

QUESTION: Sialolithiasis (calcified salivary stone) is found where? Submandibular Duct (Wharton’s)
QUESTION: Sialoliths are most common in what gland? Submandibular gland & duct
QUESTION: Some histology question about the paratoid gland. Mentions “SAUSAGE LINKS”: Answer is Sialodochitis

QUESTION: Parotid gland – Chronic sialodochitosis

QUESTION: Patients with sialadenitis (actini enlarge) caused by sialith in the duct.
QUESTION: How do you treat painful sialolith in Wharton’s duct initially?
Moist heat
Dilation of duct
- If it is a smaller stone, moist heat is the first option

QUESTION: Patients with sialadenitis (actini enlarge) caused by sialith in the duct. It is a large, painful sialoth near the orifice of Wharton’s duct.
What procedure do you do for removal?
c. cannulation & dilation (Cannulate the duct (sialotomy) to remove stone)
QUESTION: Mucous retention cyst

QUESTION: Something in maxilla Antral pseudocyst?
- The mucocele is destructive and requires surgery while the Antral Pseudocyst (mucous retention pseudocyst) does not require
intervention and will dissipate.

- A radiographic anatomical landmark: The Y line of Ennis (Inverted Y). It is created by the superimposition of the floor of the nasal cavity
(straight radiopaque line) and the border of the maxillary sinus (curved radiopaque line).

QUESTION: What is the inverted Y made up of? Maxillary sinus & floor of nasal cavity
QUESTION: What is the isthmus of Y (where nasal floor (straight radiopaque line) and maxillary sinus (curved radiopaque line) start and meet).
What are the two anatomical factors that border this? Floor of nasal cavity & maxillary sinus
QUESTION: Radiograph of earlobe and turbinate: inferior nasal turbinate, mucous retention cyst or antral pseudocyst in maxillary sinus
QUESTION: Photo of maxillary sinus with radiopacity in one of the sinus and you have to identify the condition:
mucous retention cyst à antral cyst

QUESTION: Antral pseudocyst

ANKYLOGLOSSIA:

QUESTION: Ankylglossitis- tongue tied
- congenital oral anomaly that may decrease mobility of the tongue tip & is caused by an unusually short, thick
lingual frenulum from tongue to FOM.

PARULIS (GUM BOIL):

Parulis = localized collection of pus in gingival soft tissue. Pus is produced as a result of necrosis of non-vital pulp
tissue or occlusion of a deep periodontal pocket.
QUESTION: picture of #30 RCT tooth à parulis
Carcinoma = epithelial neoplasm
QUESTION: Reason for parulis - incomplete root canal Sarcoma = mesenchymal neoplasm

TUBERCULOSIS:

Oral signs of tuberculosis = cervical lymph nodes, larynx, and middle ear. TB oral lesions are uncommon - usually chronic painless ulcers.
- Primary lesions usually enlarged lymph nodes.
- Secondary lesions on tongue, palate and lip. Rare is leukoplakic areas.

QUESTION: What does tuberculosis lesion in the oral cavity look like? Large ulcer
- Painful nonhealing indurated often multiple ulcers
- Most frequently affected sites were the tongue base & gingiva. The oral lesions look like irregular ulceration or a discrete granular mass.

HEMANGIOMA/EXTRAVASATED BLOOD:

- Hemangiomas – positive test for blanching
QUESTION: 4 yr. old kid has hemangioma on his tongue from birth. It grew at the same rate he did. What is
it? chroistoma, hamartoma, teratoma
HAMARTOMA- Normal tissue overgrowth. It grows at the same rate as surrounding tissues.
CHORISTOMA- TISSUE overgrowth in wrong location
QUESTION: What goes away from mouth by itself? Ecchymosis
- Ecchymosis - a discoloration of the skin resulting from bleeding underneath, typically caused by
bruising.

ALLERGIC MUCOSITIS:

QUESTION: Allergic stomatitis of the mouth is commonly seen because of what flavors in a toothpaste? Cinnamon
QUESTION: Causes of allergic gingivitis include:
a. flavoring in toothpaste
QUESTION: Patient has red gums and is told she has “plasma cell gingivitis”. Common cause is? cinnamon flavoring in the dentrifice

CROHN’S DISEASE:

QUESTION: Child with granulomatous gingival hypertrophy and bleeding rectal-anus has what? Crohn’s
- Crohn’s = chronic inflammatory bowel disease that affects the lining of the GI tract.

QUESTION: Oral granulomas, apthous ulcer, rectal bleeding is seen in:
a. Wegener’s granulomatosis
c. Crohn’s disease

DERMOID CYST:
A Ranula
B. Dermoid cyst
C Lymphoepithelial cyst
- dermoid cyst is a firm, dough-like, sac-like growth on or in the skin that is present at birth & range in
size.
WHITE SPONGE NEVUS:

White sponge nevus = autosomal dominant, usually presents bilaterally/symmetrically. It usually appears before puberty. Often mistaken for
Leukoplakia but leukoplakia differs in that it presents later on in life.
- Shows up as thick bilateral white plaque w/ spongy texture, usually on buccal mucosa but sometimes on labial mucosa, alveolar ridge or
FOM. Very rarely, gingival margin + dorsum of tongue.
QUESTION: White lesion on movable mucosa that you can’t wipe/stretch off? leukoplakia or white sponge nevus
QUESTION: Patient has bilateral white lines @ occlusal plane, what is primary microscopic finding? White Sponge Nevus
QUESTION: Buccal cheek of 60 yrs man, not wipeable? Leukoplakia (more on floor 50%, tongue 25%), candida, white spongy nevus

TRIGEMINAL NEURALGIA:

Trigeminal neuralgia:
th
- Age: Average age of pain onset in trigeminal neuralgia typically is 6 decade of life, but it may occur at any age. Symptomatic or secondary
trigeminal neuralgia tends to occur in younger patients > 35 years

- Nature of pain: Pain is stabbing or electric shock like sensation and is typically quite severe. Pain is brief (few seconds to 1-2 minutes) and
paroxysmal, but it may occur in volleys of multiple attacks. Pain may occur several times a day; patients typically experience no pain
between episodes.

- Distribution of pain: Pain is one-sided (unilateral, rarely bilateral). One or more branches of the trigeminal nerve (usually lower or
midface) are involved.
QUESTION: Patient feels pain on biting and feeling of fullness in maxillary posterior teeth. No decay noted, why? sinusitis, atypical trigeminal
neuralgia
QUESTION: Carbamazepine is used for Trigeminal Neuralgia, do not use to treat constant, fascial pain. Use NSAIDS
MAXILLARY SINUSITIS
QUESTION: Maxillary sinusitis bacteria: Strep pneumonia

- Drug for max sinusitis: Amox with clavulanic acid (for b-lactamase strep)

QUESTION: Which of the following is most likely to be interpreted as toothache by the patient? Maxillary sinusitis
- can cause pain or pressure in the maxillary (cheek) area (e.g., toothache, headache)

*CementoBLASTOMA = under age 30 in posterior mandible (molars/premolars), teeth vital

Cemento-osseous dysplasia aka CEMENTOMA: Cementoblastoma is a TRUE cementoma and actually likes the posterior mandible better.
• Asymptomatic periapical radiolucencies, which transform to radiopacities

Cementoma (periapical cemental dysplasia) - usually occurs in the anterior region of the mandible, starting as a radiolucent lesion that
eventually calcifies. Cementoma DOES NOT affect pulp vitality. Asymptomatic = no bone expansion. Periapical cemental dysplasia; periapical
osseous dysplasia

QUESTION: X-Ray: Black women, middle aged, anterior radiolucency (can be radio opaque), vital teeth: cemento osseous dysplasia, periapical
cemental dysplasia
QUESTION: Most common place for periapical cemental dysplasia: Lower anteriors

QUESTION: #25 has radiopaque lesion at apex.
It has normal PDL, vital, tissues normal, no caries or existing restoration? periapical cemento-osseous
dysplasia

QUESTION: Focal White females vital edentulous one lesion: Focal Cemento-Osseous Dysplasia

PERIPHERAL OSSIFYING FIBROMA:

Peripheral Ossifying Fibroma = gingival nodule composed of cellular fibroblastic connective tissue stroma, which is associated with the
formation of randomly dispersed mineralized products (bone, cementum-like tissue, or dystrophic calcification).

QUESTION: Which of the following reactive lesions of the gingival tissue reveals bone formation microscopically? Peripheral ossifying fibroma

NEUROFIBROMATOSIS (Von Recklinghausen):

Neurofibromatosis (benign tumor of peripheral nerves) = autosomal dominant disorder that causes tumors to grow in supporting cells that
make up the nerve & myelin sheath
- Patients usually present with an uninflamed, slowly enlarging, asymptomatic lesion that varies greatly in size from tiny nodules to large
pendulous masses. The lesion is rarely painful. café au lait spots & lisch nodules!

QUESTION: Clinical picture with nodules & café au lait spots: neurofibromatosis

QUESTION: Café-Au-Lait – Neurofibromatosis **Von Recklinh. Disease—neural tumors… all these
Spots-Neurofibromatosis

QUESTION: An adult patient presents with multiple, soft nodules and with macular pigmentation of
the skin. Which of the following BEST represents this condition?
a. lipomatosis

QUESTION: Which of these conditions have supernumerary teeth & lisch nodule on iris? neurofibromatosis
QUESTION: Neurofibromatosis clinical presentations: Café au lait, lisch nodules of the iris

AURICULOTEMPRAL SYNDROME/FREY’S SYNDROME:

QUESTION: Pt has problems on one side of their face when they eat, he/she recently had parotid surgery, also had to do with something with
their nerve
A. Papillon Leferve
B. Frey’s Syndrome (strong salivation)

QUESTION: Auriculotemporal syndrome (Frey syndrome) - symptom where you sweat near cheek area when eating. Often after parotid
surgery.

QUESTION: Auriculotemporal nerve is severed, what are the symptoms? gustatory sweating
- Ligation of auriotemporal nerve – disrupt gustory sweating

ACTINOMYCOSIS:

Actinomycosis = infectious subacute-to-chronic bacterial disease caused by filamentous, gram- (+) anaerobic bacteria (Actinomyces species). It
is characterized by contiguous spread, suppurative and granulomatous inflammation, and formation of multiple abscesses and sinus tracts that
may discharge sulfur granules.
- Most common clinical forms of actinomycosis are cervicofacial (lumpy jaw), thoracic, and abdominal.

QUESTION: Actinomycosis has abscess, draining fistula, & contains yellow sulfur granules. Tx is incision & drainage + antibiotics
QUESTION: Which disease is most likely to cause suppuration? Actinomycosis

CONDYLAR HYPERPLASIA:

Mandibular condylar hyperplasia = unknown etiology characterized by persistent or accelerated growth of the condyle when growth should be
slowing or ended.
- Slowly progressive unilateral enlargement of the head & neck of the condyle causes crossbite malocclusion, facial asymmetry, and shifting
of the midpoint of the chin toward the unaffected side. The patient may appear prognathic.

QUESTION: A patient presents with malocclusion and a unilateral, slowly progressing elongation of her face. This elongation has caused her chin
to deviate away from the affected side. The MOST probable diagnosis is which of the following?
A. Ankylosis
B. Osteoarthritis
C. Myofascial pain

DENS INVAGINATUS:

QUESTION: Dens in dente are most commonly seen in maxillary lateral incisor.

KERATOANTHOMA:

Keratoacanthoma (KA) = relatively common low-grade tumor that originates in the pilosebaceous glands & closely resembles squamous cell
carcinoma (SCC).

QUESTION: Lesion looks like SCC? Keratoacanthoma

a. palate
b. buccal mucosa
c. floor of mouth
d. lower lip

QUESTION: A picture of basal cell or Keratoancathoma ......on the face crater like with a crust in the middle
keratoacanthoma has a bump with a crusty crater in the middle, but BCC can be pink, waxy/pearly, or skin colored or brownish. BCC is more
reddish/can be flat while keratoacanthoma has a crust and looks really gross

SJÖGREN’S SYNDROME:

QUESTION: Sjogren’s – autoimmune destroy glands

QUESTION: Sjogren’s syndrome: destruction of salivary and tear ductsà dry mouth

QUESTION: Complications of Sjogren’s syndrome – keratoconjunctivitis, it involves the genitalia too.

QUESTION: Sjogren’s Synd associated with all EXCEPT
Herpes
SLE

QUESTION: What is most common with Sjogren’s syndrome? Lymphoma (or maybe lipoma or some other growth), pleomorphic adenoma,
increased sweating and osteoarthritis.
QUESTION: Which articular disease most often accompanies Sjogren’s syndrome?
E. Lupus arthritis.

QUESTION: Xerostomia is present in all of the following except? Options were: Sjogren’s syndrome, Vit C. Deficiency (Other parotid problems)
- Xerostomia is rarely due to a vitamin deficiency

QUESTION: Sjogren syndrome laboratory test: SS-A / SS-B (also ANA or Rheumatoid factor)

QUESTION: Secondary Sjogren Syndrome: dry eye, dry mouth, rheumatoid arthritis

QUESTION: Which of these are used in lab test for sjogren? ANA
- Typical Sjogren’s syndrome ANA patterns are SSA/Ro and SSB/La

SARCOIDOSIS:

Sarcoidosis: abnormal collections of inflammatory cells (granulomas) that can form as nodules

QUESTION: Treatment of sarcoidosis? Corticosteroids, antibiotics
QUESTION: Sarcoidosis? Know that it is granulomatous
QUESTION: Sarcoidosis commonly involved organ: lungs

OSTEOSARCOMA:

Osteosarcoma = aggressive malignant neoplasm that arises from primitive transformed cells of mesenchymal origin (and thus a sarcoma), that
exhibits osteoblastic differentiation, & produces malignant osteoid.
- most prevalent in children & young adults.
- Paget’s disease of the bone à osteosarcoma
- Symmetric widening of the periodontal ligament space is an early radiographic sign of osteosarcoma. Osteosarcoma in x ray:
SYMMETRICALLY WIDENED PDL SPACE, SUN-RAYAPPEARANCE

QUESTION: An 18-year-old male complains of tingling in his lower lip. An examination discloses a
painless, hard swelling of his mandibular premolar region. The patient first noticed this swelling 3
weeks ago. Radiograph indicate a loss of cortex and a diffuse radiating pattern of trabeculae in the
mass. Which of the following is the MOST likely diagnosis?
a. leukemia
b. dentigerous cyst
d. osteosarcoma

QUESTION: Most common primary malignant tumor of young people? Osteosarcoma

QUESTION: Osteosarcoma in x ray: sun burst and symmetrical widening of PDL.
QUESTION: Enlarge PDL and radiolucency at mandibular angle? Osteosarcoma sunburst

QUESTION: Widening of PDL is early sign of what? Osteosarcoma

QUESTION: Uniform widening of PDL and there is resorption in the bone: osteosarcoma, fibrous dysplasia

QUESTION: Patient has paresthesia and growth in mandible: is going to be osteosarcoma (young patient)

MULTIPLE MYELOMA:

Multiple myeloma (plasma cell myeloma) = plasma cell cancer, a type of WBC normally responsible for producing antibodies. Initially, there are
often no symptoms. When advanced bone pain, bleeding, frequent infections, and anemia may occur. Complications may include amyloidosis
(buildup of amyloid proteins).

Multiple myeloma/plasma cell myeloma:
o tx: chemo à poor prognosis

QUESTION: Multiple Myeloma radiographic appearance? Punched out lesions
st
QUESTION: 1 sign of multiple myeloma: bone pain (in limbs & thoracic region)
QUESTION: multiple myeloma à plasma cell

NECROTIZING SIALOMETAPLASIA:

QUESTION: Necrotizing sialometaplasia = painless ulcer on hard palate, goes away on its own w/ no scarring
QUESTION: The mucosa of the hard palate is the usual intraoral site for which of the following conditions?
- Mucocele
- Sialolithiasis
- Minor aphthous ulcer
- Major aphthous ulcer
- Necrotizing sialometaplasia

ODONTOGENIC MYXOMA:

Odontogenic myxoma = uncommon benign odontogenic tumor arising from embryonic CT
associated with tooth formation. As a myxoma, this tumor consists mainly of spindle shaped
cells and scattered collagen fibers distributed through a loose, mucoid material (soap bubble
appearance)

MYXOMA = FROM FOLLICULAR CONNECTIVE TISSUE RESEMBLING PULP TISSUE, PEOPLE IN THEIR 30s. TX = SURGICAL EXCISION

QUESTION: Pic of Myxoma pt. Usually in post. mandible, no symptoms, moves teeth, cortical
expansion and root displacement, always radiolucent and honeycombed pattern

QUESTION: Soap bubble lesion in x-ray, what is it? Giant cell, Odontogenic Myxoma, often seen
with impacted tooth
- Soap bubble lesion= odontogenic myxoma



OSTEOMYELITIS:

- Bone infection = “onion skin” appearance

QUESTION: Girl with caries into the pulp on tooth #3 – radiograph shows alternating RL/path at inferior border of mandible (a.k.a “onion skin”,
bacterial) à Garre’s Osteomyelitis aka chronic osteomyelitis

QUESTION: Garre's (proliferative periostitis) and Ewing sarcoma are both onion skin
RADIOLOGY

QUESTION: When there is no barrier, how far does the dentist need to be for protection? 6 feet, 90-135 degrees
QUESTION: Most of the x-ray is converted to? Heat
QUESTION: What is the oil in the x ray tube for? dissipate the heat (cooling)
- purpose of oil in x-ray tube housing à prevent rust, reduce radiation, dissipate heat to the target, lubricate

QUESTION: Why is there oil in x-ray tube? cools off the anode

QUESTION: Thermionic emission where? Cathode
- Thermionic emission = electron emission from a heated metal (cathode). The cathode has its filament circuit that supplies it with
necessary filament current to heat it up.

QUESTION: Something about what is the best x-ray: short wavelength, high energy
QUESTION: What is primary source of radiation to the operator when taking x-rays?
radiation left in the air
scatter from the patient
scatter from the walls
leakage from the x-ray head

QUESTION: In performing normal dental diagnostic procedures, the operator receives the greatest hazard from which type of radiation?
C. Gamma
QUESTION: What characterizes secondary radiation? coming off the matter

QUESTION: What is the max radiation dosage for a dental professional per year? 50msv/year or 5 rem/year
- per month = 4 msv, per week = 1 msv

QUESTION: Filament produces heat in the X-ray.
QUESTION: Digital image: which is digital detector? Charge coupled device

COLLIMATION

QUESTION: What does collimation do? reduces x-ray beam size/diameter & volume of irradiated tissue, reduces area of exposure
- usually with circle diameter of 2.75 in

QUESTION: Collimator function is all but: increase penetrability

QUESTION: Collimation in x-rays - reduces low energy radiation


QUESTION: What the collimator does: reduce the 1) volume of tissue being irradiated and 2) reduce the amount of scatter radiation by 60%
QUESTION: Collimation does everything except: reduce pt exposure, reduce operator exposure, film fog, reduce average energy of x-rays
(energy is unchanged)
- Scatter radiation decreases with change to rectangular collimator, film fog (scattered radiation that reaches the film, unwanted darkness
à decreased by collimation decreases and image quality increases.

QUESTION: Collimating device on the x ray does all except: prevents fogging (it REDUCES fogging)

QUESTION: Collimation control of size & shape of x-ray beam

QUESTION: The greatest decrease in radiation to the patient/gonads can be achieved by:
b. thyroid collar
c. filtration
d. collimation

QUESTION: Which of the following safety techniques provides the GREATEST DECREASE in overall radiation-risk to patients?


QUESTION: By what % do you decrease radiation when you use a square collimator vs. rectangular? 80%
FILTRATION

Filtration is a mechanism where the low quality, long wavelength x-rays are absorbed from the exiting beam. Aluminum disks absorb lower
penetrating x-rays.
Inherent filtration = glass, oil
Total filtration = aluminum

QUESTION: the use of intensifying screens à reduce the radiation

QUESTION: X-rays filters are used for? Reduced intensity of electron beam, selectively absorbs low energy photons

QUESTION: Which material is used as a filter in X-ray machines? Lead, aluminum, others

QUESTION: filter absorbs: Long wavelength

QUESTION: X-ray tube target metal is made out of: tungsten (target = tungsten/filter = aluminum)

ANGULATION

Elongation & foreshortening occurs when there is excessive vertical angulation

Central X-ray needs to be perpendicular to film and object
o Perpendicular to object but not film: elongation
o Perpendicular to film but not object: foreshortening
REFERRING TO PANOS:
- If the head/chin position is too low, the images of maxillary anterior teeth will appear elongated & the mandibular anterior teeth will
appear foreshortened.
- If the head/chin position is too high (a lack of negative vertical angulation, the occlusal plane of the teeth will then appear horizontal or,
with a positive occlusal plane, as a "frown line.") = reverse smile line

CHIN TOO FAR DOWN

QUESTION: What happens when you don’t have proper vertical angulation when taking x-rays – elongation of the object other options was
fuzzy pic (either resolution or contrast)
QUESTION: Change in vertical angulation when taking a PA will cause what?

A. Distortion
B. Magnification
C. Elongation or foreshortening
QUESTION: If you take a PA and the tooth is foreshortened, why did it happen? Vertical angulation was too large

QUESTION: Foreshortening of roots caused by excess vertical angulation

QUESTION: X-ray beam is perpendicular to the film, not to the tooth, = foreshortening
QUESTION: Overlap on bitewings due to horizontal angulation

QUESTION: X-ray with cone cut. What’s wrong? I put PID, other choices are horizontal, vertical, etc MISALIGNED XRAY TUBE HEAD, incorrect
beam centering (POSITION INDICATING DEVICE I.E. LONG PLASTIC TUBE)
QUESTION: Pano – max centrals look abnormally wide –position of pt head is too far back
- If pt is positioned too far backward, the anterior teeth image will be so wide that the outline of the crowns cannot be discerned.

QUESTION: Something that causes teeth to look longer has to do with angulation – how much tilt up and down
QUESTION: Reversed occlusal plane on pano – chin raised too high, patient head/chin tilted too far upward
• Chin up = frown

QUESTION: Pano, with short upper roots? Patient’s didn’t put tongue on the top of their mouth.

Penumbra
Penumbra = blurring at edge of structure on radiograph
- The area on the film that represents the image of a tooth is the umbra, or complete shadow.
- The area around the umbra is called the penumbra or partial shadow. It’s the zone of unsharpness along the edge of the image; the larger
it is, the less sharp the image will be.

Larger Penumbra—DECREASE contrast, less sharpness

• Umbra
• Penumbra

QUESTION: Penumbra is affected by all except:
• Moving film

I.E. 16” TUBE INSTEAD OF 8” = BETTER, SENDS MORE USEFUL BEAMS TOWARD TARGET
QUESTION: Penumbra – how to prevent this in x-rays: decrease size of focal spot, increase source-object distance, and reducing object-film
distance (should be parallel), central ray must be perpendicular to tooth, object and film, no movement.

QUESTION: How to reduce penumbra? Choices were moving object, decrease object/source distance, decrease object/film distance

QUESTION: How do you prevent penumbra?
o X-ray should be parallel (reduce object-film distance)
QUESTION: PA distortion answer according to an article online is 14%, there was answer choices 3-5%, 11-15%?

QUESTION: Pano distortion is: 25% but could range 10-30%

QUESTION: What does it look like on a pano when your patient moves during the pano? A vertical blur line vs horizontal defect.


TYPE OF X-RAYS

Water's view is best to evaluate orbital rim areas. AND SINUSES

QUESTION: If you have lesion of maxillary sinus, what kind of radiograph do you take? Waters
QUESTION: Which is most important x-ray for diagnosis of maxillary sinus? occlusal, panoramic, MRI, Waters

QUESTION: Best to see siaolilith in Wharton's?
Occlusal
Water's
PAN
PA

QUESTION: Best imaging for sinusitis or sinus infection: CT, but had occlusal radiograph, PA radiograph, Panoramic.
- Know that sinuses are best viewed with Waters technique, but this was not in answer choice neither was none of the above as a choice.
Answer will either be Waters or CT!

QUESTION: Best diagnostic image for pathology in max sinus: waters, CT, MRI, periapical, pan
QUESTION: Which radiograph would you use to view a fracture of the mandibular symphisis? Posterio-Anterior
also Mand occlusal works too. Lateral oblique for fractures in angle, body and ramus

RADIOGRAPH ANATOMY

Know the SLOB rule. Also know Vertical rule, which is same as SLOB but in a vertical dimension.
For Vertical Version, moving the tubehead UP = Spot moves UP (SAME) = LINGUAL
- https://www.youtube.com/embed/AzjvFPlZtZg moving the tubehead UP = Spot moves DOWN (OPPOSITE) = BUCCAL
…BASICALLY, STILL THE SLOB RULE, JUST IN A VERTICAL DIMENSION
Coronoid process of zygomatic process of
mandible maxilla on PA

Ghose image of contralateral

mandible

1. Coronoid process of the mandible. Examine for 15. Pterygoid plates.
coronoid hyperplasia. Tip of coronoid should not be 16. Pterygomaxillary fissure. Check for cortical integrity to
more than 1cm above superior border of zygomatic rule out neoplasia.
arch. 17. Orbit.
2. Sigmoid notch. 18. Inferior orbital rim.
3. Mandibular condyle. Evaluate for erosions, remodeling, 19. Infraorbital canal. The infra-orbital foramen should not
eburnation, subchondral cysts, osteophyte formation be viewed if the patient was properly positioned.
which may signal arthritis. 20. Nasal septum.
4. Subcondylar (condylar neck) region. 21. Inferior turbinate/soft tissue concha covering.
5. Ramus of the mandible. 22. Medial wall of the maxillary sinus.
6. Angle of the mandible. 23. Inferior border of the maxillary sinus.
7. Inferior border of the mandible. Evaluate #4 - 7 for 24. Posterolateral wall of the maxillary sinus. Examine the
cortical integrity. Rule out fractures. content of the sinus for the degree of pneumatization.
8. Lingula. Check for antral pseudocysts, chronic mucosal
9. Inferior alveolar neurovascular bundle (mandibular hypertrophy, polyposis, mucocele or neoplasia.
canal). Follow from lingula to mental foramen. In some 25. Malar process.
pts, anterior extension which exits out the lingual 26. Hyoid bone.
foramen will be visible. Evaluate relationship of 27. Cervical vertebrae
impacted teeth to the canal. 28. Epiglottis.
10. Mastoid process. 29. Soft tissues of the neck.
11. External auditory meatus. 30. Auricle (earlobe).
12. Glenoid fossa (temporal component of the TMJ). 31. Styloid process.
13. Articular eminence. Look for zygomatic air cell defect 32. Oropharyngeal airspace.
(ZACD). 33. Nasal air.
14. Zygomatic arch.

QUESTION: External oblique ridge & hyoid bone, tongue

QUESTION: They liked to ask intermaxillary suture a lot which comes up clear on radiograph and it looks like a fracture (which is an answer
choice), but it’s not.

QUESTION: Nose vs lip line in radiograph
LIP LINE NOSE LINE

QUESTION: Best view for zygomatic arches: Panoramic
Submentovertex? Zygomatic arches stick out from the sides like the handles on a jug

QUESTION: You have pano, what can’t you do without intraoral photos? space analysis

QUESTION: Pano: arrow pointing b/w posterior wall of maxilla and posterior wall of
zygomatic process of maxilla: pterygomaxillary fissure
- Tear drop shaped in max sinus - pterygomaxillary fissure à à à

QUESTION: Identify the following on x-ray: External oblique ridge, genial tubercle, Stylo
hyoid ligament on x-ray
process? ligament wouldn’t show up
a. External oblique: running down roots on

mandibular molars

b. Genial Tubricle: radiopaque line under mandibular anteriors
Radiolucency inside genial tubercles = lingual foramen

c. Stylohyoid ligament calcified?
QUESTION: Pano, what is the round opacity under #24 and #25: Genial tubercles, nutrient canal, zygomatic process of maxilla, normal anatomy
(I had lateral canal and I put that. Other choices were all pathological findings)
QUESTION: Nutrient canals seen radiographically are most common where? Mandibular incisors
Lip line

QUESTION: There was an x-ray pointing with arrow to the lower lingual anterior. The answer was nutritional canal.
MAND. TORI

QUESTION: Vertical BWX are better than horizontal BWX because? More alveolar bone

QUESTION: What cannot be seen with a PA? pterygoid hamulus, coronoid notch, mental foramen, mand. Canal (?)

QUESTION: What structure can you not see on a PA radiograph?
- Hamular process Visible
- Mental Foramen Visible
- Coronoid process Visible
- Mandibular foramen (too posterior & inferior)


QUESTION: X-ray taken from mesial of max 1st premolar, buccal root will be where? mesial, distal, occlusal
QUESTION: What can you see on a radiograph?
Lingual ridge height
Root dehiscence
Trabeculation pattern
PDL
- others are either B-L view and technically you can only see the space of the PDL not actual PDL?

EXPOSURE:

Kvp: ability for the beam to penetrate tissues, energy
mA: # of x-ray in a beam à radiation quantity (not quality!), density & patient dose

YOU WANT TO HAVE HIGH KVP AND LOW mA for MOST penetration

Film Speed Group Speed Range (reciprocal roentgens)
C 6-12

D to E will reduce radiation by 30-40% E to F reduces pt exposure by 50%
Increase in kVp/mA/time = Increased density = Decreased contrast
Dark films (overexposed/image too dense): due to incorrect mA (too high), exposure (too long), incorrect kVp (too high).

Light films (underexposed/image not dense enough): due to incorrect mA (too low) or exposure (too short), incorrect focal-film distance, or
cone too far from the patient's face, or film is placed backwards.
Inverse Square Rule = moving the source 2x away = reduction of intensity to 1/4
1
!"#$"%&#' = ; Inversely proportional
(!"#$%&'()!

Deterministic effects: has threshold, severity of effect is dose-related
Stochastic effects: no threshold & no dose-related, probability of effect /likelihood that something will happen
- Stochastic effects are associated with long-term, low-level (chronic) exposure to radiation. Increased levels of exposure make these health
effects more likely to occur, but do not influence the type or severity of the effect.
Radiosensitive: Bone marrow, reproductive cells, lymphoid cells, immature cells, intestine.
RadioRESISTANT: muscle, nerves
*FASTER film reduces x-ray exposure
QUESTION: Digital X-rays have _____ less exposure from d-films to digital films: digital has 50% less radiation exposure

QUESTION: Digital x-ray vs D speed film, numbers: 10, 30, 60, I put 60. I forget what it was asking.

QUESTION: Going from a D speed film to digital film, What’s the speed difference? Speed increases

QUESTION: By reducing film speed from D to E & still keeping film density the same. What would you need to change? Decrease Exposure time
Increasing? D speed film really isn’t used anymore (slowest) = most radiation
QUESTION: Latent period is time between when you exposed patient & clinical reaction to x-ray.
D. radiation exposure and onset of symptoms

QUESTION: Which electron shell has highest power? (f/d... outermost shell)
QUESTION: Which electron level has the highest binding energy? N K L OR M

- K is located closest to the nucleus àhighest energy

QUESTION: Radiographic Picture looks washed out/too light, no contrast, what was adjusted?
• Decrease kvp
• Increase kvp
• Increase time Increasing exposure time would also increase density

QUESTION: What was the problem with x-ray that appears too white? incorrect distance from target to film distance, low mA, low density.

QUESTION: If x-ray is too dark, it was too long in developer solution.
- Dark films (overexposed/image too dense): due to incorrect milliamperage (too high), exposure (too long), incorrect kVp (too high)

QUESTION: You take an x-ray at a certain mA, KvP and exposure time is 8 seconds when the beam is 10 inches away. What if everything were
the same except the beam was 20 inches away? quadruple the exposure time (because doubling the distance of the beam decreases its intensity to 1/4, so the
intensity would need to be multiplied by 4 to be the same) (Inverse Square Rule)
QUESTION: You increase the distance of the tube by 2x the length, how much does the x-ray exposure decrease? intensity is decreased by 4
QUESTION: If change from 8 mm cone to 16 mm, how much exposure time do you need to increase by? 2, 4, 6, 8
- Remember that going from an 8 mm to 16 mm cone means the cone/target is LONGER. This is the PID (target to film distance). If the PID
is increased there is LESS magnification. If the PID is shorter there is MORE magnification. Also density (darker x-ray) increases when kA,
more useful beams are sent to the target
mA and exposure are increased. kVp
Increase in intensity = Decrease in contrast = longer scale
QUESTION: Increase PID distance from 8 to 16, exposure time change from 0.5sec to? 0.25, 1, 2, 3...... with paralleling technique.

QUESTION: The x-ray of an interproximal underestimates the size of the actual crater (other is overestimates and is same size)

QUESTION: How do you increase the average energy of the beam? Kvp versus mA
Kvp = QUALITY of electrons in beams i.e. energy VS mA = QUANTITY i.e. # electrons
QUESTION: The severity of response increases with the amount of X-ray exposure. This effect is called: Deterministic, Stochastic, Genetic
**We should never see deterministic effects from routine dental radiographs
QUESTION: Radiation that is stochastic, with non-threshold effects would a clinician notice first – leukemia, skin burn, hair loss, bone marrow
effect Stochastic effects —> think damage to DNA i.e. radiation induced cancers like Leukemia. The more exposure you’ve had, the higher your CHANCE of seeing effects. Has NOTHING to do with
how severe of an effect you’re going to see. That’s a deterministic concept.
QUESTION: Irradiation cause saliva to have lower - sodium content

QUESTION: Know how x-rays interact with matter: photoelectric effect
- photoelectric effect: electrons are emitted from matter (metals and non-metallic solids, liquids or gases) as a consequence of their
absorption of energy from electromagnetic radiation of very short wavelength and high frequency, such as UV radiation. Electrons
emitted in this manner may be referred to as photoelectrons.

produces when water is irradiated
QUESTION: How do you minimize exposure radiation? minimizing the amount of tissue being radiated
QUESTION: Which type of radiation is constantly in effect: Inhaled radon radiation, not terrestrial or cosmic
56% of naturally occuring radiation (terrestrial and cosmic is about 15%)
QUESTION: Most radiation from nature – inhaling radon, internal, terrestrial, cosmic

Scatter tube
Scatter patient
Scatter wall

QUESTION: How does x-rays primarily damage cells? Hydrolysis of water molecules produces free radicals = indirect effect
QUESTION: Radiation induced mutation is the result of? Hydrolysis of water molecules.
QUESTION: Which structure is most radio sensitive: hemopoitic bone marrow

QUESTION: What is most radio-resistant cell: Muscle
QUESTION: Which one of the following tissues is least sensitive to ionizing radiation: muscle, lymphocytes, squamous epithelium



QUESTION: A higher kilovoltage produces x-rays with:
Greater energy levels
More penetrating ability
Shorter wavelengths
Increase in density (all these answers are true)

QUESTION: KVp inc à more penetrating, high energy
QUESTION: Increasing mA results in an increase in: Temperature of the filament & Number of x-rays produced

Not true. Increased mA = increased density = DECREASED contrast
low kVp produces high contrast (less shades of gray)
QUESTION: If you increase distance, then you need to increase mA
(to achieve the same density)
QUESTION: How do you change from a low contrast (longer scale of contrast) to a high contrast (shorter scale) without changing
density: increase mA and kvp, decrease mA and kvp, increase kvp decrease mA, decrease kvp increase mA
NO. If you have low contrast, this means a high density, meaning high mA or kVP. To

increase the contrast, you need to decrease the density i.e. lower mA and kVP.
QUESTION: If something is a structure in mouth is thick – it absorbs more radiation, appears more radio-opaque on x-ray

OSTEONECROSIS & BISPHOSPHINATES

Osteonecrosis is more common with IV drugs like Zolmeda (zoledronic acid) and aredia (palmidronate), NOT Fosamax or boniva). Suffix: -
dronate
ORAL: “AIR”
-Alendronate Oral Bisphosphates IV Bisphosphates
-Ibandronate (Boniva) - Alendronate (Fosamax) - Ibandronate (Boniva)
-Risendronate (Actonel) - Risedronate (Actonel) - Zoledronic Acid (Reclast)
IV: “ZIP” - Ibandronate (Boniva) - Pamidronate (Aredia)
-Zolendronate (Reclast)
-Ibandronate (Boniva)
-Pamidronate (Aredia)
-floxacins are fluoroquinolones (bacteriocidal)

QUESTION: To get osteoradionecrosis, radiation dose must be: Above 50 gys (above 60)


QUESTION: Bisphosphonates used for all except: multiple myeloma, osteomyelitis, metastasis to bones from breast cancer, metastasis to bones
from prostate cancer


QUESTION: Does bisphosphonate add calcium to bone à No, it inhibits osteoclast via apoptosis

QUESTION: What is the mechanism of action of bisphosphonates? Inhibit osteoclasts

QUESTION: Why is orthodontic contraindicated in this patient? pt is taking Aredia (IV bisphosphonates)

QUESTION: What is not true about a patient who takes Fosamax and will need an invasive procedure? Discontinue Fosamax 1 week before
procedure (that stuff stays in the system longer than that)

QUESTION: Pt taking bisphosphonates for 1 yr. IV, highest risk during dental tx? Osteonecrosis

QUESTION: Pt doesn’t like her bridge & didn’t like her smile. Can you do bone graph in a bisphosphonate pt and would it last? NO BONE
GRAFTING

QUESTION: A scenario about a patient who is taking bisphosphonates and gets osteonecrosis of the jaw. Diagnosis is?
- Answer is the first one bc it did not say anything about osteoRADIOnecrosis. You get necrosis due to the bisphosphonates.
(MRONJ = medication-related osteonecrosis of the jaw)
QUESTION: Osteonecrosis of jaw - more common in mandibular & has nothing to do with radiation
decreased vascular supply in mandible compared to maxilla
QUESTION: Osteoradionecrosis most associated w/ what? Mandible

QUESTION: Osteoradionecrosis scenarios - preextract questionable teeth, hyperbaric oxygen pre and post if doing invasive procedures

QUESTION: Pt has stage 1 osteonecrosis from bisphosphonate. What do you do? debride area or rinse with chlorhexidine
Only debride stage 2 and 3. Stage 1 has exposed bone but no pain/infection/erythema.
- If STAGE 1 - rinse Chlorhexidine
- If STAGE 2 - Refer to OS or do under Hyperbaric O2

QUESTION: Pt has a history of osteonecrosis & IV bisphosphonates but extractions are needed, what do you do? Do it under hyperbaric O2
QUESTION: Best tx for bisphosphate pt: Section crown off & still do RCT Don’t do it? Coronectomy/RCT residual root?
ANEMIA, BLEEDING TESTS & MEDS

ANEMIA

***Difference between aplastic, pernicious, sickle cell anemia
- Aplastic anemia: bone marrow doesn't make enough new RBC. Rare. Possible complication from carbemazepine.
- Sickle cell anemia: contain abnormal hemoglobin called “sickle hemoglobin” or hemoglobin S, autosomal recessive
- Pernicious anemia: body can't make enough healthy RBC b/c lack of vitamin B12 ***Glossitis = common problem with pernicious anemia
o they lack intrinsic factor, a protein made in the stomach. A lack of this protein leads to vitamin B12 deficiency.
(Vit B12 necessary for RBC maturation)
- Microcytic hypochromic anemia - iron deficiency anemia (most common)
- Hemolytic anemia – RBC are destroyed & bone marrow can’t produce fast enough (Glucose-6-phosphate dehydrogenase deficiency)

QUESTION: Which is not a contraindication for a patient w/ sickle cell anemia or something like that? Nitrous oxide, infection, trauma, cold
QUESTION: Which hemoglobin is affected in sickle cell anemia? S
QUESTION: Pt has sickle cell anemia & has a thrombolytic crisis, what could precipitate this?
a. Nitrous oxide / oxygen use
b. Cold
c. Trauma
d. Infection
- Sickle cell anemia is seen exclusively in black patients. Periods of unusual stress or of O2 deficiency (hypoxia) can precipitate a sickle cell
crisis.
Treacher Collins-genetic disorder characterized by deformities of the ears, eyes, cheekbones, and chin.
QUESTION: What disease is more predominate in males? The degree to which a person is affected, however, may vary from mild to severe.
Mandibular dysostosis (Treacher Collins syndrome) Complications may include breathing problems, problems seeing, cleft palate, and hearing loss.
Hypothyroidism
Diabetes
Sickle cell anemia Megaloblastic anemia—type of macrocytic anemia, includes pernicious anemia
Hemophilia X-linked recessive (DNA problem, RBCs can grow but not divide i.e. no mitosis)
• hemophilia (it is carried by the female but only effects the male)
• downs
• diabetes

QUESTION: Macrocytic anemia which vitamin deficient? A, B, C, D, E RBCs larger than normal, insufficient hemoglobin
QUESTION: Which one is microcytic anemia? Iron deficiency anemia
BLOOD TEST & MEDICATIONS + HERBAL SUPPLEMENTS
Anti- coagulants act to antagonize Vitamin K to work & prolong bleeding. INR used for Coumadin patients.
Warfarin: anti-coagulant that inhibits vitamin K reductase, which resulting in depletion of the reduced form of vitamin K (vitamin KH2).
Synthesis of vitamin K-dependent coagulation factors 2, 7, 9, and 10 and anticoagulant proteins C and S is inhibited (extrinsic pathway)

Heparin: anti-coagulant that reversibly to anti-thrombin II & prevents conversion of fibrinogen to fibrin.
Dicoumarol: anti-coagulant that inhibits vitamin K reductase & affects K-dependent coagulation factors
Hemophilia: X-linked, recessive disorder, Hemophilia A = Factor 7, Hemophilia B = Factor 9

No! Factor VIII! 8!

QUESTION: Pt is taking warfarin (Coumadin), what test do you run prior to extraction or surgery: INR (= 2.0-3.0)
QUESTION: What is the best way to test clotting function on a patient taking Warfarin? INR

QUESTION: Patient is taking warfarin, what could you do? Proceed with treatment because his INR is < 2.5

QUESTION: INR deals with PT. INR = 1 is normal (12 seconds)
- The higher the INR, the greater the anticoagulant effect (more bleeding, higher PT value) PT = extrinsic pathway
QUESTION: What INR is OKAY to place implant? 2.5, 3.5, etc
- Bleeding measurements: PTT 25-36 sec PT 5-7 sec platelets 150K-450K minimum platelets 50k bleeding time: less than 9 min INR: 1 do
not treat with more than 3.5 ***Coumadin/warfarin does NOT reduce platelet count, just affects platelet function

QUESTION: Patient is on Coumadin, what do you do prior to extractions?
a. Stop for 1 day
b. Stop medication of 5 days (stop drug 5 days before, and resume the day after surgery)
QUESTION: How does warfarin work on anti-coagulation (MOA)? Decrease K+ needed to synthesize factors II, VII, IX, X
QUESTION: The most important anti-coagulant effect of heparin is to interfere with the conversion of
A. PTA to PTC.
B. PTC to Factor VIII.
C. fibrinogen to fibrin.
D. prothrombin to thrombin.
E. proaccelerin to accelerin.

QUESTION: Pt taking dicumorol (Vit K antagonist) is probably treated for? Coronary infarct
QUESTION: Pt is taking dicumarol, what are they being treated for? Myocardial infarction (dicumarol is similar to warfarin)

QUESTION: Coumadin (warfarin): give vitamin KKKKKKKKKK

QUESTION: Alcoholic patient comes in for extraction? order: PT/INR

QUESTION: Severe alcoholic now recovering needs 24 tooth extraction, which tests are needed? INR, CBC

QUESTION: Alcoholic patient is about to undergo surgery. Which blood work test is most important?
- creatinine
- PTà extrinsic system (Vit. K coagulation factors-2,7,9,10); used to test warfarin/Coumadin effectiveness, for liver damage, and Vit. K
status
- PTTà intrinsic system; used to test Heparin
- Bleeding time

QUESTION: Accurate way to detect blood alcohol in the body except
weight
amount of food in stomach (amt of food in stomach dictates how fast your blood alcohol level will increase)
percentage of alcohol in drink Extrinsic Pathway
how fast you drank it The extrinsic pathway is activated by external trauma that causes blood to escape
from the vascular system. This pathway is quicker than the intrinsic pathway. It involves factor VII.
QUESTION: Best way to determine platelet function: Intrinsic Pathway

a. platelet count The intrinsic pathway is activated by trauma inside the vascular system, and is activated by platelets,
exposed endothelium, chemicals, or collagen. This pathway is slower than the extrinsic pathway,
b. bleeding time
but more important. It involves factors 8, 9,11, 12.
c. PTT
d. INR Common Pathway
QUESTION: Aspirin burn is due to: coagulation necrosis. Both pathways meet and finish the pathway of clot production in what is known
as the common pathway. The common pathway involves factors I, II, V, and X.
QUESTION: What does aspirin affects? Extrinsic, intrinsic, bleeding time, common pathway

QUESTION: Aspirin decrease platelet function. Aspirin does NOT reduce platelet count, volume, or mass…JUST THEIR FUNCTION

QUESTION: What determines the bleeding time? Intrinsic, extrinsic, platelet adherence, common pathway
- Bleeding time = time required for blood to stop (2-6min normal)
- Bleeding time is increased in disorders of platelet count, uremia, and ingestion of aspirin and other anti-inflammatory medication

QUESTION: Aspirin has no effect on PT, PTT, or INR. It affects platelets & bleeding time.
PT/INR = how long it takes a clot to form
E. Methylprednisolone (Medrol®)
QUESTION: Patient is taking aspirin for hypertension? Consultation with physician

QUESTION: Clopidogrel (Plavix) and aspirin: alter platelet function, inhibits platelet aggregation irreversibly
Plavix = anti-platelet, often given WITH aspirin
QUESTION: What affect does Plavix has? Inhibits platelet aggregation
Given to patients allergic to aspirin àno ulcer side effect, given to patients with past ulcer history
QUESTION: Prostaglandin inhibitor will cause all except? decrease gastric mucous PG inhibitor like aspirin WILL decrease gastric mucous.
- PG decrease gastric acid and increase gastric mucous. Inhibiting PG will increase gastric acid and decrease mucosa. That's why people
taking too much aspirin can get stomach bleeding cause more acidic and no protection
Aspirin = prostaglandin inhibitor. Cox normally leads to formation of PGs and aspirin irrev
QUESTION: What makes prostaglandin: Arachidonic acid binds to Cox (PGs cause inflammation)
QUESTION: Ginseng is an antiplatelet (interferes with coagulation – not given with aspirin). pt on warfarin, aspirin
QUESTION: Pt takes ginseng for energy, but it will interfere with ASPIRIN (not digitalis)
- Ginseng = antiplatelet

QUESTION: Pt is taking ginseng, what do you want to avoid? Warfarin, NSAIDS, and Aspirin
• Penicillin
• Aspirin
• Digitoxin

QUESTION: Pt. is taking saw palmetto, what do you want to avoid? Aspirin
- Saw palmetto enhances anti-coagulants

QUESTION: HERBAL supplement that potentiates anti-coagulation
a. St. John’s Wort natural anti-depressant
b. Saw Palmetto
c. Chamomile
d. Licorice

QUESTION: Which one has anticoagulant properties? Saw palmetto

QUESTION: Before doing extraction you look at a patient’s CBC report. What causes you to contact patient’s physician? Hematocrit was given
as 25. Hematocrit = RBC amount
- Normal values are males = 45% & females = 40%
QUESTION: Pt has an INR = 1.75. What do you do after extraction to control bleeding? Keep stuffing shit in it, bite on normal gauze, squeeze b/l
plate to collect bone fragments
QUESTION: Warfarin = INR. Know numbers! I got pt with INR of 12.5, then asks what to do next. Classmate had same questions with INR of 2.
QUESTION: Extractions for a pt with an INR of 2. what should you do?

b. gets pt off Coumadin for 2 days before extraction
c. Continue treatment
- Mosby’s states that normal INR of people on anticoagulants is 2.5-3.0.

QUESTION: Patient had extraction and socket is still bleeding 5 hours later? Refer for INR
QUESTION: Tooth extraction. 3 days later, area starts to hemorrhage, what is the cause? Fibrinolysis
QUESTION: PT (12-14 secs, Factors 2, 7, 9, 10) and INR are extrinsic pathway.
QUESTION: PTT – intrinsic factor 8, 9, 11, & 12 test for detecting coagulation defects of the intrinsic system – hemophiliac

QUESTION: Factor VIII is hemophilia A
QUESTION The drug contraindicated in pt taking gingko biloba: HEPARIN Gingko biloba = blood thinner

DIABETES

Hypoglycemia signs: headache, mental confusion, somnolence, tremors, nervousness, bradycardia, mydriasis (pupil dilation), diaphoresis
(sweating) ♣ HYPER = like a stick on fire (red, dry, has a fruity smell,…) need insulin
♣ HYPO = pale, sweaty, no smell need glucagon
QUESTION: Overweight patient that has to piss twice (x2) at night. What condition? Diabetes

QUESTION: Diabetes is more common: black men

QUESTION: Hb1Ac: measuring glucose level over extended period
(measures glycated hemoglobin)

QUESTION: Pt who took too much insulin will have all except? Hyperglycemia
QUESTION: Decrease in ⬇ glycogenosis in the liver would be expected with insulin
QUESTION: Sign of hypoglycemia – bradycardia, mydriasis (pupil dilation), diaphoresis (sweating), mental confusion

QUESTION: Pt appears disorientated & hypoglycemic à administer glucose
QUESTION: Which is a risk factor for hypoglycemia? Age, alcohol, hypertension

- risk factors for the development of hypoglycemia: exercise, alcohol, older age, renal dysfunction, infection, decreased intake of energy,
and mental health issues, including dementia, depression, and psychiatric illnesses.
QUESTION: Ketone breath à Diabetes type 1/hyperglycemic

Diabetic ketoacidosis RARE for people with Type 2 DM
QUESTION: Ketone breath & altered state of consciousness? Hyperglycemia

QUESTION: Common complication of Type I diabetes: blindness (retinopathy)
MEDICATIONS FOR DM:

TYPE 2 DIABETICS ONLY!
nd
2 generation Sulfonylureas: enhance insulin secretion (glyburide, glipizide, glimepiride)
Sulfonylureas stimulate the pancreas to release more insulin —> NOT for Type 1 diabetics Metformin (a biguanide):
Biguanides/Metformin: produces less glucose in the liver (metformin) 1) Increases the sensitivity of muscle cells to insulin
2) Reduces the amount of sugar produced by cells in the liver

Alpha glucosidase inhibitors: slow carbohydrate/glucose digestion (acarbose, miglitol)

Insulin: Rapid acting (5-15min); Short acting (30-60min); Intermediate (2-4h); Long acting (6-10h); Premixed (30-60min)

QUESTION: Glucocorticoids are contraindicated in: Diabetes
- steroids can raise blood sugar & increase the need for more medication to control sugar levels. Diabetics on steroids may have to raise
their insulin dose dramatically.
i.e. Prednisone (people gain weight on this med)

QUESTION: Oral hypoglycemic drug for diabetes? sulfonylurea & metformin

QUESTION: Why don’t you give sulfonylureas to Type I diabetic patients? They do not have beta cells for insulin & Sulfonylureas MoA is to
stimulate those cells

QUESTION: How do Sulfonylureas work? Stimulate insulin release from Beta cells in the pancreas, stimulate binding, decrease glucagon levels.
QUESTION: MOA of sulfonylurea- increase insulin PRODUCTION and SENSITIVITY by Beta cells stimulation by binding to ATP-dependent K
channels
- stimulating pancreatic insulin release by bind to ATP K+ channels & causing depolarization, which stimulates calcium ion influx & induces
insulin secretion.

QUESTION: Metformin suppresses glucose production in liver (decreasing hepatic gluconeogenesis) à decreases glucagon levels) – bind to
AMP protein kinase receptors

QUESTION: Proposed modes of action for the oral antidiabetic agents include each of the following EXCEPT one. Which one is the EXCEPTION?
A. Blockade of glucagon release from pancreas PANCREAS:
B. Blockade of catecholamine release from adrenal medulla —> ALPHA cells = glucagon
i.e. epinephrine (raises blood sugar) —> BETA cells = insulin
E. Increase affinity of tissues for utilization of available plasma glucose (metformin does this)

QUESTION: How are the various preparations for diabetic drugs classified by? by duration of action, MOA, etc
PERIO/ENDO DISEASE + DIABETES

Controlled diabetic patients do not get more periodontal disease than non-diabetic patients.

QUESTION: Controlled diabetes has same perio problems as those who don’t have diabetes: TRUE

QUESTION: What is not true regarding patient with diabetes and perio? either increase of crevicular fluid or increase of sugar in crevicular fluid
st
(of these two choices, 1 is better cuz there is sugar in the fluid)
QUESTION: Patient with diabetes, which finding is not consistent?

Increase collagenase in crevicular fluid Neutrophil impairment leads to increased susceptibility to periodontitis in diabetics.
Hyperglycemia induces decreased chemotaxis, phagocytosis, and intracellular bacterial activity in diabetics.
Increase glucose in crevicular fluid
Increase gram negative in crevicular fluid
Decrease in thickness of basilar lamina of blood vessels in periodontium

QUESTION: Diabetic patients have more of the following except: higher glucose levels in gingiva, increased anaerobic bacteria in pockets,
increased IL-1, increased collagenase
IL-1 mediates diabetic induced/obesity inflammation
QUESTION: Diabetics are more prone to perio and are less resistant to the effects of bacteria. Both statements are true.
QUESTION: By recent studies, which one has a correlation with periodontitis? Diabetes - diabetics are 15x higher at risk.
QUESTION: Pt presents with aggressive bone loss, bleeding gums, mobile teeth. What condition?
• non-Hodgkin’s lymphoma (don’t really have any obvious oral signs/symptoms, get extranodal swelling of lymph nodes in head/neck)

QUESTION: ASA III: uncontrolled diabetes ASA II = Controlled diabetic, smoker, pregnant, obese, controlled HTN
(ASA III —uncontrolled HTN, history of MI/CVA)
QUESTION: Periodontal disease is associated with what systemic diseases? Diabetes and HIV
QUESTION: When would elective endo treatment be contraindicated? Uncontrolled diabetes
QUESTION: What disease will alter healing after root canal treatment? HIV or Diabetes
Normal: 4-5.6%
DM TREATMENT MODIFICATIONS Pre-Diabetic: 5.7-6.4%
Controlled Diabetic: > 6.4% < 8%
Normal HbA1C = 4-6% Uncontrolled Diabetic: >8%
In controlled diabetic patients, HbA1C < 7%.
Uncontrolled diabetes is > 8%.

QUESTION: Diabetes, can you place implant if HbA1c = 8: No, refer to physician
QUESTION: Pt with hemoglobin A1C of 12%. Pt just visited the MD, what kind of TX we can do? Consult with an MD prior to tx

QUESTION: HgbA1c is 12 for a patient in your office? Get him out of there, haha! Refer him to physician for diabetic/sugar management.
QUESTION: Treat diabetic patient 2 hours after eating & taking insulin.

QUESTION: Kidney dialysis: best to do tx when day after dialysis or inbtwn days of dialysis

QUESTION: Insulin shock, what do you give? give insulin, give OJ, give oral sucrose
- Do NOT give more insulin, blood sugar is already low enough. Give OJ.

QUESTION: Pt is a child and is diabetic undergoes hypoglycemia in the chair if conscious give him orange juice (unconscious give him 50%
dextrose IV)
QUESTION: Child goes into insulin shock in the chair (hypoglycemia)

a. gives OJ

QUESTION: Unconscious diabetic is treated with: 50% dextrose in IV.
DIABETICS (IV SEDATION):

IV sedation for DIABETICS: Schedule in the morning.
- If insulin-dependent, have them not eat, not take short acting insulin and take half dose of long acting insulin.
- If not dependent, no food and no meds until after the surgery.

QUESTION: Patient is a non-insulin dependent diabetic & needs minor oral surgery w/ IV sedation. What should he do? clear-liquids and regular
dose of diabetes meds.
- Minor surgery: normal as long as procedure occurs within 2 hours of eating and taking meds.
QUESTION: Pt with insulin dependent diabetes & having sedation IV and LA. Ask the pt to take: high calorie food with insulin, low calorie food
with insulin (reduce dose of insulin and no food)
CONGESTIVE HEART FAILURE/HEART CONDITIONS

QUESTION: Patient with orthopnea (shortness of breath-dyspnea-while lying flat), dyspnea, pedal edema
a. Emphysema
b. Pulmonary edema
c. COPD

QUESTION: What is common symptom of CHF? Orthopnea
- other symptoms: dyspnea, fatigue, paroxysmal nocturnal dyspnea, edema

QUESTION: Most common reason for cardiac arrest of kid? Respiratory distress, congestive heart failure, cyanotic heart disease, etc
QUESTION: What is the most common heart condition in children? Ventricular septal defects
- communications between the bottom chambers, structural heart defects

QUESTION: Peripheral edema, increase systole à congestive heart failure
(digoxin lowers heart rate)

QUESTION: Patient has distended jugulars, pitting edema and dyspnea? Congestive heart failure

QUESTION: Cardiac referred pain is not consistent with? Pain that goes away with LA

QUESTION: Patient has chest pain in heart region when sleeping or at rest, what kind of angina is it?
a. Pseudo-angina
b. Unstable angina
c. Infarction

MEDICATIONS:

Hypertension:

CATEGORIES SUFFIX
CALCIUM CHANEL BLOCKERS -dipine potential for gingival enlargement
ACE INHIBITORS -prils
THIAZIDE DIURETICS -thiazide
ANGIOTENSION RECEPTOR BLOCKERS -sartan
BETA BLOCKERS -olol
ALPHA BLOCKERS -zosin, -losin

Angina: Nitroglycerin, propranolol, Ca+ channel blockers (like verapamil)
Meds Effect on Body Oxygen
Nitroglycerin vasodilator on coronary artery smooth muscle More O2 supply
Propranolol prevent chronotropic response to epi/emotion/exercise Less O2 demand
Ca+ channel blockers vasodilator of peripheral resistance Less O2 demand
Digoxin— inhibition of Na+/K+ ATPase, mainly in the myocardium = decreased heart rate
Congestive Heart Failure: Glycosides like digitalis, digoxin, ACE inhibitors
- Positive inotropic effect, ↑ myocardium contraction force by inhibiting Na+/K+ ATPase & increasing Ca+ influx
(heart beats less, but has stronger contractions)

How do Ca2+ Channel Blockers work? Thus, by blocking the entry of calcium,
Arrhythmia: Lidocaine (VA), quinidine (AF, SV), verapamil (AF), digitalis (AF, SV)
reduce electrical conduction within the heart, decrease the force of contraction
- Type 1A agents (like quinidine) – increase cardiac muscle’s refractory period (work) of the muscle cells, and dilate arteries. Dilation of the arteries
- Type 1B agent (like lido) – decease cardiac excitability reduces blood pressure and thereby the effort the heart must exert to pump blood
- Digitalis – decrease A-V conduction rate

QUESTION: Why is pt taking ACE inhibitor? Hypertension / CHF

QUESTION: Pt taking cardiac glycosides. What is it used for? hypertension, congestive heart failure, etc

QUESTION: What do cardiac glycosides (ex. digitalis) do? Inhibit Na/K ATPase & Increase Na and Ca in cell to increases the refractory period.

QUESTION: How does digitalis works? blocks Na/K ATPase = increase influx more Ca

QUESTION: Digitalis - Increase Ionotropic (contractions) effect of the heart
Chronotropic effects (from chrono-, meaning time) are those that change the heart rate
QUESTION: Use of digitalis: Post myocardial infarction, Supraventricular arrhythmia
- digitalis/cardiac glycoside = common indications for use is for atrial fibrillation

QUESTION: How does Digoxin work? Inhibits Na/K ATPase of cardiac cell membranes resulting in increase of Na concentration intracellularly,
++
cardiac glycoside, increases intracellular Ca

QUESTION: Garlic: lots of uses, usually assoc with CVD
- CI: contraceptives and anti-virals (HIV), caution with bleeding

QUESTION: Pt has history of cardiovascular disease and now, pt is taking aspirin. Pt needs ext. What should dentist do?
• Med consult with physician

QUESTION: Mechanism of most drugs that tx arrhythmias? Decreases repolarization rate, prolongs refractory period

QUESTION: When you have atrial arrhythmia, what’s the mech of action for the drug for it?
- you can give Quinidine, Verapamil, and Digitalis for atrial and the side mechanism of Quinidine is it increases the refractory period

QUESTION: General question about arrhythmias medications. They increase calcium inotropic effect, decrease SA node transmission, increase
refractory period Inotropes vs Chronotropes
-Inotropes (neg/pos) affect strength of heart contraction
QUESTION: Side effect of nitroglycerin: orthostatic hypotension and headache -Chronotropes (neg/pos) affect rate of contractions

QUESTION: Transient ischemic attack (TIA), what is false? Better chance to get stroke-true, patient should take nitroglycerin FALSE-give for
angina to prevent heart attacks.

QUESTION: Nitrates and nitriles have what systematic effect? Vasodilation of arteries à decreased BP à tachycardia
- Nitroglycerin is a nitrovasodilator. It produces nitric oxide, which activates guanylyl cyclase which, in turn, catalyzes the production of ⬆
cGMP.

QUESTION: Nitrates/Nitriles, how do they respond to angina? through blood vessels (dilate blood vessels)

QUESTION: How do nitrates work on the heart? relaxing and widening the blood vessels in the body, allowing more blood and oxygen to flow to
the heart. Since the arteries are wider, it is easier for the heart to pump blood, so it does not require as much blood and oxygen.
QUESTION: You give the nitroglycerin to the pt with angina and heart rate goes up, what's the reason? natural reflex to the decrease in blood
pressure
QUESTION: Amilnitrate & Nitroglycerine? Vasodilate coronary arteries for angina pectoris—chest pain caused by occlusion of coronary arteries
à chest pains, SOB
QUESTION: For angina drug, which drugs can’t you take: some type of hydrothiazide med
QUESTION: Diuresis (excessive urine production) after tx of angina w/ a glycoside? b/c of increased blood flow caused increased blood flow to
kidney i.e. digoxin
QUESTION: Epi and Nitroglycerine: antagonist (epi = vasoconstrictor)

QUESTION: Why give hydralazine with chloral hydrate? Decreases nausea Hydralazine = vasodilator
- Hydralazine (Apresoline) is a direct-acting smooth muscle relaxant used to treat HTN by acting as a vasodilator primarily in arteries and
arterioles to decrease peripheral resistance, thereby lowering blood pressure and decreasing afterload.
QUESTION: Main prophylactic treatment for angina? Propranolol
QUESTION: Nitroglycerin, propranolol, and something else are all used for- cardiac arrhythmias, angina
QUESTION: Which is not used in tx of angina? Nitroglycerin, Ca+ blocker, propranolol, thiazide (thiazides are usually diuretics)
QUESTION: Quinidine treats? SV arrhythmias also treats malaria
supraventricular = SV

PULMONARY/LUNGS

QUESTION: Asthma causes constriction on bronchioles, constriction of smooth muscles & inflammation of bronchioles? Beta 2 receptor for
lungs, Beta 1 receptor for heart
QUESTION: What do asthmatic patients have problem with? Wheezing when exhaling
- Wheezing à exhale with high pitch


QUESTION: COPD vs Asthma? Asthma have problem breathing in (but wheeze when exhaling), COPD has problem exhaling
Wrong? Trouble getting air IN (during inhalation) is NOT ever asthma, trouble getting air OUT (during exhalation) is. ... People with asthma have trouble getting air OUT
QUESTION: What is the most common cause for breathing difficulty in the dental chair?
Hyperventilation
COPD
Asthma

QUESTION: Most common respiratory emergency in dental office? Hyperventilation
QUESTION: Hyperventilation causes – tachycardia and tachypnea (rapid breathing)
QUESTION: Face swelling after air spray in perio pocket: soft tissue emphysema (sudden painless swelling)
- Emphysema: constriction of air sacks

QUESTION: Perio surgery, air into sulcus. What occurs? subcutaneous emphysema
**Crepitus sound = typical
Very painful, can be caused by air in handpiece, need to rx pain meds and abx
QUESTION: Pt has emphysema. What are his symptoms? Dyspnea, wheezing, cough, chest tightness. Air sacks are all destroyed (narrowing of
distal airways) type of COPD

QUESTION: Crowing sound when breathing (Stridor)?
• asthma attack
• COPD
• Pneumothorax
• laryngospasms spasm of the vocal cords that temporarily makes it difficult to speak or breathe
QUESTION: Stridor- laryngospasm - blockage of UPPER resp. tract

QUESTION: Epi for laryngiospasm, what does it do? (multiple answers- multiple choice with 3 answers each)- bronchodilater, increase HR,
increase BP

QUESTION: Theophylline is used to prevent and treat wheezing, SOB (shortness of breath), and difficulty breathing caused by asthma, chronic
bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe.
Theophylline = bronchodilator
QUESTION: Which drugs is used for asthma? Levabuterol

- Albuterol was not in it, levabuterol (xopenex), ipratropium(atrovent), Combivent, Advair, Smbicort, Spiriva, Budenoside

QUESTION: Most effective during acute asthma attack? albuterol- generic name is Salbutamol. It is a beta-2 agonist, which causes
bronchodilation (rescue inhaler) Beta-2: think you have 2 lungs = bronchodilator
Beta 1: think you have 1 heart
• Epinephrine
• atropine
• something else

QUESTION: Medication for severe asthma attack à Aminophiline (bronchodilator)

QUESTION: A child treated with albuterol. Why? Asthma

QUESTION: What drug cause asthma? Aspirin (NSAID) so NO NSAIDS for asthmatic patients
*aspirin-induced asthma is a thing
QUESTION: Which of the following drugs is can trigger asthma?
a) narcotic analgesic
b) NSAID
c) corticosteroid
d) sympatolytic amine.
QUESTION: What is used for a severe bronchial asthma attack? Albuterol, corticosteroids, aminophylline
QUESTION: Long term asthma, give corticosteroid
QUESTION: Asthmatic only use Tylenol (not aspirin bc of hypervent)à Bronchospasms If they can’t have aspirin, they can’t have ibuprofen (both NSAIDs)
QUESTION: Patient begins to wheeze, what do you not do?
o Beta-2 blocker inhaler beta-2 blocker is not a good idea. Asthma meds are beta-2 agonists
o sit pt up & make them more comfortable
o corticosteroid inhaler
o Give oxygen
QUESTION: What cause dry mouth? Albuterol
SYNCOPE
peripheralization of blood supply
Orthostatic hypotension = (head rush or dizzy spell) is a form of hypotension in which a person's blood pressure suddenly falls when standing
up or stretching.
Vasovagal syncope = the most common type of fainting, is a malaise mediated by the vagus nerve.

Trendelenburg position (for anaphylaxis) - Position in which the patient is on an elevated and inclined plane, usually about 45°, with the head
down and legs and feet over the edge of the table. This position is used in treating shock, but if there is an associated head injury, the head
should not be kept lower than the trunk.
She seems a little young to be having sex…
QUESTION: 5-month old pregnant woman with syncope, what position do you put her in?
supine with legs raise
reversed trendelburg
on her Right
on her left - to avoid compression of inferior vena cava
rd
QUESTION: If a 3 trimester pt all of a sudden feels a drop in BP, what do you do? Have pt lay on left side
QUESTION: Prego question – syncope, which side you put pt? Raise right hip up
- Baby crushing IVC so lay on left hip & raise right hip UP

QUESTION: What causes pregnant woman to syncope? Beware of compression to inferior vena ceva
QUESTION: Pregnant in supine position, what gets too much pressure?
Fetus
Placenta
Inferior Vena Cava
Superior Vena Cava

QUESTION: Most important thing to do when patient syncope – maintain airway, loosen up buttons, place head below heart, supine
QUESTION: Crown disappears down patient’s throat, what position do you put them in? Supine, Upright, Trendelberg
QUESTION: Want to determine patient physiologic rest position, place in – supine, upright/standing, tredenlburg
QUESTION: Purpose of the Trendelberg position is to? maint circulation so that the most vital organs are never hypoxic.

QUESTION: What position you place the Pt when is having syncope? TRENDELENBURG POSITION
- SUPINE WITH FEET ELEVATED SLIGHTLY
- The most common early sign of syncope is PALLOR (paleness).
QUESTION: You walk to office, pt is unconscious. What position do you place the patient in? Supine, Tendenberg, upright

• Hypovolemia
• Decreased perfusion to tissue Crazy drop in BP
• Sepsis


QUESTION: Syncope? Inhale ammonia to irritates es. trigeminal nerve sensory, 100% oxygen works except with hyperventilation syndrome.
QUESTION: High-flow 100% 02 is indicated for treating each of the following types of syncope EXCEPT one. Which one is this EXCEPTION?
A. Vasovagal
B. Neurogenic sudden drop in BP due to stressful trigger
C. Orthostatic

QUESTION: Most common dental complication/emergency in office? Syncope
QUESTION: You gave local anesthetic, BP went up to 200/100 and HR went up too, what could be due to? Due to vasoconstrictor injected into
venous system.
QUESTION: After receiving one cartridge of a local anesthetic, a healthy adult patient became unconscious in the dental chair. The occurrence
of a brief convulsion is
QUESTION: Signs of syncope: blood pressure falls
QUESTION: Signs of epi overdose: blood pressure and heart rate rises
QUESTION: Carpopedal spasm seen in? asthmatic attack, hyperventilation
- Carpopedal spasms are severely painful cramps of the hand/feet muscles.
- May be caused by low blood calcium levels or by tetanus. Trousseau sign
SEIZURES & SEDATIVE MEDICATIONS

Benzodiazepines:
- MOA – modulate activity of inhibitory NT (GABA) receptor
- Advantages vs barbs: less addictions potential, less CNS/respiratory depression, larger
therapeutic index
- can cause respiratory depression (most adverse effect)
- CONTRAINDICATIONS: Pregnant, myasthenia gravis, acute narrow glaucoma, COPD,
emphysema Myasthenia gravis is a chronic autoimmune neuromuscular disease that causes weakness in the
skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs

Grand mal seizure: Phenytoin (Dilantin) (anticonvulsant) possible gingival enlargement
Status epilepticus: Valium (diazepam)
multiple epileptic seizures without recovery between them
(Xanax = alprazolam)

QUESTION: Which of these is indicated for grand mal seizure? DILANTIN (phenytoin)
QUESTION: Most common seizure in children – grand mal seizures (AKA tonic-clonic seizure)
- Febrile seizures, which occur in young children & are provoked by fever, are the most common type of provoked seizures in childhood.
Then, generalized tonic-clonic (grand mal)

E. Chlordiazepoxide (Librium®)

QUESTION: Drug of choice of status epilepticus (seizure that last for long period)? Valium (diazapams) 5-10 mg IV / per minute
QUESTION: Diazepam is contraindicated in the following patients? Pregnancy

QUESTION: Which of the following drugs, when administered intravenously, is LEAST likely to produce respiratory depression?
A. Fentanyl
B. Diazepam
C. Thiopental
D. Meperidine (Demerol = narcotic)
E. Pentobarbital

QUESTION: What drug for patient with petit mal seizures in dental office? Ethosuximide
- Only 2 drugs for absence seizures (petit mal): ethosuximide (Zarontin) – only treats petit mal- and valproic acid (Depakene, Depacon) –
brief, sudden lapses in attention
treats grand mal, petit, and myoclonic seizures.

QUESTION: What causes/induce seizures?
a. Hyperkalemia
b. Hypophosphatasa
c. Hyponantremia (low sodium) Typo: hyponatremia
d. Hypernantremia.
e. Hypoglycemia

QUESTION: Epileptic pt least likely to take:
a. Ethosuximide – petit mal seizures
b. Diazepam - Status epilepticus
c. Lasix (furosemide) – HTN loop diuretic

QUESTION: Each of the following is an advantage of midazolam over diazepam EXCEPT one. Which one is this EXCEPTION?
- midazolam has a milder effect, but more long lasting

QUESTION: The clinical activity of a single intravenous dose (10 mg) of diazepam is most dependent on which of the following?
A. Alpha half-life
B. Betahalf-life
C. Renal excretion

QUESTION: Each of the following are narcotics used in outpatient anesthesia EXCEPT one. Which one is this EXCEPTION?
A. Fentanyl
B. Sufentanil
C. Meperidine
D. Diazepam (not a narcotic, its an anxiolytic/sedative)
E. Morphine

QUESTION: Which of the following describes the titration of diazepam to Verrill's sign for IV conscious sedation?
A. It is recommended as an end-point. Verrill’s Sign = Ptosis = Droopy eyelid
- The most frequently used signs for IV diazepam sedation are ptosis, (“the Verrill sign”), altered speech and blurred vision.

Epinephrine (EpiPen ̈)
Naloxone (Narcan ̈)
Diazepam (Valium ̈)
Flumazenil (Romazicon ̈)
Succinylcholine (Anectine ̈)(paralytic
to relax muscles during surgery)
SEDATIVES:

Benzodiazepines: enhance the effect of gamma aminobutyric acid (GABA) at GABAA receptors on Cl- channels. This increases chloride channel
frequency

- α-Hydroxylation is a rapid route of metabolism unique to triazolam, midazolam, and alprazolam à short sedative
- Benzodiazepines: ones not metabolized by the liver (safe to use in liver failure)
o LOT: Lorazepam, Oxazepam, Temazepam
- Contraindication: pregnancy

Barbiturates: enhance the effect of GABA on the chloride channel but also increase chloride channel conductance independently of GABA,
especially at high doses. Increases duration of Cl- channel opening.
- Long-acting: Phenobarbital is used to treat certain types of seizures
- Intermediate-acting. Amobarbital, pentobarbital (occasionally used for sleep), secobarbital.
- Short-acting. Hexobarbital, methohexital, thiopental

Zolpidem (Ambien) and zaleplon: short ½ life, used for insomnia, selective action @ BZ1 receptor
- Not a benzo but acts like it, reversed by flumazenil, potentiates GABA receptor

QUESTION: What’s the action of the Benzodiazepines? Facilitates GABA receptor binding by Increasing the frequency of chloride channel
opening.

QUESTION: Xanax MOA, Mechanism of action of on GABA receptors: increasing the frequency of chloride channels by benzodiazepines
- Barbiturates increase the duration of chloride channel opening

QUESTION: Benzodiazepines act on: GABA receptors

QUESTION: Which benzodiazepines is used for depression & anxiety for obsessive compulsive disorder? Xanax (alprazolam)

QUESTION: Diazepam (valium) action in GABA: Anti-convulsant & sedative

QUESTION: Anticonvulsants can cause cleft palate (teratogenic effect)

QUESTION: Valium is used for all of following except: emesis (vomiting) or insomnia


QUESTION: Hypnosis affects what?
voluntary muscles
involuntary muscles
both voluntary and involuntary muscles
glands

QUESTION: Which of the benzodiazepine don’t you give to elderly? Long acting one (like diazepam)
- Short to intermediate-acting benzodiazepines are preferred in the elderly (ex. oxazepam, temazepam, midazolam)

QUESTION: Benzodiazepines are great for dentistry due to an action of- amnesia and little memory of the event.

QUESTION: Best benzo for IV sedation – MIDAZOLAM good for amnesia


QUESTION: Best benzodiazepine for pt with liver cirrhosis Oxazepam
- LOT: Lorazepam, Oxazepam, Temazepam

QUESTION: Which drug best reverses the effect of benzodiazepines? Flumazenil reverses effects of Ambien (zolpidem)
- Flumazenil: Benzodiazepine antagonist b/c competitive GABA receptor.

A. Narcon Narcon = Naloxone
B. Flumazenil
C. Naloxone (for opioids)
D. Disulfuriam (for alcoholics)

QUESTION: Contraindication of lorazepam:
a) pregnancy
b) diabetes

QUESTION: Why do you use benzos or a barb for antianxiety? Reduced depression, does not propentiate depressants. (less respiratory
depression)
QUESTION: How benzos are anxiolytic? moderate doses ANTIANXIOLYTIC and high doses is SEDATIVE

QUESTION: Sedative rebound – Antipsychotic, part of withdrawal
- Several anxiolytics & hypnotics have a rebound effect, which cause severe anxiety and insomnia worse than the original insomnia or
anxiety disorder.
QUESTION: Which of the following barbiturates MOST readily penetrates the blood-brain barrier? Thiopental truth serum
QUESTION: Sodium Thiopental: rapid-onset short ultra-acting barbiturate(IV) for general anesthesia
QUESTION: A patient has appointment next morning, he is anxious, and the night before he had hard time sleeping, which of the following tx
would you prescribe? Ambien (sedative and makes patient sleep).
a. oxidation (occurs in the liver)
b. reduction.

redistribution.
ANTI-HISTAMINE MEDICATIONS

Histamine is bronchospastic and vasodilator. Anticholinergics block the NT AcH in the CNS and PNS, inhibit parasympathetic nerve impulses

H1 Anti-Histamines: competitive histamine receptor blockers
Technically, all anti-histamines cross the BBB, but the second generation ones do way less
- Tx of dermatologival manifestation of allergy reaction which is why they don’t cause the same sleepiness as the first gen H1 blockers like Benadryl
- Controlling Parkingson’s symptoms
- Pre-operative meds for sedation, anti-cholinergic effects
- Diphenhydramine/Benadryl – H1 anti-histamine, anti-cholinergic, sedative
o Side effects: dry mouth and throat, increased heart rate, pupil dilation (mydriasis), urinary retention, constipation –
anticholinergic
- Allegra (Fexofenadine), Claritin (loratidine), Clarinex (Desloratidine), Zyrtec (Cetirizine) = don’t cross BBB, poor CNS penetration

H2 Anti-Histamines: reduce gastric secretions by block the action of histamine on parietal cells in the stomach à Cimetidine, ranitidine,
(Antacid/antihistamine)
famotidine, nizatidine Parietal cells secrete HCl (acid) and intrinsic factor

Epinephrine = physiological antagonist of histamine

- Histidine decarboxylase (HDC) enzyme catalyzes the reaction that makes histamine from histidine w/ vitamin B6

st
QUESTION: Benadryl (diphenhydramine) - 1 generation anti-histamine - H1 blockers

QUESTION: What is used for motion sickness? Diphenhydramine (Benadryl) Dramamine and Benadryl are basically the same thing

QUESTION: What does diphenhydramine (Benadryl) cause? Xerostomia (anti-cholinergic, anti-histamine, sedative)

a. Anticholinergic Anticholinergic drugs dry secretions in the mouth, nose, throat and lungs. ...
Dry mouth is a very common effect, and if persistent can cause ulceration of the gums,
b. Antihistaminic tooth decay and fungal infections
c. Antimuscarinic

QUESTION: What property of topical diphenhydramine would alleviate pruritus (itching)? Anti-histamine
- antihistamine relieves itchy/watery eyes and itchy throat by blocking a substance (histamine) released by allergies.
- anticholinergic dries up a runny nose & the fluid that runs down your throat causing itching/irritation.

QUESTION: What anti-histaminic cause less drowsiness: H1 blocker 2nd generation
- Allegra, Claritin (loratidine), Clarinex (Desloratidine) Certizine (Zyrtec) because they don’t cross BBB, poor CNS penetration

nd
QUESTION: Which one of these has the least sedative effect? (2 generation H1 blocker)
chlorpheniramine (LEAST)
Tripelennamine
- Chlorphenamine, is a first-generation alkylamine antihistamine

QUESTION: Which antihistamine is least likely to cause drowsiness? Loratidine (Claritin) (H1 blocker, 2nd gen)


QUESTION: Which of the following would have slowest onset after IV administration? Diphenyhydramine, loratadine, rest were H1 anti-
histamine (Claritin)

QUESTION: What do you give to someone who is allergic to ester & amides LA? DIPHENHYDRAMINE (BENADRYL)


QUESTION: Detailed mechanism questions on H1 (histamine) à compete w/ histamine to bind at H1 receptor sites.

QUESTION: Effects of H1 blocker EXCEPT: (causes CNS depression)
a. CNS increase *they’re sedatives
b. CNS decrease
d. respiratory depression
e. local anesthesia

QUESTION: Actions of H1 antagonist à competitive inhibition of H1 receptors so block vasodilation, bronchoconstriction, and capillary
permeability à Vasoconstriction, bronchodilation, and decrease capillary permeability

QUESTION: H2 antihistamine à Cimetidine – decrease ulcers
- Cimetidine (Tagamet) is a histamine H2 receptor antagonist that inhibits stomach acid production & is used as an antacid.

QUESTION: Histamine 2 blocker meds - for gastric reflux or GERD (gastric esophageal reflux disease) - Cimetidine & Ranitidine
Zantac

QUESTION: What do bradykinin do? Dilate blood vessel & lower BP
Bradykinin= inflammatory mediator
QUESTION: 25 yo female breast feeding 12m old child and currently pregnant, which sedative would you give?
• Halcion
• Promethazine
• Nitrous
• Diazepam
• Phenobarbital

QUESTION: What anxiolytic to use for anxious 25-year-old pregnant woman who is breastfeeding? Chloral hydrate (avoid), nitrous (avoid),
benzo (avoid), promethazine

OPIOIDS/ANALGESICS
• Group 1 - Opiates - Naturally occurring agents derived from the opium plant
• Group 2 - Semi-synthetics
o Hydrocodone, oxycodone, hydromorphone, oxymorphone, buprenorphine (heroin is also in this group)
• Group 3 - Synthetics
(Ultram)
All of the group 1 and 2 agents are structurally very similar to each other and should not be given if a true allergy exists to any other natural or
semi-synthetic derivative.
Group 3 agents have structures different enough that they can be given to a patient intolerant to the natural or semi-synthetics without fear of
cross reactivity. They are also very different from others in this same group.

Mixed agonist-antagonist analgesic – pentazoine, naibuphrine
Naloxone – treat morphine overdone, antagonist
Methadone – used in detoxification of morphine addicts

Opioids – binds to specific receptors (ex. mu receptors) in CNS
- Symptoms: respiratory depression, euphoria, sedation, dysphoria (unease), analgesia, antitussive, constipation, urinary retention,
vomiting/nausea (trigger medullary CTZ)
- Overdose: coma, miosis (pupil constrict, pin-point pupils), hypothermia, respiratory depression (loss of sensitivity of medullary respiratory
center to CO2)

QUESTION: Which of these opioid analgesics is associated with a serious life threatening drug interaction when administered with an MAO
inhibitor?
Meperidine (Pethidine, Demerol)
morphine
fentanyl propoxyphene
codeine
- Can cause life-threatening hyperpyrexia reactions (fever)
QUESTION: Drug-drug interaction with MAOI (hydralazine) and Meperidine (opioid) so MAOI is contraindicated!
QUESTION: No opioids for patient taking MAOIs in case of head injury
QUESTION: An opiate type MAA with both agonist and antagonist properties is- pentazocine
Pentazocine is a synthetically-prepared prototypical mixed agonist–antagonist narcotic (opioid analgesic)
Another one is nalbuphine

QUESTION: Pt is addicted to oxycodone which contra indicated? codeine, pentozocaine

QUESTION: Absolute Contraindications to Opioid Prescribing: Allergy to Codeine/Oxycodone/Hydrocodone
- give Methadone or Meperidine or Tramadol instead (Group 3 synthetic)

QUESTION: Which of the following narcotics/opioids is synthetic? Meperidine (Demerol)

QUESTION: Use for sedation of children - Secobarbitol or pentobarbital (good for pre-op/anxious kids)
- Ketamine is used in emergency situations (good anxiolytic and analgesic at low doses)
- Meperidine should not be used in kids

QUESTION: Which is not done by opiates?
o Constipation
o Bronchiolar constriction
o Vomiting

QUESTION: Opioid usage shows all except: xerostomia, chronic cough, diarrhea, miosis, constipation

QUESTION: Opioid side effect – constipation

QUESTION: Opioid overdose side effect – constipation, respiratory depression, euphoria, miosis, coma
- miosis = excessive constriction of the pupil of the eye.

QUESTION: Opioid OD symptoms – answer was hypotension. Other options were irritability (restlessness), hypertension, insomnia = withdrawal
symptoms.

QUESTION: Symptom seen in oral opioid overdose: hypothermia, headache, insomnia, irritability (rest are withdrawal symptoms)
QUESTION: What is the most significant side effect of morphine/opioids? Respiratory depression
A. Comatose sleep
B. Pin-point pupils (miosis)

QUESTION: If you give too much of an opioid (but it’s not an overdose!), what’s the first sign you would see?
a. Irritation
b. Headache
c. constricted pupils and absent/slow breathing

QUESTION: Opioid Receptors- brain, spinal cord and digestive GI tract.
QUESTION: Opioid cause stomach upset by acting on the brain, not on stomach receptors!
QUESTION: Opioid agonists act by:


QUESTION: Naloxone: use for Opioid overdose.
- Naloxone blocks or reverses the effects of opioid medication, including extreme drowsiness, slowed breathing, or loss of consciousness

QUESTION: Opioid (Fentanyl, Morphine, Meperidine, Methadone, Sulfentanil, Codeine, Heroin, Dextromethorphan) reversal drug? Naloxone
QUESTION: Antidote for Percodone overdose (Oxycodone + aspirin)? all opiate antidote is Nalaxone.

- Intrinsic activity (IA) or efficacy refers to the relative ability of a drug-receptor complex to produce a maximum functional response.

QUESTION: Antagonist: Binds to receptor but lacks intrinsic activity (doesn’t activate receptor)
QUESTION: What opiate is part of the intradermal system? Fentanyl

- Fentanyl = opioid analgesic given via transdermally patch

QUESTION: Methadone helps alleviate withdrawal from heroine (opiates).
- Methadone for detoxification of opioid addicts, give to heroin addicts to decrease withdrawal symptoms
- Methadone is a synthetic opioid, analgesic, antitussive, anti-addictive, acts on MU receptors so produces similar effects of opioids but
without addictive qualities, receptor antagonist to glutamate. Long ½ life.

QUESTION: Why is nalbuphine (NUBAIN) contraindicated in previous heroin addict? It’s a mixed agonist-antagonist which may
potentiate/increase withdrawal symptoms.
QUESTION: Sedative drug such as hydroxyzine, meperidine and diazepam are carried in the blood as?
a. serum
c. red blood cells
d. hemoglobin
QUESTION: Where do opioids act? Medulla (bind to opioid receptors in CNS)

QUESTION: Where are mu receptors? Medulla

QUESTION: Codeines produces nausea because?
Activates vasodilator blah blah blah

QUESTION Mechanism of how codeine causing nausea? Chemotactic receptor zone (CRZ)

QUESTION: How does morphine cause emesis (vomiting) in the body? via central action (medulla)

QUESTION: CODEINE is analgesic, antitussive (suppress coughing), anti-diarrheal, anti-hypertensive, anxiolytic, anti-depressant, sedative and
hypnotic properties. IT IS ADDICTIVE.

QUESTION: If you had an allergy to codeine, what do you take for pain? random opioids, Tylenol #3, hydrocodone, acetaminophen with aspirin
- ALLERGY TO CODEINE: can prescribe another opioid from different class: Meperidine or fentanyl for moderate to severe pain or
acetaminophen or NSAID for mild pain.

QUESTION: Patient is allergic to codeine when you look at their medical history tab, (this is the trick about the exam, look up stuff before you
answer questions), what do you prescribe him for pain?
a. Hydrocodone with Acetaminophen
b. Tylenol 3
c. Hydrocodone with Aspirin
d. Acetaminophen + aspirin

QUESTION: What give to pt allergy to codeine? Propoxyphene
QUESTION: Allergic to Codeine, what can you give? use synthetic opioids (meperidine, tramadol) à Demerol (meperidine), Pentazocine
• Vicodin
• Naproxen
• Hydrocodone
QUESTION: Pt is allergic to aspirin, what can you give? Tylenol #3 (acetaminophen & codeine)

QUESTION: What does acetametaphine do with codeine (Tylenol #3)? Increase its activity & increase how long it’s around due to clearance

QUESTION: Why opioid analgesic containing both acetaminophen and hydrocodone so effective? acetaminophen & hydrocodone works
differently, and combining these effects makes it stronger
- acetaminophen blocks the binding of protein w/ hydrocodone, so hydrocodone level higher in blood à stronger response
- Narcotics work in brain (CNS) while NSAIDS/acetaminophen work in peripheral tissues (PNS) – 2 diff mechanisms complement each other
for effective pain reduction

QUESTION: Pt has mild pain from ortho tx. What med NOT to give?
• Aspirin
• Ibuprofen
• Hydrocodone
• Naproxen

QUESTION: What med to give for moderate post-op extraction pain? Ibuprofen, Acetaminophen, NSAID, Opioid
QUESTION: Breastfeeding mother, don’t give her what? Codeine, tetracycline, benzos
- Codeine medication may be harmful to an unborn baby, and could cause breathing problems or addiction/withdrawal symptoms in a
newborn.

QUESTION: Pt taking narcotic for long term what causes: headache due to increase intracranial pressure.

DRUG SCHEDULE

Tylenol 1 = 8mg codeine; Tylenol 2 = 15mg codeine; Tylenol 3 = 30 mg Codeine; Tylenol 4 = 60mg Codeine

Prescriptions for schedule II controlled substances cannot be refilled. A new prescription must be issued.
Prescriptions for schedules III and IV controlled substances may be refilled up to 5 times in 6 months. Prescriptions for schedule V controlled
substances may be refilled as authorized by the practitioner.

QUESTION: DEA schedules their drugs by ABUSE POTENTIAL or dependency potential (addiction)

QUESTION: DEA number required for prescribing opioids/narcotics, like codeine, oxycodeine, etc.
- DEA number (DEA Registration Number) is a number assigned to a health care provider by the U.S. Drug Enforcement Administration
allowing them to write prescriptions for controlled substances.

QUESTION: Dentist can’t write prescription for schedule class 2 for back pain.

QUESTION: What is not true of drugs? Schedule II drugs cannot get refill without prescription. The following are true:
- Schedule 3, 4, 5 drugs CAN be filled over the phone.
- Scripts must have patients name and address
- DEA number must be on each script.
o Schedule II drugs cannot get a refill. A new prescription must be written!

QUESTION: Oxycodone, Hydrocodone (changed in 2014 to schedule 2) = schedule 2 drugs

QUESTION: What can be combined with Tylenol to make it a level 2? oxycodone, codeine etc.

QUESTION Which one is a class 2 narcotic? Percoset (oxycodone + acetaminophen)

QUESTION: Vicodin schedule: 2 (acetaminophen + Hydrocodone)

QUESTION Percocet schedule: 2 (acetaminophen + Oxycodone)

QUESTION: Schedule 2: combination products containing less than 15 milligrams of hydrocodone per dosage unit (Vicodin®)
QUESTION Schedule 3: products containing less than 90 milligrams of codeine per dosage unit.

QUESTION: Schedule 4 narcotic is propoxyphene (Darvon), alprazolam (Xanax), clonazepam (Klonopin), clorazepate (Tranxene), diazepam
(Valium), lorazepam (Ativan), midazolam (Versed), temazepam (Restoril), and triazolam (Halcion).
QUESTION: Drug schedules II or III – they are all acetaminophen with opioid except for one that was hydrocodone with NSAID (vicoprofen)
QUESTION: Schedule II narcotic and anti-psychotic à neuroleptic analgesia
NSAIDS & ACETAMINOPHEN

Aspirin - baby aspirin (81mg, day), aspirin is 325mg (to 650mg) q 4-6 hrs. (max dose is 4000 mg)

Aspirin and NSAIDs inhibit platelet cyclooxygenase, thereby blocking the formation of thromboxane A2.
- Aspirin irreversibly blocks cyclooxygenase & it’s actions persist for circulating lifetime of platelet.
- NSAIDS inhibit cyclooxygenase reversibly & duration of action depends on drug dose/serum levels/half-life.
Nonselective NSAIDs (such as aspirin, naproxen, and ibuprofen) inhibit both COX-1 and COX-2. Selective NSAIDS like Celebrx target just Cox-2.
QUESTION: How do you treat acetaminophen overdose? N-acetylcysteine

QUESTION: Reversal of acetaminophen: NAC, N-acethylcysteine-liposome.


QUESTION: Pt has hepatic dysfunction; which pain medication can prescribe?
a. Oxycodone
b. naproxen
c. acetaminophen

QUESTION: What is relationship between Tylenol and aspirin? Anti-pyretic and analgesic
- Difference: aspirin is anti-inflammatory, common: anti pyretic

QUESTION: Which of the following does not have anti-inflammatory action? Acetaminophen

QUESTION: Aspirin causes - Reyes fever and adults, GI problems. If liver problems, give aspirin.
QUESTION: Aspirinà inhibits platelet aggregation
QUESTION: NSAID irreversible affect platelets & suppress inflammatory response.
QUESTION: NSAIDs – mech of action of suppressing platelets – inactivate cyclooxygenase à decreased prostaglandin synthesis
QUESTION: Aspirin stops pain by:
a. stopping the upward transduction of pain signal in the spinal cord
b. intefere with signal interpretation in the CNS
c. stopping the local signal production and transduction
stopping the signal transduction in the cortex

QUESTION: NSAIDS.irreversible or reversible (question which of the following true about NSAIDS) …answer 1 irreversibly binds answer 2
reversibly answer 3 something about bleeding time answer 4 something about platelets

QUESTION: NSAID that is least likely to affect stomach – CELEBREX (Selective NSAID - Cox 2 inhibitor only)
- Cox 2 does not increase bleeding time and less platelet adhesion.

QUESTION: What does not have an effect on platelets on this list of NSAIDS? Celebrex (Celecoxib)

QUESTION: Dyspepsia (upset stomach), what drug can cause it? Less likely to be acetaminophen, ibuprofen (less GI upset than other nsaids).
- Ibuprofen doesn’t cause as much GI upset as aspirin.

QUESTION: CASE: Patient is taking baby aspirin (81 mg).
a) How long before should you stop before surgery?
b) Is it necessary to stop? No
c) For long will the platelets be inhibited? 5-7days
- aspirin stays in body for 7 days.

QUESTION: For how long will a single dose of aspirin will have effect on the platelets? 2h, 12h, 1 day, 10 days, 1 month

QUESTION: After one effective dose of aspirin, how long must you wait before there is not effect on bleeding time? 1 week
QUESTION: Aspirin works on which pathway for pain? Cyclo-ox pathway

QUESTION: How does aspirin work to inhibit bleeding? Inhibits thromboxane A2, preventing platelet synthesis
- aspirin affects bleeding time


QUESTION: Pt has reaction to aspirin, what else can you prescribe? acetaminophen
- most NSAID cross-react with aspirin - meaning that they can cause the same types of reactions in aspirin sensitive people

QUESTION: If someone can’t take Ibuprofen, what can you give them?
a. aspirin
b. Demerol - narcotic w/out aspirin
c. Pentazocine - narcotic w/aspirin



QUESTION: Patient is on 3-5g acetylsalicylic acid per day for 3 months, what are you the most likely to see in this patient?
Acidosis and increased bleeding time
- Causes acidosis since acetylsalicylic acid is aspirin. It’s an acid & 3g daily is a lot!

QUESTION: Ketorolac is an NSAID that inhibits prostaglandin synthesis (competitive non-selective cox inhibit).

QUESTION: Oral Ketorolac (toradol) à NSAID, usually used after IV dose of Ketorolac after surgery
- Ketorolac is used to relieve moderately severe pain, usually pain that occurs after an operation or other painful procedure.

a. acetaminophen
b. aspirin
c. ketorolac
d. ibuprofen
- The other drugs are NSAIDS and they affect the kidney in a more negative way. This drug affects the liver and causes liver toxicity.

QUESTION: Tylenol – non-narcotic analgesic of choice for pt taking anti-coagulants – no anti-inflammatory properties

QUESTION: Methotrexate (immune suppressive drug) toxicity increases with use of NSAIDS or penicillin

rd
QUESTION: 3 trimester pregnant patient needs pain medication – options: Tylenol 325mg, Tylenol 3m aspirin, or ibuprofen 600mg?

QUESTION: Patient is pregnant and needs 2 teeth extracted. Pt needs post-op analgesic. What do you rx?
ibuprofen
aspirin
Tylenol 3
Tylenol (acetaminophen)
- For pregnant- only give Tylenol- NOTHING WITH CODEINE

QUESTION: What is a safe pain killer to give a woman who is pregnant? Tylenol
- Asthmatic only use Tylenol (not aspirin bc of hypervent)

QUESTION: 5-year-old patient with fever and pain. What do you Rx?
• Codeine
• Tylenol
• Aspirin
• NSAID
QUESTION: If a patient had some teeth extracted & asked what drug he can take that’ll provide at least 8 hours of relief, what would you Rx?
a. Tylenol
b. Ibuprofen
c. NAPROXEN
QUESTION: Pt wants to be able to sleep through the night following extraction what should you prescribe? Naproxen --- a nonselective COX
inhibitor—NSAID
QUESTION: Naproxen – 8 hour NSAID
QUESTION: What are you worried about when a patient is on Naproxen? DDI w/ aspirin antiplatelet activity
QUESTION: Which of the following has least effect on platelets/bleeding?
• Aspirin
• Ibuprofen
• Naproxen
BIOPSY

Incisional biopsy is a technique used when a lesion is large > 1 cm, polymorphic suspicious for malignancy, or in an anatomic area with high
morbidity

Excisional biopsy is used on smaller lesions < 1cm that appear benign and on small vascular and pigmented lesions. It entails the removal of the
entire lesion and a perimeter of surrounding uninvolved tissue margin.

QUESTION: Pt has worn denture for 19 years, now he has a sore on buccal with swelling. What do you do?
a. refer out
b. biopsy
c. cytology
d. Relieve denture in area and re-evaluate in 2 weeks

QUESTION: White patch on buccal mucosa, what’s best way to get biopsy? Smear

QUESTION: You have a lesion in mouth, you tried to treat it, still looks the same after 2 weeks – Take biopsy
- about 2 weeks—any red or white lesion that doesn’t resolve itself in two weeks – BIOPSY THAT SHIT

QUESTION: Patient comes in with preliminary diagnosis of candidiasis on ventral tongue and floor of mouth, white lesion rough and firmly
attached. What do you do? Incisional biopsy, do cultural testing and confirm that it is/is not candidiasis

QUESTION: Oral candidiasis biopsy of choice is:
a. incisional biopsy Most pigmented oral lesion = amalgam tattoo
b. excisional biopsy
c. brush biopsy (collects the cells for cytological smear)
d. cytologic smear

QUESTION: White lesion is 2x3x2 cm, what type of biopsy?
excisional biopsy
incisional biopsy
smear

QUESTION: What should you not do initially with a patient with desquamative gingivitis à BIOPSY, topical corticosteroids (other choices were,
encourage OH)

QUESTION: When you do biopsy, how do you store the specimen before it gets to oral pathologist? Formalin (answer)

QUESTION: Patient has a sore, shiny red area that when you blow air on it, a white membrane comes off and the sore starts bleeding. What
should you do? Culture and Medical management (Or biopsy + Med Man)

QUESTION: To test for malignancy, what test? Cytology, brush biopsy, Incisional biopsy
IMPLANTS

For implant placement:
- Need 1 mm bone on each side (Facial/Lingual)

- Min vertical height of bone to place implant - 10mm
- Min width of bone is 6mm
- min distance of apex of implant from nerve - 2mm
- platform of implant from adjacent CEJ - apical 2-3 mm
- between implants - 3mm
- between implant and tooth (height of contour) is 1.5 mm
- Mini implant is 2.4mm
Implant Contraindications:
- uncontrolled diabetes
- immunocompromised patients
- reduced volume and height of bone (anatomic considerations)
- bisphosphonate therapy
- bruxism
- tobacco (relative)
- cleft palate
- young kids
Open Tray Technique Vs Closed Tray Technique

- Open tray: pick up, reduces effect of implant angulation, don’t have to put coping back into impression, impression material not
deformed. Open tray is more accurate
- Closed tray: transfer, easier, better for shorter interarch distance, not suitable for deep implants, don’t work for nonparallel implants, less
accurate
PLACEMENT

QUESTION: Diff btween 1 stage and 2 stage: (1 stage) immediate loading vs (2 stage) traditional way
QUESTION: What kind of bacteria is under implants? At the apex of root canal? Gram (-) rods and filaments anaerobic
QUESTION: What bacteria is responsible for implant failure? gram (–) anaerobic
QUESTION: Bacteria around failing implants? Gram negative, motile, strictly anaerobic

QUESTION: What is the least important factor when evaluating for implant?
concavity of mandible
bone density
distance to mandibular cancel
bone width
QUESTION: Minimum distance between adjacent implants? 3 mm
QUESTION: How much space between implant and tooth? Answers were 1.5 mm, 2, 3.5 3,
QUESTION: Minimal distance from implant to nerve needed (ex. IAN, mandibular canal)? 2 mm

QUESTION: Minimum width (bucco-lingually) bone should be for 4 mm diameter implant? Choices were 5mm and 7mm à I put 7mm (4 for
diameter + 1mm each side = 6)

QUESTION: If implant with width of 4 mm is used, what should be the bucolingual width of the ridge?
a. 6mm
b. 8mm
c. 4mm
d. 10mm
QUESTION: Esthetics of a maxillary central anterior implant replacement determines

• adjacent tissue
• perio health of adjacent
• wax up to full contour
• emergence profile

QUESTION: Where should you put implant platform in esthetic area? at level of alv.crest, below opposing tooth gingiva, 1mm subgingival to
adjacent teeth CEJ, etc.
QUESTION: To obtain ideal emergence profile, where should the Implant head be in relation to adjacent gingival margin? 1-2mm above, 3-5
mm above, same level, 1-2 mm apical

QUESTION: Cervical position while placing an implant, how should the implant be placed in relation to adjacent CEJ? 2-3 mm apical the
adjacent CEJ
- Rest platforms placed 2-3 mm below adjacent CEJ.

QUESTION: Which of the following is bad for placing implants except? Radiopaque lesions

QUESTION: When placing implant in the mandibular posterior, how do you ensure you don’t hit IAN?
Look at panorex and measure with mm caliper
look at PA and put some screen over to measure


QUESTION: In anterior maxilla, for a 4mm diameter implant, how far apical to the CEJ of adjacent tooth for optimal emergence profile?
2-4 mm below cej of adj tooth

OSSEOINTEGRATION

QUESTION: How does titanium of an implant help in osseointegration? Forms titanium oxide layer


QUESTION: Implants osteointergrate best in? Anterior mandible

QUESTION: Best area to place implant? Anterior mand

QUESTION: Worst/least successful implant placement? MAXILLARY POSTERIOR
- lowest quality/density, more trabulation less cortication in maxillary posterior, Type 4 bone

QUESTION: How does fibers grow from crest of bone to implant?
Perpendicular with implant
parallel with implant

QUESTION: How does gingival fibers orient next to implant?
parallel to implant with no insertion
perpendicular with insertion
parallel with cuff
perpendicular with cuff
- Periodontium: you have long JE and CT (parallel and circular only)

QUESTION: Implant success is determined by what? Mobility
- Basic criteria for implant success are immobility, absence of peri-implant radiolucency, adequate width of the attached gingiva, absence of
infection
- Average bone loss of 0.2mm for the first year is acceptable

QUESTION: During uncovering, you realized implant is mobile & there is bone loss - failed implant, extract it!

QUESTION: What main reason implants fail?
Surgical error
does not osseointegrate

QUESTION: Major mechanisms for the destruction of osseointegration are:
Similar to those of natural teeth
Related to implant material
Related to nutrition
QUESTION: What is the worst type of force for an implant? Horizontal
QUESTION: When you place an implant, widening of crestal bone is seen because of which force? Horizontal
QUESTION: What causes the greatest incidence of implant failure?

Smoking
Hypotension

QUESTION: Where should implant/abutment interface ideally be? At height of alveolar crest

QUESTION: Trauma from occlusion in implants – not gingivitis
QUESTION: All are symptoms of TFO (trauma from occlusion) on an implant except? Gingivitis, pain, loosening of implant, breakage of
abutment screw.
QUESTION: 1 mm crestal bone remains around implant after 1 year, why? inflammation, heavy occlusal load

QUESTION: Which of these show clinically acceptable results of implant placement?
Peri-implant pathoses
implant mobility
bone loss less than .1mm per yr.

QUESTION: Pt has an implant. Do the connective tissue and epithelium attach the same as they do to natural tooth, meaning biological width?

QUESTION: Epithelial attachment for implant?
• Hemidesmosome* (epithelial attachment to tooth structure and implant are the same)
• fibronectin

IMPLANT SURGERY

QUESTION: What speed and torque for implant is used? High Torque, slow speed


QUESTION: In implant preparation, which of the following can be used?
A) hydroxyapatite irrigation
b) High Speed Hand Piece
c) Low torque Drill
d) Saline Coolant
QUESTION: Why you use irrigation in implant surgery? To prevent bone from overheating (other options were to keep it clean, etc)

QUESTION: When doing an osteotomy for implant placement, why do you use saline? to help cool down the bone

QUESTION: When placing an implant, how you keep the temperature of the bone below 56 degrees C? Alkaline irrigation

QUESTION: What is the temperature limit before bone dies in implant procedure? 47⁰C for 1-5 minutes

QUESTION: Temperature you don’t want to exceed during implant placement? They had 26, 36, 56. (No 47. I chose 56)

QUESTION: CASE - Case shows a picture of a bridge, when you look at it closely it resembles a Maryland bridge because lateral is intact. What to
do if Maryland is removed?
regular bridge
implant because lateral was intact

QUESTION: Contraindications to implant placement? Adolescents

QUESTION: Never place implants in a patient that had cleft palate

QUESTION: Bruxism is an implant CI.


QUESTION: What is the success rate of implants in 10 years? 80%

QUESTION: 13 y/o present for implants? wait until 18-20 y/o

QUESTION: All affect implant placement EXCEPT – smoking 1 pack a day, cardiovascular disease, uncontrolled diabetes, radiation of 60 Gy


QUESTION: All these are contributing factors for why implant would fail in this pt except? smoking, diabetes, AGE, etc.
QUESTION: Implant treatment are better option for smoker than perio surgery because perio surgery in smoker doesn’t work as well as non-
smoker.

QUESTION: When getting crown for implant, what occlusal scheme is preferred? Metal occlusal is preferred
QUESTION: When you use screw over cement retained? when you don't have space occlusally
- need more interocclusal space for cemented

QUESTION: What is the purpose of external hex screw? Anti-rotational
- Hex screw implant – prevent rotation of the crown

QUESTION: A lot of implants have external hex, what is it used for?

• For cementation

QUESTION: What is the component of the implant that replicates implant in cast? Analogue

QUESTION: What is most important for osseointegration in implant procedures? How well the surgical procedure is managed.

QUESTION: Osseointegration of implants should be assessed: prior to placement of restorative abutment

QUESTION: At what appointment do you first check osseointegration?
a) before taking the final impression
b) before placing the abutment
c) before cementing the crown

QUESTION: All of the following are true about surgical stents except? It tells you the number of implants you can place. Other choices were,
angulation of implant, location implant, thickness of implant. I think number of implants to be placed is decided before the stent at the time of
CT x-ray or during a consult)

QUESTION: Why do you use a stent? make sure implants are aligned properly

QUESTION: Stent - surgical template for angulation of bur for implant placement

QUESTION: What will you do when implant is inclined too buccally & you don’t want the screw to be seen on the buccal surface of crown?
Angled abutment

QUESTION: Implant placed in facial angulation, what do you do to prevent facial access for screw abutment? place an angled abutment &
cement it down; other options is correct implant placement or put composite where facial access for screw will be
QUESTION: Implant placed at angle where screw hole will be on buccal surface. What do you do so that you can’t see screw on buccal?
Cover with composite
Angled abutment cemented
Remove implant

a. torque
b. compressive
- Compressive force presses the components of the system together & normally does not introduce any mechanical problems in the
anchorage unit itself.
- Tensile loading refers to a force that tends to separate components

QUESTION: What is the problem with preloading a screw implant?
Low loading can make it loose
high loading can make it loose
low loading can lead to implant creep or something
High loading can lead to implant creep
- High frictional forces between components decrease as a result of creep leads to a decrease in preload

QUESTION: What do you want to do first when taking an impression of the implant and abutment splinting the 3 implants with a bar?
Make sure the abut is attached right when the pt comes
check fit of custom tray
insert impression coping
insert imp coping with acrylic

QUESTION: Advantages of an open tray impression - Reduce effect of implant angulation

QUESTION: Most common complication for crown? Screw loosening
QUESTION: When not to immediately load an implant?

• Bone grafting with GTR

QUESTION: Do we probe like normal for an implant? Yes

QUESTION: How to clean implant- prophy cup, plastic scalers, not stainless steel!
MULTIPLE IMPLANT: FPD, IMPLANT SUPPORTED, IMPLANT RETAINED

QUESTION: You are considering the placement of an upper and lower implant-retained complete denture. How many implants will you place in
the anterior region?
- If implant supported complete denture, add 2 more screws to each.

QUESTION: When there is FPD from natural tooth to implant, the max stress is concentrated on the SUPERIOR PORTION OF THE IMPLANT.
QUESTION: If implant and bridge are done with natural tooth, what is the complication? there is a lot of force on crown of implant that causes
fracture. à diff mobility
QUESTION: Where do you put occlusal rests for implant supported RPD? NONE

a. avoids wearing anything for 2 weeks

QUESTION: At the time of delivery of an implant supported prosthesis, only 2 of the 3 implants seat. What do you do next? separate the
prosthesis and re-index it

QUESTION: Implant retained fixed prosthesis, doctor took radiograph and it showed 2 out of 3 implants seat positively with good margin. What
should doctor do after?
• section and index
• tighten screw

ORAL SURGERY
Most impacted: mand M3 > max M3 > max canines
Most congenitally missing: M3 > PM2 > Max LI > canine
QUESTION: The most frequently impacted teeth are MANDIBULAR 3rd MOLARS (followed by maxillary 3rd molars and maxillary canines).

rd
QUESTION: Most common impacted tooth? (3 molars not an option) – maxillary canines

QUESTION: Which tooth is least likely to be missing?
Canine
nd
2 pm
Lateral incisors
rd
3 molar
rd nd
- Most commonly missing teeth are the 3 molars, 2 premolars and upper lateral incisors

rd
QUESTION: What is least missing tooth congenitally? – canines, premolars, 3 molars, lateral incisors
st
QUESTION: Extractions in ortho tx: max 1 premolars

QUESTION: Where does man branch of trigeminal nerve come thru? Foramen Ovale

EXTRACTIONS

QUESTION: Ectopic eruption of mand 1st molar in relation to primary mand 2nd molar cause some resorption, tx management? Extraction of
primary 2nd molar, separation, disking of 2nd molar

rd nd st
QUESTION: What order do you extract upper posterior molars & why? Order of extraction of teeth in maxillary molars- 3 M, 2 M, 1 M to
prevent fracture of tuberosity (most posterior teeth first)

QUESTION: Most likely to cause nerve damage during extraction? Nerve canal overlaps root apices, nerve canal narrows

QUESTION: MOST common complication of extraction? Hemorrhage, infection, root fracture
QUESTION: Radiograph of mandibular molar extraction site. Patient came back having pain & pus in that area: did not have dry socket as a
choice? Osteomyelitis
- Osteomyelitis common following tooth extraction -- bone infxn

QUESTION: Occlusal radiograph with a lot of bone resorption - patient has pain and pus was draining after few weeks of EXT – Osteomyelitis
(other were radicular cyst, lateral cyst, etc)
QUESTION: X-ray of older woman, tooth extract 3 years ago. The area still hurts and has exudate, shows cotton-wool radiograph over the ridge
area, "prob wrong") what is it? Residual cyst, osteomyelitis, 2 other lesions that are radiolucent

QUESTION: Patient w/ osteomyelitis after EXT, what do you do? curettage the walls of the socket to remove infection
QUESTION: Extraction of #30, which way do you section? Buccal- lingual
QUESTION: Resorption of bone takes place in which direction after extraction?

downward/inward
downward outward
forward inward
QUESTION: After fx a mesial root tip on a molar extraction, what’s the first thing you do? get hemostasis and visualize the root. Others, take an
x-ray, pick at it with root pick, surgical retrieval
QUESTION: Which direction do you luxate the tooth? Children: Palatably b/c molars are positioned more palatably and palatal root is strongest.
Adults: buccally!

b. for space deficiency in mandibular posterior region

QUESTION: Biggest risk with extracting a lone single remaining maxillary molar? Fracturing tuberosity

QUESTION: When extracting an erupt max molar, what is most like cause of complication? you can have broken tuberosity/sinus floor

QUESTION: Can tell if a tooth ankylosed if submerged
- Decks state that an ankylosed tooth emits an “atypical sharp sound on percussion” soooo I think different sound is right. Also “Beware of
the LONE molar” à they are usually ankylosed.

QUESTION: Minimum platelet count for oral surgery? Routine ok w/ 50,000
- emergency can be done w/ as little as 30,000 if work w/ hematologist and use excellent tissue management technique

QUESTION: You extracted a tooth & give Penicillin. The next day, patient has high fever, swelling, & dysphagia. What do you do?
Change to different antibiotic
Refer to OMFS
Add another drug to regimen

THIRD MOLAR EXTRACTIONS

rd
3 molar, Hardest to remove:
- Mesioangular, Maxillary: mesioangular impactions are the most difficult to remove, while vertical and distoangular impactions are the
easiest to remove.
- Distoangular: Mandibular:

rd
QUESTION: When extracting, where is the max 3 molar most likely to be displaced?
A. infratemporal fossa
B. maxillary sinus

QUESTION: Extraction of molars with divergent roots: hemisection

rd
QUESTION: In which direction do you luxate a distoangular maxillary 3 molar? distal palatal, distobuccal,
palatal, mesial
rd
QUESTION: Easiest Max 3 molar impaction to remove: distoangular
QUESTION: #32 - Complete horizontal bony impaction, what is the main concern? damage to nerve
QUESTION: #16 - half in bone, half in gum à It is the most common kind of impaction & easiest to take out
(both FALSE)
QUESTION: FMX, question about right side of patient, #1 and #32 were both impacted, how would you describe these impacted teeth? #1
disto-angular impaction, #32 horizontal impaction (other choices had other angulations, but with FMX, it should be straightforward to guess
them right)
rd
QUESTION: Greatest risk to injure IA nerve on extraction of 3 molars:

rd
QUESTION: Indication to extract 3 —making space for ortho, prevent crowding, pt has pain during eruption, there’s an infection
QUESTION: 65 y/o has hypertension and congestive heart disease, referred to you to TE impacted molar, absolute indication to do the TE is
when:
radiograph shows bone pathology
nd
prevent distal pocket of 2 molar
prevent jaw fracture
nd
prevent distal caries for 2 molar

rd
QUESTION: Patient has pain, trismus, inflammation for 3 molar, Tx? TE
QUESTION: Know pericoronitis treatment

- W/out surgery = clean and antibiotics
rd
- With surgery = Before surgery, control infection. IND, irrigate drain, antibiotics, then remove the 3 molar

QUESTION: Which direct do you luxate tooth #1 and #16? – Distally and Buccally

SURGERIES

Oro-antral communication Tx depends on the size:
- < 2 mm DO NOTHING
- 2-6 mm AB, nasal decongestant + figure 8 suture
- more than 6 mm = flap surgery
QUESTION: Where are you most likely to damage a nerve in vertical release of flap? lingual, Wharton’s duct and the sublingual gland
- void vertical incisions in lingual and palatal

QUESTION: When doing flap surgery on mandible, what structure do you watch for? mental nerve, mentalis attachment

QUESTION: Oro-antral communication 2mm - Do nothing

QUESTION: Oro-antral communication of 4mm, what do you do? Observe, buccal flap, palatal flap? FIGURE 8

QUESTION: You see sinus is open by 2mm after an extraction, what do you do? Do nothing and observe
- If the opening is 4 mm, do figure 8 suture.
- If the opening is 6 or more, do flap surgery

QUESTION: If you have 3mm uninfected root into sinus, what you do? You do one an attempt, and if unsuccessful, leave it alone, no surgery.
QUESTION: What is the Caudwell lock technique? Removal of root tip from max sinus, incision over canine fossa.

OS SURGERY – MEDICAL COMPLICATIONS
QUESTION: 5 yr. old kid with Adderall prescription that needs an extraction. Do you need to change the dosage? No change
QUESTION: Patient is about to undergo radiotherapy, what do you? – EXT all questionable teeth before radiation (another answer said, EXT all
teeth before radiation)

QUESTION: Therapy to avoid osteoradionecrosis? Extract questionable teeth in area to receive 60+grays

QUESTION: A patient has begun radiation therapy in the mandible and needs teeth extracted. What do you do? Do endo, and amputate the
crown without any trauma to soft tissue or bone

QUESTION: A patient received radiation therapy and requires extraction, what should the treatment be?
Extraction
extraction with alveoloplasty and sutures
extraction with alveoloplasty of basal bone and suture
pre-extraction and post-extraction hyperbaric oxygen

QUESTION: Patient is taking IV bisphosphonates and need TE?
RCT then coronotomy and seal
hyperbaric oxygen followed by TE
antibiotics and TE
atraumatic TE
- Best tx is do RCT and section crown off (as oppose to ext.)

QUESTION: It pt has been on IV bisphosphonates for two years? Do root canals and keep roots, no TE!

QUESTION: All of the following are contraindicated for bisphosphonates, except? Do RCT (other choices were invasive procedures)

QUESTION: Patient is on 6 months of IV bisphosphonate therapy, what do you do?
Hypo dives and extract
atraumatic extraction
endo with crownectomy & place sealants

QUESTION: Patient has BRONJ & bone is exposed, what is treatment? hyperbaric oxygen, sc/rp, chlorhexidine rinse (anti-bacterial rinse, and
oral antibiotics)

QUESTION: Osteoradionecrosis: Swelling, degeneration and necrosis of the blood vessels with resulting thickening of the vessel wall. Use
hyperbaric oxygen for angiogenesis

OS INSTRUMENTS

Common OS instruments:
- #9 Periosteal elevator
- Mandibular:
o #74 ash forceps (mand PM)
o #151A (premolars), #151A is modification of #151, and it’s for mandibular premolars only
o Cryer elevator: best for single retained root of extracted mandibular molar
o #17 is for mandibular molar but not fused root
o #23 Mandibular cowhorn (molars)
o #222 is for mandibular molar but fused conical root

- Maxillary:
o #65 Bayonet-shaped forceps – Max incisors or roots
o #150 (universal)
o Upper cowhorn forcep is #88 right and left for upper molars
o 286 = root tips

Mand. PM = #151A + #74 (ash forceps)
QUESTION: What number forceps to use when extracting mand premolars: 151A

QUESTION: What forceps are best for a mandibular premolar extraction? #17, #23, #74, #151, #150



QUESTION: During extraction a mandibular molar, the mesial root break. What instrument you use for root tips? Cryer forceps



SUTURE:

QUESTION: What kind of suture do you use if you are only removing on one side of tooth? sling, continuous, interrupted

QUESTION: What suture do you use when only buccal tissue is displaced? Interrupted

QUESTION: What suture do you place when you only displace facial surface of mandibular teeth? Interrupted, mattress, continuous, etc were
other options.

c. immobilizes the flap

QUESTION: What suture contains wicks that allows bacteria to enter/invade extraction site?
Gut
Silk
Nylon

QUESTION: There is an incision on the corner of lip, where do you put suture? movable to fixed tissue
- Most important is the vermilion border

QUESTION: If there is a 2 cm laceration on lip, what type of suture do you do? Continuous, in middle and work both ways, reconnect orbicularis
oris first, reconnect vermillion border first

ALVEOLAR OSTEITIS:

QUESTION: Most common negative outcome of routine TE? alveolar osteotitis, hemorrhage, infection

QUESTION: Pt is a smoker, what is pt more at risk of getting after extraction? dry socket

QUESTION: Pathophysiology of dry socket. How do dry sockets develop? Blood clots not forming.
- Dry socket: Loss of healing blood clot (fibrinolysis of clot)
QUESTION: What causes alveolar osteitis (dry socket)? Active dislodgement of blood clot (fibrinolysis of the clot)

QUESTION: MAIN CAUSE OF ALVEOLAR OSTEITIS (DRY SOCKET)? Blood clot diminished & fell out


QUESTION: Alveolar osteitis (dry socket) tx? NO ANTIBIOTICS or curettage needed. Just medicinal dressing.

QUESTION: Acute osteitis (dry socket), how to take care of it? Gentle irrigation and Medicated dressing
QUESTION: Ways to tx dry socket except:
c. sedative dressing

QUESTION: All are treatment for dry socket except? Need for oral antibiotics

QUESTION: Multiple questions about when you would not give antibiotics: all the answers were alveolar osteitis (all the others had a systemic
infection ie cellulitis), other questions about osteitis is how would/wouldn’t you treat alveolar osteitis

FACIAL FRACTURES:

Le Fort III - Nasoethmoidal complex, the zygomas, and the maxilla from the cranial base which results in craniofacial separation
- Pathognomonic sign: Periorbital ecchymosis/hematoma, diplopia (double vision) and /or subconjunctival hemorrhage, infra-orbital nerve
damage

Type of X-rays to see Fractures:

- Pano >>>> best for mandible fracture
- Reverse towne’s >>>> for condyle fracture
- Submentovertex>>>> for zygomatic fracture
- Water’s >>>> for maxillary sinus
- CT >>>> facial fracture
QUESTION: Key sign of mandibular fracture? Occlusal discrepancy or change in occlusion

QUESTION: Patient has a condylar fracture, what happens when mandible grows? asymmetric growth with damaged side lagging (unaffected
side will continue to grow)
- The fractured side will lag. The unaffected will continue growth.

QUESTION: Child has mandibular trauma, what do they have later? Midline facial asymmetry
QUESTION: What is primary consequence of trauma to jaw in kids? (normal def. of jaw, vs retarded growth vs hypertrophic growth on one side,
etc): retards growth
QUESTION: Fracture 1 condyle the other lags behind, which causes: Malocclusion

QUESTION: Most common area of fracture in children? symphysis, condyle, coronoid
nd
• MOST COMMON: condyle (29%) 2 most (angle of mandible 24.5%) – still growing, mostly cartilage
nd
• LEAST COMMON: coronoid (1.3%) 2 least (ramus of mandible 1.7%) – not attached to anything

QUESTION: Ankylosis of condyle most likely due to? Trauma or Fracture

QUESTION: Splinting closed a bone fracture – 6 weeks

QUESTION: Pt has a fractured mandible. Keep it splinting in closed reduction for how long? 6 weeks

QUESTION: Closed reduction, immobilize mandible for how long? 6 weeks,
- The standard length of maxillomandibular fixation (MMF) is 4-6 weeks.

QUESTION: Paresthesia occurs most commonly in what type of mandibular fracture? Angle fracture
QUESTION: Lower lip numbness is seen in what kind of mandibular fracture?

Body fracture
Angle fracture (fracture distal to mandibular foramen, close to IAN)
- angle of mandible fracture increases chance of IAN paresthesia and numbness


QUESTION: Lefort I fracture are associated with?
nasoethmoidal air cell
frontal sinus
maxillary sinus
mastoid air cell
QUESTION: Guerin sign is a feature of what Le Fort fracture? Le Fort 1 fracture

- Guerin’s sign: ecchymosis in the region of greater palatine vessels.

QUESTION: LeFort I = brings the lower midface forward, from the level of the upper teeth, to just above the nostrils.
- Lefort I fracture: "floating palate", Disturbed occlusion, palpable crepitation in upper buccal sulcus
QUESTION: LeFort II = separation and mobility of the midface, Gagging on posterior teeth, Anterior open bite
QUESTION: LeFort III = brings the entire midface forward, from the upper teeth to just above the cheekbones.
QUESTION: Lefort II most common injured nerve: infraorbital nerve

QUESTION: Subconjunctival hemorrhage seen in what fracture? Lefort 1, nasal, frontal sinus, zygomaticomaxillary complex
QUESTION: A patient experiences numbness of the left upper lip, cheek, and the left side of the nose following a fracture of his midface. This
symptom follows a fracture through the
A. nasal bone.
B. zygomatic arch.
C. maxillary sinus.

QUESTION: What was the most common fracture in the face? Zygomcomplex fracture

QUESTION: Which radiograph would you use to view a fracture of the mandibular symphisis? A-P or CT

QUESTION: What age does mandibular symphysis fuse/close? birth, 3, 6-9 months
QUESTION: Fracture of which part of the face would compromise pt’s respiration?
• Fracture through the body of mandibular (bilateral)

QUESTION: You get punched on lower right & broke the jaw. What do you worry about? Sucking at fighting, needing karate classes,
Contralateral condylar fracture

QUESTION: So you decide to fight back and you KTFO the guy by hitting him on the right side of the jaw/mandible, where is the other site of the
fracture?
• left condyle
• right condyle
• both
• right mandible
****Fracture is always on opposite side condyle (I hope it made you laugh….i worked really hard to make these fun questions…-vic)
QUESTION: When pulling out a tooth, the jaw fractures. What do you do? Open flap to see all of the fracture, remove all the fractured pieces,
remove all the fractured pieces that are not attached to periosteum

QUESTION: What X-rays do you take to confirm horizontal fracture? 3 x-rays moving horizontally, 3 X-rays moving vertically

QUESTION: Horizontal fracture easily seen with – multiple vertical angulated x-rays

QUESTION: What is best view to see zygomatic process? Submentovertex (SMV)

rd
QUESTION: What causes trauma in the US? auto-accidents (in 3 world is knife fights)

QUESTION: Pan showing lucency going inferior over the body of mandible close to the angle. You are informed that the patient was involved in
an accident. Identify the lucency:
a. pharyngeal airspace
b. fracture
c. artifact-retake radiograph
ORTHOGNATHIC SURGERY:

Osteotomy: surgery where bone is cut to shorten, lengthen, or change its alignment
Distractive Osteogenesis (DO): surgical process used to reconstruct skeletal deformities and lengthen the long bones of the body.
- benefit of simultaneously increasing bone length and the volume of surrounding soft tissues.
- easier in children, shows less relapse.
- 2 surgical procedures, hospitalization time is less but more discomfort -- Compliance of patient and parent is a difficulty in DO

Bilateral Sagittal Split Osteotomy (BSSO) – surgery where mandibular is split bilateral & moved to more balanced/functional position, correct
malocclusions. Stable for normal/decreased facial height but high relapse for pt w/ high mandibular plane angles.
- BSSO is the most commonly used osteotomy for mandibular advancement or retraction

QUESTION: Most commonly used surgery for mandibular augmentation? Bilateral sagittal osteotomy

QUESTION: BSSO = Vertical Osteotomy used to: push mand. forward or backward for class II.

QUESTION: How would you repair a Class II malocclusion? BSSO (bilateral sagittal split osteotomy)
- Correction of severe class II:
• BSSO

QUESTION: Worst complication of BSSO: Damage to IAN/Paresthesia

QUESTION: Most common complication of sagittal osteotomy: IAN, loss of sensitivity

QUESTION: During which surgery do you have most chance of paresthesia of lip & tongue?
BSSO
vertical ramus osteotomy
inverted L

QUESTION: Patient wants to fix Class III occlusion, what you going to do?
Lefort 1 with BSSO
Lefort 1
BSSO
Max palatal expansion with BSSO

QUESTION: 16 y.o. girl need to do Lefort + BSSO – can’t do RPE because she’s too old
QUESTION: How long do you splint mandibular BSSO? You don’t do MMF, as there is internal plate. Use an occlusal splint to help with occlusion
but not wired shut. Keep splint on 4-6 week.

QUESTION: Which of the following is the MOST common postoperative problem associated with mandibular sagittal-split osteotomies?
a. infection
b. TMJ pain
QUESTION: A patient has a skeletal deformity with a Class III malocclusion. This deformity is the result of a maxillary deficiency. The treatment-
of -choice is
A. orthodontics.
E. surgical repositioning of the mandible.

QUESTION: What’s the main difference between distraction osteogenesis and a regular osteotomy? DO has more stability during wide span of
movements

QUESTION: Distraction osteogenesis: when to use over convention: bigger stable movements
QUESTION: Complication following distraction osteogenesis (DO): Long term follow up

PERIODONTICS
QUESTION: Which ethnic group has the most chronic periodontitis? Black males

QUESTION: Black males have the highest incidence of chronic perio.
PERIODONTAL IMMUNE RESPONSE:

Periodontitis: Initial = PMN, early = lymphocytes, establish = plasma cells

Medical Conditions leading to periodontal disease: ( http://www.hindawi.com/journals/ijd/2014/850674/tab1/ )

- IDDM (diabetes) - Histiosytosis X
- HIV/AIDS - Hypophosphatasia
- Leukocyte adhesion deficiency (LAD) - Chediak-Higashi syndrome
- Leukemia - Papillon Lefevre syndrome
- Neutropenia - Down syndrome
- Acrodynia - Ehlers-Danlos syndrome

Red Complex – group of bacteria grouped together based on their association w/ periodontal disease
- red complex = P. gingivalis, Tannerella forsythia, treponema denticola
- BOP & deep pockets
Orange Complex - fusobacterium, prevotella, campylobacter
- Precedes red complex, plaque formation & maturation

QUESTION: Red complex has 3 bacteria’s: P. Gingivalis, Tannerella forsythia, Treponema denticola

QUESTION: Which one is predominant in sulcular fluid? PMN’s
QUESTION: What is predominate in established gingivitis? plasma cells
QUESTION: Which of the following species is a usual constituent of floras that are associated with periodontal health? Streptococcus gordonii
QUESTION: What bacterial species is not associated with periodontal disease?

B. P. gingivalis
C. Capnocytophaga
QUESTION: Bacteria that is not in chronic periodontitis?

Actinomyces viscosus
C. rectus
T. forsytiaas
P. gingivalis.
QUESTION: Which is related to periodontal disease? Gram negative bacteria

st
QUESTION: What is the 1 step in bacterial plaque formation on a tooth? Pellicle formation (glycoproteins, enzymes, proteins,
phosphoproteins).
nd
- 2 step is adhesion and attachment of bacteria
rd
- 3 step is colonialization and plaque maturation

QUESTION: What does plaque depend on? Bacterial interactions & bacterial polymers. It does NOT depend on host antigen.

QUESTION: Which is not part of plaque formation? Host antigen, extracellular bacterial polymers

QUESTION: Gingival recession, other than plaque amount, is related to – age, tobacco, etc

QUESTION: Plaque index is used for what?
track gingivitis progression
track disease activity
to know plaque amount
patient motivation

QUESTION: Which one is not a periodontal risk factor? Smoking, oral hygiene, malnutrition, diabetic mellitus

QUESTION: Which of the following things are associated w/ periodontal disease? Atheroschlerosis, Diabetes Mellitus, Low birth weight of
babies

QUESTION: Difference between primary and secondary occlusal trauma? Periodontal support/healthy periodontium
QUESTION: Healthy patient, probing shows bleeding, what could this be due to? Gingivitis
QUESTION: Which is least likely to occur with occlusal trauma? Gingivitis

QUESTION: Gingival index/perio index. Know their flaws: Perio index flaws are that the gingival recession was not taken into account.
- Gingival index: each of the 4 gingival areas of the tooth is given a score from 0 (normal) to 3 (severe inflamed), mostly based on color.
Score is totaled per tooth or added all together/ (total teeth #) to give GI person score.
- GI doesn't consider PD, degree of bone loss or any other qualitative changes in periodontium.
QUESTION: What is Gingival Plaque Index?

c. Interval like Celsius degree
d. Ratio e.g. Kelvin degree, or BP measurement (cannot be zero), length (cannot be negative), weight
QUESTION: What is CPITN? Community Periodontal Index of Treatment Needs

QUESTION: What is predominant in plaque 2 days after prophy? Gram (+) cocci and rods
- gram + cocci and rods normally present, gingivitis transition includes Gram (–) rods and filaments followed by spirochetal and motile
organisms.

d. spirochetes.

QUESTION: Supragingival calculus: main crystals are hydroxylapatite 58%
QUESTION: Chronic periodontitis has G (--) anaerobes.
QUESTION: Chronic periodontitis: has P. gingivalis (gram -)
QUESTION: Fusobacteria nuceatum has what specific characteristic? Bridging microorganism between early & late colonizers of dental plaque
QUESTION: All syndromes are associated w/ periodontal problems accept Stevens-Johnson Syndrome Triad: eye, mouth, genital lesions (extreme
a. Stevens-Johnson syndrome (target lesions - conjunctiva and genital problems) form of erythema multiforme)
b. Pap-lefev syndrome (palmoplantar keratoderma with periodontitis)
e. acrodynia (pain, discoloration of hand/feet, chronic heavy metal

QUESTION: Least cause of bone loss around primary teeth? Hypophosphatsia, leukemia, plaque

a. C3a, C5a
b. Endotoxin
c. Interleukin
d. B glucorinidase

QUESTION: What cytokine responsible for osteoclasts? IL-1, IL-8, IL-5, IL-3

QUESTION: Stress long term cause problem in periodontium b/c it increases cortisone and cortisone and brings immune system down

DEHISCENCE & FENESTRATIONS


QUESTION: Dehiscence: Loss of buccal or lingual bone overlying a tooth root, leaving the area covered by soft tissue only
QUESTION: Dehiscence - loss of alveolar bone on the facial (rarely lingual) aspect of a tooth that leaves a characteristic oval
QUESTION: Each of the following osseous defects would be classified as infrabony EXCEPT one. Which one is this EXCEPTION?
A. A trough
B. A dehiscence
C. A hemiseptum
CLINICAL ATTACHMENT LOSS & BIOLOGICAL WIDTH
QUESTION: Biological width is 2 mm.

QUESTION: Biological width is from the alveolar crest to the base of the sulcus.

QUESTION: Biologic width definition: junctional epithelium and _______ attachment to the tooth above the alveolar crest (at least 2mm)
a. gingival sulcus
b. epithelial attachment
c. connective tissue
QUESTION: How to determine attachment loss? From CEJ to sulcus (depth of pocket)
QUESTION: Which of the following factor is most critical in determining the prognosis of periodontal disease?
1. Probing depth
2. Mobility
3. Class 3 furcation
4. Attachment loss
QUESTION: Attachment loss: loss of connective attachment w/ apical migration of the JE away from the CEJ
QUESTION: The depth of sulcus is 5mm, the distance between CEJ and the base of sulcus is 2mm.what is the attachment loss: 2 mm
QUESTION: If recession is 2 mm and probing is 1 mm, how much attachment loss? 3 mm
QUESTION: If you have 1 mm recession and can probe 3 mm, how much attachment loss is there? 4mm

PERIO TREATMENT:
QUESTION: Perio treatment sequencing for mild-moderate chronic periodontitis? Plaque control, Sc/Rp, caries control, perio surgery
QUESTION: Why you do perio before ortho: b/c perio can cause gingival and osseous changes
QUESTION: When is the perio prognosis that poor?
Class 2 mobility
deep class 2 furcation
deep probing with suppuration (indicates tooth fracture)
QUESTION: Which teeth commonly relapse after perio tx (poor long-term prognosis)? maxillary molars due to furcation anatomy
QUESTION: Where perio Tx is more difficult? Maxillary molars due to trifurcations.
QUESTION: Which tooth is most commonly lost due to long term care in periodontal patients? max molar, max pm, man molar, man pm
QUESTION: If you have a through-and-through furcation involvement (class III furcation) on a tooth with 5 mm of root left in the bone, what do
you do?
Extract the tooth (preferred treatment)
Splint
Place Implant

QUESTION: Patient with class III furcation and 3 mm exposure? Extract

a. Section it and crown both as PFMs (hemisection)
c. GTR (guided tissue regeneration)
- Better for Class II, least successful for class III
QUESTION: Tx option: Class 2 almost class 3 furcation? Main goal of tx on class 2 is converted to class 1 furcation by doing GTR

QUESTION: Recommended treatment for a Class II that is almost a class III:
- convert class II to a class I by doing GTR
- tunneling
- extraction

QUESTION: class 2 and 3, all of the following would be a part of tx plan except? gtr, tunnel prep, odontoplasty the class 2 to a class 1 furc,
extract + place implant, hemisection

QUESTION: Most likely shape of furcation is? Wide but still not very accessible to dental tools, others used variations of that.

b. It’s wide enough and the curette is too big to clean it
c. It’s narrow enough and you can’t clean it
QUESTION: Root amputation of MB root – cut at furcation and smoothen for patient to keep clean
QUESTION: What is most common periodontitis in school-aged children: aggressive PD, ANUG, marginal gingivitis
QUESTION: Which therapy in which adding antibiotic + debridement have minimal effect for? anug, Localized aggressive, chronic periodontitis
QUESTION: How do you treat gingivitis in puberty: debridement and OHI
QUESTION: Percentage to be considered generalized perio? > 30%

QUESTION: Diagnosis for 40-year-old female w/ generalized bone loss, localized vertical bone defect, and gross calculus: Chronic periodontitis

QUESTION: Which of the following PDL disease causes rapid destruction of alveolar bone?
1. Periodontal abscess
2. ANUG
3. Chronic periodontitis
QUESTION: Two patients, old and young person w/ same perio. Which has better prognosis? Older patient (b/c younger pt had shorter time
frame to get to the same condition so more aggressive in nature)

QUESTION: Most common to cause mobility- trauma, advanced perio, periapical pathology

• Tooth mobility
• Bone resorption
• Crestal bone
• Attachment loss

ORAL HGYIENE INSTRUCTIONS & MEDICATIONS

QUESTION: Best for interproximal plaque removal in teeth without contacts: floss, waterpick, interproximal brush
QUESTION: What is not able to reach the interproximal? Toothbrush

QUESTION: Best brushing technique to clean periodontal pockets:
A. Charters
B. Sulcular (another name for modified Bass)
C. Whitman’s

QUESTION: Least effective for crevicular plaque? Water irrigating device (waterpik), nylon, toothbrush
- Water irrigation removes debris (not plaque)

QUESTION: Which of the following is likely to be abrasive after osseous surgery? Water pik, toothbrush, toothpick, rubber gum stimulator

QUESTION: Class 2 furcation, which instrument is the worst to clean a class II furcation? Tooth brush, floss, waterpik, rubber stimulating tip
- Rubber tip is for interdental papilla

QUESTION: Toothbrush and floss, how much can it reach in perio pocket?
Toothbrush 0 mm, floss 2-3 mm
Toothbrush 2-3 mm, floss 0mm
Toothbrush = 1 mm, floss = 2-3 mm
QUESTION: What can make teeth green? Bacteria, gingival hemorrhage, medications or hyperbilirubinemia (ALL of them)
A. drugs.
B. diet.
E. Genetics

QUESTION: What are proper ways to reinforce OHI: verbal and written in the dental office, verbal only, video tape
• pit and fissure

QUESTION: Why don’t you use Acidulated Fluoridated Toothpaste? Ruins Polish of Crown

QUESTION: How does Listerine act? Antiseptic mouth rinse is a broad-spectrum antimicrobial & kills bacteria associated with plaque and
gingivitis by disrupting the bacterial cell wall.
- bacterial cell wall destruction, bacterial enzymatic inhibition, and extraction of bacterial lipopolysaccharides.

QUESTION: Action of Listerine? Uncharged phenolic compound

QUESTION: What daily oral rinse would you give to a medically compromised child for plaque control? CHX, Listerine, Nystatin, stannous
fluoride, sodium fluoride


QUESTION: Action of chlorhexidine: binds to cell wall à cell membrane disruption/rupture à fluid leaks out, cell lysis (CHX bursts membranes)

QUESTION: Use of chlorhexidine à reduce plaque accumulation
- broad spectrum against gram positive and negative bacteria and fungi – Positively charged

QUESTION: What does sodium pyrophosphate do? Plaque removal
- removing crystals of Ca+ and magnesium, inhibits mineralization of biofilm/staining (inhibits Ca+ phosphate from binding)

QUESTION: Why are inorganic pyrophosphates in anti-tartar toothpaste? It acts as a tartar control agent, serving to remove calcium and
magnesium from saliva and thus preventing them from being deposited on teeth (chelating + abrasion)

QUESTION: Why is inorganic pyrophosphate in tooth paste? prevent calcium phosphate crystals, decrease number of bacteria growth

QUESTION: Periostat: 2x daily 20 mg has doxycycline, which works by inhibiting collagenase/protein synthesis

QUESTION: Periostat’s mechanism of action: inhibits collagenase, inhibits ribosome 50s, periochip,
- Reduces elevated collagenase activity in gingival crevicular fluid of patients with adult periodontitis; no antibacterial effect reported at
this dose

QUESTION: Doxycycline use? Intramicobial which inhibits MMP (matrix metaloprometase)
- Sub-antimicrobial dose doxycycline (SDD, periostat) inhibits matrix metalloproteinase (MMP)

QUESTION: Root surface tx with what agents? Use citric acid, fibronectin and tetracycline
QUESTION: Which is least complicating for OH? Fixed bridge, rheumatoid arthritis, open contact

PERIO INSTRUMENTS
QUESTION: Probing furcation from facial is best. Better access to facio-mesial furcation from facial.
QUESTION: Best way to detect furcation – curve perio probe (naber probe), curette, straight perio probe
QUESTION: Best angle to place curette on root is 45⁰- 90⁰ for working strokes.
QUESTION: What edge of curette do you want to be in contact at line angle? Lower 1/3
QUESTION: Curette, which third adapts tooth? Apical Third, Middle Third
QUESTION: Which part of instrument do you place on line angle of tooth:
middle third
third including tip
third closest to handle or entire edge
QUESTION: Which gracey curette is used for the mesial surface of distal root in max tooth? 11-12

SCALING & ROOT PLANING:
QUESTION: What is not the initial treatment for gingivitis? s/rp, OHI, corticosteroids

QUESTION: Sc/RP removes diseased cementum

QUESTION: What is not an objective of Sc/Rp? Remove cementum

QUESTION: Just did Sc/RP on pt w/ recession. What’s the best way to prevent sensitivity to newly exposed root surface? Keep root surface free
of plaque

QUESTION: After you do Sc/RP, how does new attachment form? Long junctional epithelium

QUESTION: Direction of root planning? From base of pocket to CEJ

QUESTION: What kind of gingiva is favorable for S/RP? More edematous gingiva

QUESTION: Best results from S/RP will be from a patient who has: edematous gingiva, fibrotic gingiva, loss of attachment
QUESTION: What do you do if after S/RP, there are 2 probing sites of 6 mm? Perio Surgery
QUESTION: Pt had SRP & they came back for perio maintenance but there are still 5-6 mm pocket. What do you do? Open debridement

QUESTION: Why do you check occlusion in pts with perio abscess?
- many perio lesions are caused by occlusion
- edema can cause teeth to supra erupt
- some other choices were pretty good to, but I can’t remember what they were

QUESTION: What’s the FIRST thing you do in maintenance appointment (recall)? Update medical history (other choice were address patient’s
pain, prophy, etc)

QUESTION: What do you not do at the perio maintenance apt.? SRP pockets of 1 – 3mm

QUESTION: What happens after the periodontal re-eval, what should the recall interval be set as? The recall interval is set but may be changed
if the patient’s situation changes, should be less to motivate pt, more to motivate pt

QUESTION: The normal recall appointment between periodontal treatment: 3 months
QUESTION: Best time for supportive periodontal therapy? 1, 3, 6, 9, months post s/rp


QUESTION: Pt is on a periodontal recall system. What best denotes good long term prognosis? BOP (bleeding), Plaque, Deep pockets

QUESTION: BOP most indicative of what? Inflammation
QUESTION: How long does it take to form mature plaque after removal? 24-36 hours
QUESTION: Mature plaque in
• 1-2 hrs.
• 6-8 hrs.
• 10-12 hrs.
• 24-48 hrs.

QUESTION: How many hours until plaque accumulation (after brushing or eating?)? 1 hour
QUESTION: Which part of dental anatomy on a central collects the most plaque? Facial surface, lingual surface, cingulum, mamelon,
gingivopalatal groove

ULTRASONIC:

Ultrasonic Instruments - active portion is the tip, 20-45k cycles/seconds
- Magnetostrictive: elliptical vibration pattern, all sides of tip are active (4 sides total)
- Piezoelectric: linear vibration pattern, 2 sides are more active (sides are only active)
- CONTRAINDICATED in patients with pacemaker, communicable diseases, titanium implants (use plastic tip), kids
QUESTION: Each of the following is a mode of action of an ultrasonic instrument EXCEPT one. Which one is this EXCEPTION?
A. Lavage
B. Vibration
C. Cavitation
QUESTION: Mode of action of ultrasonic: Vibration in elliptical (magnetostrictive), sonics is linear

AGGRESSIVE PERIODONTITIS:
Aggressive periodontitis usually presents with:

st st
- rapid loss of attachment and bone destruction (1 M & incisors 1 )
- familial aggregation
- depressed neutrophil function or defective PMN
- hyperreponsive macrophage, w/ elevated levels of prostaglandin E2 (PGE2) and interleukin 1β
- except for the presence of periodontal disease, patients are otherwise healthy
- elevated level of Aggregatibacter actinomycetemcomitans & sometimes, Porphyromonas gingivalis, capnocytophaga
- progression of pathogenesis may be self-limiting, good response to antibiotics

st
Localized Aggressive periodontitis: 1 molar & incisors, circumpubertal onset, robust serum antibody response to infective agents: the
dominant serotype antibody is IgG-2. Most common in blacks.
- Tx: surgery, tetracycline, metronidazole antibiotics w/ amoxicillin
- AA & capnocytophaga bacteria

Generalized Aggressive periodontitis generalized: patients < 30 y/o, poor serum antibody response
- AA, and in some cases, of P. gingivalis

QUESTION: Localized aggressive periodontitis show bone loss on first molars and incisor.
QUESTION: Where are the most teeth lost in local aggressive periodontitis? Max molars

QUESTION: What kind of bone loss do you see in aggressive periodontitis? Vertical. Others answers were horizontal, mesial distal, interprox.

QUESTION: Reason pts get aggressive periodontitis? Host can’t fight off

QUESTION: What are two things in common among generalized aggressive periodontitis & chronic periodontitis? Distribution among the teeth

QUESTION: Classical sign of aggressive periodontitis? Tooth mobility & deep pockets with lack of inflammation are initial signs of LAP.

QUESTION: Which of the following is not associated w/ Localized Aggressive Periodontitis? local factors (i.e. inflammation, plaque, calculus)
consistent w/ bone loss

QUESTION: Which of the following is not true about local aggressive periodontitis?
Affect less than 30%
Tx is scaling & systemic antibiotic
Genetic component
Not too much gingival inflammation

QUESTION: What is not a characteristic of localized aggressive periodontitis (LAP)?
Severe bone loss in anteriors
Deep probing depths for first molars
Generalized gingival inflammation

QUESTION: What is not associated with LAP (Localized aggressive periodontitis): Calculus
Sc/RP
Antibiotics
Sc/RP and Antibiotics
Antibiotics for 1 week and then Sc/RP

QUESTION: Best way to treat localized aggressive periodontitis?
a. chlorhexidine
b. H2O2 rinse
- Localized aggressive perio, treat with tetracycline
st
QUESTION: 18-year-old female w/ > 5 mm pocket on central and 1 molars? Localized aggressive Perio

NECROTIZING ULCERATIVE GINGIVITIS (NUG/ANUG)
Acute Necrotizing Ulcerative Gingivitis (Trench mouth):
- Usually 15-35 yrs old
- Punched out papilla à painful bleeding gums, ulceration of interdental papilla w/ necrotic
slough (“Vincent’s infection”)
- Sometimes, fetid odor (halitosis) & metallic taste
- Bacteria: anaerobic fusobacteria + spirochetes (ex. prevotella intermedia)
- Tx: debridement + antibiotics (metronidazole) + OHI
QUESTION: Bacteria’s present in ANUG? fusiform, spirochetes & prevotella intermedia
QUESTION: For NUG or ANUG, which microorganisms predominate? Spirochetes

QUESTION: Electron microscopic examination of the bacterial flora of necrotizing ulcerative gingivitis shows: spirocytes – (fusoform, spirocytes,
pervertoa intermedia) (intermitted spirocytes- treponema denticola)

QUESTION: Patient comes in with gingivitis, no pocketing, pseudomembranous coating that’s gray on gingiva? ANUG
QUESTION: Patient has interpapilla damage, periodontal condition, what could this be due to? ANUG
QUESTION: Cratered gingival = ANUG (NUG) – punched out papilla

QUESTION: Which of the following is the most appropriate initial treatment for a patient with HIV-associated necrotizing ulcerative gingivo-
periodontitis?
A. Debridement and anti-microbial rinses
B. Definitive root planning and curettage

QUESTION: For ANUG: Normally, you don’t give antibiotic. You only do debridement, rinse, and oral hygiene. But if the patient has a fever or
systemic indications like HIV, give metroniadozle.

QUESTION: First step in initiation treatment of HIV necrotizing ulcerative gingivitis? debridement and antibacterial rinse, antibiotics,
gingivectomy

PREGNANCY & PUBERTY:
Pregnancy gingivitis has altered metabolism of progesterone.

QUESTION: Pregnant women have more gingivitis why? Hormones (progesterone)

QUESTION: Which one of these bacteria are associated with pregnancy? P. intermedia
QUESTION: Pregnancy gingivitis caused by? hormones (progesterone) & P intermedia
QUESTION: Pregnant patient, you should not give what meds? Tetracycline, metronidazole, gentamicin and vancomycin should be avoided
QUESTION: Bacteria most associated with puberty? P. Intermedia

QUESTION: Picture of gingival hyperplasia on 14-year old girl – hormonal-induced
DRUG-INDUCED GINGIVAL HYPERPLASIA:

Drug Induced Cyclosporine Gingival Hyperplasia
QUESTION: Patient’s interpapilla gingiva is

swollen - anticonvulsant meds
(Dilantin/phenytoin)

QUESTION: What’s the #1 cause of medication
induced gingival hyperplasia? Anti-convulsant
meds Dilantin (30% of all drug induced)

QUESTION: All the following drugs cause
gingival enlargement (hyperplasia) except?
a. phenytoin
b. cyclosporin
c. nifedipine
d. digoxin

QUESTION: Medication that causes gingival
hyperplasia? Verapamil (calcium channel
blocker, hypertension)

QUESTION: All of the following drugs cause gingival hyperplasia except? Verapamil, diltiazem (CALCIUM CHANNEL BLOCKER), phenytoin
(Dilantin), nifedipine and cyclosporine—all do.

QUESTION: Gingival hyperplasia with which drugs? None of the answers were obvious like phenytoin. one of them was probably an obscure
calcium channel blocker

QUESTION: Patient is on calcium blockers, picture show gingival hyperplasia, what do you do? Tell them to see their doctor to switch meds

QUESTION: When pt is on immunosuppressant’s for transplanted liver, what happens in the mouth? CT overgrowth & hyperplasia à
cyclosporine will lead to gingival hyperplasia

PERIODONTIAL SURGERY

INCISIONS/FLAPS:
Periodontal Flaps: Periodontal flap preferred for mandibular anteriors. Lateral repositioning is done for gingival recession.

- Modified Widman flap: Internal bevel incision & instrumentation for root therapy, not pocket depth reduction but removes pocket lining
& pocket shrinks after healing.
- Displaced flap: PD reduction. Excisional procedure of gingiva = gingivectomy. Internal bevel gingivectomy but also reverse bevel. Final
placement of flap determined by first incision.
- Apical positioned flap: Internal bevel incision for pocket elimination (by apical position) and/or increases width of attached gingiva. Best
position is 2 mm apical to alveolar crest.
Distal wedge = cut to removal of excessive soft tissue distal to a terminal tooth. It’s to treat
pockets through internal thinning to gain access to bone on the distal aspect of terminal teeth.
- Advantages: close wound procedure (healing by primary intention/sutures), access to
bond, preserve zone of keratinized gingiva

a. envelope flap
b. y incision
c. Z incision

QUESTION: Doing flap surgery on mandible, what structure do you watch for? Mental nerve (If
rd
3 molar TE= Lingual)
QUESTION: Apical position flap are contraindicated in what location? Maxillary palatal
c. maxillary facial

QUESTION: Where can you not do apical flap? lingual of maxillary molars
QUESTION: When doing extrusion of canine, these flap techniques can be used except
1) Envelope flap
2) Semilunar flap
3) Apical repositioning flap
QUESTION: Where are you most likely to damage a nerve in vertical release of flap?
Lingual, Wharton’s duct and the sublingual gland
- avoid vertical incisions in lingual and palatal


QUESTION: Modified Widman flap can be characterize by all BUT? internal bevel incision,
replaced flap, reflected beyond mucogingival line
- It is internal bevel incision and replaced/nonrepositioned flap.
- Flap reflection with the MWF approach is only 2-3 mm beyond the alveolar crest
and not beyond the mucogingival junction. (Mosby)
QUESTION: I had many modified Widman flap qs, where do you make incision to? (T/F: to the base of pocket. I put false, not sure tho)
QUESTION: With a modified Widman flap, you mostly reduce bone if…
a. adapts the flap margin

QUESTION: What type of incision for maxillary palatal tuberosity reduction? T, Y

A. The most optimal flap uses a midline incision which courses from the papilla between teeth #8 and 9 posteriorly to the junction of the hard
and soft palates.
B. The most optimal flap is a reflection of the entire hard palate mucoperiosteum back to a line between the 2 first molar teeth.
C. The most optimal flap uses a midpalatal incision that courses from the palatal aspect of tooth #3 across to the palatal aspect of tooth #14
D. The most optimal flap is shaped like a "Double-Y", with a midline incision and anterior and posterior side arms extending bilaterally from
the ends of the midline incision.

rd
QUESTION: Distal wedge contraindication? On 3 molars without attach gingiva
QUESTION: CI when using distal wedge technique: Not enough keratinized tissue

• Mental nerve

QUESTION: A tooth had epithelium above CEJ, what flap would you use? Undisplaced/Replaced flap
QUESTION: Long jxn epithelium is coronal to CEJ and margin is around CEJ, what type of flap would you use?
apical position flap, Widman flap, replace flap

QUESTION: Crown lengthening procedure, what would you do? Modified woodman flap or Apical repositioned flap w/ osteotomy and
osteotomy

QUESTION: RCT w/ post and core and crown lengthening, why do crown lengthening? Ferrule effect, adequate crown length

QUESTION: To expose a mandibular lingual torus of a patient who has a full complement of teeth, the incision should be…
a. Semilunar
b. Paragingival

QUESTION: If removal of torus must be performed to a patient with full-mouth dentition, where should the incision be made?

a. initial incision
c. post-op oral hygiene

st
QUESTION: During maintenance therapy, pt has recurrent 6mm pocket on M of #4 and D of #20. What is 1 tx option?
flap surgery
scaling root planning with local microbial administration
QUESTION: To prevent exposure of a dehiscence or fenestration, what kind of flap do you do? partial or split
thickness flap
QUESTION: Split thickness flap involves what tissues? Mucosa (only) or submucosa, epithelium and CT
(submucosa)
- surface mucosa (consisting of epithelium, basement mem brane, and connective tissue lamina propria

QUESTION: In a partial thickness flap, what do you cut through? Epithelium, connective tissue, but NOT periosteum

QUESTION: Perio flap that expose bone - Full thickness

QUESTION: Full thickness flap will result in bone atrophy (or loss) in:
thin periradicular bone (so do partial-thickness flap for this)
thick periradicular bone
thick interproximal bone
thin interproximal bone

GINGIVECTOMY & GINGIVOPLASTY

Gingivectomy: Excision of gingiva, provides visibility & accessibility for complete calculus removal & thorough root smoothing to create
favorable environment for gingival healing & gingival contours.
- Goal: Eliminate suprabony pockets, eliminate gingival enlargements or eliminate suprabony periodontal abscess
- DO NOT DO gingivectomy if osseous recontouring is needed, if pocket depth is apical to mucogingival junction, if there is inadequate
attached gingiva, or is esthetics is a concern.
Gingivoplasty: Reshaping of gingival to create physiological gingival contours in the absence of a pocket.

The 3 incisions necessary for flap surgery:
A. First (internal bevel) incision
B. second (crevicular) incision
C. third (interdental)

Wound Healing:
- Primary Intention healing – tissue surface has been approximated/closed. Ex. stitch, flap, glue. Very little tissue loss
- Secondary Intention healing – extensive wound, considerable tissue loss, edges can’t be brought together. Ex. ulcer, Sc/RP, gingivectomy.
Repair time is longer, greater scaring, increased infection
- Tertiary Intention Healing – delayed/secondary closure, delayed suturing/wound closure. Ex. poor circulation or drainage to wound area
so wait, tissue grafts
QUESTION: What direction is the reverse bevel (internal bevel) incision? axial toward bone

QUESTION: Know about internal bevel incision and where to cut: apical to the base of the periodontal pockets, but coronal to the MGJ.

QUESTION: What is purpose of “bleeding incisions” in gingivectomy?
location of dehiscence
location of alveolar defects
guide for incision

QUESTION: Bleeding spots established in gingevectomy to? outline incision line

QUESTION: How does a site heal after a gingivectomy? Long junctional epithelium

QUESTION: Indications for gingivectomy – hyperplastic gingiva & suprabony pockets

QUESTION: Few questions on when to do and not to do gingivectomy? infrabony pockets, little attached gingiva, high smile line

nd
QUESTION: Which is contraindicated in 2 molar region to reduce deep pocket with limited attached gingiva? Gingivectomy

QUESTION: Patient has very little keratinized gingiva, which of the following flaps should you not do: gingivectomy

QUESTION: Pt has a PFM #18 molar with minimum keratinized gingiva with deep pocket depth. Which of the following way is not acceptable is
a way to minimize pocket depth? Gingivectomy
QUESTION: If little attached gingiva is present and have deep pockets, what will you NOT do to get rid of them
o Gingivectomy
o Cannot graft

QUESTION: Gingivectomy is contraindicated in:
when the sulcus is apical to gingival groove
sulcus is apical to convexity of tooth
sulcus is apical to the crest of alveolar bone
QUESTION: Gingivectomy is contraindicated with? Minimum attached gingiva

QUESTION: Gingivectomy is contraindicated when bottom of the pocket is apical to alveolar crest (infrabony bony pocket)

QUESTION: Which of these is a contraindication to a gingivectomy? the pocket extends beyond the mucogingival junction (also infrabony
pockets present)
QUESTION: What should be considered for gingivectomy?

level of attached gingiva
degree of attachment loss


QUESTION: Gingivectomy incision: Excisional (external bevel incision)

QUESTION: How many mm per day does epithelium grow over connective tissue? 0.5-1 mm, 1-2 mm, 2-3 mm

QUESTION: How does external bevel gingivectomy heal? Primary intention, secondary, tertiary, granular tissue formation


QUESTION: After a gingivectomy, how does the site heal?

QUESTION: External bevel incision for a gingivectomy, where is the incision made?
apical to epithelial tissue
vascular bundle
Junctional epithelium (apical to base of pocket (epithelial attachment))

PERIO REGENERATION & REPAIR

Regenerative surgery - for regeneration with bone graft while flap surgery - to get access for better S/RP.
Regeneration - type of healing that completely replicates the original architecture & function. It involves the formation of a new cementum,
PDL, and alveolar bone.
- See PDL, bone, cementum

Repair - replacement of loss apparatus with scar tissue, which doesn’t completely restore the architecture or the function of the part replaced.
End product is the establishment of long junctional epithelium attachment at the tooth-tissue interface.
- See long junctional epi, CT

QUESTION: Following flap surgery, new junctional epithelium can form on either cementum or dentin, junctional epithelium is reestablished as
early as one week. First is False, second is true.
- Not on dentin, JE is reestablished in 1-3 weeks

QUESTION: After you perform a flap surgery, where you see regeneration? Epithelial attachment via long junctional epithelium & connective
tissue adhesion.

QUESTION: The soft tissue-tooth interface that forms most frequently after flap surgery in an area previously denuded by inflammatory disease
is a
E. collagen adhesion.
F. reattachment by scar.
G. long junctional epithelium.
H. connective tissue attachment.

QUESTION: Periodontal regeneration involves – Sharpey’s Fibers, Cementum and Alveolar Bone

QUESTION: Type of healing in S/RP and free gingival graft: Long Junctional Epi and CT
QUESTION: What do you want from perio flap? Regeneration of PDL, cementum & bone

GINGIVAL GRAFT, BONE GRAFTS, GBR:

Guided bone regeneration (GBR): place barrier membranes to direct the growth of new bone & gingival tissue at sites with insufficient volumes
or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration.
Guided tissue regeneration blocks the re-population of the root surface by long junctional epithelium and gingival connective tissue to allow
cells from the PDL and bone to re-populate the periodontal defect.
Types of Soft Tissue Grafts:

- Connective-tissue grafts – most common method used to treat root exposure. Skin flap is cut at the palate & tissue from under the flap
(subepithelial connective tissue) is removed & stitched to the gum tissue surrounding the exposed root.
- Free gingival grafts – Similar to a CT graft, free gingival grafts use palatal tissue but instead of making a flap and removing tissue under the
top layer of flesh, a small amount of tissue is removed directly from the roof of the mouth & then attached to the gum area being treated.
This method is used most often in people who have thin gums to begin with & need additional tissue to enlarge the gums.
- Pedicle grafts – gum grafted from or near the tooth needing repair. The flap (pedicle) is only partially cut away so that one edge remains
attached & the gum is then pulled over or down to cover the exposed root and sewn into place.

QUESTION: 3 things you need when doing GTR: bone, Sharpey’s fibers, & cementum

QUESTION: How do you fix gingival recession in anterior region? pedicle graft (laterally repositioned flap, never lose blood supply)

QUESTION: Purpose of lateral graft (Pedicle graft) à For gingival recession

QUESTION: 8-year-old with anterior crossbite, has recession on anteriors. What type of tx would you do?
a. chlorhexidine
c. pedicle graft

QUESTION: Free gingival graft gets blood from base first.
QUESTION: Free gingival graft: Which area can be affected:

§ Greater palatine nerve bundle
§ Nasopalatine nerve bundle
§ Nasopalatine artery
§ Greater palatine artery

QUESTION: Most likely to be damage (complication) when you take tissue from gingival graft? Damage to greater palatine neurovascular
bundle
QUESTION: What nerve is most likely injured when transferring donor tissue to area of free gingival graft (mucosal graft)? Greater palatine
QUESTION: Mucosal graft epithelization by connective tissue from underlying tissue (recipient site)
QUESTION: Where does the epithelial cells for a graft come from?
a. Donor epithelium

c. donor CT
d. recipient CT

QUESTION: You only have 4 mm of bone (alveolar ridge) above max sinus, how do you do bone graft?
fill graft towards sinus
fill graft towards alveolar ridge
fill graft towards mesial
- Don’t add to alveolar ridge, it’s not going to integrate so fill towards sinus
QUESTION: Only 4mm of bone below ridge and sinus where do you place graft? Floor of sinus (NOT Top of ridge)
QUESTION: What graft is best for sinus lift? Autogenous & alloplastic
QUESTION: Your patient was referred to an oral and maxillofacial surgeon for an implant, and you were advised that she was going to need a
sinus lift procedure with placement of an autogenous bone graft. What is the definition of that graft?

QUESTION: Which is the most predictable when restoring an edentulous mandibular ridge? Autograft
QUESTION: What is a graft from a different species? Xenograft
QUESTION: How to replace large chunks of mandible? Autogenous graft
QUESTION: What is the most osteogenic? ONLY autograft
LEARN THIS!
QUESTION: Freezed dried cadaver bone is a type of what graft? Allograft

QUESTION: Decalcified freeze dried bone allograft: has bone morphogenetic proteins (BMP)
QUESTION: Best allograft material: dried freezed bone

QUESTION: Freeze dried bone has the advantage of having which protein: bmp/pdgf (bone morphogenic protein, Platelet-derived growth
factor)

QUESTION: Which hormone is used to bone graft? BMP (bone morphologic protein)

QUESTION: Which type of grafts causes bone growth? Osteoinductive, Osteoconductive
- OsteoINDuctive à Allograph, autograph

QUESTION: Maxillary canine is contraindicated in a grafting procedure.

QUESTION: Least likely to need bone graft? one wall, two wall, three wall wide, three wall narrow
- Wide & deep 3 wall defect = GTR, narrow 3 wall defect = bone graft regeneration?


QUESTION: Best prognosis for a guided tissue regeneration? three walled defect


QUESTION: Facial recession on mandibular canine of 14-year-old à graft not indicated? Reposition with ortho?

st
QUESTION: Which is least likely to be successful facial soft tissue graft? – Lower 1 premolars (no canine in the choices)?

st
QUESTION: Least desirable place to place graft: mandibular 1 premolar space

QUESTION: Tx for Class II furcation involvement (also called cul-de-sac)? GTR

QUESTION: Class 3 furcation, which not an option? GTR
- Class III furcations are least successful in GTR procedures.

QUESTION: The purpose of GTR is to prevent: Long J.E, migration of PDL cells, migration of CT cells
QUESTION: In guided tissue regeneration, inserted material is preventing which of the following attached to tooth structure?
• epithelial
• connective tissue (hinder the migration of fibrous CT while supporting the growth of bone)
• gingival
- GTR excludes gingival epithelial cells to allow progenitor cells to close the wound. Gingival epithelium and connective tissue are excluded
by the membrane. Progenitor cells form cementocytes and fibroblasts which form new cementum and PDL fibers. This gives you
regeneration of the attachment apparatus and not long junctional epithelium. LJE is not as strong as the original attachment apparatus
(which is lost by debridement).

QUESTION: The purpose of a barrier: Apical movement of PDL cells, coronal movement of PDL cells
QUESTION: Which tx is best for Class III furcation?
b. apical flap
c. HEMISECTION
d. root amputation
- hemisection = mand molar, to treat Class II or III furcation invasions
- root amputation = max molars
QUESTION: In a through and through furcation lesion, which is the least appropriate treatment? GTR
QUESTION: Contraindication for max molar with class II furcation? hemisection w/ crown
QUESTION: How to treat an RCT mand molar that has Class III furcation involvement: hemisection and place 2 crowns to act as 2 premolars.
Root amputation is for maxillary teeth.

QUESTION: Hemisection of mandibular molar, which has best prognosis:
• Furcation that is more coronal or apical

- One wall defect – usually only one interdental wall remains and is called hemi septum if remaining wall is proximal. Poor prognosis for
periodontal regeneration since it is difficult to stabilize the graft material to be used in its proper
place.

QUESTION: Bony area between two premolars has no mesial, facial and lingual wall, what is it called?
Hemiseptum
QUESTION: After periodontal surgery, the dentist leaves interproximal bone apical to radicular bone. What
is this called? negative architecture.
QUESTION: Most important issue that determines success after periodontal surgery? Plaque control of the area

FRENECTOMY:

Sequence to close diastema in a child with low labial frenum:
1) wait for the canines to erupt
2) close the diastema with ortho
3) perform the frenum surgery

QUESTION: 10 y/o kid has a thick upper buccal frenum with diastema between 8 & 9. Tx?
wait til upper permanent canines erupt (then, do frenectomy)
frenectomy
use elastics
QUESTION: If diastema is caused by a frenum, you don’t do a frenectomy until the canines have erupted.
QUESTION: All of the following are risk for ortho treatment except? Frenal displacement (other choices, were plaque management, bone loss,
resorption)
QUESTION: Which of the following explains why the Z-plasty technique used in modifying a labial frenum is considered to be superior to the
diamond technique?
d. it decreases the effects of scar contracture
- improves the appearance of scars and purpose is to relax the frenum pull à less contracture

ORTHODONTICS

Sagittal: curve of SPEEà Anterior-posterior
Frontal: curve of Wilsonà Left and right

Problematic = high rate of relapse
FACIAL CHARACTERISTICS & GROWTH:

QUESTION: Dolichocephalic – long narrow face
QUESTION: Which is correct? Growth of Mandible is both intramembranous and endochondral.
QUESTION: Scammon Growth curve: Neural tissue grows until what age? 5 y/o (this was the number on the test, but on book it is about 6-7)

QUESTION: Which tissue show most growth in first 6 years and then plateau? lymph, neural, genital
QUESTION: Which system is most fully developed at birth?

a. muscle system
b. neural system
c. gonadal system

QUESTION: Which grows faster, maxilla or mandible? Maxilla grows earlier and faster (b/c it is closer to brain)
QUESTION: What is the best radiograph for showing prediction about ossification? Wrist hand radiograph

QUESTION: Majority of the tissues in FACE are derived from?
A) ectoderm
b) mesoderm
c) ectoderm and mesoderm
d) endoderm
QUESTION: Eruption sequence of pediatrics? Central-Central, Lateral-Lateral, 1M-1M, Canine-Canine, 2M-2M
QUESTION: Overjet in permanent teeth should be? 2-3mm
QUESTION: The space for the eruption of permanent mandibular second and third molars is created by the
QUESTION: Low occlusal plane leads to what? decreased biting force, other options were tongue biting, excessive bite force

OCCLUSION:

nd nd
Arch length: Distal 2 PM to distal 2 PM or Mesial M1 to Mesial of M1
Arch width: Inter-canine space

Class II = convex, Class III = concave
QUESTION: What do you do to camouflage class 2? Extract upper premolar
QUESTION: Facial profile of class 2 malocclusion? Convex
QUESTION: Normal class 1 occlusion has maxillary MB cusp in buccal groove of mandibular molar.

st
QUESTION: Little girls, ortho casts were taken, what occlusion class is she? Class 1 (her 1 permanent molars were out, mesiobuccal cusp of
st st
upper 1 molars on buccal-lingual groove on lower 1 molars.

st st
QUESTION: What’s the occlusion when MB cusp of max 1 molar is distal to buccal groove of mand 1 molar? CLASS III

QUESTION: Distalized occlusion w/ upright central anterior and deep bite: Class II div II

QUESTION: What's the difference between primary class II and permanent class II? Shallow grooves, broad contacts
QUESTION: Class III is due to what? Maxillary retrusive & mandibular protrusion
QUESTION: Most common type of occlusion in primary teeth: Flush terminal plane

QUESTION: Highest percentage of occlusion in the US? class I, class II, class III
QUESTION: What Percentage of population have class I normal occlusion? 30%
QUESTION: Most common patients to have anterior tooth fractures or trauma? Class II div I
QUESTION: Most likely to cause fracture in children? Class II division I
QUESTION: Class III patient: which of the following is not helpful in establishing whether pt has retrognathic maxilla or prognathic
mandible? photographs, study models, ceph analysis, clinical exam

QUESTION: A child who has a distal step in the primary dentition generally develops which of the following molar relationships in the
permanent dentition?
A. Class I
B. Class II
C. Class III
- Distal step à Class II + End-end occlusion; Mesial step à Class I + Class III

QUESTION: What happens to the permanent molar occlusion in the presence of a flush
(straight) terminal plane and mandibular primate spaces?

QUESTION: Class II is formed with distal step.
QUESTION: Class I can be formed with flush terminal or mesial step
QUESTION: Which of the following will most likely lead to a class 2 malocclusion on a
patient
distal step
terminal flush plane
mesial step
st
QUESTION: Where are the primate spaces? MAX: between LATERAL & CANINE; MAND: between CANINE & 1 MOLAR
QUESTION: What makes space for mandibular teeth when they erupt? Primate space
QUESTION: What is the purpose of primary teeth? Space holder of permanent teeth
nd
QUESTION: Premature loss of which tooth will cause mesial drift of permanent tooth? Primary 2
molar
- Leeway space (of Nance) = sum of primary tooth M/D widths is greater than sum of
permanent successors (C + 2 PM). When primary teeth fall out, there is extra space to help
st
relieve crowding. If nothing done, then 1 molars drift forward.
- Usually 1.8 (total) mm in maxillary, 3.6(total) mm in mandible
QUESTION: The late mesial shift of a permanent first molar is primarily the result of closure of which of the following spaces?
A. Canine
B. Leeway
C. Primate
D. Extraction

QUESTION: What will account for the anterior space for the perm. mandibular incisors?
a. Flaring of the max incisors
b. Primate space!!
c. Leeway space
- Because this is the space between the canines and the central incisors; Leeway is for posteriors

QUESTION: What allows for more space for eruption of permanent lower incisors?
Allow them to protrude buccally
Use primate space
Use early mesial shift (which actually is primate space)
Leeway space (aka late mesial shift).


QUESTION: If a mandibular primary canine is prematurely lost, what would happen?
Incipient malocclusion
Insufficient arch size in anterior region
When laterals erupt, canine’s root are resorbed
When canine is shed, midline will shift in the direction of the lost tooth.

QUESTION: Child lost both his primary mandibular canines prematurely, what does this lead to? Lack of arch space
QUESTION: Primary tooth lost prematurely, what does that do to permanent tooth? Delayed eruption of perm
- If the kids’ primary molar is lost, the eruption is delayed. If the pt loses primary after age 7, eruption is accelerated


QUESTION: Moyers predict MD canine & premolars using a table, with the sum of all 4 primary lower incisors.

QUESTION: A dentist will perform a Moyers' mixed dentition analysis. Which of the following teeth will be measured to predict the size of the
unerupted canines and premolars?

a. increased
b. decreased

QUESTION: What does the Moyers probability chart predict when a transitional dentition analysis is performed?
QUESTION: Tanaka predict MD canine & premolars width using 1/2 of sum of all 4 lower incisors
QUESTION: Ugly duckling phase: diastema between maxillary centrals (#8 & #9)
- Maxillary central incisors can also be quite distally inclined when they first erupt
- When maxillary centrals erupt, they move labially & have diastema. When permanent canines erupt, centrals move mesially to close
diastema.

QUESTION: The ugly duckling phase refers to? Mixed dentition

QUESTION: Ugly duckling stage: Wait for canines before doing ortho on centrals

QUESTION: Pt has minor crowding in the anterior mandibular region that has displaced the centrals. How you fix it? Do stripping.
- Ortho stripping (IPR, ContacEZ) = filing down the teeth, usually for 1-3 mm crowding

CROSSBITE, OPENBITE, ARCH LENGTH/WIDTH, & APPLIANCES

Most posterior cross-bites appear to be unilateral. Usually, due to bilaterally underdeveloped maxilla with a shifting of the mandible to one side
during closure.

Common Ortho Appliances:

Palatal Expander (RPE):
- best < 15 yrs old
- widen the maxillary

Reverse Pull Headgear:
- attached to braces & pull distally, anchor to head
- correct A-P discrepancies, slow maxillary growth,
correct overjet

Lower Lingual Holding Arch:
- prevents man molars from shifting forward, spread
crowded teeth
- 2 bands on lower molars + U-shaped bar
- Used for bilateral man molar loss after perm incisors
or loss > 1 tooth in man
Nance Holding Arch:
- 2 bands around molars + acrylic button on palate
st
- Space maintainer, premature loss or if 1 molars
need to be prevented mesial shift

Hawley Retainer:
- Removable, used after braces to maintain

Band & Loop:
- early tooth loss & space maintenance
- loss of a first primary molar

QUESTION: Anterior permanent tooth most likely to erupts in crossbite? Maxillary laterals

QUESTION: What head gear would you use to correct a class III? Reverse pull headgear (also called protraction facemask)
QUESTION: Which headgear is used for pt who needs to bring maxilla towards protrusive? Reverse pull/facemask (protraction headgear)

QUESTION: A patient with maxillary arch constriction of 3 mm and a posterior crossbite, what will you see?
Normal midline
Midline shift towards the unaffected side
Midline shift toward the affected side

QUESTION: Patient has 3 mm palatal constriction, what is most likely complication? Bilateral crossbite
QUESTION: Hawley appliance is NOT used for correction of skeletal crossbites.

QUESTION: Unilateral posterior crossbites in kids are usually due to a MANDIBULAR SHIFT; treat w/ MAXILLARY EXPANSION

§ True unilateral maxillary constriction & functional crossbite
§ Mandibular shift
§ Bilateral constriction
- If true unilateral maxillary constriction à fix using unequal W arch or asymmetrical maxillary expansion

QUESTION: What is indicated for the tx of unilateral posterior cross bite? Elastics from lingual of max mol to Buccal of mand molar
- A single tooth cross bite can be adjusted by placing cross elastics from maxillary lingual to mandibular buccal.

QUESTION: When to fix cross bite in a child? ASAP/correct immediately

QUESTION: What kind of appliance for posterior cross bite and when? Quad Helix (with digit sucking) or Palatal Expander, correct immediately
Quad Helix
Appliance

QUESTION: Most common cause of anterior crossbite: thumbsucking, lack of interdental arch space, mouth breathing

QUESTION: If patient has their nose always stuffed (chronic nasal congestion) & they breathe through their mouth, what happens? Anterior
open bite, some of the other choices posterior open bite, constriction on arches
- Mouth breather à anterior open bite

QUESTION: Mouth breakers have a facial feature: incompetent lip, convex profile, narrow palatal vault, bilateral crossbite

QUESTION: Anterior crossbite is done by all except: functional shift vs lower third of face is hypertrophied
QUESTION: Leveling of mandibular teeth à OPEN BITE (treats the overbite)
QUESTION: 8-year-old child, there is a recession in a mandibular incisor with posterior crossbite, which of the following treatment options is the
least acceptable?
b. graft
d. observation

QUESTION: 10-year-old child loses primary first molar, what is the space maintenance appliance needed? None, since premolar erupting at this
age

QUESTION: 10 y/o patient has crown on first primary molar and second primary molar is going to be extracted due to caries. What should be
done in order to maintain space?
a. Nothing - because premolar is about to erupt
b. band loop
c. distal shoe

QUESTION: Can tx all with appliances except crepitus.

st
QUESTION: Loss of a primary right 1 molar in a 3-year-old child requires placement
of a:
a. band and loop
b. distal shoe
st
QUESTION: Lower 1 molar come out too early, what do you do? Band and Loop

nd
QUESTION: Child lost primary 2 molar: distal shoe

QUESTION: Most common space maintainer - band and loop

st
QUESTION: Patient has a stainless steel crown on tooth #L (primary man 1 M), it’s going to be EXT, but what else will be needed? Do band-
and-loop for space maintenance

QUESTION: Characteristics of a band and loop space maintainer include all of the following except?
If leakage from cement, it can lead to recurrent decay


QUESTION: What primary reason for restoring primary teeth? To maintain arch space

nd
QUESTION: What tooth is the most important to keep for space maintenance: Primary 2 molar
nd
QUESTION: What is the most common tooth that involves space management in primary teeth? 2 molar
QUESTION: How to do measure the projected arch length space for permanent teeth?
nd nd
- Arch length: Distal 2 PM to distal 2 PM or Mesial M1 to Mesial of M1
- Arch width: inter-canine space

nd nd
QUESTION: What tooth erupting FIRST would cause some sort of arch discrepancy? Man 2 perm molar erupting before the 1/2 man perm
premolar
st
QUESTION: Lower 1 primary molar tooth has lower permanent premolar underneath, what will determine when the premolar will come in?
st
a. How fast roots of 1 primary molar resorbs
b. age of patient
c. how much of root of premolar is formed
QUESTION: What race has most deep bites? White

- Severe deep bite is nearly twice as prevalent in whites as blacks or Hispanics, while open bite > 2 mm is 5x more prevalent in blacks than
in whites or Hispanics

QUESTION: The best age to correct a thumb sucking habit is: during primary dentition. Kids are easier to desensitize (5-6 years)
- Mild displacement of the primary incisor teeth is often noted in a 3-4 y/o thumbsucker, but if sucking stops at this stage, normal lip and
cheek pressures soon restore the teeth to their usual positions.
- If the habit persists after the permanent incisors begin to erupt, orthodontic treatment may be necessary to overcome the resulting tooth
displacements.

TOOTH DEVELOPMENT
Teeth erupt through bone when 2/3 formed, erupt through gingiva when ¾ formed.
Permanent teeth erupt lingual & inferior to primary teeth

QUESTION: What stage does supernumerary or hypodontia anomalies occur? Initiation stage, histodifferentiation, proliferation
QUESTION: What physiologic stage is supernumerary teeth? Initiation

QUESTION: Post emergence eruption is mostly result of: root development, bone growth
- Phase begins as tooth emerges through gingiva & moves into occlusal contact.

QUESTION: The primary tooth is missing/extracted. The perm tooth root is 1/3 formed. What is driving the eruption of the perm tooth? Either
something about vascular supply to the tooth or the fact that the root is 1/3 formed
QUESTION: When does tooth (crown) start to emerge in the oral cavity?
a. When root starts to form
b. Only after crown has been formed WHEN DONE CALCIFYING
c. After complete root formation
d. After ¾ root has been formed (through gingival) (2/3 erupts through bone!)

QUESTION: How long for the root to complete formation after eruption? 2.5 - to 3.5 years

QUESTION: Apical root closes---2 ½ - 3 ½ years after eruption

QUESTION: Calcification of premolar tooth at birth? NO

QUESTION: Pt has 12 primary teeth & 12 permanent teeth, what the patient’s age? 8.5 yrs old

QUESTION: Which direction do succedaneous anterior teeth erupt? Lingual

QUESTION: If a child’s permanent mandibular incisors are erupting but their primary mandibular incisors are still there, where would they
erupt? they would erupt lingually

ORTHO TREATMENT PLANNING
Labial bow for tipped teeth:

o Passive labial bow - treats overjet
o Active labial bow – for incisor retraction
Ortho Sequence:
st
1 - Light Round Wires: level and align
nd
2 - Rectangular/Square wires: corrects vertical discrepancies (working arch wires), control crown & root movement
rd
3 - Light Round Wires: Finishing arch wires (finishing touches)
- Rectangular wire is used for root torque.
- Round wire basically moves the tops of teeth (above gums) to level, align, and rotate them but the root part lags behind and needs to be
straighten within the jaw bone w/ rectangular wires.

QUESTION: Edgewise bracket - for intrusion motion (ortho brace bracket)

QUESTION: Ortho case: Patient’s upper central were little flared & needed to be uprighted more, what appliance do you use? Rectangular Arch
Wire (Other choices were headgear, facemask, etc)

QUESTION: Advantage of rectangular orthodontic wires – Control crown and root movement

QUESTION: Center of tooth when ortho is tipping it? Middle of root, apex, 0.5 of apex

QUESTION: Force put on crown, where is center of translation or rotation? Halfway down root, CEJ, past apex

QUESTION: Ortho finger springs are used for? To fix tipping of anterior mand and maxillary teeth
QUESTION: How do you prevent rotation in ortho? Anti-rotational clasp

QUESTION: What is moderate crowding? less than 4 mm is moderate (>4 = severe crowding)

QUESTION: How to patient with 16mm of overjet: Ortho w/ surgery, premolar extraction route

QUESTION: Patient needs ortho with partially erupted #17 and #32. Radiographically, both teeth had crowns with distal area that are
susceptible pericoronitis. What do you do? EXT both teeth surgically

QUESTION: You need to ortho for kid with very poor oral hygiene. What treatment is best? Removable

QUESTION: Best time to fix lingually inclined incisors? When canines erupt

QUESTION: If a child has 3mm crowding on the lower and permanent canines haven’t erupted, what do you do? Nothing
QUESTION: Primary anterior tooth intruded 5mm. How would you treat it?
• Extract
• Splint
• Ortho to bring it down

QUESTION: Ortho uprighting of molar, what is the common problem & what should you do? Occlusal interferences - need to adjust occlusion

QUESTION: Why would you move a tooth (ortho) before doing perio?
More likely to get bone loss after perio surgery
Easier to move now
Stable teeth are harder to access

a. intermittent
b. direct
c. continuous
d. indirect

QUESTION: Which one of the following doesn’t happen in the PDL during ortho movement? Chemical change in PDL

QUESTION: Orthodontic movement- widened PDL due to decalcification? Due to tension
- Compression (where tooth is moving toward) and tension side (where tooth is moving away from). First, widened PDL occurs on tension
side in presence of light prolonged orthodontic forces, indicating tooth movement is
soon to begin.
- Compression side: osteoclasts are removing lamina dura
- Tension side: Osteoblasts are laying down new bone

QUESTION: Which of the following soft tissue elements (fibers) are commonly associated with
relapse following orthodontic rotation of teeth: Supracrestal
- Supracrestal fibers, in particular transseptal fibers, have been implicated as a major
cause of postretention relapse of ortho treatment.

QUESTION: What causes rotation of a tooth after ortho therapy? Transeptal fibers

QUESTION: What fibers cause reversement of a rotated tooth after ortho treatment?
Transseptal fibers

QUESTION: Finish ortho tx in a non-compliant patient, what you do for retention – fix retention, removable retention, supracrestal fiberotomy

QUESTION: Ortho Case: 14 yr. old kid w/ pano; all PM’s congenitally missing except #28 (missing 7 of them); retained primary molar crowns
over congenital missing PM’s
ii. Using a ceph, you gotta tell if facial profile is convex, straight, or concave à all 3 were CONVEX
iv. Given ANB = 6, What class is it? Class II
v. Other ortho pt: explorer catches in a pit of #19? What would your tx be? PRR
QUESTION: Ortho Case: 15 yr. old kid. Upper & lower canines are ectopically erupted out of the arch; besides that, everything else was normal
in this case.
i. How do u treat?
st
1. Extract 1 PM’s & bring canines into arch OR take out 4 canines & keep PM’s (take out canines)
st
2. if you’re gonna extract 1 PM’s, what would you NOT use: 150, 151, 3_, 2_ _ (answer must be 1 of the last
rd
2; look em up) if 222(universal 3 molars), if #32 universal bayonet so (222?)
iii. Ortho pt has never had a restoration? What would you do? sealants, do nothing
st
QUESTION: Permanent 1 molar ectopically erupting with slight resorption of primary teeth. Tooth most likely needs ortho, what would you
use? separating device (Can use elastic separators)
QUESTION: Ectopic maxillary molar eruption needs what? Ortho intervention

oooLATERAL CEPHALOMETRICS:

Website: http://www.theyoungdentist.com/uk/features/articles/780-a-beginners-guide-to-lateral-cephalometric-radiographs
A point (A): The point of the deepest concavity anteriorly on the maxillary
alveolus
B point (B): The point of the deepest concavity anteriorly on the mandibular
symphysis
Sella (S): The midpoint of the sella turcica (pituitary fossa)
Nasion (N): The most anterior point on the fronto-nasal suture
Orbitale (Or): The most anterior, inferior point on the infraorbital rim
Porion (Po): The upper midpoint point on the external auditory meatus
Anterior Nasal Spine (ANS): The tip of the anterior nasal spin
Posterior Nasal Spine (PNS): The tip of the posterior nasal spine
Gonion (Go): The most posterior, inferior point on the mandibular angle
Gnathion (Gn): The most anterior, inferior point on the mandibular symphysis
Menton (Me): The most inferior point on the mandibular symphysis
Pogonion (Pog): The most anterior point on the mandibular symphysis

Important Ortho Relationships:
- Frankfort Plane: orbitale – porion

- Mandibular plane (MnPl): gonion – menton
- Maxillary plane (MxPl): anterior nasal spines (ANS) - posterior nasal spines (PNS)
- ANB: angle represents the relative A/P position of the maxilla to the mandible & is used to find skeletal class
ANB = SNA – SNB, normal ANB is 2-3⁰

- (+) ANB angle = maxilla is positioned anteriorly relatively to the mandible (Class I or Class II malocclusion cases).
- (--) ANB angle = maxilla is positioned posteriorly relative to the mandible (Class III malocclusion cases).

The normal range is 1°-5°.
>5° indicates a Class II skeletal jaw relationship, protrusive maxilla or retrognathic mandible.
<1° indicates a Class III skeletal jaw relationship, deficient maxilla or prognathic mandible.
QUESTION: Esthetic analysis, # of vertical proprotions in the face? Five

- Vertically by 5 lines (4 planes)
- Horizontally by 3 lines (2 planes)

QUESTION: What does a bigger SNA means? Maxilla is more protrusive
- SNA-SNB=ANBà maxilla to mandible relationship

QUESTION: Female w/ ANB angle = 6⁰, what skeletal classification? Class II (protrusive maxilla or retrognathic mandible)
QUESTION: ANB = -4⁰: Class III

QUESTION: ANB is -6 degrees, what’s the facial profile? Class III
QUESTION: SNA 76 AND SNB 78, what’s the facial profile? 76-78 = ANB = -2⁰ so pt is Class III

QUESTION: SNA AND SNB 78, what’s the facial profile? 78-78 = ANB = 0⁰ so pt is Class III

QUESTION: SNA 82 AND SNB 80, what’s the facial profile? 82-80 = ANB = 2⁰ so pt is Class I
QUESTION: Frankfort’s horizontal plane = porion (upper external auditory meatus) to orbitale (inferior border of orbit)

QUESTION: Fox plane is parallel to Camper’s line (alar of nose – mid tragus line) – for anterior-posterior plane
- Fox plane is parallel to interpuppillary line – for anterior plane

QUESTION: Fox plane landmarks: Lower alla upper tragus and interpupillary distance

PHARMACOLOGY

PHARMACOKINETICS:

Enterohepatic circulation: Substances that undergo enterohepatic circulation are metabolized in the liver (by conjugation), excreted in the bile,
and passed into the intestine (where bacteria break some of the conjugated drug, releasing the unmetabolized drug again) where they are
reabsorbed across the intestinal mucosa (returns to systemic circulation) and returned to the liver via the portal circulation.
- Drugs may remain in the enterohepatic circulation for a prolonged period of time as a result of this recycling process. thus increase in
their half-lives.

First pass effect: After a drug is swallowed, it is absorbed by the digestive system and enters the portal circulation to the liver.
- Alternative routes of administration (e.g., intravenous, intramuscular, sublingual) avoid the first-pass effect.

Therapeutic index - estimate of the margin of safety of a drug. Higher TI = more safe
!"#$%& !"#$ !"

TI = !""#$%&'# !"#$ !"
Potency: response to a drug over a given range of concentrations. Depend on dose of drug; less mg for same efficacy has more potency
Bioavailability: Highly absorbed drug (high bioavail.) requires a lower dose than poorly absorbed. Most important determinant of drug dose is
POTENCY of drug. (the proportion of a drug or other substance that enters the circulation when introduced into the body and so is able to have
an active effect.)
Efficacy: max effect/intensity of the drug. Depends on level of drug binding to its receptor (antagonists are not efficient/no intrinsic activity)
- Max effect is also called as intrinsic activity.
- Elimination rate of a drug influences its half-life, determines the frequency of dosing required to maintain therapeutic plasma drug levels.

Idiosyncrasy: abnormal response to drugs due to various factors, hard to predict

QUESTION: Epinephrine = physiological antagonist of histamine & nitroglycerin
- Doesn’t act on same mechanism (epi = α vasoconstriction vs nitro = smooth muscle dilatator) but opposing action
- Same mechanism = competive antagonist; physiological antagonist = competing physicological effects

QUESTION: What best describes biotransformation? Increase in polarity, more ionized and more water soluble
- Whatever helps its excretion – polar and more water soluble

QUESTION: In relation to their parent drug, conjugated metabolites are what? more ionized in plasma (more water soluble)

QUESTION: What happens to a drug after conjugation? more ionic, more hydrophilic, more active

QUESTION: What do you use sodium bicarbonate for? All drugs or alcohol (Phenobarbitals)
- Excretion of acidic drugs is accelerated with sodium bicarbonate

QUESTION: Excretion of an acidic drug will be enhanced if the patient is given which of the following? Sodium bicarbonate

QUESTION: First pass metabolism: enzymatic degradation in the liver prior to drug reaching its site of action

QUESTION: First pass refers to: enterohepatic circulation, metabolism in liver

st
QUESTION: Oral drugs – undergo 1 pass metabolism in liver.

QUESTION: What is used to determine whether a drug will cross glomerulus: attached to a protein or not; other option is whether the drug is
acid or base; other is if its positive or negatively charged

Weak acid,
Weak base
Liposoluble - NON ionized drugs are soluble in lipid.
Hydrophobic
Hydrophilic-

QUESTION: When a drug does not exert its maximum effect is because it’s bound to?
Albumin
gamma
betasomething
alpha
- drugs highly bound to plasma proteins will not enter liver to be metabolized, resulting in longer half-life.

QUESTION: What protein is used to attach to medication: alpha or beta or gabba globulin, albumin
QUESTION: Which of the following best explains why drugs that are highly ionized tend to be more rapidly excreted than those that are less
ionized? The highly ionized are

QUESTION: Therapeutic Index LD/ED is a measure of: safety of drug
QUESTION: LD50 means at this dose, 50% of the test animals died

QUESTION: What is bioavailability of a drug? amount of drug that is available in blood/plasma

QUESTION: What does bioavailability measured?
How much drug is absorbed in the circulation
Blood to urine ratio

QUESTION: What pharmacokinetic factor influences the need for multiple doses in a day (dose rate)? half-life; other option is bioavailability, or
clearance
QUESTION: Drug dosing has to do with: half life

QUESTION: Two different drugs with same dosages, bind to the same receptor, and cause same intrinsic affect. However, they have different
affinities for the receptor. In which aspect these 2 drugs are similar?
a. ED50
b. LD50
c. Potency
d. Efficacy
- Efficacy bc they can both produce the same maximal response if enough is given
QUESTION: Drug A has greater efficacy than Drug B – Drug A will produce higher effect at lower dose. Drug A has a higher potency.

QUESTION: Fixed dose drug A w/ low dose of Drug B increase drug B effect when same dose of drug a is give w/ increased does of drug B:
competitive antagonist, synergism, partial agonist
- partial agonists bind & activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist.

QUESTION: Three carpules (2 ml carpules, 40 mg/ml) of local anesthetic X are required to obtain adequate local anesthesia. To obtain the same
degree of anesthesia with local anesthetic Y, five carpules (2 ml carpules, 40 mg/ml) are required. If no other information about the two drugs is
available, then it is accurate to say that drug X:
X&Y are = in potency & efficacy. (?)

A. agonism.
B. potency.
C. efficacy.
D. specificity.

ALPHA & BETA ADRENERGIC DRUGS:

Adrenergic Receptor blockers: α/β adrengic drugs act by blocking competitive inhibition of post-junctional adrenergic receptors

Effect of Epinephrine in presence of α/β receptors:
- Epinephrine stimulates both α/β receptors à HR increased, vasoconstriction
- Epinephrine reversal – when also taking α blocker (ex. prazosin, phenoxybenzamine, chlorpromazine) cause decrease in BP b/c β-
mediated vasodilation predominates à BP decrease (alpha blocker), HR increase
o Beta2 trumps A1 so vasodilation happens & BP decreases
- Vagal reflex – blocked by atropine, vagus stimulates decrease heart rate
- If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, however, the beta-blocker prevents the
vasodilation, leaving unopposed alpha vasoconstriction. (alpha-1)

Receptor activation would cause:

Eye: mydriasis (A1, B) – Dilation of pupil

Heart: increased contraction (B2)

Vascular smooth muscle: vasoconstriction (A1)

Skeletal muscles: vasodilation (B2)

Bronchial muscle: dilation (B2)

Sweat Glands: sweating

Alpha-1 agonist: increase smooth muscle tone, vasoconstrictor à ↑ BP
Alpha-2 agonist: given orally b/c they cause hypotension by reducing sympathetic CNS outflow

QUESTION: What does Alpha-1 do? Vasoconstriction of peripheral vessels (smooth muscle)

QUESTION: When you stimulate alpha 1 receptors what happens?
a. Vasoconstriction
b. Hypertension

QUESTION: What does alpha-1 receptors do to the heart? Vasoconstriction, increase blood pressure, increase peripheral resistance, mydriasis
(pupil dilution) and urinary retention


QUESTION: Heart has beta-1 receptors.

QUESTION: Slow infusion of epinephrine will cause which of the following and know which receptor is responsible - Alpha 1 (Vasoconstriction
during anaphylaxis), Beta 1 (Increases cardiac output), Beta 2 (bronchodilation)

QUESTION: Patients BP spike after EPI, what receptor? B1

QUESTION: Hemostatic agents in retraction cord target what receptor?
• a1 (vasoconstriction)
• b1
• b2
• gaba

QUESTION: Retraction cord with epinephrine can cause: increase HR, BP
- do not use in hyperthyroid or cardiac disease.

QUESTION: After using a gingival retraction cord, tissue reacts by recession. Where do you see this the most? Lingual, buccal, interproximal.

a. prazosin (alpha 1 blocker…blocks vascular smooth muscle constriction)
c. theophylline (treat asthma, COPD…it relaxes bronchial smooth muscle…so I guess it does do smooth muscle…)
- answer should be an alpha-1 antagonist/blocker

QUESTION: Which of the following combinations of agents would be necessary to block the cardiovascular effects produced by the injection of
a sympathomimetic drug?
Atropine and prazosin
Atropine and propranolol
Prazosin and propranolol
Phenoxybenzamine and curare
- sympathomimetic drug injection (ex. NE) stimulates α/β receptors so α-blocker prazosin + β blocker propranolol is needed.
- Atropine is an muscarinic/cholinergic receptor blocker that would stimulate heart (opposite effect)

QUESTION: Each of the following drugs produces vasoconstriction of vessels if injected into the gingiva EXCEPT one. Which one is this
EXCEPTION?
Phenylephrine (Neo-Synephrine®)
Norepinephrine (Levophed®)
- Terazosin, selective alpha-1 antagonist, is used to tx HTN & enlarged prostate (BPH)

QUESTION: Epinephrine + propanol: increases BP, decreases HR
- Propranolol is a nonselective beta blocker so epi only acts at only alpha receptors, which in the periphery are mainly alpha-1 receptors
- This causes vasoconstriction & Increased ⬆ BP à increased firing, which triggers aortic and carotid sinuses à increased vagal activity
on the heart à decreased ⬇ HR.

QUESTION: Change propranolol for? Metoprolol ... little change on HR, but no marked increase in BP.
- METOPROLOL = selective B blocker and is ok to use with EPI!

QUESTION: Propranolol + epinephrine = bad reaction due to: drug interaction, anxiety, allergy

-alpha 1
-alpha 2
-beta 1
-beta 2
- If a patient on a nonselective beta-blocker receives a systemic dose of epinephrine, however, the beta-blocker prevents the
vasodilation, leaving unopposed alpha vasoconstriction. (alpha-1)

QUESTION: What is the effect seen when propranolol and epinephrine are injected simultaneously - in cases of mild reactions it causes
hypotension; in severe reaction it is malignant hypertension
QUESTION: All these drugs alter ionic movement except - Propranolol, others were CCB, HCTZ, and Digoxin

QUESTION: A patient receiving propranolol has an acute asthmatic attack while undergoing dental treatment. The most useful agent for
management to the condition is?
a. Morphine
b. Epinephrine
c. Phentolamine
d. Aminophylline
e. Norepinephrine
- Aminophylline: Bronchodilator, class theophylline

QUESTION: The drug-of-choice for the treatment of adrenergically-induced arrhythmias is:
quinidine.
lidocaine.
phenytoin.
propranolol

QUESTION: Direct alpha sympathomimetic: clonidine (alpha2), gueanethidine (indirectà acts on neurons to inhibit NE release), methyldopa
(alpha2).

QUESTION: Epinephrine Reversal with? Alpha adrenoceptor blockers (ex. phenoxybenzamine)
- inhibit the vasoconstrictor effect but not the vasodilator effect of epinephrine = low BP instead of high BP
QUESTION: Epinephrine reversal: after giving a patient epinephrine, following hypertension, which of these drugs would cause a drop in BP?
Phenoxybenzamine
QUESTION: What receptor or signaling pathway is linked most directly to α2-adrenoceptor stimulation? Inhibition of adenylyl cyclase through
GI, resulting from stimulation of α2-adrenergic receptor, leads to intracellular ⬇ cAMP

AMPHETAMINES (INDIRECT- ACTING SYMPHATHOMIMETICS)

Indirect-activing sympathomimetic drugs:
- amphetamine, tryamine, ephedrine = stimulate release of stored NE
- TCA & cocaine block NE re-uptake
- MAOI block enzymatic NT destruction

NE stimulates both alpha & B1 receptors more than B2.

FOR ADHD (Attention-deficit/hyperactivity disorder):
- Methylphenidate = Ritalin
o Methylphenidate: blocks dopamine uptake in central adrenergic neurons by blocking dopamine transport or carrier proteins.
- Amphetamine = Adderall
o Amphetamines & cocaine: increase catecholamine NE SERETONIN DOPAMINE release as a primary mechanism.
§ Amphetamines stimulate CNS alpha receptors
o Adderall: psychostimulant medication composed of amphetamine and dextroamphetamine, which increases the amount of
dopamine and norepinephrine in the brain

QUESTION: ADHD diagnosis = more boys than girls

QUESTION: Which one is true about ADHD? most common in boys

QUESTION: Amphetamines – lead to NE release in brain
- stimulate the release of norepinephrine from central adrenergic receptors & at higher dosage, release of dopamine

QUESTION: Methylphenidate = Ritalin, Amphetamine = Adderall.

QUESTION: Kid is taking Adderall (amphetamine) & is very anxious what do you do? Tell him to stop taking amphetamine on the day
appointment
- Amphetamine can induce anxiety, and are contraindicated for patients that are very nervous


QUESTION: Amphetamines, what are symptoms? Increased heart rate & excitability


QUESTION: Pediatric pts taking amphetamine every day, what can be observed in pt’s health history? ADHD
- The kid has ADHD, know the medication for ADHD. Methylphenidate was one of the medications they asked

AUTONOMIC: ANTICHOLINERGIC & CHOLINERGIC DRUGS

Cholinergic drugs – slow heart, constrict pupils (miosis), stimulate GI smooth musc, stim sweat, saliva
- Cholinergic crisis: bradycardia, lacrimation, salivation, voluntary muscle weakness, diarrhea, bronchoconstriction – tx w/ atropine
- Salivary secretion increases with use of Pilocarpine (cholinergic agonists), Neostigmine (cholinergic agonist & reversible
anticholinesterase)
Anticholinergic agent: blocks the neurotransmitter acetylcholine in the CNS/PNS.
- Atropine/scopolamine overdose: confusion, hallucinations, burning mouth, hyperthermia – tx w/ physostigmine (reverse
anticholesterase)
- Salivary secretion DECREASES with use of atropine and scopolamine (anti-cholinergic)

Direct-acting cholinergic agonist = pilocarpine, methacholine (used for xerostomia)
Indirect-acting (prevent enzyme breakdown):
- Reversible anti-cholinesterase = Physotigmine (CNS/PNS) & neostigmine (PNS only)
- Irreversible anti-cholinesterase = Insecticides + organophosphate (tx by regenerate AcH using pralidoxime)

Competitive muscarinic receptor blockers = Atropine, scopolamine, propantheline

Know which drugs mimic parasympathetic (cholinergic), be able to pick from a list which does not belong (Acetylcholine, Atropine, d-
tubocurarine, neostigmine, Nicotine, Physostigmine, Pilocarpine)
- Atropine: Muscarinic antagonist (anticholinergic), antidote for organophosphates and insecticides, blocks vagal reflex à tachycardia
- Belladonna derivatives – anticholinergic
- Neostigmine: cholinesterase inhibitor, doesn’t penetrate BBB, tx of M. gravis, increase salivation, PNS
- Physostigmine: used for atropine & scopolamine overdose, tx of glaucoma, acetylcholinesterase inhibitor, CNS&PNS
- Pilocarpine: Muscarinic agonist, for glaucoma and xerostomia
- Scopolamine: anticholinergic agent, used for motion sickness & in eye drops to induce mydriasis (dilation),

QUESTION: What is used for motion sickness? scopolamine
QUESTION: Neostigmine and pilocarpine increase? Salivation

- Pilocarpine (muscarinic agonist) & neostigmine are parasympathomimetic that acts as a reversible acetylcholinesterase inhibitor. They
increase salivation, urination, bronchoconstriction, bradycardia, miosis (pupil constrict), vasodilation
QUESTION: Glycopyrrolate effect? reduce salivary (muscarinic anticholinergic)
QUESTION: Atropine: is sympotatic, decrease salivation
QUESTION: What meds decrease saliva? atropine, scopolamine

- Pilocarpine, methacholine, neostigmine, etc. cause salivation.

QUESTION: If patient has xerostomia, what medication won’t you give? Atropine - anticholinergic
QUESTION: What drug does not cause miosis of the eyes? Atropine
QUESTION: Insufficient cholinesterase leads to hypotension? (bradycardia) Other answers: tachycardia, restlessness,

QUESTION: Pt have bradycardia, what should we give him? Atropine b/c atropine will increase heartrate causing tachycardia.

QUESTION: Drug to decrease saliva because you want to take an impression- ATROPINE (DECREASES), Pilocarpine (INCREASES), Neostigmine
(INCREASES)

QUESTION: Xerostomic pt, give pilocarpaine or cevimeline.
- Cimeviline just like pilocarpine to increase salivation in xerostomia


QUESTION: Pilocarpine used for? parasympathomimetic alkaloid, for tx of glaucoma and xerostomia.

QUESTION: What is the side effect of pilocarpine (Tx of dry mouth) in toxic dose?
Apnea
Cardiac shock
- nontoxic side effects>>> excess sweating and salivation, bronchospasm
QUESTION: Propantheline bromide (pro-Banthine): anti-cholinergic (anti-muscarinic), relieve cramps or spasms of the stomach, intestines, and
bladder.
QUESTION: Which of the following groups of drugs is contraindicated for patients who have glaucoma? Adrenergic, Cholinergic, Anticholinergic
Adrenergic blocking
QUESTION: Which of the following drug groups increases intraocular pressure and is, therefore, contraindicated in patients with glaucoma?
A. Catecholamines

QUESTION: A patient has a deficiency in acetylcholinesterase. After giving her this drug, action is prolonged. I put d-tubocurarine (inhibits
acetylcholine receptoràweakness of skeletal muscles)
QUESTION: Decrease of pseudocholinesterase would lead to increase in? Succinylcholine or tubocurare

QUESTION: Administration of succinylcholine to patient deficient in serum cholinesterase would cause…
a. convulsions
b. Hypertension
c. prolonged apnea

QUESTION: 2-3 questions on miosis (opioids + cholinergic) vs mydriasis (anticholinergics + increase serotonin) and which drugs or conditions
cause which?

DOPAMINE DRUGS
Carbidopa/Levodopa (Sinemet): most potent combo med for Parkinson’s. Carbidopa addition prevents levodopa from being converted into
dopamine in the bloodstream, peripheral enzymatic degradation so more reaches the brain. Therefore, a smaller dose of levodopa is needed to
treat symptoms.
- L-dopa is a precursor to NT like dopamine, norepi, and epi. It’s a sympathomimetic & is used in tx of Parkinson’s to increase dopamine

QUESTION: A patient who has Parkinson’s disease is being treated with levodopa. Which of the following characterizes this drug’s central

QUESTION: Cause of Parkinson? Dopamine deficiency, give them methyldopa (levodopa) to increase dopamine in the CNS

QUESTION: Why do you need to take carbidopa with levodopa: prevents breakdown of levodopa before it crosses the blood brain barrier

QUESTION: How does carbidopa tx Parkinson’s disease? potentiates effects of dopamine

bCHOTICS:
Anti-psychotics: sedate, blunt emotional expression, attenuate aggressive & impulsive behavior. Produce anticholinergic adverse effects,
dystonias and extrapyramidal symptoms. Tardive dyskinesia most common after several years.
- Phenothiazines (PTZ): Block DA receptors, act on the extrapyramidal pathway
QUESTION: Where in the brain does anti-psychotics works? blocking the absorption of dopamine
QUESTION: What catecholamine does Phenothiazine (anti-psychotic) affect? Dopamine, serotonin, acetylcholine
QUESTION: Phenothiazine (anti-psychotics) side effect: Tardive Dyskinesia
QUESTION: What acts on extrapyramidal? Phenothiazines (chlorpromazine)
QUESTION: What is the most common psych disorder? anxiety, depression, ADD, schizophrenia
QUESTION: Lithium is used for treatment of? Manic phase of bipolar disorder

DEMENTIA & DEPRESSION

QUESTION: Patient is in her 70’s, she lives alone, what could she be suffering from? Depression
QUESTION: Most common psychological problem in elderly? Depression
QUESTION: What is associated with depression? Age, economic status, professional status, etc
QUESTION: Most common mental illness among elderly? Depression
QUESTION: Main sign of dementia:
a. confusion
b. short term memory loss
c. long term memory loss
- short term memory loss = first main sign. Long term loss occurs later.
QUESTION: Which is not a sign of dementia: long-term memory loss
QUESTION: Most common mood disorder: generalized anxiety or depression?

ANTI-DEPRESSANTS:
Category Common Medications Notes
Selective serotonin Prozac, Zoloft, axil, Laxapro, Luvox - Well tolerated

reuptake inhibitors (SSRIs) - Inhibits serotonin
Tricyclic antidepressants Rarely used due to side effects - Inhibits serotonin/5-HT, norepi, muscarinic M1,
(TCA) histamine H1, α-adrenergic receptor
TCA 2nd generation- Nortriptyline - Caution in cardiac patients: risk of AF, AV block, or
(Pamelor, Aventyl), Desipramine ventricular tachycardia.
(Norpramin), Protriptyline - More lethal in overdose than newer antidepressants.
(Vivactil), Amitriptyline Don’t take w/ MAOI
Monoamine oxidase Rarely used due to side effects - Inhibit MAO type A & B, enzyme that breaks down
inhibitors (MAOIs) serotonin, dopamine, norepi
Phenelzine, tranylcypromine - Significant drug interaction w/ opioids &
sympathomimetic amines (don’t give w/
phenylethylamine or phenylephrine)
Serotonin-norepinephrine Venlafaxine (Effexor), duloxetine

reuptake inhibitors (SNRIs) (Cymbalta)

Buspirone (Buspar): partial agonist at a specific serotonin receptor (5-HT1A). Doesn’t cause CNS depression/muscle relaxant or anti-convulsant

QUESTION: Where in the brain does anti-depressants works? decrease amine-mediated neurotransmission in the brain

QUESTION: Tricyclic anti-depressant (TCA) mechanism of action: inhibit reuptake of NE and 5-HT (serotonin)

nd
QUESTION: TCA 2 generation- Nortriptyline (Pamelor, Aventyl), Desipramine (Norpramin), Protriptyline (Vivactil)

QUESTION: How do tricyclics work?- by not allowing reuptake of neurotransmitter (NE, 5-HT, serotonin)

QUESTION: What catecholamine do tricyclic antidepressants affect? Dopamine, serotonin, acetylcholine

QUESTION: Patient is taking TCA anti-depressants what do you take into consideration? Limit duration of procedures, keep in mind the
epinephrine limit

QUESTION: Side effect of having TCA and epi: HTN, hypotension, hyperglycemia, hypoglycemia


QUESTION: If someone has a history of depression & wants to quit smoking, what do you give? Zyban (Bupropion), it’s an anti-depressant &
smoking cessation aid
- not Chantix (smoke cessation only)

QUESTION: Amitriptyline – most common tricyclic antidepressant, inhibits reuptake of NE and serotonin

QUESTION: Zoloft works on what receptor? Presynaptic monoamine transporters (inhibit reuptake of 5-ht)
- Sertraline hydrochloride (Zoloft) = selective serotonin reuptake inhibitor (SSRI)

QUESTION: Prozac (fluoxetine) - acts on serotonin (SSRI)

- St. John’s Wart = noncompetitive reuptake inhibitor of serotonin yeah because is for depression
QUESTION: What does St. John's Wart do? Decrease the body immunity
QUESTION: St johns wart- used for? Depression, don’t use with benz and HIV medication
- In HIV pt, it interacts w/ anti-HIV drugs & reduces their function so the immunity decreases

QUESTION: Know drugs used for conscious sedation à SSRIs/BDZ Diazepam and Prozac (fluoexitine)

QUESTION: Buspirone - psychotropic w. anxiolytic; low CNS depression, low psychomotor skill impairment
- Buspar—different from benzodiazepines because it does NOT cause CNS depression, muscle relaxant, or anti-convulsant!!!!!** UNIQUE!!!
Anxiolytic and antidepressant

ANTI-INFLAMMATORY/CORTICOSTERIODS:
- Side effect profile: gastric ulcers, immunosuppression, acute adrenal insufficiency, osteoporosis, hyperglycemia, redistribution of body fat.
QUESTION: Strongest glucocorticoid/long-acting Corticosteroid? Dexamethasone
QUESTION: Negative effect of chronic use glucocorticoids? Infection, reduce inflammation, hyperglycemia.

QUESTION: GI effects with corticosteroids: Ulcers.

QUESTION: Long term side effect of corticosteroids- osteoporosis and hyperglycemia
QUESTION: What is the side effect of prolonged corticosteroid therapy? Osteoporosis
QUESTION: Too much cortisone causes what to bone?

Osteoporosis
Osteopetrosis
Osteosclerosis
QUESTION: Long term glucocorticoids use- shows all of following except? Hypoglycemia
- does lead to: osteoporosis, hyperglycemia, immunosuppression

QUESTION: Where do you see moon faces? steroid treatment
QUESTION: Containdation for corticosteroid use: diabetes (also: HIV, TUBERCULOSIS, CADIDIASIS, PEPTIC ULCER)
QUESTION: Aspirin contraindicated with: corticosteroid use (b/c no protection of stomach lining)
QUESTION: Steroid insufficiency: 200mg/two weeks in last 2 years, 20 mg 2 weeks in last 2 years, 10 mg or 1 mg
QUESTION: Critical dose of steroids for adrenal insufficiencies - 20 mg of cortisone or its equivalent daily, for 2 weeks within 2 years of dental
treatment
QUESTION: Least amount of cortisone to affect the adrenergic system? 2 mg for 2 weeks for 2 years
QUESTION: Pt taking corticosteroid with rheumatoid arthritis, pt needs TE, why would you consult with physician? full blood panel, assess for
- want to make sure pt can produce enough corticosteroid with addition to what they are taking so you won’t have over inflammatory
response from TE

QUESTION: Pt on 3 months tx of steroids, what is your tx? no tx and consult GP for dose

QUESTION: If a pt. has been using 10 mg of corticosteroid for 10 years, what would you do for pt. before any tx? Have pt continue and increase
the dose

QUESTION: Cortisone exerts its action by binding to intracellular receptor, receptors on membrane, proteins in plasma
- Enter cell and bind to cytosolic receptor migrate to nucleus gene expression or with plasma membrane on target cells

QUESTION: If pt doesn’t get steroid tx in time for their temporal vasculitis, what will have happened?
• hearing loss
• vision loss

QUESTION: Asthma – long-term asthma give corticosteroid to decrease inflammation
- Inhaled corticosteroids are the most effective medications to reduce airway inflammation and mucus production.

NITROUS OXIDE:

Absolutely contraindications: severe respiratory compromised, COPD, respiratory infection, pneumothorax/collapsed lung

Relative contraindications: cardiovascular conditions, pregnancy (teratogenic effect), nasal congestion, children with high anxiety,

QUESTION: Nitrous oxide is in the blue cylinder (oxygen in green)
QUESTION: Nitrous oxide oxidizes the cobalt in vitamin B12, resulting in the inhibition of methionine synthase. Nitrous oxide has greater
analgesic potency than other inhaled anesthetics
QUESTION: Dreaming while on nitrous is what? Overdose or normal
QUESTION: How do you check to see if the oxygen (reserve) bag is okay? It shouldn't be that full or that collapsed
QUESTION: Contradictions of nitrous oxide use: Hypertension, pregnancy
QUESTION: What is an absolute contra-indication for the use of Nitrous Oxide? Sickle cell anemia, nasal congestion,
QUESTION: Device used in evaluation of N20? Pulse oximeter (measure amount of O2 in blood)
QUESTION: The correct total liter flow of nitrous oxide-oxygen is determined by the amount necessary to keep the reservoir bag 1/3 to 2/3 full.
a. 40 %
b. 50%
c. 70% (for Adult)

QUESTION: Nitrous for pedo pt is at 50%, what we do? We stop giving it.
QUESTION: Nitrous safety switch happens at what percent? 70%
QUESTION: Percent nitrous that can NOT increase beyond because of a safety? 70%
QUESTION: Why is nitrous oxide used on children? Alleviate anxiety
QUESTION: Child with fear is best treated with: nitrous oxide
QUESTION: What is an adverse effect of nitrous? Nausea
QUESTION: If patient does not have 100% oxygen after nitrous oxide? Diffusion hypoxia
st
QUESTION: Nitrous should not be given in 1 trimester of pregnancy
QUESTION: When is nitrous contraindicated for a child? upper respiratory tract infection
QUESTION: When is nitrous contraindicated? Asthma or COPD

LOCAL & GENERAL ANESTHESIA

LOCAL ANESTHESIA:

LA Mechanism of Action: LA work on impulse conduction directly by:
- Inducing reversible & dose-dependent reduction of AP height à progressing to total inhibition
- Blocking Na+ entry into cells à prevent expected transient permeability increase.
LA Chemistry - Most LA consist of:

- Lipophilic group (ex. aromatic ring) = facilitates penetration into nerve sheath
- Intermediate chain (ester or amide link) = ester is more prone to hydrolysis so shorter action duration
- Hydrophilic 2⁰ or 3⁰ amino terminus = weak base that is either charge or uncharged
Amino Esters (no I before –caine) Amino Amides (“I” before –caine)
- Cocaine - Lidocaine
- Procaine - Mepivacaine
- Chloroprocaine - Prilocaine
- Tetracaine - Ethidocaine
- Benzocaine - Bupivacaine
- Ropivacaine
- Articaine
Metabolized by plasma/liver esterase, releases PABA Metabolized in liver cytochrome P450 enzyme (except
prilocaine – plasma + kidney, articaine – has ester
group, conjugated in plasma)

- Xylidine Derivatives (amides) - 4
o Lidocaine
o Mepivacaine
o Bupivacaine
o Etidocaine
- Toluidine Derivatives: Prilocaine
- Thiophene Derivative: Articaine

Both onset of action & duration of action depend on: dose & lipid solubility (potency)
- Lipid solubility (potency): Increased lipid solubility, rapid penetration + duration
Onset of Action depends on:

- Injection site
- Nerve morphology/sensitivity
o A-δ & C fibers (conduct pain sensation) are blocked w/ lower [LA] than Aα motor fibers.
- Tissue pH: more acidic/ionization à slower
- pKa of drug: pKa – pH = log [ionized/unionized]
o High PKa à slow onset. MORE RAPID ONSET à AGENT w/ LOW PKA VALUES.
Duration of action:
- diffusion away from site of action – MAJOR FACTOR, depends on vascularity of tissue surrounding the nerve.
- protein binding: high protein bound à prolong duration (ex. bupivacaine, etidocaine, tetracaine)
MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI - 7mg/kg for adult | 4.4mg/kg for pediatrics

Max dose of Epinephrine:
- Max dose of epi for cardio pt: 0.04mg (2 carps of 1:100k epi, 1 carp of 1:50k epi , or 4 carp of 1:200k epi max = 4 carps)
- Max dose of epi for healthy person: 0.2 mg (8 carp of 1:100k epi)

QUESTION: Know where L.A. metabolized? Amides made in P450 enzyme of liver. Esters in pseudocholinesterase of plasma.
QUESTION: Mech of action of local anes on nerve axon – decreases sodium uptake through Na+ axon channels
QUESTION: What is the primary reason for putting epi in LA? to slow its removal from the site. PROLONG DURATION OF ACTION
d. all of above

QUESTION: Local anesthetics broken down by what: biotransformation

QUESTION: Patient got LA injection & started breathing fast, hands and finger are moving, heart rate is up - You injected into a blood vessel
QUESTION: Patient get LA injection, he started to breathe a lot, HR goes up, due to what? cardiovascular response to vasoconstrictor
QUESTION: HTN pt. you just gave 4 carpules of 2% xylocaine with 1:100k epi. BP went up to 200/100. what’s possible mechanism/cause? Due
to vasoconstrictor injected into venous system.
QUESTION: You gave local anesthetic, BP went down to 100/50 and HR went down too, what could it be due to? Syncope
QUESTION: Infection around a tooth & can't numb patient, why? Infection reduces the free base amount of anesthetic (lowers pH)
QUESTION: Why doesn’t anesthesia work when you have an infection? Decreased pH (acidic environment) leads to more ionized form (less
nonionized)
QUESTION: Abscess, give LA, decreased in effect, why? LA is unstable in low pH or LA is in ionized form, needs to be in free base form or
unionized form to cross membranes
QUESTION: Where do you inject if infiltration in the area will not be able to avoid the infection? Block
QUESTION: As LA becomes more ionized, it becomes more water soluble.

- When irreversible pulpitis, the teeth that are hard to anesthetize are the mandibular molars > mandibular premolars > maxillary
molars & premolars > mandibular anterior teeth.
- fewest problems w/ the maxillary anterior teeth

QUESTION: The pKA of an anesthetic will affect what. Metabolism, potency, peak effect? ONSET
KNOW THIS!
QUESTION: When do you know that is it a non-odontogenic pain? When pain is not relieved with LA
QUESTION: What slows the metabolism of lidocaine? Propranolol
- stays in system longer because propranolol slows down heart à slower blood delivery to liver à metabolism of lidocaine is slower à
stays in system longer)

QUESTION: How much epi for a cardio pt? 0. 04mg
QUESTION: Lidocaine is not metabolized in plasma (but in liver)
QUESTION: Which of the following anesthetic can be used as topical? butamben, dibucaine, lidocaine, oxybuprocaine, pramoxine,
proparacaine, proxymetacaine, and tetracaine
QUESTION: Which pair of anesthetics is most likely to cause cross allergy? Lidocaine and mepivocaine
QUESTION: What anesthesia do you give IV for ventricular arrhythmia?
a. Quinidine
b. Lidocaine

QUESTION: Cocaine overdose symptoms? pinpoint pupils or mydriasis (pupil dilation)
- Cocaine OD—mydriasis
- Opiate OD—pinpoint pupil

- Cocaine has intrinsic vasoconstrictive activity
QUESTION: Cocaine is a natural drug
QUESTION: Pt is in rehab for cocaine, what you prescribe for pain? ADVIL
- Symptoms of methemoglobinemia: cyanosis, headache, confusion, weakness, chest pain

- can be treated with methylene blue

QUESTION: Levonordefrin is added to certain cartridges containing mepivacaine to: increase vasoconstriction.

QUESTION: best LA to use w/o vasoconstrictor:
a. pro
b. benzo
c. lido
d. articaine

QUESTION: Articaine(septocaine): metabolized in blood first.
- unique bc it is an Amide, but has an ester group that is metabolized in the bloodstream

QUESTION: Articaine - conjugated at blood Stream by esterase (unlike other amides, it metabolized in blood stream).

QUESTION: Anesthesia of facial nerve will cause all except:

a. epinephrine
b. procaine
c. bisulfite
d. lidocaine
QUESTION: Pt taking MAO inhibitors what you CAN NOT give him: epinephrine, opioids (Meperidine)
- Local anesthetics containing EPI are contraindicated in patients taking MAO inhibitors.
QUESTION: Mix MAOI and epi to get? HTN
QUESTION: What is the best indicator for success of intra-pulpal anesthesia? feel the back pressure during injection
Back pressure
Type of anesthetic
- back pressure anesthesia stops hemorrhage, anesthesia after 30 sec, patient doesn’t feel it

QUESTION: Which order will sensation disappear? 1. pain, 2. temp, 3. touch, 4. pressure
QUESTION: The dentist is performing a block of the maxillary division of the trigeminal nerve into which anatomical area must the local
anesthetic solution be deposited or diffused?
e. canine space
LIDOCAINE CALCULATIONS:
QUESTION: Lidocaine calculation: a cartridge that contains 1.8 ml of solution at a 2% (20mg/ml) lidocaine concentration, how much drug? 36
mg/ml of drug (20 mg/ml X 1.8 ml/cart. = 36 mg/ml)
QUESTION: Lidocaine calculation: 2% lidocaine or 1:100,000. how much anesthetic is in a cartridge? 36mg
QUESTION: Max dosage of 2% lidocaine for a kid in mg/kg: 4.4 mg/kg

- MAXIMUM allowable dose of 2% lidocaine with 1: 100,000 EPI - 7mg/kg for adult’s 4.4mg/Kg for Pedo

QUESTION: Numb the kid, how many hours is the soft tissue numb? 3 hrs.
QUESTION: When you numb IA nerve, which roots of primary teeth are numb?
QUESTION: Kids have higher pulse, basal metabolic activity & higher respiratory rate but lower BP
QUESTION: Typical pulse for a 4-year-old is 110 (12 yr. old is 75, adult is 70)

QUESTION: 20 kg child how many mgs of lidocaine can you give: 88mg
- Max lidocaine w/ epi for kids = 4.4 mg/kg X 20 kg = 88 mg

QUESTION: Kid is 16kg, How many mg max amount of lidocaine? 70mg
QUESTION: 88 lbs. (40kg) child patient is given 2 cartridges 1.8 ml each of 2% lidocaine with 1: 100,000 epinephrine. Approximate what % of
maximum dosage allowed for this patient was administered?
a. 10%
c. 40%
d. 60%
- 88lbs*2.2 kg/lb. = 40 kg. 40kg*4.4mg/kg (max dose for lido) = 176mg = max dose for this patient; 36 mg x 2 cartilages = 72 mg injected
à 72mg injected/176mg = 40%

QUESTION: 50 lb. patient given 5 carps of 2% lido with 1:100k epi. During procedure 20 min later, he started twitching his arms and legs & went
unconscious (convulses), why? Overdose of lidocaine, overdose of the epi (causes HTN), allergy
QUESTION: Maximum recommended dosage of lidocaine HCl injected subcutaneously (not IV) when combined with 1:1,00,000 epinephrine is?
a. 100 mg
b. 300 mg
c. 500 mg
d. 1 gram

QUESTION: 3.6ml of 4% prilocaine contain how much anesthesia?
a. 72 mg
b. 80 mg
c.144 mg
d. 360 mg
- 4% prilocaine = 40 mg/mL; 3.6 mL x 40 mg/mL = 144 mg
QUESTION: How many carps of 4% [X] anesthetic should be given if maximum amount that you want to give is 600mg of drug? - approximately
8 carps (go over calculation)
- 4% = 40 mg/mL = 600/40 = 15 mL/1.8ml (in 1 carp) = 8 carps

QUESTION: The maximum allowable adult dose of mepivacaine is 300 mg. How many milliliters of 2% mepivacaine should be injected to attain
the maximal dosage in an adult patient?
a. 5
b. 10
c. 15
d. 20
e. 25
- 2% mepivicaine = 20mg/ml; 300mg/20 = 15 mL

- Maximum dosage: prilocaine (600 mg) > articaine + lidocaine (500 mg) > Bupivacaine (90 mg)

QUESTION: A recently-introduced local anesthetic agent is claimed by the manufacturer to be several times as potent as procaine. The product
is available in 0.05% buffered aqueous solution in 1.8 ml. cartridge. The maximum amount recommended for dental anesthesia over a 4-hour
period is 30 mg. This amount is contained in approximately how many cartridges?
a. 1-9
b. 10-18
c. 19-27
d. 28-36 (approx. 33 cartridges)
e. Greater than 36
- 0.05% = 0.5 mg/mL = 30m mg/ (0.5 mg/mL) = 60 mL/ (1.8 mL/carp) = 33.3 carp

QUESTION: What determines max. dose for anesthetic for a child? Weight

GENERAL ANESTHESIA:

QUESTION: A 26-month old child w/ 12 carious teeth. How to treat?
a. General Anesthesia
b. Oral sedation
c. Nitrous oxide
d. local anesthesia

• Respiration
• Electo cardiogram
• Skin and oral mucosa color

QUESTION: #1 cause for problems during IV sedation? Hypoxia
QUESTION: A 77 years old female 110 lbs. weight requires removal of mandibular teeth under local anesthesia. She is apprehensive. The
appropriate dose of IV diazepam to sedate her?
a. 5 mg
b. 10 mg
c. 15 mg
d. 20 mg
- 2mg for midazolam IV, 10 mg diazepam IV

o
QUESTION: Pt goes home from elective orthognathic sx and in 24hrs, without sign of inflam or edema, but a fever of 102 F- Atelectasia
[=collapse of lung] (or pneumotosis – depending on answers)
- Atelectasia and pneumotosis = most common cause of fever within 24 hour of GA

ANTIBIOTICS

PREMEDICATION REQUIREMENTS:

Premediate these conditions à artificial heart valve, previous IE, congenital heart (valvular) defect, total joint replacement w/ co-morbidity
2. History of infective endocarditis
3. Certain specific, serious congenital (present from birth) heart conditions, including:
o unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
o a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter
intervention, during the first six months after the procedure
o any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a
prosthetic device
4. Cardiac transplant that develops a problem in a heart valve.
Pre-med with odontogenic infection:

• Tetracycline for periodontal infections (better penetration, stays in bone tissue longer)

Amoxicillin Clindamycin
Adults: 2g orally 1hr prior to appointment Adults: 600mg orally 1hr prior to appointment

Children: 50 mg/kg (not to exceed adult dose) orally 1hr Children: 20mg/kg orally 1hr prior to appointment
prior to appointment

QUESTION: Which procedure least likely to produce bacteremia? extraction, non-surgical endo, oral prophylaxis

o Cardiac pacemaker

QUESTION: Prophylactic treatment for prosthetic heart valves – premedication required

- Just stay away from ultrasonic and electric testing/ electrocautery

QUESTION: (Again with different options) need premedication for… congenital heart defect with severe problems

QUESTION: Kid had unrepaired cyanotic congenital heart disease with something valves. Premediate with amoxicillin and you need to know the
dosage so that you pick the right dosage 60 lb. kid. 50mg/kg dosage.
QUESTION: What is the pre-medication dosage for child 44 lbs.? 1-gram amoxicillin 1 hour prior Tx.
- 44 lbs. = 20Kg X 50mg/Kg = 1000mg = 1g Amoxicillin

QUESTION: Pt w/ mitral valve prolapse w/ regurgitation – don’t premedicate
QUESTION: (Patient’s medical tab say he is allergic to Amoxicillin), He needs to be premediated, what do you prescribe? Clindamycin, 600mg
1hr before the dude shows up for the appointment.
QUESTION: If patient is allergic to ampicillin, then what antibiotic should be given? Clindamycin, but should be 600 mg and the answer choice
was wrong since they said 2 g so he picked cephalomycin. Fixin (I doubt its cephalomycin…because similar to cephalosporin and those are cross
allergenic with penicillin…Xtina) --**I think he meant cephamycin, but yea similar to cephalosporin. **CEPHALEXIN probably the answer… if
allergic to pen give 2 g of it.
QUESTION: Man has accident and pin placed in arm. What antibiotic prophylaxis does he need? None

QUESTION: Pt w/ total knee replacement but was taking Amoxicillin for a while; how do you premeditate? NO (or MED CONSULT)


QUESTION: Pt had hip replacement 10 years ago, what do you use to premeditate? No premedication needed
QUESTION: Pt needs antibiotic prophylaxis. He is taking penicillin already, what do you give him? Clindamycin

QUESTION: What is recommended prophylaxis for pt that can’t take penicillin? Clindamycin

QUESTION: IE pre-medications why? benefits of premedication outweigh potential harm associated with penicillin
QUESTION: Endocarditis definition: inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or
prosthetic valves)
QUESTION: Infectious Endocarditis pre-medications definition? For patients who has cardiovascular problems and are at risk of infection over
their lifetime.
QUESTION: When is it appropriate to prescribe antibiotic prophylaxis in patient with previous infective endocarditis? if consequence of
potential infection is detrimental to life

• RCT
• Some sort of surgery
• IA injection

QUESTION: Guideline of antibiotic prophylaxis, especially for kids - for kids, Amox is 50mg/kg and Clinda is 20 mg/kg
QUESTION: Know the doses for someone that is allergic to penicillin, what you can give them? Clarithromycin 500mg
QUESTION: If a patient is allergic to Ampicillin, what else can you premedicate with? Clindamycin 600mg 1, Cephalexin 2g, Azithromycin 500
mg, or Clarithromycin 500 mg all 1-hr before.

ANTIBIOTICS:

Erythromycin (Azithromycin and Clarithromycin) are macrolides. They are –static & bind to 50S ribosomal unit to inhibit protein synthesis.
Penicillin is –cidal and inhibits peptidoglycan cell wall by binding to transpeptidase

QUESTION: Broad spectrum antibiotics like tetracycline: increase superinfection and resistance.
QUESTION: broad spectrum antibiotics à increase superinfection (infxn by candidiasis) and resistance.
QUESTION: Why don’t we use broad spectrum antibiotics? Produce resistant bacteria
QUESTION: If you increase spectrum of bacteria, it leads to more infections
QUESTION: Antibiotics are least useful for tx of this periodontal conditions: LAP, NUG, chronic periodontitis
QUESTION: Antibiotic metabolism is affected by chronic tx with what drugs? Benzos, barbs, SSRI, TCA
QUESTION: Pt is taking an antibiotic, which is metabolized in the liver. Metabolism of this antibiotic is decreased by which drug?
a. TCA
b. SSRI
c. phenothiazine
d. diazepam

QUESTION: You give antibiotics through IV, patient experience sudden allergic reaction, what’s the FIRST thing you do? Remove the IV line.
(others were clear airway, give oxygen, etc)
QUESTION: Penicillin, why is this so good to give as an antibiotic? Low toxicity, cheap
QUESTION: Mechanism of action of penicillin is closely related to? Keflex (cephalexin)
QUESTION: What is the effect of Penicillin and Cephalosporin’s (cell wall synthesis) via beta lactam ring

QUESTION: Transpeptidase enzyme is inhibit by penicillin
- Transpeptidase, a bacterial enzyme that cross-links the peptidoglycan chains to form rigid cell walls

QUESTION: Which of the following penicillin would be used to treat a Pseudomonas infection?
Nafcillin (Unipen)
Amoxicillin (Amoxil)
Benzedrine penicillin (Bicillin)
Phenoxymethyl penicillin (Pen-Vee K)
Ticarcillin (Thar)
- Ticarcillin is a carboxypenicillin. Its main use is for the treatment of Gram-negative bacteria, particularly Pseudomonas aeruginosa.

QUESTION: Why do penicillins have decreased effectiveness in abscess? hyaluronidase, pen unable to reach organism
QUESTION: With cyst, why doesn’t penicillin work well? b/c can’t penetrate cyst barrier
- Penicillin V potassium is a slow-onset antibiotic, bacteriocidal against gram (+) cocci & major pathogen of mixed anaerobic infections. In
the absence of an allergic reaction, penicillin VK is the drug of choice in treating dental infections.

QUESTION: For an infection: give PenVK 500mg à give 1g at once and then 500 mg every 6 hours (7 days)

QUESTION: What antibiotic used for endo, pulpal involvement? PEN VK (yes it actually says VK together)

QUESTION: All are true except? Cephalosporin has a broader spec than Penecillins
st
- cephalosporin is a beta lactam antibiotic, bactericidal, 1 generation, more concentrated on gram (+), more resistant to penicillinase
QUESTION: Tetracycline mechanism of action: protein synthesis inhibitor (30s), bacteriostatic
QUESTION: How does tetracycline work? Block activity of collagenase, bind to 30S (block AA linked tRNA)
- Tetracycline is usually not used because they cause yeast infections, as well opportunistic infect.
QUESTION: Doxycycline - act on 50S ribosome (there were no 30S choice)
- Doxycycline reversibly binds to the 30 S ribosomal subunits and possibly the 50S ribosomal subunit(s), blocking the binding of aminoacyl
tRNA to the mRNA and inhibiting bacterial protein synthesis.
- It’s a tetracycline, treats malaria

QUESTION: Something about periodontal dressing and that it has 20mg of Doxycycline and asks about its mechanism (there was nothing about
bacteriostatic or inhibits 30S ribosome): Inhibits collagenase
- 20 mg = no anti-bacterial effect but it inhibits collagenase

QUESTION: Which antibiotic is anti-microbial and anti-collagenlyctic? clindamycin, doxycycline, metronidazole, amoxicillin
QUESTION: Tetracycline does not do one of the following:
reduce host response
reduce bacterial infection
reduce host collagenase
decrease gingival crevicular fluid flow
QUESTION: Minocycline & Doxycycline: all is true except? Both increase GCF secretion, both released in GCF (Gingival crevicular fluid)
- tetracycline is more concentrated in GCF more than in blood

QUESTION: Mechanism of action of Minocycline in the Arestin: decrease collagenases activity
- Minocycline, another tetracycline antibiotic, has also been shown to inhibit MMP activity.
QUESTION: Which one of the following drug is chelated with C++? Tetracycline
QUESTION: Which drug would inactivate the latter? Antacids- Tetracycline

- Don’t take iron supplements, multivitamins, calcium supplements, antacids, or laxatives within 2 hours before or after taking tetracycline.
Antacids and milk reduce the absorption of tetracycline.
QUESTION: Tetracycline is bacteriostatic.

QUESTION: What is most affected by tetracycline? Enamel or Dentin, causes intrinsic stain

QUESTION: What age are you most likely get infection that resulted in enamel hypoplasia or tetracycline staining? before 4 months in utero for
primary; birth for permanent
QUESTION: What medication do you not give to lactating female? Codeine and tetracycline
rd
QUESTION: Pt allergic to penicillin, what could be cross-reactive? à Cephatriaxone (3 gen cephalosporin)
QUESTION: What drug has cross allerginicity with Penicillin? Cephalosporines (Cephalexin)
- both have Beta lactamase ring. If pt has allergic to penicillin, then pt has allergy to cephalosporin

QUESTION: Child comes in with an oral infection and is NOT allergic to Pen. What do you prescribe?
a. Penicillin
b. Amoxicillin
c. Tetracycline

QUESTION: Pt is taking tetracycline. Which of the following drugs would be contraindicated? Penicillin

QUESTION: What happens when you have penicillin and decide to prescribe tetracycline with it? Tetracycline will decrease the efficacy of
Penicillin.
- Don’t do it. Tetracline is bacteriostatic whereas penicillin is bacteriocidal. The two mechanisms of action (CIDAL+STATIC) cancel each other
out because when you need bacterial growth to actually use penicillin, but you don’t have that growth when you prescribe Tetracycline.
ANTAGONISTS
QUESTION: Penicillin and erythromycin taken together cause: (cidal vs static)

•summation
•potentiation
•antagonists

QUESTION: #1 side-effect of erythromycin is? Stomach upset.
QUESTION: In lethal doses of erythromycin, what do you see? Hepatocellular, GI damage

QUESTION: Myasthenia gravis patient, what can’t you give them? Erythromycin, clarithromycin, penicillin or Impemene
QUESTION: If you have maxillary sinusitis, what antibiotic would you give? Amoxicillin with clavulanic Acid (Augmentin)
- Clavulanic acid increases spectrum of action & restored efficacy against amoxicillin-resistant bacteria that produce β-lactamase.
QUESTION: What the clavulanic acid do when is mixed with amoxicillin (Augmentin)? decrease sensitivity from b-lactamase
QUESTION: clavulanic acid in amoxicillin - prevents beta lactam degradation by beta lactamase producing bacteria
QUESTION: Augmentin: blocks the action of penicillinase, penicillinase resistant

QUESTION: Metronidazole - prescribed in necrotizing ulcerative gingivitis (NUG) or aggressive periodontitis
- metronidazole is contraindicated in patients on alcohol causing disulfiram type of reaction
- has red urine
QUESTION: Metronidazole: given for aggressive periodontitis. Makes your pee a different color? True
QUESTION: Antibiotic against only anaerobes parasites (protozoa)? Metronidazole
QUESTION: Which med kills only anaerobic and parasites: metronidazole

QUESTION: Clostridium difficile (colon inflammation) is treated with metronidazole. Unless pt is pregnant or breastfeeding, then use
vancomycin.

QUESTION: Best treatment of localized aggressive periodontitis: tetracycline, Doxycycline

• amoxicillin
• vancomycin
• azithromycin (this inhibits protein synthesis)

QUESTION: Gentamycin (aminoglycosides) - May cause auditory nerve deafness
QUESTION: aminoglycosides: ototoxicity and nephro toxicity
QUESTION: Antibiotic that helps with MRSA: Vancomycin

QUESTION: Pseudomonas colitis: c. difficile and clindamycin

QUESTION: Which of the following describes clindamycin?
a. inhibits cell wall synthesis


QUESTION: Chloramphenicol (antibiotic) - aplastic anemia

ANTI-CANCER DRUGS:

QUESTION: Anti-cancer drugs are least likely to cause what? Ulcers, thromboembolism
QUESTION: What’s an adverse effect of a drug that you can’t mix with antibiotics? Methotrexate because it won’t clear out of the system,
specifically with amoxicillin.
- Penicillin can decrease elimination of methotrexate (cancer drug), increasing risk of methotrexate toxicity, which can cause seizures.
QUESTION: Methotrexate (MTX) is an: antimetabolite and antifolate drug. Used for tx of cancer, autoimmune diseases, ectopic
pregnancy, and for the induction of abortions. It inhibits folic acid metabolism.
QUESTION: Which drug will be used to treat an overdose of methotrexate? Leucovorin
- Methotrexate toxicity effects can be reversed by folic acid (leukovorin)

QUESTION: Which medication for anticancer works on folate synthesis/ prevents folic acids synthesis/prevents folic acid production:
methotrexate
QUESTION: Methotrexate is an anti-cancer drug that inhibits folate reductase
QUESTION: Drug agonist of folic acid? Sulfa, Trimethoprim, Methotrexate
QUESTION: Anti-cancer drug (Mechlorethamine), that was an alkylating agent, what was it effect? Neurotoxic

QUESTION: Alkalizing anti-cancer drug called procarbazine causes: Hepatotoxicity
- Inhibits CYP450, increased effect of barbiturates, phenothiazenes, and narcotics. Has monoamine oxidase inhibition properties (MAOI),
and should not be taken with most antidepressants and certain migraine medications.

QUESTION: Non-alkylating anti-cancer side effect? myelosuppression (BONE MARROW SUPPRESSION)

ANTI-VIRAL MEDICATIONS:
Valacyclovir = prodrug, can’t swallow acyclovir
Common Anti-virals:
- Amantadine: Influenza A
- Oseltamivir (Tamiflu) & zanamivir: influenza A and B
- Acyclovir: Herpes I, II, VZV, EBV
- Gancyclovir: CMV
- Ribavirin: Hep C and resp syncytial virus
- AZT, Didanosine, Zalcitabine, Abacavir, Ritonavir, Saquinavir,
Nelfinavir, Amprenair: HIV

QUESTION: Picture of lesion at corner of mouth, patient says it
comes and goes now and then, what type of infection would you
suspect? Viral

QUESTION: Amantadine is an anti-viral and anti-parkinsonian or
anti-TB and its anti-viral.

QUESTION: Which one is an antiviral agent? Amantadine

QUESTION: What anti-viral is used to for all the these: HSV, VZV, CMV? Valacyclovir
QUESTION: What virus causes postherpatic neuralgia? VZV

QUESTION: Acyclovir has selective toxicity mechanism of action b/c:
inhibits viral mRNA
inhibits cellular mRNA in infected cells
only phosphorylated and activated in infected cells
- Inhibits mRNA, doesn’t work on DNA
QUESTION: Which of the following is not properly matching the anti-viral med with the virus that caused the disease? Retrovir was matched
with coxsackie (retrovir is used for HIV/AIDS)
QUESTION: Give drugs and paired it with the disease. Choose the wrong pair: Retrovir with varicella zoster

HIV & HIV MEDICATIONS:

QUESTION: HIV patient with sinusitis due to what? Murcomycosis

QUESTION: CD4 count and T-cell count for HIV symptoms: pt had HIV CD4 less than 200

QUESTION: Pt has viral load of 100,000: pt has high virus load and prone to infection

QUESTION: Pt’s viral load was 100,000, and T cell count was 50. What is the right statement? Pt’s T cell count is too low
- Healthy T-cell count: 500-1500 units/ml

QUESTION: Which of the following is not a risk of oral cancer
a. Tobacco
b. Alcohol
c. HPV
d. HIV

a. amantadine (Parkinson’s)
e. isoniazid (TB)

QUESTION: What oral manifestation is seen in children with HIV? Candidiasis
QUESTION: Candidiasis & HIV, what do you give systemic or topical anti-fungal? Nystatin

ANTI-FUNGAL MEDICATIONS:
- Azoles: inhibit lanosterol conversion to ergosterol
- Polyenes: bind to ergosterol on cell membrane and create a pore/transmembrane channel
o Includes Amphotericin B
Topical anti-fungal: Mycelex (clotrimazole), Nystatin, Ketoconazole

Systemic anti-fungal: Fluconazole (Diflucan), Amphotericin B, Ketoconazole
- Know “FAK”

QUESTION: Easy question on Nystatin: “swish & swallow”
QUESTION: Systemic antifungal: Fluconazole (diflucan)
QUESTION: Medication for angular chelitis: nystatin
QUESTION: Oral anti-fungal infection: Nystatin

- Clotrimazole(Mycelex) and Nystatin are oral anti-fungals

QUESTION: Griseofulvin: used for athlete’s foot.
- treat fungal infections such as ringworm, "jock itch," and athlete's foot.

QUESTION: Clotrimazole mechanism of action: Alter the enzyme for synthesis of ergosterol, which alters cell membrane permeability

QUESTION: Mechanism of miconazole (antifungal): inhibits the synthesis of ergosterol a critical component of the cell membrane
QUESTION: Best topical antifungal? Mycelex
REMOVABLE PARTIAL DENTURES

REMOVABLE PARTIAL DENTURES:

SUPPORT (rigidity, vertical forces): Denture base, major connector, and rests
STABILITY (rocking, horizontal forces): minor connector (lingual plates, guide planes, etc)
RETENTION: indirect and direct retainers
o NEVER MAJOR CONNECTORS
Retentive clasp: engages undercut below height of contour, gingival 1/3 of the crown (suprabulge)
- engage in undercut to prevent movement
Reciprocal clasp: passively touches above the height of contour, middle 1/3 of the crown
- Functions:
o Provide stability & reciprocation against retentive arm
o Denture is stabilized against horizontal movements
o Acts as indirect retainer (prevent minor rocking)

Indirect retainers: consists of one or more rests, their minor connectors, and proximal plates adjacent to edentulous areas.
o Located on the opposite side of fulcrum line, assist direct retainer to prevent denture displacement
o Should be placed far from distal extension base

Primary stress bearing area/retention:
- Mandibular – buccal shelf (slow resportion, access determined by buccinator attachment)
- Maxillary: ridges in RPD, hard palate

REMOVABLE PARTIAL DENTURES COMPONENTS:

QUESTION: Purpose of Major Connector
Stability and Rigidity
Stability and Retention
Retention and Rigidity
Rigidity and Esthetics
QUESTION: Requirement of a major connector? Rigidity/support

QUESTION: Purpose of the reciprocating arm of clasp: Stabilization

QUESTION: Reciprocating arm counteracts the effects of direct retainer, stabilizes the tooth, indirect retainer

QUESTION: Reciprocal clasp is placed on or above the height of contour.
QUESTION: Reciprocal anchorage in ortho – bodily movement, tipping, rotation, equal and opposite force
QUESTION: Where does the retentive clasp engage on abutment: passively on the suprabulge
- Retentive clasp-- gingival third of the crown w/I the undercut (suprabulge), Reciprocal Clasp-- middle third of the crown

QUESTION: Retentive clasp is not base metal alloy.
QUESTION: What is function of rest? Support (resistance to VERTICAL seating forces)
QUESTION: The purpose of the rest seat is: prevent displacement
QUESTION: What’s the purpose of an indirect retainer? to prevent distal extension from lifting up
QUESTION: Function of minor connector? Stability (resistance to horizontal forces)
QUESTION: Main purpose of buccal flange of Mx denture? Stability

QUESTION: What does not have an effect on clasp flexibility? Amount of undercut

QUESTION: Primary stress bearing area in mandible: buccal shelf
QUESTION: What is main area of support for distal extension RPD?
Ridge
buccal shelf
external oblique ridge
nd
QUESTION: Primary support for max denture – max: ridge, 2 -palate
nd
QUESTION: Primary support for mand: buccal shelf, 2 - ridges
QUESTION: What connects major connector with occlusal rest seats? Minor connector
QUESTION: What is reason for the altered cast technique when doing a distal extension RPD? support but not sure (others were retention,
esthetics, etc)
- Altered cast method of impressions mostly for distal extension (Kennedy Class I & II arch form), requires selective tissue placement to
obtain desired support from tissues, mostly in mandibular area

QUESTION: What property of RPD framework will limit adjustments of clasps?
a. Yield strength
b. Ductility
c. Stiffness

QUESTION: What mechanical property effects permanent composition for RPD clasps?
Stiffness HIGH MODULUS OF ELASTICITY = STIFFER
Yield strength
Ductility
Hardness

QUESTION: When tx planning an RPD for a pt what’s the first thing you do? Mount casts. Others, find undercuts, find abutments, extract
hopeless and perio teeth.
QUESTION: Best way to eval available space for rests-mounted casts
QUESTION: Which of the following explains why a properly designed rest on the lingual surface of a canine is preferred to a properly designed
rest on the incisal surface?

QUESTION: After surveying and designing which is the first step you do? reduction the axial for proximal plate
QUESTION: Pt presents with a restricted floor of the mouth, only 6 mandibular anterior teeth and diastema b/w several teeth, which of the
following major connector is appropriate for this pt: lingual plate with interruptions in the palate at the diastemas
QUESTION: First step in realigning a distal extension denture you must first- try in the framework

METAL CHARACTERISTICS

QUESTION: RPD denture frame or PFM, what metal is responsible for allergic reaction? nickel, chromium, cobalt or copper
QUESTION: Allergy to nickel is most common

RPD ERRORS:
QUESTION: What happens when no indirect retainer on distal extension: distal extension pop up off of tissue
QUESTION: Insufficient indirect retention on RPD when what happens? Distal extensions lift away from mucosa
QUESTION: With mandibular bilateral distal extension RPD, when you place pressure on one sides the opposite side lifts and vice versa, what is
the problem?
b. rests do not fit
d. occlusion
QUESTION: Pt complains “it feels loose” from a new bilateral distal extension RPD. Edentulous bilateral and rocking of denture- inadequate
seating of denture or inadequate indirect retainers.
QUESTION: RPD rocks when you apply pressure on either side of fulcrum line, why? inadequate indirect retainer

QUESTION: Pt complains “it feels loose” from a new bilateral distal extension RPD. Why? I put retainers are passive on the abutments they
should fit passive.
Thin flanges bases
Deflective Occlusal contacts
Indirect retainer

QUESTION: Distal extention lower RPD, when you push on that area & the indirect retainer rest comes up, how do you tx?
Reline (if its excessive à altered cast)
Tighten clasps

QUESTION: The main reason of breaking of RPD clasp? High Module of Elasticity (less likely to change shape – less deformation = VERY RIGID)

QUESTION: Pt comes in w/ interim partial denture. If you fabricate it in cast partial, how is it gonna be different?
Aesthetics of teeth
Retention
Resistance to occlusal loading – cuz interim doesn’t have rest seats)

QUESTION: In Max CD vs opposing Mand bilateral distal extension (Kennedy class 1), why is the anterior of the wax rim beveled? length is good
esthetically but there is not enough interocclusal space @ that length.

QUESTION: Beveling on upper occlusan rim due to? length is adequate for esthetics but inadequate interarch space

QUESTION: Patient has occlusal rims prepared and bevels the max, why?
-VDO and length of max occ rim was adequate
-Length of occlusal rim as adequate but VDO was wrong

KENNEDY CLASSIFICATION:
QUESTION: In which classification is a direct retainer very important? Kennedy class 2
QUESTION: Describes a denture with bilateral edentulous space anterior to natural teeth: Kennedy class 4
QUESTION: Which type of Kennedy classification doesn’t have a modification? Kennedy Class IV

COMPLETE DENTURES

QUESTION: Which one of the following is usually an issue for denture patients? Lower denture (other were maxillary dentures, and some other
things)
QUESTION: Retention of denture is impacted by saliva flow (THIN & watery saliva is better and aids in adhesion)
THICK/ROPEY SALIVA = WORST
QUESTION: Saliva and denture, which one is correct? Relationship that leads to denture and tissue adhesion, no relationship
QUESTION: Physiologic rest position: When mandible and all of supporting muscles are in their resting posture, Muscle guided position

PALATAL SEAL & PALATAL TORI

QUESTION: Primary stability for an edentulous CD on maxillary? Palate and residual ridges
QUESTION: Posterior extension of post palatal seal is: 2mm past vibrating line (fovea palatini) 2MM IN FRONT OF FOVEA PALATINI
QUESTION: Which 3 things determine the posterior palatal seal? throat form, tissue type and fovea location
- dentist look at before placing palatal seal – vibrating line, throat configuration, tension of tissue throat form, tissue type and fovea
location.
QUESTION: Which of the following best explains why the dentist should provide a postpalatal seal in a complete maxillary denture? The seal will
compensate for:


QUESTION: If the palatal vault is too deep: vibrating line is more pronounced and forward
- The higher the vault, the more abrupt & forward the vibrating line is.
More pronounced
Forward
Backward
- In the palate class III variation, there is a high vault in the hard palate. Soft palate has an acute drop and a wide range of movement. The
vibrating line is much more anterior and closer to the hard palate. This gives a narrow posterior palatal seal area.
QUESTION: When do you remove palatine torus? Prevents seating of denture & formation of posterior seal
QUESTION: Patient is going to get dentures and he has palatine tori, why should it be removed? To increase peripheral seal, Because the
mucosa is too small and it will hurt him

QUESTION: Palatal tori, when should it be removed?
• If posterior to vibrating line
• 3mm anterior to vibrating line - interferes with posterior palatal seal
QUESTION: Pt has bilateral maxillary tori that extends to the posterior palatal seal. You need to make an upper and lower complete. What
should you do?
a. Make a post palatal strap
b. Make CD around tori, remove tori and allow to heal, reline denture
c. Remove tori, then make CD
QUESTION: Guy has no upper teeth and palatal tori that extends to soft palate. What type of major connector to use? Horseshoe, AP, Palatal
strap (unless option to remove)
Stent sutured into mucobuccal fold —> to promote good healing
QUESTION: Reason for splint in palatal torus removal: prevent infxn, flap necrosis, hematoma formation
QUESTION: Mandibular tori in first premolar and canine. If you were to remove the tori, would you have the patient sign an informed consent
of lingual nerve injury? Yes

FACEBOW TRANSFER & PLASTER INDEX
QUESTION: Hinge axis: Face-bow

rd
QUESTION: What does the facebow do? translates the relationship of the maxilla to the terminal hinge axis using a 3 point of reference

QUESTION: Primary purpose of plaster index of occlusal surface of max denture before removing the denture from the articulator and cast:
Preserve face-bow transfer

QUESTION: Why take plaster index? Teeth are then put back exactly in their original position aided by plaster key (mounting jig)
QUESTION: You delivered a set of complete dentures. Why do you take impression of max denture and mount it to articulator? (clinical
remount): so you don’t have to take facebow registration again (preserve facebow)

QUESTION: Lab & clinical remount, why are they done? Establish and maintain VDO, correct errors in capturing VDO
- remounts are done if CO needs to be corrected or if VDO is incorrect

QUESTION: Dentist mounted maxillary cast without using facebow, but now wants to increase vertical dimension 4mm: open articulator 4mm,
get new CR(most anterior superior), take new facebow, lateral movements

QUESTION: If you want to increase patient’s VDO by 4mm, what do you do?
take new CR
take new facebow
adjust articulator
change condylar angulation
increase VDR

QUESTION: What to do if you increase VDO after mounting? New CR and remount
SOUNDS & VDO/VDR

SIBILANT sounds (hissing, “s/sh” sounds) allow maxillary incisors to nearly touch the mandibular incisors.
- Check VDO
Fricative sounds (“f/th” sounds) are made by allowing the maxillary incisors to nearly touch the slightly inverted lower lip.
- check labial incline of anterior teeth
VDR-Freeway Space=VDO

QUESTION: At what point do you check the proper placement of teeth? At the tooth try in appt
QUESTION: When do you check for silabount sounds: at the try-in appt.

QUESTION: If doing a denture try-in, where would the teeth touch compared to vermilion border when saying “F” sound? they would just
touch (wet/dry lip line)
QUESTION: What can’t the patient say if upper anterior are too superior and forward for denture teeth? F and V
QUESTION: What do you use to check if VDO and anterior teeth are set correctly for denture teeth? S sound
QUESTION: Asked about what sound will determine VDO? S sound. This will bring teeth slightly together with 1-1.5 mm separation. This is the
“closest speaking space”
QUESTION: S, z, and ch sounds the teeth must be: close together or far apart Clicking sounds mean they’re over-opened (too much VDO)
QUESTION: When the denture wearer says “S” sounds & the posterior teeth are touching, why? excessive vertical so decrease VDO
QUESTION: Which position depends on patient’s posture (sitting up vs laying down)? VDR (other options are centric relation or vdo and
someone else)
QUESTION: Patient has short lower face and sagging lips. What should you do? increase VDO
QUESTION: Patient has clicking with dentures – inadequate resting space, insufficient interocclusal distance
QUESTION: If you hear teeth clicking in denture patient it is due to? vertical dimension = too little VDR and too much VDO
QUESTION: A patient who has a moderate bony undercut on the facial from canine-to-canine needs an immediate maxillary denture. There is
also a tuberosity that is severely undercut. This patient is best treated by
QUESTION: When you find VDO & the max tuberosity touches retromolar pad, what should you do?
• Open VDO
QUESTION: An examination of a complete denture patient reveals that the retromolar pad contacts the maxillary tuberosity at the occlusal
vertical dimension. To remedy this situation, which of the following should be performed
b. covers the tuberosity with a metal base
c. increases the occlusal vertical dimension
d. reduces the retromolar pad by surgery
QUESTION: Immediate denture and has undercuts and tuberosity, what do you do? Remove tuberosity, remove both don’t remove any?
QUESTION: Patient feels fullness of upper lip after delivery of complete denture: Overextended labial flange

TISSUE CHECK
QUESTION: After a couple of months of delivery of upper and lower complete, patient complains of burning of lower lip? Candida or impinges
of mental nerve.
QUESTION: You give patient a maxillary denture and they come back with generalized soreness under the denture. no sore spots or anything
visible clinically, what's causing this? allergy, significant malocclusion (gross occlusal misalignment)
QUESTION: Pt has general soreness along ridges from complete denture, what should you do? reline, adjust occlusion
QUESTION: Pt has worn denture for 19 years, now he has a sore on buccal with swelling, what do you do? Refer out, biopsy, cytology, relieve
denture in area and re-evaluate in 2 weeks

QUESTION: A 6x3 mm asymptomatic white lesion seen under old man wearing a denture for 19 years, what is first thing done at initial
treatment?
Adjust and check in one week
Incision
Excision
Cytologic
- Relieve any trauma, watch for 2 weeks, then biopsy, when your biopsy, you can do incisional

QUESTION: Patient has mobile upper anterior maxillary tissue that is inflamed. Before making new denture, what do you do?
A) gingivectomy Tissue conditioning is an effort to restore the health of the tissues of the denture foundation area
B) apply conditioner to existing denture before master impressions are made by relining the dentures with temporary denture reliners.
C) make new denture that will immobile the existing tissue
D) something else

QUESTION: No posterior teeth & incisal wear on the anterior why? Absence of posterior teeth
QUESTION: Reason for cheek biting with dentures? inadequate horizontal overjet, lack of vertical overlap, Increased VDO
- not enough horizontal overlap of posterior teeth, insufficient VDO

QUESTION: Pt wearing a complete dentures & is cheek biting: posterior teeth set up with no horizontal overlap.

QUESTION: You fit new completed denture and the patient complains of cheek bite, what will you do?

DENTURE PROCESSING
QUESTION: Which denture base is not light cured?

a. Pressure formed
d. Pour or fluid resin technique salt and pepper technique —> put it into pressure pot
QUESTION: A denture tooth falls off the denture after processing, why? there was some wax
that was not removed

DENTURE SET UP

QUESTION: How far do we extend a maxillary complete denture? To the Hamular notch
QUESTION: Why don’t you set denture teeth on the incline up towards the retromolar pad? because it dislodges the denture
QUESTION: Which of the following explains why mandibular molars should NOT be placed over the ascending area of the mandible?
E. The occlusal forces over the inclined ramus would dislodge the mandibular denture.
QUESTION: During try-in of mandibular denture, you want to check for full movement of the tongue & do all working movements
QUESTION: If teeth on the wax try- in don’t occlude like they did on the articulator what do you do? Remount, redo teeth and retry
QUESTION: What is the main benefit of immediate complete denture? Esthetics
QUESTION: When making a denture base, the hamulus is too close to the retromolar pad? Surgery, don't put base on hamulus don't put base
on retromolar pad or increase vd?
- that’s the area where the mandibular turns from horizontal to vertical

QUESTION: Coronoid process displace upper denture if: too bulky at max distobuccal
QUESTION: Coronoid – when open mouth can dislodge denture (mand denture = masseter)
QUESTION: Open mouth while maxillary border molding - Coronoid process will block buccal extension
QUESTION: Best way to prevent speech problems in complete dentures keep teeth in same position

QUESTION: Made pt denture which shows to much of max teeth. There are 3 mm of freeway space. What would you do?
lift up occlusal table? Decrease VDO (not sure about this…because the freeway space doesn’t seem excessive…would seem like the only solution
is remake the CD…Xtina)
-interocclusal space (freeway space) averages 2 to 4 mm.

QUESTION: You are correcting the VDO of a patient, your articulator emminentia is set at 20 degrees, you later correct it to 45 degrees. What
do you do next? Adjust bennet angle, new centric relation record, increase the VDO, others? Decrease incisal guidance, or increase
compensating curve.
- Bennet angle is calculated using condylar incline so you can adjust bennet angle too

QUESTION: If denture teeth were set to a 20-degree condylar setting when the teeth need to be at 45 degrees, what will need to be changed?
• Incisal guidance increased
- Or DECREASE INCISAL GUIDANCE (to compensate for increase in condylar guidance). Steep condylar path requires steep compensating
curve, and decreased incisal guidance)
QUESTION: The condylar guidance is increased from 20 to 45 degrees, what do you do? Increase the compensatory curve

QUESTION: A patient presents for try-in evaluation of balanced occlusion of complete maxillary and mandibular dentures. A dentist notes that
protrusive excursion results in separation of posterior teeth. This dentist can best correct this problem by

QUESTION: Protrusion denture causes dislodging. Increase compensating
curve!!
QUESTION: Setting condylar inclination on articular using protrusive, what
do with the pin? Remove the pin (lift up)

QUESTION: incisal guide pin position while checking protrusive, why?
determine condyle guidance
QUESTION: Reason for Incisive guide table? Anterior guidance
- When making a guide table…. Lift the pin up about 2 mm

QUESTION: What is the best way to preserve the anterior guidance?
Translating the horizontal & vertical relationship onto the incisal table

QUESTION: How to determine the angle of the incisal table? By the horizontal plane (occlusal plane) of occlusion and a line in the sagittal plane
between incisal edges between maxillary and mandibular central incisors.

QUESTION: Which plane is most important on anterior guidance: Horizontal/occlusal

QUESTION: Pt with class III will have the mandibular incisal angle? Increased, decreased

QUESTION: CASE: Lower natural anterior teeth, upper PFM anterior teeth. Lowers had incisal wear facts, what do you think this is due to?
Heavy incisal guidance (this was the most logical answer, as PFM vs natural teeth, natural teeth wear off)
- Same patient: a picture of him doing incisal guidance, what is this patient doing? – Incisal guidance (lower teeth and upper teeth were at
edge to edge position)
- Same patient: when he does anterior guidance, what is happening to the TMJ? Translation
o anterior guidance…TMJ TRANSLATES
QUESTION: Retruded tongue habit with full denture means what? Difficulty swallowing

QUESTION: Border molding of lingual mandibular portion done by what movement? Wetting of lips with tongue

DENTURE MUSCULATURE:
QUESTION: Mandibular denture border sitting on what muscle due to its orientation of its
fiber? Masseter
QUESTION: Posterior buccal extention of a mandibular complete denture is limited by:

Masseter muscle
QUESTION: What muscle can you impinge on with denture? Masseter, medial pterygoid, or
lateral pterygoid
a. Medial pterygoid
c. Masseter

QUESTION: What muscle covers dentures flanges & doesn’t affect stability? Buccinator
- the buccinators does not affect stability!!
QUESTION: Denture will not be displaced by which muscle due to direction of fibers? Masseter, buccinators, lateral pterygoid, medial pterygoid
• Buccinator
• Masseter
QUESTION: Lower denture impression lingual area muscle – mylohyoid
QUESTION: Which muscle helps border hold in the posterior lingual flange? Mylohyoid
mold
- Other muscles that help are: palatoglossus, superior pharyngeal constrictor, genioglossus (lingual border of mandibular impression)

QUESTION: Man. Lingual flanges are affected by
• geniglossal
• mylohyoid

QUESTION: Mand CD interfere with what muscle in lingual side? Mylohyoid.
QUESTION: What determines lingual border of Mandibular impression? BOTH Superior Pharyngeal Constrictor/mylohyoid muscle and buccal
is masseter.
QUESTION: What muscles help in retention of lower complete denture: palatoglossus, superior pharyngeal constrictor, mylohyoid and
genioglossus.
QUESTION: Denture outline in border molding affected on the lingual of mandible by what? Superior constrictor, palatoglossis, genioglossis,
mylohyoid
QUESTION: You would relieve a mandibular denture in the area of the buccal frenum to allow which muscle to function properly? Orbicularis
oris

OVERDENTURES:

QUESTION: How do you protect roots under an overdenture – RCT with cast copings
QUESTION: What is not important for an overdenture? clinical crown size
QUESTION: Which teeth roots are retained under an overdenture? PICK roots from dense bone areas such as Mandibular Canine
- Pref = canine à premolars à incisors àmolars
- Bilateral, symmetrical, with healthy attached gingiva, adequate perio support (>1/2 root in bone), limited/no mobility
QUESTION: What is the best way to treat a tooth supported lower denture? Use metal copings to cover teeth
QUESTION: A patient has acromegaly and needs dentures. Which denture will not fit? Maxillary or Mandibular
pituitary gland produces too much growth hormone ->
QUESTION: Which of the following is the endocrine involvement that is related to jaw deformity: Acromegaly
PITUITARY PROBLEM

a. acromegaly
b. cherubism
c. Albrights
d. pagets

QUESTION: First sign of increased (we think in reference to VD) occlusion? TMJ, myofascial, attrition, abfraction
COMBINATION SYMDROME:
KELLY Syndrome (Combination syndrome) - In pt with completely edentulous maxilla & partially edentulous mandible with preserved anterior
teeth, they have severe anterior maxillary resorption combined with hypertrophic and atrophic changes in different quadrants of maxilla and
mandible.
**Plummer–Vinson syndrome (PVS), also called Paterson–Brown–Kelly syndrome or sideropenic dysphagia, is a rare disease characterized by
difficulty in swallowing, iron deficiency anemia, glossitis, cheilosis and esophageal webs.
- Class I mandibular RPD vs max CD, bone loss in anterior max, overgrowth in max tuberosity, papillary hyperplasia of hard palate,
supraeruption of man teeth, bone loss under distal extension
QUESTION: Guy has treatment plan that is going to be combination syndrome so what is the ultimate goal when you make his cd upper and rpd
lower: Balanced occlusion on both anterior and posterior teeth of mouth during centric relation; (other option was wanting balanced
occlusion (didn’t mention ant vs post teeth, during excursive movement)

QUESTION: Combination syndrome = Kelly syndrome: Pt with maxillary complete denture – retained mandibular anteriors and not lower RPD.
Pt shows: denture anteriors teeth doesn’t show, flabby anterior ridge, tuberosities flabby and enlarged, lower anterior teeth extruded above
plane of occlusion and atrophy of lower posterior ridge.
QUESTION: Pt has flabby anterior tissue:• Caused by combination syndrome • Causes decreased VDO
QUESTION: A flabby, maxillary anterior ridge under a complete denture is frequently associated with
A. V shaped ridges.
C. osteoporosis.
DISORDERS/SYNDROMES

QUESTION: What causes problems in babies in embryo? Teratogens (Any agent that can disturb the development of an embryo or fetus)
Carcinogen
QUESTION: Definition of teratogen: Any agent that can disturb the development of an embryo or fetus. Teratogens may cause a birth defect in
the child. Or a teratogen may halt the pregnancy outright.

MUSCLE DYSTROPHY

Muscular dystrophy: group of muscle diseases that weaken the musculoskeletal system & hamper locomotion. Characterized by progressive
skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells and tissue.
- Muscular dystrophy: muscle weakness, “long face” which is characterized by a lower vertical facial height and open bite/
“myotonic face”
QUESTION: Muscle dystrophy; after local anesthetic is most likely due to? Lidocaine toxicity, increase duration of action, increase onset, Can’t
be supine
QUESTION: What can be seen on a patient with muscle weakness of the face? Cross bite, buccal tilting of molars, long upper face, lower face
with open bite
QUESTION: Considerations for muscular dystrophy: increase in dental disease if OHI is neglected, weakness of muscles of mastication
(decrease biting force, open mouth breathing)

ADDISON’S DISEASE & OTHER ADRENAL DIEASES
LOW CORTISOL —> bronzing , can get pigmentation inside mouth
Addison's disease (primary adrenal insufficiency/ Random fact: Kennedy had it!): chronic endocrine disorder, adrenal glands do not produce
enough steroid hormones (too little cortisol & sometimes, insufficient aldosterone).
- Symptoms generally come slowly & include abdominal pain, weakness, skin darkening and weight loss.
- Adrenal crisis may occur with low blood pressure, vomiting, lower back pain, and loss of consciousness. An adrenal crisis can be triggered
by stress, such as from an injury, surgery, or infection.
- Tx: give cortisol

QUESTION: What Addison disease causes: pigmentation of the mucosa

QUESTION: Addison’s shows up as what in the oral cavity? pigmentation on buccal mucosa
QUESTION: What clinical symptoms in the mouth would you see for Addison’s disease? Hyperpigmentation
QUESTION: Pheochromocytoma: neuroendocrine tumor in medulla of adrenal gland à excess catecholamines (ex. epi)
Can occur with Von Recklinghausen Neurofibromatosis
Pheochromocytoma—high amounts of NORepi mainly, sometimes can cause HYPERglycemia
CEREBRAL PALSY:

Cerebral palsy (CP): group of permanent central motor/movement disorders that appear in early childhood, caused by abnormal development
or damage to the parts of the brain that control movement, balance, muscle tone, and posture. Signs and symptoms vary & include: poor
coordination, stiff muscles, weak muscles, and tremors. Other problems w/ sensation, vision, hearing, swallowing, and speaking.
nd
QUESTION: Lots of questions on cerebral palsy (something about whether or not it is a developmental disorder) (2 after autism)
QUESTION: CP patient - which is not true? CP = NEURODEVELOPMENTAL DISORDER
-Can happen pre and post-natally, often due to HYPOXIA situation
b. all bruxism **GOOD THING—it’s a “non-progressive” disease, so it doesn’t get worse over time
SPASTIC/hypertonic = tight, stiff muscles = 75% of people (GABA doesn’t work in upper motor neurons), so
MOUTH BREATHERS/TROUBLE WITH DEXTERITY AND BRUSHING TEETH neurons OVER-excited
QUESTION: Cerebral palsy – patient will have spastic oral mucosa during treatment.
QUESTION: Pt has involuntary uncoordinated movements with larynx problem? Cerebral palsy
QUESTION: Common finding in a patient with cerebral athetoid palsy: Anterior Teeth fracture
- cerebral athetoid palsy: damage to basal ganglia, has both hypertonia/hypotonia
dyskinetic-involuntary muscle movements

CLEFT LIP/PALATE:

QUESTION: Case: Black girl around 7 years old presents with unilateral cross bite; she had a cleft palate that was fixed. Palate in picture looks
like a triangle and laterals are towards the palate.
A) What is the pigmentation? racial pigmentation
B) What is the most likely cause of the crossbite? early loss of laterals, due to cleft palate
QUESTION: When does cleft lip and palate develop? 6-9 weeks in utero CLEFT LIP: 6-7 WEEKS IN UTERO; CLEFT PALATE: 8-10 WEEKS IN UTERO
QUESTION: Patients with cleft lip and palate, what occlusion is mostly seen? class III malocclusion
QUESTION: Cleft lip is more common in boys; cleft palate more common in girls.
QUESTION: Pt had cleft lip and palate. Later in life during ortho analysis, what do you see? Deficient maxilla, normal mand
QUESTION: Most prevalent developmental deformity in Maxilla? Cleft Palate
o Cleft lip and palate CLASS 1—SOFT TISSUE ONLY
CLASS 2—HARD AND SOFT PALATE TO INCISIVE FORAMEN
QUESTION: What is cleft palate class III? Soft & hard palate plus alveolar process CLASS 3-COMPLETE UNILATERAL , INCLUDES SOFT/HARD /LIP/ALVEOLAR RIDGE
CLASS 4—COMPLETE BILATERAL, INCLUDES SOFT/HARD AND/OR LIP AND ALVEOLAR RIDGE
QUESTION: What mostly gives cleft lip/palate? Genetic, autosomal dominant, autosomal recessive, environmental, multi-factorial
QUESTION: All of the following are the reasons for closing a cleft lip except?
Support the premax on a unilat cleft
Help speech
Support the ala of the nose.
QUESTION: Speech problems associated with cleft lip and palate are usually the result of? Inability of soft palate to close air flow into the nasal
area
QUESTION: A cleft lip occurs following the failure of permanent union between which of the following?
QUESTION: Age for repair of cleft palate w/ normal canine eruption: When canine tooth is ¾ formed (8-9years old)
QUESTION: When correcting cleft problem, how do you end/finish? Suturing lip

QUESTION: Percentage of cleft lip and cleft palate in Caucasians? 1/750
- Asians = 1/500, Asians have it the most common *You’re more likely to see a combo of cleft lip and palate than just cleft palate alone
QUESTION: Cleft lip is seen in how many Americans? 1/300. 1/700. 1/1100, 1/1500 *CLEFT LIP IS MORE COMMON
QUESTION: Cleft palate is seen in how many Americans? 1/300. 1/700. 1/1000, 1/1500
QUESTION: Incident of cleft palate & lip in US - 1 in 1000 vs Incident of cleft palate w/out lip in US – 1/2000 (CDC 2012)
QUESTION: Patient was Angle’s Class I according to molar relationship but Skeletal class III because of ANB and cleft palate ANB = SNA-SNB <2 = Class III
QUESTION: What surgery will a pt with cleft palate most likely need? move maxilla up, move mandible back (mandibular set back)
- Pt get cleft lip & palate surgery. This usually cases future Class III tissues so at later age, they need to come back to move the mandible to
correct Class III (mandibular setback)
QUESTION: How does a kid with fetal alcohol syndrome present with? anencephaly, midface deficiency, cleft lip

TREACHER COLLINS SYNDROME:

Treacher Collin’s Syndrome: autosomal
dominant. Usually presents w/ cleft palate,
shorten soft palate, malocclusion, anterior
open bite, enamel hypoplasia An inherited
condition in which some bones and
tissues in the face aren't developed.

QUESTION: Which disorder has the least developmental delay? Treacher Collins syndrome (Underdeveloped or absent)
QUESTION: Treacher Collins has loss (hypoplasia) of zygomatic bone. What do patients with cleidocranial dysplasia have? Loss of clavicle
QUESTION: Describes patient saying they have mandibular hypoplasia, malformed ear, lower eyelids, ear pinna – Treacher Collins
Could have no external ear tissue at all
QUESTION: Treacher Collins syndrome à know pt's are not mentally retarded and they have ear abnormalities

DOWN SYNDROME/BIRTH DEFECTS:
- Trisomy 21/Down Syndrome manifestations:
o Midfacial hypoplasia à Class III profile
o Delayed eruption of teeth
o Supernumery teeth
o Doesn’t have a higher chance of caries but does have a higher change of periodontal disease
QUESTION: What is true of patients with Down Syndrome/trisomy 21? Lower incidence of dental caries
QUESTION: What is a characteristic of patients with Down syndrome? midfacial hypoplasia
(see the same in Treacher Collins)

QUESTION: What orthomanifcastion does Turner syndrome and trisomy 21 associated with? short midface
FEMALES XO
QUESTION: What is orbital hypertelorism? Wide-set eyes (seen in Crouzon, Cleidocranial dysostotosis, GOrlin Syndrome, Down’s syndrome)

QUESTION: Which does NOT result in delayed development? Trisomy 21, Trisomy 18 (Edward syndrome), Hurler Syndrome
(mucopolysaccharides), Cru di Chat rare genetic disorder due to chromosome deletion on chromosome 5, cry sounds like a cat
- Edward’s syndrome: small head (microcephaly) accompanied by a prominent back portion of the head (occiput), low-set, malformed ears,
abnormally small jaw (micrognathia), cleft lip/cleft palate, upturned nose, narrow eyelid folds (palpebral fissures), widely spaced eyes
(ocular hypertelorism)
CROUZON SYNDROME: premature fusion of certain skull bones (craniosynostosis), prevents the skull from growing normally and affects the shape of the head and face

GORLIN—Nevoid basal cell carcinomas everywhere

EDWARD SYNDROME—Trisomy 18, lots of miscarriages, if born babies die within a year
HURLER SYNDROME—Lysosomal storage problem, progressive deterioration, hepatosplenomegaly, dwarfism, and
BONES AND SUTURE LINES: unique facial features. A progressive mental retardation occurs, with death frequently occurring by the age of 10 years

QUESTION: What resembles epiphyseal plate? Synchondrosis
- Synchondrosis: almost immovable joint between bones bound by layer of cartilage (ex. vertebra,
epiphyseal growth plate)
QUESTION: What age does the mandibular symphysis close? 6-9 months à à à à à à à à à à à à
Symphysis: two flat bones grow together & join

QUESTION: Sphenooccipital closure, what kind of tissue fills it in? Cartilage
-
Interstitial growth – occurs by the mitotic division and deposition of more matrix around chondrocytes already established in the
cartilage.
- Ex – CONDYLE, nasal septum, and spheno-occipital snychondrosis

QUESTION: Which of these undergo suture closure latest?
• sphenoethmoidal
• Sphenoccipital
• Intrasphenoid
• Intraoccipital
QUESTION: What is synostosis? ABNORMAL FUSION OF BONES * think Crouzon Syndrome
QUESTION: What is craniosynostosis? Early closure of suture between bones (in your head)

CROUZAN SYNDROME:
*FGF problem —premature closure of bones in the skull

st
- Autosomal dominant, 1 branchial arch syndrome, mutation in fibroblast growth factor
receptor II à fibrous joints between certain bones of the skull (cranial sutures) close prematurely (craniosynostosis).
- BEATEN METAL SKULL

Most notable characteristic of Crouzon syndrome is cranial synostosis, but it usually presents as
brachycephaly, which results in the appearance of a short and broad head, exophthalmos or
proptosis (bulging eyes due to shallow eye sockets after early fusion of surrounding bones),
hypertelorism (greater than normal distance between the eyes), hypoplastic maxillary, & mandibular
prognathism
Fuzzy radiograph!

QUESTION: Synostosis – early/late closing of sutures - Crouzon syndrome
QUESTION: Patient w/ deficient mid-face, proptosis, etc? Crouzon syndrome (could also be Turner’s syndrome if female, or Treacher Collins)
QUESTION: Pt has ocular proptosis, maxillary hypoplasia, premature suture closing (synostosis)?
treacher-collins
Crouzon
Pierre robin infant has a CLEFT PALATE, retrognathia (smaller than normal lower jaw), a tongue that falls back in the throat, and difficulty breathing
cleidocranial

HURLER & HUNTER’S SYNDROME:

Both are lysosomal storage disease (MCUOPOLYSACCHARIDOSIS)
- HURLER SYNDROME (mucopolysaccharidosis type I (MPS I), gargoylism): autosomal recessive
disorder due to buildup of glycosaminoglycans (GAG, formerly known as mucopolysaccharides)
due to a deficiency of alpha-L iduronidase, an enzyme responsible for the degradation of
mucopolysaccharides in lysosomes à heparin sulfate and dermatan sulfate occurs in the body.

-
- HUNTERS SYNDROME (mucopolysaccharidosis II (MPS II)): genetic X-linked recessive disorder,
due to defect in anchoring between the epidermis and dermis, resulting in friction and skin
fragility. Deficiency in enzyme iduronate 2-sulfatase (I2S) also, leading to GAG build up.

QUESTION: Hurler and Hunter’s syndromes, what do they have in common? They both have mucopolysaccaridosis & buildup of GAGs
GLYCOSAMINOGLYCANS
QUESTION: Hunter syndrome has what? Lysosome storage disease. Get abdominal hernias, ear infections, prominent forehead, enlarged
tongue, ID, stiff joints

CLEIDOCRANIAL DYSPLASIA:

Cleidocranial dysostosis = hereditary congenital disorder (usually
autosomal dominant), where there is delayed ossification of midline
structures. Bone defects usually involve clavicle (hypoplastic or aplastic clavicle) & skull. Short, big head, shoulders moved in.

- Dental – narrow high palate, increased rate of cleft palate, presence of many unerupted permanent, retained primary, & supranumery
teeth w/ distorted crowns/root shape

QUESTION: What is the most significant finding in cleidocranial dysplasia? odontoma, supernumery teeth, sparse hair, multiple impacted teeth,
retained teeth
QUESTION: Cleidocrainal dysplasis – supernumerary teeth & problems with eruption

• cleidocranial syndrome
• downs syndrome

QUESTION: Many questions (5) on Cleidocranial dysplasia: Multiple unerupted supernumerary teeth, Retention of primary teeth, delayed
eruption of permanent teeth, Missing clavicle
QUESTION: What allows for compression of skull during birth? Fontanelles

QUESTION: What is the part of the infant’s head that allows it to change shape? Fontanelles (enable
the bony plates of the skull to flex
- Fontanelles close anterior 12-18 months, posterior 3-4 months
QUESTION: What is the part of the infant’s head that allows it to change shape? Fontanelles
QUESTION: Which structures in a baby allow the head to deform in the birth canal? fontanelles

PAPILLON LEFEVRE SYNDROME:

Papillon–Lefèvre syndrome (PLS) - palmoplantar keratoderma w/ periodontitis. It’s an
autosomal recessive disorder caused by a deficiency in cathepsin C.
st
- Severe perio à early/young loss of primary & permanent teeth after eruption of 1
molar cathepsin C is the physiological activator of groups of serine proteases
- Hyperkeratosis of palm & feet sole from immune and inflammatory cells vital for defense of an organism.

QUESTION: 15 yr. old w/ edentulous and keratosis on hands and feet. They gave ugly
picture of thick soled feet. à Papillon Lefevre syndrome

QUESTION: What is Papillon–Lefèvre syndrome? You get periodontitis, keratosis on hands
and soles, and premature loss of primary teeth.


PIERRE ROBIN SYNDROME:

Pierre Robin Syndrome: unknown case. Characteristics: micrognathia, glossoptosis (tongue falls back in the throat,
hard to breath), high arch palate, cleft palate, and absent gag reflex. Teeth appear when baby is born.
QUESTION: Pt has glossoptosis, micrognathia, and cleft palate? Pierre Robin syndrome
- Glossoptosis = refers to the downward displacement or retraction of the tongue
QUESTION: Triad of cleft palate, glossoptosis and absent gag reflex. What is it? Pierre-Robin Syndrome

WEBBER SYNDROME:

Sturge-Weber syndrome: neurological disorder present at birth. Characterized by a port-wine stain on the face and
brain or eye abnormalities due to overabundance of capillaries near skin surface. Sometimes seizures or neurological
symptoms
QUESTION: Sturge-Weber syndrome? vascular malformation, eye and hemangioma
QUESTION: Sturger Webber syndrome: Port Wine Stain

METABOLIC SYNDROME *GROUP OF RISK FACTORS
Normal BMI range: about 18.5-25
QUESTION: Pt has high cholesterol, hypertension and diabetes, metabolic problem, which does he have: metabolic syndrome
QUESTION: Pt has BMI of 36, is overweight & has high cholesterol. What syndrome? Metabolic Syndrome
QUESTION: What is the normal % fat intake per day- 30%
- Recommended daily dose of fat: 30% of total calorie and saturated fat is 10% of daily calorie intake

THYROID & PARATHRYOID DISEASE

THYROID DISEASE:

QUESTION: Which do you give a hyperparathyroid child for normal development of teeth? Vitamin D (Brings in Ca+) HYPERPARATHYROID = TOO MUCH CALCIUM
QUESTION: Thyrotoxicosis symptoms – DIAPHORESIS (sweating), fever, hypertension and TACHYCARDIA
- thyroid storm is a severe version of thyrotoxicosis GRAVES DISEEASE = HYPERTHYROIDISM
-Low TSH, high amounts of T3 and T4
QUESTION: Thyrotoxic pt. manifestation? Tachycardia
QUESTION: LA with epinephrine contraindicated in? Uncontrolled Diabetes, hypothyroidism, hyperthyroidism
QUESTION: Symptoms of hypothyroid attack: loss of brain function due to severe, longstanding low levels of thyroid hormone in the blood
(hypothyroidism)
- Hypothyroidism primary symptoms are altered mental status & hypothermia. Hypoglycemia, hypotension, hyponatremia, hypercapnia,
hypoxia, bradycardia, hypoventilation may also occur.
QUESTION: Myxedema is due to? severe hypothyroidism
- Myxedema: swelling of skin, waxy consistency seen in Grave’s disease
QUESTION: With which endocrine systemic disease does thick hair become thin hair? thyroid – hypothyroidism (cretinism in kids and
myxoedema in adults)
QUESTION: PT was gaining weight, has lower voice, fine hair, feels cold – hypothyroidism
- symptoms of hypothyroidism: weight gain, bradycardia, cool to touch/cold, fatigue
QUESTION: Which thyroid drug doesn't let iodine bond to hormone? Radiated Iodide (for hyperthyroidism)
QUESTION: Graves’ Disease (Hyperthyroidism) - exophthalmos
QUESTION: Thyroid hormone decrease, which drug do you give? Levothyroxine (for hypothyroidism)

PARATHYROID DISEASE & HYPOPHOSPHATASIA

Hypophosphatasia - metabolic bone disease, low alkaline phosphatase
QUESTION: Increase in alkaline phosphatase is related to? Hyperparathyroidism
QUESTION: Decreased alkaline phosphatase is related to: Hypophosphatasia —> early loss of deciduous teeth

QUESTION: What disease causes decrease in alkaline phosphatase? Malnutrition, hypophosphatasia, hypothyroidism, pernicious anemia
QUESTION: Central Giant Cell Granuloma is seen with pts with which condition? Hyperparathyroidism

Too much calcium in the blood because it came from bones
ETHICS & PATIENT/PRACTICE MANAGEMENT

Ethics:
- Beneficence- “Do good”.
- Patient Autonomy- “Self-governance”.
- Nonmaleficence- “Do no harm”. Dentists are to keep skills and knowledge up-to-date and practice within their limits in order to protect
the pt from harm.
- Justice- “Fairness”.
- Veracity- “Truthfulness”.

LOTS OF ETHICS QUESTIONS: what to say what to do in these situations. If your patient is looking around a lot at your masks and gloves, safety
equipment, what’s the most appropriate response? Some of the answers are vague. (YUP –Vic)
ETHICS PRINCIPLES:
QUESTION: Tell patient that he needs to take of amalgam fillings bc they are not good for his health (hazardous): not practicing veracity
(truthfulness)
QUESTION: Pt presents with amalgam restorations in good shape and the dentist suggest to change them for composites due to systemic
toxicity of the amalgam. What ethic principle is the dentist is violating? Veracity

QUESTION: What principle has to do with a patient’s self-governance & privacy? Autonomy

QUESTION: Something about dentist needs to keep up to date with new technology and learn and practice new procedures: Non-maleficence
QUESTION: Dentist keeps on current dental medicine to provide current standard of care. What part of the ethical code does this relate to?
Non-maleficence
QUESTION: Dentist refers a difficult case to a specialist, what ethic principle is this? Non maleficence
- Having non-maleficence is knowing your limitations and referring patients out to specialist

INFORMED CONSENT:

QUESTION: Informed consent à autonomy


QUESTION: Dentist lets the patient sign informed consent - autonomy
QUESTION: What you do first before getting informed consent? make sure patient can sign or has guardian, consult physician, discuss options
with relatives, etc

QUESTION: 82 y/o pt comes w/ younger person who hands the dentist paper saying the pt has a legal guardian. Now what? You must have
consent of this guardian before treating the 82 y/o pt.

QUESTION: 90-year-old patient comes in with son, who has a document mentioning the guardian of the patient - must have consent from them
to treat the patient
QUESTION: The 16 yr. old can take the decisions for the elder pts if: If the elders are deaf and dumb, if the boy makes the payment, if the
elders are over 60yrs, if the kid has the power of an attorney

QUESTION: Consent - do not need to discuss the witness signature (I think)

QUESTION: When should patient sign informed consent forms for surgery? AFTER there has been a discussion w/ the dentist about the
surgery

QUESTION: Inform consent most contain all except: cost of Tx
QUESTION: If you don’t obtain informed consent, what kind of offense is this? Battery

QUESTION: What happen when patient doesn't sign the consent? Battery
- health care provider commits a battery if the provider performs a procedure for which the patient has not given consent.

QUESTION: Emancipated minor: if the kid is under 18, know exceptions of how they become emancipated minor
- Emancipated minor assumes most adult responsibilities before reaching the age of majority (usually 18). If she/he graduated from
high school, has been married, has been pregnant, or responsible for his or her own welfare and is living independently of parental
control and support.

QUESTION: How is FACT witness is different from expert specialist?
- fact witness = individual, who has personal knowledge of events pertaining to the case & can testify as to things they have
personally observed or witnessed. They may not offer opinions, which are the province of the expert witness
- Expert witnesses offer opinions, unlike a fact witness, that may assist the judge in understanding technical knowledge in order to
support their ability to make a sound ruling in a case. An expert witness can be a credentialed specialist in fields.
EMOTIONAL RESPONSE:

Apathy- indifferent
Empathy- to walk in their shoes, share the emotional state they are feeling
Sympathy- to be concerned about someone, do not have to share the same emotional state as them.
QUESTION: Child came with a history of aggressive behavior and is crying, then should the dentist show empathy or sympathy or control
QUESTION: Rapport best with: empathy; other choices were sympathy, compassion
QUESTION: What best characterizes rapport? Understanding patient’s feeling and talking with patient
QUESTION: Definition of rapport? mutual openness / harmonious relationship
- Rapport = mutual sense of trust and openness between individuals that, if neglected, compromises communication.
QUESTION: A successful practice is built on - friendship COMMUNICATION? Good clinician-patient relationship
QUESTION: What is the best to communicate with patient- apathy, empathy, or some other stuff
QUESTION: Empathy is not: shared personal experiences, Imagination, understanding
QUESTION: Which do you not need to show empathy to the patient?
a. open-mindedness
QUESTION: Definition of Empathy – Patient wanted to give you paperwork, and you acknowledge their concerns
QUESTION: When should the dentist NOT use para-phrasing?
QUESTION: Finding out whether a pt is listening: Eye contact
QUESTION: Which statement is NOT correct about “Paraphrasing”? to put in your own words
- Paraphrasing: repeating, in one’s own words, what someone has said. This serves to confirm one’s understanding, validate a patient’s
feelings, convey interest in the patient’s experience (thereby building rapport), and highlight important points.
QUESTION: Patient complains of pain in relation to a particular tooth. The best answer/reply of the dentist would be:
QUESTION: While the dentist is preparing a large carious lesion in Tooth #30 for a restoration, a pulp exposure occurs. The patient angrily
shouts at the dentist, "Your incompetent 'creep'- -you're responsible for this problem!"- Of the following possible responses the dentist could
make, which one is the most emphatic?
C. I can see that you're very upset. You thought the tooth could be restored and now this problem has occurred.
E. I'm sorry this happened, but we must get on with the procedure.
QUESTION: When the dentist enters the operatory, the patient, who is new to the office, stands close to the wall, has his arms folded, and is
looking at the floor. The dentist should initiate communication by saying which of the following?
A. Let's get going; I've got a lot to do.
B. What are you angry about?
C. Didn't my assistant get you seated?
D. You seem uncomfortable; did you have a bad dental experience?
E. Hi, I'm Doctor Wilson, what brings you here today?

QUESTION: Pt complains of high fees of dentist, how should the dentist answer? Fee is fine according to the geographic area, it is fair and
reasonable, I have to make a living too

QUESTION: Patient says, “I’ve been brushing like you showed me but I still have cavities.” What do you do?
a. Go over OHI?

QUESTION: The closest a dentist should get to their patient is? Tap their shoulder

QUESTION: Reason to not have parent in room with dentist and kid? communication barrier between dentist and child, OSHA violation, HIPAA
violation,

Precontemplation stage of change are not even thinking about changing their drinking behavior. They may not see it as a problem, or they
think that others who point out the problem are exaggerating.
Contenplation: Individuals in this stage of change are willing to consider the possibility that they have a problem, and the possibility offers hope
for change. However, people who are contemplating change are often highly ambivalent. They are on the fence. Contemplation is not a
commitment, not a decision to change.

A: Precontemplation, contemplation, action, denial
SMOKING
Nicotine Replacement Therapy (NRT)
Method Availability Description

Over-the-
Nicotine Patches The nicotine patch is placed on the skin and gives users a small and steady amount of nicotine.
Counter
Over-the- Nicotine gum is chewed to release nicotine. The user chews the gum until it produces a tingling feeling, and
Nicotine Gum
Counter then places it between their cheek and gums.
Nicotine Over-the- Nicotine lozenges look like hard candy and are placed in the mouth. The nicotine lozenge releases nicotine as
Lozenges Counter it slowly dissolves in the mouth.
A nicotine inhaler is a cartridge attached to a mouthpiece. Inhaling through the mouthpiece gives the user a
Nicotine Inhaler Prescription
specific amount of nicotine.
Nicotine Nasal
Prescription Nicotine nasal spray is a pump bottle containing nicotine, which is put into the nose and sprayed.
Spray
Other Quit Smoking Medications
Method Availability Description

Bupropion, also known as Zyban®, helps to reduce nicotine withdrawal and the urge to smoke. Bupropion can be used
Wellbutrin safely with NRT. Also for depression.
Bupropion Prescription
C.I. contraindicated in patients with a seizure disorder, current or prior diagnosis of anorexia nervosa or bulimia, or
Buspirone (Buspar)
undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs.
can get serotonin syndrome
Varenicline, also known as Chantix®, helps to reduce nicotine withdrawal and the urge to smoke. It also blocks the
effects of nicotine from cigarettes if the user starts smoking again.
C.I: Alcohol Intoxication, Depression, Increased Cardiovascular Event Risk, Coronary Artery Bypass Graft, Heart Attack,
Varenicline Prescription
CHANTIX Acute Syndrome of the Heart, Angina, Transient Ischemic Attack, Stroke, Peripheral Vascular Disease, Severe Renal
Impairment, Seizures, Feel Like Throwing Up, Schizophrenia, Manic-Depression, Having Thoughts of Suicide, Habit of
Drinking Too Much Alcohol. DON’T COMBINE WITH PATCHES

TYPES OF CONDITIONING:

- Positive reinforcement: Positive consequence that increases behavior
§ you brush, you get a sticker
§ = adding a reinforcing stimulus following a behavior that you want to happen again
- Negative reinforcement: Removal of negative consequence that increases behavior
§ Stop pain from toothache, pt realizes he should brush
§ = a bad consequence is removed after a good behavior is exhibited
- Positive punishment: aversive Conditioning, negative consequence that decreases negative behavior
o = [adding negative consequence after emitting undesired behavior]
§ everytime you don’t brush, you have to clean your room
- Negative punishment: Removal of positive stimulus in order to decrease an undesirable behavior
o = [removing positive item after undesired behavior happens]
§ don’t brush, no allowance
- Operant extinction: child cries, don’t give attention (yeah this crap showed up –Vic)

Basically, know that reinforcement is more effective than punishment because in punishment, you have resentment, you avoid the punisher,
and you are not taught positive behavior.
Most important component of systematic desensitization is exposure to fearful stimulus
QUESTION: During the child's first visit, the dentist requested that the parents wait in the reception room. The child cries moderately, but
tearfully, throughout the dental examination and prophylaxis. The dentist "gave her permission" to cry while he/she worked and then took no
notice of her crying. Her crying diminished in intensity over time and then stopped. With respect ONLY to the crying behavior, the dentist has

QUESTION: Pt with manic depression disorder that he/she is not willing to get treated for, is now getting dental treatment from you. What do
you see in this patient:
A) bipolar
b) depression
c) excitement?
QUESTION: Definition of Operant extinction? removal of reinforcements that decrease a behavior

- disappearance of a previously learned behavior when the behavior is not reinforced.

QUESTION: Behavior shaping: providing positive reinforcement for approximation of behavior you are desiring

QUESTION: Which describes a stage in Piaget’s model of cognitive development? I put preoperational.
- Piaget proposed 4 stages of cognitive development:
1. Sensorimotor stage = extends from birth to the acquisition of language
2. Pre-operational stage = starts when the child begins to learn to speak at age 2-7.
3. Concrete operational stage = ages of 7-11 (preadolescence) years, characterized by the appropriate use of logic
4. Formal operational stage = adolescence and into adulthood, roughly ages 11-20, intelligence through the logical use of
symbols related to abstract concepts.

QUESTION: A behavior modification device (ie thumb sucking deterrent) is an example of: POSITIVE PUNISHMENT (negative consequence that
decreases negative behavior) YOU’RE ADDING SOMETHING TO DECREASE A BEHAVIOR
QUESTION: Patient is given oral habit reducing appliance to prevent an oral habit, what is this considered? POSITIVE PUNISHMENT
QUESTION: Eye contact, smiling, and telling pt doing good job (praising) is what type? social reinforcement
QUESTION: Desensitization works if the base of the behavior problem is fear
QUESTION: Main disadvantage to desensitization? Time
QUESTION: Classic condition, which is an example? – pain (as in, you see dentist, you assume pain is coming
What is an example of stimuli in classical conditioning: dentist (all others were responses)?
QUESTION: What is an example of conditioned stimuli with pt that have had previous bad experiences? dental chair (all others were responses)
a. Dental chair
c. Fear
d. Anxiety
QUESTION: How to deal with angry patient? Listen and validate emotion, agree with patient, ignore anger then investigate after

PEDIATRIC BEHAVIOR MANAGEMENT:

QUESTION: How to reduce stress & dental anxiety? Tell-show-do
QUESTION: Based on Frank behavioral rating scale, what is the rate that indicates positive rapport with dentist? rating 4
QUESTION: 6-year-old int. disabled child. Treatment is a recall. Would you give sedation, antianxiolytic, voice control or positive
reinforcement? INTELLIGENCE DISORDER?
- with ID, you want to be short and brief, explain things, tell-show-do, and REWARD. Positive reinforcement.
QUESTION: What is the best way to treat a developmentally disabled patient? Consistency
- Disabled pt, should be treated by flatterness, permissible, consistency

QUESTION: Autistic kids have what characteristic? Repetitive behavior
QUESTION: Disable patient comes in and not cooperative, how should you act? Permissiveness (give patient freedom & treat in the way patient
feel comfortable)
QUESTION: Patients with autism will usually show?
- Children with autism are easily overwhelmed by sensory overload, which can cause “stimming” (flapping of arms, rocking,
screaming, etc).
- Autistic children are hypersensitive to loud noises, sudden movement, and things that are felt.

QUESTION: Child patient – you smile, tell him good job, and pat him on the shoulder. These are examples of negative reinforcement, social
reinforcement, or token reinforcement.
QUESTION: If kid complained and whined in the beginning but at the end, is very good: you compliment how well they were at the end of the
procedure. Pt is exposed to an unpleasant stimulus while engaging in the targeted behavior, the goal being to create an aversion to it.
QUESTION: Voice control method used with children’s - Aversive conditioning (punishment to deter unwanted behavior, ex. hand over mouth)
QUESTION: What is the purpose of the voice control technique? Sets boundaries à Aversive conditioning
st
QUESTION: 8-year-old patient, 1 dental visit ever, scared of dentist? What’s the most likely answer?
a. Television
b. Parents
c. Peers
QUESTION: If a child is afraid, allow the child to express fears
QUESTION: How do you treat a fearful child? use sedation, let him watch another patient,
QUESTION: Young patient is scared b/c he has no control what to do? tell him to raise his hand if he needs a break/ you to stop
QUESTION: A kid is on recall appointment and is not cooperative. You should do voice control followed by? Alternating appraisal
QUESTION: Patient is very young and fearful first time you meet them – try to talk to them, go down at their height.
QUESTION: Patient 2 yrs old and scared, who do you ask to help position the patient?
ask parent to position patient for you
get assistant to do it
you do it yourself
QUESTION: The restraining of uncooperative 2 yr. child should be done by. Dentist, Assistant, Parent
QUESTION: 4-year-old kid, best position?
Knee to knee with head on parent’s lap
QUESTION: Patient comes in with 1-year-old child, how do you do exam? parent and dentist are knee to knee, baby's head is in dentist's lap
QUESTION: 8-year-old boy, when will he behave better?
Nobody inside
QUESTION: What is a 2 yr. old most afraid of? 4 yr. old?
• 1-3 yr. old: SEPARATION
• 4-6 yr. old: UNKNOWN
- pediatric fears correlated with age
QUESTION: Uncooperative 2-year-old, what are they scared of? separation anxiety
QUESTION: 4-5-year boy is scared of? Unknown
QUESTION: You help a child help recognize what they are afraid of and make outward positive connection: cognitive restructuring
(psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts)
QUESTION: Behavior Modeling: when the kid is afraid and you use a sibling or someone older to show how they should behave
QUESTION: A 4 yr. old child management? empathy and respect
QUESTION: Replacing words like LA with sleepy juice is called as Euphemism (relabeling)

st
QUESTION: Pedo 1 visit. Multiple carious teeth on anteriors. During anesthesia is well cooperative and doesn’t cry or move. Once begin tx,
begins to cry. What do.
• Keep working
• Voice control
• More anesthesia
• Oral sed
• N20

ANXIETY:


- Anxious patients are the most difficult patients as they often cause the dentist to become anxious as well.

QUESTION: Difference between fear and anxiety – anxiety has no specific cause (generalized), fear has a localized cause, fear decreases pain
and anxiety increases pain, fear is painful, anxiety is a disease

QUESTION: Dental anxiety can be caused by patient’s helplessness. What would reduce it? Telling the patient to raise her/his hand when feels
pain

QUESTION: A patient is going to the dentist and has never had local anesthetic. He recently got a flu vaccine and is now afraid of needles. The
fear is due to what?
Location
Generalization
Translation

QUESTION: Define anxiety according to Freud and K: aversive inner state that people seek to avoid or escape.

QUESTION: What do Freud and Erikson say about anxiety? Inability to overcome a conflict in a particular stage that will lead to anxiety.
Inadequate resolution becomes anxiety
- An inadequate resolution would indicate a child's insecurity and anxiety.
- An Adequate Resolution would mean that a child was able to overcome the conflict in each stage and develop properly. This
applies similarly to the other 8 stages.

QUESTION: Patient has dental fear, what is most likely due to? previous traumatic dental procedure
QUESTION: What would most cause a man to have anxiety? traumatic past experience, or finances, peers, unpleasant staff
QUESTION: Constantly exposing the pt to get from the fear factor is desensitation.
QUESTION: Systematic desensitization- 3 steps: Construct a hierarchy, relaxation exercises, associate components of hierarchy with relaxation
state
QUESTION: Panic attacks usually produce a sense of unreality, a fear of impending doom, or a fear of losing control.

OTHER PARTS OF THE ADA ETHNICS CODE: FEES, ADVERTISING/MARKETING, CREDIENTIALS

Fees (discusses overbilling), Advertising & marketing, ethics (patient values & harm), credentials (dentist cannot state they are certified in a
specialty when they’re not)
QUESTION: What is not included in the ADA code of ethics?
• Advertising
• patient values
• Fees
a. Cost
b. Specialty
QUESTION: A dentist has an ethical obligation to report a colleague in all these situations except?
c. abusing patients

QUESTION: if you find problems with a medical conditions occurring with a certain drug, who do you contact? OSHA, FDA, EPA
QUESTION: If there is an adverse reaction to a medication in the office, who do you notify? a) FDA b) CDC c) HIPPA d) OSHA e) EPA.
QUESTION: Asked which statement was correct for HIPPA? Must give privacy form to pt but you don’t need confirmation of receipt, fax and
HIPAA
email standard, etc.
QUESTION: What’s not the reason for rising dental costs? number of dental students in dental schools

INSURANCE & GOVERNMENT DENTAL CARE:

Medicaid – income based; Medicare – age based (elderly, > 65 y/o)
Think “i” for “income” Think takes “CARE” of old people
States & federal government share in the cost of Medicaid, States may pay health care providers directly on a fee-for-service basis or states
may pay for Medicaid services through prepaid, capitated payments to health plans or other entities. Within federally imposed upper limits for
certain services, each state has broad discretion to determine the payment method and payment rate for services

• Insurance pays a flat fee/patient pays the rest – co payment PPO
• Provider is paid per patient not per procedure – capitation HMO-gets paid per head

- HMO’s – dentists are paid a fixed rate for each individual per month. Dentist is paid regardless patient was seen or not. If value of
services exceeds payments, dentist’s loss. If payment exceeds value of services, dentists gain.
Dentists can charge the patient the difference to upgrade services i.e. HMOs dont pay for porcelain crowns, only base metal crowns…but who

wants that? So the patient pays out of pocket to upgrade to porcelain. Pretty shitty.
QUESTION: What does Medicaid cover? Extractions, one-time denture, children until 18. CHIP = children’s health insurance plan = family income too high for Medicaid
QUESTION: If you need a medical record from your patient’s physician, your patient needs to give you a permission to do that. Based on which
principal/policy? I picked Medicaid/Medicare bc the choices were CDC, OSHA, blood borne, some random nonsense. There wasn’t HIPAA
QUESTION: What sector of government provides funding for dental care? Medicaid, Medicare, grant, HMO
QUESTION: Who pays for Medicare: federal program that pays for covered health services for most people 65 years old and older and for
most permanently disabled individuals under the age of 65.
QUESTION: Government spends most of the money in Medicare, Medicaid, HMO.
QUESTION: Medicare is a federal program that provide health care for elderly. It does not cover dental. Answer: Both statements
are true
QUESTION: Most aid for finance: Medicaid, Medicare, and hmo
QUESTION: Most dental procedures for the elderly are paid for by out of pocket cash.
QUESTION: Which of the following is the leading payer for dental treatment? Insurance or self-pay
a. government
b. insurance
c. cash
QUESTION: Majority of health service in USA: private insurance.
QUESTION: who pays most of dental Tx: 56% patients, 33% third parties private insurance
QUESTION: 73yo woman makes $23,000/year. how should she receive dental care?
• Medicaid *THE POINT IS MOST PEOPLE PAY FOR DENTAL WORK THEMSELVES WITH CASH (NOT INSURANCE)
• Medicare ***MEDICARE DOES NOT COVER DENTAL!
QUESTION: A 65 yr. old lady living on 40k pension per year, wants to get dental treatment. She does not have any other physical abnormality
besides tooth pain in her molars. From where does the money covered for her treatment come from?
a. Medicaid does not cover dental for adults MEDICAID LIMITS:
b. Medicare. - does not cover dental for elders -SINGLE PERSON —> $16, 500
c. Private Insurance - private dental IF she has it -FAMILY OF 4 —> $33, 500

a. Medicare wI dental coverage
b. Medicare w/o dental coverage
c. Medicaid wI dental coverage
d. Medicaid w/o dental coverage

QUESTION: Insurance question about adverse selection (adverse selection deals with the idea that those at higher risk are more likely to buy an
insurance policy. If the price for the policy is the same for nonsmokers and smokers, it is more likely that smokers will buy the insurance,
because it is more “worth it” to them—because they are at higher risk for disease. This is averse to the insurance. So the prices need to be
different.
Adverse selection refers generally to a situation where sellers
have information that buyers do not have, or vice versa, about
• only take pt with low risk some aspect of product quality. In the case of insurance, adverse
• take both selection is the tendency of those in dangerous jobs or high-risk
• something about taking pt of all ages lifestyles to get life insurance

QUESTION: Know about capitation: Dentist is paid a fixed fee to see patients enrolled in program; HMO = capitation dental plan
QUESTION: You work at a HMO office and the patient has used up all his yearly benefits, what can you do?
HMOs DON’T HAVE ANNUAL MAX LIKE PPOs
QUESTION: Your office is fee schedule and pt needs new crown but pt used up all of her allowance (or something like that)? what do you do?
Charge the same fee

QUESTION: Which one is related to employee insurance, where you get a discount from the insurance and also you can go to a dentist of your
preference? PPO, HMO HMO = “HEALTH MAINTENANCE ORGANIZATION”

QUESTION: Which one is related to a dental insurance, that only allows you to go to a group of dentists at a specific location? – Closed Panel
(other choices were open panels and other things)
QUESTION: Company offers dental insurance to its employees that can go to selected dentist, what is this example of? Closed panel
QUESTION: On a prepayment basis, dental patients receive care at specified facilities from a limited number of dentists. This practice plan is
classified as which of the following?
A. Closed panel
B. Open panel
C. Group practice
D. Solo practice

QUESTION: Which of the following represents a dental program in which eligible patients receive services at specified facilities from a limited
number of dentists?
A. An open-panel can see patients out of network 3 TYPES OF HMO:
B. A closed-panel -OPEN PANEL—PATIENT PAYS FIXED FEE AND CAN GO TO WHOEVER THEY WANT (HMO, OF COURSE)
C. A capitation group -CLOSED PANEL- HMO LIMITS PATIENT’S CHOICE OF DENTIST
-GROUP PRACTICE -TYPE OF CLOSED PANEL, HAS ALL SPECIALISTS, PATIENT HAS TO GO TO THEM, NO CHOICE
D. A prepaid group

QUESTION: Direct Reimbursement: self-funded group dental plan in which the employee is reimbursed based on a percentage of dollars spent
for dental care provided, and which allows employees to seek treatment from the dentist of their choice.

QUESTION: If you are an employer and you provide your employee with reimbursements for dental care they received from a dentist of their
choice it is called: direct reimbursement,

QUESTION: patient goes to the dentist and needs to pay something before seen: Copayment
QUESTION: What happened in 1997: SCHIP (state children insurance health program)
- SCHIP (State Children's Health Insurance Program) provides matching funds to states for health insurance to families with children.
It covers uninsured children in families with incomes that are modest but too high to qualify for Medicaid.

QUESTION: 1997 law passed that state must look after children that cannot afford healthcare - State Children's Health Insurance
Program (SCHIP) AKA Children's Health Insurance Program (CHIP)

INSURANCE TERMS:

Unbundling - separating of a dental procedure into component parts with each part having a charge so that the cumulative charge of the
components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure.
Bundling - opposite of unbundling & can occur on the insurance carrier end. It’s the systematic combining of distinct dental procedures by
third-party payers that results in a reduced benefit for the patient/beneficiary.
Upcoding or overcoding is defined by the ADA as "reporting a more complex and/or higher cost procedure than was actually performed."
Downcoding is defined by the ADA as "a practice of third-party payers in which the benefit code has been changed to a less complex and/or
lower cost procedure than was reported except where delineated in contract agreements."
rd
QUESTION: Dentist did not accept a copayment and did not report it to the 3 party (insurance)? Overbilling
Waiving co-pays is OVERBILLING, not allowed to do this
QUESTION: Dentist charge for $500 for a crown. insurance only covers $400. Dentist waves copayment ($100) but still let insurance knows that
he charges $500 for crown, what’s this action called?
a. Down coding
b. Overbilling
c.Price fixing
d.Unbundling

QUESTION: The dentist charges separately for core build up and the crown but the insurance company says that the core builds up is part of
crown. What is this called? Bundling
QUESTION: Doctor billed insurance couple of procedures, when actually there is a global procedure that combines them all, what did he
commit? Unbundling

QUESTION: Dentist does the treatment for 2 crowns but the insurance company paid for one crown, what is it? Downcoding
Better example is dentist did a PFM, but insurance company paid for base metal crown (much lower fee)

QUESTION: You performed a two surface restoration and coded it that way. Insurance came back with coding it as only one surface restoration.
What is this called? Downcoding or upcoding This doesn’t happen either lol. Better example is dentist did a composite and the insurance paid for an amalgam (cheaper), so the patient
has a higher patient portion.
QUESTION: What is it called when a dentist charges several procedures instead of one?
a. upcoding
b. downcoding
c. unbundling
d. bundling

QUESTION: The patient retires & loses health benefits. The treatment is done on the next day. The pt requests that the
dentist enter the previous day’s date and the dentist does so. What is this called? Fraud

ABUSE:

Child abuse sign:
- multiple untreated injuries
- lag time bt injury and tx
- comminuted facial fractures
- parents with different stories
- Most common in children under 3
Abuses that have to be reported to authorities - colleague practicing with chemical impairment, colleague advertising falsely on media, child
saying they’re a specialist when they’re not maybe
abuse, domestic violence, elderly abuse Can’t do SPLIT FEES i.e. sharing money they make with advertising agency
(i.e. NO REFERRAL FEES)
QUESTION: When treating elderly patients what should be your concern? Health of patient
QUESTION: What’s true about child abuse cases? You’ll see at least 2 a year.
QUESTION: It is required mandatory to report all except: child abuse, reaction to drug, etc
QUESTION: You suspect child abuse. Who do you call? Social services
QUESTION: If there is an elderly woman in your chair & you think there might be abuse. What do you have to do? Tell family or tell human
health services
each person licensed by the Dental Board of California and Dental Hygiene
Committee of California is a "mandated reporter" for known or suspected abuse
QUESTION: Which is not true of elder abuse: or neglect of a child, elder or dependent adult and incidents of violence.
Most of the elder abuse is at victims home
must report known or suspected cases to the county department for child protective
services, adult protective services or to local law enforcement.
Mostly it is by the victim’s relative
elder’s abuse is often over reported and exaggerated
QUESTION: Unauthorized use of elderly’s ATM card is not a sign of abuse but in some situation, it is under consideration. (Both are true)
QUESTION: Elderly abuse is often: underreported
a. Vulnerability
d. Stress

DENTAL PRACTICE:

QUESTION: When opening a dental practice, what makes it more successful? Better communication
QUESTION: What do general dentists report as being their biggest issue? fearful patients, business/financial issues, staff training
QUESTION: Patient is bothering the dentist, dentist got upset. The assistant drops instruments in the floor & the dentist was so piss that he had
it out with the assistant. What you you call that reaction ? Transference
- Transference is a unconscious redirection of feelings from one person to another
QUESTION: Most eye injury in practice happens to who: dentist, dental assistant, hygienist, custodian


QUESTION: When do you most likely get a puncture wound: pre procedure, during, post-proceduring cleanup, needle recapping


QUESTION: What test for every year? Hep B

QUESTION: Dentist can diagnose which of the following? Bulimia (reflected in oral condition)

QUESTION: A patient comes in with rampant decay. What is the primary responsibility of the dentist? figure out etiology of decay FIRST

QUESTION: Patient is in your office for a treatment plan, all of the following should be done when you explain the proposed treatment to the
patient, except? Use professional terminology (other choices were the risk of not getting a procedure done, the fee of the procedure, etc)

st
QUESTION: New patient comes into office, what do you do 1 visit? Full exam, record probing, med history, impressions.

QUESTION: First step before/in treatment planning: make sure patient doesn't need translator, consult with physician about pre-existing
medical conditions

QUESTION: Patient is ready to hear your treatment plan, all of the following are true except? Guarantee the success of treatment!

QUESTION: First step in tx planning is? treat the initial pain and discomfort of the pt. Other choices were see how you can make a preventitive
plan, treat all restorations.

QUESTION: Proper order for treatment planning – emergency care, disease control, reevaluation, definitive treatment, maintenance care

• Med history of the patient (If the lab test was choose may be that)
• ESR lab results Sed rate, or erythrocyte sedimentation rate ( ESR ), is a blood test that can reveal inflammatory activity in your body.
A sed rate test isn't a stand-alone diagnostic tool, but it can help your doctor diagnose or monitor the progress of an inflammatory disease
QUESTION: Patient comes to your office, complains about how other dentists did really bad job, and tells you how you are the best dentist in
the world. What mental condition is she suffering from? Borderline Personality Disorder

QUESTION: Pt comes in saying she’s been to 5 different dentists the last 6 months. A few minutes later, she’s telling you how great of a dentist
you are and that she’ll refer all of her friends to you. This example of: Borderline. Other choices were paranoia & schizoid.
- Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships.

IF QUESTION ABOUT MANIC/DEPRESSIVE…THINK BIPOLAR TOO
QUESTION: Patient with bipolar disease comes in for dental care, choses not to take his medication and states he is in the “manic phase,” what
do you expect from treating this patient?: he will have unpredictable reactions during the treatment, he is will be obsessed about is esthetics
(not sure if it means he is going to be continuously manic or just general bipolar disorder)

QUESTION: When trying to change person, what is most important? trying to determine whether they are willing to change
QUESTION: Patient who has a complex medical history that is not debilitating but will require medical management and dental modifications –
ASA 3 ASA 2—SMOKER, PREGNANT, WELL-CONTROLLED ANYTHING
- ASA2- mild systemic disease, ASA3-severe systemic disease ASA 3-DIABETES, UNCONTROLLED STUFF, MI/CVA LONG TIME AGO
ASA 4—SEVERE SYSTEMIC STUFF, RECENT MI/CVA, CONSTANT THREAT TO LIFE CONDITION

QUESTION: You have a test that is not accurate but gives consistent result: this means test is reliable
QUESTION: Which of the following are necessary for a test to be accurate: Specificity, reliability, validity
QUESTION: Something about nonverbal vs verbal communication: nonverbal is not as reliable
QUESTION: Dentists have to have proper accommodations for disable people. Dentists have to treat HIV people the same as others. Both
statements are true
CLEANING UP:

QUESTION: One patient left, and before getting another patient, how would you clean your operatory? Use disinfecting spray à let it sit for 10
minutes and then wipe off
QUESTION: Disinfection? Destroy majority of microorganisms but not bacterial spores.

- Bacterial spores = benchmark organism for sterilization

QUESTION: Benchmark for sterilization: bacillus spores
- I think it’s Clostriduim Botulinium
ITS JUST SPORES

QUESTION: Mycobacterium is the benchmark for disinfection (TB)

QUESTION: Definition of disinfectants – Inanimate objects (non-living)
ANTISEPTIC MEANS APPLIED TO LIVING/BIOLOGICAL TISSUES
QUESTION: Antiseptic: can be safely applied to tissues, but will kill most living organisms
QUESTION: Denaturation of the proteins - alcohol and autoclave; Coagulation of proteins - dry heat
QUESTION: Steam Autoclave: 20 minutes at 121⁰C & 15 psi.

steam
dry heat – 160 C or 320⁰ F
oxide pressure


QUESTION: Which method of sterilization does not corrode instruments/burs? – Dry Heat, Ethylene oxide
QUESTION: Which method of sterilization does not dull carbide instruments? Dry heat
QUESTION: Sterilization most destructive to burs & causes rusts: Steam heat, dry heat, unsaturated vapor, chemical, ethylene oxide

QUESTION: What is best to sterlize carbide burs? DRY HEAT or unsaturated chemical vapor àno corrode or dull
- Ethylene oxide is for heat-sensitive instruments MAINLY USED IN HOSPITALS

QUESTION: Anti-retraction valves - used to prevent aspiration of patient materials into some dental handpieces and waterlines – prevent
patient to patient cross-contamination.
Dental handpieces are required to have approved anti-retraction valves, which prevent contaminated
fluids such as saliva from being sucked back into the handpiece. These valves are designed to stop
retraction of resilient, pathogenic bacteria in oral fluids

OSHA (Occupational Safety and Health Administration):

QUESTION: What’s not found on the OSHA poster? How many days each employee is allowed to work with that chemicals
QUESTION: Which one applies to OSHA guideline? Update it once a year!
QUESTION: What are the hep B vaccine rules by OSHA? all must always be offered and able to get the vaccine
QUESTION: Once a year, you have to check for one of the following:
HIV
HEP B
HEP C
QUESTION: If worker didn’t get Hep B vaccine because he is more concerned about HIV? Tell him it’s easier to get hep B à must sign that they
legally don’t want
QUESTION: Who is at least risk for HEP B infection?
a) food servers
b) Down syndrome
c) drugs addicts
QUESTION: OSHA does all except: material safety data sheet MSDS, which is made by manufacturer
QUESTION: Hazard Communication Standard: created by OSHA to make sure employees know about hazardous/toxic materials
QUESTION: Hazard Communication Standard states – every chemical hazard has to be evaluated then reported to employer & employees
a) created by OSHA
b) What does it control: amalgam, sharps, blood
QUESTION: OSHA sets bloodborne pathogen standard for dentistry, HIV and HBV
DENTAL STATISTICS & STUDIES

(There were AT LEAST 5 q’s on this crap….)
T test: used to compare whether the means of 2 groups are statistically different—assume that standard deviation is unknown. Small sample
size
Z test: used to compare the means of 2 groups are statistically different if the variances like standard deviation are known. Large sample size.
Chi-square test: tests correlation b/w two independent variables
Case control study — RETROSPECT study that compares people that have the disease to people that do not have the disease. Also, looks back
to see how the risk for the disease is compared to actually getting that disease.
- start with disease and look backwards for exposure
- ex. How did people react to the new mouthwash vs nonusers IN OTHER WORDS, IF YOU WERE EXPOSED TO SOMETHING IN THE PAST,
THE ODDS RATIO —> RETROSPECTIVE. LOOKS BACK AFTER AN EXPOSURE AND ASKS “WHAT HAPPENED?” WHAT ARE THE ODDS THAT YOU’RE GOING TO GET A DISEASE/OUTCOME?
*GIVES YOU
Cohort study — PROSPECTIVE study where there is more than one sample/cohort and evaluations are done to see how certain risk factors the
groups have are related to developing a certain disease.
- look forward from exposure to disease development, through time to see how develops disease, then looks at various factors (no
one has diease yet)
- ex. how will/does people react to using new mouthwash vs nonusers
**COHORT STUDY—TELLS YOU THE RELATIVE RISK—> LOOKS FORWARD I.E. PROSPECTIVE
Cross sectional study — EPIDEMIOLOGICAL study that looks at the entire population. Not like case control, that only studies a certain group
with a specific characteristic.
- all variables measures simultaneously at one point in time
- Example: It was observed that there was less caries in certain geographic areas. Higher fluoride in water supplies was suspected
as the probable cause

*SNAPSHOT IN TIME OF A CERTAIN POPULATION OF PEOPLE
Longitudinal Study —TIMED study that looks at a certain set of people (same people) over a long period of time.

Descriptive studies - time, place, person (prevalence, incidence)
Correlation studies - measure linear relationship between two factors within defined groups, no cause and effect established
Clinical Trial — Use randomization and blinding to compare effects of treatment with non-treatment. This is the Gold Standard for establishing
cause and effect.
- Trials to evaluate the effectiveness and safety of medications or medical devices by monitoring their effects on large groups of
people.
- Clinical research trials may be conducted by government health agencies such as NIH, researchers affiliated with a hospital or
university medical program, independent researchers, or private industry.
Typically, government agencies approve or disapprove new treatments based on clinical trial results. While important and highly effective in
preventing obviously harmful treatments from coming to market, clinical research trials are not always perfect in discovering all side effects,
particularly effects associated with long-term use and interactions between experimental drugs and other medications.

QUESTION: If a dentist is reading an article, where should he look for the definition of dependent and independent variables? method ,
introduction, discussion, results, summary
QUESTION: Where would you look in a scientific journal to find the dependent and independent variables
• Intro
• Materials
• Methods
• Conclusion
• Summary


QUESTION: All are the qualities of a double blind study except? You need 2 control groups.

QUESTION: Researcher wants to find incidence of oral cancer in nursing home what study? Cross-sectional

QUESTION: Research done to determine caries rate at a nursing home. What kind of study is this? Cross-sectional
QUESTION: Which type of study determines relative risk ratio: Cohort
QUESTION: What parameter study lets you have a risk quotient? Cohort
QUESTION: Efficacy, what study would you do? CASE CONTROL

QUESTION: Study among smokers & nonsmokers in a period of 6 years (2000-2006) to develop disease? Cohort, cross sectional
- By: disease/non-disease: case control; by time: cohort
QUESTION: What type of studylets you find causation- analytical, cross-sectional, case-control, cohort

QUESTION: Myestena Gravis patients are involved in a study. The doctor is conducting a study and is trying to find out how many of these
patients has periodontitis. What study is he conducting? Case control study

QUESTION: The problem with this study is that you don’t know if the disease came from drinking or not. What study is it? Cross
Followed a group for 6 years à cohort
Gave patients survey about their treatment à cross sectional

QUESTION: Dentist is doing research on 5 unrelated patient with different background. He record data ……etc. Dentist is doing what kind of
research?
a. clinical trial
b. cohort
c. sectional
QUESTION: Study group A and B give some agents for plaque control then compare which agent is more effective. Which study is that? Clinical
trial
QUESTION: A study is done to determine the affectiveness of a new antihistamine .To do this, 25 allergic pt‟s are assigned to one of the two
groups ,the new drug (13 pt’s) , placebo (12 pt’s) . The pts are followed for 6 months . This study is called: Cohort, Cross-sectional, Case
controlled, historical cohort, clinical trial. ( assigned or give is the clue )

QUESTION: A study is designed to determine the relationship between emotional stress and ulcers. To do this, the researchers used hospital
records of pt's diagnosed with peptic ulcer disease and pt. diagnosed with other disorders over the period of time from july 1988 to july 1998 .
The amount of emotional stress each pt. is exposed to was determined from these records. This study is:
A) Cohort B)Cross-sectional C) Case-study* D)Historical Cohort E)Clinical Trial

QUESTION: A researcher conducting a research between students self studying and those attending lectures what is the independent variable?
students participating in research, material studied, Students results, Lecture of self study
- ATTENDING LECTURE or SELF STUDY (INDEPENDENT VARIABLE)
- STUDENTS RESULT (DEPENDENT VARIABLE)

QUESTION: Crossover study advantages: influence of confounding covariates is reduced because each crossover patient serves as his or her
own control and are statistically efficient and so require fewer subjects than do non-crossover designs (even other repeated measures designs).

QUESTION: Means of caries risk assessment for 3 groups: white, black, Hispanic what test do u use to compare?
A) chi square b) variance c) t-test

QUESTION: How do you compare between 2 constant variables? CHI SQUARE, regression analysis
QUESTION: Two groups of 100 ppl, gave them different foods & asked how they felt afterwards. which test to compare the 2 groups answers à
chi squared test

QUESTION: Want to compare 2 groups of people, male and female for something, what test do you look at? Multiple regression, Chi square
Test, T-test

QUESTION: What test measures 2 nonparametric data? Chi-square, normal distrubition, spearman, wilcoxin, kruskal wallis
QUESTION: Two common VARIABLE..what statistical test would you use? Chi-test, T-test, correlation analysis, or standard deviance
QUESTION: Given a case – what is the dependent variable? independent variable influences a dependent variable, or variables. Ie: effect of
Temperature on plant growth, temp = independent and growth; height, weight, # of fruits = dependent

QUESTION: confounding variants - a third variable or a mediator variable, can adversely affect the relation between the independent variable
and dependent variable. This may cause the researcher to analyze the results incorrectly. The results may show a false correlation between the
dependent and independent variables, leading to an incorrect rejectionof the null hypothesis.
THIS SHIT IS SO BORING, KEEP GOING…YOU CAN DO IT!
QUESTION: If you have a study of confounding variable – minimize confounding variables by randomizing
- minimize confounding variables by randomizing groups, utilizing strict controls, and sound operationalization practice all
contribute to eliminating potential third variables.

HYPOTHESIS:

Null hypothesis (H0) is a hypothesis which the researcher tries to disprove, reject or nullify.
- refers to the common view of something, while the alternative hypothesis is what the researcher really thinks is the cause of a
phenomenon.

Type I and Type II Null hypothesis:
- Type I Error- rejecting the null hypothesis when it is true. This is an alpha error. Another way to say this is, to reject a null that
should be accepted.
- Type II Error- accepting a false null hypothesis. This is a beta error. Another way to say this is, to accept a null that should be
rejected.


If the observed probability is ≤ .05 (5%), null hypothesis is rejected & outcome is judged as “no effect”. In this case, the alternative hypothesis is
adopted P , 0.05 = REJECT NULL = RESULTS ARE STATISTICALLY SIGNIFICANT I.E. DIDN’T JUST HAPPEN BY CHANCE

If the observed probability is > 5% the decision is to accept the null hypothesis & results are called “not statistically significant.

Sensitivity – percent of persons with the disease who are correctly classified as having the disease
- True Positive (TP) - Those that actually have it
- False negative (FN) - Those that are misdiagnosed as not having it
!"
!"#$%&%'%&( =
!" + !"
Specificity – percent of persons without the disease who are correctly classified as not having it
- True Negative (TN)-Those who are ACTUALLY disease free
- False positive (FP)- Those that are misdiagnosed as not as being disease free
!"
!"#$%&%$%'( =
!" + !!

QUESTION: Experiment was done and error = 0.05 was the goal but when completed it was 0.01. The question asks what type of error was it?
a. Type I
b. TYPE 2
c. no error: Error of less or equal of 0.5 no statistical significance..

QUESTION: P-significant value is equal to 0.01, your theory should be right, so you you will reject null hypothesis
QUESTION: Type I – false rejection of null hypothesis (false negative/incorrect regection) = less dangerous in terms of research and Type II –
false acceptance of null hypothesis (false positive/failure to regect) – less problematic bc no conclusion is made from a rejected null. But type 2
is more dangerous medically bc a patient is diagnosised as HEALTHY when they actually have the HIV.
QUESTION: The power of a statistical analysis is ultimately to: reject the null
QUESTION: Dentist in his clinic notices a new diseases this is? incidence
QUESTION: What is the statistical measure for the total number of cases per population, regardless of time of onset? I put prevalence
QUESTION: For a population, the research divides the number of disease cases by the number of people. By so doing, this investigator will have
calculated which of the following rates?
a. incidence Incidence should not be confused with prevalence, which is the proportion of cases in the population
at a given time rather than rate of occurrence of new cases. Thus, incidence conveys information about the
b. odds ratio
risk of contracting the disease, whereas prevalence indicates how widespread the disease is.
c. prevalence
d. specificity
QUESTION: Specificity: Proportion of truly nondiseased persons who are so identified by a screening test (measures “how good a test is at
correctly identifying nondiseased persons). Sensitivity tests identifying diseased persons.

- Specificity (without disease) and sensitivity (with disease)
QUESTION: If a dentist was able to correctly ID disease free patients w/ the diagnostic study, it has? high specificity.
QUESTION: You were looking for a disease in a study, disease was not present, what’s this called? – Specificity!
QUESTION: “if test determines those who do not have the disease is…specificity, sensitivity, validity.

QUESTION: Study says 95 out of 100 people had the disease what is lab value: 95% sensitivity
QUESTION: A study failed to report 5 cases of caries. What is this called? 1. True Positive, 2. True Negative, 3. False Positive, 4. False Negative
QUESTION: Incidence of caries in your office this year is 300 out of 1000, last year it was 200, so what is it for this year? 10%
- Incidence refers to NEW cases so the answer is (300-200)/1000 = 100/1000 = 0.1

QUESTION: Dentist has 300/1000 patients with periodontitis; last year only 200 had periodontitis, what is the incidence for this year: 10%
MEAN, MEDIAN, MODE:

mean (average)
median (middle number)
mode (number that shows up the most)

QUESTION: Which does not describe the spread of data? median. Range. Variance, stand deviation, standard error


QUESTION: Which of the following represents the variability about the mean-value of a group of observations?
A. Sensitivity
C. t-Statistic
D. Specificity

QUESTION: Histogram is used to show (standard deviation): mean, correlation of 2 variables, variance

QUESTION: Outliers control:
a. mean
b. median
c. mode

QUESTION: An outlier has the biggest effect on which of the following? Standard deviation

ORGANIZATION MEANS

- Categorical (nominal) is like black hair, blonde hair
- Ordinal: order or rank
o Ex. Low, medium, high or highschool, college, graduate school
- Interval is like ordinal but the values are EQUALLY SPACED – 10, 15, 20,
- Cardinal indicate quantity, tells how many
- Nominal names or ID something
- Ratio

QUESTION: Your office uses perio scale 1= gingivitis 2= mild perio 3= moderate/severe etc, what type of scale is this? Nominal, ordinal, ratio,
cardinal


QUESTION: Pulse + BP + Kelvins, what kind of measurement? nominal, ordinal, interval, ratio

a. ratio
b. nominal
c. interval

RANDOM QUESTIONS
QUESTION: When you smile, what is the black space buccal of teeth and next to cheeks? Buccal corridor
- it’s the space between teeth & cheek
QUESTION: Initiation of first menstruation cycle (menarche) is best indicative of what? Cognitive age, dental age, skeletal age
QUESTION: Menarche onset: before growth, during peak of growth, after peak of growth

QUESTION: Neuropraxia: transient episode of motor paralysis with little or no sensory or autonomic dysfunction. It
describes nerve damage in which there is no disruption of the nerve or its sheath.
- Interruption in conduction @ the axon (reversible nerve damage)

QUESTON: Axon damage most likely to cure itself? Neuropraxia

QUESTION: Neuropraxia involves: both perineurium and epineurium, only perineurium, only epineurium, none of the above (temporary
damage, nerve left intact)

QUESTION: What is Trephination? Hole is drilled or scraped into the human skull

QUESTION: Patient has HEB B antigens (HBsAg) in surface. What state is patient?
A. chronic
B. acute hepatitis contagious
C. acute hepatitis not contagious

QUESTION: If pt has HBsAb (antibody), that means that he was either vaccinated or recovered form infection

QUESTION: Patient tests POSITIVE HEP B test, all of his organs will be affect except:
Pancrease
Ugh, these typos…
Kidney
GI
thyroid
QUESTION: Biggest difference across cultures regarding pain:
Variability in pain threshold rather than pain tolerance
variability in pain tolerance rather than pain threshold
difference in stimulus awareness rather than pain tolerance
difference in stimulus awareness rather than pain threshold

QUESTION: Most common cause of frequent urination during 3 trimester? Pressure of uterus on bladder, gestatory diabetic
QUESTION: Innervation of soft palate? Glossopharyngeal
QUESTION: Best to use on infected oral wound? hydrogen peroxide, chlorhexidine
QUESTION: Which one is associated with bilirubin? Kernicterus

- Kernicterus is a bilirubin-induced brain dysfunction.

QUESTION: Multple Endocrime Neoplasia Syndrom: MEN- adrenal over production MENs
QUESTION: CASE:
b. What is her dental age based on x-rays à advanced, chronological lags behind dental
c. Tx for #D à TE
d. What to do with lesion on distal of #S (look incipient, resorbed): apply fluoride varnish every week, do DO comp or amalgam,
observe and reassess next visit, disc the distal surface
e. Both child and guardian should receive oral health instructions, oral health care should include daily fluoride rinses à both
statements are true.

QUESTION: Macroglossia seen in all EXCEPT?
See in Downs, usually see in patients that have been edentulous for a while
Causes of MACROGLOSSIA
- Inflammatory-------glossitis
- Traumatic-----------post operative edema
- Metabolic causes-------myxedema, amyloidosis, lipoid priotenosis, chronic steroid therapy And acromegaly.
Graves Sarcoidosis Long face
- Congenital causes------cretenism, hemangioma, lymphangioma, downs syndrome, beckwith-weidman syndrome, generalized
gangliosidosis syndrome, mycopolysachridosis.
Q. Through the bloodborne pathogen standard, the occupational safety and health
administration directs
activity for each of the following except one. Which one is the exception?
a. Using barrier techniques
b. Using material safety data sheets
c. Obtaining hepatitis B vaccines
d. Communicating hazards to employees
e. Performing housekeeping
Q. Stress and illness are often related. The best description of their relationship is which
of the following?
a. Stress is primary cause of illness
b. Illness is adaptation to stress
c. Stress is a psychological reaction
d. They often occur together but are casually unrelated
e. Stress is contributory to illness and illness is usually stressful
Q. On the basis of diagnostic test results, a dentist classifies a group of patients as

being free from
disease. These results possess high
a. Sensitivity
b. Specificity
c. Generalizability
d. Repeatability
Q. In pursuit of what the dentist believes is best for the patient, the dentist attempts to
control patient
behavior. This is known as
a. Autonomy
b. Competence
c. Maleficence
d. Paternalism
Q. Most epidemiologic studies indicate that gingivitis in children is relatively common. A

strong positive
association between specific nutritional deficiencies and the presence of periodontal
disease in children
and adults has been demonstrated.
1. both r true
2. both r false
3. 1st true, 2nd false
4. 1st false , 2nd true
Q. In assessing patient’s dental fears, the dentist should use each of the following
factors except one.
Which one is the exception?
a. Verbal statements
b. Physiological responses
c. Behavior
d. Personality
Q. HIPAA was designed to

A) ensure the security and privacy of health information
B) provide insurance coverage for providers
C) increase hospital testing ability
D) encourage employees to stay in their jobs to retain insurance coverage
Q. information about subjects in a study included their ethnicity. what level of

measurement is ethnicity?
1. ordinal
2. nominal
3. ratio
4. Interval
Q. MOST APPROPRIATE TEST TO DETERMINE THE DIFFERENCES BETWEEN TWO

MEANS?
CHI SQUARE TEST
T TEST
BOTH
Q. A patient after extraction says"Thank you,that wasent as bad as i expected,but my

sister told me that
the first night after having a tooth pulled is very painful.What if the medication u gave
me isnt strong
enough!?Choose the most appropriate answer.
1)Did she make you feel worried about that?
2)It sounds like you are worried that you might not have enough pain relief when ur
home.
3)I understand your concern
4)Dont worry i'll give you plenty of pain medication
5)it sounds like your sister had a unusually bad experiance.Dont let other worry
you,you'll be just fine.
Q. The most important concept of C.E.A. Winslow’s definition of public health is:
To encourage mental and physical efficiency
Promotion through organized community effort
Individuals acting alone can solve any problem
The science and art of preventing disease
( C.E.A. Winslow, characterized public health practice as the science and art of DISEASE
PREVENTION, prolonging life, and promoting health and well-being THROUGH
organized community effort.)
Q. A moderately mentally challenged 5-year-old child becomes physically combative.

The parents are
unable to calm the child. Which action should the dentist take?
Force the nitrous oxide nosepiece over the child’s mouth and nose.
Hand over mouth exercise (HOME).
Discuss the situation with the parents.
Firm voice control.
Q. Which of the following is the principal nonverbal cue that two or more people can
use to regulate
verbal communication?
eye contact
gentle touch
facial expressions
Q. In an experiment comparing the effectiveness of new flouride gel verses an older

flouride gel, a null
hypothesis is rejected when
1) a chi square is zero
2) a chi square is high
3) a chi square is low
4) the experimental and control groups have similar results
( If you have higher chi-square, there is a high likely chance of your p-value being less
than 0.05, so in that case you reject your null hypothesis.)
Q. On a prepayment basis, dental patients receive care at specified facilities from a

limited number of
dentists. This practice plan is classified as which of the following?
Closed panel
Open panel
Group practice
Solo practice
Q. Which of the following computer databases contain references to dental literature
electronically ?
1)LEXUS
2)OVOID-MEDLINE
3)Dental Abstracts
4)Index to dental Literature
Q. The measure of the quality of care provided in a particular setting is called:

Quality assurance
Quality evaluation
Quality assessment
Quality inspection
Q. Which of the following is a social enforcer for a child?

a. Dentist provides toothbrush kit
b. Allows child to watch his favorite tv show
c. Provide the child with stickers of his best cartoons
d. Pat on the back of the child's shoulder
Q. Which is not a part of classical conditioning:

1. Acquisition
2. Equilibration
3. Discrimination
4. Generalization
5. Extinction
6. Spontaneous recovery
Q. The following were the scores for six dental students in their restorative dentistry
exam :
56, 64, 68,46, 82,86.
Therefore the median is_____________
68
64
67
40
66
Q. Which of the following may be used to disinfect gutta percha points?

1)Glass bead
2)Autoclave
3)Chemical solutions
4)Dry heat
Q. Correlation analysis shows that as the income of population increases, the number of
decayed teeth
decreases. Therefore, an expected value for this correlation coefficient (r) would be -
1?T/F
Q. Which federal agency protects the health of Americans and provides essential human
services?
NIH
HRSA
DHHS
AHRQ
None of the above
Q. Which is the most important feature of systematic desensitization?

Muscle relaxation
Diaphragmatic breathing
Cognitive restructuring
Exposure
Education
Q. Which statement is incorrect about behavior change?

a.Shaping is a behavior change strategy in which the patient learns though
demonstration.
b.The behavioral model consists of antecedents, behaviors, and consequences.
c.Goals are long-term targets, whereas objectives are reachable steps along the way.
d.Positive consequences will strengthen a behavior and negative consequences will
weaken it.
e.Consequences of today’s behavior will affect behavior tomorrow.
Q. network model is often used in

1. D-IPA
2. D-HMO
3. D-PPO
Q. If a dentist is stuck with a needle while treating an HIV-infected patient, which
should he perform?
a.Stop work and apply hypochlorite 1:10 to the finger for 5 minutes
b.Stop work, compress the affected area, and apply hypochlorite
c.Antiretroviral therapy
d.Stop work, compress the affected area, and wash with soap and water
Q. The substitution of a relaxation response for an anxiety response using a relaxation

strategy such as
diaphragmatic breathing when one is exposed to a feared stimuli is called?
1)Progressive muscle stimulation
2)Habituation
3)Flooding
4)Systematic desensitization
5)Biofeedback
Q. When a patient expresses anger about a physician’s colleague,

which of the following statements would be the most appropriate
response?
a. Why are you so aggravated over something so trivial?
b. Before I ask any questions, please calm down.
c. What concerns do you have about how you were treated?
d. Why don’t we go talk to Dr. X about your anger?
Q. A patient has difficulty inhibiting the gag reflex during x-ray procedures. The patient
is asked to take
an x-ray packets home and practice holding the packet in his mouth for increasingly
longer periods.
Which technique is being used?
Graded exposure
Modeling
Reinforcement
Behavioral control
Systematic desensitization
Q. Which is not correct about stress?

a. Predictability-less predictability causes more stress.
b. Controllability - less controllability causes the more stress.
c. Familiarity-less familiarity causes more stress.
d. Positive situations are less stressful than negative situations.
e. Imminence-more imminent situations are more stressful.
Q. The following component of a scientific article provides the reader with detailed
information regarding
the study design:
A. Introduction
B. Background
C. Literature review
D. Methods
E. Abstract
Q. incidence of untreated coronal caries is higher in

causcasians or african american or identical for both
Q. A patient says that, “Even if there is some pain, it will be brief. I have effective
methods of coping.”
The patient reminds himself of this during dental procedures. This patient’s statement
exemplifies which
strategy?
Self-efficacy induction
Relaxation statement
Rational response
Imagery
Q. Ryan white care act provides dental care to HIV + / AIDS individual. They get their
funds via
1. NIH
2. AHRO
3. HRSA
4. NIDCR
Q. A student performs a complicated symphony, and he becomes less anxious each

time he performs.
Which phenomenon is this?
Habituation
Covert conditioning
Psychoeducation
Q. 5 year survival rate of oropharyngeal cancer is
1-25%
2-50%
3-60%
4-75%
Q. OSHA standard for mercury is

1. 1mg per cubic meter for 8 hr work shift
2. 0.1 mg cubic meter for 4 hr work shift
Q. Percentage of USA with Community water fluoridation

a. 40%
b. 60%
c. 80% it is 67-74
Q. Prevalance of subgingival calculus in US ADULTS as suggested by surveys is

A-0-0.25
B-0.25-0.5
C-0.5-0.75
D-0.75-1.0
Q. percentage of DFS is more in

- cacucasians , hispanics , blacks, asians
Q. outliers control
mean
median
mode
standard deviation
Q. Contaminate sharps must be handled in such ways except for

a.The container must be labeled
b.The container has a metal case
c.The container has to be non puncturable
d.The container must be closable.
Q. Which is the acceptable CDC water quality in a dental office?

<250 CFU/mL
<500 CFU/mL
<125 CFU/mL
<700 CFU/mL
Q. Which is the best question to ask a slightly nervous child?
1.Are you worried about pain?
2.Are you nervous?
3."Why can't you be quiet?"
4."Can you tell me what is bothering you?" Are you worried about the needle?"
Q. Test result which erroneously assigns an individual to a specific diagnostic or

reference group, due
particularly to insufficiently exact methods of testing is known as:
A false negative test
A true negative test
A false positive test
A true positive test
Q. Gi index - ordinal , right?
Q. Which term listed below measures the proportion of those without disease who
are correctly identified by a negative test:
Specificity
Sensitivity
Reliabilty
Q. A 38-year-old man is fearful of injections. First, you show him the syringe. You talk
about the
characteristics of the needle. You then place the needle in his mouth with the cap on
and simulate the
procedure with the cap on. You then simulate the procedure with the cap off.
Eventually, you proceed
with the injection. What method is being used to reduce fever?
1.Cognitive control
2.Systematic desensitization
3.Habituation
4.Flooding
5.Behavior modification
Q. if there is an article and if you want to underatand the definition of

Dependent and independent, which part of the article you look:
Introduction
Method
Body
Result
Summary
(its introduction or background in which u describe ur hypothesis definitions of
dependant and independant variables,
innovations, specific aims... define variables in introduction, methods of variable
recording is in method section)
Q. Researches showed to remove plaque from the resident’s teeth more effectively with
mechanical
toothbrushes than with manual ones. What is the independent variable in this study?
1) The gingival health of the residents
2) The amount of plaque present on the resident’s teeth
3) The type of toothbrush used
4) Time of day that brushing took place
5) How long teeth were brushed
Q. 70 percent dentists become anxious with anxious dental patients.

True /false
Q. Obtaining informed consent hold true in each of the following cases except:
1. A conscious mentally competent patient.
2. A pregnant patient
3. In emergency cases
Q. Providing and explaining the informed consent to the patient in understandable

terms is considered a
duty of:
1. The office receptionist
2. Dental assistant
3. Resident
4. Attending dentist
Q. In the section of a scientific aritcle,the researcher interprets and explains the results
obtained in?
1)results
2)summary and conclusion
3) discussion
4)abstract
5)none of the above
Q. HOME is an example of:
1. Positive reinforcement
2. Negative reinforcement
3. Positive punishment
4. Negative punishment
Q. Restoring a carious tooth relieved the toothache in a patient which further motivated
him to perform
better oral health care. This is a type of
Q. One of your patient is having a dental problem that is not under your capability and
you are referring
that patient to a specialist,this type of behavior comes under which of the following
codes?
1)autonomy
2)beneficience
3)veracity
4)nomaleficience
Q. what do we watch in a patient during dental dental treatment to find out if he's in
pain??
1) saliva
2) hair
3) lips
4) eyes
5) eye brows
Q. Women have a lower survival rate of cancer of the lip..T/F?
Q. Dental waterline should be flushed at beginning of day for

1.30 sec
2.45 sec
3.60 sec
Q. 1 L of 1 ppm of NaF contains how many G flouride? Ans:0.5

Q. what is the difference between flooding and systemic desensitlization?
Ans. Systemic desensitization uses a hierarchy of slowly increasing the anxiety
provoking stimuli like from least anxiety
provoking to most allowing the pt to use his coping skills.
In flooding there is a intense prolonged exposure to a feared stimulus at a time wherein
the pt uses coping skills to deal with the exposure.
In simple language systemic desensitization is step by step increase stimulus
And In flooding, it is everything at a single step
Q. While extracting a maxillary molar, you lose a root down the maxillary sinus which
cannot be retracted
at the moment. You do not inform the patient of the incident. Which code of ethical
principle did you
break?
1. Beneficence
2. Non malifecence
3. Patient Autonomy
4. Veracity
5. Justice
Q. Which will aid in the cognitive appraisal of a threat?

1.Adaptability, preventability, inevitability, and constancy
2.Controllability, familiarity, predictability, and imminence
3.Interference, adaptability, longevity, and reactance
4.Validity, reliability, adaptability, and predictability
5.Accountability, reliability, validity, and familiarity
Q. Which of the following are necessary for a test to be accurate?

1)specificity
2)reliability
3)validity
4)sensitivity
Q. when patient have to pay from his pocket??

deducible
copay
third pary payment
Q. A dentist is doing research on 5 unrelated patient with different background. He record data
……
etc.dentist is doing what kind of research?
a. clinical trial
b. cohort
c. Cross sectional
Q. how does parent of special needs child feel most of the time?
a.Hopeless
b.depressed
c.agitated
Q. which of the following MOST accurately explains how biofeedback works

a. it reduced cognitive dissonance
b. it stimulates the sympathetic nervous system
c. it relax and to some extent hypnotizes the patient
d. it distracts and engages the patient in an active coping task.
e. it enables the patient to gain control of certain physiological function
(Biofeedback therapy involves training patients to control physiological processes such as
muscle tension, blood pressure, or heart rate.
These processes usually occur involuntarily, however, patients who receive help from a
biofeedback therapist can learn how to completely manipulate them at will.
Biofeedback is typically used to treat chronic pain, urinary incontinence, high blood pressure,
tension headache, and migraine headache. )
Q. According to ADA publication entitled principles of ethics and code of professional conduct,
adentist can announce specialization in which of the following?
a. implantology
b. hospital dentistry
c. aesthetic dentistry
d. dental public health
e. geriatric dentistry
Q. What does the Weight and height stand for in recordings? Ans: Ratio
Q. where you can find dental literature online?

a. MEDLINE
b. lexus
c. Dental town
d. google
Q. Which of the following exhibits the MOST personal behavior by the dentist
A. leaning toward the patient
B. facing directly toward the patient
C. being seated 2 feet from the patient
D. touching the patient gently on the arm
Q. which is the acronym for a patient management system?

a. recruit
b. success
c. optimum
Q. persistent and repetitions questions asked by an 8 years old patient during treatment are ?
a. attempted to delay treatment
b. medication of hyperactivity
c. sign that child may be autistic
d. expression of the child curiosity about the treatment.
Q 1. Through the bloodborne pathogen standard, the occupational safety and health
administration directs
activity for each of the following except one. Which one is the exception?
a. Using barrier techniques
b. Using material safety data sheets
c. Obtaining hepatitis B vaccines
d. Communicating hazards to employees
e. Performing housekeeping
Q 2. Stress and illness are often related. The best description of their relationship is which of
the following?
a. Stress is primary cause of illness
b. Illness is adaptation to stress
c. Stress is a psychological reaction
d. They often occur together but are casually unrelated
e. Stress is contributory to illness and illness is usually stressful
Q 3. On the basis of diagnostic test results, a dentist classifies a group of patients as being
free from
disease. These results possess high
a. Sensitivity
b. Specificity
c. Generalizability
d. Repeatability
Q 4. In pursuit of what the dentist believes is best for the patient, the dentist attempts to
control patient
behavior. This is known as
a. Autonomy
b. Competence
c. Maleficence
d. Paternalism
Q 5. Most epidemiologic studies indicate that gingivitis in children is relatively common. A

strong positive
association between specific nutritional deficiencies and the presence of periodontal disease
in children
and adults has been demonstrated.
1. both r true
2. both r false
3. 1st true, 2nd false
4. 1st false , 2nd true
Q 6. In assessing patient’s dental fears, the dentist should use each of the following factors
except one.
Which one is the exception?
a. Verbal statements
b. Physiological responses
c. Behavior
d. Personality
Q 7. HIPAA was designed to

A) ensure the security and privacy of health information
B) provide insurance coverage for providers
C) increase hospital testing ability
D) encourage employees to stay in their jobs to retain insurance coverage
Q 8. information about subjects in a study included their ethnicity. what level of measurement
is ethnicity?
1. ordinal
2. nominal
3. ratio
4. Interval
Q 9. MOST APPROPRIATE TEST TO DETERMINE THE DIFFERENCES BETWEEN

TWO MEANS?
CHI SQUARE TEST
T TEST
BOTH
Q 10. A patient after extraction says"Thank you,that wasent as bad as i expected,but my sister
told me that the first night after having a tooth pulled is very painful.What if the medication u
gave me isnt strong enough!?Choose the most appropriate answer.
1)Did she make you feel worried about that?
2)It sounds like you are worried that you might not have enough pain relief when ur home.
3)I understand your concern
4)Dont worry i'll give you plenty of pain medication
5)it sounds like your sister had a unusually bad experiance.Dont let other worry you,you'll be
just fine.
Q 11. The most important concept of C.E.A. Winslow’s definition of public health is:
To encourage mental and physical efficiency
Promotion through organized community effort
Individuals acting alone can solve any problem
The science and art of preventing disease
Q 12. A moderately mentally challenged 5-year-old child becomes physically combative. The
parents are unable to calm the child. Which action should the dentist take?
Force the nitrous oxide nosepiece over the child’s mouth and nose.
Hand over mouth exercise (HOME).
Discuss the situation with the parents.
Firm voice control.
Q 13. Which of the following is the principal nonverbal cue that two or more people can use
to regulate
verbal communication?
eye contact
gentle touch
facial expressions
Q 14. In an experiment comparing the effectiveness of new flouride gel verses an older
flouride gel, a null
hypothesis is rejected when
1) a chi square is zero
2) a chi square is high
3) a chi square is low
4) the experimental and control groups have similar results
Q 15. On a prepayment basis, dental patients receive care at specified facilities from a limited
number of
dentists. This practice plan is classified as which of the following?
Closed panel
Open panel
Group practice
Solo practice
Q 16. Which of the following computer databases contain references to dental literature
electronically?
1)LEXUS
2)OVOID-MEDLINE
3)Dental Abstracts
4)Index to dental Literature
Q 17. The measure of the quality of care provided in a particular setting is called:
Quality assurance
Quality evaluation
Quality assessment
Quality inspection
Q 18. Which of the following is a social enforcer for a child?

a. Dentist provides toothbrush kit
b. Allows child to watch his favorite tv show
c. Provide the child with stickers of his best cartoons
d. Pat on the back of the child's shoulder
Q 19. Which is not a part of classical conditioning:
1. Acquisition
2. Equilibration
3. Discrimination
4. Generalization
5. Extinction
6. Spontaneous recovery
Q 20. The following were the scores for six dental students in their restorative dentistry exam
56, 64, 68,46, 82,86. Therefore the median is_____________
68
64
67
40
66
Q 21. Which of the following may be used to disinfect gutta percha points?
1)Glass bead
2)Autoclave
3)Chemical solutions
4)Dry heat
Q 22. Correlation analysis shows that as the income of population increases, the number of
decayed teeth
decreases. Therefore, an expected value for this correlation coefficient (r) would be -1? T/F
(X is q ( income increase) and y ( no of decayed decrease) so the value is -1)
Q 23. Which federal agency protects the health of Americans and provides essential human
services?
NIH
HRSA
DHHS
AHRQ
None of the above
Q 24. Which is the most important feature of systematic desensitization?

Muscle relaxation
Diaphragmatic breathing
Exposure
Education
Q 25. Which statement is incorrect about behavior change?

a.Shaping is a behavior change strategy in which the patient learns though demonstration.
b.The behavioral model consists of antecedents, behaviors, and consequences.
c.Goals are long-term targets, whereas objectives are reachable steps along the way.
d.Positive consequences will strengthen a behavior and negative consequences will weaken
it.
e.Consequences of today’s behavior will affect behavior tomorrow.
Q 26. network model is often used in

1. D-IPA
2. D-HMO
3. D-PPO
Q 27. If a dentist is stuck with a needle while treating an HIV-infected patient, which should
he perform?
a.Stop work and apply hypochlorite 1:10 to the finger for 5 minutes
b.Stop work, compress the affected area, and apply hypochlorite
c.Antiretroviral therapy
d.Stop work, compress the affected area, and wash with soap and water
Q 28. The substitution of a relaxation response for an anxiety response using a relaxation
strategy such as diaphragmatic breathing when one is exposed to a feared stimuli is called?
1)Progressive muscle stimulation
2)Habituation
3)Flooding
4)Systematic desensitization
5)Biofeedback
Q 29. When a patient expresses anger about a physician’s colleague,which of the following
statements would be the most appropriate response?
a. Why are you so aggravated over something so trivial?
b. Before I ask any questions, please calm down.
c. What concerns do you have about how you were treated?
d. Why don’t we go talk to Dr. X about your anger?
Q 30. A patient has difficulty inhibiting the gag reflex during x-ray procedures. The patient is
asked to take an x-ray packets home and practice holding the packet in his mouth for
increasingly longer periods.
Which technique is being used?
Graded exposure
Modeling
Reinforcement
Behavioral control
Q 31. Which is not correct about stress?

a. Predictability-less predictability causes more stress.
b. Controllability - less controllability causes the more stress.
c. Familiarity-less familiarity causes more stress.
d. Positive situations are less stressful than negative situations.
e. Imminence-more imminent situations are more stressful
Q 32. The following component of a scientific article provides the reader with detailed
information regarding
the study design:
A. Introduction
B. Background
C. Literature review
D. Methods
E. Abstract
Q 33. incidence of untreated coronal caries is higher in

causcasians
or african american or
identical for both
Q 34. A patient says that, “Even if there is some pain, it will be brief. I have effective
methods of coping.” The patient reminds himself of this during dental procedures. This
patient’s statement exemplifies which
strategy?
Self-efficacy induction
Relaxation statement
Rational response
Imagery
Q 35. Ryan white care act provides dental care to HIV + / AIDS individual. They get their
funds via
1. NIH
2. AHRO
3. HRSA
4. NIDCR
Q 36. A student performs a complicated symphony, and he becomes less anxious each time
he performs. Which phenomenon is this?
Habituation
Covert conditioning
Psycho-education
Q 37. 5 year survival rate of oropharyngeal cancer is
1-25%
2-50%
3-60%
4-75%
Q 38. OSHA standard for mercury is

1. 1mg per cubic meter for 8 hr work shift
Q 39. Percentage of USA with Community water fluoridation

a. 40%
b. 60%
c. 80%
Q 40. Prevalance of subgingival calculus in US ADULTS as suggested by surveys is

A-0-0.25
B-0.25-0.5
C-0.5-0.75
D-0.75-1.0
Q 41. percentage of DFS is more in

- cacucasians , hispanics , blacks, asian
Q 42. outliers control

mean
median
mode
standard deviation
Q43. incidence of coronal caries is higher in

causcasian or african american or identical for both
Q 44. Contaminate sharps must be handled in such ways except for

a.The container must be labeled
b.The container has a metal case
c.The container has to be non puncturable
d.The container must be closable
Q 45. Which is the acceptable CDC water quality in a dental office?

<250 CFU/mL
<500 CFU/mL
<125 CFU/mL
<700 CFU/mL
<1000 CFU/mL
Q 46. Which is the best question to ask a slightly nervous child?

1.Are you worried about pain?
2.Are you nervous?
3."Why can't you be quiet?"
4."Can you tell me what is bothering you?" Are you worried about the needle?"
Q 47. Test result which erroneously assigns an individual to a specific diagnostic or reference
group, due particularly to insufficiently exact methods of testing is known as:
A false negative test
A true negative test
A false positive test
A true positive test
Q 48. Gi index - ordinal, right
Q 49. Which term listed below measures the proportion of those without disease who
are correctly identified by a negative test:
Specificity
Sensitivity
Reliability
Q 50. A 38-year-old man is fearful of injections. First, you show him the syringe. You talk
about the characteristics of the needle. You then place the needle in his mouth with the cap on
and simulate the procedure with the cap on. You then simulate the procedure with the cap off.
Eventually, you proceed with the injection. What method is being used to reduce fever?
1.Cognitive control
2.Systematic desensitization
3.Habituation
4.Flooding
5.Behavior modification
Q 51. if there is an article and if you want to underatand the definition of

Dependent and independent, which part of the article you look:
Introduction
Method
Body
Result
Summary
Q 52. Researches showed to remove plaque from the resident’s teeth more effectively with
mechanical toothbrushes than with manual ones. What is the independent variable in this
study?
1) The gingival health of the residents
2) The amount of plaque present on the resident’s teeth
3) The type of toothbrush used
4) Time of day that brushing took place
5) How long teeth were brushed
Q 53. 70 percent dentists become anxious with anxious dental patients.

true
false
Q 54. Obtaining informed consent hold true in each of the following cases except:
1. A conscious mentally competent patient.
2. A pregnant patient
3. In emergency cases
Q 55. Providing and explaining the informed consent to the patient in understandable terms is
considered a duty of:
1. The office receptionist
2. Dental assistant
3. Resident
4. Attending dentist
Q 56. In the section of a scientific article, the researcher interprets and explains the results
obtained in?
1)results
2)summary and conclusion
3)discussion
4)abstract
5)none of the above
Q 57. HOME is an example of:

Q 58. Restoring a carious tooth relieved the toothache in a patient which further motivated
him to perform better oral health care. This is a type of
Q 59. One of your patient is having a dental problem that is not under your capability and you
are referring that patient to a specialist, this type of behavior comes under which of the
following codes?
1)autonomy
2)beneficience
3)veracity
4)non-maleficience
Q 60. what do we watch in a patient during dental treatment to find out if he's in pain??
1) saliva
2) hair
3) lips
4) eyes
5) eye brows
Q 61. Women have a lower survival rate of cancer of the lip..T/F?
Q 62. Dental waterline should be flushed at beginning of day for

1.30 sec
2.45 sec
3.60 sec
Q 63. 1 L of 1 ppm of NaF contains how many G flouride?
Q 64. what is the difference between flooding and systemic desensitlization?
Q 65. While extracting a maxillary molar, you lose a root down the maxillary sinus which
cannot be retracted at the moment. You do not inform the patient of the incident. Which code
of ethical principle did you break?
1. Beneficence
2. Non malifecence
3. Patient Autonomy
4. Veracity
5. Justice
Q 66. Which will aid in the cognitive appraisal of a threat?

1.Adaptability, preventability, inevitability, and constancy
2.Controllability, familiarity, predictability, and imminence
3.Interference, adaptability, longevity, and reactance
4.Validity, reliability, adaptability, and predictability
5.Accountability, reliability, validity, and familiarity
Q 67. Which of the following are necessary for a test to be accurate?

1)specificity
2)reliability
3)validity
4)sensitivity
Q 68. when patient have to pay from his pocket??
deducible
copay
third pary payment
Q 69. A dentist is doing research on 5 unrelated patient with different background. He record
data ……etc. dentist is doing what kind of research?
a. clinical trial
b. cohort
c. Cross sectional
Q 70. how does parent of special needs child feel most of the time?
a.Hopeless
b.depressed
c.agitated
Q 71. which of the following MOST accurately explains how biofeedback works
a. it reduced cognitive dissonance
b. it stimulates the sympathetic nervous system
c. it relax and to some extent hypnotizes the patient
d. it distracts and engages the patient in an active coping task.
e. it enables the patient to gain control of certain physiological function
Q 72. According to ADA publication entitled principles of ethics and code of professional
conduct, adentist can announce specialization in which of the following?
a. implantology
b. hospital dentistry
c. aesthetic dentistry
d. dental public health
e. geriatric dentistry
Q 73. What does the Weight and height stand for in recordings? ratio?
Q 74. where you can find dental literature online?

a. MEDLINE
b. lexus
c. Dental town
d. google
Q 75. Which of the following exhibits the MOST personal behavior by the dentist
A. leaning toward the patient
B. facing directly toward the patient
C. being seated 2 feet from the patient
D. touching the patient gently on the arm
Q 76. which is the acronym for a patient management system?

a. recruit
b. success
c. optimum
Q 77. Persistent and repetitions questions asked by an 8 years old patient during treatment
are?
a. attempted to delay treatment
b. medication of hyperactivity
c. sign that child may be autistic
d. expression of the child curiosity about the treatment.
A patient’s mandibular canal is positioned lingually to her mandibular third molar. In what direction
would the canal appear to move on a radiograph, if the X-ray tube were moved inferiorly (i.e., if the x-
ray beam were pointing superiorly)?
A- Apically
B- Mesially
C- Distally
D- Occusally
Which of the following neuralgias is correctly associated with its cranial nerve?
A furcation radiolucency in a 5-year-old child’s primary molar is most due to
A- Trauma
B- Pulpal necrosis
C- Normal anatomy
Which of the following is most likely the major consideration prior to performing a gingivectomy?
53. Regeneration of the periodontal attachment apparatus include

What is the tube made up of?
What type of wavelength should be obstructed or something like that?
When takin an xray if a patient moves and if the distance between the patient and xray is more than
recommended how would the xray look like? Very weird question
X ray of an ear lobe–
X ray of a periapical irregular radiolucency
One advantage of using a fiber-reinforced post for restoring an endodontically treated tooth is that it
Carrot stick question
A 65-year-old white male smokes 2 packs of cigarretes per day. He had a heart attack six weeks ago and
continues to have chest pains even while at rest. He is transported to the office by wheelchair because
be becomes extremely short of breath with even mild exertion. The physical status that best describes
the above patients is I got this same question but the options were totally different. It was something
like call patient for multiple visits per week please check this question
Mandibular hypoplasia, coloboma of the lower eyelid, and malformations of the prinna of the ear are
fracture of which of the following diseases?
A- Apert Syndrome
D- Crouzon syndrome (craniofacial dysostosis
Question related to sequence of extraction in a pedo patient of an 11 year old patient who has multiple
caries and
Melanoma found commonly in which area ?
What will happen if you wash xray film under running water for a very long time?
Diagnosis of a periapical, asymptomatic radiolucent lesion?

Antifungal that can only be used topically?
Which medications acts on GABA and PABA ?
Not a reliable blood test for hemophilia?
Which is not a side effect of opiods?
Unstimulated salivary flow?
I don’t rembr exactly but their was a question about rg of sickle cell or thalassemia patient.
Similar kind of question hydroquinione and elon in developing agent converts silver halide
crystals and generates
grey tones
black tones
white tones
definition of rapport
neurogenic shock and maniac disorder treatment ?
4–5 questions based on null hypothesis and type of error?
Questions on working and non–working? I think it was from rita .
Tetracycline mostly affects which part of a tooth in a kid ? I don’t rember the age but I am sure it was
not related to pregnant lady taking tetracycline
A white lesion appearing on and off on tongue?
Mango question What was Chess and Thomas categories of Childern Temprture?I (Activity ,
rhythmicity,
distraction, approach)
Distance between Implant and tooth?
Burkitt lymphoma?
Kelly’s syndrome?
Which of the following is a interference during working movements for a posterior complete crown
restoration?
. During a routing examination, the dentist sees a large radiolucency at the apex of the maxillary right
first premolar. The tooth is not painful, does not respond to pulp testing, and has no evidence of a sinus
tract. The most probable diagnosis is
Diagnostic radiology is based on which of the following interactions of X-radiation with matter?
A- Thompson effect
B- Pair production
A question on melkerson Rosenthal syndrome
In examining a maintenance patient, the dentist observes residual calculus, bleeding on probing, and
probing depths less than 5 mm. The dentist should do which of the following?
A- Scaling root planing and antibiotics
B- Osseous surgery
Treatment fo HPV, CMV, EBV? Valcyclovir
Elder abuse? department of health and human services
A dentist has planned in-office-bleaching and porcelain laminate veneers for a patient’s maxillary
anterior teeth. What would be the best sequence of treatment?
Fluoride supplement for 9 months old ?
Topical antibiotic in oral cavity?
From KIWI
Ques 955, 1051, 1061, 1063, 1067,1122, 1128,1129, 1141, 1142,1149,1165,1177, 1355, 1394, 1400.1402
Day 2
From kiwi
I had similar kind of cases but very twisted questions and vague answers but were about 40–50% same.
Case 2, case 15, case 21, 27, 36
These are questions from rita’s file. The highlighted questions are from my and
few previous exams. They are the most repeated questions from this file.

D- Analgesia
ANS:C
Q7: Adrenal suppression may result from which of the following regimens of
hydrocortisone?
A- 20 mg for 2 weeks within 2 years
B- 2 mg for 2 weeks within 2 years
C- 10 mg for 1 week within 1 year
D- 1 mg for 1 week within 1 year
ANS:A
Q8: Which of the following 2 designs in tooth preparation can be used with
all-ceramic crowns?
A- Butt-joint shoulder or chamfer
B- Bevel or butt-joint shoulder
C- Bevel or feather edge
D- Chamfer or feather edge
ANS: A
Q9: The highest incidence of caries around Class II composite resin

restorations occurs on which of the following margins?
A- Occlusal
B- Facial proximal
C- Lingual proximal
D- Gingival proximal
ANS: D
Q11: Which of the following is NOT correct concerning informed consent?

A- It must be obtained in advance of treatment
B- It must be in writing
C- It must include risks, benefits, and complications
D- It must include treatment options
ANS: B
Q12: When performing a pulpal evaluation, the dentist should ideally use
which of the following as controls?
A- Adjacent teeth only
B- Adjacent teeth and opposing tooth
C- Adjacent teeth and contralateral tooth
D- Opposing tooth and contralateral tooth
ANS: C
Q15: A fail-safe mechanism on an analgesia machine for nitrous oxide and

oxygen prevents the delivery of nitrous oxide greater than
A- 20 percent
B- 50 percent
C- 70 percent
D- 90 percent
ANS:C
Q18: What is the most likely pulpal diagnosis for a primary molar with deep
Q22: Which of the following clinical entities is most likely to be misdiagnosed

as an endodontic lesion?
A- Lateral periodontal cyst
B- Periodontal abscess
C- Tori or exostoses
D- Gingival cyst
ANS: A
Q23: A patient is complaining about bleeding and pain when they brush.
Which is the most appropriate initial response to initiate the patient’s oral
health behavior change?
A- “So you want healthy teeth and the gums but it hurts when you brush”
B- “No pain no gain. You want the benefits of brushing but it hurts”
C- “Keep brushing even if it hurts. You know you have to do it”
D- “I’d to hear that you are brushing every day when you come back”
ANS: A
Q24: Low-dose aspirin therapy prevents the formation of thromboemboli by

preferentially inhibiting which of the following?
A- Phospholipase A2 in the blood vessels walls
B- Prsotacyclin synthetase in the blood vessels walls
C- Tromboxane synthetase in the platelets
D- Vitamin K in the liver
ANS: C
Q25: What is the predominant method of financing dental care in Health

Maintenance Organizations?
A- Fee for service
B- Capitation
C- Usual, customary, and regular fee
D- Table of allowances
ANS:B
Q26: Billing for a full-mouth series of radiographs as if they were a number of

individual radiographs is an example of
A- Non-rendering services
B- Upcoding
C- Unbunding
D- Mischaracterization
ANS: C
Q28: Which differential diagnostic method is best for determining whether

pathosis is endodontic or periodontic in nature?
A- Pulp vitality testing
B- Nature of symptoms
C- History of periodontal disease
D- Location of swelling, if present
ANS: A
Q29: Which action represents the most effective means of preventing caries
on overdenture roots?
A- Daily treatment with prescription fluoride gel
B- Coverage of roots with cast copings
C- Daily treatment with antimicrobial rinse
D- Placement of amalgam restoration in root canal orifice
ANS : B FIRST FROM DD IF NOT AVAILABLE THEN A
Q30: Which type of enamel caries has a broad area of origin with a conical or
pointed extension towards the DEJ?
A- Pit and fissure caries
B- Smooth surface caries
C- Cusp tip caries

D- Root surface caries
ANS: B
Q32: A patient on intravenously administered bisphosphonate therapy for 2

years has caious and non-restorable anterior teeth. Which is the best
treatment option?
ANS: B CORONOCTOMY , EXTRACTION CONTRAINDICATED HERE
Q36: Which of the following conditions is associated with hypodontia?

A- Ectodermal dysplasia
C- Apert Syndrome
D- Gardner syndrome
ANS: A
Q37: Cervical caries can be secondary to the effect of radiation on

A- Enamel
B- Dentin
C- Cementum
D- Salivary gland
E- Alveolar crestal bone
ANS: D
Q39: Methods to prevent overheating of the bone implant site preparation
include the use of which of the following?
A- High speed handpiece
B- Chlorhexidine irrigation
C- High torque handpiece
D- Air cooling
ANS: C LOW SPEED HIGH TORQUE
Q40: When the isthmus of a MOD cavity preparation is extended beyond 1/3 of
the cusp-tip to cusp-distance, the restoration of choice is a
A- MOD amalgam
B- MOD inlay
C- MOD onlay
D- Full crown
ANS:C RESISTANCE ISSUE
Q41: What final process in coronary arteries causes myocardial infarction

rather than angina?
B- Arterial spasm
C- Thrombosis
D- Fatty deposits
ANS:C
Q44: The minimum required bony buccolingual ridge width in millimeters for
placement of 4.0 mm root form implants is which of the following?
A- 4
B- 6
C- 8
D- 10
ANS:B
Q45: What is the EXCEPTION to the 5 principles of the ADA Principles of

Ethics and Code of Professional Conduct?
A- Nonmaleficence
B- Competency
C- Justice
D- Veracity
ANS:B
Q46: An articulating paper mark on the lingual incline of the buccal cusp of
the mandibular molar represents which type of interference?
A- Working
B- Non-working
C- Protrusive
D- Retrusive
ANS:B
Q47: Which of the following is most likely to create complications when
making an acrylic resin temporary restoration for a large MOD onlay
preparation?
A- Overextended resin removed
B- Undercuts in the preparation blocked out
C- Completion of polymerization outside the mouth
D- Occlusal surfaces left in slight infraocclusion
ANS:D SOME SUGGEST B, it is not c because it says outside the mouth, check it

A- With anxiety
ANS:D
Q49: Administration of nitrous oxide/oxygen is contraindicated in which of

the following conditions?
A- Asthma
B- Hemophilia
C- Nasal congestion
ANS:C
Q50: A dentist administered a survey to patients to determine their

satisfaction with practice characteristics and services provided. The survey
was administered to patients seen during 1 month. Which type of study
design was used by the dentist?
A- Cross-sectional
B- Cohort
C- Case control
D- Clinical trial
ANS: A

ANS : A

ANS: A
Q53: For a patient with myasthenia gravis, which of the following
medications is acceptable?
A- Erythromycin
B- Clarithromycin
C- Imipenem
D- Penicillin
ANS: D
Q54: The gingival around teeth and the mucosa around implants have similar
A- Connective tissue attachments
B- Alignment of collagen fiber bundles
C- Non-keratinized junctional epithelia
D- Distribution of vascular structures apical to the junctional epithelia
ANS:C
Q55: 40-year- old patient has 32 unrestored teeth. The only defects are deep-
stained grooves in posterior teeth. The grooves are uncoalesced. What is the
A- Periodic observation
B- Pit and fissure sealant
C- Preventive resin restoration
D- Application of topical fluoride
ANS:A
or extent of
A- Decay
B- Pain
C- Inflammation
ANS:C mosbey second edition page 5
Q61: A person best exemplifies active listening by doing which of the

following?
A- Rephrasing the listener’s understanding of the speaker’s communication
B- Using direct eye contact
C- Gathering pertinent information from the speaker quickly and succinctly
D- verifying that the speaker has heard what the listener has said
ANS:B
Q64: Which of the following represents the most frequent cause of failure of
dental amalgam restorations?
B- Improper cavity design
C- Improper condensation
D- Inadequate trituration
ANS:A failure is due to moisture contamination , fracture is due to improper cavity design
Q65: Which primary tooth, if lost prematurely, will most frequently result in
space loss?
A- Maxillary canine
B- Maxillary first molar
C- Mandibular second molar

ANS: C
Q66: Which of the following explains why proper contouring of the axial
surface of complete cast restorations is extremely important?
A- Retention
B- Occlusal wear
C- Effect on gingival tissue health
D- Ability to provide caries resistance
ANS:C
Q68: A 52-year-old female presents with red, glossy, and swollen gingival.
She has denuded and red areas on both buccal mucosae. The lesions have
been present for months and vary from time to time in severity. Which of the
following represents the most probable diagnosis?
A- Vitamin deficiency
B- Linear gingival erythema
C- Erosive lichen planus
ANS: C
Q70: Stridor is diagnostic for

A- Laringospasm
B- Bronchospasm
C- Hypotension
D- Hypothermia
ANS: A
Q71: Which of the following represents the function of occlusal (night)

guards?
A- Reduce mobility
B- Prevent bruxism
C- Increase attachment level
D- Redistribute forces on the teeth
ANS:D it doesn’t prevent bruxism, it eliminates its effects on teeth by distributing forces
Q73: Which of the following refers to a decreased occlusal vertical

dimension?
A- Vertical dimension that leaves the teeth in a clenched, closed relation in normal position
B- Occluding vertical dimension that results in a excessive interocclusal clearance when the mandible is
in rest position
C- Insufficient amount of interarch distance because of the bony ridges
D- Condition in which the patient cannot open mandible because of temporomandibular joint pathology
ANS:B
Q74: Which of the following is NOT an indication for removal of a third molar?
A- The presence of bony pathology
B- History of repeated pericoronal infections
C- Prevent crowding and displacement of the incisor teeth
D- Advanced, generalized periodontal disease that endangers the second molar
ANS:C
Q75: The decision to reduce a cusp and restore it should be based primarily
upon which principle?
A- Outline form
B- Retention form
C- Resistance form
D- Convenience form
ANS:C
Q76: A patient says, “I have been avoiding coming to see you because there
is an ugly, red sore spot on the roof of my mouth”. Which of the following
responses by the dentist best exemplifies a reflective response?
A-“Has you diet changed lately”
B-“You really shouldn’t worry about it”
C-“Don’t be afraid, I’ll take a careful look”
D-“You should have had something like that looked at right away”
E-‘It sounds as if you’re quite concerned about this condition”
ANS:E
Q77: Filtration is used in dental x-ray machines to remove

A- Scatter radiation photons
B- High energy electrons
C- Long wavelength photons
D- Low energy electrons
ANS:C
Q78: In examining a maintenance patient, the dentist observes residual

calculus, bleeding on probing, and probing depths less than 5 mm. The
dentist should do which of the following?
A- Scaling and root planing
B- Osseous surgery
ANS:D some suggested a , but it is a secondary visit , it means dentist failed to

eliminate all the calculus at the first visit , maybe because improper access or
visualization , so the suggested tt here to open flap for debridement
Q79: Which of the following sealer components interferes with composite

resin polymerization?
A- Zinc oxide
B- Zinc stearate
C- Polyvinyl resin
D- Eugenol
ANS:D
Q80: Which of the following is LEAST important in determining the outline

form a class III composite restoration?
A- Convenience for access
B- Extension for prevention
C- Size, shape, and location of caries
D- Esthetics
ANS:B
Q83: If there is insufficient space between the maxillary tuberosity and the
retromolar pad, then the dentist should
A- Open the articulator to gain space
B- Avoid covering the pad with the mandibular base
C- Avoid covering the macillary tuberosity
D- Surgically reduce the occlusal aspect of the tuberosity
ANS:D
Q84: Which of the following factors has the LEAST effect on the prognosis of
a periodontally involved tooth?
A- Degree of mobility
B- Suppuration from the pocket
C- Amount of attachment loss

D- Degree of furcation involvement
ANS:B
Q88: The incisal guide table is designed to

A- Allow selective grinding of anterior teeth
B- Prevent overclosure of the vertical dimension
C- Prevent posterior cusps from exceeding the condyle angle
D- Protect the function and arrangement of anterior teeth
ANS:D
Q89: Pseudomembranous colitis can occur most readily after prolonged oral
administration of which of the following drugs?
A- Erythromycin
B- Penicillin V
C- Clindamycin
D- Sulfisoxazole
E- Azithromycin
ANS:C
Q90: Trough the bloodborne Pathogen Standard, the Occupational Safety and
Health Administration (OSHA) directs all health-care workers, in carrying out
infection control, to use universal precautions.
- Based on these OSHA guidelines, patients identified as carriers of blood-

borne pathogens require special infection-control considerations

ANS:C
Q91: Which finding would most likely suggest a non-odontogenic toothache?

A- Pain intensified by heat
B- Local anesthesia does not eliminate pain
C- Dull, aching, throbbing pain
D- Pain intensity changing over time
ANS:B
Q93: For the porcelain veneer preparation, the standard amount of tooth
reduction in the middle one third of the facial surface is
A- 0.3 mm
B- 0.5 mm
C- 0.8 mm
D- 1.0 mm
ANS:B
Q96: Which form external root resorption is associated with pulpal necrosis?
A- Inflamatory
B- Replacement
C- Surface
D- Idiopathic
ANS:A
Q97: When designing a clinical study, one uses the power of the statistical
test to accomplish which of the following?
A- Measure validity

ANS:C
Q98: Which type of root resorption results in ankylosis?

A- Inflamatory
B- Replacement
C- Internal
D- External
ANS:B
Q99: - Which of the following can have prodromal symptoms which mimic
dental pulp pain?
A- Cytomegalovirus infection
B- Herpangina
C- Herpes zoster
D- Primary herpetic stomatitis
ANS: C
Q100: The drug of choice for marked bradycardia is which of the following?
A- Atropine
B- Epinephrine
C- Propanolol
D- Calcium chloride
ANS: A
Q101: Diagnostic radiology is based on which of the following iteractions of

X-radiation with matter?
A- Thompson effect
B- Pair production
ANS:C
Q104: Which part of the cutting edge of the curet should be adapted to the
line angle of the tooth?
A- Lower third
B- Middle third
C- Upper third
D- Entire cutting edge
ANS:A
Q107: Primary dentition calcification begins at

A- 2 months in utero
B- 4 months in utero
C- 8 months in utero
D- Birth
ANS:B
Q110: Angioedema is associated with which of the following medications?
A- Angiotensin-converting enzyme (ACE) inhibitors
B- Calcium channel blockers
C- Beta-blockers
D- Diuretics
ANS: A
Q111: Periodontal maintenance following completion of active periodontal

therapy
A- Should only be done by periodontist
B- Should be tailored to the needs of the individual patient
C- Is not a cost-effective approach for ongoing patient care
D- Requires strict adherence to a 6-month interval
ANS:B
Q114: What is the optimal average amount of fluoride, in ppm, for public
drinking water of most communities?
A- 0.5
B- 0.7
C- 1.0
D- 1.2
ANS:C OR B , STILL ARGUING ON THIS ONE
Q115: Which of the following is the most important factor in determining

patient satisfaction with dentures?
A- Dentist-patient relationship
B- Bone height for denture fit
C- Patient personality traits
D- Technical quality of the denture
E- Cultural definitions of esthetics
ANS:E OR C NOT CONFIRMED YET
Q116: After receiving an inferior alveolar nerve block the patient develops a
needle track infection. Which of the following anatomic spaces might have
been involved?
A- Temporal
B- Submandibular
C- Pharyngeal
D- Pterygoid
ANS: D
Q120: Which of the following would be the best orthognathic surgical option
for a patient that has an 8mm anterior open bite?
A- LeFort I osteotomy
B- Intraoral vertical oblique osteotomy
C- Sagittal split osteotomy
D- Sliding genioplasty
ANS:A
Q121: Some metal elements used in ceramic restorations have been known
to cause reactions in patients. The most common causative element is
A- Cobalt
B- Nickel
C- Chromium
D- Beryllium
ANS:B
Q124: Tree months ago, an epidemiologist conducted clinical examinations to

assess the dental caries experience of elementary school children. The study
could best described as
A- Retrospective
B- Case- control
C- Cross-sectional
D- Prospective
ANS:C
Q129: -What pathogenic microbiota is most likely associated with a failing

implant?
ANS:C
Q131: Which of the following is NOT true regarding orthodontic tooth

movement?
ANS: B
Q132: The dentist places a MOD amalgam restoration on tooth 30. The
patient bites down immediately after carving, and the marginal ridge
fractures easily. Which amalgam properties contributed to this failure?
A- Creep
B- Resilience
C- Edge strength
D- Setting time
ANS: D
Q133- Which of the following is NOT an internal line angle found in a disto-
occlusal (DO) class II cavity preparation?
A- Axio pulpal
B- Axio gingival
C- Distoaxial
D- Mesio facial
ANS:C
Q134- When used for intravenous conscious (moderate) sedation, midazolam

(Versed) produces
A- Amnesia
B- Analgesia
C- Antitussive activity
D- Cardiovascular depression
ANS:A
Q135- Perforation at which of the following sites has the poorest prognosis?
A- At the apex
B- 3mm coronal to the apex
C- 3mm apical to the gingival sulcus
D- 3mm coronal to the gingival sulcus
ANS: C
Q140- Which of the following represents the initial consideration in the

treatment planning progress?
A- Medical/systemic evaluation
B- Periodontal evaluation
C- Radiographic evaluation
D- Elimination of pain and discomfort
ANS:A KAPLAN
Q143- What is the most common form of wound healing after a periodontal
flap surgery?
ANS: A
Q145- The purpose of electronic pulp testing is to differentiate

A- Various stages of pulpitis
B- Normal pulp from diseased pulp
C- Between pulpitis and periodontitis
D- Between responsive and unresponsive pulpal nerves
ANS:D
Q147- Which of the following best describes the outcome of and intrapulpal
anesthetic injection?
A- Provides anesthesia by back-pressure
B- Control intrapulpal hemorrhage
C- Does not create any period of discomfort during injection
D- Usually provides anesthesia after 30 seconds of depositing anesthetic
ANS:A
Q148- Smokeless tobacco has NOT been associated with which of the
following?
A- Tooth abrasion
B- Gingival recession
C- Verrucous carcinoma
D- Nicotine stomatitis
E- Squamous cell carcinoma
ANS:D
Q149- Opiates do NOT produce which of the following effects?

A- Diuresis
B- Euphoria
C- Mental clouding
ANS:A
Q157: A 21-year-old male has a painless, compressible and fluctuant, slowy

growing enlargement of the anterior midline of the neck. Which of the following
is the most likely diagnosis?
A- Squamous cell carcinoma
B- Branchial cleft cyst
C- Thyroglossal duct cyst
D- Epidermoid cyst
Ans: c
Q159: Dens invaginatus is most commonly associated with which tooth?

B- Mandibular central incisor
C- Maxillary lateral incisor
D- Mandibular lateral incisor
Ans: c
Q161: A child watches her older brother receive dental treatment. The dentist
notices that the next time the child is in the dental chair her behavior is greatly
improved. This is an example of
A- Classical conditioning
B- Primary reinforcement
C- Modeling
D- Cognitive coping strategy
Ans: C
165. The strength of a soldered connector is best increased by
A- Using a higher carat solder
B- Electroplating the joint with gold prevent corrosion
C- Increasing its dimension in a direction parallel to the applied force
D- Increasing its dimension in a direction perpendicular to the line applied force
E- Increasing the with of the joint by having a space of at least 0.5 inch between
the parts to be soldered
Ans: C
Q170: Rising with a new mouthrinse results in a statistically significant decrease

in the Gingival Index (GI) score, but does NOT result in improved oral health for
the patient. This finding suggest which of the following?
A- Non-clinical significance
B- Double-blind study
C- Improper study desing
D- Bias
Ans: A
Q173: Which of the following is NOT one of the major classes of drugs used to
treat angina?
A- Thiazides
B- Beta-blockers
C- Nitrates and nitrites
D- Calcium channel blockers
ANS:A
Q176: What is the best indicator of periodontal stability over time for the
patient on periodontal maintenance therapy?
A- Plaque control
C- Probing depths
Ans: B
Q178: A 45-year-old patient has undergone scaling and root planing in all 4
quadrants. The oral hygiene of the patient is excellent but generalized 5 mm
and 6 mm pockets remain that bleed upon probing. What is the next step and
the best treatment for the patient?
A- Periodontal surgery
B- Maintenance therapy
C- local drug delivery
D- additional round of scaling and root planning
Ans: a
Q179: A dentist considers using nitrous-oxide conscious sedation for a patient.

This type of sedation will be contraindicated, however, if the patient has a
history of which of the following?
A- Psychosis
B- Chronic pain
C- Hypertension
D- Dental anxiety
E- Depression
Ans: A
q181:Which of the following is NOT true regarding topical fluoride?
A- Promotes remineralization of surface enamel
B- Inhibits bacterial plaque glycolysis
C- Has a direct antibacterial effect on plaque
D- Enhances enamel pt and fissure coalescence
ans:D
Q183 : An extended course of cortisone therapy can produce
A- Osteoporosis
B- Osteopetrosis
C- Osteoclerosis
D- Osteochondritis
ANS:A
Q186:A 55-year-old patient with a history of angina pectoris requires extraction

of several teeth. Which of the following should NOT apply to this patient?
A- Preoperative sedation
B- Preoperative sublingual nitroglycerin
C- Preoperative prophylaxis with an antibiotic
D- Limiting the local anesthetic with epinephrine 1:100,000 to 4 ml
ANS:C
Q188: Repeated fracture of a metal ceramic partial fixed dental prosthesis

is primarily caused by
• Insufficient retention form
• Improper firing schedule
• Failure to use a metal conditioner
• Inadequate framework design
ANS:D
Q190: Which of the following mesial root surfaces is unlikely to be

thoroughly cleaned with the use of floss?
• Maxillary central incisor
B- Mandibular fist premolar
C- Maxillary first premolar
ANS:C
Q192: Which characteristic is most frequently associated with
osteoradionecrosis?
• Maxillary location
B- History of radiation therapy with 42.50 Gy (4,250 rads)
C- History of bisphosphonate usage
D- Mandibular location
ANS:mostly d
Q193: What is the most likely cause for hemorrhage 3 day after removal of a
mandibular third molar?
A- Vascular fragility
B- Platelet deficiency
C- Prothrombin deficiency
D- Fibrinolysis
Ans: D
Q198: The access opening for a maxillary central incisor of a 14-year-old patient is
triangular in shape
A- To establish straight line access
B- Due to the shape of the crown
C- To include any remnants of pulp horns within the access opening
D- To facilitate the final restoration of the access opening
Ans:c
Q199: 20mg doxycycline hyclate’s primary mechanism of action is

• Breackdown of the phospholipid bilayer
B- Inhibition of DNA gyrase
C- Inhibition of the 50s ribosomal subunit
D- Inhibition of collagenase
Ans:d
Q200: Which of the following would be the first step to perform during
a reevaluation appointment?
• Establish a plan for maintenance intervals
Ans:c
STILL NOT CONFIRMED
Q201: A patient has a 7-years-old chipped porcelain veneer on tooth 9

and desires to have the veneer repaired instead of replaced. Which of the
following should be done to the porcelain before repairing with
composite?
A- Pumice, etch, bonding resin, silanate
B- Sandblast, etch, bonding resin
C- Silanate, pumice, bonding resin
D- Micro-etch, etch, silanate, bonding resin
Ans:d
Q207: What is the easiest method for examining a 12-month-old child?

ANS: C
Q211: The decision to replace an existing amalgam restoration should be made as soon as
the restoration exhibits
A- Creep
B- Recurrent caries
D- Ditching around occlusal margings
ANS:B
Q212: A child’s behavior problem can be managed by desensitization if the basis of the
problem is
A- Pain
B- Fear
C- Emotional
D- The parents
ANS: B
Q213: Drug-induced hypnosis can be produced by depressing which of the following?

A- Cerebellum
B- Hypothalamus
C- limbic system
ANS:C
Q214: Surgical flap access therapy is indicated and most beneficial when used
control
ANS:A
Q217: Which of the following most closely resembles normal parotid gland histologically?
ANS:A
Q219: Which of the following premolars is most likely to have three canals?
A- Maxillary first
B- Maxillary second
C- Mandibular first
ANS: A
Q220: A 14-year-old female has gingival tissues that bleed easily on gentle probing. The color
of the gingiva ranges from light red to magenta. Probing depths range from 1 - 3mm. Some of
the interdental papillae are swollen. Which of the following represents the most likely diagnosis?
A- Gingivitis
ANS:D
Q222: A displaced fracture of the mandible courses from the angle to the third molar. This
fracture is potencially difficult to treat with a closed reduction because of
ANS:D
Q223: Which of the following is the most reliable method for determining the pulp
responsiveness of a tooth with a full coverage crown?
C- Thermal test
D- Palpation
ANS:C
Q227: What is the minimum amount of bone needed between 2 adjacent implants?
A- 1mm
B- 2mm
C- 3mm
D- 4mm
ANS:C
Q228: Which of the following would be LEAST likely to lead to the development of root
surface caries on facial surfaces?
ANS:C
Q229: A dentist has planned in-office-bleaching and porcelain laminate veneers for a patient’s
ANS:A
Q231: A patient with Stage I medication related osteonecrosis of the jaw (MRONJ) with
exposed bone in the maxilla is best treated with
ANS:D
Q232: If a particular test is to correctly identify 95 out of 100 existing disease cases, then that
test would have a
D- Validity of 95%
ANS:B
Q234: Which of the following directly image the TMJ disc?

A- TMJ tomography
B- TMJ arthrography
ANS:D
Q241: The best time perform oral surgery on a patient receiving dialysis 3 times per week is
A- Day of dialysis
ANS:C
Q247: At 90 kVp and 15mA at a BID distance of inches, the exposure time for a film is 0.5
inches?
A- 0.25 seconds
B- 1.0 second
C- 2.0 seconds
D- 4.0 seconds
ANS:C (0.5*4=2.0 SEC)
Q249: Dental phobia is classified as a personality disorder

experience
ANS:D
Q250: Causality (cause and effect) may NOT be inferred from which of the following studies?
A- Cross-sectional
B- Cohort
C- Case-control
D- Clinical trial
ANS:A
Q251: One advantage of using a fiber-reinforced post for restoring an endodontically treated
tooth is that it
ANS:B
Q254: Which of the following is a interference during working movements for a posterior
complete crown restoration?
ANS:D
Q255: Which permanent teeth are least often congenitally missing?

A- Lateral incisors
B- Canines
C- Premolars
D- Third molars
ANS:B
REMEMBER QUESTIONS FROM MAY/28 POSTED BY PAULA GOMEZ
https://www.facebook.com/?ref=logo
1.side effects of nitrates

-i choose something with flushing headaches
2.battery
3.veracity
4.Main principle of behaviour management
5.pat comes to your dental practice for first time.what you do to make her comfort?
-sit side to side
-quickly writing notes while listening
-make her recline her to comfort
-uproght in her chair at eye level(i chose this)
6.IV bisphosphates are not given in which situation

-multiple myeloma
-metastatic cancer of breast
-metastaic cancer of prostate cancer
-osteomyeltis
7.main cells in crevicular fluid

8.which anitibiotic has more conc in crevicular fluid?(no tetracycline in options)
9.what is the main reason for failure of posterior composite which has direct or indirect
effect?(no occlusal wear in option)
-something related to bonding agent
-silane
-polmerization(i choose)
10. dentigerous cyst radiograph(got only three radiographs on day one)
11.ameloblastic fibroma saying that this RL appearence somehting(rest all options were
with mixed appearence of RQ anD RL)
12.pat. with denture since 19 years.had a 6*3 mm white lesion,he doesnt know from
when .what would you do at the initial visit?
-biopsy
-observe
13.pat dont want to quit smoking. which stage it would be when smoking cessation change ?(my
advice read the complete question)
14.coumadin effect reduced,which drug does that?
15. cherubism, what is true?bilateral
16.reinforced znoe ,what is added in znoe to make it reinforced?
17.liquid in gic
18.pain on stimulus but subsided when removed-reversible pulpitis
19.few questionds on amalgam(cavity prep-retention and resistance,know them well)\
20.2 test were conducted to check the efficacy of 2 drugs .what study
21.3 months ago ,caries analyses was done on school chldren .whta type of study?
22.pat. at risk of infective endocarditis.In which situation you give antibiotics?periapical surgery
23.child had pain after procedure what would you give?tyelnol
24.qpoids effect except(no diuresis, diarrhea in options) there was something pain blockage at
peripheral fibres
25.true and false
-idiopathic osteomyeltis and condensing ostetis has same radiodology
-IO in vital and CO in non vital
26.bisphosphates what is common?same ques that we discuss in group-42gy ,
mandible,maxilla
27.least likely diagnostic feature for NUG

-clinical attachment
-gingival necrosis
-gingivsl bleeding
-pseudomembrane
28.pKa effect
29.10mA for 1 sec and den time reduced to 0.5sec ,what is mA?
30 first evidence for proliferation of dental lamina
?
31.supranumerary common in which region?
32.shape for access prep of mand 2nd molars
33.maximum constriction in cervical to occlusal in which primary tooth?
34.pain radiate to ear,which tooth?
35.autistic child
36. down syndrome,all dental problems are due to
-large tongue
-midface deficiency
37.early loss of primary teeth,which condition?
38.montokulast
39.prostaglandins blocked what will not happen?(yhis question discussed in group)
40. hazard communication standard ,what do they do?
41.who developed hazard communication standards?
42.why we clean our tongue?

43.osha not concerned with(same ques as it is in very imp file of pat management)
44.casuality(cause and effect0in which study?(cohort but also know prosp or retro-they have
asked like in which one in particular)
45.k-sparing drug
46.xerostomia due to(actually the mechanism of action was given in options)
47.another down syndrome question asking about the child characteristic
48.CL and CP repaired done.refered to orthodontist for pseudeprognathism.what is the
reason for maxillary undergrowth?i chose a normal outcome after surgery
49.mucocutaneous and systemic antifungal agent ,which is orally well absorbed?
50.Dry socket ,what is the first thing you do?
51.post extraction complication
52.intraoperative soft tissue complication of extraction
53.complication for maxillary extraction
54.#212 clamp -where to punch holes for rubber dam?
55.distance between two adjacent implants
56.external root resorption in pulp necrosis is called?(my last question)
Manage
57.osseointergation in which part of maxilla and mandible

58.best bone for impalnt?options were just numbers like 1,2,3,4
59.where are the progenitor cells for new PDL reattachement situated?
60.concussion,what would you do?
61.L.a calculation for a 16kg child?
62.separation of epithelial from connective tissue,which condition?(first ques on my screen)
-lichen planus
-pemhigus
-pemphigoid
Day2-was horrible,so dont remember much
one pedo case -a child had so many problems -kidney transplant,some chemo for something
one case was ortho-a girl 14 years -canine ectopically erupted.
one case on pat with poor oral hygiene with no medical concerns just smoking and on rehab for
drug and alxohol abuse which is successful sice 18 montha, was in jail for the same for 1 year.
for this i was asked what pain med to give.(i think this case was posted on group but wasnt
discussed)
REZA 2016 (NEW YORK )
BOARDS
OPERATIVE:
- Unfilled resin
- has a coefficient of thermal expansion that is 7-8 times that of a tooth.
- Changes temp slowly due to low thermal conductivity and diffusivity.
- Dead tracts - empty dentinal tubules with no odontoblasts. When they calcify they are called sclerotic dentin.
- Primary dentin - forms the initial shape of the tooth. Deposited BEFORE completion of the apical foramen
- Secondary dentin - formed AFTER the completion of the apical foramen. Formed at a slow rate as functional stress is placed on the tooth.
- Tertiary dentin - aka reparative or reactive dentin. Produced by secondary odontoblasts.
- Percolation - the cyclic ingress and egress of fluids at the restoration margins. Recurrent decay increases with increased percolation.
- Zinc Phosphate cement
- Shrinks slightly when setting
- Initial mixture is very acidic (pH 3.5) so can cause irreversible pulp damage
- Must place 2 coats of cavity varnish to prevent pulp damage
- Superior strength compared to other cements - mechanical interlocking
- Can be used as a secondary base over CaOH placed over pulp exposure
- Zinc polycarboxylate
- most soluble cement
- bonds by CHELATION - carboxylate groups chelate to calcium in the tooth
- lower compressive strength than zinc phosphate but higher tensile strength
- not irritating to pulp so no primary base is needed
- can be very thick
- short working time
- Glass ionomer cements -
- least soluble cement. Disadvantage is that it has a higher cement film thickness.
- Contains fluoro alumino-silica powder and polyacrylic acid
- Acts like a fluoride sponge and can absorb fluoride
- ZOE cements
- pH is near 7
- one of the least irritating of dental cements
- BUT do NOT place directly on pulp (direct pulp capping) or it will irritate pulp
- Soluble in oral fluids
- Difficult to remove from cavity preps
- Compromises composite bonding
- Calcium hydroxide
- Used as a base
- Effective in promoting the formation of secondary dentin
- Base - thickness of 1-2mm
- Used for their low thermal conduction
- Placed in deep portions of cavities to insulate pulp
- Cement - thickness of 15-25 microns
- Cavity liner - thickness of 5 microns
- Placed as thin coat over exposed dentin
- 2 groups
- Cavity varnish aka solution liner - ex Copalite
- Does not act as a thermal barrier.
- Inhibits polymerization with composites
- Reduces marginal leakage
- Suspension liner - CaOH or zinc oxide with resins. Ex. Dycal. Thicker than solution liners. Prevents thermal shock. Appears
radiolucent so can be confused with caries.
- Dentin - zones of caries
- Zone 1 - normal dentin -
- Zone 2 - sub-transparent dentin - demineralized due to caries, no bacteria are found, capable of remineralization
- Zone 3 - transparent dentin - further demineralized due to caries, no bacteria are found, capable of remineralization
- Zone 4 - turbid dentin - zone of bacterial invasion, tubules are filled with bacteria. NOT capable of remineralization
- Zone 5 - infected dentin - outermost zone, decomposed dentin filled with bacteria. Must be totally removed.
- Bacteria
- Streptococcus species produce dextran sucrose (aka glycosyltransferase) which catalyzes the formation of extracellular glucans (dextrans and
mutans) from dietary sucrose.
- Lactobacillus species do not produce dextran - they produces a different extrapolysaccharide - lexan.
- S. Sanguis is the the most frequently isolated Streptococcus in the oral cavity. Also found the earliest.
- Enamel demineralizes at pH 5.5. Remineralizations occurs above 5.5
- Fluoride - concentrations above 4mg/L can be toxic.
- Acidulated phosphate fluoride gels - ph 1-4 - contraindicated on porcelain and composite restorations and implants because it can cause pitting
and etching of them. Most common in-office fluoride tx.
- If pt has porcelain, glass ionomer, or composites - use neutral 2% NaF. Acidualated fluoride and stannous fluoride remove the glaze from these
restorations.
- Sodium Fluoride - 2%, pH 9
- Acidulated phosphate fluoride - 1.23%, pH 3-4
- Stannous Fluoride - 8%, pH 2
- Excreted by kidney.
- Optimal public water levels are 0.7-1.2ppm
- Uptake is greatest in enamel
- Birth to 6 months - NO fluoride
- 6 months - 1 year - .25 mg only if conc is less than .3ppm
- 3-6 years - .50mg if conc is less than .3ppm, .25mg if if conc is less than .6ppm
- 6-16 years - 1mg if conc is less than .3ppm, .50mg if conc is less than .6ppm
- NO fluoride if water levels are greater than 0.6ppm
- Fluoride interacts with hydroxyapatite to form fluorapatite which is less acid soluble and more resistant to caries.
- Class III
- Composite resin is not recommended for Class III lesions on the distolingual of canines
- When preparing adjacent Class III lesions, prepare the larger one first but fill the smaller one first.
- Retentive grooves are placed along the gingivoaxila and incisoaxial line angles
- Sealants
- Use topical fluoride AFTER sealants because fluoride inhibits etching.
- Brittleness - has high compressive strength but low tensile strength. Ex. Amalgam.
- Creep - deformations over time in response to constant stress. Aka strain relaxation
- Modulus of elasticity - a measure of the stiffness or rigidity of a material. The higher the MOE, the stiffer and more rigid the material.
- Resilience - the energy that a material can absorb before the onset of any plastic deformation
- Elastic limit - the greatest stress to which a material can be subjected so that is will return to its original dimensions when the forces are released.
- Proportional limit - the greatest stress - a material with high proportional limit has more resistance to permanent deformation.
- Ductility - the ability of a metal to easily be worked into desired shapes. Ex - form a wire.
- Malleability - the ability of a metal to be hammered and compressed into a thin sheet without rupturing.
- Gold is the most ductile and malleable metal. Silver is second.
- Composites
- Inferior compressive strength and abrasion resistance compared to amalgams
- Polymerization shrinkage - causes internal stresses and gap formations at butt-joint interfaces
- C-factor - the ratio of bonded to unbonded surfaces. High C factor = cavity is more likely to be damaged.
- Composite resins are dimethyacrylate monomers and polymerize by the addition mechanism that is initiated by free radicals which are
generated by chemical activation or external heat/light.
- Chemically activated - self cure - benzoyl peroxide initiator
- Light activated - visible light has replaced UV light.
- Amalgam
- Brittle, but has good compressive strength
- A decrease in particle size will increase compressive strength and decrease setting expansion
- The more free mercury, the more setting expansion
- The more time of trituration, the less expansion and greater strength
- Mercury content greater than 55% decreases strength
- Coefficient of thermal expansion is TWICE that of tooth structure - so percolation occurs during temp changes.
- The tensile strength of amalgam is 1/5 - 1/8 of its compressive strength
- Contents
- 40-70% silver - decreases setting time, increases setting expansion, increases strength
- 25% tin - decreases expansion, decreases strength, increases setting time.
- 6% copper - ties up tin reducing gamma 2- formation, increases strength, reduces tarnishing, reduces creep
- High copper - 9-30% have less marginal break down and less likely to corrode
- 3% mercury
- Ag3Sn + Hg à Ag3Sn + Ag2Hg3 + Sn3Hg
- Gamma = Ag3Sn - the unreacted alloy, the hardest and corrodes the least
- Gamma one = Ag2Hg3 - forms matrix for unreacted alloy
- Gamma two = Sn3Hg - weakest and softest phase. Most susceptible to corrosion.
- Corrosion products - tin oxide and tin sulfide - help provide an excellent seal.
- Poor thermal insulator so ideally keep 2mm (1-1.5mm is ok) of dentin between amalgam and pulp - place CaOH \or ZOE as a base
- Investing
- Refractory filler - Silicon Dioxide (SiO2), 60% of the investment. Provides thermal expansion.
- Binder - 30% of the investment. Hardens and holds the investment together.
- Gold foil
- Annealed aka degassing to remove volatile surface impurities
- Gold Casting Alloys
- High gold alloys used for cast restorations are - greater than 75% gold or other noble metals
- ADA type I - highest gold content, 83% noble metals, easily burnished since very ductile
- ADA type II - greater than 78% noble metals, good for larger inlay and onlays
- ADA type III - greater than 75% noble metals, good for onlays and crowns
- ADA type IV - greater than 75% noble metals, good for bridges and RPD, the hardest of high-gold alloys
- Components
- Gold - resists tarnish and corrosion, increases ductility and malleability
- Copper - HARDENS casting
- Silver - modifies the red color
- Platinum - raises melting temp, increases tensile strength, decreases coefficient of expansion
- Paladium - raises melting temp, increases hardness, whitens gold
- Base metals - aka non-precious metals - high strength and low density but LESS resistant to corrosion
- Indirect pulp cap - CaOH base placed over a thin layer of questionable dentin that remains covering the pulp. SECONDARY dentin formation can form.
- Pins
- Should be placed 1-1.5mm inside the cavosurface margin and at least .5mm inside the DEJ.
- The optimal depth of the pinhole is 2mm
- Should be 2mm into dentin, 2mm within amalgam, 1mm from DEJ
- NO bends
- Burs
- Rake angle - The most important characteristic - the angle made between the line connecting the edge of the blade to the axis of the bur and
the rake face. Can be positive or negative.
- Clearance angle - the angle formed between the clearance face and a tangent to the path of rotation
- The greater the clearance angle, the less friction.
- Instruments
- Formula
- 1st number - the width of the blade in tenths of mm. ex. 1mm = 10
- 2nd number - the primary cutting edge angle
- 3rd number - the blade length in mm
- 4th number - the blade angle
PERIO
- Dehiscenece - a loss of the buccal or lingual bone overlaying the root portion of a tooth, leaving the area covered by soft tissue only.
- Cementum
- Radicular cementum - the cementum only found on the root surface
- Coronal cementum - the cementum that forms on the enamel covering the crown
- Cellular cementum - cementum containing cementocytes in lacunae within the cementum matrix. It occurs more frequently on the apical 1/3 rd
of the root and in furcations. It is usually the thickest to compensate for attritional wear of the occlusal /incisal surface and passive eruption of
the tooth.
- Acellular cementum - cementum without any cells in its matrix. Usually predominates on the coronal 2/3rds of the root. It is thinnest at the
CEJ. It plays a major role in tooth anchorage.
- The main function of cementum is the attachement of principle fibers of the PDL.
- Contains two types of collagen fibers
- Sharpey's fibers - terminal portions of the principal fibers of the PDL that are embedded in the cementum (run perpendicular to the
cementum) on one end and alveolar bone on the other end. They serve to attach the tooth to surrounding bone.
- Type I collagen fibers - are within the cementum itself and run parallel to the surface of the cementum.
- Gingival fibers of the FREE gingiva - 4 groups - the collagen fibers that extend from the cervical cementum of the tooth into the gingiva are called gingival
fibers. Aka supreacrestal connective tissue fibers. Their function is to support the gingiva and keep it closely adapted to the tooth surface and sustain it
against forces during mastication.
- Circular fibers - encircle the tooth around the most cervical part of the root and insert into the cementum and lamina propria of the free gingiva
and the alveolar crest. They resist ROTATIONAL forces.
- Dentogingival fibers - extend from the cementum apical to the epithelial attachment and course laterally and coronally into the lamina propria of
the gingiva.
- Dentoperiosteal fibers - extend from the cervical cementum over the alveolar crest to the periosteum of the cortical plates of bone.
- Alveologingival fibers - insert in crest of alveolar process and spread out through the lamina propria into the free gingiva.
- Transeptal fibers are sometimes classified as a separate group of gingival fibers.
- Gingival apparatus - describes the gingival fibers and the epithelial attachment.
- Gingival ligament - includes the dentogingival, alveologingival, and circular fibers.
- Indifferent fiber plexus - found in the PDL. They are small collagen fibers associated with the larger principal collagen fibers and run in all directions.
- The major storage sites of histamine are mast cells, platelets, and basophils.
- Diabetics has 15 TIMES the risk of developing periodontal disease as compared to the non-diabetic population.
- Hereditary Gingivofibromatosis - a rare genetic disease causing generalized gingival enlargement, often extensive enough to cover the teeth. There is a
lack of inflammatory cells, proliferating capillaries and vascular engorgement.
- The fibers in gingival connective tissue is composed of TYPE I COLLAGEN.
- The collagen turnover in the gingival is not as rapid as in the PDL but faster than the rest of the body.
- Collagen accounts for 60% of gingival protein.
- Vitamin C is needed for the hydroxylation of proline and lysine essential for collagen formation.
- Polishing - use a thin, watery mixture of polishing paste or polishing at a low speed with light pressure to reduce the abrasive action of the polishing agent.
- Pedicle - a glycoprotein deposit that coats the tooth and is colonized by bacteria
- Primary colonizers - gram-positive bacteria such as Strep sanguis, Step mutans, and Actinomyces Viscosus.
- Secondary colonizers - gram negative species such as Fusobacterium nucleatum, prevotella intermiedia, and capnocytophaga species
- Tertiary colonizers - porphyromonas gingivalis, campylobacter rectus, eikenella corrodens, actinobacillus actinomyecetemcomitans, and oral
spirochetes
- Junctional epithelium - a collar-like band of stratified squamous non-keratinized epithelium 10-20 cells thick near the sulcus and 2-3 cells thick at the apical
end
- In health it is usually .25-1.35 mm long
- Epithelial attachment - the inner layer of cells that attaches the gingiva to the tooth. Consists of internal basal lamina and hemidesmosomes.
- The PRIMARY epithelial attachment refers to the attachment of reduced enamel epithelium to the tooth.
- The SECONDARY epithelial attachment refers to the attachment of the junctional epithelium to the tooth
- Sulcular eoithelium = aka crevixular epithelium - the stratified squamous epithelium lining the inner aspect of the soft tissue wall of the gingival sulcus
extending from the gingival margin to the junctional epithelium.
- Tooth mobility
- 0 = no mobility
- 1 = barely distinguishable tooth movement
- 2= any movement up to 1mm
- 3 = any movement more than 1 mm or teeth that can be depressed or rotated in their sockets.
- Periodontal health
- Gram-positive, non-motile, facultative anaerobes
- S. salivarius - the MOST ABUNDANT
- S. mutans and S. sanguis - appear only when teeth are present
- By age 4-5, the oral flora resembles that of an adult
- In perio disease à gram negative, motile, strictly anaerobic bacteria
- Chronic gingivitis = porphyromonas gingivalis
- ANUG = two priniciple bacteria
- Spirochetes - treponema denticola - seen in the deeper areas of the lesions
- Prevotella intermedia
- Interproximal necrosis - ulceration of papilla and pseudomembrane formation on marginal tissues.
- NO attachment loss!!!!
- History of soreness and bleeding gums when eating or brushing
- Aggressive periodontitis
- Two most common organisms -= Actinobacillus actinomycetemcomitans and Capnocytophaga ochraceus
- Rapid and severe attachment loss confined to incisors and first molars.
- Absence of local factors such as plaque
- Free gingival graft - taking a section of attached gingival from another area of the mouth - usually the hard palate - and suturing it to the recipient site.
- Laterally positioned flap - aka pedicle flap
- Used to correct or prevent recession by providing root coverage
- Double papilla flap - a variation of the laterally positioned flap, except the papilla between the teeth on either side are moved over the exposed root.
Indicated when there has been recession on the labial or gingival but not in the papilla.
- Modified Widman Flap - a modification of the replaced flap. It is a FULL thickness flap. Used on SINGLE rooted teeth and on the surface of molars with
pockets or defects. Allows you to gain access to tooth and bone, reduce pocket depth, preserve KAG, and heal by primary closure.
- Repositioned flaps
- Includes replaced flaps, modified Widman flaps, and excisional new attachment proedcures.
- All heal by repair, all are pocket reduction procedures
- Free mucosal autograft - CT without epithelial covering, often used on canines where there is little keratinized gingival to create a band of gingival-like
tissue.
- Free gingival grafts - when healing, the epithelium degenerates forming a necrotic slough. Re-epithelialization occurs by proliferation of epithelial cells
from adjacent tissue and surviving basal cells in the graft tissue.
- The most critical factor in determining whether a tooth should be extracted or have surgery performed on it is the amount of Attachment Loss.
- Full thickness flap - include surface mucosa (including epithelium, basement membrane, and connective tissue lamina propria) and the contiguous
periosteum of the underlying alveolar bone. Used when the attached gingival is thin - 2mm or less in width.
- Partial thickness flap - includes only the mucosa, which is separated from the periosteum by sharp dissection. Alveolar bone is NOT exposed. This flap
is used in the preparation of recipient sites for free gingival grafts or when a dehiscence or fenestration is present on a prominent root. Used when the
attached gingival is thick - > 2mm
- Gingivectomy - when pocket depth is eliminated by resecting the tissue coronal to the pocket base. Must have lots of KAG.
- Periodontal file - primary function is to crush or fracture heavy tenacious accessible SUPRA-gingival calculus.
- Hoes - wide, straight cutting edge cannot adapt to curved tooth surface. Most effective on the buccal and lingual surfaces NOT mesial and distal surfaces.
- Sharpening instruments
- Avoid producing a wire edge by making sure the last stroke is drawn TOWARD the cutting edge, not away.
- The optimal internal angle between the face of the blade and the lateral surface of a universal curet and gracey curet is 70-80 degrees.
- Root sensitivity - most accepted theory is the Hydrodynamic Theory = the pain of root sensitivity results from indirect innervations cause by dentinal fluid
movement in the tubules which stimulates mechanoreceptors in the pulp.
- Attachment loss = probing depth + recession
- Attached gingiva = from the mucogingival junction to the free gingival groove (the base of the sulcus)
- The narrowest band of attached gingiva is found - on the facial surfaces of the mandibular canine and first premolar and the lingual surfaces
adjacent to the mandibular incisors and canines.
- The greatest width of attached gingiva is found in the incisor regions.
- To measure it - place the probe on the external surface of the gingiva and measure from the mucogingival junction to the gingiva margin = total
gingva. Then insert the probe and measure the probing depth. Subtract probing depth from total gingva = width of the attached gingiva
- Free gingiva = from the free gingival groove ( base of the sulcus) to the gingival margin
- Free gingival cuff - is lined by sulcular epithelium which is continuous with the oral gingival epithelium at the gingival margin.
- Free gingival groove = demarcates the junction between the free gingiva and the attached gingiva
- Mucogingival junction = separates the attached gingiva from the alveolar mucosa
- Site Specific Controlled Release Antibiotic Therapy
- Actisite = aka periochip - disinfectant or antibiotics used as an adjunct to scaling and root planning. Placed in the pocket to control perio
inflammation. TETRACYCLINE 12.7MG. For 7-10 days.
- Atridox = a biodegradable controlled release gel containing DOXYCYCLINE. Delivered via a syringe system to the pocket.
- Periochip = a gelatin chip containing 2.5mg CHLORHEXADINE GLUCONATE.
- Periostat = a twice a day, orally administered tablet containing 20mg DOXYCYCLINE. Promotes attachment level gain and reduces pocket
depth.
- PDL - is 0.2mm wide in health. Decreases with age.
- Consists of regularly arranged bundles of collagenous fibers - Collagen Type I
- Does NOT contain mature elastin - only immature forms - oxyltalin and eluanin
- The main type of cell in the PDL is the Fibroblast
- The alveolar bone directly surrounding the tooth cavity is called the Cribiform Plate.
- The layer of cribirform plate into which collagen fibers of the ligament are anchored is called Bundle Bone.
- Sharpey's Fibers - large collagen fibers that course between the cementum and the alveolar bone. They project into the cementum between groups of
cementoblasts. Lies perpendicular to the surface of cenentum.
- Epithelial Rests of Malassez - remnants of the epithelial root sheath that remains following the disintegration during root formation. Located in the PDL
- Plaque - Organic and inorganic solids constitute approximately 20% (mostly bacteria) and water accounts for 80%
- Pellicle - includes albumin, lysozyme, amylase, IgA, proline-rich proteins and mucins
- The source of minerals in supragingival calculus is saliva. And crevicular fluid in subgingival calculus.
- Calculus -
- Inorganic components - calcium and phosphates with small amounts of magnesium and carbonate. Hydroxyapatite predominates the
crystalline structure.
- Takes 12 days to form
- Toothpaste
- Fluoride - sodium fluoride or sodium monofluorophosphate
- Abrasives - calcium phosphate or calcium carbonate - removes stains and plaque
- Surfactants or detergents - sodium lauryl; sulfate - creates a foam
- Humectants - glycerin or water - to retain moisture
- Binder or thickener - carrageenan or cellulose gum - to add texture
- Preservatives - sodium benzoate
- Chlorhexidine Gluconate 0.12% - can cause REVERSIBLE stains, can impair taste perceptions . Has low systemic toxicity.
- Has the greatest RESIDUAL concentration in the mouth after use - rapidly absorbed by teeth and the pedicle and slowly released
- Ex. Peridex and Periogard
- Stannous fluoride - antimicrobial due to tin ion. Anti-cavity.
- Quaternary Ammonium compounds - not as effective as others in reducing plaque or gingivitis. Best at eliminating bad breath. Ex. Scope or Cepacol.
- The bacteria that form plaque and calculus release toxins that stimulate the immune system to produce powerful infection fighting CYTOKINES - ex. TNF
Alpha and IL-1Beta and IL-4. The cytokines overproduce the enzyme COLLAGENASE which breaks down proteins, including the CT that supports teeth.
- Attached gingiva = keratiniezed, stippled, DEEP rete pegs, thick lamina propria, few elastic fibers, indistinct submucosa, firmly attached
- Alveolar mucosa = non-keratinized, unstippled, short and wide rete pegs, thin lamina propria, numerous elastic fibers, distinct submucosa, movable
- Cervical line contours
- Greatest on the mesial surface of anterior teeth - most on maxillary centrals
- CEJ curves toward the apex on facial and lingual surfaces and away from the apex on the mesial and distal.
- Oral mucosa
- ALL oral mucosa, whether keratinized or non-keratinized, is STRATIFIED squamous type.
- Keratinized - vermillion border of lips, hard palate, dorsum of tongue, gingival tissues
- Non-keratinzied - buccal mucosa, floor of mouth, lateral and ventral surfaces of tongue, gingival col, sulcular epithelium, alveolar mucosa, soft
palate.
- Masticatory mucosa - composed of free and attached mucosa of the hard palate. Keratinized with thick lamina propria.
- Lining or Reflective mucosa - thin, moveable, non-keratinized, thin lamina propria
- Mucogingival junction - the junction of the lining mucosa with the masticatory mucosa
- Perio probing - taken from the junctional epithelium to the margin of the free gingiva. Most important reason for using the perio probe is the determine
LOSS of ATTACHMENT.
- Interproximal areas - probe should touch the contact area and the tip should angle slightly beneath and beyond the contact area. Angle the
probe at 10 degrees at the interproximal so the tip of the probe is placed apical to the contact point of adjacent teeth.
- Recession - from CEJ to the marginal gingiva. Measured as a positive value.when apical to the CEJ but a negative value when coronal.
- Common on LEFT canines of RIGHT handed people (or right canines of left handed people)
- Gingival curettage - when the cutting edge of the curette is directed against the soft tissue wall of the pocket. Refers only to treatment of the pocket wall -
removing sulcular epithelium and inflamed connective tissue - NOT planning against the root of the tooth. Promotes soft tissue re-attachment.
- Perio curet
- The lower shank of the Gracey Curet is parallel to the tooth surface being scaled.
- The lower shank of the universal curet is tilted slightly toward the tooth.
- Naber's 2N or Hamp probe - used to detect and clinically diagnose furcation involvement
- Ultrasonic scaler - uses high frequency sound waves. g
- Magnetostrictive units have an ELLIPTICAL pattern of vibroatiion of the tip so all sides of the tip are active.
- Piezoelectric units have a linear or back and forth movement of the tip so only 2 sides of the tip are active
- Sonic scalers - air-turbine instruments. Uses air pressure from high speed handpieces to produce vibrations.
- Sonic instruments do NOT release heat the way ultrasonic instruments do
- Scaling and Root planning
- BOP is the best indicator of inflammatory perio dx. Absence of BOP is used to evaluate ScRP success,
- Cementum, dentin, and calculus are removed during root planning
- Alveolar process - consists of alveolar bone proper and supporting alveolar bone
- Alveolar bone proper - immediately surrounds the root of the tooth. PDL fibers attach to it. Consists of two layers - 1) Compact lamellar bone
2) Bundle bone
- Bundle bone - is the layer that the PDL fibers insert into
- Supporting alveolar bone - surrounds alveolar bone proper and gives support.
- Cortical plate - aka compact lamellar bone - forms the outer and inner plates. Thicker is mandible.
- Spongy bone - aka cancellous bone - fills in the area between the cortical plates. NOT present in the anterior part of the mouth.
- Principal fibers of the PDL - composedof bundles of type I collagen fibers
- Transeptal fibers - extend from tooth to tooth, CORONAL to the alveolar crest and embedded in the cementum of adjacent teeth. NO
attachment to alveolar bone. Help keep the teeth aligned and maintain the integrity of the dental arches
- Alveolar crest fibers - extend from the cervical cementum to the alveolar crest. Provides counterbalance to occlusal forces on apical fibers and
resist lateral movements
- Horizontal fibers - run perpendicular from the alveolar bone to the cementum. Resist LATERAL forces.
- Oblique fibers - slant occlusally from cementum to alveolar bone. Resistant to masticatory forces (forces along the long axis of the tooth).
Found in the APICAL 2/3RD. MOST numerous - 1/3rd of ALL principal fibers!!
- Aplical fibers - radiate apically from cementum of tooth to bone. Offer INITIAL resistance to tooth movement in the occlusal direction. Prevents
tipping and dislocation of the tooth.
- Interradicular forces - ONLY found on multi-rooted teeth. Extend from cementum in the furcation to alveolar bone.
- Phenytoin (Dilantin) - highest incidence of drug induced hyperplasia. PLAQUE DOES cause the overgrowth so hygiene is important (unlike Hereditary
Gingivofibromatosis)
- Pseudopocketing - pocketing without attachment loss. Caused by expansion of marginal tissue coronally.
- Horizontal Classification of Furcations - GLICKMAN
- Grade I - furcation probe can feel the depression
- Grade II - CUL-DE-SAC lesion. Probe can enter under the roof of the furcation.
- Grade III - total bone loss with a tunnel opening of the furcation. But furcation is not clinically visible.
- Grade IV - grade III but furcation is clinically visible.
- Bone grafts have relatively little effectiveness in treating furcations.
- Guided tissue regeneration is useful in Grade II furcations.
- Poorest prognosis is worst on MAX 2nd molars.
- Suprabony pockets
- Base of pocket is coronal to the crest of alveolar bone
- Destruction of bone is horizontal in nature
- Transeptalfibers are horizontal
- Supracrestal fibers follow normal bone contours
- Infrabony pockets
- Base of pocket is apical to crest of alveolar bone so there is a defect within the bone
- Bone loss is angular or vertical creating holes
- Transeptal fibers are oblique
- Supracrestal fibers follow angular pattern of osseous defect.
- Gingival pocket = pseudopocket - marginal tissue is expanded coronally. NO attachment loss.
- Perio pocket= true pocket - gingival sulcus is deepeded and there is APICAL migration of the epitheliual attachment (inner layer of the junctional
epithelium)
PEDIATRIC DENTISTRY
- Cystic Fibrosis
- An inherited recessive disease of the exocrine glands that causes the body to produce an abnormally thick, sticky mucous due to faulty
transport of sodium and chloride within cells lining organs such as the lungs and pancreas.
- Salt does not move properly due to defective channel for chloride to exit cells.
- Most affects pancreas, respiratory system, sweat glands.
- Symptoms - very salty tasting skin, persistent coughing, wheezing or pneumonia, excessive appetite but poor weight gain, bulky stools
- Steatorrhea - foul smelling stools
- Dx - Sweat test - elevation in sodium and chloride
- Die young in 20-30s due to lung failure.
- Dental - mouth breathing due to URI, open bite, high palatal vault,
- Pierre Robin Syndrome - hereditary disorder causing micrognathia, glossoptosis (downward placement or retraction of tongue), and high arched or cleft
palate.
- Primary teeth
- The sum of the M-D widths of PRIMARY molars in one quadrant is 2-5mm GREATER than the pre-molars that succeed them.
- Enamel thickness on occlusal surfaces of primary teeth is a uniform 1mm thick. Permanent teeth enamel is 2.5mm thick.
- Crowns are shorter
- Pronounced buccal and lingual cervical ridges
- Constricted cervical area
- Occlusal table is narrow facial-lingually
- Anatomy is shallower - short cusps, less deep fossa
- Prominent mesial cervical ridge - easy to tell right from left
- Roots - longer and more slender. Narrow mesiodistally and broad lingually. Very divergent and less curved. Little or no root trunk.
- Leeway space = the size difference between primary posterior teeth and permanent canine and premolars. Primary teeth are bigger causing space when
they fall out
- Mand arch - 3.1mm space.
- Max arch - 1.3mm space
- Ritalin = Methyphenidate - a mild CNS stimulate used to treat ADHD
- Measles - aka Rubeola - caused by paramyxovirus. Koplik's spots
- Rubella - aka German measles
- Small pox - aka Variola
- Diphtheria - caused by Corynebacterium diphtheria.
- Scarlet Fever - an exotoxin mediated disease caused by Group A beta-hemolytic streptococci. Causes "strawberry tongue" due to enlarged fungiform
papilla.
- Most common primary tooth to be retained - Mand 1st molars
- From age 6-12, the body;s kymph tissue is 200% of its normal adult mass. Lymphoid tissue decreases at puberty.
- Periodontium
- Cementum is thinner is primary teeth - it increases with age.
- Primary gingiva is more red, more vascular, thinner, and less keratinized. Less stipling. Rounded and rolled gingival margins.
- PDL runs parallel to primary teeth. PDL runs more horizontal in adults
- Tooth development
- Growth center = lobes - the area of the tooth germ where the cells are particularly active.
- Lobes are PRIMARY centers of calcification that form the crown of a tooth
- Represent cusps on posters teeth and mammelons and cingula on anterior teeth
- Separates by developmental grooves
- Minimum # of lobes from which ANY tooth is developed = 4
- ALL anterior teeth - 3 labial lobes, one lingual
- Premolars - 3 buccal and 1 lingual
- EXCEPT Mand 2nd premolar - 3 buccal and TWO lingual
- 1 molars - 5 lobes, one for each cusp
st
- 2nd molars - 4 lobes

- Pulpotomy - inflammation and degenerative change in coronal pulp
- Use CaOH in PERMANENT teeth when there is a pulp exposure but healthy pulp tissue and immature root development.
- Use Formocresol pulpotomy when carious exposure in PRIMARY tooth - moist cotton pellet for 5 minutes
- Pulpectomy
- On primary teeth - fill canals with ZOE so primary roots can resorb normally
- Direct pulp capping - rarely done on primary teeth because CaOH often irritates the pulp causing internal resorption. Can use MTA.
- Indirect pulp treatment - done on deep carious lesions adjacent to the pulp - leave caries to avoid pulp exposure and cover with CaOH and seal with ZOE
or glass ionomer.
- Contraindicated in primary dentition
- Contraindicated if already symptoms of pulpal involvement.
- Fractures - Ellis Classification
- Class I - simple fracture of crown involving little or no dentin - smooth enamel edges and restore
- Class II - extensive fracture of crown involving considerable dentin but no pulp - apply CaOH or glass ionomer to exposed dentin and restore
- Class III - extensive fracture of the crown with a pulpal exposure - apply CaOH and temp restoration immediately. If not immediate, do CaOH
pulpotomy until apex closes and then pulpectomy. Use ZOE NOT gutta percha.
- Class IV - fracture where entire crown is lost - CaOH pulpotomy until apex closes and then pulpectomy.
- Primary max central incisor - the only anterior tooth in either dentine to have shorter inciso-cervical height than mesio-distal width. Erupts with no
mammelons.
- Primary mand central - more resembles perm mand LATERAL
- Primary max lateral - just like central but smaller
- Primary mand lateral - SMALLEST primary tooth
- Mand central is smallest PERM tooth
- Primary max canine - differs from permanent max canine in that the Mesial Cusp Ridge is longer than the Distal Cusp Ridge. And the cusp on the primary
canine is longer than sharper.
- *** ALL other canines have longer Distal Cusp Ridge!!!!!
- Primary max 1st molar - Resembles premolar/molar. Often 4 cusps. MB cusp is widest and longest
- Primary mand 1st molar - has a prominent transverse ridge that unites the MB and ML cusps - separates the mesial portion of the occlusal surface
- Does not resember any other primary or permanent tooth
- MB cusp is the largest and longest - 2/3rd of the buccal surface.
- Primary max 2nd molar - has the greatest faciolingual diameter of ALL primary teeth.
- Primary mand 2nd molars - LARGEST primary tooth.
- Max 1st molar is largest perm tooth
- Eruption
- When a tooth erupts, ½-2/3 of the root is developed. Primary roots complete in 6-18 months after eruption. Permanent roots complete 2-3 yrs
after eruption.
- Permanent mand centrals - erupt 6-7 yrs
- Permanent max central - 7-8 yrs
- *** Rule of Four - helps you determine the number of teeth present at any given time. Eruption of 4 teeth every 4 months.
- 7 months -2mand centrals and 2 mand laterals (4 teeth)
- 11 months -2max central and 2 max laterals (8 teeth)
- 15 months - 4 first molars (12 teeth)
- 19 months - 4 canines (16 teeth) *** CANINES erupt AFTER 1st molars
- 24 months - 4 second molars (20 teeth)
- Hertwig's Root Sheath - determines the number, size and shape of roots. Forms as the crown portion of the tooth nears completion when the outer
enamel epithelium and the inner enamel epithelium combine at the cervical loop region to form a bilayered structure.
- Tooth development
- Tooth development is initiated by the mesenchyme's inductive influence on the overlying ectoderm.
- The enamel of the tooth is derived from the ectoderm of the oral cavity. All other tissues come from the mesoderm/mesechyme.
- Ectodermal cells determine crown root and shape.
- Initiation - initial interation between oral epithelium and mesenchyme and formation of the dental lamina. Week 5.
- Bud stage - involves proliferation as the dental lamina grows into 10 buds per arch. Mesenchyme starts proliferating and shape of teeth
become evident. Enamel organ starts to form. Week 8.
- Cap stage - PROLIFERATION AND DIFFERENTIATION in two ways - 1) Morphodifferentiation - change into other shapes 2)
Histodifferentiation - branch into different tissues. Week 9-10.
- By the end of the cap stage, the tooth germ is complete!! Consists of enamel organ, dental papilla, and dental sac.
- Bell Stage - DIFFERENTIATION forming 4 different cell types in the enamel organ - OEE à Cuboidal, IEE à Columnar, Stellate Reticulum à
Stratum intermedium. Week 11-12
- Appositional Stage - cells deposit specific dental tissues - enamel, dentin, cementum, pulp
- Maturation Stage - mineralization begins AT DEJ.
- Crowns of all 20 primary teeth begin to calcify, 4-6 months in utero. Takes 10 months to calcify.
- Permanent teeth begin to develop 4 months in utero. Max and mand 1st molars begin to calcify AT BIRTH.
- 3RD molars begin to calcify 8-10 yrs of age.
- Histogenesis - formation and development of tissues
- 1) Elongation of inner enamel epithelial cells of the enamel organ - causes mesenchymal cells to differentiate to odontoblasts
- 2) Differentiation of odontoblasts
- 3) Deposition of 1st layer of dentin
- 4) Deposition of 1st layer of enamel
- The last primary tooth to be replaced by a permanent tooth is usually MAX CANINE at age 11-12.
- Nitrous oxide - must always have at least 20% O2. CNS depressant. Combined volume of gases is 3-5L/min. N2O is LESS soluble is blood.
- Chloral hydrate - widely used for pediatric sedation. A sedative/hypnotic. Acts on the CNS to induce sleep. Onset is 15-30 minutes.
- Meperidine (Demerol) - a synthetic opiate agonist. Used to treat moderate to severe pain.
- Apexogenesis - a vital pulp therapy to encourage continued physiological development and formation of the root end. MTA is often used.
- Most common congenitally missing PRIMARY tooth - primary max lateral.
- Primary vs Permanent
- Primary anterior teeth crowns are wider MD and shorter inciso-cervically than permanent counterparts.
- Enamel ends abruptly at the cervical line on primary teeth rather than becoming thinner like in permanent teeth.
- The thickness of coronal dentin in primary teeth is ½ that of permanent teeth.
- Do NOT need gingival bevel in Class II preps on primary teeth since enamel rods extend OCCLUSALLY from the DEJ in primary teeth.
- Primary teeth are LESS opaque on x-ray film due to higher inorganic content
- Amelogenesis Imperfecta - inherited, dominant, abnormal enamel formation. Dentin is normal.
- Type I = Hypoplastic - thin but normal enamel. May appear pitted. Aka Enamel Hypoplasia
- Type II - Hypomaturation - adequate amount of enamel but enamel doesn't mature. Appears rough and discolored.
- Type III - Hypocalcified - Normal amount of enamel but inadequate mineralization. Enamel is rough and gets worn down.
- Dentinogenesis Imperfecta - inherited, dominant, causes dentin to be under mineralized. Can affect deciduous and permanent dentition. Crowns are grey
and opalescent.
- Type I - associated with osteogenesis imperfect. Blue Sclera! Fragile bones, hearing loss.
- Type II - most common, NO OI
- Type III - Brandywine type - multiple PARLs and large pulp chambers.
- Concresence - fusion of cementum only
- Apert Syndrome - a genetic defect causing malformations in skull, midface, hands, and feet. Mandible is often retruded causing Class III malocclusion.
Tx is by Lefort III surgical procedure.
- Crouzon Syndrome - autosomal dominant, causes craniosynostosis, maxillary hypoplasia, short head, shallow orbits, calcified stylohyoid ligaments
- Rieger's Syndrome - delayed sexual development and hypothyroidism. Causes hypodontia, under-developed pre-maxilla, cleft palate, and protruded
lower lip.
- Treacher Collins Syndrome - aka mandibulofacial dysostosis - autosomal dominant, causes slanted palpebral fissures, malformed ears, severe mandibular
hypoplasia.
- Cleidocranial dysplasia - autosomal dominant, partial or complete absence of clavicles, defective ossification of skull, missing or supernumerary teeth.
Prolonged retention of primary teeth.
- Ectodermal dysplasia - hereditary, abnormal skin, hair, nails, teeth, sweat glands. Teeth develop abnormally causing anodontia or oligodontia (partial).
Retained primary teeth. CONICAL shaped anterior teeth.
- Pediatric Abx prophylaxis - Amoxicillin 50mg/kg orally 1 hr prior to appt.
- Local Anesthesia
- Max dose of lidocaine - 4.5mg / kg per appt.
- Do NOT use Bupivacaine (Marcaine) on children - amide LA with high toxicity
- A 1.8ml 2% lidocaine with 1:100,000 epi contains - 36mg of lidocaine and 0.018mg of epi
- Because 1ml of a 2% solution contains 20mg of lidocaine. And 1ml of 1:100,000 epi = 0.010mg of epi
- Depress SMALL UNmyelinated fibers FIRST - conduct pain and temp
- Depress large myelinated fibers last
- The order of loss of function is - pain, temp, touch, proprioception, skeletal muscle tone
- Class II on primary - width of isthmus is 1/3rd the intercuspal width. NO gingival bevel.
- Cretinism - severe hypothyroidism in a child due to congenital absence of Thyroxine. Causes under-developed mandible, enlarged tongue, delayed teeth
eruption
- Congenital porphyria - teeth appear pink/brown naturally, but scarlet under UV light. Skin is sensitive to sunlight.
- Cleft palate - more common in females
- Class I - only soft palate
- Class II - soft and hard palate but not alveolar processes
- Class III - soft and hard palate AND alveolar processes on one side of premaxilla
- Class IV - soft palate and alveolar processes on BOTH sides of premaxilla
- Cleft Lip - more common in males. More common on left side.
- Class I - unilateral notching of vermillion border ONLY but not lip.
- Class II - unilateral notching of lip but not extending to floor of nose
- Class III - unilateral notching of lip that extends into floor of nose.
- Class IV - ANY bilateral clefting of lip
- Primary Herpetic Gingivostomatitis - inflamed gingiva, sore throat, fever, lymphadenopathy, and small fluid filled vesicles on mucosa. Debridement does
not help. Abx do not help.
- ANUG - interdental papilla become necrotic and punched out. Debridement and Abx reduce symptoms. Caused by spirochetes, fusobacterium and
prevotella intermedium
- Ludwig's Angina - when cellulitis involves submandibular, sublingual, and submental space. Medical emergency!
- Neuroblastoma - the most common malignant tumor seen in neonates
- Achondroplasia - most common form of short limbed dwarfism. Large head with short arms and legs. Prominent forehead. Children die in 1 st year of life.
Class III occlusion is common, severe teeth crowding due to small maxilla.
- Acute lymphocytic leukemia - ALL - aka "Leukemia of Childhood" - cells that normally develop into lymphocytes become cancerous and replace normal
cells in bone marrow. Most responsive to therapy!
- Hodgkin's Lymphoma - malignant growth of cells in lymph system.
ENDODONTICS
- MTA (mineral trioxide aggregate) - contains Ca and phosphate. Has a high pH so it induces hard tissue formation. Causes low levels of inflammation.
Difficult to manipulate and has a LONG setting time.
- Thermal sensitivity is the earliest and most common symptom of an inflamed pulp.
- Phoenix abscess - aka recrudescent abscess. Develops as an acute exacerbation of a chronic apical abscess when granulomatous zone becomes
contaminated or infected by elements from the root canal. Causes acute symptoms and large PARL. ALWAYS preceded by chronic apical perodontitis.
- Granuloma - growth of granulomatous tissue cause by pulpal death and diffusion of toxic products into periapical area. NO symptoms.
- Cyst - an inflammatory response of the apex that develops from a PRE-EXISTING granuloma. A central, fluid-filled, epithelium lined cavity. NO
symptoms.
- ** A granuloma and a cyst can only be differentiated by histological examination.
- Hemophilia is NOT a contraindication to RCT.
- Semi-lunar flap - aka submarginal curved flap - a simple, curved, horizontal incision. However - provides limited access and visibility, can easily be torn,
etc. Not esthetic so do not used for anterior root end surgery.
- Submarginal triangular - aka rectangular flap - requires at least 4mm of attached gingiva and healthy periodontium. Scalloped incisions in KAG with one
or two vertical incisions. Better access and visibility.
- Full mucoperiosteal flap - MAXIMUM access and visibility. Raised from gingival sulcus. Able to visualize bony defects, do ScRP, etc.
- Bleaching
- Superoxol - most common bleaching agent for RCT teeth. 30% aqueous solution of hydrogen peroxide and water. Directly oxidizes stain
producing substances. Use HEAT to liberate the oxygen in the bleaching agent. Chairside.
- Most common post op problem is acute apical periodontitis.
- Causes change in both enamel AND dentin.
- Walking Bleach technique - place paste of Sodium Perborate and 2-3 drops of Superoxol in tooth chamber for 4-7 days.
- Referred pain
- Forehead - max incisors
- Nasolabial area - max canines and premolars
- Temporal region - max 2nd PM
- Ear - mand molars
- Mental region of mandible - mand incisors, canines, or PM
- Access openings
- Max central - triangular
- Mand molars - trapezoidal
- Tooth tips mesially and lingually so if access is drilled straight, often the mesial marginal ridge ad lingual surface are undercut
- # of roots
- 40% of mand molars have a 2nd canal in distal root.
- The lingual wall of mandibular teeth is most easily perforated when preparing an access opening due to the lingual inclination of these teeth.
- The mand 1st molar is the MOST COMMON tooth that requires endo!!
- The max 1st molar is the posterior tooth with the HIGHEST endo failure rate!
- SLOB - the object toward the lingual side (closer to the film) shifts to the same direction as the repositioned x-ray cone. Ex. X-ray cone is angled more
mesial, the lingual root shifts more mesial.
- EPT - stimulates nerve endings with a low current and high potential difference in voltage. Stimulates A-Delta sensory fibers in the pulp. Indicates if there
are vital sensory fibers present ONLY.
- ** In a COMBINED endo-perio lesion, do ENDO FIRST and then perio management.
- "Pink" tooth - a pinkish appearance of a tooth due to growth of granulation undermining coronal dentin. Considered pathognomonic of internal resorption.
- Transplantation - the transfer of a tooth from one alveolar socket to another
- Do NOT replant primary teeth - can damage permanent tooth
- File canals and place CaOH 10-14 days after replanting
- Replace CaOH every 3 months for 1 year
- After 1 year do RCT
- Only do if tooth is out of mouth less than 2 hours
- Orthodontic extrusion is sometimes used to repair resorptive lesions or perforations in the cervical area.
- Root submersion - involves resection of tooth roots 3mm below the alveolar crest and then covering it with a mucoperiosteal flap. Used if rampant caries
or perio problems in order to "save" the tooth.
- X-rays - stand at least 6 feet away in the area that lies between 90-135 degrees to the x-ray beam.
- E speed film - more sensitive to x-ray, faster film so requires less radiation exposure
- The higher the kVp, the lower the patient radiation dose
- External resorption - caused by periradicular inflammation, dental trauma, ortho forces, or bleaching of non-vital teeth
- Replacement resorption - when the root is resorbed and replaced by bone causing ankylosis
- Internal resorption - caused by dental trauma resulting in loss of vitality and subsequent infection, CARIES, cracked tooth, pulp capping with CaOH à Do
pulpectomy
- Avulsion
- Less than 30 minutes results in little resorption. More than 2 hours results in EXTERNAL resorption.
- Milk storage is best - neutral pH.
- Do not touch tooth socket.
- Splint for minimum of 2 weeks so PDL can reattach
- Root anatomy
- Apical part of root contains more collagen - Type I and III - mainly Type I.
- Cell rich zone - inner most pulp layer, contains FIBROBLASTS
- Cell free zone or Zone of Weil - rich in capillaries and nerves. Contains Nerve Plexus of Raschkow
- Odontoblastic layer - outermost pulp layer, contains odontoblasts, closest to dentin.
- Mantle dentin - first formed BEFORE odontoblast layer
- Circumferential dentin - most of the dentin
- Secondary dentin - forms AFTER tooth erupts and throughout life - causes pulp to get smaller over time
- Tertiary dentin - aka reparative dentin - irregular, laid down due to injury or irritation
- Primary function of the pulp is DENTIN formation
- Myelinated fibers - sensory
- Unmyelinated fibers - motor, regulate blood vessels
- Parallel sided and tapered posts are preferred. Threaded screw posts can cause fractures.
- The minimum (most conservative) preparation to restore an endodontically treated tooth to prevent fracture is an onlay that covers the cusps and
marginal ridges.
- Pulp chamber retained amalgam - you need to place amalgam 3mm into each canal.
- Perio probing
- Conical shaped - typically a perio problem. Bone loss begins at crestal bone level and progresses apically forming a cone.
- Dx test - pain to LATERAL percussion usually means perio problem
- Narrow sinus tract type - normal probings around rest of tooth with one point that drops to apex. RCT
- Blow out type - normal probings around rest of tooth with one point that drops to apex. RCT
- # of Canals
- 59% of Max 1st molar have MB2 canal - just lingual to the orifice of MB1
- 25% of mand 1st PM have 2 canals with two foramina.
- 97% of Mand 2nd PM have only 1 canal
- Max 2nd PM have a higher incidence of accessory canals (60%) than Max 2st PM.
- Mand canine - root canal is THIN mesiodistally but WIDE labiolingually
- Cementoma - most frequently seen in the anterior region of the mandible. Does not affect pulp vitality. Aka periapical cemental dysplasia
- Traumatic bone cyst - not a true cyst since no epithelial lining. Seen in young people, asymptomatic, scallops, teeth are vital
- Globulomaxillary cyst - seen between lateral incisor and canine roots. Teeth are vital.
- Broaches - contain barbs notched out of the instrument shaft. Use with caution because if forced apically, the barbs can bend and engage the walls of the
tooth and can't be removed. NOT used for canal enlargement.
- Hedstrom files - very effective cutting instrument. Can plane dentin walls faster than k-type files or reamers.
- Pulp capping - pin point accidental exposure. Repair is accomplished by the formation of a dentin bridge at the exposure site. Can make subsequent
endo difficult due to severe calcifications in the root canal. Dycal.
- Solvent Softened Custom Cones - studies show that it does NOT result in a better apical seal. Used when there is a lack of an apical stop or an
abnormally large apical portion of the canal.
- After endo, it usually takes 6-12 months before a marked reduction in the size of the radiolucency is evident on an x-ray.
- If penicillin does not help resolve a periapical abscess, try clindamycin.
- Sodium Hypochlorite - conc. of 5.25% or less.
- Endo Retreatment
- A crown-down sequence of instruments is used - coronal to apical
- Rotary instruments are faster and improve access earlier over heated instruments
- Use LIGHT apical pressure with NiTi rotary
- Remove over-extended gutta percha cones by extending the file periapically
- Chloroform is the agent of choice to dissolve gutta percha. (Eucalyptol is less effective)
- EDTA - Ethylene Diamine Tetra-Acetic Acid
- A chelating agent with the capability to remove the mineralized portion of the smear layer
- Can decalcify up to 50micrometer thin layer of the root wall
- Used in 17% concentration
- RC- Prep and EDTAC are forms of EDTA
- EDTAC is EDTA with the addition of Cetavlon - a quaternary ammonium compound - inactivated by NaOCl
- RC-Prep is EDTA with urea peroxide.
- Has a self limiting decalcifying process that stops as soon as the chelator is used up - acts on calcified tissues and sclerotic canals
- Will remain active for 5 days if not cleaned out with NaOCl
- Has a limited value as irrigation solution
- Broken instrument
- If the instrument protrudes past the apex, raise a flap and remove the instrument surgically followed by gutta percha filling of the canal.
- If the instrument breaks off in the canal, but minimal canal enlargement has been done, obdurate to the point of blockage and then do an
apicoectomy and retrofilling.
- If the instrument breaks off at the apical 1/3rd and there is no PARL, fill the remaining canal, inform the patient and place on 3-6 month recall.
- Filing - push-pull action with emphasis on the withdrawl.
- Reaming - repeated clockwise rotation of the instrument, produces a round canal.
- ZOE sealer - fills in the discrepancies between the core filling material and the dentin wall. Disadvantages - stains, slow setting time, non-adhesive, very
soluble.
- Mand incisors and Max PM1 are most often perforated.
- Acute osteomyelities - most often occurs due to a dental infection and result in bone necrosis. Causes severe pain, high temp, lymphadenopathy, moth
eaten appearance
- Maxilla - well localized to area of initial infection
- Mandible - more diffuse and widespread
- Max lateral incisor - root is often curved or dilacerated.
- Max central, lateral, and canine all have distal axial inclination - incline bur to distal so mesial portion of the root is not perforated.
- Mand central incisor - root is narrow mesiodistally but wide labiolingually. May have TWO canals present.
RADIOLOGY
- kVp - Kilovoltage - controls the SPEED of ELECTRONS. Has nothing to do with the number of electrons. Changes the potential difference between the
anode and cathode. 65-100 kVp
- controls the QUALITY of the x-ray beam
- increasing kVp causes the resultant x-ray to have a longer scale of contrast (and reduces the subject contrast - ex, thick jaw bones)
- mA - milliamperage - controls the TEMP of the tungsten filament which increases the NUMBER of elections. 7-15mA
- controls the QUANTITY of x-rays
- Density - increases as mA, kVp, or exposure time increase.
- Contrast - low contrast = many shades of gray - is preferred with dentistry. Only affected by kVp - higher kVp means more shades of grey
- Dental X-ray Tube components
- Filament is located in the cathode - made of tungsten wire
- Copper is used to house the anode because it is a good thermal conductor and can dissipate heat from the tungsten target
- Molybdenum cup - aka the electron focusing cup, electrostatically directs electrons from the filament in the cathode to the focal spot on the
anode.
- Primary radiation - the radiation generated at the anode of the x-ray tube. Follows the inverse square law measured from the focal spot.
- Secondary radiation - aka scattered radiation - arises from interactions of the primary radiation beam with the atoms in the object being imaged. Degrades
the image.
- Scattering
- Coherent scattering
- Photo electric absorption
- Compton scattering - majority of scattering xrays
- MPD - Maximum Permissible Dose - 0.5REM for general people. 5 REM for people working near radiation.
- Collimation - diameter of the x-ray beam can be no more tha 2.75 inches in diameter
- Image magnification - reduced by using a long cone, increasing the distance of the x-ray source to the film
- RAD = radiation absorbed dose - the amount of energy actually absorbed in a material.
- REM = roentgen equivalent man - relates the absorbed dose in human tissue to effective biological damage.
- QF = quality factor = 1
- Fixer
- Contains - a clearing agent, an antioxidant preservative, an acidifier, a hardener (NO accelerator)
- Clearing agent - sodium or ammonium thiosulfate - dissolves and removes the undeveloped silver halide crystals from emulsion.
- Developer
- Developing agent - hydroquinone - changes the exposed silver halide crystals to black metallic silver.
- Herringbone effect - the film was placed backwards in the mouth
- Panoramic
-
- Chin tilted upward à reverse occlusal plane with mand structures look narrow and max structures look wider - looks like a frown
- Chin tilted downward à occlusal plane is like a V with an excessive upward curve. Severe interproximal overlapping and anterior teeth are
distorted.
- Paralleling technique
- Film is placed parallel to long axis of tooth and central ray is peroendicular
- Object-film distance is GREATER in order to keep film parallel to tooth à causes image magnification and loss of definition
- Source-film distance is GREATER in order to compensate for the mage magnification. LONG CONE - greater exposure time
- Bisecting technique - film is placed along the lingual surface of the tooth. Imaginary line bisects the long axis of the tooth and the plane of the film.
Central x-ray is positioned perpendicular to the imaginary bisector.
- Image on the film may be dimensionally distorted
- DECREASED exposure time
- Use SHORT cone which results in divergent rays
- May not be able to judge alveolar bone height
- Submentovertex Projection - neck is maximally extended and the film cassette touches the top of the head. X-ray enters the head under the chin and
exits at the vertex (top of the head). Allows direct visualization of the base of the skull and clear view of ZYGOMATIC arches.
- Waters Projection - patient places face against the film with chin touching and nose 1 inch away. X-ray enters behind pts head. Best technique to see
MAX SINUS.
- Townes Projection - pt lies on back with film under head. X-ray source is from the front but rotated 30 degrees from the Frankfort plane and directed right
at the condyles. Best technique for seeing CONDYLES and RAMUS
- Lateral Cephalometric - used to evaluate the growth and development of the face.
- Filtration - the removal of parts of the x-ray spectrum using absorbing maerials in the x-ray beam.
- Inherent filtration - done by the x-ray tube or tube shield, the glass envelope of the x-ray tube, the oil cooling the tube,
- Added filtration - done by placing thin sheets of aluminum in the cone to filter the useful beam further.
- Long wavelength xrays are easily absorbed. Shorter wavelength xrays penetrate objects more readily.
- Digital radiography requires less radiation than conventional radiography because the sensor is more sensitive to x-rays so the exposure time is 50-80%
less than those for E-speed film.
- The area from which x-rays emanate is called the - focal spot - this is the area of the tungsten anode that receives the impact of the speeding electrons
and converts them into x-ray PHOTONS.
- What 3 factors influence image sharpness? The focal spot, film composition, and movement
- Tungsten target - embedded in the ANODE at the point of electron bombardment. Tungsten is used due to its high atomic number, high melting point,
high thermal conductivity (dissipates heat), and low vapor pressure (maintains a vacuum at high temp)
- Intensifying screens - converts x-ray energy into visible light which exposes the screen film. Decreases the amount of radiation a pt receives.
- Target-film distance - determined by the PID (position-indicating device)
- Short cone = 20cm / 8 inches - exposes MORE tissue by producing a more divergent beam
- Long cone = 41cm / 18 inches - reduces the amount of exposed tissue by producing a LESS divergent beam and a sharper image.
- Osteoradionecrosis - most common factors precipitating it are pre and post irradiation extractions and periodontal disease. Caused by damage to blood
vessels.
- Hamulus - aka hamular process - a small hook like projection of bone extending from the medial pterygoid plate of the sphenoid bone. Located posterior
to the max tuberosity.
- A film will appear BROWN when it is NOT completely fixed.
- Fogged film - faulty safelight in darkroom
- Radioresistant cells - mature bone, muscle, and nerves
- Radiosensitive cells - small lymphocytes, bone marrow, reproductive cells, immature bone cells.
- When taking radiographs, the operator should stand at least 6 feet away from the pt. And 90 to 135 degree angle to the beam.
- Inverse square law - original intensity/new intensity = new distance ^2/original distance^2
- For a given beam of radiation, the intensity is inversely proportional to the square of the distance from the source of radiation.
- Ex. PID length changed from 8inch to 16 inch, so the resultant beam is ¼ as intense.
- Intensity - the total energy of the xray beam. The product of the quantity (# of photons) and the quality (energy of photons) per unit of area per
time of exposure.
ORTHODONTICS
- Space maintainer
- Very important if primary 2nd molar is lost. Must maintain space for the 2nd PM. Perm 1st molar will tip mesially and rotate into its space.
- Can be removed as soon as the permanent tooth begins to erupt through the gingiva.
- Torque - controlled root movement labiolingually or mesiodistally while the crown is held relatively stable.
- Recurring tooth rotations after ortho correction occur due to persistence of Elastic Supracrestal Gingival Fibers (mainly free gingival and transseptal fibers)
- Most often needed with Max Lateral incisors.
- Supracrestal fibers are commonly associated with relapse following ortho rotation of teeth.
- Bone formation
- Intramembranous ossification - takes place in membranes of connective tissue. Osteoprogenitor cells differentiate into osteoblasts. A collagen
matrix is formed which undergoes ossification.
- The flat bones of the skull and part of the clavicle are formed
- The maxilla and mandible are formed this way
- Endochondral ossification - how the rest of the skeleton forms. Takes place within a hyaline cartilage model. Cartilage cells are replaced by
bone cells (osteocytes replace chondrocytes), an organic matrix is laid down and calcium and phosphate are deposited.
- Forms short and long bones.
- Forms the ethmoid, sphenoid and temporal bones
- Bone growth - ONLY Appositional!!
- Growth of cartilage - can grow in two ways - Interstitial growth and Appositional Growth
- Appositional growth - recruits fresh cells, chrondroblasts, and adds to the surface of the matrix.
- Interstitial growth - occurs by the mitotic division and deposition of more matrix around chondrocytes already established in the cartilage.
- Ex - CONDYLE, nasal septum, and spheno-occipital snychondrosis.
- After age 6, the greatest increase in size of the mandible occurs distal to the first molars.
- Resorption occurs on the anterior surface of the ramus to create space for mandibular molars.
- Serial extractions
- Mainly used for arch length discrepancy - over 10mm.
- 1) Primary Canines
- 2) Primary 1st Molars
- 3) Permanent 1st Premolars - must occur before permanent canines erupt
- Maxillary arch lengthens due to bone deposition in the - tuberosity region.
- Mandibular anterior crowding occurs in normal young adults due to - late mandibular growth (NOT 3rd molars)
- 98% of 6 year old have a median diastema. 49% of 11 year olds have it too.
- If less than 2mm, it will usually close spontaneously
- If caused by an abnormal frenum - align teeth orthodontically and THEN do a frenectomy.
- Impacted teeth
- Most common - max canines
- M-D diameter of maxillary permanent teeth is 128mm. Mandibular permanent teeth is 126mm.
- Steiner's Analysis
- SNA (sella turcia, nasion, point A) - Normal is equal to 82 degrees. Maxillary retrognathism - SNA angle LESS than 82. Greater than 82 is
maxillary prognathism.
- SNB - normal is 80 degrees. Greater than 80 is mandibular prognathism. Less than 80 is mandibular retrognathism.
- ANB - normal is 2 degrees. A class I skeletal profile has ANB of 2 degrees. Greater than 4 is Class II skeletal profile. Less than 0 is Class III
skeletal profile.
- Describes the relation of the max and mand denture bases.
- Headgear
- Components - neck strap, chin cup, face-bow, head cap.
- Force required for anchorage - 250g for 10hr/day. Force required for traction - 500g for 14-16hr/day
- Permits posterior movement of teeth in one arch without adversely disturbing the opposite arch.
- High pull - has a head cap, places a distal and upward force on maxillary teeth and the maxilla. Indications - class II, div 1 with open bite.
- Cervical pull - has a neck strap, places a distal and downward force on maxillary teeth and the maxilla. Disadvantage - can extrude maxillary
molars resulting in an open bite. Indications - class II, div 1.
- Straight pull - places force in a straight distal direction from the max molar. Indications - class II, div 1
- Reverse pull - has an EXTRAORAL component that is supported by the chin, cheeks, forehead. Indications - class III malocclusion to protract
the maxilla.
- Hyperparathyroidism - can cause PREMATURE eruption of primary teeth.
- Poor man's Cephalometric analysis - do a facial profile analysis
- Tongue thrusting does NOT lead to an open bite.
- Indirect method of bonding brackets - more complex and technique sensitive.
- Mouth breathing - causes SKELETAL open bite, "Long Face Syndrome"
- Quad Helix - a FIXED appliance, consists of 4 helices, used for posterior cross bites caused by digital sucking habit. NOT a functional appliance
- Functional Appliances
- Tissue borne
- Frankel - the ONLY tissue borne functional appliance!!! Expands the arch by padding against the pressure of the lips and cheeks on
the teeth and postures the mandible forward and down. REMOVABLE.
- Tooth borne
- Activator- advances the mandible to an edge to edge position to induce mandibular growth
- Bionator - a trimmed down version of the Activator making it more comfortable
- Herbst - can be fixed or partially removable. Mandible is postured forward to induce growth.
- Twin block - a two piece acrylic appliance that postures the mandible forward.
- The Frankfort-Horizontal plane is constructed by drawing a line connecting PORION and ORBITALE. The best representation of the natural orientation of
the skull.
- Nance appliance - has a small acrylic button that rests against palatal tissue and bands around 1st permanent molars . used when premature BIlateral
loss of max primary teeth.
- Band and loop - used after UNILATERAL loss of primary first molars. Prevents mesial migration of primary 2nd molar.
- Distal shoe - used to prevent unerupted 1st permanent molars from moving mesially with premature loss of primary 2nd molars.
- Lingual arch appliance - used when BOTH primary 1st molars are lost and permanent mand incisors are erupted. Primary 2nd molars or perm 1st molars
are banded.
- Molar uprighting - Takes about 6-12 months, Use a fixed edgewise orthodontic appliance
- Ectopic eruption - occurs when a tooth erupts in the wrong place. Most commonly seen in max 1st molars and mand incisors.
- Leeway space - refers to the space created due to the fact that the permanent canine, 1PM, and 2PM are smaller mesiodistally than the primary canine,
1st molar and 2nd molar. Accomodates the permanent canines which are larger than primary canines.
- Mand leeway space = 3-4mm, Max leeway space = 2-2.5mm
- Late mesial shift - when the permanent 1st molars move mesially into the leeway space after the primary 2nd molars are shed causing a LOSS
in arch length.
- Primate space - spacing in the anterior part of primary dentition. Caused by the GROWTH of the dental arches!!
- In the max arch, the primate space is located btwn the lateral incisors and canines
- In the mand arch, the primate space is located btwn the canines and 1st molars
- Primary molar relationships
- Mesial step - the distal surface of the lower 2nd primary molar is mesial to the distal surface of the upper 2nd primary molar. This allows 1st perm
molars to erupt into a normal occlusion.
- Flush terminal plane - aka flat plane or end to end - the distal surfaces of the max and mand 2nd primary molars are in an end-to-end
relationship. The 1st perm molars do NOT erupt immediately into normal occlusion but into Class II temporarily until late mesial shift when 1st
perm molar shift mesially.
- Distal step - where the distal surface of the mandibular primary 2nd molar is located to the distal of the distal surface of the max primary 2nd
molar. In these cases, the permanent molars erupt into a class II relationship.
- Permanent mandibular canines erupt FACIALLY to primary mandibular canines.
- Permanent teeth normally move occlusally and buccally while erupting.
- Permanent 1st PM usually erupts between 10-12 years old.
- Conditions associated with multiple supernumerary teeth: Gardener's syndrome, Cleidocranial dysplasia, Down's syndrome, Sturge-Weber syndrome.
- A steep mandibular plane angle correlates with - a LONG anterior facial vertical dimension and an anterior open bite.
- A flat mandibular plane angle correlates with - a SHORT anterior facial vertical dimension and an anterior deep bite.
- Edgewise Appliance - used in the tx of comprehensive malocclusions of the adolescent permanent dentitions. Consists of bands on all the teeth, tubes on
the last molar and brackets on all other teeth.
- Primary growth centers of the maxilla = spheno-occipital and sphenoethmoidal junctions and nasal cartilaginous septum
- Secondary growth sites of the maxilla = frontomaxillary suture, zygomaticotemporal suture, pyramidal process of palatal bone, alveolar process
- Posterior cross bites - Should be corrected as soon as possible - at an EARLY age, even if perm 1st molars haven't erupted yet. Often corrected by
palatal expansion.
- Crowding
- When space lacking is less than 4mm, it can be obtained by stripping some interproximal enamel from anterior teeth
- When space deficiency exceeds 4mm, it indicates extraction for correction.
- Pseudo Class III - when a patient adopts a jaw position forward in order to avoid the interference of teeth.
- "Sunday Bite" - when a person postures their mandible forward in order to improve Class II esthetics. .
- Class II, Div I - a distal relationship of the buccal groove of the mandibular 1st perm molar to the MB cusp of the max 1st perm molar along with the max
laterals being in extreme labioversion (protruded).
- Class II, Div II - when the maxillary LATERALS have tipped labially and mesially (sometimes overlapping the centrals)
- Subdivisions - when the distocclusion occrs on one side of the dental arch only
- An anterior crossbite in a primary dentition usually indicated a SKELETAL growth problem.
- A retrognathic profile - when the mandible is markedly retruded. Associated with Class II malocclusion.
- Class II malocclusion is also referred to as retrognathism or overbite
- A prognathic profile - when the mandible is markedly forward of the maxilla giving a concave midfacial appearance. Indicative of a Class III malocclusion.
- Archwires - should possess high strength, low stiffness, high range, and high formability.
- Loops and helices are incorporated into archwires to increase the activation range.
- The stiffness of ortho wires is a function of the length of the wire, the diameter of the wire, and the alloy composition.
- Can be made of stainless steel
- Chromium cobalt alloys - can be softened or hardened by heat treatment.
- Titanium alloys - offers a combo of strength and springiness and reasonably good formability.
- Hawley retainer - clasps on molar teeth, outer bow with adjustment loops spanning from canine to canine, and acrylic palatal coverage
- Palatal coverage is the major source of anchorage
- Can be made for the upper or lower arch
- Cross bite
- An ANATOMIC crossbite (skeletal), as opposed to a FUNCTIONAL crossbite (from thumb sucking), usually demonstrates a SMOOTH closure
to centric.
- A FUNCTIONAL crossbite is usually caused by thumbsucking and does not demonstrate smooth closure into CO.
- Displaced teeth related to functional shifts are usually seen in posterior crossbites after prolonged thumbsucking and anterior
crossbites in mildly prognathic children.
- A corrected anterior crossbite is best retained by the normal incisor relationship that is achieved through treatment (of the overbite), NOT by
appliances.
- Tx usually starts with Maxillary Expansion
- Reverse overject is associated with Class III skeletal patterns with more than two maxillary anterior teeth in linguoversion.
- Scissor bite or bilateral lingual cross bite - results from a narrow mandible or a wide maxilla.
- Overbite - the vertical overlapping of the max anterior teeth over the mand anterior teeth.
- Overjet - the horizontal projection of the max anterior teeth beyond the mand anterior teeth.
- Moyer's Mixed Dentition Analysis - where the size of the UNerupted canines and premolars is predicted from the knowledge of the M-D size of the
mandibular INCISORS that have already erupted. (max incisors are not used due to the variability in size)
- Measure the M-D diameter of mand incisors and add them together
- Measure the space avail for mand incisors
- Subtract 1 from 2
- A NEGATIVE number indicates CROWDING in the incisor region
- Wrist-hand radiograph - best predictor of the time of pubertal growth spurt - look at ossification and development of the carpal bones of the wrist, the
metacarpals of the hands and the phalanges of the fingers.
OSHA/ BEHAVIORAL SCEINCE/ PUBLIC HEALTH

- Autoclave - minimal temp required is 250F (121C) for 15-20 minutes. Yields 15 lbs of pressure steam per square inch.
- Moist heat destroys bacteria by denaturation of high protein containing bacteria.
- Applies heat under pressure which speeds up the denaturation process
- Must do spore testing on a weekly basis to test the units
- Flash cycle - 270F (134C) at a pressure of 30psi for a minimum of 3 minutes.
- Dry heat sterilization - at temp 320F (160C) for 2 hours!! (or 340F (170C) for 1 hour)
- Destroys microorganisms by COAGULATION of proteins
- Effective and safe for metal instruments
- Does NOT dull or corrode instruments
- Unsaturated chemical vapor sterilization - at temp 257F (132C) for 20-40 minutes. Yields 20lbs of pressure of sterilizing vapor.
- A solution of alcohol, formaldehyde, ketone, acetone, and water is used to produce the vapor.
- Temp and pressure is greater than used for autoclave.
- Does NOT rust or corrode instruments.
- Rapid Heat Transfer Sterilization - at temp 375F (191C) for 12 minutes for wrapped instruments and 6 minutes for unwrapped.
- Does not dull cutting edges, items are dry at end of cycle.
- 2% Glutaraldehyde - an ALKALIZING agent highly lethal to all microorganisms. Takes 10 HOURS.
- Disinfectants
- Alcohols - the most widely used antiseptic, used to reduce the number of microorganisms on the SKIN surface. Denatures proteins, extracts
membrane lipids, and acts as a dehydrating agent. Not an effective surface cleansing agents.
- Isopropyl alcohol 90-95% - used in hospitals
- Ethanol 70% - used to clean skin
- Iodine - most effective skin antiseptic. Acts as an oxidizing agent and combines irreversibly with proteins.
- Quaternary Ammonium Compounds - widely used for skin antiseptics. Classified as CATIONIC detergents.
- NOT sporocidal , tuberculocidal or viricidal.
- Anionic surface acting agents include detergents (synthetic) and soaps (natural).
- Intermediate level disinfectant - The marker microorganism for intermediate surface disinfection is - mycobacterium tuberculosis
- Sterilization - the killing or removal of ALL microorganisms, including bacterial spores.
- Disinfection - the killing of many, but not all microorganisms. Does not kills spores. Refers to chemicals applied to INANIMATE surfaces, not skin.
- Antiseptics - similar to disinfectants but may be applied to living tissue.
- Hand washing
- Chlorhexidine gluconate - a skin antiseptic and an antimicrobial agent.
- Triclosan - a potent wide spectrum antibacterial and antifungal agent.
- Isopropyl alcohol 60-80% - do NOT use water
- Ethylene oxide - a gas that is widely used as a sterilization agent, especially for disposable plastic ware in hospitals. Toxic to humans and flammable so
use is limited. Takes 10-16 hours!! Functions as an alkylating agent by irreversibly inactivating cellular nucleic acids (DNA) and proteins.
- Chlorine - the active component is hypochlorite (bleach). Dilution of 1:100 with water. A powerful oxidizing agent that inactivates bacteria and most
viruses by oxidizing free sulfhydryl groups.
- All reusable items that come in contact with a patient's blood, saliva, or mucous membranes must be sterilized using heat.
- Test specificity - a medical term defined as the ratio of true negative tests to the total unaffected patients tested. It is expressed as a percentage. It
measures a screening test's ability to correctly identify the absence of disease. It has few false POSITIVES. It is independent of disease prevalence in
the community.
- Test sensitivity - a medical term defined as the ratio of true positive tests to the total number of affected patients tested. It is expressed as a percentage.
It measure a screening test's ability to correctly identify the presence of a disease. A test with high sensitivity has few false NEGATIVES. It is independent
of disease prevalence in the community.
- Classical conditioning - aka pavlovian or respondent conditioning. a stimulus that leads to a response.
- Operant conditioning - the basic principle that a consequence of a behavior is in itself a stimulus that can affect future behavior. Ex. Positive and negative
reinforcement.
- Health Belief Model - suggests that individuals will act to prevent disease only when they believe that they are susceptible to it.
- Nitrous oxide - acceptable maximum exposure level allowed by OSHA is 1000ppm.
- OSHA regulates contaminated sharps - blood or saliva.
- Employer must maintain a medical record for each employee whose job involves occupational exposure to blood and other potentially infectious materials.
- OPIM = other potentially infectious materials
- Center for Disease Control and Prevention recommends a minimum of 20-30 seconds of flushing of the water lines between patients.
- The FDA is responsible for regulating handpieces and their sterilization procedures.
- Hepatitis vaccine - Recombivax HB and Engerix-B.
- Waste that is capable of causing a poisonous effect is called - toxic waste.
- Hazardous waste - causes harm or injury to the environment
- Infectious waste - waste that contains strong enough pathogens in sufficient quantity to cause disease.
- OSHA bloodborne pathogens standard - a comprehensive rule that sets forth the specific requirements OSHA believes will prevent the transmission of
bloodborne diseases to employees. Requires that a written exposure control plan be reviewed annually.
- Documents that contain info concerning a hazardous chemical are called MSDs - Material Safety Data Sheets
- Capitation fee - a method of payment for dental services in which an individual or institutional provider is paid a fixed, per capita amount without regard to
the actual number or nature of services provided to each patient.
- HMO - health maintenance organization - a self contained staff model practice in which no distinction is made between the providers of
insurance and the providers of health care.
- ADA's Principles of Ethics and Code of Professional Conduct (ADA code) - has 3 components - The Principles of Ethics, The Code of Professional
Conduct, The Advisory Opinions.
- Incidence - the number of new cases of a specific disease occurring within a population over a certain amount of time. Expressed as a rate - cases per
population / time.
- Prevalence - the proportion of persons within a population suffering from a disease at a given point in time. Expressed as a %.
- 3rd party dentistry - a system where a provider of coverage contracts to pay for some of the patient's dental tx. Ex. Insurance
- DMFT - Decayed/missing/filled teeth - an irreversible index. Applied only to permanent teeth. Scores range from 0-32. Best index used.
- DMFS - Decayed/missing/filled surfaces - Scores range from 0-160
ORAL SURGERY
- TMJ
- Myofascial Pain Dysfunction - the most COMMON cause of TMJ pain. Muscle spasm and limited jaw opening.
- Internal Derangement - when the articular disc is pulled anteriorly by the superior head of the lateral pterygoid muscle.
- With reduction - when the disc is misplaced anterior to the condyle at rest and returns to the head of the condyle during function.
Clicking and popping.
- Without reduction - when the disc is always anterior. No sound. Reduced maximum opening to less than 30mm.
- Degenerative Joint Disease aka osteoarthritis - seen in older patients. Usually asymptomatic.
- Articular disc is usually displaced anteromedially.
- Major blood supply is from Superficial temporal artery and Maxillary artery.
- Fibrous capsule is innervated by Auriculotemporal nerve (V3).
- Anterior region of the joint is innervated by Masseteric Nerve and Posterior deep temporal nerve (v3)
- A ginglymoarthroidal joint - it glides and rotates.
- Temporomandibular ligament - aka lateral ligament - runs from the articular eminence to the mandibular condyle. Provides lateral
reinforcement for the capsule. Prevents posterior and inferior displacement of the condyle. The MAIN stabilizing ligament of the TMJ. Keeps
the head of the condyle in the mandibular fossa if fractured.
- Sphenomandibular and Stylomandibular ligaments - considered accessory ligaments.
- Sphenomandibular ligament is most often damaged in IA nerve block.
- Blood pressure
- Cuff should be 80% long and 40% wide of the arm circumference.
- Cuff too small - produces falsely elevated readings
- Cuff to large - produces falsely low readings
- Glucocorticoids - retard healing by interfering with the migration of neutrophils and mononuclear phagocytes into the site of inflammation. Reduce the
digestive ability of macrophages. Inhibit the formation of granulation tissue by retarding capillary and fibroblast proliferation and collagen synthesis.
- Bone healing
- Primary intention - involves both endosteal and periosteal proliferation. Occurs when bone is incompletely fractured or fractured bone ends are
placed together. Little fibrous tissue is produced with minimal callus formation.
- Secondary intention - involves mostly endosteal proliferation. Occurs when fractured bone remains more than 1mm apart. Contains a lot of
fibrous tissue and forms a callus.
- Cranial Nerves
- CN 3, 7, 9, 10 all have parasympathetic activity.
- Trigeminal nerve - sensory and motor, NO parasymp.
- Mandibular Division - V3
- Long buccal nerve - sensory only
- Auriculotemporal - sensory only
- Lingual nerve - sensory only, anterior 2/3 of tongue
- Inferior alveolar nerve - sensory and motor, to mand teeth and skin of chin and lower lip.
- Mesencephalic nucleus - mediates proprioception ex. Muscle spindle.
- Main sensory nucleus - mediates general sensation ex. Touch
- Spinal nucleus - mediates pain and temp from head and neck
- If facial nerve is cut AFTER it exits the stylomastoid foramen, muscles of fascial expression would be affected.
- Tongue -
- Motor - hypoglossal XII
- Sensory - anterior 2/3 gets taste from chorda tympani branch from Facial nerve and sensory from lingual branch of V3. Posterior gets taste
and sensory from glossopharnygeal nerve.
- Blood supply - from the lingual artery mainly, tonsillar branch of facial artery and ascending pharyngeal artery.
- The least common site for a mandibular fracture to occur is at the coronoid process.
- The mandible deviates to the side of the injury.
- Prothrombin time (PT) - normal is less than 11 seconds
- Partial Thromboplastic time (PTT) - detects coagulation defects of the INTRINSIC system. The basic test for hemophilia. Normal is 25-36 secs.
- Platelet counts - normal is 150,000 - 450,000 per 1cu mm of blood. The minimal platelet count for oral surgery is 50,000.
- INR - the preferred lab test for assessing anticoagulant therapy in pts taking warfarin. Normal INR is 1. Target INR is 2-3 for anti-coagulant pt. NO oral
surgery should be done if INR is greater than 5.
- Inhaled general anesthetics - usually preceded by IV or IM of a short acting sedative hypnotic drug like Thiopental.
- Halothane - powerful, can be toxic to the liver
- Enflurane - less potent, more rapid onset and faster awakening. Increases intracranial pressure risking seizures so contraindicated with
seizure disorders.
- Isoflurane - not toxic to liver but can cause cardiac irregularities.
- Desflurane - may cause coughing and excitation during induction so used with IV anesthetics. Requires electrically heated vaporizer so it can
be delivered as a gas at room temp.
- Sevoflurane - does not cause coughing, so can be used without IV agents for rapid induction. Most commonly used with PEDO patients.
- Nitrous oxide - a weak anesthetic, often used with thiopental to produce surgical anesthesia. Has the FASTEST induction and recovery.
- Works on the Central Nervous System
- Maximal safe concentrations - 70% nitrous, 30% oxygen
- Anticholinergic drugs - ex. Atropine - are given post operatively to decrease the risk of bradycardia during surgery.
- Interfere with the binding of acetylcholine at its receptor.
- Inhibit secretion from all glands in the nose, mouth, pharynx. Decrease the flow of saliva and secretion from respiratory glands
- Can cause mydriasis - dilated pupils
- Increase heart rate
- Inhibitory effect on motility though the GI tract
- Contraindicated for pts with glaucoma and nursing mothers
- Dialysis - perform oral surgery the day AFTER dialysis.
- Mandibular advancement or set back- performed by mandibular ramus sagittal split osteotomy. The position of the condyle is unchanged.
- Vertical ramus osteotomy - used to set the mandible posteriorly to correct prognathism.
- Vertical body osteotomy - involves extracting mandibular teeth bilaterally along with a piece of bone to slide the mandible back to correct prognathism.
- Step osteotomy - make bilateral step shaped cuts in the body of the mandible
- A Le Fort I osteotomy is most commonly used to correct maxillary retrognathia.
- Pericoronitis - most commonly involved tooth is MAND 3rd molar. Cleanse beneath tissue flap, salt water rinse, soft diet.
- Grafts
- Alloplastic grafts - SYNTHETIC, inert, man-made synthetic materials
- Wound healing
- 1) Inflammatory stage - consists of a vascular and cellular phase. Neutrophils and lymphocytes predominate.
- 2) Proliferative stage - the fibroblastic stage where collagen and new blood vessels are formed
- 3) maturation stage - the remodeling stage where collagen fibers continue to increase tensile strength.
- IMF lasts for 3-6 weeks.
- Carotid sheath - contains carotid arteries, internal jugular vein, vagus nerve, and deep cervical lymph nodes. NOT the sympathetic trunk which lies
posterior.
- The optimum site for IV sedation for an outpatient is the median cephalic vein.
- Verrill's Sign = 50% ptosis of the eyelids (droop)
- MAC = Minimum alveolar concentration - the alveolar concentration of anesthetic at which 50% of the patients are unresponsive to a standard surgical
stimulus.
- Meyer-Overton Theory - anesthesia commences when a chemical substance reaches a certain molar concentration in the hydrophobic phase.
- Second gas effect - potent agents are administered with nitrous oxide so that the potent agent will be delivered in increased amounts to the alveoli as a
gas rushes to replace the nitrous oxide absorbed by pulmonary blood.
- Sutures - "0" is the baseline average size. Most common is 3-0 or 4-0.
- As suture diameter decreases, "0's" are added or numbers followed by "0s". Ex. 000 and 3-0 are the same size.
- As suture diameter increases, numbers are assigned.
- Resorbable sutures evoke an intense inflammatory reaction.
- Monofilament sutures - material made from a single strand. Ex. Plain and chromic gut.
- Polyfilament sutures - multiple fibers are braided or twisted. Ex. Silk, dexon, and vicryl.
- Remove in 5-7 days.
- MAO inbibitors - used for depression and Parkinson's disease. Ex. Isocarbonaxazid, Phenelzine, Tranylcypromine, and Selegiline.
- Increases endogenous concentrations of norepinephrine, dopamine and serotonin by inhibiting monoamine oxidase which breaks them down.
- Meperidine - a potent narcotic analgesic used to tx moderate to severe pain and as a cough suppressant. Most widely used narcotic. Produces slight
euphoria but no miosis.
- If meperidine is taken with MAO inhibitors - causes hyperpyrexic reactions leading to seizures or comas.
- Vertical Releasing incisions - made at LINE angle of tooth.
- Le Fort Fractures
- Le fort I - aka horizontal fracture - fracture through the maxilla just above the maxillary teeth. Results in open bite.
- Le fort II - fracture causes maxilla to separate from the facial skeleton.
- Le fort III - horizontal fracture where entire maxilla and one or more facial bones are separated from upper face. Causes restricted mandibular
movement.
- American Society of Anesthesiologists (ASA) classifications
- ASA I - normal, healthy pt
- ASA II - mild systemic disease or significant health risk factor like smoking, alcoholism, or obesity.
- ASA III - severe disease that is not incapacitating
- ASA IV - severe systemic disease that is a constant threat to life
- ASA V - a moribund patient not expected to survive without the operation
- ASA VI - a declared brain dead patient whose organs are being removed for donor purposes.
- Sublingual gland - made up of MUCOUS cells. Innervated by Facial nerve. Blood supply is sublingual artery.
- Psychogenic reaction - caused by psychological factors rather than physical factors. Tx with
- Diazepam (valium) - 5-10mg orally
- Pentobarbital (Nembutal) - 50-100mg orally
- Secobarbital (seconal) - 50-100mg orally
- Promethazine - 25mg orally
- Dissociative anesthesia - reduces anxiety and produces a trance-like state. Primary use is in emergency situations like an injury. Pt won't remember the
procedure.
- KETAMINE - increases secretions, increases BP, muscle tone and heart rate, but not respiration. Often causes LARYNGOSPASMS.
- General anesthesia
- The medulla is the last area of the brain to be depressed. It contains the cardiac, vasomotor and respiratory centers of the brain.
- Eyes are taped shut to prevent corneal abrasion.
- Biopsy
- Use block anesthesia, but if infiltration is used, it must be 1cm away from the lesion.
- Place specimen in 10% formalin solution.
- Excisional biopsy - when entire tumor is removed. Incisional biopsy - when only a portion of the tumor is removed.
- Thrombocytopenia - less than 50,000/mm3 of platelets. Normal platelet count is 150,000 - 450,000mm3
- Chronic bronchitis - a productive cough, often with wheezing. Strongly associated with cigarettes.
- Cor pulmonale - the enlargement of the right ventricle
- Local Anesthetics
- Amide type - undergo biotransformation in the LIVER. i + caine. Ex. Lidocaine, mepivacaine
- Ester type - undergo rapid biotransformation in the BLOOD PLASMA. Ex PROCAINE, tetracaine. Allergic rxns are more common,
- Local anesthetics are most effective in tissues that have a pH of above 7 - this is why inflamed tissue is less affected since it is more acidic.
- Stop axonal conduction by blocking sodium channels. Reversibly bind to and inactivate them.
- Epinephrine calculations…
- Differential blockade - sympathetic functions are lost first, then pain sensation, then temp, touch, deep pressure. Motor function is lost last.
- Small diameter fiber are affected first
- Myelinated fibers become blocked first
- A delta fibers and C fibers - small diameter, transmit pain, blocked sooner
- A alpha - motor fibers to skeletal muscle
- Can reduce salivary flow by reducing anxiety and sensitivity during the procedure
- Diabetes
- Fasting blood glucose level above 140mg/dl.
- Non-fasting glucose level greater than 200mg/dl.
- Hemophilia - inherited as a sex linked recessive trait. Prolonged PTT (partial thromboplastin time), but normal PT and bleeding time.
- Hemophilia A - a deficiency of clotting factor VIII. Most common.
- Hemophilia B - aka Christmas Disease - a deficiency in clotting factor IX.
- Von Willebrand's disease - inherited as autosomal dominant bleeding disorder. vWf binds normally binds to factor VIII and facilitates in platelet adhesion.
- Cavernous sinus thrombosis - a blood clot often caused by staph aureous due to a maxillary odontogenic infection via the venous drainage of the maxilla
due to absence of valves.
- Frenectomy
- Diamond excision and Z plasty - effective when mucosal and fibrous tissue band is NARROW. Relaxes the pull of the frenum.
- V-Y advancement - preferred when the frenal attachment has a WIDE base.
- CPR - if pulse - 1 breath every 5-6 secs or 10-12 breaths per minute. If no pulse - 15 compressions to every 2 breaths.
- Trismus - caused by spasm of MEDIAL pterygoid muscle after IA injection if injection is BELOW the mandibular foramen.
- Neuroleptic anesthesia - a combination of a narcotic analgesic and a neuroleptic agent and nitrous oxide. ONLY produces an unconscious state if nitrous
oxide is also administered. If no nitrous, then pt remains conscious. Ex. Droperidol and fentanyl
- Impacted 3rd molars - remove when root is 2/3rd formed
- Mand - most difficult - distoangular, vertical, horizontal, mesioangular
- Max - most difficult- mesioangular, horizontal, vertical, distoangular
- MESIOANGULAR impaction is most common 43%
- Max 3rd molars are occasionally displaced into max sinus or infratemporal space
- Steroids
- Small doses 5mg prednisone/day have adrenal function suppressed in a month
- 100mg cortisol/day (20-30mg prednisone) have adrenal function suppressed in a week
- Have pt take double dose on day of surgery
- Short term therapy for 1-3 days of even high dose steroids will NOT alter adrenal cortical function.
- Suppressive doses of steroids will take a year to regain full adrenal cortical function.
- If an adrenal crisis, give IV or IM injection of hydrocortisone
- Body naturally secretes 20mg of hydrocortisone every day. 200mg when stressed
- Caldwell-Luc approach - a procedure that eliminates blind procedures and facilitates the recovery of large root tips or entire teeth that have been displaced
into the max sinus. Make an opening into the facial wall of the antrum above the max premolar roots.
- The palatal root of the max 1st molar is most often dislodged into the max sinus.
- If a root tip of a mand 3rd molar disappears while trying to retrieve it, it is most likely in the submandibular space.
- Stridor - high pitched, noisy respiration, like the blowing of wind. Caused by partial obstruction of the airway at the level of the larynx or trachea.
- Palpate the posterior aspect of the mandibular condyle externally over the posterior surface of the condyle with the mouth open (NOT through the
external auditory meatus -this can cause false joint sounds)
- Wharton's duct - aka submandibular duct - enters the floor of the mouth near the lingual frenula.
- A Class II lever is used during tooth extractions.
- Benzodiazepines - used to tx anxiety and sleep disorders. No hangovers unlike barbiturates.
- Diazepam - used for muscle spasticity in pts with cerebral palsy, IV used for status epilepticus
- Alprazolam - has selective anxiolytic effects in pts with agoraphobia
- Barbiturates - provide sedation but NO analgesia. They are CNS depressants and have anti-convulsant effects. Enhance GABA receptor binding and
prolong the opening of chloride channels.
- Ex. Thiopental - an ultra short acting barbiturate used IV to induce surgical anesthesia.
- Ex. Phenobarbital - used in long term management of seizures. LONG acting.
- Ultra short acting - thiopental, thiamylal, methohexital
- Do not use with pts with respiratory disease. Highly addictive.
- Chloral hydrate - the ONLY non-barbituate sedative -hypnotic used in dentistry. Most often used in pedo patients. A PRO-drug that is metabolized to the
active metabolite. Rapidly absorbed in 15-30 minutes and lasts 4 hours. Does NOT relieve pain. Dose- 50mg/kg up to 1g.
- Opioid analgesics
- Ex. Morphine, codeine, fentanyl, meperidine, methadone, propoxyphene, levorphenol, hydrocodone, oxycodone, and pentazocine
- Percodan = oxycodone and aspirin - STRONGEST pain medication you can prescribe and still have pt ambulatory
- Percocet = oxycodone and acetaminophen
- Naloxone - a mew opioid receptor competitive antagonist used to counter the effects of an opioid overdose
- Cushing syndrome - most common cause is pituitary adenomas. Aka hypercortisolism. Most common in females 5:1. Moon faces, buffalo hump
- Autotransplantation - most often used to transplant 3rd molar into site of unrestorable mand 1st molar.
- No oral surgery within six months of a heart attack.
- Isograft = tissue surgically transplanted from an individual of the same species who is genetically related to the recipient.
- Allograft = tissue surgically transplanted from an individual to a genetically non-identical individual of the same species.
- The most popular used implants are ROOT form endosseous implants.
- Endosseous implants - surgically inserted into jawbone.
- Root form - cylindrical in shape, can be smooth, threaded, or perforated
- Blade implants - flat in appearance, used when insufficient width of bone but adequate depth.
- Subperiosteal implants - fit on top of supporting areas in the mandible or maxilla under the mucoperiosteum.
- Transosseous implants - actually penetrate the entire jaw so they emerge on the opposite side.
- Lymph nodes
- Submental - tip of tongue, floor of mouth, mand incisors, center of lower lip
- Submandibular - front of scalp, nose, upper and lower lip, max and mand teeth, anterior 2/3 of tongue
- Blood
- Hematocrit - the volume percentage of red blood cells in whole blood. Minimum acceptable for surgery is 30%.
- Warfarin (coumadin) - interferes with vitamin K which is involves in the manufacture of prothrombin in the body. Increases PT and PTT.
- Metabolic acidosis - excessive blood acidity characterized by low levels of bicarbonate in the blood. Causes - diabetic or starvation ketoacidosis
- Respiratory acidosis - excessive blood acidity cause by a build up of carbon dioxide in the blood due to poor lung function or slow breathing.
- Metabolic alkalosis - blood is alkaline due to high levels of bicarbonate. Causes - vomiting, diuretics
- Respiratory alkalosis - blood is alkaline due to rapid or deep breathing resulting in low blood carbon dioxide levels.
- Max 1st molar - innervated by PSA and MSA nerves.
- Scopolamine - a pre-op medication used to produce amnesia and decrease salivary and respiratory secretions. It blocks the action of acetylcholine at
parasymp sites in smooth muscle, secretory glands, and the CNS. Often used to prevent motion sickness.
- Max sinus opens up into the hiatus semilunaris located in the middle meatus of the lateral nasal cavity.
- Marsupialization is the tx of choice for a recurrent ranula or for cysts close to vital structures.
- Enucleation - the total removal of a cystic lesion - is the tx of choice for congenital cysts, mucoceles, and odontogenic cysts.
- Extraction
- Max deciduous molar - luxate palatally! Because primary molars are more palatally positioned and the palatal root is strong and less prone to
fracture.
- Max permanent molars - luxate buccally.
- Highest incidence of fractures occurs in - young males 15-24. Due to trauma.
- Bacterial endocarditis - prosthetic heart valves, pulmonary shunts or conduits, prior BE,
- Amoxicillin 2g, 1hr prior to procedure (4 500mg tablets)
- Clindamycin 600mg, 1 hr prior to procedure if allergic to penicillin NOT erythromycin
- Children - amoxicillin 50mg/kg or clindamycin 20mg/kg
- Lingual artery - arises from the ECA at the hyoid bone and does NOT accompany the course of the lingual nerve.
- Acetaminophen - has anti-pyretic effects but NO anti-inflammatory effect. A weak COX inhibitor.
- Pterygomandibular raphe - insertion point for superior pharyngeal constrictor and buccinators muscles.
- Buccinators muscle is pierced by needle in IA block.
- Congestive heart failure - results from impaired pumping ability by the heart. A ventricular ejection fraction below 50% indicates CHF. Usually LEFT
ventricle fails first.
- ACE inhibitors - captopril, lisinopril - dialate blood vessels and reduce the hearts workload
- Beta blockers - carvedilol, bisoprolol, metoprolol, atenolol - reduce arrhythmias and improve mechanical efficiency of the heart
- Inotropes - digoxin - increase the strength of cardiac contractions
- Diurectics - lasix, aldactone, zaroxolyn - eliminates water and sodium through kidneys and reduces edema and shortness of breath
- Atelectasis - when mucous or a foreign object obstructs airflow in a mainstem bronchus causing collapse of the affected lung tissue into an airless state.
- Pneumothorax - when air leaks into the pleural space causing the lung to recoil from the chest wall.
- Osteomyelitis - most often caused by STAPH AUREUS. Due to reduced blood supply. Most common in mandible since dense cortical bone causes less
blood.
- An inflammatory process within medullary (trabecular) bone that involves the marrow spaces.
- Suppurative - can be acute, chronic, or infantile
- Non-supurative - can be chronic sclerosing, Garre's osteomyelitis, or actinomycotic osteomyelitis.
- Contradictions to tooth extractions - cellulitis, acute pericornitis, irradiated jaws, ANUG, uncontrolled diabetes
- Masticator space - consists of the masseteric, pterygomandibular, and temporal spaces. Bounded by muscles and fascia of mastication. Infections of
zygomatic and temporal bones and abscesses of mand molar teeth may pass to the masticator space.
- Propylene glycol in IV valium can cause phlebitis - irritation or inflammation of a vein.
- Parotid gland - purely serous (same as von Ebner's glands)
- Most common mid face fracture - zygomaxillary complex - 40%
- Geudel's Stages of Anesthesia
- Stage I - amnesia and analgesia - administration of anesthesia and loss of consciousness. Reflexes are still present.
- Stage II - delirium and excitement - loss of consciousness and onset of total anesthesia. WORST stage.
- Stage III - surgical anesthesia - regular pattern of breathing, respiratory and CV failure begins
- Stage IV - premortum - signals danger, low BP, pupils dialated, skin is cold
- Most common developmental cyst is - nasopalatine duct cyst - a heart shaped radiolucency on midline.
- Most accurate way of taking body temp - rectally
ORAL PATHOLOGY
- Hepatitis - the presence of surface antigen in pts serum indicates the pt is infectious for hepatitis (carrier state). Hepatitis is very HEAT resistant - more
than HIV.
- Hep A - transmitted enterically - fecal/oral route. An RNA enterovirus. Initial symptoms appear after an incubation period of 3-6 weeks.
Increase in serum level of transaminases due to liver damage. Recovery occurs in 4 months.
- Hep B - double stranded DNA, transmitted by parental and sexual contact - sex and IV abuse - blood, breast milk, amniotic fluid. LONG
incubation period of 6-8 weeks
- Hep C - high incidence of CHRONIC disease, cirrhosis and hepatocellular carcinoma. MOST common reason for liver transplants
- Hep D - found ONLY in pts with acute or chronic Hep B!!! makes Hep B infection more severe.
- Hep E - transmitted enterically. Similar to Hep A.
- Neurilemoma (aka Schwannoma) - a well demarcated, benign lesion consisting of fibroblastic proliferation of the nerve shealth cells (Schwann cells).
Most frequently located on the TONGUE.
- Traumatic neuroma - caused by trauma to peripheral nerve. Most common site is MENTAL foramen.
- Neurofibroma - 2 forms
- Solitary neurofibroma - asymp, occurs on tongue buccal mucosa and vestibule.
- Parts of the syndrome of Neurofibromatosis - aka von Recklinghausen's Disease - autosomal dominant inherited, multiple neurofibromas on
skin, and 6 or more café au lait spots
- Palisaded encapsulated neuroma - sessile, smooth nodule under 1cm in diameter. Most common seen on nose and cheek.
- Nasopalatine duct cyst - aka incisive canal cyst - MOST COMMON maxilla cyst, MOST COMMON non-odontogenic cyst. seen as a marked swelling of
palatine papilla. Distal to roots of central incisors. Teeth test VITAL.
- Globulomaxillary cyst - appears between roots of lateral incisor and canine. PEAR shaped. Can cause roots of teeth to diverge.
- Median palatal cyst - situated in midline of hard palate posterior to premaxilla. Painless.
- Lateral periodontal cyst - 95% seen in MAND cuspid area, assoc with VITAL tooth, TEAR DROP shaped.
- White sponge nevs - asympt, white, folded and spongy, HERDITARY as autosomal dominant, most commonly bilaterally on buccal mucosa. Has an
eosinophilic condensation in the perinuclear region of cells in the superficial layers of the epithelium. No tx.
- Hairy tongue - hypertrophy of FILLIFORM papillae
- Tongue papillae
- Fillliform - MOST NUMEROUS, NO TASTE BUDS, highly keratinized
- Fungiform - flat, mushroom shaped, found at tips of tongue and lateral margins
- Circumvallate - LARGEST, circular in shape, located in back of tongue. Associated with VON EBNERS glands. LEAST numerous.
- Foliate - found on lateral margins
- Taste buds are present on fungiform, circumvallate and foliate papillae only.
- Osteosarcomas - aka osteogenic sarcomas - cause SWELLING and localized PAIN, MOST COMMON malignant neoplasm in bone. Males 30-40. Early
radiographic feature - symmetrically widened PDL around one or more teeth
- Karposi's sarcoma - cancer of the lining of blood vessels
- AIDS - caused by RNA retrovirus
- Lymphoepithelioma - swelling on lymph node is most common symptom, seen in East Asian young adults, show metastasis at EARLY stage to cervical
lymph nodes.
- Multiple myeloma - multiple "punched out" radiolucencies in involved bone, a primary MALIGNANT neoplasm of bone characterized by progressive
destruction of the marrow with replacement by neoplastic PLASMA cells. Men 40-70s. Common early symptom in pain in lumbar or thoracic region.
Jaws are a rare primary site but become involved 70% of the time - seen in molar-ramus area. Lab findings - hypergammaglobulinemia of IgG, Bence
Jones proteinuria. Poor prognosis.
- Traumatic bone cyst - aka Simple Bone cyst - NOT a true cyst. PSEUDOcyst. often seen in young people, usually seen in MANDIBLE between cuspid
and ramus. Teeth are VITAL. May contain blood, fluid or be empty. SCALLOPS around roots.
- Dentigerous cyst - contain crown of UNERUPTED tooth or odontoma, arises from remnants of REDUCED ENAMEL EPITHELIUM. 2nd most common
odontogenic cyst.
- Primordial cyst - aka Follicular cyst - contains NO calcified structures. Lined with stratified squamous epithelium. Found in the place of a tooth. Arises
from epithelium of enamel organ
- Aneurysmal Bone Cyst - an uncommon expansile osteolytic lesion of bone consisting of a proliferation of vascular tissue that forms a lining around blood
filled cystic lesions. Seen in TEENS, can be tender, NOT common in jaws, PSEUDOcyst - not a true cyst since no epithelial lining. Appears similar to
CGCG. Honey comb or soap bubble. Teeth are moved, filled with blood, fibroblasts, macrophages, and multinucleated giant cells.
- Residual cyst - when a tooth associated with a radicular cyst is extracted but the cyst remains and persists.
- Gingival cyst - rare, usually seen in canine and bicuspid areas of MANDIBLE
- Fissural cysts - aka developmental cysts - NON-DENTAL in origin, include nasoalveolar, median palatal and nasopalatine cysts.
- Odontogenic Keratocyst - ages 10-30, associated with IMPACTED teeth, RECURS, 50% seen in MAND 3RD MOLAR area
- Benign cementoblastoma - usually occurs in MAND 1st PM to molar region, comes from the PDL!!, males under 35, VITAL tooth
- Gigantiform cementoma - derived from PDL, seen in AA females
- What is the most common osseous malignancy? Osteosarcomas.
- Periapical cemental dysplasia -aka cementoma - seen in middle aged AA females, MAND incisor region, derived from PDL, opacities are BONE not
cementum, teeth are VITAL, seen in middle aged AA women, NO tx.
- 3 stages - osteolytic à cementoblastic à mature stage
- Cementifying fibroma - derived from PDL, painless swelling in mandible
- Pindborg tumor aka Calcifying Epithelial Odonotgenic Tumor - most common in mand molar area, derived from REE, seen in middle age, painless swelling
- Adenomatoid Odontogenic Tumor - aka adenoameloblastoma - seen in TEENS, in anterior maxilla
- Squamous Odontogenic Tumor - derived from Rests of Malassez, ectodermal in origin
- Ameloblastic Fibroma - most common over UNerupted molars in young pts, OFTEN mistaken for ameloblastoma - except
- Compound odontoma - looks like a TOOTH, most common in max incisor/cuspid area,
- Complex odontoma - conglomerate masses of dental tissues - enamel, dentin, cementum, disorganized
- Dilatin - an anticonvulsant drug used to control epileptic seizures, causes fibrous hyperplasia of gingiva
- Addison's Disease - aka chronic adrenocortical insufficiency - results from hypofunction of the adrenal cortex, causes bronzing of entire skin. Causes
diffuse pigmentation of oral mucosa. Skin pigmentation disappears following therapy but oral pigmentation persists!! Pts may not be able to tolerate
stress. Clinical symptoms don't appear until 90% of adrenal cortex is destroyed.
- Albright Syndrome - aka McCune Albright syndrome - a severe form of polyostatic fibrous dysplasia involving ALL bones, CAFÉ au lait spots, endocrine
dysfunction, precocious puberty in girls. Increased incidence in osteosarcomas.
- Peutz- Jeghers Syndrome - aka Hereditary Intestinal Polyposis Syndrome - INHERITED, causes multiple intestinal polyps and intraoral melanin
pigmentations often seen on LOWER lip. The polyps in the colon may undergo malignant change.
- Cushings syndrome - a hormonal disorder caused by prolonged exposure to high levels of CORTISOL, causes upper body obesity, moon face, buffalo
hump, thin arms and legs
- Nevus
- Intradermal nevus - MOSTCOMMON skin lesion, aka common mole, nevus cells lie exclusively in dermis.
- Junctional nevus - nevus cells located at interface between epithelium and lamina propria, flat, considered premalignant and can become
malignant melanomas
- Compound nevus - nevus cells located at interface between epithelium and lamina propria and also deep in dermis, raised and solid
- Blue nevus - congenital, color caused by deep cutaneous or subcutareous deposits of melanin
- Intramucosal nevus - MOST COMMON intraoral nevus, But intraoral nevi are generally uncommon. Often seen on HARD PALATE, nevus cells
are located in connective tissue or lamina propria of oral mucosa.
- Congenital nevi - aka birthmarks - usually large, greater than 10mm, 15% occur on skin of head and neck, have higher incidence of malignant
transformation.
- Median Rhomboid Glossitis - caused by chronic Candida albicans infection. Devoid of FILLIFORM papillae.
- Burning mouth syndrome - most common in POST menopausal women, feels like front of mouth was scalded but clinically normal.
- Osler-Weber-Rendu Syndrome - aka Hereditary Hemorrhagic Telangiectasia - autosomal dominant disorder, causes telangiectasias on face, neck,
mucosas, recurrent EPISTAXIS, and positive family hx of the disorder
- Encephalotrigeminal Angiomatosis - aka Sturge Weber Disease - congenital disease, PORT WINE STAIN distributed over trigeminal nerve, UNILATERAL
- Juvenile nasopharyngeal angiofibroma - rare, benign polyp neoplasm seen in TEEN MALES, causes a mass in nasopharynx causing nose bleeds.
RECURS.
- Pyogenic granuloma - arises from minor trauma to tissues, appears as a soft, pedunculated growth with a smooth red surface, caused by hyperplastic
granulation tissue. Often called PREGNANCY tumor.
- Peripheral Giant Cell Granuloma - always occurs on alveolar mucosa or gingiva, a reactive lesion to calculus, poor dental restorations, perio disease.
70% are seen in ANTERIOR of jaw. Pedunculated, broad based growth with smooth, red/blue color. Seen in pts OVER 20 (CGCG is seen is pts under
20). More common in FEMALES. Resembles a fibroma or pyogenic granuloma clinically.
- Hemangioma - common tumor caused by proliferation of blood vessels. More common in FEMALES. Present at birth or early in life. Do NOT do
incisional biopsy!!
- 3 types
- Capillary, Cavernous, and Hemangioendothelioma
- Nutritional factors, especially the amount of protein a pt is consuming, affects wound healing.
- The fixative of choice to preserve biopsy specimens is 10% buffered FORMALIN.
- Excisional biopsy - entire lesion is removed
- Incisional biopsy - only a portion of the lesion is removed, used when lesion is too large to excise without a diagnosis.
- Ludwig's Angina - a severe and spreading infection that involves the submandibular, submental, and sublingual spaces BILATERALLY. Often results from
odontogenic infection. RAPID onset. Most serios complication is edema of the glottis.
- Erythrocyte Sedimentation Rate (ESR) - a non-specific screening test that monitors the progression of disease by measure the rate at which RBCs settle
out in a tube of unclotted blood. mm per hour. Elevated rates indicate inflammation.
- Estimated toxic dose for fluoride ingestion is - 5-10mg/kg. Death can result from 2g of fluoride in an adult and 16mg/kg in kids. Symptoms - convulsions,
hypotension
- Sodium carboxymethylcellulose - a saliva substitute that increases the viscosity of saliva. Used to treat xerostomia.
- Malignant melanoma - only account for 4% of all skin cancers, but the GREATEST number of skin cancer related deaths.
- Basal cell carcinoma - metastasis is RARE, local invasion destroys underlying skin and tissue. Caused by sun or x-rays.
- Eryhtroblastosis fetalsi - occurs when fetus has Rh-positive blood and mother has Rh-negative blood. Most common form is ABO incombatability.
- Leukemia - a form of cancer that begin in the blood forming cells of the BONE MARROW. Leukocytes are damaged or remain in immature form and
multiply excessively. Results in decreased number of normal leukocytes, RBCs and platelets.
- Which form is most common in children? ALL - Acute Lymphocytic leukemia - peak age is 4 years old. MOST responsive to therapy.
- Acute leukemia - a malignant proliferation of WBC precursors (blasts) in BONE MARROW and lymph tissue. IMMATURE forms of WBCs are
found. Causes ANEMA resulting in fatigue, absence of functioning granulocytes causing infections, and thrombocytopenia. Spleen and liver
are enlarged and lymph nodes are enlarged. High ESR.
- Acute Myeloid Leukemia - MOST MALIGNANT form of leukemia where hematopoietic precursors of the bone marrow are arrested in early
stage of development. Greater than 300% of blasts are in the blood or bone marrow contain AUER RODS in their cytoplasm.
- Acute Lymphocytic Leukemia - in 75% of cases, the lymphocytes are neither B or T cells but NULL CELLS. Untreated pts die in 6 months, but
with intensive chemo and bone marrow transplants they can live up to 5 years. Death due to hemorrhage or bacterial infection.
- Chronic leukemia - characterized by proliferations of lymphoid or hematopoietic cells that are more mature than those of acute leukemias.
Have a slower onset and progression. And a longer less devastating course. Cause massive splenomegaly, lymph node involvement,
petechiae and ecchymoses. Lab findings show leukocytosis above 100,000 per cu. Mm with mature forms of granulocytes and lymphocytes
predominating.
- Chronic myeloid leukemia - 90% associated with PHILADELPHIA chromosome and low levels of leukocyte alkaline phosphatase. Survival is
only 4 years with death due to hemorrhage or infection.
- Chronic lymphocytic leukemia - older patients can survive years with NO tx. LEAST MALIGNANT type.
- Stem Cell Leukemia - abnormal cells that are poorly differentiated but are considered to be precursors of lymphoblasts, myeloblasts, or
monoblasts but the cells are too immature to classify.
- Aleukemic leukemia - leukemic cells present in the bone marrow but the circulating white blood cells are neighter immature nor increased in
number.
- Subleukemic leukemia - leukemic cells appear in the blood but there is no sig increase in the number of white blood cells.
- A leukemoid reaction - a marked increase in the number of circulating granulocytes.
- Lymphangioma - most commonly seen on TONGUE, they are benign hamartomas of lymphatic channels. Do NOT become malignant. Some regress
spontaneously during childhood.
- Lymphangioma simplex - aka capillary lymphangioma -
- Cavernous lymphangioma -
- Cystic lymphangioma - aka cystic hygroma - huge macroscopic lymphatic spaces
- Scleroderma - a systemic disease that affect many organ systems. Causes inflammation and progressive tissue fibrosis and occlusion of
microvasculature by excessive production of types I and II COLLAGEN. Shows abnormally WIDE PDL that is uniform in width. Resorption of the angle of
the ramus.
- Congenital epulis of newborn - composed of cells identical to a granular cell myoblastoma (aka granular cell tumor). Contains granular cells. Seen in
anterior maxilla and is 10 times more likely to occur in females.
- Granular cell myoblastoma - aka granular cell tumor - most common on TONGUE. Contains granular cells and pseudoepitheliomatous hyperplasia.
- Osteoporosis - aka Albers-Schoeberg Disease or Marble Bone Disease - most common type of bone disease, usually caused by drop in estrogen during
menopause.
- Osteomyelitis - an acute pyogenic infection of bone, caused by S. AUREUS. Affects LONG bones in children. Affects vertebrae and pelvis in adults. Bone
gets infected and produces pus resulting in an abscess which deprives the bone of oxygen.
- Condesing osteitis - aka chronic focal sclerosing osteomyelitis - an unusual reaction of bone to infection. A well circumscribed radioopaque mass of
sclerotic bone surrounding the apex of a tooth. Most commonly seen with mand 1st molar, associated with long standing periapical infection.
- Cleft lips - results when the medial nasal process fails to fuse with the lateral portions of the maxillary process. 1st branchial arch!! Fusion occurs during
the 6th-7th week. Most common on LEFT.
- Cleft palate - occurs in 8th-10th week.
- Osteogenesis imperfect - caused due to a genetic defect that causes imperfectly formed or inadequate amount of COLLAGEN. Results in weak bones
that FRACTURE easily. Pale blue sclera. Teeth - obliterated pulps, narrow and short roots, deciduous teeth are more severely affected.
- Associated with Type I Dentinogenesis Imperfecta.
- Hypophosphatasia - a genetic metabolic disorder of bone mineralization cause by a deficiency in ALKALINE phosphatase which is essential in calcification
of bone tissue. Can cause blue sclera, premature loss of teeth, large pulp chambers and canals.
- Paget's disease - pts have HIGH levels of alkaline phosphatase
- Acromegaly - a hormonal disorder that results when the pituitary gland produces excess growth hormone. 90% have a benign tumor of the pituitary gland
called an adenoma. AFTER adolescence (Gigantisism occurs BEFORE adolescence).
- Hyperthyroidism - too much thyroxin in the body which stimulates cell metabolism.
- Most severe form is Graves Disease - most severe and most common. Causes a GOITER and exophthalmos.
- Plummer's Disease - aka toxic nodular goiter - nodules or lumps in the thyroid that become overactive.
- Osteomalacia - related to Vit D abnormalities, softening of bones due to Vit D deficiency. Osteoid tissue fails to calcify.
- Cerebral Palsy - insult or anomaly in brain's motor control centers.
- Down Syndrome - congenital defect caused by chromosomal trisomy 21.
- Myasthenia Gravis - an autoimmune disorder where antibodies form against Acetylcholine Nictotinic postsynaptic receptors at the myoneural junction.
Muscles fatigue. Causes xerostomia since salivary glands don't get stimulated.
- Multiple sclerosis - attacks the CNS (brain and spinal cord), thought to be an autoimmune response that attacks CNS tissues. More common in WOMEN.
Often seen with Bell's Palsy and Trigeminal Neuralgia.
- Myofascial pain-dysfunction syndrome (MPDS) - main cause is muscle spasm due to fatigue. The muscle most apt to cause tenderness is LATERAL
pterygoid.
- Squamous cell carcinoma - most common type of oral cancer and 90% of all malignant neoplasms in the oral cavity. Most common site is LOWER LIP.
Tobacco use including smokeless is the primary risk factor.
- Central Ossifying Fibroma - seen in young females. Posterior mandible in 90% of cases.
- Condylar hyperplasia - progressive, UNIlateral overgrowth of the mandible, chin deviates toward UN-affected side.
- Condylar agenesis - absence of ALL or portions of coronoid process, condyle and ramus
- Central Giant Cell Granuloma - a non-neoplastic process, can behave aggressively and expansile, destroys bone and displaces teeth. 0ver 70% occurs in
mandible anterior to 1st molar. Occurs EXCLUSIVELY within jaw bones. Occurs due to trauma or a tooth extraction. Seen in young pts under 30. Twice
as more common in FEMALES. Appears similar to ameloblastoma or odontogenic keratocyst. Histologically contains multinucleated giant cells.
- Actinomycosis - SULFUR granules, a subacute bacterial infection caused by Actinomyces israelii. Can cause LUMPY JAW due to abscesses. Tx is long
term penicillin.
- Histoplasmosis - a chronic lung infection caused by inhaling spores of Histoplasma capsulatum. Causes chronic non-healing ulcer. Tx with Amphotericin
B, itraconazole or ketoconazole.
- Mikulicz's Disease - aka Benign Lymphoepithelial Lesion - an autoimmune process that is a clinical variant of Sjogren's Syndrome. Parotid gland and
submandibular gland is enlarged.
- Hyperparathyroidism - a metabolic disorder resulting in too much Calcium released from bones. Often results in FRACTURE as first symptom. Can result
in malocclusion due to shifting of teeth. Loss of lamina propria or well defined cystic radiolucencies. Multinucleated giant cells are found.
- Hypoparathyroidism - LOWERS blood Calcium and RAISES phosphate levels.
- Hypocalcemia - results from low parathyroid hormone levels. Clinical manifests as TETANY. Positive CHVOSTEK'S sign - twitching of facial muscles
when facial nerve near parotid gland is tapped.
- Histiocytosis X - a generic name for a group of disorders that cause an increase in HISTIOCYTES - including monocytes, macrophages, dendritic cells.
- Letterer-Siwe Disease - acute disseminated form - aggressive, seen in infants and young children, widespread on skin and mucosa.
- Hand-Schuller-Christian Disease - chronic disseminated - characteristic traid of exophthalamos, diabetes insipidus, and lytic skull lesions
- Eosinophillic Granuloma - focal chronic - solitary localized bone destruction, looks like periodontal disease or apical lesions. The most
BENIGN form. Complications can affect lungs resulting in pneumothorax.
- Pemphigus Vulgaris - blistering of skin caused by igG antibodies binding to SUPRA BASILAR cells.
- Acantholysis - intercellular edema and loss of intercellular bridges with loss of cohesiveness.
- TZANK cells - clumps of cells floating free in the vesicle space
- Trigeminal neuralgia - aka douloureux - a pain syndrome characterized by pain accompanied by a brief facial spasm or tic. Pain follows UNIlateral
SENSORY distribution of CN V. Feels like sudden stabbing pains with duration of under 2 minutes. Pain is provoked by TRIGGER zones. Tx is
CARBAMAZEPINE - an analgesic and anticonvulsant.
- Mumps - paramyxovirus acquired by respiratory droplets, 90% of cases occur before age 14. Can cause sterility in men due to orchitis. Elevated serum
amylase. LIVE attenuated vaccine.
- Syphilis - Hutchinson's incisors, infection with spirochete Treponema Pallidum. Most infectious stage is the SECONDARY Stage.
- Primary = chancre, NON-painful
- Secondary = HIGHLY infectious, occurs 6 weeks after non-tx of primary syphilis, mucous patches, condyloma lata (elevated plaques)
- Tertiary = gumma ( a focal, nodular mass), seen on palate and tongue, bacteria can damage eyes, heart, and CNS!! Neurosyphilis =
headache,
- Frey's syndrome - aka auriculotemporal syndrome - caused by damage to auriculotemporal nerve and subsequent reinnervation of the sweat glands by
parasympathetic salivary fibers. Often results in gustatory swelling - flushing and sweating on involved side of face during eating.
- Postherpetic neuralgia - persistent burning, itching along cuteanous nerve following herpes zoster attack.
- Acinic Cell carcinoma - derived from serous acinar cells found exclusively in PAROTID gland. Rare tumor.
- Adenocarcinoma -found in minor salivary glands of nose and paranasal sinuses.
- Fibrous dysplasia - radioopaque, non-circumscribed, GROUND GLASS appearance, asymptomatic regional alteration of bone replaced by fibrous tissue.
Can transform into malignant osteosarcomas.
- Monostotic - MOST COMMON form 80%, affects ONE bone (usually ribs or femur), Maxilla is often affected
- Polystotic - affects multiple bones- often long bones, face, clavicles, and pelvis, seen in children, mainly females,
- Albright's syndrome - aka McCune Albright syndrome - most severe form of polystotic fibrous dysplasia. Café au lait spots on skin, endocrine
abnormalities causing precocious sexual development in females. Can result in pathologic bone fractures.
- Jaffe Syndrome
- Tzank smear - done to detect HERPES viruses.
- Epstein Barr virus - causes infectious mononucleosis, and has been associated with the development of 2 forms of cancer - Burkitt's Lymphoma and
Nasopharyngeal carcinoma. The virus infects B lymphocytes. Causes the production of IgM heterophile antibodies that can be detected with The
Heterophile Test which is highly diagnostic.
- Rubella - causes German measles, causes flat pink spots on face and other body parts
- Paramyxoviruses - cause measles (rubeola) and mumps. Measles = Koplik's spots in oral cavity.
- Agranulocytosis - a severe reduction in circulating granulocytes, usually neutrophils. More than half the cases are caused by INGESTION of a drug -
antimetabolic, antibiotic,and cytotoxic drugs.. Usually causes ulcers in the mouth.
- Cyclic neutropenia - a form of agranulocytosis - pts exhibit severe gingivitis but NO ulcerations
- Polycythemia vera - condition of TOO many RBCs. Blood becomes too thick to pass in small blood vessels causing clotting and strokes. Gingiva appears
very red and swollen, petechiae and ecchymosis.
- Primary polycythemia - excess erythrocytes are produced due to a tumor. SPLENOMEGALY occurs due to vascular congestion in 75% of pts.
- Secondary polycythemia - increased # of erythrocytes due to chronic tissue hypoxia or high altitude, or erythropoietin secretion.
- Achondroplasia - most common type of dwarfism. Upper arms and thighs are shorter than forearms and lower legs. Head is large, prominent forehead
and saddle-like nose, prognathic mandible. NORMAL torso, but short arms and legs. Overcrowding of teeth, ear infections.
- Ewing Sarcoma - MOTH EATEN radiolucencies of medulla and erosion of cortex with expansion. A malignant neoplasm of bone. Seen in pts 10-20.
PAIN and swelling of involved bone.
- MEN - a group of genetically distinct familial diseases involving adenomatous hyperplasia and malignant tumor formation in several ENDOCRINE glands
- MEN III - multiple endocrine neoplasia syndrome - an autosomal dominant condition characterized by multiple mucosal neuromas in the oral
cavity, endocrine neoplasms (pheochromocytomas of the adrenal medulla and medullary carcinoma of the thyroid gland), and Marfan's
features.
- Paget's Disease - aka Osteitis Deformans - chronic bone disorder where bones become enlarged and deformed - dense but fragile. Seen in pts OLDER
pts. Dentures stop fitting. Develops slowly. COTTON WOOL appearance, hypercementosis, and loss of lamina dura. Labs - INCREASE serum
ALKALINE phosphatase but normal serum phosphate and calcium. Risk of osteosarcomas.
- Cystic fibrosis - a congenital metabolic disorder causing exocrine glands to produce abnormal secretions - thick, viscous mucous. Tend to be mouth
breathers, enlarged salivary glands, intrinsic teeth staining due to tetracycline used. REDUCED caries rate.
- TNM -
- T = size. T1 (less than 2cm diameter), T2 (4cm in diameter), T3 (greater than 4cm diameter)
- N = lymph node involvement. NO - not palpable and no metastasis. N1 - unilateral palpation and not fixed but metastasis is suspected. N2 -
Bilateral lymph nodes, not fixed but metastasis is suspected. N3 - bilateral lymph nodes, FIXED and metastasis is suspected
- M = distant metastasis. MO - no metastasis. M1 - clinical or radiographic evidence of distant metastasis other than regional lymph nodes. \
- Sjogren's Syndrome - an autoimmune chronic inflammatory disorder characterized by infiltration of exocrine glands (salivary and lacrimal) with
lymphocytes and plasma cells. Causes xerostomia, keratoconjuctiva sicca (dry eyes), and rheumatoid arthritis. Tx - symptomatic.
- Histologicaly identical to Benign lymphoepithelial lesion in a salivary gland.
- Stomatitis nicotina - NOT considered to be pre-malignant. Just stop smoking.
- Erythema multiforme - an acute self-limited eruption characterized by a distinctive clinical eruption of an iris or target lesion - BULLSEYE (central lesion
surrounded by concentric rings of pallor and redness over the dorsal aspects of hands and forearms.
- EM Major - aka Stevens-Johnson Syndrome - an SEVERE acute form that involves the skin and mucous membrane. Large bullae. Positive
Nikolsky sign. Dark red crusted lesions on lips and eyes. Classic triad - eye lesions, genital lesions, and stomatitis. BLINDNESS can occur
due to secondary infection. Tx is just supportive and symptomatic.
- Chronic EM minor - mildest form, small lesions, aphthous ulcers.
- Developmental (Fissural) Cysts - nasopalatine duct cyst, nasolabial cyst, median palatal cyst, median alveolar cyst.
- Nasolabial cyst - aka nasoalveolar cyst - is EXTRAOSSEOUS and typically found within soft tissue of upper lip.
- Nasopalatine cyst - most common, heart shaped
- Congenital Cysts
- Thyroglossal duct cyst - found in midline, symptom is hemorrhage into the mouth due to rupture of overlying veins
- Branchiogenic cyst - arises from persistence of 2nd branchial arch cleft. Located along anterior border of SCM.
- Dermoid cyst - contains hair, sebaceous and sweat glands, and even tooth structures! Most common on floor of mouth.
- Metastatic tumors - may be asymptomatic, mandibular molar region is affected most frequently. Rarely seen in max or mand, BUT a tumor of the jaws
may be the FIRST evidence of dissemination of a known tumor from its primary site - usually BREAST, kidney, lung, colon, prostate, thyroid. NOT the
brain.
- Most COMMON malignancy affecting skeletal bones is metastatic carcinomas.
- Adenoid cystic carcinoma - MOST COMMON malignant tumor of MINOR salivary glands. Often seen with facial nerve paralysis. Slow growing but often
infiltrates NERVES. Seldom metastasizes.
- Mucoepidermoid carcinoma - MOST COMMON malignant salivary gland neoplasm. Mainly seen in the PAROTID gland.
- Warthin's tumor aka Papillary Cystadenomalymphomatosum- a slow growing cystic tumor that almost always occurs in older men. Exclusively PAROTID
neoplasm. NON-tender. Seen at angle or ramus of mandible.
- Oncocytomas - benign salivary tumors, very rare 1%, usually found in parotid gland of older pts. Abundant MITOCHONDRIA.
- Sialoscintigraphy - a simple, non-invasive procedure that can separate benign tumors from malignant tumors.
- Choristoma - a mass of histologically NORMAL tissue that presents in an ABNORMAL location.
- Hamartoma - a developmental defect characterized by an overgrowth of tissues NORMAL to the organ in which it arises.
- Teratoma - a NEOPLASM composed of multiple tissues FOREIGN to the organ in which it arises. Can be benign or malignant.
- Anaplastic - a malignant neoplasm composed of Undifferentiated cells. This is a HALLMARK of malignant transformation.
- Pleomorphism - cellular variation in size and shape
- Verrucous Carcinoma - aka Sniff Dipper's Cancer - a distinct, diffuse, papillary, superficial, non-metastazing form of SCC. Rarely metastasizes.
- Nevoid Basal Cell Carcinoma -aka Gorlin and Goltz Syndrome - autosomal dominant. characterized by multiple odontogenic keratocysts.
- Geographic tongue - desquamation of FILLIFORM papillae.
- Melkersson-Rosenthal Syndrome - appear with fissured tongu, cheilitis granulomatosum, and facial nerve paralysis.
- Pernicious anemia - can manifest orally as GLOSSITIS. A MEGAblastic anemia caused by lack of secretion of INTRINSIC factor in normal gastric juice -
as a result B12 is not absorbed which is needed for the maturation of erythrocytes. A Schilling 24-hr urine test is done to eval if B12 is being absorbed.
- Thalassemia major and minor - HEMOLYTIC anemias that result from a genetic defect. LOW levels of erythrocytes and abnormal hemoglobin. Pts exhibit
anemic PALLOR. Anterior teeth flare with malocclusion.
- Odontogenic Keratocyst - derived from the DENTAL LAMINA. 70-80% occur in mandible. If multiple,eval for Gorlin Syndrome. Great tendency to
RECUR!
- Odontogenic myxoma - Arises from follicular connective tissue resembling pulp tissue. An aggressive tumor, recurrence is common.
- Ameloblastoma - consists entirely of odontogenic epithelium. MOST AGGRESSIVE odontogenic tumor. MOST COMMON epithelial odontogenic tumor.
- Solid (multicystic or polycystic) - most aggressive kind and requires surgical excision.
- Gardner's Syndrome - a rare autosomal dominant disease characterized by GI polyps, multiple osteomas, and soft tissue tumors. Inevitable outcome is
COLON CANCER due to adenocarcinoma by the 4th decade. Multiple impacted and supernumerary teeth.
- Osteomas have a COTTON WOOL appearance. Most often seen at angle of mandible
- Burkitt's Lymphoma - associated with EBV, a high grade NON-Hodgkin's lymphoma. FIRST cancer associated with VIRAL etiology. Bone appears MOTH
EATEN.
- African form - manifests as a large osteolytic lesion in the jaw, seen in very young children - 3yo, often involves jaws
- Non-african form - manifests as an abdominal mass, seen in older children - 11yo,
- Ectodermal dysplasia - a hereditary condition characterized by abnormal development of skin, hair, nails, teeth, and sweat glands. All structures derived
from ectoderm. More common in males. CONICAL TEETH - need dentures.
- Cleidocranial dysplasia - an inherited disorder of bony development characterized by absence of collar bones, protruded jaw, wide nasal bridge,
RETAINED primary teeth. Supernumerary teeth and unerupted teeth.
- Pierre Robin syndrome - an inherited disorder that presents as micrognathia and retrognathia of the mandible, glossoptosis (posterior displacement of
tongue), and cleft palate. Often seen with respiratory problems.
- Peutz-Jeghers - a genetic condition marked by hyperpigmentation and freckling of lips, hands, face, and benign polyps called hamartomas in SMALL
intestine.
- Cherubism - a familial disease where the maxilla expands and the orbits look upward, lesions are characterized by multinucleated giant cells. Seen
mostly in male children around 5yo. Often seen with delayed eruption. Multilocular radiolucencies of the mandible. Similar to CGCG but with perivascular
collagen cuffing.
- Lesions containing multinucleated giant cells - CGCG, hyperparathyroidism, and anuerysmal bone cysts.
- Bell's Palsy - damage to facial nerve. Most commonly seen in pregnant women and people with diabetes or a URI. Unilateral paralysis of all facial
muscles - loss of forehead wrinkles, drooping eyebrow, sagging lip. Subsides in 2-3 weeks.
- Sialoliths - mostly found in Submandibular (wharton's) duct. Calcium and phosphate salts around a nidus or mucous or bacteria. Pain intensifies at
mealtimes. Radiographically seen best with a mandibular occlusal view.
- Ranula - a TRUE retention cyst, fluctuant and painless
- Mucocele - NOT a true cyst (not lined by epithelium), it is mucin surrounded by granulation tissue.
- Herpes
- Corticosteroids are contraindicated in pts with herpes simplex infections.
- Lipschultz bodies - the nuclei of epithelial cells are often multiple with margination of the chromatin around the intra-nuclear inclusions.
- Tzank smear - a scrapping taken from an unroofed vesicle to diagnose herpes.
- Mucormycosis - an aggressive, opportunistic infection with a high affinity for afflicting individuals with DIABETES due to the decreased ability of
neutrophils to phagocytize and adhere to endothelial walls. Tx with Amphotericin B.
- Herpangina - Group A coxsackie virus. Localized to the posterior soft palate and nasopharynx. Clears up in 1 week.
- Thrombocytopenic purpura - aka Werlhof's disease - a bleeding disorder characterized by a deficiency in the NUMBER of platelets.
- Thrombotic thrombocytopenic purpura - a severe and often FATAL disease caused by LOW platelet count in the blood due to consumption of platelets by
thrombosis in the terminal arterioles and capillaries.
- One of the most common inherited disorders among African Americans is - sickle cell anemia - RBCs are crescent shaped, abnormal hemoglobin S due
to genetic defect - mutation of thymine for ADENINE. More common in females and seen before age 30. LARGE marrow spaces due to loss of
trabeculae. Lamina dura and teeth are unaffected. Reduced lifespan of RBCs from 120 days to 20 days.
- Aplastic anemia - etiology is unknown, thought to be chemicals or radiation exposure, bone marrow does not produce enough
RBCs. FATAL!!! The MOST serious and life threatening blood dyscasia associated with drug toxicity.
- Plummer-Vinson syndrome - causes iron deficiency anemia, along with atrophic changes to oral and esophageal mucosa, koilonychias (spoon-shaped
fingernails) and dysphagia due to esophageal stricture. Often causes carcinoma of the oral mucous membranes.
- Dentin dysplasia - a hereditary defect in dentin formation where coronal dentin and tooth color is normal. Root dentin is abnormal with a gnarled pattern
and associated with SHORT AND TAPERERD ROOTS.
- Type I - RADICULAR dysplasia - more common, normal crowns, obliterated pulp cavities, SHORT ROOTS, PARLs
- Type II - CORONAL dysplasia - semi-transparent opalescent PRIMARY teeth but normal permanent teeth. Obliterated pulp chambers, pulp
stones.
- Amelogenesis imperfecta - a hereditary ectodermal defect, only affects enamel not dentin, pulp, or cementum. Affects primary and permanent teeth
- Type I - Hypoplastic - enamel is NOT FULLY FORMED to full thickness. Results from defective formation of the enamel matrix.
- Type II - hypocalcified - QUANTITY of enamel is NORMAL but enamel is SOFT and can be removed during prophy. Results from
defective mineralization of enamel matrix.
- Type III - hypomaturation - enamel can be pierced by an explorer tip and chipped away. Results from IMMATURE crystallites.
- Internal resorption - resorption of the dentin of the pulpal walls. RCT has high success rate.
- External resorption - invasion of the cervical region of the root by fibrovascular tissue which progressively resorbs dentin, enamel, and cementum. RCT is
no help/
- Abfraction - cervical erosive lesions caused by tensile and compressive forces during tooth flexure.
- Most commonly ankylosed tooth is the primary 2nd molar.
- Hypercementosis - the excessive deposition of SECONDARY cementum on the roots. Most frequently seen on PREMOLARS. Commonly seen with
PAGET'S disease.
- Dentinogenesis Imperfecta - an inherited disorder of dentin, autosomal dominant. Teeth have an amber, grey or purple opalescence or translucency.
Abnormal constriction at cemento-enamel junction. Pulp chamber is often obliterated.
- Type I - dentin abnormality associated with OSTEOGENESIS imperfecta
- Type II - MOST COMMON, has NO bone involvement
- Type III - Brandywine Type - only dentin involvement but also multiple pulp exposure in primary dentition.
- Anodontia - congenital absence of ALL teeth
- Oligodontia - refers to the congenital absence of 6 or more teeth, but not all
- Hypodontia - refers to the absence of only a few teeth
- Diphyodontia - having 2 successive sets of teeth ex. Humans
- Hypsodontia - having high crowns. Seen with diets of abrasive foods.
- A papilloma is a benign epithelial neoplasm. A fibroma is a benign neoplasm of connective tissue origin
- Inflammatory fibrous hyperplasia - aka epulis fissuration - seen on maxillary in area of denture borders. Caused by ill-fitting dentures. Surgical excision
and remake denture.
- Inflammatory papillary hyperplasia - aka palatal papillomatosis - seen on hard palate, caused by poor oral hygiene under denture. Surgical excision and
remake denture.
- Verruciform xanthoma - a papilloma look alike lesion. Seen in middle aged and older females. Cause is unknown.
- Melanoma
- Superficial spreading - MOST COMMON type
- Nodular - POOREST prognosis
- Lentigo maligna - usually seen in elderly
- Acral lentiginous - LEAST COMMON, seen on palms, soles, or under nails, more common in African Americans.
PROSTHODONTICS
- Electrosurgery - do NOT use with pts that have pacemakers! Excellent for hemostasis. Too low a current can cause tissue drag.
- TMJ - a ginglymoarthroidal joint meaning that it glides and rotates.
- Upper compartment of TMJ - between mandibular fossa and articular disk. ONLY SLIDING movements or translation motion occurs here
- Lower compartment of TMJ - between condyle and articular disk, ONLY hinge type or rotary motion occurs here.
- A high palatal vault or a constricted palate can cause whistling sounds.
- 5 factors that govern the establishment or balanced articulation
- Inclination of condylar guidance (dictated by pts anatomy)
- Inclination of incisal guidance
- Inclination of occlusal plane
- Convexity of compensating curve
- Angle and height of the cusps
- Cast chromium cobalt for RPD framework - low density and weight, high modulus of elasticity (very stiff), low cost, resistant to corrosion
- Chromium - resists tarnish and corrosion
- Cobalt - contributes strength and rigidity
- Nickel - increases ductility
- Alginate
- Diatomaceous earth - the main component 50%, acts as a filler
- Gypsum products - all come from the mineral gypsum which is the dehydrate form of CALCIUM SULFATE. When heated, water is lost and gypsum is
converted to the HEMI-hydrate form of calcium sulfate (a powder). When water is added, the hemihydrates is converted back to the DI-hydrate form of
calcium sulfate.
- Type II - Dental plaster - produced by heating gypsum in an open vessel at 150-160C. Produces particles that are porous and irregularly
shaped. The WEAKEST gypsum product. BETA-hemihydrate
- Type III - Dental stone - produced by heating gypsum under STEAM pressure in an autoclave at 120-150C. Produces particles that are
UNIformly shaped and less porous. ALPHA- hemihydrate
- Type IV - Die stone - produced by BOILING gypsum in a 30% aqueous solution of Calcium Chloride and Magnesium Chloride. A HIGH
strength die stone - the LEAST porous and STRONGEST.
- Elastic impression materials
- Aqueous hydrocolloids
- Agar (reversible)
- Alginate (irreversible)
- Non-aqueous hydrocolloids
- Polysulfides
- Silicones
- Condensation - involves ionic species and produces water as a by-product.
- Addition - ex. PVS - involves adding Carbon units on each side of the C=C double bond. NO IONIC forms are involved
- Polyethers
- All elastomeric impression materials - contract slightly during curing
- Elastomers - impression materials that have elastic or rubber-like qualities
- Non-elastic impression materials - plaster, compound, waxes, ZOE
- Polyvinylsiloxane impression material - aka ADDITION silicones - most widely used and most accurate. LESS polymerization shrinkage, low distortion,
high tear strength, NO biproducts during the reaction.
- SULFUR in powdered latex gloves retards the setting
- Polysulfides - aka rubber base - polymerizes in an exothermic reaction. Excellent flow properties and a high flexibility and tear strength. STRONGEST
resistance to tearing. Low resistance to deformation. Requires a use of custom tray. LONG setting time 8-12 minutes. Sets by S-S cross linking
- Base - the white paste, contains a low molecular weight polysulfide polymer called MERCAPTAN and titanium oxide.
- Accelerator - the brown paste, contains LEAD DIOXIDE.
- Custom trays are important since elastomers are more accurate in UNIFORM, thin layers of 2-4mm thick.
- Alginate -
- The setting reaction is a "Double decomposition" reaction between potassium alginate and calcium sulfate.
- Both over and under mixing can reduce the strength of the impression.
- 0.25 inch (3mm) of alginate should remain over all critical structures between the impression tray and the tissue.
- Sodium phosphate - serves as a retarder of the setting reaction. Once all of it reacts, the sodium alginate reacts with Ca2+ ions to form
calcium alginate.
- Agar impression material - REVERSIBLE hydrocolloid where the materials physical state can be changed from a GEL to a SOL by the application of heat,,
VERY high accuracy. Hydrophillic. Dimensionally unstable so must be poured immediately and only used one. Use is limited by the need for special
equipment. Setting does NOT involve a chemical reaction.
- Non-aqueous elastic impression materials
- Cost - alginate (cheapest) < agar and polysulfide < condensation silicones < addition silicones < polyethers (most expensive)
- Dimensional stability - addition silicone (most stable) > polyether > polysulfide > condensation silicone > hydrocolloid
- Wettability - hydrocolloids (best) > polyeither > hydrophilic addition silicones > polysulfides > hydrophobic addition silicones and condensation
silicones
- Castability - hydrocolloics (best) > hydrophilic addition silicone> polyether > polysulfide > hydrophobic addition silicone = condensation silicone
- Stiffness - polyether (most) > addition silicone > condensation silicone > polysulfide = hydrocolloids (least stiff)
- Tear strength - polysulfide (greatest) > addition silicone > polyether > condensation silicone > hydrocolloids (least tear strength)
- ZOE impression paste - an INELASTIC impression material. Sets into a hard, brittle mass. Setting time can be accelerated by adding a little water to the
mix and retarded by adding oils to the mix.
- Calcium chloride - functions as an accelerator of the setting time
- Oil of cloves - contains 75-80% eugenol.
- Rosin - facilitates the speed of the reaction which results in a smoother, more homogenous product.
- Silicones - aka condensation silicones - record surface detail well and have excellent elastic properties but a LOW tear strength. LESS expansive than
PVS and polyethers. Must pour up immediately!! Within 30 minutes. POOR dimensional stability - because the setting reaction is a condensation
reaction that occurs by eliminating an ether or methyl alcohol.
- Polyether impression material - working and setting times are shorter than for polysulfides but similar to PVS. EXCELLENT Dimensional stablIity when
DRY so more than one cast can be poured up. MOST RIGID compared to other materials so it tears easily and can be difficult to remove from mouth. Set
VERY quickly - forms a rubber by a cationic polymerization process. Truly hydroPHILIC.
- Investment Materials
- Gypsum bonded - binder is gypsum. Used when casting conventional gold alloys
- Phosphate bonded - binder is a metallic oxide and a phosphate. Used when casting base metal alloys for metal-ceramic crowns.
- Silica bonded - binder is a silica gel. Used when casting base metal alloys for partial denture frameworks.
- You add stone to water when mixing to result in better powder mixing and reduced chance for air bubbles.
- When a high proportion of water is used in mixing up stone, the powder particles are farther apart. This results in LESS expansion with a retarded setting
time and a weaker producr.
- Color
- Chroma - the saturation or strength of a color
- Value - the relative amount of lightness or darkness in a color - the MOST IMPORTANT factor in shade selection
- Hue - the color tone (blue, yellow, red)
- The shade of a ceramic crown should be matched by - 1) Value 2) chroma 3) hue
- Metamerism - when teeth appear to be one color under one type of light but appear different under another light source.
- Strain hardening or work hardening - hardening (or deformation) of a metal at room temperature.
- Compensating curve - the anteroposterior curvature in the median plane and the mediolateral curvature in the frontal plane in the alignment of the
occluding surfaces and the incisal edges of artificial teeth that are used to develop balanced occlusion.
- Centric relation - aka Retruded Contact Position - a bone to bone relationship. It is a LIGAMENT guided position.
- Primary centric holding cusps are the max lingual cusps. Secondary centric holding cusps are the mandibular buccal cusps.
- Grind secondary centric holding cusps only if there is a balancing side interference.
- Camper's line (plane) - the line running from the inferior border of the ALA of the nose to the superior border of the TRAGUS of the ear. The occlusal
plane is parallel to the Camper's line and the interpupillary line when setting denture teeth.
- Group function - aka unilateral balanced occlusion - all posterior teeth on a side contact EVENLY as the jaw is moved toward that side. All teeth on the
non-working side are FREE of any contact.
- Posselt's envelope of mandibular motion - shows a SAGITTAL section.
- Tooth contacts are of longer duration in swallowing than in chewing.
- Kennedy Classification
- Class I - bilateral distal extension
- Class II - unilateral distal extension
- Class III - unilateral endentulous spaces bound by teeth - tooth borne
- Class IV - anterior distal extension crossing the midline (missing canines)
- Modifications - added for additional edentulous areas.
- Wrought wire clasps - must have an ELONGATION percentage of MORE THAN 6% to allow the clasp to bend without microstructure changes that could
compromise its physical properties. The elongation is the most important mechanical property involved.
- The strength, hardness and tensile strength is 25% GREATER than the cast alloy from which it is fabricated. - tougher than cast clasps
- Indirect retainer - refers to RESTS, located as far anterior as possible to prevent vertical dislodgement of the distal extension base of an RPD. Not
necessary on tooth-borne RPDs.
- Immediate dentures
- A reline or rebase is required in 8-12 months.
- Two step schedule for immediate dentures - 1) Extract all posterior teeth EXCEPT a max PM1 and its opposing tooth to retain a posterior stop
for VDO. 2) fabricate denture after healing. Extract anterior teeth at time of denture insertion.
- The most frequent cause of porosities in a denture is - insufficient pressure on the flask during processing. Should be 20-30 psi. if insufficient, the
porosities occur in the thickest part of the denture.
- Denture overextension -
- An overextended DISTOBUCCAL corner of a mandibular denture will push against the MASSETER during function.
- Masseter originates from the zygomatic process of the maxilla and inserts at the angle and lower lateral side of the ramus of the
mandible.
- Denture displaced when smiling = over extended buccal notch and buccal flange
- Denture displaced when yawning or opening wide = over extended distobuccal flange hitting the coronoid process
- Tingling or numbness at corner of mouth or lower lip = excessive pressure from lower buccal flange on mental foramen.
- Posterior Palatal Seal - .5mm deep near the midline and 1.5mm deep 3mm outside of the midline. Extends up to the medial boundary of the
pterygomaxillary notches.
- 4 types of casting alloys
- Type I - weakest, has the greatest elongation, used for INLAYS
- Type IV - the strongest, has the least elongation, used for high stress bridges and partial denture frameworks
- High-gold noble alloys - 98% gold, platinum and palladium.
- Nobel alloys like gold, platinum, and palladium do NOT oxidize on casting.
- Palladium-Silver alloys - 50-60% palladium and 30-40% silver - Silver is NOT a noble metal so it oxidizes on casting.
- Nickel-chromium alloys - 70-80% nickel and 15% chromium. Readily oxidize which can cause PFM interface problems.
- Base metal dental casting alloys - alloys with less than 25% noble elements. Much STRONGER and has a LOWER density. MUCH higher melting temp.
Nickel is responsible for the ductility of the alloy. Chromium produces a passivating film for corrosion resistance. Cobalt increases the rigidity of the alloy.
- Porcelain adheres to metal primarily by a CHEMICAL bond.
- Ante's Law - the root surface area of the abutment teeth supported by bone must equal or surpass the root surface area of the teeth being replaced by
pontics in a bridge.
- Soldering - The strength of a solder joint is proportional to its SURFACE AREA. The solder must melt at at least 150F below the fusion temp of the metals
being soldered. Flux is used to dissolve surface impurities and protect the surface from oxidation while heating.
- POTASSIUM FLUORIDE is commonly added to flux to dissolve the passivating film that may prevent wetting of the metal with the solder.
- An antiflux is used to outline the area to be soldered in order to restrict the flow of solder - most commonly used is a soft graphite pencil
- Quenching - when a metal is rapidly cooled from an elevated temperature to room temp or below. Done to rapidly terminate a process that only occurs at
elevated temperatures.
- Annealing - the controlled cooling of a material to increase ductility and strength. It involves first heating a material for a given time and then slow cooling.
- Fritting - a process of manufacturing low and medium fusing porcelains. It involves raw constituents of porcelain to be fused, quenched, and ground back
to an extremely fine powder. The frit can then be added over by other metallic substances to produce color in porcelain.
- Clasp Assembly - in an RPD, the retentive clasp arm and a reciprocal or stabilizing clasp arm, plus any minor connectors or rests.
- Reciprocal bracing is usually on the lingual and retentive portion of the clasp assembly is on the buccal.
- Stressbreakers - effectively dissipate vertical forces to terminal abutments. However, this occurs at the expense of the residual ridge where the thrust of
the functional stress is directed.
- Precision attachment restorations - a pre-constructed attachment with male and female portions that fit together in a precise fashion with little tolerance.
provide retention without an unslightly display of metal. The functional load is dispersed down the long axis of the abutments by virtue of the low central
loading at the base of the attachments. These restorations permits patient access to all areas of the tissue when the dentures are not in place. CANNOT
be used in distal extension RPDs without a stressbreaker!!!
- Semiprecision attachment - cast into the crown and the RPD. The female and male parts fit together with much more tolerance than the precision
attachment resulting in less retention.
- Dental surveyor - an instrument used to determine the relative parallelism of oral anatomy.
- Ceramics
- In-Ceram Zirconia - has a higher flexural strength than most other porcelains.
- A Seven-eighths crown is a ¾ crown whose vertical distobuccal margin is positioned slightly mesial to the middle of the buccal surface.
- Sintering - done when processing ceramics to increase its DENSITY. Changes the porcelain from a powder to a solid.
- Ceramic restorations are severely damaged by acidulated fluoride.
- Gelation - the term given to the setting process of a hydrocolloid material - changing from a sol to a gel.
- Hysteresis - refers to a material's characteristic of having a melting temp different from its gelling temp.
- Methylmethacrylate (MMA) - most common polymer used in dentistry.
- Acrylic resin
- The powder is the polymer. The liquid is the monomer (ex. Methylmethacrylate)
- A patient wearing a complete max denture who complains of a burning sensation in the palatal area indicates too much pressure exerted by the denture
on the incisive foramen. If burning occurs in the mand anterior area, too much pressure is exerted on the mental foramen.
- Overdenture - the most important benefit is the preservation of the alveolar ridge thanks to retained roots.
- The primary indicator of the accuracy of border molding is the stability and lack of displacement of the tray in the mouth.
- Modeling compound has a relatively LOW thermal conductivity.
- Primary support area of max denture - residual ridges. Secondary support area of max denture are - palatal rugae.
- Anterior guidance - aka anterior coupling - a tightly overlapping relationship of the opposing max and mand incisors and canines which produces
disclusion of the posterior teeth when the mandible protrudes or moves from side to side. It is the result of horizontal and vertical overlap of the incisors.
- Bennett Movement - aka Lateral shift or Immediate shift - Refers to the WORKING side condyle ONLY. In the early stages of lateral movements, the
condyle rotates with a slight lateral shift in the direction of the movement.
- In a lateral movement, the NON-working side condyle moves downward, forward, and medially. The WORKING side moves laterally.
- Guiding cusps = balancing = non-supporting cusps - they do not occlude or fit into fossae or marginal ridge areas of the opposing arch. Max buccal and
mand lingual.
- Prolonged sensitivity to heat, cold and pressure after cementation of a crown or a fixed bridge is usually related to occlusal trauma.
- Pontics
- Sanitary pontic - leaves a space between the pontic and the ridge. Most common if esthetics are NOT an issue. Convex in all areas.
- Saddle pontic - looks the most like a tooth. Covers the ridge labiolingually with a large, concave contact. Impossible to clean so should not be
used.
- Modified ridge lap pontic - gives the illusion of looking like a tooth but possesses ALL convex surfaces for ease of cleaning. Good for esthetics.
- Conical pontic - rounded and conical. Good for thin mandibular ridges in non-esthetic zones.
- Ovate pontic - a sanitary substitute for the saddle pontic. Set in the concavity of the ridge to give the appearance that it is growing like a tooth.
- Cement
- Ceramic crowns are bonded with composite resin!!! Provides the strongest bond.
- Zinc phosphate cement - has a good compressive strength, BUT HIGH pH! Apply 2 layers of varnish to protect the pulp.
- Zinc polycarboxylate - adheres to calcified dental tissue and is more biologically compatible than zinc phosphate.
- Sprue pin - the diameter should be equal or greater than the thickest portion of the pattern. 10 gauge sprue pin is used on most patterns. 12 gauge pin is
used on small premolars.
- For optimum perio health, restoration finish lines should be - supragingival whenever possible to allow for hygienic cleaning.
- The path of insertion for an anterior ¾ crown should be - be parallel to the incisal ½-2/3 of the labial surface rather than the long axis of the tooth. (or else
an unnecessary amount of gold with show esthetically)
- Posterior fixed bridge - the pontic should contact in CO and maybe in working-side movement. But should NOT be in contact in NON-WORKING side
movement.
- The protrusive condylar path inclination influences the mesial inclines of the mandibular cusps and the distal inclines of the maxillary cusps.
- Arcon articulator - has the condylar elements on the lower member of the articulatory and the condylar path elements on the upper member. The ANGLE
between the condylar inclination and the occlusal plane is FIXED. Used for diagnostic study casts.
- Non arcon articulator - has the condylar elements on the upper member of the articulator. More popular for denture fabrication.
- Packing cord
- Alum - aka aluminum potassium chloride - use if pt has hypertension or hyperthyroidism
- Zinc chloride - it is caustic and causes delayed healing by causing necrosis of the sulcular epithelium and connective tissue. Should NOT be
used in impregnated cord.
- Hamulus - a small hook-like projection of bone that extends from the medial pterygoid plate of the sphenoid bone. Serves as the superior attachment of
the pterygomandibular raphe.
- Epulis fissuratum = inflammatory fibrous hyperplasia - results from overextension of denture flanges. Occurs in vestibular mucosa where the denture
flange contacts the tissue. Painless folds of fibrous tissue surround the flange.
- Paget's Disease - aka osteitis deformans - excessive breakdown of bone followed by abnormal bone formation. New bone is enlarged but weakened with
heavy calcifications. Pt complain dentures are feeling tight
- Bilateral balanced occlusion - dictates that a maximum number of teeth should contact during mandibular excursive movements.
- Unilateral balanced occlusion - aka group function - calls for all teeth on the working side to be in contact during a lateral excursion.
- Mutually protected occlusion - aka canine guidance - when anterior teeth protect posterior teeth in all mandibular excursions. The most widely accepted
arrangement of occlusion.
- Mastication:
- Open - lateral pterygoid, anterior belly of digastrics, and omohyoid
- Close - masseter, medial pterygoid, anterior fibers of temporalis
- Protrude - lateral pterygoids together
- Retract - posterior fibers of temporalis
- Porcelain
- Rust at temps over 2000F
- In an all ceramic crown, the core material is a high strength sintered ceramic.
- Opaque porcelain - the first layer. It effectively covers the metallic sheen of the underlying casting. Creates a CHEMICAL bond to the metal
alloy.
- Body porcelain - makes up the bulk of the restoration, provides most of the color or shade.
- Glazed porcelain - nonporous, resists abrasion, possesses esthetic ability and is well tolerated by the gingiva. The LEAST irritating to gingival
tissues.
- 20% shrinkage occurs during firing of the porcelain.
- Low fusing porcelain - usually used for the manufacture of PFMs
- High fusing porcelain - used for denture teeth
- Medium fusing porcelain - used for all ceramic and porcelain jacket crowns
- COMPRESSIVE strength (350-550 MPa) is greater than its tensile or shear strengths.
- A mixture of FELDSPAR and QUARTZ.
- Kaolin - a clay, is a sticky material that binds the particles together when the porcelain is unfired. Household porcelain has more of this.
- Aluminous porcelain uses alumina instead of quartz as a strengthener. It is stronger.
- Degassing - the process by which a casting is heated in a porcelain furnace to a temp of 980C to BURN OFF any remaining impurities prior to
adding porcelain. If temp is too low, an oxide layer forms and decreases the bond of the porcelain.
- Pickling - the process of removing surface oxides from a casting prior to polishing. The solution is acidic an reduce the surface oxides.
- Crystalline reinforced glass - a glass in which a crystalline substance such as leucite is dispersed. It imparts strength to the ceramic. Ex. IPS
Empress
- Alumina - used to reinforce glass.
- Major connectors
- Anterior-palatal strap - 6-8mm wide, to provide strength with minimum tissue exposure, the MOST RIGID major connector. Should cross the
midline at right angles.
- Palatal horseshoe shaped - used when a large torus
- Single palatal bars - not often used since they lack rigidity. Use is limited to toothborne restorations for bilateral short span edentulous areas.
The wide, thin bar is MORE RIGID with less bulk compared to a narrow bar.
- Mandibular lingual bar - requires an minimum of 7MM of vertical height between the gingival margin and the floor of the mouth. The upper
border is a minimum of 3mm below the gingival margins and at least 4mm wide.
- Retainers
- Extracoronal retainers - aka Clasps - the most common type. 2 types - suprabulge and infrabulge
- Suprabulge retainers - the clasp originates ABOVE the height of contour and angle downward until the tip engages the undercut.
- Infrabulge retainers - clasp originates BELOW the survey line.
- Intracoronal retainers - attachments build into the contour of a crown to produce mechanical and frictional retention. Give optimal esthetics.
NOT used when an RPD is a distal extension since more functional motion is necessary without torquing the abutment tooth.
PHARMACOLOGY
- Efficacy - aka Intrinsic ability or Ceiling effect - the ability of a drug to produce a desired therapeutic effect regardless of dosage. Drugs that have the
greatest maximum effect have the highest efficacy.
- Potency - the relative concentration of two or more drugs that produce the same effect. Determined by the affinity of the receptor for the drug. It is a
comparative term used to compare drugs.
- EC50 = the dose that causes 50% of the maximal effect. The SMALLER the EC50, the more potent the drug.
- An additive effect - when two drugs have similar effects and are administered in combination resulting in a response that is the sum of the individual
actions of each drug alone. The response is NO greater than that which would be expected if the drugs were given one at a time. They are not enhanced
by being used in combination.
- A synergistic effect - occurs when the combination of two drugs having similar pharmacological effects is GREATER than the sum of the individual actions.
- Ex. Alcohol is synergistic with Valium, narcotics, and barbiturates.
- Bioavailability - the measurement of the rate and amount of therapeutically active drug that reaches the systemic circulation. Affected by the dissolution of
a drug in the GI tract and destruction in the liver. IV injections provide 100% bioavailability!!
- Cumulative action - when a drug is administered repeatedly, a higher concentration of the drug than desired may be achieved. resulting in excessive
accumulation.
- Idiosyncrasy - a response to a drug that is unusual or abnormal or one that grossly deviates from the routine reaction
- Nervous system
- Cholinergic neurons - secrete Acetycholine
- PRE-ganglionic neurons in BOTH the symp and parasymp are cholingeric
- POST-ganglion neurons in the parasym are cholinergic
- POST ganglion neurons in the symp that innervate SWEAT glands are adrenergic.
- Adrenergic neurons - secrete NE
- POST-ganglion neurons in the symp are adrenergic EXCEPT those that innervate SWEAT glands
- Cholinergic Receptors - CONSTRICT pupils (miosis), slows the heart, stimulates smooth muscles of bronchi, GI tract, gallbladder, bile duct, and bladder,
stimulates sweat, salivary, tear, and bronchial glands.
- Muscarinic - located in autonomic effector cells in the heart, vascular endothelium, smooth muscle and exocrine glands.
- Nicotinic receptors - two kinds - at neuromuscular junction and autonomic ganglia.
- Nicotinic Receptor Antagonists - divided into ganglion-blocking drugs and neuromuscular blocking drugs.
- Ganglionic blockers - very potent but seldom used because side effects include parasympathetic blockade = pronounced xerostomia,
constipation, blurred vision, postural hypotension.
- Ex. Mecamylamine and Trimethaphan - used to tx severe or malignant hypertension and emergency hypertensive crisises. Cause
a RAPID fall in blood pressure.
- Neuromuscular blockers - produce complete skeletal muscle relaxation and facilitate endotracheal intubation. Used as an adjunct to surgical
anesthesia. Major danger is TOO much paralysis causing respiratory failure.
- Depolarizing - NON-competitive, depolarizes and desensitizes the neuromuscular end plate so it can't be stimulated again.
- Ex. Succinylcholine - protype - Caution in pts with low levels of pseudocholinesterase which breaks down
succinylcholine because it can cause respiratory failure.
- Non-depolarizing - Competitive with acetylcholine at nicotinic receptors. Prevent acetylcholine from stimulating motor nerves
causing muscle paralysis.
- Ex. Tubocurare (prototype), mivacurium, vecuronium, doxacurium, pancuronium, atracurium.
- Neostigmine and pyridostigmine - cholinesterase inhibitors. Reverse the blockage of these drugs.
- Cholinergic Agonists
- Cholinesterase inhibitors - inhibits the break down of Acetylcholine in the body resulting in a cholinergic effect. INDIRECT acting
cholinomimetic agents.
- Ex. Neostigmine, Physostigmine, Edrophonium, Pyridostigmine
- Edrophonium - an INDIRECT acting cholinomimetic. Often used to diagnose myasthenia gravis due to its rapid onset and distinguish
it from a cholinergic crisis.
- Pralodoxime - a cholinesterase REACTIVATOR. Used as an antidote to reverse muscle paralysis resulting from organophophate
anticholinesterase pesticide poinsoning
- Cholingergic alkaloids - Ex. Pilocarpine -Directly stimulates cholinergric receptors. Used to stimulate salivary flow in pts with xerostomia due to
radiation therapy. Also used to tx open angle glaucoma.
- Ex. Cevimeline - used to tx Sjogren's Syndrome pts
- Choline Esters - cause a fall in BP due to generalized vasodilation, flushing of the skin, and slowing of heart rate. Topical application causes
miosis of the eye.
- Ex. Methacholine, Bethanechol, Carbachol
- Receptors - alpha receptors are mostly excitatory causing vasoconstriction and contractions, Beta receptors are mostly inhibitory causing vasodilation and
relaxation of respiratory smooth muscle.
- The heart is mainly B1 receptors.
- A1 - found in arterioles in skin, mucosa, viscera, kidney and veins. Cause constriction.
- A2 - found in presynaptic nerve endings à inhibit NE release. Found in postsynaptic CNS à decrease sympathetic tone
- B1 - most common receptor in the heart à increase the heart rate and increase the force of contraction
- B2 - found in arterioles à cause dilation. Found in bronchial and smooth uterine muscle à cause relaxation.
- Adrenergic Agonists aka Sympathomimetic agents
- Divided into A1, A2, B1, B2.
- Direct acting - act directly on Alpha and beta receptors Ex. Epinephrine!!
- Indirect acting - cause the release of stored NE at the postganglionic nerve endings to produce their effects.
- Used to control superficial hemorrhage - A1 agonists, vasoconstrictors. Ex. Epinephrine
- Allergic shock - A1 adrenergic agonists - vasoconstrictors, Ex. Epinephrine. B2 adrenergic agonists - relaxes bronchial smooth muscle and
dilates airway.
- Nasal decongestant - A1 - adrenergic agonists - vasoconstrictors. Ex. Phenylephrine.
- Bronchial relaxation and airway dilation - for asthma attack - B2 adrenergic agonists. - cause bronchodillation
- Ex albuterol, epinephrine, salmetrol, metaproterenol
- Cardiac stimulation - B1 adrenergic agonists. Ex. Isoproterenol
- Epinephrine - stimulates BOTH Alpha1,2 and Beta1,2 receptors. Constricts arterioles, relaxes bronchial smooth muscle, decreases blood volume to
nasal tissue, causes a hypertensive response, actions are opposite of histamine. Used to alleviate an acute asthma attack, to tx anaphylactic response, to
prolong the activity of LA, to restore cardiac activity in cardiac arrest.
- A1 receptor - cause vasoconstriction and reverse hypotension
- B2 receptor- dilate the bronchial tubules
- B1 - stimulate cardiac muscles and increase cardiac output
- Norepinephrine - stimulates ALPHA receptors ONLY
- Epinephrine reversal - seen in pts receiving ALPHA blockers - since epinephrine stimulates BOTH alpha and beta receptors, these patients only have beta
receptors stimulated causing a FALL in BP. (alpha receptors increase BP, beta receptors decrease BP)
- Sympatholytic - aka anti-adrenergic drugs - a drug that acts in a way OPPOSITE to the sympathetic nervous system. Used to treat HYPERTENSION.
- Beta adrenergic blockers - most common side effects are weakness and drowsiness
- Non- Selective
- Propranolol - non-selective - blocks both B1 and B2 receptors
- Timolol - non-selective - blocks both B1 and B2 receptors
- Nadolol - non-selective - blocks both B1 and B2 receptors
- Selective - safer to use with pts with a hx of asthma or bronchitis. At HIGH doses, they are no longer selective for B1 - they also will
block B2 receptors and affect smooth muscle
- Metoprolol - blocks B1 receptors ONLY - similar to Atenolol, has a long duration of action due to a long half life, Used to
tx HTN, angina.
- Atenolol - blocks B1 receptors ONLY - similar to metoprolol - has a low lipid solubility so it is renally eliminated and
minimally metabolized.
- Low lipid solubility means it has less potential for causing CNS side effects compared to lipid soluble beta
blockers.
- Acebutolol - B1 selective blocker ONLY - used to tx HTN and control ventricular arrhythmias. Low lipid solubility. Has
mild intrinsic sympathomimetic activity - meaning it is a partial agonist at B2 receptors.
- Alpha adrenergic blockers - act on blood vessels and cause them to relax. Commonly used to reduce high BP and to treat enlarged prostate.
Side effects - can cause HYPOtension.
- Selective alpha antagonists - used to tx HTN, can cause orthostatic hypotension
- Tolazoline - blocks A2 receptors - used to tx persistent pulmonary HTN of the newborn
- Prazosin - blocks A1 receptors, rarely used
- Doxazosin - blocks A1 - most commonly used to tx HTN since it has a long duration of action.
- Terazosin - blocks A1 - used to tx benign prostate hypertrophy
- Non-selective alpha antagonists - used for pre-surgical management of pheochromocytoma. NOT used to tx cardiac conditions
because blocking both receptors can cause tachycardia.
- Phentolamine - blocks BOTH A1 and A2 receptors
- Phenoxybenzamine - blocks both A1 and A2 receptors
- Centrally acting agents - inhibit adrenergic nerve transmission through actions within CNS
- Clonidine, guanfacine, guanabenz, methyldopa
- Neuronal depleting agents - deplete catecholamine (NE) and serotonin stores from adrenergic terminals and in the brain
- Reserpine and guanethidine
- Modafinil - used to improve wakefulness during daytime sleepiness. A CNS stimulant. Used for narcolepsy, sleep disorders, unlabeled use to treat
ADHD.
- Monoclonal antibodies -
- Adalimumab - a recombinant monoclonal antibody that binds to TNF-alpha receptor sites. Used to treat rheumatoid arthritis.
- Alefacept - a monoclonal antibody used to treat moderate to severe plaque psoriasis.
- Infliximab - a monoclonal antibody used to treat ankylosing spondylitis, Crohn's disease, and rheumatoid arthritis. Binds to TNF-alpha receptor
sites.
- Trastuzumab - a monoclonal antibody which binds to the extracellular domain of the human epidermal growth factor receptor 2 (HER-2). Used
to treat pts with metastatic breast cancer whose tumor overexpress the HER-2 protein and are not receiving chemo.
- Immunosuppressants
- Pimecrolimus - used to tx mild to moderate atopic dermatitis.
- Sirolimus - used for prophylaxis of organ rejection in pts receiving renal implants.
- Tacrolimus - used to tx moderate to severe atopic dermatitis in pts not receiving conventional therapy.
- Granisetron and Ondansetron - selective 5HT3 receptor antagonists used to treat emesis caused by cancer chemotherapy.
- 5HT3 is a serotonin receptor that when activated during chemo for cancer, causes emesis (nausea and vomiting). These drugs prevent emesis
and nausea and vomiting associated with radiation therapy. (5-Hydrotryptamine typ3 3 receptor)
- Barbituates
- Depress neuronal activity by increasing membrane ion conductance, reducing glutamate induced depolarizations and potentiating the inhibitory
effects of GABA.
- Have a steeper dose-response relationship than benzodiazepines.
- Metabolized in the LIVER
- DO NOT possess analgesic properties.
- May precipitate acute porphyria in susceptible patients.
- DECREASE the half lives of drugs metabolized by the liver because they induce the formation of the liver microsomal enzymes that metabolize
drugs. Causes an increase clearance and decreases the effectiveness of these drugs.
- Cause of death from overdose is from respiratory failure.
- Ultra short acting -5-20 minutes, IV, used for the induction of general anesthesia, metabolized in liver, the MOST LIPID SOLUBLE
- EX - thiopental and methohexital
- The brief duration of general anesthetic action of an ultra-short acting barbiturate is due to the rapid rate of redistribution from the
brain to peripheral tissues. They maintain anesthesia only while in the brain. Because of their high lipid solubility, they rapidly leave
the brain for other tissues so the pt wakes up.
- Short-acting - 1-3 hrs, can be used orally for their hypnotic and calming effect. Often used before dental appt to reduce anxiety.
- Ex. Secobarbital and pentobarbital
- Intermediate acting - 3-6 hrs, can be prescribed to relieve anxiety before a dental appt. used for day time sedation and to tx insomnia.
- Ex. Amobarbital and Butabarbital
- Long acting barbiturates - 6-10hrs, used for daytime sedation and tx of epilepsy, the LEAST lipid soluble.
- EX. Phenobarbitol, Mephobarbital, and Primidone
- Benzodiazepines - aka tranquilizers. Used to alleviate anxiety, induce sleep, and via IV to cause conscious sedation for outpatient surgery. Depress the
LIMBIC system and reticular formation by potentiating GABA neurotransmitter. Preferred over barbiturates since it has less addiction potential and
produces less profound CNS potential. Do NOT use if pt has acute narrow angle glaucoma and psychoses. Does NOT cause respiratory depression.
- Diazepam (valium) - tx of anxiety, tension, muscle spasm, and as an anticonvulsant. Agent of choice to reverse STATUS EPILEPTICUS
induced by a local anesthesia overdose. Can be locally irritating to tissue so use large veins if given via IV to avoid thrombophlebitis. Most
common side effect is drowsiness.
- Ex. Chlordiazepoxide, alprazolam, lorazepam,
- Tx insomnia - flurazepam, triazolam, temazepam
- Midazolam (Versed) - comes as a liquid for pre-op sedation in children and as an injectable for IV conscious sedation.
- Triazolam - a pre-op sedative used in dentistry. Metabolized by liver by the P-450 isoform CYP 3A4 enzyme.
- If a drug inhibits the action of CYP 3A4, it would increase the serum levels of triazolam.
- Ex. ANTIFUNGAL (itraconazole, ketoconazole, fluconazole, miconazole, etc) inhibit the CYP 3A4 isoform!!
- Flumazenil - a benzodiazepine ANTAGONIST - used to reverse the residual effects of benzos after an OVERDOSE.
- Buspirone - an orally administered anxiolytic (an anti-anxiety agent) that is structurally and pharmacologically distinct from benzos and barbiturates. Does
NOT possess anti-convulsant or muscle relaxant properties. Does NOT impair psychomotor function. Does NOT cause sedation or physical dependence.
Very slow onset of action (up to 2 weeks). Works by diminishing serotonergic activity.
- NSAIDS - anti-inflammatory effects. Inactivate the enzyme prostaglandin endoperoxide synthase (Cyclooxygenase) in the arachidonic acid cascade
reducing prostaglandin synthesis.
- Propionic acid derivatives - ibuprofen, fenoprofen, ketoprofen, naproxen, piroxicam, flurbiprofen, nabumetone
- Acetic acid derivatives - indomehtacin, sulindac, tolmetin
- Fenamic acid derivatives = meclofenamate, mefenamic acid
- NON-selective NSAIDs - Ex. Ibuprofen, Naproxen and Flurbiprofen - inhibits both COX1- and COX-2. Enhances the anti-coagulant effects of
Warfarin. Can cause GI ULCERS.
- Cox-1 - produces prostaglandins in the GI tract. Help protect the formation of GI ulcers.
- Cox -2 - produce prostaglandins are sites of surgery, infection, and inflammation.
- Ibuprofen - inhibits the production of prostaglandins in peripheral tissues which reduces the inflammatory response at sites of
surgery, infections, or injury. This reduces perceived pain. Inhibits platelet aggregation (reversible so platelets are normal once
drug leaves the system) so should NOT be used by pts on Coumadin!!
- Ex. Advil, Nuprin, and Medipren
- Motrin - contains 400mg of ibuprofen or higher and requires Rx.
- Aspirin - a Salicylate. inactivates Cyclooxygenase which synthesizes prostaglandins. Analgesic, antipyretic, and anti-inflammatory.
IRREVERSIBLE platelet inhibitor so it reduces blood clotting and can cause prolonged bleeding until new platelets are formed -
potentiates the anticoagulant effects of Warfarin.
- Overdose causes Salicylism - causes tinnitus, vertigo, nausea, sweating, vomiting.
- Reyes Syndrome
- Cox-2 Selective inhibitors - Ex. Celecoxib - does NOT affect platelet function. Great for pts taking Warfarin or aspirin. Used to tx rheumatoid
and osteoarthritis, dysmenorrhea. No risk of GI ulcers.
- Acetaminophen - analgesic and antipyretic effect. Does NOT reduce inflammation!!! Affects CENTRAL prostaglandin synthasis - it is a weak
inhibitor of prostaglandin production in peripheral tissues. NO effects on platelets or the coagulation pathway - good drug to give to pts on anti-
coagulants. Can cause hepatic necrosis in large doses.
- Codeine and Hydrocodone - narcotic analgesics effectively reduce pain but do NOT reduce inflammation. Work within the brain to block
ascending pain impulses traveling to the brain from the periphery.
- Antipsychotic Agents - improve mood and behavior and have neuroleptic effects (emotional quieting and development of EXTRAPYRAMIDAL symptoms
due to the effect on the basal ganglia.
- Neuroluptic agents - major tranquillizers, used in acute manic episodes.
- **** Phenothiazines - most COMMONLY used. Blocks dopaminergic sites in the brain. Causes sedation, ANTI-EMETIC activity, potentiates
effects of narcotics.
- Ex. Chlorpromazine and Thioridazine
- Ex. Chlorprimazine, Promazine, Thiordazine, Fluphenazine, Mesoridazine, Triflupromazine, Acetophenazine, Trifluoperazine
- Tardive Dyskinesia - an EXTRApyramidal disease - an IRREVERSIBLE side effect resulting from long term phenothiazine therapy.
Causes involuntary, repetitious movements of the face, limbs, and trunk.
- Butyrophenones -
- Haloperidol and droperidol - highly effective antipsychotic drugs used to tx schizophrenia. Also used to tx Tourette's Syndrome. A
potent dopamine antagonist.
- Thioxanthenes -
- Chlorprothixene and thiothixene - less potent group of antipsychotics. Used to tx schizophrenia.
- Diverse heterocyclic antipsychotics - treat schizophrenia and have proven to be more effective and less toxic than older drugs. NEW - not only
antagonized dopamine, but also antagonize serotonin in the brain.
- Ex. Molindone, clozapine, loxapine, olanzapine, risperidone, and quetiapine.
- Extrapyramidal syndrome (EPS) = muscle spasms of the oral-facial region. Results from the blockade of dopamine receptors in the basal
ganglia.
- Anti-depressants
- Tricyclic antidepressants - the drugs of choice to treat UNIpolar depression. Inhibit neuronal reuptake of norepinephrine and serotonin in the
brain. Ex. Elavil - induce significant xerostomia. CAUTION with HTN meds - they increase NE levels in tissues and can increase BP.
- Ex Amitriptyline, Doxepin, Imipramine
- Most widely used tricyclic antidepressant is Amitriptyline (Elavil) - displays the greatest anti-cholinergic effects (dry mouth)
- Serotonin and NE reuptake inhibitors - Ex. Effexor - induce significant xerostomia. CAUTION with HTN meds - they increase NE levels in
tissues and can increase BP.
- Ex. Venlafaxine, Norptriptyline, Desipramine
- Selective serotonin reuptake inhibitors - have revolutionized the tx of depression. Can also tx panic attacks. High specificity for blocking only
the reuptake of serotonin. Ex. Prozac - have no secondary anti-cholinergic effects so they do NOT cause xerostomia. No effect on BP.
- Ex. Citalopram, Escitalopram, Fluoxetine, Paroxetine, Sertraline
- Fluoxetine (Prozac) - prototype. Has the longest half life.
- 2nd generation - Ex. Buproprion, Trazodone, Nefazodone, Mirtazapine
- MAO inhibitors
- Ex. Phenelzine, Tranycypromine, Isocarboxazide
- Chemotherapy
- 8 classes of drugs
- Alkylating agents - alkylate DNA so it cannot replicate. Form COVALENT alkyl bonds to nucleic acids. Most commonly bind to
guanine. Used to tx chronic leukemias, lymphomas, myelomas, and breast and ovarian cancers.
- Ex. Cisplatin, Cyclophosphamide
- Cisplatin - side effects cause nausea and vomiting, hair loss, xerostomia, mucositis.
- Ex. Mechlorethamine, Cyclophosphamide, Chlorambucil, Melphalan, Carmustine, Lomustine, Semustine, Busulfan
- Anthracyclines - destroy DNA so the cell cannot replicate. Ex. Daunorubicin and Doxorubicin
- Antibiotics - specifically used to tx cancer, not bacteria. Ex. Dactinomycin
- Antimetabolites - interfere with selected biochemical reactions necessary for cell growth. A cell cycle specific drugs acting primarily
in the S phase of the cell cycle = DNA synthesis. Interfere with biosynthesis of purine and pyrimidine bases.
- Ex. 5-Fluorouracil, 6-Mercaptopurine, and Methotrexate
- Ex. Methotrexate, Fluorouracil, Floxuridine, Mercaptopurine, Thioguanine
- Methotrexate - causes ulceration of oral tissues.
- Antimicrotubular - affects microtubule assembly in cells to inhibit cell mitosis. Ex. Paclitaxel
- Antiestrogen - block tumors that are stimulated by estrogen. Ex. Tamoxifen
- Vinca alkaloids - mitotic spindle poisons. Ex. Vinblastine and Vincristine
- Gonadotropin hormone releasing antigen - inhibit gonadotropin secretion . Ex. Leuprolide.
- Mucositis is a common reaction to cancer chemo. Mucosa begins to desquamate and develop ulcerations.
- Alopecia - hair loss occurs 1-2 weeks after tx.
- Aromastase inhibitors -
- Exemestane - an irreversible, steroidal aromatase inhibitor. Prevent the concersion of androgens to estrogens by tying up the
enzyme aromatase. Lowers circulating esterogens - helpful in breast cancers where growth is estrogen dependent.
- Letrozole - first line treatment of horomone receptor positive or metastatic breast cancer in post menopausal women.
- Corticosteroids
- Used to tx - asthma, arthritis, allergies, aphthous stomatitis, lupus, and TMJ pain, Addison's Disease
- Contraindications - latent infections, AIDS, herpes, gastric ulcers, CHF
- Long term effects - abdominal edema, peptic ulcers, osteoporosis, muscle weakness
- Nasal and inhaled corticosteroids do NOT achieve significant blood levels.
- Glucocorticoids - Used as anti-inflammatory agents. Affect carbohydrate, lipid and protein metabolism. ENHANCE gluconeogenesis through
the breakdown of endogenous proteins which are converted to glucose.
- Aerosols - Triamcinolone, Beclomethasone, Fluticasone, and Budesonide - used for chronic asthma and bronchial disease.
- Nasal sprays - Triamcinolone, Fluticasone, Budesonide
- Mineralocorticoids - regulate sodium and potassium metabolism by INCREASING sodium retention and potassium depletion which can lead to
edema and hypertension.
- Opiates - aka narcotic analgesics. Raise the pain threshold to increase pain tolerance. Used to relieve moderate to severe pain, as pre-anesthesia
medications, as analgesic adjuncts during anesthesia, as antitussives, and antidiarrheals. Cause drowsiness and sleep as a side effect. Most serious
side effect is respiratory depression. Produce drug dependence. Do NOT cause peptic ulcers. Do NOT affect blood clotting or affect pts taking Warfarin.
- Opium alkaloids
- Codeine
- Morphine - NOT used in dentistry due to high addictive liability.
- Synthetic derivatives
- Meperidine = Demerol - an IV supplement during conscious sedation. LESS potent than morphine. Also used as an oral medication
after dental surgery. The ONLY narcotic agent that does NOT cause miosis.
- Hydrocodone = Vicodin
- Oxycodone = Oxycontin - side effects include nausea and constipation.
- Fentanyl - a potent narcotic analgesic used primarily as an IV supplement during conscioius sedation or general anesthesia. 80-100
times MORE POTENT than morphine. Can be administered as a lollipop or skin patch.
- Pentazocine - chemically related to morphine. Has weak analgesic properties.
- Hydrocodone with Acetaminophen = Vicodin, Lorcet, Lortab
- Hydrocodone with ibuprofen = Vicoprofen
- Oxycodone with acetaminophen = Percocet, Roxicet, or Tylox
- Oxycodone with ibuprofen = Combunox
- Codeine with Acetaminophen = Tylenol #3
- Opioid antagonists = Naloxone - used in opioid overdoses. Also - Nalmefene and Naltrexone.
- Endogenous opioids - produce morphine like effects
- Beta-endorphins - bind to opioid receptors in the brain and have potent analgesic activity
- Enkephalins - bind to opioid receptors in the brain. More widely distributed than beta-endorphins. Plays a role in pain, movement, mood, and
behavior.
- Dynorphins - the MOST powerful of the endogenous opioids. Found in the CNS and PNS.
- Opioid receptors
- Mu = prototype opoid agonist is morphine.
- Delta = enkephalins bind here
- Kappa = dynorphins bind here
- Interferons - act to induce gene transcription, inhibit cellular growth and alter the state of cell differentiation. Used to tx hairy cell leukoplakia, chronic Hep
B, recurring genital warts, and tx of multiple sclerosis.
- Anti-hypertensive agents - lower BP by reducing the total peripheral resistance and reducing cardiac output through a variety of mechanisms.
- Diuretics - inhibit sodium reabsorption in renal tubular cells within the kidney to cause excess sodium and urinary excretion resulting in reduced
blood volume
- Thiazides - inhibit sodium reabsorption in the renal tubules causing excretion of sodium and water. Ex. Hycdochlorothiazide
- Loop diurectics - inhibits the reabsorption of sodium and chloride in the ascending loop of henle. Ex. Furosemide (Lasix)
- Potassium-sparing diuretics - conserve potassium so none is lost. Result in increased sodium and decreased potassium
concentrations at the end of the distal convoluted tubules. Most important toxic effect is hyperkalemia.
- Ex. Spironolactone and Triamterene - competes with aldosterone receptors sites in renal tubule causing increased
secretion of sodium, chloride and water but no effect on potassium.
- Spironolactone - a pharmacologic antagonist of aldosterone in the collecting tubules.
- Beta adrenergic receptor blockers - reduce the volume of cardiac output into the circulation resulting in reduced peripheral pressure
- Cardioselective beta blockers- B1 receptor in heart muscle is blocked - Ex. Atenolol and Metoprolol
- Non-cardioselective beta blockers - Ex. Nadolol, and Propranolol
- ACE inhibitors - inhibit the conversion of inactive Angiotensin I to Angiotensin II (the vasoconstrictor). Results in peripheral vasodilation and
increases urinary volume excretion.
- Ex. Lisinopril, Ramipril, Captopril and enalapril
- Calcium channel blockers - inhibit calcium entry into vascular smooth muscle causing vasodilation of coronary and peripheral blood vessels.
- Ex . Amlodipine, Diltiazem, Nifidepine
- Tolazoline - a parental antihypertensive agent. Causes direct peripheral vasodilation by CENTRALLY stimulating A2
- Methyldopa - most effective when combined with a diuretic. Produces a false transmitter which replaces NE in vesicular storage sites. Used to
tx HTN in pts with renal damage.
- Clonidine - used in combination with Thiazide diurectics and hydralazine. An A2 selective agonist - it relaxes blood vessels and lowers BP.
- Guanfacine and Guanabenz - stimulate A2 adrenergic receptors reducing peripheral vascular resistance.
- Angiotensin II blockers - prevents angiotensin II from constricting the blood vessels which raise BP. Angiotensin II also stimulates the release of
aldosterone which promotes sodium and water retension.
- Ex. Losartan, Valsartan, Candesartan, Irbesartan
- Direct vasodilators - act on smooth muscle of arterioles resulting in a decrease in peripheral resistance and blood pressure.
- Minoxidil - very effective so it is reserved for extreme hypertension
- Nitroprusside and diazoxide - parental vasodilators used in hypertensive emergencies.
- Nitroglycerin
- Angina pectoralis - pain in the heart and chest during the occlusion of coronary arteries. Triggered by physical exertion, increased BP and
vasoconstriction.
- Nitroglycerin - a coronary artery vasodilator. Relaxes blood vessels to increase blood flow so more oxygen can get to the heart. Effective
sublingually in 2-4 minutes.
- Nifedipine and diltiazem - calcium channel blockers used to prevent angina attacks.
- Propranolol and atenolol - beta blockers used to decrease the work load of the heart so less oxygen is required.
- Cholesterol
- HMG-CoA Reductase Inhibitors - aka Statins - lowers blood cholesterol by inhibiting a key enzyme in cholesterol synthesis pathway in the liver.
- These drugs can increase the breakdown of skeletal muscle causing the release of muscle protein. This protein can overload the
kidneys causing renal failure. CAUTION - Erythromycin enhances this side affect!!!
- Ex. Atorvastatin (Lipitor), Simvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin
- Anti-coagulants
- Used to prevent CAD, angina pectoris, myocardial infarction, and strokes. NOT hypertension.
- The MOST valuable test used to evaluate the patient as a surgical risk - PT (Prothrombin Time)
- INR - international normalized ratio - 1 = normal prothrombin time of 12 sec. Values greater than 1 = there is an anticoagulant effect.
- The higher the INR value, he greater the anticoagulant effect. Values between 1-1.5 are considered safe for surgery (12-18 sec)
- Other drugs that increase pts bleeding time - aspirin, NSAIDS, Clopidogrel (Plavix), Ticlopidine, Coumadin and Heparin
- Heparin - inactivates THROMBIN and prevents the conversion of fibrinogen to fibrin. Enhances ANTITHROMBIN III which impairs Factor Xa
inactivating thrombin.
- Ex. Enoxaparin, Dalteparin, Tinzaparin - low molecular weight heparin type anticoagulants.
- Contains within mast cells and basophils. Neutralizes tissue thromboplastin and also block thromboplastin generation.
- Warfarin (Coumadin) - interferes with the hepatic synthesis of VITAMIN K dependent coagulation factors like factors II, VII, IX, and X resulting
in the inability of the coagulation pathway to produce THROMBIN. Prolong blood clotting times.
- Vitamin K - a FAT soluble vitamin involved in the synthesis of factors II, VII, IX, X, and prothrombin in the liver. enhances blood
clotting!
- Aspirin - inhibits blood clotting by inhibiting PLATELET aggregation in an IRREVERSIBLE way. Does NOT affect the coagulation pathway, but
prevents clotting by inhibiting the fibrin clot from forming. Takes 5-7 days for normal clotting to resume.
- Clopidogrel (Plavix) - inhibits platelet aggregation in an IRREVERSIBLE manner similar to aspirin. But does not cause gastric ulcers like
asprin.
- Glycoprotein IIb/IIa inhibitor type of antiplatelet agents - REVERSIBLE anti-platelet agents. Used to prevent acute cardiac ischemic
complications. Administered via IV. Ex. Abciximab, Eptifibatide, Tirofiban.
- Thrombin-inhibitor type anticoagulants - administered via IV to prevent post-op deep vein thrombosis after hip surgery. Directly inhibits
thrombin.
- Ex. Lepirudin, Argatroban, Danaparoid
- Antisialagogues - classified as anticholinergics. They block postganglionic cholinergic fibers. Reduce spasms of smooth muscle in the bladder, bronchi,
and intestines. Relax the iris sphincter = mydriasis, decrease gastric, bronchial, and salivary secretions, decrease perspiration.
- Ex. Atropine Sulfate, Glycopyrrolate, Belladonna derivatives, Propantheline bromide
- Contraindications - glaucoma, CV problems, asthma
- Anti-muscarinic agents - no intrinisic activity - they simply bind to the receptor site and prevent Acetylcholine from binding. Often used to prevent motion
sickness. To cure traveler's diarrhea.
- Ex. Atropine, Scopolamine, Glycopyrolate, Propantheline
- Cholingeric drugs - induce the formation of saliva. Stimulate acetylcholine cholinergic receptors. Cause miosis (papillary constriction), excessive
sweating, increased GI motility, bradycardia.
- Direct acting - methacholine, carbachol, bethanecol, pilocarpine
- Indirect acting - neostigmine, physostigmine, edrophonium, pydridostigmine
- Monoamine Oxidase Inhibitors - used to treat depression. Antagonize MAO which is responsible for the degradation of the naturally occurring
monoamines - epinephrine, norepinephrine, dopamine, and serotonin. An increase in MAO in the brain helps depression.
- Ex. Isocarboxazid, Tranylcycpromine, Phenelzine
- Do NOT give EPINEPHRINE to patients taking MAO inhibitors!!!!
- Interact with MANY drugs! - meperidine, epinephrine, and ephedrine.
- Foods that contain TYRAMINE are prohibited if taking this drug
- Antihistamines - histamine is preformed and stored in cytoplasmic granules of tissue mast cells and blood basophils. It is released in response to IgE
allergic reactions. Can both stimulate and depress the CNS.
- H1 blockers - involved in ALLERGIC reactions. Do NOT prevent the release of histamine but rather compete with free histamine from binding.
Block vasodilation, block constriction of bronchi, block capillary permeability.
- First generation - Ex. Diphenhydramine (Benedryl), - have a BROAD spectrum of action. Can cause drowsiness.
- Second generation - Ex. Chlorpherniramine, Loratidine (Claritin), Desloratidine (Clarinex), Fexofenadine (Allegra) - cause less
sedation and drowsiness than first generation agents.
- H2 blockers - involved in GASTRIC secretions. Mainly used to treat DUODENAL ulcers. REVERSIBLE competitive agonists of H2 receptors.
- Ex. Cimetidine (Tagamet), Femotidine (Pepcid)
- Rantidine - used to treat GERD by competing with histamine in the GI tract.
- Hepatic drug metabolism -
- Microsomal enzyme inhibition - ex. P450 micrsomal drug metabolizing system -
- Routes of Drug Administration
- Subcutaneous administration of a drug - 15 minutes
- Oral route - takes 30 minutes
- Intramuscular - takes 5 minutes since blood flow through muscles is rapid
- Inhalation - gains access to general circulation within 5 minutes
- Topical ointments or creams - not intended for systemic drug administration
- Patch - releases drugs over 12-24 hours
- Local Anesthetics - decreases sodium uptake through sodium channels of the axon resulting in decreasing the nerve excitability below a critical level so
impulses can't propagate along the axon. NO effects on potassium.
- Amides - metabolized in the LIVER by the hepatic microsomal enzyme system (caution for pts with liver disease!)
- Ex. Lidocaine, Mepivacaine, Prilocaine, Bupivacaine, Articaine
- Bupivacaine - has the LONGEST duration of action - 5-7 hrs for an IA block!
- Articaine - aka Septocaine - 4% solution. An amide but chemically unique because it has an ester group attached to it - this allows it
to be metabolized by plasma cholinesterase. The ONLY amide-type LA metabolized in the BLOODSTREAM rather than the liver.
- Max dose recommended - 7mg/kg.
- Prilocaine - used for nerve blocks, epidural and regional anesthesia. Longer acting than lidocaine. When metabolized, it produces
methemoglobin - a less effective kind of hemoglobin. Do NOT use in pts with LIVER disease.
- For lidocaine, a dosage of 4.4mg/kg should NOT be exceeded. Max dose 300mg (15ml)
- 2% = 20mg/ml x 1.8ml/carpule = 36mg/1carpule
- Esters - metabolized in PLASMA by plasma cholinesterase. Mainly used as topical anesthetics, NOT injectable due to high incidence of allergy
to PABA.
- Ex. Benzocaine, tetracaine, dibucaine. Procaine = novocaine. Cocaine is an ester!!!
- The BISULFATES are what might cause an allergic reaction.
- Allergic reactions are more common in Ester-type LA.
- Overdose - causes restlessness, tremors, seizures followed by CNS depression, bradycardia, slowed respiration.
- SMALL UN-myelinated nerve fibers which conduct pain and temp are affected first.
- They are fat soluble drugs that are converted to their water-soluble hydrochloride salts for injections.
- ONLY NON-IONIZED (where the free base is readily avail) form can readily penetrate tissue membranes. Once injected, the pH of
the tissue favor the non-ionized form BUT if there is an infection and the tissue is more acidic, there is a reduction in the non-ionized
form.
- Glaucoma - an increase in intraocular pressure. Caused by poor drainage of the aqueous humor and can cause blindness.
- Pilocarpine - eye drops cause papillary constriction allowing drainage of the aqueous humor to reduce pressure
- Latanoprost - a prostaglandin analog. Eye drops reduce intraocular pressure by increasing the outflow of the aqueous humor.
- Betaxolol - a beta blocker, eye drops reduce intraocular pressure by reducing the production of aqueous humor
- Bimatoprost - same action as latanoprost
- Xerostomia - caused by many drugs
- Tricyclic Antidepressants - Ex. Amitriptyline
- Anti-histamines - Ex. Diphenhydramine (benedryl)
- Anti-cholinergics - Ex. Atropine
- Benzodiazepines - Ex. Diazepam
- Rheumatoid Arthritis - a chronic inflammatory disease of joints that results in joint pain, swelling, and destruction. Characterized by chronic inflammation
of the synovium which lines the joints. Prostaglandin, leukotrienes, accumulate and destroy the synovial lining. These drugs, except gold, can be used to
treat Osteoarthritis too.
- DMARDS = disease modifying anti-rheumatic drugs
- Ex. Prednisone, Gold injections (decrease prostaglandin production), Methotrexate.
- Ex. Nabumetone and Piroxicam - NSAIDS that inhibit prostaglandin synthesis
- Ex. Etanercept - used when DMARDs are not adequate. Binds to TNF to decrease the inflammatory process.
- Ex. Infliximab - used to tx Crohn's disease and rheumatoid arthritis. Binds to TNF alpha.
- Proton Pump Inhibitors - GI drugs that reduce the formation of stomach acid by inhibiting the proton pump of stomach parietal cells.
- Ex. Omeprazole and Lansoprazole
- H2 receptor blockers - Histamine normally stimulates the gastric parietal cells to produce HCl.
- Ex. Ranitidine, Cimetidine and Famotidine
- Allergic reaction
- Immediate - onset reactions like anaphylaxis which occur within 30 minutes and are IgE mediated.
- Accelerated - reactions that occur 30 min to 48 hrs later. Usually not life threatening - urticaria, wheezing, pruritus.
- Delayed - take longer than 2 days to develop. 80-90% of all penicillin reactions are this type - skin rash.
- Asthma -
- Fluticasone - an inhalation corticosteroid used to decrease inflammation in the airway. Enhances the bronchiodilating effects of B2 agonists.
Side effects - can cause fungal infections of mouth and throat.
- Also - Triamcinolone, Beclomethasone, Budesonide
- Anti-epileptic drugs
- *** Phenytoin (Dilantin) - causes Na channel blockade. Used to treat tonic-clonic grand mal seizures. Can cause severe gingival hyperplasia.
- Gabapentin - used to tx partial seizures
- Carbamazepine - used as prophylaxis for partial seizures. Also treats tonic-clonic grand mal seizures and TRIGEMINAL NEURALGIA.
- Diazepam - tx for status epilepticus and in emergency tx of seizures.
- Valproic acid - tx for pts with complex partial seizures and pts with multiple seizure types. Can cause liver failure and blood dyscrasia.
- Ethosuximide - effective in tx of absence seizures by causing a Calcium Channel blockade.
- Bipolar disorder - Ex. Lithium - used to tx the manic phase.
- Amphetamines - sypathomimetic amines that have a stimulating effect on BOTH the CNS and PNS. Pass readily into the CNS and cause a rapid release
of NE in the brain. Increase systolic and diastolic BP, act as weak bronchodilators and respiratory stimulants. High potential for abuse.
- Tx - ADHD, Narcolepsy, Weight loss
- Ex. Dextroamphetamine (Adderol)
- Anti-arrhythmics - uses the Vaughan-Williams classification system to classify them.
- Group 1 = block sodium channels. Further classified on the basis of their effects on ACTION POTENTIAL
- Group 1A - PROLONG the action potential. Ex. Quinidine, procainamide, amiodarone, disopyramide.
- *** Quinidine (prototype) - treats atrial fibrillation and supraventricular tachycardia. Not effective with life-threatening
ventricular fibrillaiton
- Procainaminde -used to tx atrial fibrillation, atrial flutter. Derived from the ester local anesthetic procaine.
- Group 1B - SHORTEN the action potential. Ex. Lidocaine, mexiletine, and tocainide.
- Lidocaine - used via IV to treat ventricular arrhythmias. Acts on fibrillating ventricles to decrease the cardiac excitability
but spares the atria
- Group 1C - have NO effect on action potential duration. Ex. Flecainide.
- Group 2 - beta blockers Ex. Propranolol and esmolol.
- Group 3 - potassium channel blockers Ex. Amiodarone
- Ex. Amiodarone - the most potent and broad spectrum anti-arrhythmic. Blocks sodium, calcium, and potassium receptors AND beta
receptors. Suppresses both supraventricular and ventricular arrhythmias.
- Group 4 - Calcium channel blockers (also used to tx angina)
- Verapamil (prototype) - inhibits the entry of calcium through the slow channels of the calcium dependent tissues of the myocardium
in the SA and AV nodes. Drug of choice for paroxysmal supraventricular tachycardia stemming from the AV node.
- Diltiazem, Nifedipine
- General Anesthesia
- Four stages
- Amnesia/analgesia
- Delirium - los of eyelid reflex, purposeless movement, dilated pupils, reflex vomiting, tachycardia, hypertension - BAD!
- Surgical
- Medullary paralysis - cessation of respiration resulting in death - BAD
- Inhalation agents - Desfluorane, sevofluorance, Halothane, isoflurane, enflurane - effective at 3-5% conc.
- IV agents
- Barbiturates - Thiopental, Methohexital, Ketamine
- Benzodiazepines - Diazepam, Midazolam, Iorazepam
- Neuroleptic opiods - combine fentanyl and droperido.
- Nitrous Oxide - Produces sedation and mild analgesia. a gas at room temp and pressure. Can NOT produce general anesthesia except at concentrations
greater than 80%. Not flammable. Must be given with a minimum of 20% oxygen.
- Nitrous oxide = blue. Oxygen = green
- Glucocorticoids - steroid hormones produced by the adrenal cortex. Side effects - can cause peptic ulcers!
- Glucocorticoids - affect arachidonic acid metabolism by inducing the synthesis of a protein that inhibits the productin of phospholipase A2
resulting in a decrease in production of prostaglandins and leukotrienes.
- Ex. Cortisol, prednisone, dexamethasone, triamcinolone
- Mineralocorticoids - secreted from zona glomerulosa in the adrenal cortex. Regulate sodium and potassium reabsorption in the kidney and
increases BP (a decrease in sodium concentration causes juxtaglomerular cells on the kidney to secrete rennin which converts
angiotensinogen to angiotensin I. Angiotensin II stimulates the release of aldosterone.
- Ex. Aldosterone, deoxycorticosterone, fludrocortisones
- Colony Stimulating factors - stimulate the production of neutrophils and erythroid progenitor cells in the hematopoietic process
- Darbepoetin alpha - induces erythropoeisis by stimulating the division and differentiation of erythroid progenitor cells. Used to tx anemia
associated with chronic renal failure
- Pegfilgastrim and sargramostin - stimulates the production, maturation, and activation of neutrophils. Used to decrease the incidence of
infection in pts with nonmyeloid malignancies or after bone marrow transplants.
- Urinary elimination of drugs is controlled by - glomular filtration, tubular reabsorption and active transport.
- Anti-malarials- Mefloquine, Chloroquine, Quinine, Halofantrine, Combo of atovaquone and proguanil, combo of sulfadoxine and pyrimethamine
- Bisphosphonate drugs - used to treat and manage osteoporosis and prevent hypercalcemia. BRONJ!
- Ex. Zolendronic acid, Palmidronate, Alendronate (Fosamax)
- Controlled Substance Act of 1970 - Schedule of Drugs - must have DEA number.
- Schedule I - not considered legitimate for medical use. Cannot be prescribed. Ex. LSD, heroin, marijuana.
- Schedule II - strong potential for abuse and addiction but have legitimate medical use. Cannot be called in to the pharmacy over the phone.
Cannot prescribe refills - a new Rx must be written. Ex. Amphetamines, Morphine, Cocain, Oxycodone, Codeine
- Schedule III - less potential for abuse or addiction. Ex. Tylenol #3, Vicodin (combo with codeine or hydrocodone)
- Schedule IV - Benzodiazepines, chloral hydrate
- Beta-lactam Antibiotics - include cephalosporins, penicillins, monobactams, and carbapenems
- Beta-lactamases -enzymes produced and secreted by bacteria as a defense against antibiotics..
- Ex. Cephalosporinease and penicillinase
- Methicillin renders the antibiotics stable in the presence of these enzymes
- By combining CLAVULANIC ACID with penicillin - the beta lactamase enzyme is permenantly inhibited by the acid.
- AUGMENTIN - combines amoxicillin and clavulanate potassium.
- Probenecid - often co-administered with antibiotics to delay the renal clearance of it to elevate and prolong the serum concentration of the
antibiotic when high tissue concs are necessary. Also used to tx gout.,
- Imipenem -a beta lactam antibiotic derived from thienamycin. The first CARBAPENEM antibiotic.
- Aztreonam - a parental synthetic beta lactam antibiotic. Limited to gram negative rods. Has no gram positive or anerobic activity.
- Penicillins - contain a beta-lactam ring structure joined to a thiazolide ring. BACTERIOCIDAL - inhibit cell wall synthesis
- Penicillin G - prototype penicillin,
- Penicillin VK - preferred for oral infections because it is more acid stable. Associated with the highest incidence of ALLERGY! Can
be prescribed to pregnant women. Very LIMITED spectrum of action - gram positives and anaerobes.
- Which penicillin has the widest spectrum of antibacterial activity? Carbenicillin
- Aminopenicillins - Ex. Ampicillin and Amoxicillin - characterized by the amino substitution of pencillin G.Inhibit CELL WALL
synthesis. Used to tx URI and UTI. NOT stable to beta-lactamases. Very effective against GRAM -.
- Amoxicillin - has an EXTENDED spectrum of action - higher oral absorption, high serum levels, long half life than
ampicillin.
- Bacampicillin - used to tx upper and lower respiratory infections, UTI. Better absorption than ampicillin and decreased GI
side effects.
- In large doses, it inhibits the renal tubular secretion of METHOTREXATE
- Methicillin - used to tx SEVERE penicillinase producing staphylococcal infections. Given IV.
- MRSA - methicillin resistant streptococcus aureus - resistant to all penicillinase resistant penicillins and cephalosporins.
Tx with Vancomycin….
- Degraded by stomach acid so MUST be given parentally - methicillin, penicillin G, and carbenicillin
- Acid stable - penicillin VK, Amoxicillin, Ampicillin, Nafcillin, Oxacillin, Cloxacillin, Dicloxacillin
- Extended spectrum - aminopenicillins
- Broad spectrum - carbenicillin, piperacillin, ticarcillin. They have the WIDEST spectrum of all penicillins
- Penicillinase-resistant - methicillin, nafcillin, oxacillin, cloxacillin, dicloxacillin - they have a protected beta-lactam ring.
- Cephalosporins - BROAD spectrum antibiotics. BACTERIOCIDAL. Affect the bacterial CELL WALL during cell division. Four generations -
gets broader action against gram + and decreased activity against gram -. 10% of those allergic to penicillin are also allergic to cephalosporins.
- 1st generation - cephalexin, cephradine, cefadroxil, cefazolin
- 2nd generation - cefaclor, cefuroxime, cefoxitin
- 3rd generation - cefixime, cefoperazone
- 4th generation - cefepime
- Macrolide antibiotics -prototyle is Erythromycin. Ex. Azithromycin, Clindamycin, clarithromycin - BACTERIOSTATIC - Inhibits PROTEIN SYNTHESIS by
binding to 50S subunit of bacterial ribosome.
- Intrinsic activity against H. influenza.
- Erythromycin - know to cause adverse GI effects. Usually enteric coated because stomach acid destroys them.
- Clindamycin - can cause severe diarrhea and pseudomembranous colitis due to overgrowth of Clostridium difficile. Active against gram +,
many anaerobic organisms, including Bacteroides fragilis. Can be given to pts allergic to penicillin since there is no cross allergenicity.
- Tetracyclines - inhibit PROTEIN synthesis by binding to 30S subunit of bacterial ribosome. BROAD spectrum. BACTERIOSTATIC. Useful in tx of acne,
periodontitis associated with Actinobacillus actinomycetemcomitans = ANUG!!, rickets. Absorption in GI tract is inhibited by divalent and trivalent cations
liked Ca2+, Mg2+, Fe2+, and Al3+ - they chelate the drug preventing absorption. Do not take with dairy, iron, or magnesium!!! Side effects - yeast
infections!!, Associated with photosensitivity causing red rashes.
- Aminoglycosides - BACTERIOCIDAL, have BROAD spectrum, used mainly to treat AEROBIC gram - infections. Bind IRREVERSIBLY to 30S subunit of
ribosome inhibiting PROTEIN synthesis. Severe side effects - OTOTOXICITY and NEPHROtoxicity. Administered by IM or IV since poorly absorbed
orally.
- Gentamicin - Amikacin, Tobramycin, Netilmicin,
- Streptomycin - was once used to tx tuberculosis.
- Chloramphenicol - a BROAD spectrum, major side effects - can cause APLASTIC ANEMIA, bone marrow suppression, and Gray syndrome.
- Sulfonamides - structurally similar to PABA which is used by bacteria to synthesis folic acid. Inhibits PABA which inhibits cell growth. BACTERIOSTATIC.
Not used to tx dental infections. Used to treat UTI.
- Metronidazole- NOT a true antibiotic since it is not found in natural organisms - it is a SYNTHETIC substance produced in the chemical laboratory.
- Agents affecting cell wall - penicillins, cephalosporins, bacitracin, vancomycin, cycloserine, azteronam, imipenem
- Agents interfereing with protein synthesis - tetracycline, aminoglycosides, chloramphenicol, erythromycin, lincomycin, clindamycin, azithromycin,
clarithromycin
- Agents interfering with bacterial metabolic pathways - sulfonamides
- Agents affecting bacterial DNA - metronidazole (flagyl), trimethoprim, fluoroquinolones (ciprofloxacin)
- Bacteriostatic abx - tetracyclines, clindamycin
- Antibiotic prophylaxis
- For pts with total joint replacement -
- Amoxicillin - penicillin family. 2g 1hr prior. Tx of choice to prevent bacterial endocarditis
- Clindamycin - 600mg 1hr prior.
- Cephalexin - 1st generation cephalosporin. 2g 1hr prior.
- Cephradine - 1st generation cephalosporin. 2g 1hr prior
- HIV
- Nucleoside reverse transcriptase inhibitors - nucleosides which inhibit the viral enzyme known as reverse transcriptase. Inhibits the HIV viral
RNA from being made into a DNA segment.so the genome can't be copied.
- Ex. Stavudine, Didanosine, Zalcitabine
- Protease inhibitors - suppress viral replication by inhibiting protease, the enzyme responsible for cleaving viral precursor peptides into infective
virions.
- Ex. Indinavir, Nelfinavir, Ritonavir, Saquinivir
- Non-nucleoside reverse transcriptase inhibitors - inhibit the catalytic reaction of reverse transcriptasr that is independent of nucleoside binding.
- Ex. Delavirdine, Adefovir, Nevirapine
- Anti-fungal
- Ex.Amphotericin- B- given IV or orally to treat SEVERE systemic fungal infections. Associated with kidney toxicity.
- Ketoconazole - avail as a cream or tablet
- Fluconazole - tablets ONLY, used to tx oral and esophageal candidiasis
- Nystatin - avail as oral suspension or a cream. Drug of choice for candidiasis
- Clotrimazole - ONLY avail as a troche.
- Drugs that cause orthostatic hypotension - antihypertensives (guanethidine), phenothiazines (chlorpromazine,thioridane), tricyclic antidepressants
(doxepin, amitriptyline, imipramine), narcotics (meperidine), antiparkinsons drug (Levodopa)
- Herpes labialiis - pencyclovir, acyclovir cream or tablets,
- Penciclovir - a cream indicated for recurrent herpes labialis. Not avail for systemic dosing. Inhibits viral action by selectively inhibiting herpes
viral DNA synthesis.
- Antiprotozoal Agents
- Nitazoxanide - tx diarrhea caused by giardia. Interferes with electron transfer reaction essential for protozoa anaerobic metabolism.
- Atovaquone - tx pneumocystitis carinii pneumonia (PCP)
- Eflornithine - tx of trypanosmoma brucei (sleeping sickness). Also used to remove unwanted hair from face.
- Furazolidone - tx diarrhea caused by giardia and vibrio cholera
- Metronidazole (flagyl) - synthetic antibiotic effective against trichomonas vaginalis and anaerobic bacterial infections.
- Tuberculosis - bacterial infection caused by mycobacterium tuberculosis. Combination of drugs are always used.
- Isoniazid, Rifampin, pryrazonamide, and ethambutol - often given in a four drug regimin
- Amyl nitrite - a vasodilator administered by inhalation ONLY. Used in emergency treatment of cyanide poisoning because it oxidizes hemoglobin to
methemoglobin which binds cyanide tightly keeping it in the peripheral circulation so it can't access tissues.
- CNS stimulatants -
- Analeptics = a CNS stimulant which has the ability to overcome drug induced respiratory depression and hypnosis. NOT for overdose of CNS
depressants!
- Ex. Pentylenetetrazol, nikethamide, doxapram, picrotoxin, strychnine.
- Xanthines - Ex. caffeine, theophylline and theobromine. Caffeine is the ONLY OTC stimulant.
- Theophylline - used to tx asthma by stimulating respiratory centers of the medulla and causing bronchial dilation.
- Sympathomimetic amines - Ex. Amphetamines. POTENT CNS stimulants used to treat narcolepsy, obesity, and ADD.
- Ex. Methylphenidate, phenmetrazine
- Cardiac Glycosides - aka Digitalis. Tx SUPRAventricular arrhythmias, cardiogenic shock, and congestic heart failure. Help the heart beat more strongly
(a positive inotropic effect) and more efficiently. INCREASES the refractory period of cardiac muscle. Inhibit the Na-K-ATPase membrane pump which
results in an increased calcium ion influx into the cell causing stronger muscle contractions.
- Ex - Digoxin - the most versatile and widely used. A positive inotrope which is independent of normal sinus rhythm and adrenergic stimulation.
- Rx
- Superscription - pts names, address, age, date
- Inscription - name of drug and strength (ex. Amoxicillin 500mg tablets)
- Subscription - directions to pharmacist (ex. Disp - 4 tabs
- Transcription - directions to pt (ex. Sig - take 4 tabs 1 hr prior to dental appt)
- Signature
- Anti-diabetics - used to treat NON-insulin dependent diabetes II that's can't be controlled by diet alone.
- Glyburide and chloropropamide - stimulates insulin release from the pancreas. Reduces glucose output from the liver by increasing insulin
sensitivity at peripheral targets.
- Metformine and pioglitazone - increase insulin sensitivity at peripheral targets
- Toblutamide - a sulfonylurea which stimulates the synthesis and release of insulin from the pancreas. Als increases the sensitivity of insulin
receptors and improves the peripheral utilization of insulin.
- Insulin -
- Short acting - 8-12 hours
- Intermediate acting - 18-24 hr.
- Insulin zinc suspension - aka lente insulin - an INTERMEDIATE acting insulin with a duration of over 24 hours after a single
injection.
- Isophane insulin suspension
- Long acting - more than 36 hour, Ex. Protamine zinc insulin and Ultralente insulin
- Ex. Humulin 70/30 = brand name for 70% isophane insulin suspension and 30% regular insulin injection. FAST onset, LONG duration.
Regular insulin provides the fast onset. The suspension provides long duraction.
- Disulfiram (antabuse) - used to treat alcohol abuse. It is an antioxidant that interferes with the hepatic oxidation of the acetaldehyde metabolized from
alcohol. It inhibits aldehyde dehydrogenase resulting in large amounts of acetaldehyde in the body.
- Antacids - decrease the concentration and total load of gastric acid.
- Aluminum salts - Ex. Aluminum hydroxide - the MOST POTENT of all, but has less neutralizing capacity.
- Sodium bicarbonate - ex. Alka seltzer
- Calcium carbonate - ex. Amitone, tums
- Magnesium and aluminum products - Maalox and Mylanta
- Gout
- Colchicine - drug of choice. Reduces the inflammation during acute attacks. Impairs leukocytic migration to inflamed areas and disrupts urate
deposition and subsequent inflammatory response.
- Indomethacin - NSAID that is commonly used
- Spasmolytic drugs - skeletal muscle relaxants - relieve muscle spasms without paralysis. Act in the CNS or skeletal muscle cell rather than at the
neuromuscular plate. Used in chronic CNS diseases like multiple sclerosis, cerebral palsy, and Cerebrovascular accidents.
- Chronic muscle spasms
- Baclofen - a derivative of GABA. Reduces spams in the spinal cord. Used to tx multiple sclerosis.
- Carisoprodol - used to tx muscle spasms associated with acute temporomandibular joint pain.
- Acute muscle spasms
- Cyclobenzaprine - relieves muscle spasms through a central action, possibly at the brain stem level. Used to relieve acute, painful
musculoskeletal conditions. NOT effective for muscle spasms caused by cerebral or spinal cord diseases.
- Methocarbamol - centrally acting muscle relaxant used to relieve acute, painful musculoskeletal conditions and tetanus.
- Quinine - widely used to relieve nocturnal leg cramps.
- Parkinson's Disease - a slow, progressing, degenerative disorder of the nervous system. Tremors, sluggish initiation of movements, muscle rigidity.
Nerve cells in the basal ganglia degenerate resulting in lower production of DOPAMINE.
- *** Carbidopa - used to treat Parkinson's disease. MUST be used in combination with LEVODOPA. Levodopa replenishes the brains supply of
dopamine. Carbidopa inhibits the peripheral decarboxylation of levodopa so more can reach the brain.
- Bromocriptine or pergolide - dopamine agonists given in addition to levodopa to enhance its action.
- Selegiline - a selective MAO inhibitor which usually demainates dopamine in the brain.
- Amandtadine - potentiates dopaminergic responses.
- ADHD
- Methyphenidate (Ritalin) - a mild CNS stimulant. Increases attention span, reduces hyperactivity, and improves behavior.
- Ex. Focalin, Concerta, Adderall, Strattera, Metadate CR
- Strattera - the brand name for atomoxetine, the first NON-stimulant approved for treating ADHD.
- Anti-diarrhea
- Loperamide - aka Imodium - acts on intestinal muscles to inhibit peristalsis. A member of the OPIOID family, but does not penetrate the CNS
like codeine so it can be sold OTC. No evidence of dependence.
- Diphenoxylate and atropine - lomotil - inhibits excessive GI motility. Requires a Rx.
- Oral contraceptives - block ovulating by inhibiting FSH and LH.
Most drugs travel through the blood stream by binding to albumin protein, which is abundant in plasma. The unbound portion is free to leave the blood to be taken up
in tissues where the drug elicits its effect.
RQ’s June 2018
Guys I wish for all of us to get the “PASS”
1. Most common area of caries?

2. Curette angle
3. Which AB you give if pt has allergy to penicillin? Clinda 300 mg / tetra 500 mg
4. clindamycin MOA?
-30s ribosome
-50s ribosome
5. after IV injection of antibiotic, pt started to wheeze on inspiration, hypotension, tachycardia etc.

-hypoglycemia
-anaphylaxis
- adenoid crisis
6. causality (cause and effect) is not seen in which study?cross sectional
7. zinc polycarboxylate powder ?
8. self drilling pin is used on?
-large tooth only
flat surface
-curved surface
9. tachycardia is seen in all except?
- hyperthyroidism
-anemia
- obstructive jaundice
10. Defiant kid, how do you control?

- tsd
-physical restraint
-voice control?
11. researcher wants to study the efficacy of two mouthwashes in two groups. What type of study?
- cohort
-cross sectional
-clinical trial
- longitudinal
12. Sulfonamide MOA
13. Which antibiotic in NUG (penicillin V was not there)
-metronidazole
-clindamycin
Believe in yourself and you will succeed!

Never don't give up!
14. Primary teeth lost prematurely in?
-hypophosphatasia
-papillon levefre
-some other conditions which doesn’t
15. 17. gingevectomy incision?
- apical to junction epithelium
-apical to gingival fibers
- apical to mucogingival fold
16. best test for pulp necrosis?
- ice stick
-endo ice
- EPT
17. Test for teeth with crown
18. Disadvantage of ¾ crown
19. Some crazy q about % of woman in the USA : who have work after age 65/ which % disorved /
or at age X there are more woman single than men. Something like this
20. Caldwell-Luc surgery on max sinus, in case you did extraction and fractured root is located in the
max sinus. They ask on which wall of the max sinus you do this kind of surgery. Medial/lateral /
don’t remember
21. More in men – hemophilia
22. Tautodontism – 2 qs – stage and definition
23. Drugs cause xerostomia, treat xerostomia, and cause hyperplasia
24. All side effects of nitroglycerin
25. What do you give to pt with low immune system, who got tetanus.
26. How to store amalgam?
27. Zygomatic process on panoramic
28. Definition of geographic tongue
29. Which x ray do you take for perio disease in pedo?
30. Angle classes, ANB, SNB, SNA
31. Cephalometric – sella
32. Placebo drugs are effective in 25% cases
Dentist’s attitude will effect the outcome of placebo drug
- true and false type question
33. which muscle effects the shape/form of lingual flange in molar area?
-palatoglossus
-mylohyoid
-genioglossus
34. what will you not do at a perio maintenance visit?
-check oral hygiene and plaque index
-root planning of 1-3mm pockets
-schedule pt for any required restorative work

35. which drug is used for mucocutaneous and systemic fungal infections?
-miconazole
-fluconozole
-some other antifungal
36. most common complication of extraction of maxillary teeth?
-dry socket
-sinus perforation
-hemorrhage
37. class 2 inlay design?
-diverging from gingival wall to pulpal wall
-diverging from pulpal wall to gingival wall
38. blow to lower orbit, eye movement limited to?

-upper
lower
-lateral
39. what is used to adjust a porcelain crown?

-carbide bur
-diamond bur
-green stone
40. feature of cherubism?

-bilateral jaw involvement
-early childhood
41. scrap amalgam is stored in? (no sulphide option)
-biohazard bag
-sealed container
-ethyl chloride
- metal container
42. qfor ideal class V, the retention form should have:
-parallel mesial and distal walls
-parallel occlusal and gingival walls
-retention grooves in occlusal and gingival walls
-retention grooves in mesial and distal walls
43. healing of periapical radiolucency will be slowest in?

-diabetic pt
-aids/hiv pt
-hypertensive pt

44. Patient is diagnosed with BCC. He says “just throw it to me doctor, do I have the cancer or
NOT?” What will be your first response?
-this cancer has better prognosis than others
-don’t worry chemotherapy will take care of it
-Do you have someone here to be with you?
45. retentive clasp tip is located in?

-middle third
-gingival third
-junction of gingival and middle third
-junction of middle and occlusal third
46. Treatment of dry socket: irritation/dressing
47. disadvantage of sedation?
-multiple drugs need to be given
- high chance of adverse effects

48. broken root of lower molar is going to which space?
49. Pemphigus – intraepithelial
50. All about tumors of salivary gland from mango
51. AOT, OKC, which one more common/ less common
52. Most allergy – nickel
53. Discoloration of pfm
54. D.d between apical abscess and apical periodontitis and necrosis of the pulp
55. Most ressistent tissue . only muscle or only nerve in the options
56. Osteoradionecrosis – mandible
57. # of FURCATIONS – if 3rd molars are missing in maxilla – 8-10-12-14. The ans is 8. Because
they ask FURCATIONS, not difurcation, not trifurcation.
58. what is reciprocal anchorage?

-tipping
-two equal and opposite forces
59. effect of Coumarin will be reduced by
-hepatic insufficiency
-increase in hepatic enzymes
-drug is displaced from proteins
60. what will you not do for aids/hiv patient?
-mouth rinse prescription
-antifungal prescription for candidiasis
-multiple free gingival grafts

61. elective RCT is done in?
-tooth that has pain since 1 month
-short crown that needs to be an abutment for a bridge
-pulp exposure
62. Active stabilization/immobilization is done in?

-patient who was previously cooperative suddenly becomes unco-operative (there were other
options, I didn’t know anything abt this!)
63. you made a zirconia crown on right mandibular molar. When patient bites, it shifts to the right.
What area is effected?
(mandibular incline – cusp)
-buccal – buccal
-lingual – buccal
-buccal – lingual
-lingual – lingual
64. A radiograph of lower mandibular area, shows an unerupted 3rd molar that has a unilocular
radiolucency next to 2nd molar. Histology says it is lined by nonkeratinized stratified sq
epithelium. Dentigerous cyst
65. Laryngospasm - stridor
66. Which forceps you don’t use for extraction of pm? #23 it is for man molars
67. Know very well syndromes with supernumerary teeth and hypodontia
68. Day 2 bacteria in plaque
69. Drug that potentiates GABA neurotransmitter
70. D.d. b/w primary and secondary trauma
71. All about nitrous. 70%, contra. Asthma/ copd/ usefil for anxiety/ effective or not in defiant
children
72. Pt after SRP. OHI EXELLECT. Pockets like 5-6 mm. what do you do next?
73. Cells in cellulitis
74. What first on teeth after brushing?
75. Calcification of permanent teeth. 2 man molar
76. Dd b/w OKC/ameloblastoma in x ray
77. Autism in kids- repetition – I checked.
78. Know very well immunosuppressive drugs (also CellCept)
79. Kid with fever for few days – mononucleosis or stomatitis?
80. Ectodermal dysplasia
81. Cleft palate 1:700
82. More perio disease: white/ black, woman/man
83. A lot of behavior q’s and true/false and what do you tell to pt in case x

84. Pharma rq’s – guys those q’s from my notes, check if the answers are 100% right:
Used in asthma? Albuterol / corticosteroid, theophylline
Disadvantage of oral sedative? Something with GI
Safety for kids after extractions – Acetaminophen
Pseudomembranous colitis? Cause by Clostridium difficile and clindamycin. Treated by
carbencillin/ciprofloxacine and for pregnant vanco
Not to give to pt with asthma ? aspirin (induced bronchospasm), NSAIDS
Steroid dose need medical consultant? 20 mg for 2 weeks 2 years
Methotrexate? Tx cancer , rheumatoid arthritis psoriasis. anticancer agent enzyme
inhibition
KNOW SCHEDULE 2!!!!
Montelukast (Brand name Singulair)- Anti-Inflammatory. It can treat allergies and
prevent asthma attacks. MOA: blocks the action of leukotriene D4 on the cysteinyl
leukotriene receptor CysLT1 in the lungs and bronchial tubes by binding to it. This
reduces the bronchoconstriction otherwise caused by the leukotriene, and results in less
inflammation.
Metforim( glucophage) is used to treat diabetics type 2
Varenicline(Chantix) - Smoking cessation aid. It can be used as part of a support program
to help people stop smoking
Treatment of ANUG: Debridement, H2O2/ chlorhexidine rinses, antibiotics if systemic
symptoms (fever, lymphadenopathy). If it is systemic: Metronidazole, Amoxicillin.
Xerostomia treatment:
- Pilocarpine (Salagen) - if xerostomia caused by salivary gland hypofunction resulting
from radiotherapy for cancer of the head and neck. It's cholinergic agonist.
- Cevimeline (Evoxac) - is indicated for the treatment of symptoms of xerostomia in
patients with Sjigren's syndrome. It's pharmacologic category is cholinergic agonist.
Same drug for HSV, VZV , CMV? Valacyclovir. FOR SURE
16 kg of 3 year old how many mgs LA to give? 16 x 4.4 : 70.4 mg

Nitroglycerin (antianginal = coronary artery vasodilator) This drug is the single most effective
agent available for the management of acute angina episodes.
Side effects: the two most common adverse effects caused by nitroglycerin are orthostatic
hypotension and headache DD131. It is sublingually effective within 2-4 minutes – 0.3mg).
Note: It dilates mostly veins.
Indications: angina, acute myocardial infarction, and congestive heart failure. (FA)
Metronidazole can be used to treat: necrotizing ulcerative gingivitis (NUG).
Moa of suphauryl anti diabetic drug? increase insulin production by stimulating b
cells of pancreas
Side effect of albuterol - Candida and xerostomia (Dryness of mouth inc susceptabilty to
candidal infection)
Montelukast Moa - Leukotriene receptor antagonist
K sparing drugs - Eplerenone (Inspra), Spironolactone (Aldactone), Triamterene
(Dyrenium) toxic effect is hyperalkemia.
Cevimeline - For treatment of xerostomia
Aspirin should stop dts 81 mg before extraction? True or false - yes as in dd, stopped 7
days before extraction (CHECK THIS ONE, NOT SURE)
Gingival hyperplasia – drugs such as cyclosporine, nifedipine (Procardia®) phenytoin
(Dilantin®)

DAY 2 – CASES
It is copy – paste from some rq’s file. I had very similar cases.
Case 1. Old man who was a wheat farmer, smoked 40 packs per year for 40 yrs. Had Lisinopril,
aspirin 81 mg, had a white patch on lower lip
q- why is the white patch on the lip- actinic chelitis or leukoplakia
q- histopathology of the white lesion- more keratin
q- he had max 3rd molars on both sides they asked which rpd classification
q- lower molars had mods and various pocket depths, lower anteriors had mobility, furcation- they
asked to classify the type of perio disease
q – prognosis affected by- (a) mobility (b) furcation (c) contour of restorations (d) replacement of
missing teeth
q- one tooth had fractured amalgam mod- which is best method of restoration- pins, pfm, onlays
q- if it was to be extracted what would be the complication it was a max rc treated molar with big
amalgam with pins
q – pointed to fordyces granules in pic
q. had posterior crossbite and collapsed occlusion- reason was asked
few more q regarding type of clasp and occlusal rest
case 2: Young girl with asthma, posterior cross bite on left side , narrow maxilla, left max posterior
had a band and loop space maintainer
Q – estimate age of pt , whether earlier or late for chronological age
q. mobility of deciduous canine present , permanent tooth bud was way up still, what to do?
q. asked whether all teeth were present or not which was missing- had a missing mand 2nd pm
q- type of resorption in deciduous 2 molar
q- the 1st pm was at same level as deciduous molar- why
q- caries risk assessment
q- reason to retain 2molar- complicated options
q- ankylosed deciduous doesn’t prevent what?- supra eruption of opposing tooth, since it itself was in
infraocclusion
q- had to identify hyoid bone on her ceph
another q in DAY 1 related to ceph was which structure appears as a single in lat ceph- orbit, ramus,
pterygomaxillary fissure, sella
Case 3:A 20 years old girl , complains of occasional pain in the back lower jaws, has asthma
Take albuterol
Q:
3rd molar
Occlusal trauma
Caries
Steroid inhaler
B2 agonist inhaler
Give oxygen

JULY 26
Recent RQs
1. Most often lost in perio – max m due furcation
2. Kidney dialysis – tx: one day after dialysis
3. Diabet type I – blindness
4. Oral wound -3% H202
5. Fracture is released earliest – condyle fracture
6. Neuropraxia
7. Neurofibromatosis type I : café-au-laite macule, axillary freckling, iris hamartomas
8. Scleroderma: widening PD ligament + bilateral resorb of angle
9. Acromegaly – classIII
10. Cleidocranial dysplasia –supernumerary
11. Hyperpara thyroidism – macroglossia is not seen
12. Ameloblastoma – local invasion
13. PA cemento-osseous dysplasia : ant mandible, middle age black women
14. Recurrent apthous ulcer – stress
15. Behcet`s syndrome –aphtous ulcer
16. Epinephrine reversal – alpha 1 rec
17. Vasoconstrictor –alpha 2 REC
18. Midazolam
19. Bipolar disorder – lithium
20. What antifungal drug involve ergosterol? Clotrimazol, ketoconazole, fluconazole, …one more ( no
miconazole in option)
21. Anti- cholinergic and cholinergic – several questions, knew name of drugs and action
22. Warfarin – INR
23. Alcoholic pt – INR
24. X-ray - tip of nose
25. Most common crown/root ratio? 1:1, 1:2, 1:3, 1:4 ans 1:2
26. Informed consent - autonomy

27. Laser wavelength? Violet, ultraviolet,…
28. Needed for remineralization? Calcium and phosphor, fluoride, …
29. Spatial resolution - xrays
30. Hypochlorite – all exept chelation, disinfected gutta percha,dissolve necrotic tissue
31. Taurodontism – which stage? Morpho –ANS , hysto, initiation
32. Most common site for caries initiate – pit and fissure
33. Reciprocal anchorage –two equal and opposite forces
34. Grow last? Cranial vault, cranial base, maxilla, mandible
41. Most superior apical filling? MTA
42. Percussion –inflammation of PDL?
43. Vertical root fracture – best treatment – extraction -ANS
44. SLOB rule
45. BULL – working
46. Pain from lower molar irradiation – ear
47. Replacement resorption –ankilotic
48. Most radioresistance – muscle (nerve no in option)
49. X-ray – photoelectric effect
50. Distance 8-16, exposure time 0.5 -? - 2,0
51. Collimation
52. Disk –MRI
53. Grand mal –phenytoin
54. Measles – Koplic spots
55. 0,28 F – needed systemic supplemental fluoride
56. F in water 0,7 -1,0 -1,2
57. Best sterilization control – biological monitors
58. Main causes osteoporosis –nutrition, estrogen
decreased
59. Anestisia cross allergy: lidocaine –mepivacain
Pilocarpine –lidocaine Prilocain- ... Lidocaine –benzocain

60. X-ray – genial tubercles
61. X-ray -mand tori
62. Osteogenesis imperfecta – blue sclera
63. Treacher Collins – midface deficiency, no ear pinna
64. Attrition
1. Etiology for supernumerary teeth- answer is ATAVISM.
2. Mandibular first molar calcification I think I went for 2-3 years
3. Minimum bone needed for osteotome sinus lift- not sure about this
4. Some xrays on pagets, photo of tongue with hematoma, questions on concresence, fusion,
osteogenesis imperfect seen with what it is DI. Xray with hyoid bone, mylohyoid ridge, stafnes cyst, root
piece, odontoma, guys remember the landmarks well I actually had a lot of xrays on day 1.
5. Neurofibromatosis features and they asked which one is asymptomatic
6. Antidote for narcotic and diazepam.
7. Nitroglycerin and epinephrine what antagonism- answer is physiologic
8. Antagonist has high affinity and no intrinsic activity
9. Maximum drug effect- EFFICACY
10. Drug with high oral first pass metabolism will have low BIOAVAILIBILITY
11. Antifungal as troche CLOTRIMAZOLE
12. Lot of questions on aspirin and anticoagulants
13. Aspirin will cause inc bleeding and hypoprothombinemia I got this wrong I put dec prothrombin time
so remember everything about aspirin
14. Herbal products contraindicated with aspirin
15. Guys remember non selective beta blockers like propanolol are contraindicated with epinephrine
they CAUSE HYPERTENSION. But beta 1 blockers like atenolol are safe with epinephrine. I had this on
day 2
16. Which study does not depend on sample size there was no cohort in option I went with CASE
CONTROL and I checked its right but do double check this
17. What causes porcelain greening on cervical COPPER
18. Non working interference
19. Incisal guidance and face bow simple questions

20. Reciprocal clasp feature STABILIZATION
21. External locus of control
22. Questions on case studies which led to a common answer clinical trial, they basically asked about a
drug being tested by FDA so which study
23. Know how to calculate negative and positive predictive value
24. Most dental care in USA is self pay
25. Know unbundling and downcoading difference
26. Systemic desensitization
27. Negative reinforcement. Guys do mosby and very very impt file most impt
28. Intra pulpal anesthesia by back pressure. There is one more option like works in 30 secs but that’s
not correct one
29. A few easy ones on dry socket
30. Which one is a caries causing bacteria but not the one to initiate caries I went for lactobacilli. Strep
would initiate caries
31. Site for initiation of caries
32. Which bur used to give chamfer margin
33. Ludwigs angina which spaces
34. How to record masseter ask patient to bite with pressure
35. Know histodifferntiation and morphodifferntiation
36. They asked about when nitrous is contraindicated in pregnancy I choose first trimester there was an
option like all trimesters also but 1 trimester is an absolute contraindication
37. Question on thyrotoxicosis feature is tachycardia
38. Most common seizure in children FEBRILE
39. Mucocele location lower lip
40. For an unfavorable fracture they asked what would be the interference something like that I went
for the pull of muscles
41. LA without epinephrine MEPIVACAINE
42. Gracey curette no 11 and 12 for mesial of posteriors
43. Which procedure cant be done in presence of minimal attached gingiva I went for DISTAL WEDGE
44. Which graft for a large defect I went for DFDB. Cant go for autograft as it would leave a large defect.
45. Single implant feature hex
46. Treatment for dry socket
47. Anterior triangle cavernous sinus thrombosis
48. What not to consider for implant I choose age we discussed it on group
49. Patient had oral lesions with persistent bleeding I went to AML
50. Temporal arteritis causes blindness
51. What would a dentist refer a patient for again temporal arteritis
52. Best site for implant D1
53. What bur for occlusal adjustments for porcelain
54. Reverse smile line chin up
55. Short dose of radiation for a long time will lead to carcinogenesis
56. Tricyclic antidepressants amitryptiline and imipramine
57. Organophosphate poisoning
58. Side effect of alkylating agent I went for bone marrow depression
59. PEN V dosage
60. Pseudomemb colitis caused by clindamycin
61. Drug most effective on gingiva doxycycline
62. What is not a treatment for class 2 furcation I choose extraction
63. Drug safe in Parkinson penicillin
64. Know validity and reliability
65. T test for 2 means
66. Diabetes most common in blacks
67. Chronic perio common in blacks
68. Whats not seen in
Incisal and coronal parts matched in pfm crowns by:
A. Internal coloring of porcelain
B. External glazing
C. Polishing and grinding to change light reflection
D. Firing under high temp

Mod onlay?? When converge and diverge?? Diverge from gingival to pulpal
1. Most often lost in perio – max m due furcation
2. Kidney dialysis – tx: day after dialysis
3. Diabet type I – blindness
4. Oral wound -3% H202
5. Fracture is released earliest – condyle fracture
6. Neuropraxia
7. Neurofibromatosis type I : café-au-laite macule, axillary freckling, iris hamartomas
8. Scleroderma: widening PD ligament + bilateral resorb of angle
9. Acromegaly – classIII
10. Cleidocranial dysplasia –supernumerary
11. Hyperpara thyroidism – macroglossia is not seen
12. Ameloblastoma – local invasion
13. PA cemento-osseous dysplasia : ant mandible, middle age black women
14. Recurrent apthous ulcer – stress
15. Behcet`s syndrome –aphtous ulcer
16. Epinephrine reversal – alpha 1 rec
17. Vasoconstrictor –alpha 2 REC
18. Midazolam
19. Bipolar disorder – lithium
20. What antifungal drug involve ergosterol? Clotrimazol, ketoconazole, fluconazole, …one more ( no
miconazole in option)
21. Anti- cholinergic and cholinergic – several questions, knew name of drugs and action
22. Warfarin – INR
23. Alcoholic pt – INR
24. X-ray - tip of nose
25. Most common crown/root ratio? 1:1, 1:2, 1:3, 1:4
26. Informed concern- autonomy

27. Laser wavelength? Violet, ultraviolet,…
28. Needed for remineralization? Calcium and phosphor, fluoride, …
29. Spatial resolution
30. Hypochlorite – all exept chelation, disinfected gutta percha,dissolve necrotic tissue
31. Taurodontism – which stage? Morpho, hysto, initiation
32. Most common site for caries initiate – pit and fissure
33. Reciprocal anchorage –two equal and opposite forces
34. Grow last? Cranial vault, cranial base, maxilla, mandible
41. Most superior apical filling? MTA, IRM,??? 42. Percussion –inflammation of PDL?
43. Vertical root fracture – best treatment – extraction? 44. SLOB rule
45. BULL – working
46. Pain from lower molar irradiation – ear
47. Replacement resorption –ankilotic
48. Most radioresistance – muscle (nerve no in option) 49. X-ray – photoelectric effect
50. Distance 8-16, exposure time 0.5 -? -2,0
51. Collimation
52. Disk –MRI
53. Grand mal –pheniton
54. Measles – Koplic spots
55. 0,28 F - needed supplemental fluoride
56. F in water 0,7 -1,0 -1,2
57. Best sterilization control – biological
58. Main causes osteoporosis –nutrition, estrogen
decreased
59. Anestisia cross allergy: lidocaine –mepivacain
Pilocarpine –lidocaine Prilocain- ... Lidocaine –benzocain
60. X-ray – genial tubercles
61. X-ray -mand tori
62. Osteogenesis imperfecta – blue sclera

63. Treacher Collins – midface deficiency, no ear pinna
64. Attriction
JULY 27th FRIDAY

1-Pediatric xerostomia is usually caused by???
- Medication
- Chronic Mouth Breathing
2- You are to cement the final crown. What is THE MOST PRACTICAL WAY TO ENSURE ITS FIT?
- place a die spacer and avoid margins
- grind the internal aspect of crown
-create an occlusal hole on crown
3- You are to prepare for a metal ceramic crown. Where are you going to place the facial margins?
At Cervical line
Gingival crest
Gingival crest and Epithelium
4-Indication of General Anesthesia:
2 years old Kid with tons of caries
5-What is not an advantage of Oral Sedation?
What is not an advantage of Nitrous Sedation ?
6-What is not an advantage of Metal Denture Base?
- inaccuracy in tissue contact
- bares more weight in Maxilla
7-retentive clasp tip location
- gingival third
- gingival third and middle third
8-Major connector requirements?
- Stable and Hard
- Rigid and Rentive
- Stable and Rigid
9-Material that causes hypersensitivity reaction?
Nickel
chromium
Cobalt
10-PATIENT comes in to your office with MOD AMALAGAM restoration that has a crack on mesial and
distal aspects of isthmus. What do you do?
- observe
- remove and see further underlying details
11-Applying air after application of dentin bonding system will
- evaporate solvent in the liquid component
- for the bonding to spread out and reach retentive portion of preparation
12-Impression material that is moisture tolerant?
13-Impression material that is hydrophilic?
14-Patient with RA, on steroid therapy. Patient needs to have multiple extraction. Youre getting a
clearance for what reason?
- Adrenal Insufficiency
- possible risk if infection

15-Lower Mandibular Incisor has a thin attached gingiva. What is true about this?
- there is a likely chance it will have a gingival recession
- it is very much indicated for a fgg
thanks!!!
16-What influences the fgg success rate on lower mandibular 2nd and 3rd molar?
Internal Oblique Ridge
external Oblique Ridge
Mylohyoid Ridge
17-What should not be done on HIv/ AIDS PATIENT:
Do tons of FGG on thin keratinized tissue
Prescribe Nystatin
Prescribe ABX
18-Testing a drug and efficacy, what study? clinical trial
What is not seen in variance? Cross sectional (i think I remember the wordings wrong)
19-Where is the drug action of xerostomia drugs?
Beta 1
Alpha Adrenergic
Catecholamines
Answer B
20-Patient is taking Non selective beta 1 drug. What should you be concerned of? (The given options
were all related to anesthesia) - limited local anes - limited vaso constrictor
21-Osha facilities
What and except (MSDS)
22-Resorbed maxillary anterior ridge will make your crown look what?
long. Long at the cervical
23-Bulimic patients seen: Young African American
24-How to make crowns look narrow?
-Place facial line angles labially and deepen interproximal embrasure
25-The ratio of cleft: 1 to 700
26-Neurofibromatosis Type 1 : features and except
27-K Sparing Drug: Spironolactone
28-What influences the occlusal plane of a mandibular rod?
- height following the 1/3 or 1/3 retromola pass
- occlusal plane of max anterior
29-Where does melanotic melanoma occurs: Ant Gingiva and Hard Palate
30-Acetaminophen and Aspirin combined action?
31-3 y/o old Intruded his tooth. Whats the ideal thing to do
- let the tooth re erupt on its own
- try to displace to original spot and splint

32-New crown on #30, during trial fit jaw deflects to the right, where is the interference? mandible
incline cusp
33-Plane of Face divided into ? HOrizontal and Verical
34-what muscle forms the lingual flange - mylohyoid
35-The only pathology you can identify through microscrope or histology
- OKC
- Cyst
36-Cohort age in USA
55 to 64
64-75
76-85
85 and older
37-The disadvantage of using retraction cord:
- Coagulative necrosis of blood vessels
- lateral displacement of gingival tissue
- vertical displacement of gingival tissue
38-5 year old kid was biking and fell of. Patient cannot bite or occlude on right side. He was cleared and
no radiographic findings. Whats the possible diagnosis?
Right condylar fracture
Left condylar fracture
Right hamarthosis of tmj
Left hamarthosis of tmj

39-Smoking is associated with :
Root caries
Occlusal caries
Smooth surface caries
40-What is true about luting agents?
- contains fluoride which provides anti cariogenic activity
- GIC is less radiopaque than Zinc Phosphate
41-Specific Plaque Hypothesis tells us that:
- specific organism gram + cocci rods are responsible for disease
- specific organism gram - anaerobes are responsible for disease
42-Crown to Root fracture typically seen @ what tooth?
- Mandibular Incisor
- Maxillary Inciso
43-You are to perform pulp test on a test. Best way to do it?
thermal test
Percussion
Ept
(No cold test)
44-Nitroglycerin side effects: flushing, headache..
45-Pulp test on a tooth***
On a tooth with a full

JULY 29 SUNDAY
1-Hemorrhage in mn after extraction due to /fragidity,
fibrinolysis
2-Function of mid palatine suture in set of denture ?
give support ,
retention,both
3-child when cry become blue ?
inc in heart rate or dec
4-Correction of an inadequate zone of attached gingiva on several adjacent teeth is best accomplished
with a/an?
c. double-
5-pt with ulcer in the mouth and seqstrum due to truma ,ask about the location?palate,
lingual in the floor ,
lingual near the oblique ridge ,
buccaly near the ridge
6-Smoker patient what don’t u see:
a) Increased BOP
b) decreased gingival inflammation
7-Pt takes too much opioid, what do you see?
1. Insomnia -
2. Irritability
3. Headache
4- cold
Diabetic undergoing surgery
Take clear fluids with same insulin intake
Take clear fluids with 1/2 amt of insulin?
9-Resective osseous surgery is best suited for periodontal sites with
A. severe attachment loss.
B. severe intrabony defects.
C. teeth with short roots.
D. early to moderate bone loss
10-child come to u bec her upper teeth set behinf the lower but in the radiograph the child look like cl 2
What type of profile ?
convex
concave
11-leat common fracture tooth

12-An uncooperative 5 year old child has a carious lesion in her primary mandibular second molar. There
is no tooth mobility, but the practitioner notes a small, draining sinus tract adjacent to the tooth. Which
of the following is t/t of choice?
a. Extraction
b. Pulpectomy
c. Indirect pulp therapy
d. Calcium hydroxide pulpotomy
e. Formocresol pulpotomy
13-pt positive ept ,sensitive to cold and linger pain,pain to specific tooth?irreversible pulpitis,
symptomatic irrive with periodontal ,
symptomatic irr with apical absucss
14-what do you see when your max is constricted by 3mm?
A,bilateral cross bite
B.shift midline towards the effected side
C.shift midline towards the unaffected side
15-Which cyst is most likely to lead to the development of an ameloblastoma?
A. Radicular
B. Residual
C. Primordial
D. Dentigerous
E. Stafne bone cyst
16-You take an X-rays at a certain MA & kvp & exposure time is 8 seconds when the beam is 10 inches
away . What if everything were the same except the beam was 20 inches away???
10
20
16 seconds
32 seconds
17-Treatment of traumatic bone cysts usually involves

A. opening the area, followed by induction of bleeding
B. opening the area, followed by packing the cyst
C. enucleation
18-The best way to produce a radiographic image with low contrast is by doing which of the following?
(1)Increasing the kilovoltage peak (kVp)
(2)Increasing the milliamperage (mA)
(3)Increasing the focal spot-skin distance
Case 1: old man , has MI, had adenocarcinoma before, took radiotherapy for that, hepaƟƟs before 24b
yrs,
smokers, knee replacement before 6 months,
Oral findings: white patch on floor of mouth, anterior cross bite, missing maxillary molar and exostosis
on the
buccal of mandibular premolar /molar area, melanotic macule on the palate
Quest:
3. Patch on the floor can be all except: stomaƟs nicoƟnia
4. Which lab test for the viral infecƟon : HgSab ,/ HgcAb/, Transaminase ,/ no test
5. The paƟent is at increased risk for all except:
Procedure related bleeding / Hyposalivation / Osteoradionecrosis / SCC
Related only to the anterior region ( on the left side he had a missing canine maxillary and the posterior
bite
looked collapsed)
8. Most important to consider when deciding for the anƟbioƟc prophylaxis : Ɵme elapsed since the
surgery
4- no test
5- osteoradionecrosis
6- retained primary tooth - lingual eruption of permanent
8- prophylaxis should be given
6-The most common etiologic factor for non-skeletal
anterior crossbites is a lack of space for the permanent
incisors.9 The early loss of maxillary deciduous teeth,
impacted or lost permanent posterior teeth, or impacted
canines would allow the maxillary anterior teeth to
drift distally and palatally
how u know it’s hepatitis a?
I m confused between hbsa and no test . Hepatitis was 24 yrs back so he doesn’t need any special care
for that ( I read somewhere ) trying to find out source for that
but just a don’t need but if b we need but I don’t know here what’s type
reply...
Case 2: 8 yr old girl with many missing teeth due to caries and poor oral hygiene.. anterior cross bite
and a
supernumary tooth
Injury to the nerve due to any previous accident can be increased(or somthg like that) during ortho
2. All are negaƟve sequel of extracƟon of the supernumary tooth except
Necrosis of 7
Non erupƟon of 7
Necrosis of 8
Necrosis of 6
3. CorrecƟon of the anterior cross bite will result in all except
Improve erupƟon of tooth 11
One more option
4. CorrecƟon of cross bite ASAP
1-a
2-necrosis of 6
3-2...
3 -3 I guess
correction ASAP -true
True/ false question--FALSE-FOR DIASTEM
Case 3:
Take albuterol
Quest:
3rd molar
Occlusal trauma
Caries
2. She starts wheezing on expiraƟon . what will u Not do
Steroid inhaler
B2 agonist inhaler
Give oxygen
1- tmj pain may be depending on other options
2-give oxygen
it says what will u not give
I checked it mango it says you can give oxygen
Yes but I think all options can
Be given
2-STEROID INHALER
AT EMERGENCY WE DONT GIVE THIS..
Quest:
2. All are risk of extracƟon of the upper teeth. Which is LEAST excepted
Dry socket
Tuberosity fracture

Case 5
with 18 present. Has radio opaciƟes in that edentulous area.
ExtracƟon of 18
1. Smoking is a contribuƟng factor for period
JULY 30 MONDAY
1-Hemorrhage in mn after extraction due to /fragidity,
fibrinolysis
2-Function of mid palatine suture in set of denture ?
give support ,
retention,both
3-child when cry become blue ?
inc in heart rate or dec
4-Correction of an inadequate zone of attached gingiva on several adjacent teeth is best accomplished
with a/an?

c. double-
5-pt with ulcer in the mouth and seqstrum due to truma ,ask about the location?palate,
lingual in the floor ,
lingual near the oblique ridge ,
buccaly near the ridge
6-Smoker patient what don’t u see:
a) Increased BOP
b) decreased gingival inflammation
7-Pt takes too much opioid, what do you see?
1. Insomnia -
2. Irritability
3. Headache
4- cold
Diabetic undergoing surgery
Take clear fluids with same insulin intake
Take clear fluids with 1/2 amt of insulin?
9-Resective osseous surgery is best suited for periodontal sites with
A. severe attachment loss.
B. severe intrabony defects.
C. teeth with short roots.
D. early to moderate bone loss
10-child come to u bec her upper teeth set behinf the lower but in the radiograph the child look like cl 2
What type of profile ?
convex
concave
11-leat common fracture tooth

12-An uncooperative 5 year old child has a carious lesion in her primary mandibular second molar. There
is no tooth mobility, but the practitioner notes a small, draining sinus tract adjacent to the tooth. Which
of the following is t/t of choice?
a. Extraction
b. Pulpectomy
c. Indirect pulp therapy
d. Calcium hydroxide pulpotomy
e. Formocresol pulpotomy
13-pt positive ept ,sensitive to cold and linger pain,pain to specific tooth?irreversible pulpitis,
symptomatic irrive with periodontal ,
symptomatic irr with apical absucss
14-what do you see when your max is constricted by 3mm?
A,bilateral cross bite
B.shift midline towards the effected side
C.shift midline towards the unaffected side
15-Which cyst is most likely to lead to the development of an ameloblastoma?
A. Radicular
B. Residual
C. Primordial
D. Dentigerous
E. Stafne bone cyst
16-You take an X-rays at a certain MA & kvp & exposure time is 8 seconds when the beam is 10 inches
away . What if everything were the same except the beam was 20 inches away???
10
20
16 seconds
32 seconds
17-Treatment of traumatic bone cysts usually involves
A. opening the area, followed by induction of bleeding

B. opening the area, followed by packing the cyst
C. enucleation
18-The best way to produce a radiographic image with low contrast is by doing which of the following?
(1)Increasing the kilovoltage peak (kVp)
(2)Increasing the milliamperage (mA)
(3)Increasing the focal spot-skin distance
JULY 31st TUESDAY

1. Study conducted in a nursing home- cohort, case, descriptive, longitudinal ?
2. Rubber dam doesn’t protect what? Mercury vapors.
3. Most common medical emergency in dentistry? Syncope, hyperventilation both were in
option...
4. LA calculation
5. sensitivity and specificity calculations
6. Phenytoin used in which conditions- status epileptics, grand mal, petit mal, absence
seizures?
7. LA without vasoconstrictor- mepi 3%
8. Primary herpetic gingivostomatis question
9. Fusion of teeth with dentin and cementum
10. Not true regarding orthodontic movement? Chemical changes in pdl
11. Sec Hyperparathyroidism - renal failure
12. Xerostomia treatment?
13. Manual dexterity of brushing- 2-5,6-9,10-12 Year’s.
14. 4ys kid with 0.25mg fluoride. Treatment?
15. Zirconia crown on R mandibular molar, deflected right on biting.. occlusion affected?
16. Bur used to polish porcelain?
17. Crown has low retention buccolingually..what will u do ? Groove buccal, lingual grove,
proximal groove ?
18. Picture of hemangioma- lateral border of tongue.
19. Multiple myeloma how do you identify ? Pano and occ, pa and occlusal, bitewing and pa ?
20. Fetal alcohol syndrome what u won’t see ? Midface, palpebral fissures, philtrum defects ?
21. Anterior mandible radg- nutrient canals
22. Candidiasis Troche- clotrimazole in option
23. Most ankylosed teeth ?
24. Pain at mental foremen- traumatic neuroma, neurofibromas, ossifying fibroma and last one
with neuro something
25. Flap done and diseased tissue removed..how will new tissue grow ? Apical to gingiva,
apical to cdj..like options..
26. Same kind of flap quest.. what is the newly formed attachment called ? Replacement,
enhancement, reattachment ?
27. Saturation in ? Chroma
28. Inc powder in Zn phosphate ?
29. Mand. 3rd molar root disappear into ? Submand space
30. Cervical white spot of premolar with Matt kind- varnish or no treatment ?
31. Which do not recur.. AOT
32. Rad pic pano radio opacity in mandible..given it’s slowly growing..fibrousdysplasia, pagets, ossifying
fibroma, odontoma?
33. Throtoxic crisis- tachycardia
34. Dental pay in USA- self
35. Blacks mostly seen - perio, gingivitis...?
36. Smoking effect on perio/ not socioeconomic dependent - T/F
37. Skin abnormalities and melanotic patches ? Peutzoger/ Albright
38. Cavernous sinuous- anterior triangle
39. Pain when ? Enamel 2mm, dentin 2mm, 3mm from pulp ?
40. Amalgam broke less than 0.5mm.. what you do ?
41. Composite on posterior tooth? It’s success depends on and why does failure occur ? 2
quesns
42. Avulsion is classified as ?
43. Lip paresthesia ? Okc , metastatic tumor, cerebovascular damage?
44. Radg of condensing osteitis..they did mention the tooth is vital..
45. Most fractured tooth ? Jus mand molar
46. 5year kid not cooperating at all.. tel parents to control and get him back was only good one
I found. other weird options..
47. Oral sedation disadvantage?
48. If drug bypass liver..dec bioavailability, enterohepatic circulation ?
49. FDA quesn.. drugs and prescription something..
50. Clinical attachment loss.advanced
51. Posterior tooth extending subgingivally . crown lengthening or caries excavation?
52. When to take consent form sign ? After doc discuss treatment with pt.
53. Best indicator for periodontal stability ? Bop, plaque, attachment loss
54. Best indicator for anug ? Type of bacteria
55. How can u say the condition is not aids ? Features of it given
56. Test not used for bacteria... intelukien 1
57. Primary stress bearing areas in max and mand.. no exact options.. palatial seal and buccal
shelf, residual ridges for both, rugged and residual ridge..
58. Least osteogenic ? Cancellous, cortical?
59. Arch length measurements? Menial to medial of premolar/ molar/ canine..
60. What is not best way to maintain after perio surgery ? Toothpick water irrigating device ,
interdental brushes ?
61. Alveolar osteitis first line of treatment? Dressing
62. How to chk vdo ? S
63. Lesion 0.3mm for three months.. excision biopsy
64. Which tooth pops out in max and mand if lack of arch ? 2 separate quesns 65. Trphenation ? Relieve
pressure/apical puncture / softissue tear ?
66. Ct. Tissue development? 1mm per month/ 0.5mm per week kind of options 67. Temporal arteritis
complication ? Vision loss in options
68. Wheelchair quesn with same options
69. Gold thermal expansion quesn.
70. When do u remove palatal tori ?
CASES..
1. 8year old with poor oral hygiene.lives with mom and brother.many extractions at age 5..not
allergic to any jus topical meds for any allergic reactions if occur. She has anterior cross bite in pics..lat
to lat max.. what happens to facial gingiva ? What treatment to correct ? Why did it occur ? How do you
do that in detail ? What you tel for good oral hygiene maintenance- it will affect your ortho tx/ give oh
instructions and follow up/ electric tooth brush ?
2. 75yr old male, smokes sigarette since 5years. Has all medical condnts.. M
AUGUST 1st WEDNESDAY

1.Leeway space
2. Dental crossbite cause? lack of space for anterior dentition
3. Light Film? insufficient exposure time
4. Complex perception of pain and stress?
5. PDL disease more common in? Black male
6. Bulimia more common in? black young female
7. What happens if you leave a radiograph too long in a developer?
8. Loss of which premature primary tooth could cause loss of arch space? (primary 2nd mandibular
molar)
9. Asymptomatic tooth but hurts to bite after 2 weeks of newly placed crown, No percussion senstivitiy
and the tooth is vital? Cracked tooth, periapical periodontitis
10. Composite too white but otherwise acceptanle class 4 rest, what to do? Re-do, stain, …
11. Composite Class III, with stains in the margin, what to do? Reveneer, re-do, stain
12. Battery (doing surgery without consent)
13. Autonomy (consent form)
14. Precontemplation
15. Mandibular molar 30 moved to the right during occlusion, where is the interference?
16. Interference in balance

17. Interference in working
18. Bone involved in Le Fort I? (maxillary sinus)
19. Leukotriene, associated with systemic diseases? (asthma, thyroid, etc)
20. Ectodermal dysplasia (2 questions)
21. Pemphigoid mucous membranous
22. Furcation in primary molar? (due to pulp necrosis)
23. Time to close apices of eruption of primary teeth? (9-15 months)
24. Frenum Labial prevent movement of which muscles? (triangle, zygomatic, canine)
25. Combination syndrome (Kelly)
26. Ulcerative lesion in palate ?(necrotizing sialometaplasia)
27. Function of Beta-1 agonist? (increase Heart rate, Dilatation of bronchial muscles)
28. Loosed primary teeth in young kid, cause? (hypophosphatemia)
29. Melanoma more common in? (Palate and gingiva, gingiva, floor of the mouth)
30. Healing of occlusal trauma? (narrow PDL)
31. Fracture infraorbital ridge … glazed?... downward, forward, medial or lateral
32. Prostaglandin is inhibited by?
33. Amalgam Class II retention? (proximal grooves, axial pulpal bevel, )
34. Large pulp chambers? (tauradontism)
35. Indications of selective Endo?
36. who has Best prognosis? ( internal resorption, vertical fracture, avulsed tooth,)
37. Secondary prevention?
38. Disensitization ?
39. Arrested caries? (brown shiny enamel at the cervical region of the tooth, discovered after gingival
recession)
40. Mandibular molar endodontically treated with furcation involvement 5mm to apex, how to
treatment plan (hemisection and treat as if it where 2 premolars)
41. Least common missing permanent tooth? Canine
42. How many Americans have fluoride water? (74%)
43. Max. Dosage of local anesthesia with a child weighing 16kg? (72)
44. Safe of nitriousoxide? (70%)
45. 5 year old intruded tooth, what do you do? (observe)
46. Maxillary RPD and mandibular denture patient wants to have a denture that crowns last longer?
(composite teeth, proceleain teeth, hybrid acrilyic teeth)
47. Radiograh? Pericapical cemento-osseous dysplasia
48. Radiograph of dentigerious cyst
49. Smokeless tabacoo is associated with (verrucous papillary lesions)
50. Opioid side effects except? ( congestion and pinpoint pupil dialation)
51. Diazepan does? (relax muscles, treatment for epileptic, causes amnesia)
52. Sulfonamide? inhibits Gaba
53. Apex closing in non-vital tooth. (Apixification)
54. Distance between dental implants? (3mm)
55. Retentive points of the RPD clasp? (gingival or middle 3rd. , gingival third)
56. New research shown that Tobacco is associated with? root caries,
57. Kids systemically compromised, what do you use? (chlorhexidine or sodiumfloride)
58. Everything is associated except? (jaundice)
59. A patient becomes cyanotic/ respiratory stress after you administer topical anesthesia in an
ulcerative area, what is the most likely thing the patient is suffering from? (allergic, diabetic crisis, sickle
cell crisis)
60. Hexi to upright a mandibular molar, where does it have to be located?
61. Cleidocranial dysplasia is the same as Pier Robinsons syndrome to….? (t/F)
62. Mand central primary teeth calcification? (5-7months?)
63. Mandibular Premolar drain to the sublingual space
64. Ludwigs angina?
65. What is the most common emergency in a dental office ?(Syncope)
66. Pregnant women need to be positioned to the left during syncope to avoid? compression of inferior
cava vein
67. If you have a patient having intravenous bisphosphonate and you need to do a dental treatment
what would you do? (endo, extract, …)
68. Which condition do you see secuestra formation? (osteomyelitis, osteonecrosis, etc?)
69. Xrays will display? bone loss associated with the CEJ
70. In a Perio maintainece every 3 month: could be modified if patients condition changes? Can never
be modified?
71. Axial wall of MOD onlay
72. Most common type of bone loss in chronic periodontitis? (horizontal)
73. Caries elements? (bacteria + polysaccharides + enamel or Bacteria + situated carbohydrates +

susceptible tooth)
74. After surgical graft epithelium comes from? (receiver site)
75. What do you see radiographically in osteoporosis? (fine trabeculation, dimeralization of ostoids
islands)
76. After cleaning the tooth surface form first the alternative is? material alba, pellicle, bacteria, plaque
77. Fibroma caused by? trauama and irritation
78. Sealing complete dentures too posteriorly will cause? (gag reflex, hyperplasia of mucosa, more
retention, less retention)
79. Pronouncing the letter F or “ph”, The incisal edge of the anterior mandibular teeth: (contact at the
vermillion of the lower lip, anterior to the vermillion of the lower lip, posterior to the vermillion of the
lower lip)
80. Treatment fo HPV, CMV, EBV? Valcyclovil
81. Antifungal for oral and systemic candiasis? (miconosol, clotrimadol, fluconazole)
82. Xerostemia is most often caused by in younger kids? (medication, SJrogren, mouth breathing)
83. Osteonecrosis is most common in? posterior mandible
84. Descamative gum bleeding treatment?
85. Local acute aggressive periodontitis initial therapy? (SRP or SRP with antibiotics)
86. Hematoma, freckles, melanoma, which of them disappears by itself?
87. Ranula tx? (marsupilization)
88. Elder, what is the most common? depression
89. Dementia is associated with? short term amnesia, long term amnesia
90. Elderly people normally surfer from? decreased learning, decreased attention?
91. Geographic tongue?
92. Why do you brush your tongue? (prevent bad breath)
93. Anesthesia duration is due to all of the following except for. . .

94. Periapical abscess vs periodontal abscess? Electrical pulp test
95. Macroglosia is seen in all the conditions except? (alidosis, hypothryroism, acromegalia,
hyperparathyroidism)
96. Mixedma is seen in? hypothyroidism
97. In a clinical trial your samples you organize it alphabetically and you pick randomly every 10 people,
what kind of randomized selection is this? (simple randomized, stratified randomized)
98. Basal cell carcinoma patient, how do you react? ( do you have anyone with you what you would like
to come to the room?)
99. There is a compliant patient that is now denying to do a root canal tx, what is the appropriate
approach? (if you don’t do the rtc it will get worse, is there something you want to know about the
treatment plan?)
100. Insurance charged crown + post under the same procedure: Bundling ?
101. What do you not do with the consent form? Don’t give it before the exam
102. Actinomycosis? fistula in the head and neck
103. Which is only a radiolucent lesion: Ameloblastoma, AOT, Pingborg tumor, Ameloblastic fibro-
odontoma
104. KOT, Ameloblatoma, AOT, which is the less recurrent?
105. Condensing osteitis
106. After RCT Periapical radiolucency slightly enlarged in the radiograph, what is the cause? Fibrous
scar, angulation of Xray
107. Space maintainer, bend and loop, has everything except? a vertical thing that prevents the
overeruption of the opposite tooth.
108. Asymptomatic apical periodontitis
109. A practice of 1 Hygienist and 3 doctors, the hygienist has harmed the patient, who is liable? The
hygienist and the attending doctor
110. Irreversible pulpitis
111. Best diagnosis for irreversible pulpitis?
112. Liable test pulp in a crowned tooth (cold test EPT, Xray, Percussion and palpation)
113. Progenitor cell for perio rehabilitation, comes from gingiva, connective tissue or PDL?
114. Periodontium regeneration: cementum, alveolar bone, sharpeys fibers, or cementum, alveolar
bone and gingiva?
115. Penicillin B is a good option, why? (inexpensive, broad spectrum, non toxic)
116. Labial extrusion of the canine (gingival recession)
117. Treatment for multiple chronic dislocation condyles. (athroscopy, condylotomy, total joint
replacement)
118. Clarithromyocin acts upon the ribsome-50
119. Potassium sparing is an Amiloride
120. Vicodin belongs to what drug class I, II, III, or IV?
121. There is a picture of a multiple pyogenic tumor or Lymphoma, etc. pt is taking antibiotics for a
infection of the skin.
122. The opaque porcelain does all the following except ?
123. The disadvantage of Distraction osteogenesis vs osteotomy (patient follow up time)
124. Inflammatory resorption
125. AED has the general caratheristics of, the citated many characteristic of AED but I only remember
the option that said if is contraindicated in those younger than 12 years old?
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SAIRAJA CHOUDARY RQs…….May 9-10 /2018
1.periodontal disease most nearly fulfill koch's postulates.

a LAP b chronic periodontitis c.NUP
2. fremitus
3.which teeth are most frequetly involved in root amputation.
a. maxillary 1st molar b mand first molar 3 max 1st premolar 4. mand
3rd molar
4.which miller defect respond best to mucogingival surgery.
5.bone sagging?
6 .osseointegration.
7.bacteria associated with peri implantis
8. surgical technique for ridge augmentation? some confused choices
9.inverse bevel incison
10 infammatory mediators may be indicator of disease activity
a interlukin 2 b tissue necrosis factor 3. Il6
11.which enzyme and cytokine is secreted by a macrophage
a. TNF b transforming growth factor c. protease d all of the above
12. allograft has following charactersitics except
a osteoconductive b osteogenic c osteoinductive d demineralized
13. typical dose of nitroglycerin
14. which is not a feature of primary resistance form in amalgam
prepration
a adequate thickness b. rounded axiopulpal line angle c vertical wall
convergence
15. film thickness is important propert of
a silicate cement b zinc phosphate cement c calcium hydroxide d direct
filling resins
16. the asbestos liner is used in castin ringto
a permit extension of the mold b prevent movement of the ring c retard
the heating of the mold d. faciliate venting of the mold e all of the
above
17. ferrule effect
18. gingivectomy
19 chemical used for test vitality
a methyl alcohol b ethyl chloride c methyl chloride d ethyl alcohol
20. conservative treatment of hypersensitive erosion areas
21 moa of meprobamate
22metal ceramic restoration may fail due to fracture of ceramic material .
this can avoided by..
23. inlammed capillary hemangioma of the oral cavity similar to
microscopically
24. MWF
25. pellicle formation involves which of the following
26. what kind of response do recently erupted permanent teeth usually
give to pulp test
a very reliable b very unreliable c always respond d better than young
adult permanent teeth e same as young adult permanent teeth
27 an asymptomatic sinus tract is adjacent to the mesiofacial root of
tooth, probable diagnose is
a acute apical abcess b suppurative apical periodontitis c chronic apical
periodonttis d periapical granuloma
28. in a radiograph ground glass appearence, loss of trabecular pattern
and complete loss of lamina dura . diagnose is
29. burning tongue is a symptom of
30developing tooth bud is damaged so that the tooth erupts with defective
enamel . this condition is
31. sialolith
32 a common gutta percha solvant is
33. when the free margin of the gingiva is enlarged as result of
inflammation its crest moves
a apically b distally c cervically d occlusally e mesially
34. trauma from occlusion is least likely to effect
35. the least common cyst in the oral cavity
36. selective grinding for equalibrium complete denture is best
accomplished when the dentures
37. early movement following surgery for tmj joint ankylosis is
a harmful b desireable c unimportant d indicated only when ankylosis is
limited to one side
38. the presence of ecchymosis in the sulci, the floor of mouth or hard
palte is usually indicative of
39. obstructive sialedenitis may result from
40. the base of the pyramid shaped maxillary sinus is
41. implant in congestive cardiac failure
42. picture q
Leukoplakia and which biopsy
43. Smokers palate and treatment
44. Melanosis and treatment
45. X rays
Fibro odontoma
Stafnes cyst
46. Girl with sna 87 and snb 82 they gave a lateral ceph and had a
few q on this
47. Defn of couple and movement by it
48. Got a q about a periapical cyst and xray had no periapex
49. Ameloblastomaxray and treatment
50. Distal extension ptbest combination of implants fpd and rpd don’t
remember this one
51, Q about ferrule
Q about how much ortho extrusion for ferrule
52. 1 xray with poor obturation and asked reason for failure
53. Cracked amalgam and reason for failure options had both to wide
and less deep
54. Direction of regeneration in implants like coronalyy connective tissue or
pdl or apically connective tissue or pdl
55. Which study uses questionnaires
56. Do least common side effect of drugs (not most)
57. Least common reasons for choosing any treatment for pt
58. Least common effect of LA with beta blockers
59. Oro antral fistula 8 mm treatment
60. Q about early loss of second molars and this was least common
effect as well
61. And which space maintainer at what age
62. Do the worst quality xrays from google. The xrays are hopeless
63. Pt on aspirin and clopidogrel and q about implants for this pt
64. Weird q on bisphosphonates and rct and extraction
65. Least common type of study used for different population
66. 1 q on cartridges of la required for 64lb child
1 q on negative percentage
1 on amount of la for 16kg child
Asa classification q
I got 1 occlusion q about non working interference
67. My test was mostly perio with a few other subjects. This is for day
1 and day 2. Pics were ok. But xrays were terrible. Do definitions and
asa classification for all subjects esp pt management
These q look like rqs but they were very twisted and close options
I got lots of q on gtr and lots on implant. Drug interactions. And
medically compromised and treatment plans for them
68. IMPLANT, rpd, fpd indications in CHF, hepatitis B and Asthma
69. Lots of perforation questions with different levels and prognosis and
treatment. Weird options
70. 1 q about incisor perforation not specific which one and least
common area of perforation
Scatter
Blanch
Mitigate
1. Implant/ endo?
Succes?
Exceed
Dependent on operato
2. Odontoblast nuclei within dentinal tubules

Deccisation
Chemical
Mechanical
Thermal
3. Amalgam redo
Veracity
Justice
Beneficience
Autonomy
4. Acute status epilepticus

Midazolam
Phenytoin
Epinephrine
5. Ept correct Except

More reliable than cold in pulp necrosis?
6. Radiolucent
Nares
Midpalatal suture
Turbinates
Mylohyoid ridge
Genial tubercles
Nasal fossa
7. Enamel deminarelized
Tenancious
Rough cavitated
More resistant to acid
Softer
Smaller apatits
8. Radiation
9. Radionecrosis mostly in
42Grey radiation
Biphosphonate
Mandible
Maxilla
10. Insurance for kids smth XXI in 1997

Medicaid
Health children insurance
11. Burkitts Lymphoma

EBV?
Whartins duct
Mandibular duct
12. Smth inflammation? I forgot

IL1
IL2
IL6
IL10
13. C factor periodontitis?
14. Nytro adverse effect

Headache flushing sweating
I chose
15. Radiopaque?or lucent
Osteopetrosis opaque
Osteoporosis lucent
Paget’s Disease lucent
OsteoSmthelse
16. GIC advantages than composite

Abrasion resistant
Compression resistant
Chemical bonding
17. Radiation of mri
X rays
Gamma rays
Smth else
18. Soft tissue complication while extracting

Tearing?
19. Earlobe x ray

I put mastoid preocess mzfk
20. Geographic tongue photo

Erythtoplakia
Migratoru glossitis
21. On cephalometric looks single

Sella turcica i put
Orbitale
Pterygomax fissure
Mandibular plane
22. For radiation Q

Maximum permissible dose what is that
23. Giant cell granuloma

Pseudoepithelial surroundingsmth
24. Some programm in 1997 XXI smth

Children Health Insurance Program – ans
DAY 2!
Case 1.
Male 64 yrs with white lesion on lip

Smoke ciggarettes and smokeless tobacco
Brown pogmentation on palate
Bad quality of photos
Complaint Anterior teeth misalign
1. What is in microscope of brown pigmentstion?

Hemosiderin
Melanin
Melanicytes
Smth like blood vessels
2. The reason of that brown pigmantation

Smokless tobacco
Smoking ciggarettes
Medication
Smth else
3. Reason of that white lesion on the lip

Smokless tobacco
Smoking ciggarettes
Medication
Smth else
4. Some big yellow nodule on the buccal (looked like Fordyce spots) but yellow and q was
about one nodule and it was inside the buccal…
quality of the picture was bad…couldn.tsee SPOTS clearly What is inside?
Adipose tissue I put this dunno why. don't ask.
Lymphoepitelial cyst
Mucous glands
Sebacous glands this is for Fordyce spots
5. Biopsy
Should include everyrhing except
Normal site or smth
Submucous tissue
Smth else
6. Biopsy q On ventral side of the tongue EXCEPT

Be careful submandubular gland
Be careful to avoid sublingual gland
Case. 2
Female 54 yrs
Diabetes
Divorced 20 yrs ago
3 daughters
HbA1c 8% or smth diabetes controlled?
White lesion ventral tongue

Diff diagnose
Verrucose carcinoma
SSC
Migrate glossitis
Lichen Planus?
Bunch of qs about her periodontal status

What is most imp
What is least
For long term periodontal prognosis what is most imp
I remember this question for few cases
Options were
Occlusal support
Furcation involvement
Vertical bone loss
Nutrition
For another patient was queastion T or F again about that status
Case 3.
Girl 10 years old
With good oral hygiene
Divorced parents
Missing permanent second premolar on pano!
7. And here was the question about caries risk!

Low
Medium
High
I put medium cuz divorced parents, right?
8. Cephalometric question about radiopacity anterior to C4.

Hyoid bone I put this
Esophageal pouch
Thyroid duct
Smth else
No epiglottis in the options
9. Cephalometric q about radiopaque line which goes through roots of teeth #3 and #6
Inferior orbital plane
Palatal process of maxillary bone I put
Zygomatic arch
Smth else
10. What kind of root resorption tooth K?

Infectious
Replacemnet I guess cuz next Q about ankylozed
Inflammation
External
internal
11. First premolar 21 and tooth K
Both ankylosed
Both not fully erupted
K ankylosed 21 not fully erupted I guess this
21 ankylosed K not fully erupted
12. Question haw many missing teeth?

0
1 (second premolar)
2
3
4
Case 4. Lady 24 yrs

Takes Amitriptilyne
Ibuprofen
Smth on the palate
13. Anterior teeth 8 and 9 had white spots on incisal

Reason?
Ai
DI
Fluoride
Smth else
14. Anterior crossbite till the molars - what is true?

ULtimately close itself?
Incisal attrition?
15. Interraction with pts medications(Amitriptilyne and Ibuprofen) EXCEPT
Epinephrine
Carbocaine
Atropine
Aspirin
16. Smth on the palate looked a bit red

Cytology says stratified squamous epithelium, fibrous connective tissue, vital cortical bone
and trabecules. What is it?
Exostosis I put
Some cysts
And staff
17. Smth on the tongue (small whitish) all over the tongue. I was sure it is geographic
tongue
Erythema migrans(how many names r they going to give for geographic tongue)
Lichen planus
Candidiasis
Amth else
Male Elderly
Had some gold crowns
Tooth #9 was discolored like darker greyish than others

Was Question
18. The vitality of the tooth #9 is questionable T/F
19. #30 mesiobuccal cusp was also restored with amalgam MOD
They what can you do except full crown
I picked lab made onlay
Options lab made inlay
Pin post amalgam
Resin based composite
Q about brown discloration of the gum between teeth #9 and #10

What will we see
Melanocytes
20. Radiolucent under composite
Caries
Base calcium hydroxide
Cyst? Like wtf
21. Had a lets say lesion on the canine’s cusp and insical aea of the tooth#5 (which was
with gold onlay) Due to what? (Obvy it was grinding )
Occlusal function
Smth else
RQS March 28, 2018
File made by LINA NBDE II
1. First sign of HIV infection ( it didn’t say first stage like all the others)
a. Asymptomatic
b. Opportunistic infection
2. Most common cause of osteoporosis
a. Estrogen
b. Nutrition
c. genes
3. Sjorgen complication
a. Pleomorphic adenoma
b. Osteoarthritis
c. Lymphoma
4. Whats does OARS stand for in patient interviewing?
a. Open ended, awareness, reflection, summary
b. Open ended, affirmation, reflection, summary
5. Prostaglandin analogue M has an affect on gastric ulcers – what is used for (something along
those lines)
a. Zollinger syndrome
b. NSAIDs
6. All of the following are seen in chronic perio except
a. P. Intermedia
b. P. Gingivalis
c. Actinmyces V.
d. T. Forsyntheia
7. Doctor does a full mouth series but charges patient for each individual radiograph – what is that
a. Unbundling
b. Bundling
c. Upcoding
8. How does Benadryl (diphenhydramine) work?
a. Increase vascular permeability – it decreases it
b. Increased salivation – it decreases it
c. Motion sickness
9. Rubeola – mental retardation
a. Genetics
b. Chromosomal
c. Acquired
10. Pt who gets renal dialysis 3 days a week – when can you do oral surgery
a. Day before
b. 1 day after
c. 2 days after
11. When do you apply chlorhexidine while doing a composite restoration (something along those
lines)
a. Before you etch
b. After you etch
c. After you apply bonding agent
d. After you cure the restoration
12. How do you sterilize gutta percha
a. Dry heat
b. NAOCl
(no glutaldehyde in the options)
13. Function of NaOcl
a. Remove necrotic tissue
b. Chelates
c. Reduces hemorrhage
d. Cavitation
14. Which is the least toxic to tissues (not verbatim but along those lines)
a. Saline
b. NaOcl
c. Hydrogen peroxide
d. edta
15. Alcoholic pt – what do you check before doing anything
a. INR
b. Creatine
c. CBC
16. Pt who regurgitates.. what do you see?
a. Erosion
b. Abrasion
c. abfraction
17. remineralized enamel
a. cavitated and needs to be removed
b. cavitated and something
c. non cavitated but in close proximity to DEJ
d. non cavitated
18. side effect of codeine
a. potentiates CNS effects/depression
b. diarrhea
c. cough
19. which condition of an amalgam would make your restore it
a. tarnish and corrosion
b. recurrent caries
c. marginal ditching
20. pt places aspirin in their mouth and house a bunch of white stuff on their cheeks – why do you
have the white spots?
a. Necrotic
b. Hyperkeratosis
21. Dentist communication with the patient – provided an increasing set of numbers like 7% verbal,
35% tone, 55% of __
a. Non verbal
b. Eye contact
c. Active listening
22. What is the result of a child taking antibiotics
a. Candidiasis
b. Lichen planus
c. Histicytoxis X
23. Story line about a patient with steatorrhea, defective chloride channels
a. Diabetes
b. Cystic fibrosis
c. HIV/AIDS
d. Lead poisoning
24. Whats affiliated with osteoradionecrosis
a. Maxilla
b. Mandible
c. 45GY (4500 radians)
25. What is common in pt with diabetes type 1
a. Ataxia
b. Blindess
26. Based on the CDC, what is the maximum amount of community fluoride
a. 0.7ppm
b. 1.0ppm
c. 1.2ppm
27. What is the recommended amount of fluoride in community fluoride
a. 0.7
b. 1.0
c. 1.2
28. What is most likely to cause a pulpal response during tooth prep ( I think the question is also in
the dental mastery app)
a. Dessication
b. Heat
c. Bacterial invasion
29. When you’re doing an implant
a. High speed
b. High torque
c. Air cooling
30. Some new mouthwash that reduced the gingival index but then the pt didn’t have an increase in
their overall oral care (something along those lines)
a. Study design was wrong
b. Bias
31. Warthin tumor is mostly seen where
a. Submandibular gland
b. Sub lingual gland
c. Parotid
32. Story about you gave epi and the effects – the effects of epi was heightened when taken with
phenothiazine because
a. Dopamine
b. Adrenergic receptor
c. Beta receptor
33. Which has the greatest margin of safety for a pt with renal disease
a. Acetaminophen
b. Flurbiprofen
c. Ibuprofen
d. Ketoprofen
e. Ketorolac
34. When can you NOT do a gingivectomy
a. Apical to the crest
b. Coronal to the gingival groove
35. Drug that comes in troches
a. Fluconazole
b. Clotrimazole
36. Difficult tooth surface to floss
a. Max premolar
b. Man pre molar
c. Max canine
37. Whats the order for delivering a cast crown
a. Internal – marginal integrity - occlusion – contacts
b. Occlusion – contacts – marginal intergrity
c. Internal – contact – marginal integrity – occlusion
38. Whats the common cause for porosity in porcelain
a. Inadequate condensation
39. Repeated fracture of the metal framework – why
a. Poor framework design
40. What does fluoride not do
a. Remineralize enamel
b. Antimicrobial
c. Arrest glycosation
d. Cause the pit and fissures to coalesce
41. Pt who swallowed a crown – you took an xray – where is the crown most likely location
a. Left bronchus
b. Right bronchus
c. Infundibulum
42. Most common cause of amalgam failure
a. Moisture contamination
b. Inadequate depth
c. Over triturated
43. Allergy to crown is most likely due to
a. Nickle
b. Beryllium
c. Chromium
44. What can base alloys be used for
a. Single crown
b. Bridge
c. Long span
45. Story line about a guy who only had 4 anterior teeth remaining and was completely edentulous
in the maxilla – how will the mandible look
a. Crowns look short
b. Crown appear longer
46. Contraindication to uses nitrous
a. Psychoses
b. Depression
c. Anxiety
47. Whats the effect if you give diazepam to the eldery
In older patients, the drug greatly increases the risk of falls, broken bones, and confusion. It
can also cause dependence and withdrawal symptoms.
48. What is not part of the 5 code of ethics
a. Justice
b. Competency
c. Autonomy
49. Whats the hematologic malignancy that affects plasma cells
a. Burkitt
b. Multiple myeloma
c. Thrombocytopenia
50. What do you see in MI but not angina
a. Thrombosis
b. Artherosclerosis
51. Pt who took oxycodone and developed hypotension and itching – why?
a. Histamine
b. Allergy
c. Forgot options
52. Place denture in the mouth and they experienced temporary salivation due to
a. Parasympathetics
53. Pt satisfaction with dentures
a. Dentist-patient relationship
b. Bone height or denture fit
c. Patient personality trait
d. Technical quality of denture
e. Cultural definition of esthetics
54. Which drug wouldn’t raise a concern for perio problems
a. Prednisone
b. Methotrexate
c. aspirin
d. Hydrochlorthiazide
55. Which isn’t in the line of drugs for angina
a. Calcium channel blockers
b. Nitrates
c. Beta blockers
56. What would be a concern for someone who on a vasodilator and also taking drugs for erectile
dysfunction
a. Hypotension
57. How long after doing an esthetic gingivectomy do you have to wait before you can do general
restorative work?
a. 1-2 weeks
b. 3-5 weeks
c. 7-9 weeks
d. 20+ weeks
58. Two part question – the epithelium of a free autogenous gingival graft undergoes degeneration
at the recipient site
Genetic info to the nature of the epithelium overlying the connective tissue is contained within
the graft connective tissue
a. TT
b. FF
c. TF
d. FT
59. After you did perio surgery, how can you determine if the junctional epithelium grew or not –
something along those lines
a. Clinical
b. Histological
c. Subtraction radio
60. Herpangina is due to
a. Human enterovirus
b. Herpes
c. Candida
d. Hiv
61. Whats active against herpes simplex virus, varicella zoster virus, and cytomegalovirus?
a. Amantadine
b. Zidovudine
c. Ribavirin
d. valacyclovir
62. What is mostly seen in the gingival crevicular fluid?
a. igG
b. igA
c. IgM
d. igE
63. older patient comes to your office – what is your primary concern (no mention that the pt has a
hearing problem)
a. speak to the patient slowly
b. include the patient in the treatment plan
c. find out if they have a guardian
In the treatment planning book – the concern is they more than likely have a caregiver
64. what is considered an endo emergency
a. necrotic pulp with asymptomatic periapical
b. irreversible pulpitis with asymptomatic periapical
c. necrotic pulp with symptomatic periapical
65. what mouthwash do you give to a medically compromised child?
a. Listerine
b. Sodium fluoride
c. Chlorhexidine
In the pedo book as being used on autistic children and down syndrome pt
66. Which is the most radioresistant cell
a. Nerve
b. Bone
c. Saliva
Nerve>Muscle>Brain cells> Bone cells>
67. The theory of radiology that deals with white matter radiation (forgot how it was phrased)
a. Photoelectric
b. Thompson effect
68. The complete absence of teeth are
a. Anodontia
b. Hypodontia
c. Oligodontia
69. Fancy term for an eye infection/ involvement
a. Pemphigus
b. Pemphigoid
70. Patient who is diabetic – which of the following would not cause a reason for insulin (something
along those lines)
a. Stress
b. Trauma
c. Sedation
71. When you are with a child patient smiling and giving them praise
a. Positive reinforcement
b. Social reinforcement
72. What can you not see on a periapical radiograph
a. Max sinus
b. Mandibular foramen
c. Mental foramen
73. What drug is considered safe to give to a patient with myasthenia gravis
a. clarithryomycin
b. azithromycin
c. imipinem
d. Penicillin
74. What kind of trauma causes necrosis
a. Inflammatory
b. Replacement
c. surface
75. What kind of trauma causes ankyloses
a. Inflammatory
b. Replacement
c. Surface
76. What is true about neonatal teeth
a. Must be extracted
b. Common in the mandibular incisor area
c. Supernumerary tooth
Pedo book – they said its not required to be extracted but the concern is that it can be
aspirated
77. First pass effect
a. Absorbed in the small intestine
b. Biotransformation in the liver
78. Which is similar or seen in behchet ?
a. Ulcer
79. What is lithium used for
a. Depression phase of mania
Dentin book
80. Perio maintenance
a. Must be done by periodontist only
b. Must be strictly 6 months
c. Depends on each patient
81. Test to use for crown
a. Thermal test
b. Ept
82. Oral lesion that is easy to treat
a. Varix
b. Hematoma
c. Macule
83. Macroglossia not seen in
a. Amyloid
b. acromegaly
c. Hyperparathyroid
84. Why do you ask for a medical consult
a. To gain information
b. To get clearance
c. To build a better relationship with the consulting doctor
85. What is not included in a consent
a. Alternative treatment with a specialist
b. Risk
c. Cost
86. Periocoronitis
a. Extract immediately
b. Curettage
c. Refer to oral surgeon
d. Give antibiotics
(The question didn’t mention anything about having a fever or swelling)
In oral surgery book
87. The lingual nerve is in a certain position – if you move the beam inferiorly (cone head is facing
superiorly) where is the nerve
a. Mesial
b. Distal
c. Apical
88. Where are caries found in a composite restoration
a. Occlusal
b. Facial lingual
c. Facial mesial
The question was worded funny but it seemed like they were referring to recurrent
caries – they didn’t mention if it was a class 1 or 2 – I guessed A but not 100%
89. What is not true about periapical cemento osseous dysplasia
a. Mostly seen in women
b. Black people
c. Anterior maxilla
90. Ameloblastoma
a. Associated with enamel
b. Local invasive
c. Expansile
Day 2
1. two part true false question – first one was maslow theory on patient needs (this is true)
Theory of need. From more important to less (Phychologycal) basic needs, food, shelter > ( Safety)
job security, etc. > (Social) part of team, feeling wanted > (Self Steem) level of status > (Self
actualization ) profesionally goals etc.
2. you had to look at the drugs – the patient is taking the oral bisphosphonate rispedoronate – the
cause of perio is due to
a. plaque
b. medication
3. theres a new hypothetical test that is used to diagnose caries – what does this new test need to
have : clinical trial
4. patient was taking cimetidine – what does this drug cause
a. xerostomia
Rqs: April : 10 and 11th
Day 1:
1. In which of the x ray the maxillary sinus appears closer to roots?

- Bitwings
- Panaroma
- Bisecting angle technique
- Paralleling angle
2. Minimum width of the maxillary palatal strap

- 3mm
- 4m
- 8mm
- 12mm
3. For treatment planning for an implant what is NOT considered
- Bone quality
- Region of mouth
- Pt. age
- Smoking history
4. Most important feature in a single implant placement:
Antirotational element in the implant
5. Internal connection in the implant:
Attaching the abutment to the implant
6. Which drug works by mechanism other than acting on receptors
- Digitalis glycoside
- Osmotic diuretics
- Benzodiazepine
- Opiods
7. Secondary hyperparathyroidism can be caused by : Renal failure
8. Route of spread of Hepatitis A
- Respiratory
- Blood
- Food and beverages
- Inert environmental services
9. Most important in complete denture for protrusive movements
Condylar and incisal guidance
10. Two factors that will decide the placement of the posterior composite
- Technique and case selection
- Resin type and technique
11. Support for kennedy class 3 with modification one
- Indirect retainers
- Occlusal rest
- Denture base
- Major connector
12. You have to make a fixed partial denture , but the palatal cusp tips interfere in all excrusive
movement. What will be ur next step
- Make the prosthesis
- Grind the palatal cusp tips
- Mount and evaluate the diagnostic cast
13. Occlusion in which all the posterior teeth disarticulate when the right excrusive movment is
made
- Group function
- Mutually guided
14. Which is least important in causing root caries
- Low salivary rate
- Elevated levels of sucrose consumption
- History of chemo/ radio therapy
- S. sanguis dominated plaque on adjacent tooth
15. Most common site for caries intiation
- Pit and fissure enamel
- Cervical to contact area
16. Rubber dam does NOT protect against
-exhaled nitrous oxide
-Mercury vapour inhalation during amalgam removal
- aspiration of inlay
- laceration of tissue
- unnecessary chemical exposure
17. characteristics feature of fetal alcohol syndrome
- cleft lip
- midface deficiency
-.anencephlay
18. which of the following is incharge of dental materials and devices
- FDA
-national institute of technology

Agriculture and something
19. During border moulding for the masster which movement is done
- lateral movement of mandible
Close mandible against pressure
20. To record lingual flange
- functional movement of tongue
- full movement of tongue
21. candida albicans will increase in
- radiotherapy
- chemotherapy
22. what teeth are charactericts at dental age 11
- all 2nd premolar
- all 2nd molar
23. headgear used to move th maxillary dentition forward
- cervical
- protraction.face mask
- straight pull
High pull
24. not found in trisomy 21
- macroglossia
Class 3
Rampant decay
Delayed eruption
25. intraoral and skin nodules and macular pigmentation , no other clinical sign or symptom
- peutz jegher
Mc Albright
Neurofibromatosis
Hereditary familial
26. dentition in achondroplasia
Normal
Macrodontia
Supernumary
27. least desirable in making a crown seat completely
Use die spacer
Use disclosing agent to identy discrpencies
28. what will happen when u increase the powder in zinc phosphate cement
Decrease viscosity
Decrease solubility
29. initial treatment for gingival bleeding , loss of strippling and rolled margins
SRP
Oral hygiene instruction
30. radiographic feature of sickle cell anemia
31. pt has von willibrand disease, which of the following will you use ( something on these line)
aminocaproic acid
desmopressin
factor replacement with desmopressin
factor replacement with aminocaproic acid
32. handing out questionnaire at the end of a evalution . what type of study
Case series
Cross sectional
Cohort
Case control
33. first pass metabolism
Enterohepatic circulation
Metabolism in liver
34. a question on drug response and drug percent graph. What they have in common. ( I don’t
remember exactly)
35. Clinical attachment loss is seen is which stage
Intial
Early
Established
Advanced
36. which dentifrice for dentin hypersensitivity
5% Cacl2
5% KNO4
2 more options
37. White spot on facial surface non cavitated and has matte finish. Treatment
5% fluoride varnish
No treatment
38. 10% chlorhexidine is used in
Pit and fissures
Secondary caries prevention arnd restorations
39. Ideal material to replace the loss of large alveolar bone
Autologous
Dried freeze decalcified
40. side effect of allkylating anticancer agents
Nephrotoxity
Ototoxicity
Bone marrow suppression
41. which orofacial pain will you refer the patient to a physician
Cluster headaches
Temporal arthritis
Trigeminal neuralgia
Glosspharengeal neuralgia
42. which of the following is not part of scientific article
Interpretation
Method
Result
Introduction
43. best method to deliver xylitol( smthing of this sort)

Chwing gum
Varnish
Mouthwash
44. Active ortho tteatmet s completed in a child with a history of poor oral hygiene, best retainer to give
Removable
Fixed
No retainer
Supracrestal fibrotomy
45. Acc to WHO classification, avulsion in classified as
Dental hard tissue
Luxation
Soft tissue
46. in relation to the marginal ridge , height of matrix band for class 2 should be
Below
At same level
1mm higher
3 mm higher
47. you did a large MOD amalgam . after 2 days pt complains of sensitivity and pain of 2 sec on cold .
cause and treatment
GIC linear- redo
50. hypoxia in a patient under GA. First sign
Increase pulse rate

51. all of the following affect the base thickness except
Size of tooth
Base thickness
52. sequence of usinf retraction cord in double cord technique
# 00 then #000
#00 or# 000 then #1
#1 then #2
# 00 then# 2
(smthg of this type)
53. Pt present with moderate cellulitis and fever of 100.8 . after incision and drainage what will u do
2g amoxicillin – single dose
Penicillin VK – 1g followed by 500mg 4-6 hrs for 7-10 days
Erythromycin – 1g followed by 500 mg for 7- 10 days
No antibiotics
54. interdental bone is apical to redicular bone. Its called
Flat
Scalloped
Reverse
Normal
55. which of the test is Not used for type of bacteria and its metabolic products
DNA test
Enzyme test

1.Leeway space
2. Dental crossbite cause? lack of space for anterior dentition
3. Light Film? insufficient exposure time
4. Complex perception of pain and stress?
5. PDL disease more common in? Black male
6. Bulimia more common in? black young female
7. What happens if you leave a radiograph too long in a developer?
8. Loss of which premature primary tooth could cause loss of arch space? (primary 2nd mandibular
molar)
9. Asymptomatic tooth but hurts to bite after 2 weeks of newly placed crown, No percussion senstivitiy
and the tooth is vital? Cracked tooth, periapical periodontitis
10. Composite too white but otherwise acceptanle class 4 rest, what to do? Re-do, stain, …
11. Composite Class III, with stains in the margin, what to do? Reveneer, re-do, stain
12. Battery (doing surgery without consent)
13. Autonomy (consent form)
14. Precontemplation
15. Mandibular molar 30 moved to the right during occlusion, where is the interference?
16. Interference in balance
17. Interference in working
18. Bone involved in Le Fort I? (maxillary sinus)
19. Leukotriene, associated with systemic diseases? (asthma, thyroid, etc)
20. Ectodermal dysplasia (2 questions)
21. Pemphigoid mucous membranous
22. Furcation in primary molar? (due to pulp necrosis)
23. Time to close apices of eruption of primary teeth? (9-15 months)
24. Frenum Labial prevent movement of which muscles? (triangle, zygomatic, canine)
25. Combination syndrome (Kelly)
26. Ulcerative lesion in palate ?(necrotizing sialometaplasia)
27. Function of Beta-1 agonist? (increase Heart rate, Dilatation of bronchial muscles)
28. Loosed primary teeth in young kid, cause? (hypophosphatemia)
29. Melanoma more common in? (Palate and gingiva, gingiva, floor of the mouth)
30. Healing of occlusal trauma? (narrow PDL)
31. Fracture infraorbital ridge … glazed?... downward, forward, medial or lateral
32. Prostaglandin is inhibited by?
33. Amalgam Class II retention? (proximal grooves, axial pulpal bevel, )
34. Large pulp chambers? (tauradontism)
35. Indications of selective Endo?
36. who has Best prognosis? ( internal resorption, vertical fracture, avulsed tooth,)
37. Secondary prevention?
38. Disensitization ?
39. Arrested caries? (brown shiny enamel at the cervical region of the tooth, discovered after gingival
recession)
40. Mandibular molar endodontically treated with furcation involvement 5mm to apex, how to
treatment plan (hemisection and treat as if it where 2 premolars)
41. Least common missing permanent tooth? Canine
42. How many Americans have fluoride water? (74%)
43. Max. Dosage of local anesthesia with a child weighing 16kg? (72)
44. Safe of nitriousoxide? (70%)
45. 5 year old intruded tooth, what do you do? (observe)
46. Maxillary RPD and mandibular denture patient wants to have a denture that crowns last longer?
(composite teeth, proceleain teeth, hybrid acrilyic teeth)
47. Radiograh? Pericapical cemento-osseous dysplasia
48. Radiograph of dentigerious cyst
49. Smokeless tabacoo is associated with (verrucous papillary lesions)
50. Opioid side effects except? ( congestion and pinpoint pupil dialation)
51. Diazepan does? (relax muscles, treatment for epileptic, causes amnesia)
52. Sulfonamide? inhibits Gaba
53. Apex closing in non-vital tooth. (Apixification)
54. Distance between dental implants? (3mm)

55. Retentive points of the RPD clasp? (gingival or middle 3rd. , gingival third)
56. New research shown that Tobacco is associated with? root caries,
57. Kids systemically compromised, what do you use? (chlorhexidine or sodiumfloride)
58. Everything is associated except? (jaundice)
59. A patient becomes cyanotic/ respiratory stress after you administer topical anesthesia in an
ulcerative area, what is the most likely thing the patient is suffering from? (allergic, diabetic crisis, sickle
cell crisis)
60. Hexi to upright a mandibular molar, where does it have to be located?
61. Cleidocranial dysplasia is the same as Pier Robinsons syndrome to….? (t/F)
62. Mand central primary teeth calcification? (5-7months?)
63. Mandibular Premolar drain to the sublingual space
64. Ludwigs angina?
65. What is the most common emergency in a dental office ?(Syncope)
66. Pregnant women need to be positioned to the left during syncope to avoid? compression of inferior
cava vein
67. If you have a patient having intravenous bisphosphonate and you need to do a dental treatment
what would you do? (endo, extract, …)
68. Which condition do you see secuestra formation? (osteomyelitis, osteonecrosis, etc?)
69. Xrays will display? bone loss associated with the CEJ
70. In a Perio maintainece every 3 month: could be modified if patients condition changes? Can never Commented [PL1]: aintanence
be modified?
71. Axial wall of MOD onlay
72. Most common type of bone loss in chronic periodontitis? (horizontal)
73. Caries elements? (bacteria + polysaccharides + enamel or Bacteria + situated carbohydrates +

susceptible tooth)
74. After surgical graft epithelium comes from? (receiver site)
75. What do you see radiographically in osteoporosis? (fine trabeculation, dimeralization of ostoids
islands)
76. After cleaning the tooth surface form first the alternative is? material alba, pellicle, bacteria, plaque
77. Fibroma caused by? trauama and irritation
78. Sealing complete dentures too posteriorly will cause? (gag reflex, hyperplasia of mucosa, more
retention, less retention)
79. Pronouncing the letter F or “ph”, The incisal edge of the anterior mandibular teeth: (contact at the
vermillion of the lower lip, anterior to the vermillion of the lower lip, posterior to the vermillion of the
lower lip)
80. Treatment fo HPV, CMV, EBV? Valcyclovil
81. Antifungal for oral and systemic candiasis? (miconosol, clotrimadol, fluconazole)
82. Xerostemia is most often caused by in younger kids? (medication, SJrogren, mouth breathing)
83. Osteonecrosis is most common in? posterior mandible
84. Descamative gum bleeding treatment?
85. Local acute aggressive periodontitis initial therapy? (SRP or SRP with antibiotics)
86. Hematoma, freckles, melanoma, which of them disappears by itself?
87. Ranula tx? (marsupilization)
88. Elder, what is the most common? depression
89. Dementia is associated with? short term amnesia, long term amnesia
90. Elderly people normally surfer from? decreased learning, decreased attention?
91. Geographic tongue?
92. Why do you brush your tongue? (prevent bad breath)
93. Anesthesia duration is due to all of the following except for. . .
94. Periapical abscess vs periodontal abscess? Electrical pulp test
95. Macroglosia is seen in all the conditions except? (alidosis, hypothryroism, acromegalia,
hyperparathyroidism)
96. Mixedma is seen in? hypothyroidism
97. In a clinical trial your samples you organize it alphabetically and you pick randomly every 10 people,
what kind of randomized selection is this? (simple randomized, stratified randomized)
98. Basal cell carcinoma patient, how do you react? ( do you have anyone with you what you would like
to come to the room?)
99. There is a compliant patient that is now denying to do a root canal tx, what is the appropriate
approach? (if you don’t do the rtc it will get worse, is there something you want to know about the
treatment plan?)
100. Insurance charged crown + post under the same procedure: Bundling ?
101. What do you not do with the consent form? Don’t give it before the exam
102. Actinomycosis? fistula in the head and neck

103. Which is only a radiolucent lesion: Ameloblastoma, AOT, Pingborg tumor, Ameloblastic fibro-
odontoma
104. KOT, Ameloblatoma, AOT, which is the less recurrent?
105. Condensing osteitis
106. After RCT Periapical radiolucency slightly enlarged in the radiograph, what is the cause? Fibrous
scar, angulation of Xray
107. Space maintainer, bend and loop, has everything except? a vertical thing that prevents the
overeruption of the opposite tooth.
108. Asymptomatic apical periodontitis
109. A practice of 1 Hygienist and 3 doctors, the hygienist has harmed the patient, who is liable? The
hygienist and the attending doctor
110. Irreversible pulpitis
111. Best diagnosis for irreversible pulpitis?
112. Liable test pulp in a crowned tooth (cold test EPT, Xray, Percussion and palpation)
113. Progenitor cell for perio rehabilitation, comes from gingiva, connective tissue or PDL?
114. Periodontium regeneration: cementum, alveolar bone, sharpeys fibers, or cementum, alveolar
bone and gingiva?
115. Penicillin B is a good option, why? (inexpensive, broad spectrum, non toxic)
116. Labial extrusion of the canine (gingival recession)
117. Treatment for multiple chronic dislocation condyles. (athroscopy, condylotomy, total joint
replacement)
118. Clarithromyocin acts upon the ribsome-50
119. Potassium sparing is an Amiloride
120. Vicodin belongs to what drug class I, II, III, or IV?
121. There is a picture of a multiple pyogenic tumor or Lymphoma, etc. pt is taking antibiotics for a
infection of the skin.
122. The opaque porcelain does all the following except ?
123. The disadvantage of Distraction osteogenesis vs osteotomy (patient follow up time)
124. Inflammatory resorption
125. AED has the general caratheristics of, the citated many characteristic of AED but I only remember
the option that said if is contraindicated in those younger than 12 years old?
May 22 Rqs:
1. AED What is true about it? Discharged when needed, not used in kids below 8 years,
2. What give to prevent tetanus? DPT vaccine (Toxoid – inactive vaccination)

3. Primary teeth lost early why? Hypophosphatsia, Papillon levefre, cherubism,
Hypothyroid, EDS, Chediak Higashi, Sucrvy, Juvenile diabetes, Gauchers, Acatalasia,
Leukemia, Cyclic Neutropenia, Langerhans cell histiocytosis, Agranulocytsois, dentin
dyplasai, odotnodyplasia, scleroderma, aplastic anemia, Tb, Facial tunours
4. Pregnant in syncope when we position her what are organ we are trying to avoid pressure
on ? Lung aorta inferior vena cabs heart
5. Sulfonyurea how does it work Increases the synthesis and release of insulin from
pancreas and increases sensitivity of insulin receptors.
6. Lefort 1 fracture – Horizontal fracture, transmaxillary fracture, Floating palate, Gurein
sign and Cracked Pot
7. I had a lot of interferences
8. Propriatary drug?? – Brand name. trade name
9. Drug conjugation – adds a molecule to make it water soluble and less lipid soluble
10. Which is true of strep Mutants – Can live on non shedding surface
11. Kiwi 940 1211 1231 1240 1245 1334 1340
12. Most common post op complication after ext – Dry socket
13. Most common with max ext - haemorrhage
14. Osteoradionecrosis Mandible 42 grs
15. Battery
16. Phlebitis – inflammation of veins
17. Zygomatic process on pano
18. Which is more stable composite ? Lightcure tegdma
19. Best bone type for implant – D1 type 2
20. Best place for an implant - mand ant
21. Gingivectomy
22. MWF
23. Batería with NUG ?
24. LAP TREATMENG – SRP + Antiobiotcs
25. RANULA TX - Maruspialization or exicison of recurrent
26. MUCELE CAUSE - Trauma
27. X-ray looked white why? Inadequate developer
28. mA 5 time 1 Changed to 0.5 what should MA be 10
29. Which pathology doesn’t show radioopacity
30. Dentigerous cyst
31. What can be seen on the hard palate? Nicotinic stomatitis
32. Salivary stone mostly in? Wharthon
33. Pregnant what is safe in all trimesters? Ibuprofen, Tylenol 3, and two other options
34. Pt have diastema and problems What do you evaluate further because pt want to correct
for esthetic
35. Implant analong Whats the purpose of it – A replica of the entire dental implant that
replicate implants and their position in patients mouth
36. Female with headache and TmJ problems relived by laying down and avoiding light and
noises What should be in the differential diagnosis - tinnitus
37. Something about athlete wears occlusal guard, and have pain in tmj when walking??
MPDS
38. Opioids side effect, except?
39. Pt with confusion how to treat ? Glucose
40. After giving iv drug, tachycardia hypotension ... what is the patient having?
41. Led lights compared to halogen light what is a disadvantage ? Curing depth or weight?
42. Kid 16 kg, lido dose ?
43. How to differentiate between later perio cyst and apical - ept
44. A lot of endo qs
45. Crown on lower right molar when pt closing there is a shift to the right, Whats the
interference?
46. Which primary tooth has most convergence facial lingual – Max 1st Molar
47. Chronic perio most common in Black males
48. DMF is index of ?? Caries or oral health status
49. Kid with actinic chelitis why ? vit b12 def or candidiasis
50. Most common perio maintenance interval – 4-6 weeks??
51. Another question about perio maintencae and compliance of patient
52. First thing to do during a maintence visit? Update medical history
53. Non vital tooth open apex? Apexification
54. Primary tooth intrusion what do you do ? observe
55. Lower molar with furcation class 3 5 mm away from the apex What do you do? Extract,
hemisection with crown ?
56. Buccally erupted canine 16 year old kid, what is most likely to see ? recession
57. Similar between acetaminophen and aspirin ? Analgesic, antipyretic
58. Distance between X-ray source and MID SAGITAL PLANE. 5 feet
59. Biopsy of lip lesion, pt say, tell me if I have cancer or not, what best answer?
60. Pt say I don’t have time to quit smoking ? precontemplation
61. Dentist ignores pt anger behavior ? extinction
62. Hygienist works at a practice that has 3 dentist , hygienist caused injury why is
responsible ? Hygiene Alone, hieginisya and 3 dentists, hygienist and supervising dentist,
or only dentist ?
63. Fail safe n2o delivery system – 70%
64. Most common side effect of n2o - nausea
65. What appears after 2 hours from cleaning teeth – plaque formation
66. Most common cause of replacing anterior composite – marginal leakage? (Check mosby)
67. Most common cause for amalgam failure – moisture contamination
68. Amalgam was contaminated, what will happen? Doesn’t adhere to walls, less strength ... I
don’t remember
69. Claps tip should be where? Gingival 1/3 or between gingival and middle 1/3?
70. Claps fracture, work hardening
71. Implant placement high torque low speed
72. How to make sure when doing a CaOh pulp cap that pulp is well protected ? 2mm, or add
gic on top, or make sure the restoration is well sealed on the margins ?
73. How to control plaque for a kid, metally challenged
74. Cell in cellulitis - leuckocutes
75. Implant to implant distance – 3mm
76. A question about what is true about specific theory of plaque
77. What is leeway space
May 18 Rqs:
1. Laryngospasm
2. Pt- denture ques Upper cd and lower rpd - what occlusion (Bilateral balanced in
eccentric)
3. When to remove torus
4. Most common tumor
5. Torus removal for denture ?
6. When Tuberosity was interfering what to do
7. Bleeding 3 days after extraction in mand 3 rd molar- due to- infection
8. R/ g to identify soft tissue of nose
9. Ext auditory meatus
10. Mental foramen
11. What not seen on radiograph - mand Foramen
12. Oral ulceration with bone sequestration due to trauma but no systemic disease is found
where ? Necrotizing sialo
13. Common to implant and tooth - JE
14. DISTN bets 2 implants- 3 mm
15. Positive predictive value - 20 % T and fsfd calculation
16. Warthins - parotid
17. Flexure- abfraction
18. Tranquilizers - what will happen
19. Common to all - gypsum, stone-
20. High wp - dec expansion
21. Pulp damage- heat
22. Hydrodynamic theory
23. Primary cause of no eruption-
24. Fluoride supplement to give 5 year old 0.38 ppm
25. Spatial resolution
26. CCD ques - electronic transfer
27. Image is less improved than conventional
28. Zygomatic fracture- ct
29. TMJ disc- MRI
30. What u have to reduce and immobilize for less time - condyle fracture
31. Most pm with 3 canals – PM1
32. Tooth least common to be missing - canine
33. Tetra at 5 years - tooth affected Canine, premolars and molars
34. Not due to non smoking tobacco- nicotine stomatitis
35. Erosive lichen planus - lady ques
36. Sodium hypo- not do - chelate
37. Gingivectomy - not to do- infrabony
38. Perio stability what to check – attachment loss
39. Mental foremen
40. Genial tubercle
41. External auditory meatus
42. Can’t be used in Angina- Thiazides
43. Confounders- RCT
44. Cause and effect can’t find- cross sectional
45. P< 0.05, p came 0.01 Null hypo rejected- correct decision
46. Tranquilizers- depressant action added
47. Pemphigus- intraepithelial , acantholysis
48. Disc 25 mm anterior 5 mm reciprocal click- moves from anterior to normal
49. Autoclave monitoring - bacterial spores
50. Least common to be absent- canine
51. Ant guidance - hori condylar guidance
52. Which wud u not give to inc secretion - propenthaline
53. C factor
54. Temporary ques-
55. infraocclusion
56. Phenothiazine and epi reversal
57. Block for anteriors
58. If ridge resorbed how will the incisors look? Long, narrow, lingual, Buccal
59. Diff between periapical and periodontal lesion - pulp vitality
60. Dif between periapical cyst and granuloma- biopsy
61. How to check if JE is formed after therapy
62. Rinsing with a new mouthrinse results in a statistically significant decrease in the
Gingival Index (GI) score, but does NOT result in improved oral health for the patient.
This finding suggest which of the following? A- Non-clinical significance B- Double-
blind study C- Improper study desing D- Bias
63. Pt satisfaction - cross sectional
64. Gastric bypass and surgery- cohort
65. Ginseng interaction - aspirin
66. Mimic tooth pain- herpes zoster
67. Misdiagnosed as abscess- lateral periodontal cyst
68. Bell’s palsy- 7th nerve
69. Xerostomia - saliva amount
70. Total saliva in a day
71. Treachery Collins
72. Amox- clav combo for resistant sinusitis
73. Which fracture needs to be released early- condyle
74. Why fovea are not included in denture
75. Maslow theory of motivation
76. SLOB ques
77. VDO and Interocclusal space ques
78. Q87. aphthous stomatitis is associated with what ? a. herpes b. cmv c. EBV d. tomato
allergy e. human leukocyte count
79. Curette what part adapted to tooth- distal 3rd
80. Which statement most accurately describes the finish line and margin of crown? A- The
finish line should be placed in hard dentin when it is possible B- The crown margin at the
gingival crest accumulates the least amount of food C- The location of the crown margin
is more important than the fit and finish D- The subgingival crown margin may be an
etiologic factor in predisposing periodontitis Ans -D
81. First pass metabolism - in liver
82. Apex locator can’t be used for - curvature of canals
83. Blue sclera - osteogenesis imperfecta
84. Axial surface- gingival health
May 14 Rqs:
Q1) Curette angle?
-20 - 30
-45 – 90
q2) Bulemia is more common in?

-black males
-young Caucasian females
-young black female
q3) clindamycin MOA?

-30s ribosome
-50s ribosome
q4) after IV injection of antibiotic, pt started to wheeze on inspiration, hypotension, tachycardia
etc.
-hypoglycemia
-anaphylaxis
- adenoid crisis
q5) causality (cause and effect) is not seen in which study? crossectional
q6) zinc polycarboxylate powder ? Zinc oxide + Magnesium oxide
q7) self drilling pin is used on?

-large tooth only
flat surface
-curved surface
q8) tachycardia is seen in all except?

- hyperthyroidism
-anemia
- obstructive jaundice
q9) Defiant kid, how do you control?

- tsd
-physical restraint
-voice control
q10) autogenous bone for large volume of graft is taken from?

- ilium
- ribs
- ramus
q11) researcher wants to study the efficacy of two mouthwashes in two groups. What type of
study?
- cohort
-cross sectional
-clinical trial
- longitudinal
q12) a 3 year old kid was given 2 ml of lidocaine. He develops a reaction, swelled lips and hives.
What emergency drug will u give?
-diazapam
-epinephrine
-nalaxone
q13) Sulfonamide MOA
q14) Which antibiotic in NUG (penicillin V was not there)

-metronidazole
-clindamycin
q15) Primary teeth lost prematurely in?

-hypophosphatasia
-papillonlevefre
q16) gingevectomy incision?

q17) film is too light? Cause?

-developer temp too high
- less exposure time
q18) lease associated with lip/cheek biting?

-dec horizontal overlap in posterior teeth
-decvdo
-teeth set up too lingually
q19) least useful retention/resistance form in crown?

-parallelism
-path of insertion
-length of axial walls
-total area of 2 axial walls
q20) what type of movement would cause contact on buccal incline of maxillary lingual cusp?
- protrusion
-working side
-non working side
q21) in human subject research, many elements should be considered, most important being:
-have a positive outcome
-obtain informed consent from participants
-participant pose no risk
q22) zirconia is strong because?

- covalent bonding between zirconia and oxygen
- phase transformation under stresses
q23) best test for pulp necrosis?

- ice stick
-endo ice
- EPT
q24) Placebo drugs are effective in 25% cases

Dentist’s attitude will effect the outcome of placebo drug
true and false type question
q25)which muscle effects the shape/form of lingual flange in molar area?

-palatoglossus
-mylohyoid
-genioglossus
q26)what will you not do at a perio maintenance visit?

q27)which drug is used for mucocutaneous and systemic fungal infections?

-miconazole
-fluconozole
q28)most common complication of extraction of maxillary teeth?

-dry socket
-sinus perforation
-hemorrhage
q29)class 2 inlay design?

q30) selective grinding is done to?

-restore bilaterally balanced occlusion
-to direct the forces along the long axis of teeth
q31) vertical releasing incision starts from midfacial area.- false

It is often given to provide proper access - true
-true and false question about both statements
q32) midfacial injury, lower eyelid is numb and theres bruising on skin lateral to the nose. Which
sinus wall is effected?
-upper
-medial
-lateral
-floor
q33) blow to lower orbit, eye movement limited to?

-upper
lower
-lateral
q34)onlay indication?
-because upper tooth is restored
-reduced dentinal support
-some other options I forgot
q35)grade 3 furcation, endo treated mandibular molar. Best tx option?

- GTR
-hemisection, extract one root and give 3 unit
-hemisection with 2 crowns
- exctract entire tooth
q36) what is used to adjust a porcelain crown?

-carbide bur
-diamond bur
-green stone
q37) feature of cherubism?

-early childhood
q38) scrap amalgam is stored in? (nosulphide option)

-biohazard bag
-sealed container
-ethyl chloride
q39)seizures are more common in?

-encephaloangiomatosis
-hereditary telengectasia
q40) for ideal class V, the retention form should have:

q41) a 3 unit bridge for replacing maxillary canine is :

- it is a simple bridge, as all 3 unit bridges are simple
- it is a simple bridge, it follows the Ante’s law
- it is a complex bridge as the inter abutment axis is not parallel (something like tht)
q42) 3mm crowding in 8 year old, tx options:

- disking of canines
-extract the canines
-extract and provide lingual arch
q43) disadvantage of implant using cement retained abutment?

- only option that seemed right was ‘cement in sulcus’
q44)Patient complains of headache and jaw pain. She says it gets better when she lies down
away from light and loud noises. Condition is ?
-tinnitus
-migraine
-mpds
q45) healing of periapical radiolucency will be slowest in?

-diabeticpt
-aids/hivpt
-hypertensive pt
q46)Patient is diagnosed with BCC. He says “just throw it to me doctor, do I have the cancer or
NOT?” What will be your first response?
q47) Patient comes one month after you placed the crown, theres discoloration in cervical area.
What is it?
-microcracks in porcelain
-amine in resin cement
-caries
q48) retentive clasp tip is located in?

-middle third
-gingival third
q49) for CaOH in pulp capping to be successful, it should be:

-atleast 2mm in thickness
-covered by gic base
q50)disadvantage of fillers in compostite?

- some options regading the refractive index
-it is opaque
q51) disadvantage of sedation?

q52) buccally erupted (ectopic) canine have what greater chance?

-hypoplasia
-gingival recession
-deep bite
q53) what is reciprocal anchorage?

-tipping
q54) effect of Coumarin will be reduced by

q55) what will you not do for aids/hiv patient?

q56)elective RCT is done in?
-pulp exposure
q57) what is true about subgingival varicosities?

- more common in young age
- rarely may become problematic if theres thrombosis
-not associated with any systemic condition
q58) combination (kelly’s) syndrome:

-occlusal plane is tipped downward anteriorly
-resorption of posterior ridges in maxilla
-can be improved with implants in posterior mandible
q59) healing after occlusal trauma is removed, what is seen?

-resorption of bone
-resoprtion of cementum
-narrowing of PDL
q60) Active stabilization/immobilization is done in?

-patient who was previously cooperative suddenly becomes unco-operative (there were other
options, I didn’t know anything abt this!)
q61) sign on injecting anesthesia intravascularly?

-no anesthesia
-inc heart rate/palpitation
q62) function of ferrule?

- prevents rotation of core
-prevents fracture
q63) you made a zirconia crown on right mandibular molar. When patient bites, it shifts to the
right. What area is effected?
-buccal – buccal
-lingual – buccal
-buccal – lingual
q64) A radiograph of lower mandibular area, shows an unerupted 3rd molar that has a unilocular
radiolucency next to 2nd molar. Histology says it is lined by nonkeratinized stratified sq
epithelium. Dentigerous cyst. pic was something like this:
q.65) a radiograph showed mandibular posterior area. There was a radiolucency with some
diffuse radiopaque structure in the middle. Question was asked to identify radiolucent-
radiopaque lesion. I chose ameloblastic fibro-odontoma as other options were radiolucent.
pic was something like this but 100 times bad quality
q.66)a panoramic xray was given to identify a landmark:
it was marked where point C is at –zygomatic process of maxilla

May 14 Rhiti Rqs:

2. Tt of ranula- masupialization (option had excision of submandibular gland …that’s
wrong)
3. Feature of muscle weakness disorders- long lower facial height
5. Aspirin does not increase what?- bleeding time, prothrombin time, acidosis, renal
prostaglandins
7. How to obtain confidence of child- positive reinforcement, tell show do
8. Biotransformation of drugs
9. Coumarin effects decreased by? – Brabituates and Chloral hydrate
11. 5-6 q on glaps and gingivectomy which were easy- they play around with indications
12. q about 22 yr old girl with fever , malaise, lymphadenopathy, multiple ulcers on
tongue, palate with swollen gingiva- anug, acute herpetic gingivostomatitis, marginal
gingivitis, herpangina
15. Lymphoma in jaws- hodgkins, non –hodgkins
16. Q about not a topical drug delivery sytem in perio- I discussed it with someone I
remember, ans was metronidazole gel
17. Symptoms of pedal edema, persistent cough, obese, raises end diastolic pressure,
guess disease- I marked chf
18. Which antihistamine for peptic ulcer- diphenhydramine, citrezine, ranitidine
21. Q about man with good oral hygiene and stained buccal groove- observe
22. Collimation purpose
23. How to prevent gonadal exposure during mandiopa- e films, lead apron, thyroid collar
25. Which impression material gives off h2 gas
26. Which impression material not for cast impressions - alginate
27. Connector in fpd should be greatest in which dimension- mesio-distal, buccolingual,
occluso-gingival
28. P<0.01 , reject null hypothesis- option had both correct decision and type 1 error
30. Q on cleidocranial dysplasia about open sutures – large frontanelles, delayed closure
of sutures, skull maturation is delayed. Sutures open for a longer than normal Sagittal
suture sunken gives skull flat appearance
31. Neurogenic sarcoma?
32. Calcified falkcerebri-? Gorlins
33. DistobuccAL flange extended in max denture and mand denture which structures
obstructed – max – cornoid, mand - massater
34. While recording pps what is kept in mind except- fovea palatine, vibrating line,
pterygoid notch, throat form and tuberosity
35. Kid was taking Ritalin- which disease (ADHD)
36. Local vasoconstrictor which la- cocaine, benzocaine, lignocaine, procaine
37. Lithium toxicity affecting renal function, which analgesic to be given – oxy or aceta
38. Recovering from alchoholism, which analgesic to be given except- ibuprofen,
Percocet, vocodin, tylenol3
39. Child in pre something stage of cognitive behavior- what is problem- establishing
communivation
40. Child is uncooperative is 2 yrs old, retrain by- parents, papoose, assistant, sedate
41. Fail proof mechanism of nitrous oxide cylinder – 70%
42. Conscious sedation- verbal response, pain response, eye response, touch response
43. Pregnant woman in syncope due to which structure - IVC
44. Short crown premolar as abutment in fpd- inlay,onlay, pfm, all ceramic crown
45. Why wait for 1 week between bleaching and veneering – to ensure color change is
complete
46. Porcelain veneers frequently changed due to- chipping or discolouration ? debonding
47. 3 q on hue, value ,chroma each asking known rqs
48. sealants bond to teeth by? – mechanical tissue tags
49. 2 statements about ethics.. q like which are true or false- individuals can discuss about
ethics and come to different conclusions something like that
50. 2 q on sibilant sounds- how are teeth touching or contacting…are they supposed to be
different?!!!
51. Implant template what for? Guide for implant placement
54. Max 3rd molar root displaced into which space? - infratemporal
56. old man had a lot of carious class v lesions, ideal material for restoration- amalgam,
direct gold, gic, composite
57. for gingivectomy incision directed where? Directed towards base of pocket
58. In tooth supported rpd, which part prevents movement of abutment? Direct retainer-
clasp
59. Which is poorest form of temporary restoration- zoe, composite with zn phosphate,
cold cure set in mouth cemented with zoe, cold cure set in cast cemented with zoe
60. Bruxer had old mod amalgam with sec caries, which material to be replaced with-
composite, amalgam, all ceramic
61. Effect of norepi prolonged by- moa , neuronal uptake inhibitor
62. Cholinesterase inhibitors- sympatholytic, sympathomimetic, parasympatholytic,
parasympathomimetic
63. Doesn Lisinopril cause k+ depletion? No
66. 1 pathetic rf of fibrous dysplasia m guessing because I saw no boundaries of the
lesion
68. filteration in xrays? Aluminium
69. High voltage kvp resultant xrays will have? High density low contrast long scale
70. Palatal tori reaching pps, how to construct cd – remove tori
71. Features of dementia – short term memory loss
72. Elderly patients have lesser effect to cns drugs, t/f – No change
73. Which tumor has enamel, dentin, pulp, cementum? - odontoma
74. Defining rapport in fancy terms …sounded like an English exam
75. Gracey curette for mesial surface – 11 and 12
76. Angulation of scaler tip – 45-90
79. organism which can produce metabolic products from estradiol – P intermedia
80. interocclusal record of 1mm was taken with facebow, options asking whether its
possible or not
82. hyperpyrexia, tachycardia, nervousness, diarrhea, tachypnea- pheochromocytoma,
thyroid storm
83. primary side effect of albuterol- xerostomia, candidiasis, caries, dysguesia
84. if pt had gum boil, you do rct, what tt for gum boil- curettage, excision, local
antibiotics, no tt
87. movement during extraction of mand molars – luxation and rotation
88. forceps for fractured tooth at level of furcation- 23 (Cowhorns)
89. vital tooth radiolucency at mand premolar roots - LPC
90. periapical radiopacity not related to inflammation, neoplasm, fibro-osseous lesion or
systemic disease- idiopathic osteosclerosis
91. which tooth not suitable for occlusal seat placement- canine, lateral incisor, premolar,
molar
92. patient taking amytrptilline, what happens when administered la with epi – too many
catecholamines and increase vasoconstriction
93. epi reversal by which drug – alpha bolcker
94. about proscar- option did not have bph had prostatic cancer something about
inhibiting 5 alpha reductase (Acts on testosterone for BPH)
95. emphysema pt- what considerations in dental set up- I had options regarding nitrous
oxide, reclining in supine position, administration of epi – NO not gievn
96. transillumination helps identify what by illuminating tooth- craze line, vertical tooth
fracture, microleakage and another option
97. a weird q about in pa radiograph, bone defect of osseous crater is underestimated,
overestimated, undiagnosed, remains the same something like that…find out
98. q on unbundling, bundling and up and down coding where they confuse you with
similar sounding terms
99. iopa shows patent coronal pulp chamber which changes appearance in the middle of
root indicates what?- calcification, internal resorption, canal bifurcation, pulp stones
100. clearance btw occlusal seat on marginal ridge and opposing cusp
101. chronic burning mouth in- merkelson Rosenthal, candidiasis, lichen planus,
pemphigus
102. in chronic perio all are risk factors except- smoking, age, diet and saliva
104. Which antihypertensive causes orthostatic hypotension – beta blockers
105. Pt had asymptomatic apical periodontitis, histopath shows plasma cell,
macrophages, mast cells- apical granuloma, cyst, abscess, neoplasm
106. Which mediator produced by plaque bacteria induces bone loss- endotoxin
107. Which mediator found in areas of bone loss- IL-1,IL3,IL2,IL8
109. Antifungal used both in topical and systemic forms- options had fluconazole and
miconazole
110. Test correctly identifies 95 diseased individuals of 100, characteristic of test- 95%
sensitivity, 95%specificity, 95% ppv, 5%npv
112. Young woman with shiny cervical lesions on cervical third on palatal surfaces of
maxillary anterior- erosion, abrasion, attrition, abfraction
113. Intensive drug therapy of diabetes mellitus has following objectives- 1. Home
blood sugar eval
2. type 1 and 2 dm control
3. home urine glucose analysis
something else
114. Size and shape which stage of dental development - bell
May 23 RQs:
1. Left Ramus look thicker than the right ramus in the panoramic X-ray. Reason:
A. Panoramic error
B. Mid-facial deficiency
C. Past Trauma
2. What drug can cause constipation? Naproxen. Opioids or anticholinnergic
3. Signage posted seen in
A. High speed turbine
B. Laser
C. Light cure
4. Patient with recurrent angular cheilitis, what is the reason?
A. Candidosis
B. Recurrent aphtous
C. Herpes simplex 1
D. Herpes simplex 2
5. In what place Radiation can cause cervical caries.
A. Enamel
B. Dentin
C. Salivary gland
D. Cement
6. Taurodontism in which stage Histo of Bell and apposition
7. What makes up the periodontum: pdl, bone and cementum all
8. Tyrotoxic crisis produce: tachichardia
9. Pt with big caries to say what type:
Rampant caries or b. Childhood caries. It was rampant in first and second primary
molars.
10. How to differentiate between chronic apical perio and chronic apical abcess. A.
Radiograph b. Pulp test c. Percussion d. EPT
11. Most important factor affecting pulp response.
A. Heat
B. Depth to which dentinal tube are cut
C. Desiccation
D. Invasion of bacteria.
12. Hemofilia A characteristic – seen more in males (Genitic, spontaneous mutation or
transferred from parents in 2/3rd cases. Missing of factor 8, X-linked recessive, Increase
PTT, normal PT and norml bleeding time)
13. Type of study to determine a gastric disease and his relation with nutrition.
A. Observational
B. Descriptive
C. Cohort
D. Cross sectional
14. True positive 32, true negative 40, fase positive 8 and false negative 20. What is the
sensitivity?
A. 20
B. 40
C. 60
D. 80
15. Main reason of osteoporosis in USA
A. Nutrition
B. Estrogen
C. Genes
D. Environment
16. Mronj treatment
17. Reciprocal anchorage: 2 oppose and equal forces.
18. Hypotension and itching by: histamine
19. % of h2o2 use in oral wounds? 3%
20. If patient has soft tissue injury of head and neck what is done first :
A.ABC
B.close the wound s
C. Stitch it
D.None
23. Tetracycline prescribed for a 5 yrs old which permanent teeth is going to be most affected?
A. First molars. b. Incisors c. Canine
24. Hemophilia a has increased PTT, normal PT and bleeding ? T or F
25. Abraham Maslow described a hierarchy of needs in orderto better understand an individual's
motivation. True or false. (He says needs motivate our behavior)
26. Disadvantage of oral sedation
A. Short acting
B. Adverse reaction
C. Need multiple drug
D. Incomplete absorption in the GI
May 3
1. In which of the x ray the maxillary sinus appears closer to roots?
Bitwings
Panaroma
Bisecting angle technique
Paralleling angle
2. Minimum width of the maxillary palatal strap
3mm
4m
8mm
12mm
3. For treatment planning for an implant what is NOT considered
Bone quality
Region of mouth
Pt. age
Smoking history
4. Most important feature in a single implant placement:
Antirotational element in the implant
5. Internal connection in the implant:
Attaching the abutment to the implant
6. Which drug works by mechanism other than acting on receptors
Digitalis glycoside
Osmotic diuretics
Benzodiazepine
Opiods
7. Secondary hyperparathyroidism can be caused by : Renal failure

Route of spread of Hepatitis A
Respiratory
Blood
Food and beverages
Inert environmental services
8. Most important in complete denture for protrusive movements
Condylar and incisal guidance
9. Two factors that will decide the placement of the posterior composite
Technique and case selection
10. Support for kennedy class 3 with modification one
Indirect retainers
Occlusal rest
Denture base
Major connector
11. You have to make a fixed partial denture , but the palatal cusp tips interfere in all
excrusive movement. What will be ur next step
Make the prosthesis
12. Occlusion in which all the posterior teeth disarticulate when the right excrusive movment
is made
Balanced occlusion
Group function
Mutually guided
Fully balanced occlusion
13. Which is least important in causing root caries
Low salivary rate
S. sanguis dominated plaque on adjacent tooth
14. Most common site for caries intiation
Pit and fissure enamel
Cervical to contact area
15. Rubber dam does NOT protect against
-exhaled nitrous oxide
-Mercury vapour inhalation during amalgam removal
- aspiration of inlay
- laceration of tissue
- unnecessary chemical exposure
16. characteristics feature of fetal alcohol syndrome
- cleft lip
- midface deficiency
-.anencephlay
17. which of the following is incharge of dental materials and devices
- FDA
-national institute of technology
Agriculture and something
18. During border moulding for the masster which movement is done
- lateral movement of mandible
Close mandible against pressure
19. . To record lingual flange
- functional movement of tongue
- full movement of tongue
20. candida albicans will increase in
- radiotherapy
- chemotherapy
21. what teeth are charactericts at dental age 11
- all 2nd premolar
- all 2nd molar
22. headgear used to move th maxillary dentition forward
- cervical
- protraction.face mask
- straight pull
High pull
23. not found in trisomy 21
- macroglossia
Class 3
Rampant decay
Delayed eruption
24. intraoral and skin nodules and macular pigmentation , no other clinical sign or symptom
- peutz jegher
Mc Albright
Neurofibromatosis
Hereditary familial
25. dentition in achondroplasia
Normal
Macrodontia
Supernumary
26. least desirable in making a crown seat completely
Use die spacer
Use disclosing agent to identy discrpencies
27. what will happen when u increase the powder in zinc phosphate cement
Decrease viscosity
Decrease solubility
28. initial treatment for gingival bleeding , loss of strippling and rolled margins
SRP
Oral hygiene instruction
29. radiographic feature of sickle cell anemia
30. pt has von willibrand disease, which of the following will you use ( something on these line)
aminocaproic acid
desmopressin
factor replacement with desmopressin
factor replacement with aminocaproic acid
31. handing out questionnaire at the end of a evalution . what type of study
Case series
Cross sectional
Cohort
Case control
32. first pass metabolism
Enterohepatic circulation
Metabolism in liver
33. a question on drug response and drug percent graph. What they have in common. ( I don’t
remember exactly)
34. Clinical attachment loss is seen is which stage
Intial
Early
Established
Advanced
35. which dentifrice for dentin hypersensitivity
5% Cacl2
5% KNO4
2 more options
36. White spot on facial surface non cavitated and has matte finish. Treatment
5% fluoride varnish
No treatment
37. 10% chlorhexidine is used in
Pit and fissures
Secondary caries prevention arnd restorations
38. Ideal material to replace the loss of large alveolar bone
Autologous
Dried freeze decalcified
39. side effect of allkylating anticancer agents
Nephrotoxity
Ototoxicity
Bone marrow suppression
40. which orofacial pain will you refer the patient to a physician
Cluster headaches
Temporal arthritis
Trigeminal neuralgia
Glosspharengeal neuralgia
41. which of the following is not part of scientific article
Interpretation
Method
Result
Introduction
42. best method to deliver xylitol( smthing of this sort)
Chwing gum
Varnish
Mouthwash
43. Active ortho tteatmet s completed in a child with a history of poor oral hygiene, best retainer
to give
Removable
Fixed
No retainer
Supracrestal fibrotomy
44. Acc to WHO classification, avulsion in classified as
Dental hard tissue
Luxation
Soft tissue
45. in relation to the marginal ridge , height of matrix band for class 2 should be
Below
At same level
1mm higher
3 mm higher
46. you did a large MOD amalgam . after 2 days pt complains of sensitivity and pain of 2 sec on
cold . cause and treatment
GIC linear- redo
47. hypoxia in a patient under GA. First sign
Increase pulse rate
48. all of the following affect the base thickness except
Size of tooth
Base thickness
49. sequence of usinf retraction cord in double cord technique
# 00 then #000
#00 or# 000 then #1
#1 then #2
# 00 then# 2
(smthg of this type)
50. Pt present with moderate cellulitis and fever of 100.8 . after incision drainage what will u do
2g amoxicillin – single dose
Penicillin VK – 1g followed by 500mg 4-6 hrs for 7-10 days
Erythromycin – 1g followed by 500 mg for 7- 10 days
No antibiotics
51. interdental bone is apical to redicular bone. Its called: Flat, Scalloped, Reverse, Normal
52. which of the test is Not used for type of bacteria and its metabolic products
DNA test
Enzyme test
Someones rqs:
1. Not use for cast restoration – irreversible hydrocolloid

2. lesion bear lip -
3. cerebral palsy caused by? – Injury to brain motor center, High bp causes, Leads to spastic
paralysis. More prone to periodontal dieases, caries, Bruxism and malocclusion, more
succesptible to trauma especially max anterior)
4. Denture stomatitis caused by? (Ill fillting dentures – reline, candiaidis – nystatin)
5. Bisphosphate since 6 months ( For invasive procedures stop therapy n wait
for 6months otherwise go for endo , coronectomy too , leaving root tips in the bone)
6. Varies most on primary teeth – max lateral
7. Pt says can notcope out with dental treatment -
8. Cls 3 bevel ? – inciso-occlusal or icisogingival bevels
9. Apicetomy indication and contraindication
10. Pet mal medication - ethosuximide
11. Child patient you smile and say good job – social reinforcement
12. Antibiotic for max sinusitis - Augmentin
13. Local anesthesia for hyper thyroid patient ? Mepi
14. Exact moa of h1 -
15. How to motivate for oral hygiene -
16. Low sag factor - (Sag.. degree of deformity ( high sag .. high deformity, and verses
Vera) when firing to pfm)
17. Side effect clipridogel – antiplatelet drug (Bleeding)
18. What do to do to remove supporting bone ? - Ostectomy
19. Anug treatment – debridement, h2o2
20. What med not to use in angina -
21. Primary support area max n mandibular
22. Gtrfurcation ? class 2
23. Major connector function - stability
24. EDTA function – chelation, removes inorganic contenet
25. Hypochlorite function – antibacterial, removes debriss, irrigant
26. What happens in hystodidffernyiation – dyplasia, hypoplaisa
27. Dental material n technology who is responsible – ADA, FDA
28. Anb – 0-2
29. Max 3 molar which space and mand which space
1. . Most pay in dentistry?
2. Cash
3. . Post and core dentist hanged separately insurance considered it on procedure?
Bundling
4. . Traumatic injury to mandible no control act on right posterio side what’s wrong?
Hemato..... right condyle
5. . Most common site for caries pit and fissure
6. . Best side for implant bone type 1-2-3-4 I said 1
7. . 3 years old trauma to centrals what you do? Watch
8. . Distance between 2 important 3 mm I had this question 3 times in the exam

9. . Day 2. IV Antibiotic injection during IAN causes? Which artery did it get in to? Which is
a branch of ? External carotid
10. . Day 2 know that Cellcept causes gingival hyperplasia
11. . Know numbers of all forceps used for max premolar extraction they are 3 you need to
know which is not
12. . X-ray picture Canal like radio lucency in ramus that is mesio distal airways
13. . Mod amalgam filling M part broken in the occlusal surface what do you do? Redo
14. . Question about benadryl MOA
15. . Steps done during wax try in in denture includes all but try face bow
16. . Day two patient asks you to extract all his teeth which ethics contradicts here
17. Autonomy and Nonmaleficence
18. . 2 questions easy about working and non working interferences during lateral movement
19. . Failure of amalgam filling due two moisture contamination. Had this question two or
three times
20. . During gingivectomy cut direction? Coronal or apical? and you only go through which
tissues? Keratinized ?
21. . A lot of pulp diagnostics scenarios not hard to figure like cold lingering pain
22. . Day two ortho movement produces changes in all but ( pdl- pulp- chemical.......)
23. . Tylenol 3 is type 3 controlled drugs
24. . Which primary tooth, if lost prematurely, will most frequently result in space loss?
25. . Day 2 patient had gastric bypass surgery and had erosion in teeth what’s the cause I
don’t remember options 😞
26. . Necrotizing ulcerative gingivitis differential diagnosis
27. . Day two radio opaque root like shape what is it? I said remaining roots
28. . day two while extracting first molar in went in the max sinus what do you do? Flap and
close monitor? Refer to oral surgeon ? Open and try to get it and give him type of med
forgot what it was and one more option
29. . Stridor is diagnostic for ?Laringospasm
30. . Which of the following is NOT an indication for removal of a third molar?
31. The presence of bony pathology
32. History of repeated pericoronal infections
33. Prevent crowding and displacement of the incisor teeth
34. Advanced, generalized periodontal disease that endangers the second molar
35. . Retention grooves in class 5 located axio gingival wall
36. . How we achieve retention in class 2. Prevent restoration from moving proximally?
Retention grooves
37. . Most facio lingual inclination in which primary molar?
38. . Mandibular 2 nd primary molar mostly look like?
39. . Day two when surgically extracting mandibular 3rd molar problem because ?external
oblique ridge
40. . Which of the following factors has the Most effect on the prognosis of a periodontally
involved tooth?
41. . Calcification of permanent mandibular 2 nd molar start at
42. . Day 2 Post and core we do it to?
43. . Ledge during Endo retreat what we do? I said bypass
44. . Least preferred fixed prosthetic to replace a missing tooth 3/4 bridge. Inlay bridge.
Onlay bridge. Full bridge?
45. . The drug of choice for marked bradycardia is which of the following? Atropine
46. . Which pigmented lesion of the oral cavity will resolve spontaneously? Hematoma
47. . Distance between X-ray tube and patient in cephalo? 5 feet
48. . LeFort I osteotomy involves? max sinuse
49. . Some metal elements used in ceramic restorations have been known to cause
reactions in patients. The most common causative element is? Nickel
50. . When saying F the upper teeth should touch? Posterior to vermilion
51. Q131: Which of the following is NOT true regarding orthodontic tooth movement?
ANS: B
52. . HIV count
53. . Which of the following statements most describes the purpose of using sodium
hypochlorite during biomechanical preparation?
54. Dissolves necrotic tissue
55. Reduces hemorrhage
56. Produces cavitation
57. Chelates inorganic tissue
58. . electronic pulp testing how it works?
59. . Which of the following best describes the outcome of and intrapulpal anesthetic
injection?
60. Provides anesthesia by back-pressure
61. . Smokeless tobacco has NOT been associated with which of the following? Nicotine
stomatitis
62. . In conducting a patient interview, the dentist should begin by asking questions that are
general, because it provides the patient with a greater opportunity to express his or her
concerns and emotions
Both statement and the reason are correct and related
63. . 6-year-old patient exhibits defiant behavior at a recall examination. Which of the
following techniques is indicated for the examination? Voice control
64. . Few questions 3-4 about porcelain that I haven’t seen before.
65. . The highest incidence of caries around Class II composite resin restorations occurs on
which of the following margins? Gingival, proximal
66. . Day two case premolar after treatment pain only on one cusp
67. . 2 questions about Adontogentic kerato cyst
68. . Child see another patient. Modeling
69. . Asthma patient taking albuterol has? dry mouth.
70. . HIV patient initial infection is symptoms free. Acute infection was not an option
71. . Infections arising from the periapical region of mandibular third molars perforate
through the lingual cortex to the? Submandibular space
72. . What is the best indicator of periodontal stability over time for the patient on periodontal
maintenance therapy? Bleeding on probing
73. . A similar question to this
74. 45-year-old patient has undergone scaling and root planing in all 4 quadrants. The oral
hygiene of the patient is excellent but generalized 5 mm and 6 mm pockets remain that
bleed upon probing. What is the next step and the best treatment for the patient?
75. Periodontal surgery
76. . Hygienist made mistakes 3 doctors there who’s responsible ? she and attending dr
77. . What is the most likely cause for hemorrhage 3 day after removal of a mandibular third
molar? Fibrinolysis
78. . Access opening for mandibular 1st molar shape triangular or trapezoidal?
79. . Chipped ceramic don’t wanna re do ?Micro-etch, etch, silanate, bonding resi
80. . Same concept question on day 2 Which of the following might precipitate an asthma
attack? NSAID
81. . PA cemento-osseous dysplasia : ant
82. mandible, middle age black women
83. . cemento-osseous dysplasia PA pictures
84. . Brush tongue for? Bad breath
85. . 3-4 questions Anti- cholinergic and cholinergic
86. . Big pulp short roots? Taurodontism
87. . Nitroglycerin downsides or side effects
88. . First thing to do in dry socket? Irrigation- Dressing- curettage
89. . Ludwigs angina which space?
90. . Asked about a tooth in x-ray when did that happen? histodifferntiation and
morphodifferntiation X-ray was bad
91. . Radio opacity in mid canine root
92. . Chronic perio common in blacks
93. . Dry mouth in kids and elderly? Mouth breathing
94. . retentive clasp tip location? gingival third
95. . Impression material that is moisture tolerant
96. . Which receptors is the action of xerostomia on? alpha, beta ?
97. . The ratio of cleft: 1 to 700
98. . Vertical
99. Hole for class 5 prep should be more to the buccal
100. The best time perform oral surgery on a patient receiving dialysis 3 times per
week is? Day after dialysis
101. Similar concept question
102. 90 kVp and 15mA at a BID distance of inches, the exposure time for a film is 0.5
seconds. In the same situation, which of the following should represent the exposure
time at 16 inches?
103. But had to know new time to get same pictures
104. Causality (cause and effect) may NOT be inferred from which of the following
studies?
105. A- Cross-sectional
106. . Acromegaly – classIII
107. . Which of the following represents the 3 essential factors for the initiation of the
carious lesion? Bacteria, suitable carbohydrate, and susceptible tooth
108. . Same concept but different way to say it
109. Which permanent teeth are least often congenitally missing? Canines
110. . Gingivectomy is NOT indicated when the base of the pocket is located? Apical
to the alveolar crest
111. . Regeneration of the periodontal attachment apparatus include?
Cementum, bone, and periodontal ligament
112. We have a small occlusal caries dentist made a composite filling on top of it what
will happen
113. . Adrenal suppression may result from which of the following regimens of
hydrocortisone? 20 mg for 2 weeks within 2 years
Guys these are general notes from previous discussions are done here by
very smart people smile emoticon
General notes
rubber dam gives a black background appearance, affecting the Shade
selection
Everything will llook whiter than it actually is
The attachment of the JE to the tooth surface can occur on enamel,
cementum, or dentin. The position of the EA on the tooth surface is initially
on the cervical half of the anatomical crown when the tooth first becomes
functional after tooth eruption.
ferrule means
"a metal ring or band around a slender shaft that prevents splitting". In
dentistry it basically means a ring of solid tooth structure going around your
crown prep. I believe most prosthodontists recommend 1 mm minimum of
good tooth structure in order to put a crown on a tooth in order to have a
decent prognosis (this doesn't include the build-up). I may be wrong about
the 1 mm minimum- you definitely want as much tooth structure as possible
going around the tooth. This creates what is referred to as a "ferrule effect"
which improves retention and resistance, exactly and the longer the ferrule
the more the resistance to fracture!
welcome...check mosby p 27 as well to get it..
In Davis Crowns a Post + Core is Casted where core covers 1-1.5 mm on
to prepared coronal tooth stump to prevent vertical splitting of root due to
wedging effect of cast post= Ferrule effect
*Forceps #
89# Maxillary right molar
90# Maxillary left molar
17# Mandibular molar
23# Mandibular molar roots
210# Maxillary 3rd molar
222# Mandibular 3rd molar
150A# Maxillary premolar and molars
151A# Mandibular premolars
150S#Maxillary primary teeth
151S#Mandibular primary teeth
65#Max premolars
286#Max premolars,incisors and root tips
Whats penumbra???
Smaller the focal spot area sharper the image appears
Fuzzy unclear area that surrounds a radiographic image is called as
penumbra
So ↑ in source to object distance
↓ in film to object distance.
Smoking is not a contraindication for the placement of dental implants,
however, failure rates are higher in smokers. The failure rate is related to
the amount of smoking on a daily basis and the pack/years history for the
patient.
Based onon angle formed by cutting edge with edge of the blade.
Away from the handle distal GMT
Towards the handle mesial GMT.
BURS-:
330- pear shaped, 34 inverted cone, 6-round, 558 straight fissure cross cut.
round- 1/4, 1/2, 1, 2,3,4,5,6,7,8,10
Inv cone- 33 1/2, 34,35,36,37,38,39, 36L, 37 L
Straight plain- 56,57,58,59,60, 57L,58L
Straight cross cut- 556,557,558,559,560,557L, 558L
Tapered fissure plain- 169, 170,171,169L,170L, 171L
taperd cross cut - 699(l)700 (l),701,702,703,
End cutting-957,958
Wheel-14
Pear- 329,330,331 331L, 332
It's dried blood. Someone mentioned on the earlier posts only dripping wet
blood comes under regulated waste; went by that explanation
y-shaped in antral. I remember someone had got this in their exam.
ITS BBBB...CHECKED WIKI...ITS ASKING MOSTLY SO B MAKES
SENSE..At low doses, nitroglycerin will dilate veins more than arteries
(reduces preload, primary mechanism of action), but at higher doses it also
dilates arteries (afterload reduction) and is a potent antihypertensive agent.
In cardiac treatment, the lowering of pressure in the arteries reduces the
pressure against which the heart must pump, thereby decreasing
afterload.[18] Dilating the veins decreases cardiac preload and leads to the
following therapeutic effects during episodes of angina pectoris: subsiding
of chest pain, decrease of blood pressure, increase of heart rate, and
orthostatic hypotension.
Ectopic eruption sequences: Its max first molar>max canine>mand
canine>mand second premolar>max lateral.... Most common to least
Hep C. Also associated with chronic liver disease, hepatocellular
carcinoma and the no 1 cause of liver transplantation in US
Other names for alarm clock headache: Cluster headache, Horton's
headache, red neuralgia, histamine headache, and Sphenopalatine
neuralgia
best post= parallel and best pin= self threading
Biostatistics in Pt management
* Validity....> should be compared to gold standard and should be high
sensitive,specific and unbiased
*Realibility....> should be reproducible and repeatable with same value
means produce similar results
* Sensitivity....> % of persons having the disease TP/TP+FN X 100%
* Specificity ....> % of persons not having the disease TN/TN+FP X 100%
* predictive value positive....> TP/TP+FP X 100%
* predictive value negative....> TN/TN+FN X 100%
Highest prevalence of caries = Hispanics
Highest DMFT = White (caucasian) (highest amount of restored teeth)
Highest untreated primary teeth = Hispanic
Highest untreated perm teeth = Black (African American)
Moderate periodontitis = Black males ( African American)
Class II caries = Whites (caucasian)
Class III caries = Blacks (African American)
Cleft lip/palate w/ Class III occlusion = Native American
Cleft lip alone = Asian
Cleft lip in USA = 1:700 to 1:800
class 2 malocclusion : whites of northern European descent
class 3 malocclusion : Asian
Caucasians have more lip cancer while African american have more
oropharyngeal carcinoma.
Anterior open bite: African American(blacks)
Deep bite: cuacasian( whites)
Cemento osseous dysplasia - black middle aged wome
so caries is generally low in down sy and periodontal disease are high in
these patients. At the same time in case of cystic fibrosis due to medication
(antibacterial specially tetracycline) and composition of saliva caries is very
lowe(lower than Down sy). If you had both, then choose CF smile emoticon
,I red this today in oral patho smile emoticon
il-8 attracting inflammatory cells, TNF similar to il-1 but less potent, mmp 8
is collagenase so they involve in periodontal tissue destruction.
Minimum thickness of a connector is 3 mm
Mesiodistal area is shared by pontics and connectors
..In Class 2 -->Amalgam (internal line angles are rounded)
but in case of Class 2 -->Inlay (internal line angles are sharp)
umm..In working side interferences:BULL rule (inner inclines)
In Balancing side interferences:Mandibular Buccal Cusp (inner inclines)-----
-->although they are Secondary Centric Holding Cusp
we never grind Maxillary lingual Cusp (Primary Centric holding Cusp)
Can be both D and B.. Supracrestal fibrotomy B is particularly for
rotations..while D keep the contacts wide is for lower anteriors so as to
make sure to prevent slippage of contacts...as given by Raleigh Williams
and I think also in Garber...I ll go with D...
For Cusp Protection via GOLD
a.Capping is done in Functional cusp
b.Shoeing (Veneer) is done in Non functional cusp except Buccal cusp of
MAXILLARY PREMOLARs and MOLARs
for minikin ..its 3 mm
minim ...5 mm
cross bite:----Dentoalveolar: Inclined plane, Reverse SS Crown, Tongue
Blade, Maxillary Hawley with Z-Springs, and Posterior Bite Block
Combination to discclude the anterior dentition
Functional... check for the premature contacts.... Most likely they are
primary canines which are the culprits as they haven't attritioned with rest
of the primary dentition
osseous resective surgery includes ostectomy and osteoplasty.......in which
aim is to reduce and removve supporting and non supporting bone ......in
this first of osteoplasty includes technique of fesooning which is vertical
grooving or bone festooning to reduce buccal and lingual thickness of bone
interdentally........
Aldosterone release and presence of insulin causes uptake of potassium
from blood stream causing hypokalemia
Both true,etching time for primary teeth is 30-60 seconds.
patient is aware of problem but there are some barriers like time,
expenses.. so it comes under contemplating
Overextended max denture ______ result in sore throat
Condylomata acuminata (6-11) HPV while 16 18 , 31 33 HPV for verrucous
carcinoma
1 nd 2
High copper(no gamma 2 phase no loss of marginal integrity)
Spherical(less hg content 40-45%)
Acromegaly :Enlarged Tongue
Pieer robins:Posterior tongue displacement(glosoptosis)
Down:fissured
Does anyone have a reference for 3?
A crown's color is selected by looking at the adjacent teeth. And if it has
gotten 'lighter' means the adjacent teeth have stained. And since a crown is
selected by looking at surrounding teeth only, will we not change the crown
rather then messing with all these other teeth?
Flouride fatal doses
Fatal dose 16 mg/kg in children
2g in adults
while toxic dose 5-10mg/kg in children
Agranulocytosis, you see ragged ulcer in gingiva and palat
@Yeah Swiss cheese pattern in cribriform is seen in adeno ....and honey
comb in acinic
1.5 mm between tooth and implant and 3 mm between two implants
This was discussed here a few days ago , someone wrote that serial
extraction may cause deep bite , coz of lack of support , so in case there is
already deep bite present then its better not to do it
it's written in decks that OSHA responsible for all the employees to get hep
b vaccination and it tells cdc to take care of those vaccination..I don't
remember
Bonding agent contains a hydrophilic n hydrophobic strata . Hydrophilic
part bonds to dental tissues n composite should bond to the hydrophobic
part... since dentin contains more organics n H2o than enamel, the agent
bonds better to dentin than enamel
GINGIVAL CYST of newborn or adult Not seen radiologically. Not to be
mistaken with Epstein’s Pearl (on median palatal raphe) and Bhon’s nodule
- seen on alveolar ridge of the newborn.
Operant conditioning (sometimes referred to as instrumental conditioning)
is a method of learning that occurs through rewards and punishments for
behavior.
b, you dont remove caries when they are half way in enamel.. they are
treated by flouride tx... but when it touched DEJ you have to remove it
16 Weeks between the 1st n 3rd dose n 8 weeks between dose 2 n 3. If
only dose 3 is left it should be given immediately
For ADHD patient ask patient to have the medicine 1/2 hr before
appointment, rest is all same , keep short appointment and morning one,
Yes most is chlorphenarmine maleate then phenargan then least is
diphenhydramine
Aluminum is the weakest crown material for implant abutment
pneumbra, causes indiscrete margins of x-ray's film
245- cavity prep
Prospective-->foward in time (starts with the risk factor and ends with the
disease)
Retro(back)pective--->Backward in time(starts with the Disease and asking
about the risk factor in the past)
iagnostic Clues Craze lines are frequently confused with cracks, but can be
differentiated by transillumination. If the tooth is cracked, the light will be
blocked, allowing only a segment of the tooth structure to light up; if the
tooth only has a craze line, the entire tooth structure will light up,shouldn't
the answer be Periapical abscess then as the tooth is intact?What is the
answer?
Ok,Periapical abscess seems appropriate as the whole tooth is intact n can
be illuminated.
low grade mucoepidermoid carcinoma has best prognosis
Iopa of max canine in periapical region lateral wall of nasal fossa and
anterior border of maxillary sinus form an inverted Y known as inverted Y
OF ENNIS
B, this is what I found
Most Sensitive: Blood-forming organs
Reproductive organs
Skin
Bone and teeth
Muscle
Least sensitive: Nervous system
Physical restraints for moderate retarded child at emergency ... Cos voice
control and HOME are for pts with normal mental activity.. GA not possible
as it is an emergency visit...
Thanks sir smile emoticon what's the sequence of hue value chroma when
we have to match a shade?
First Hue then Chroma then Value
Wavelength dependence ------> hue
Concentration dependent------->chroma
Reflection of amount of light dependent-----> value
For years, people with asthma and allergies have been told to avoid
antihistamines because they dry sinuses and cause constriction of the
airways and sedation. Newer antihistamines, including fexofenadine
(Allegra), loratadine (Claritin), and cetirizine (Zyrtec) may be beneficial for
mild allergic asthma, but antihistamines are still problematic and are usually
not beneficial for moderate to severe asthma. People should not use
antihistamines if a sinus or respiratory infection is present. Used routinely,
antihistamines thicken mucous secretions and can worsen respiratory
infections. It is particularly important to treat any co-existing sinus infection
in people with asthma because they might not respond to asthma
treatments unless the infection is first cleared up.
Contemplation
reason:
Contemplation . pt is thinking about quitting but not enough motivated yet..
pre-Contemplation .. pt is not even thinking of quitting
i think that denial and preContemplation are the same..
action. pt is actually working to quit.
correct me if i am wrong ...
yep... I was reading some random article and according to tht., if
fluconazole isn't the given choice then ketoconazole is the answer...for
systemic anti fungal
According to A.D.A., the acceptable dimensions of a tooth brush are
(a) 1-11/4 inch long, 5/16-3/8 inch wide, 2-4 rows, 5-12 tufts per row
caries is seen on which aspect of 1st primary molar??
distal surface, occlusal,
Ans is occlusal.
Full ext—how long do you wait for max denture o 1 day
o Same day o 1 week
o T- 8 week o 16 week
6 weeks for preliminary impression and 8 weeks for final impression
The pain from the loss of
pulpal vitality is the most common presenting complaint ofpatients with
combined lesions.
The symptoms reported are those most often found with pulpal disease.
Thermal
pulp testing provides information relative to the status ofthe pulp, and
dental radiographs
can confirm the presence of apical changes and the extent ofbone loss.
Careful probing
confirms the presence and morphology ofany periodontal pocket and
permits location of
the conmunication with the apical lesion.
In combined endodontic-periodontic lesions, it is generally wise to treat the
endodontic
component first, because in many cases this will lead to complete
resolution of the
problem.
After successful endodontic treatment, the residual periodontal pocket that
remains can
be more predictably heated. The periodontal therapeutic objeclives vary
with the extent
Permissive way....wid special child
decisive is when its a normal child and u know he has ro capabilities to
understand the reason
ans is pemphigoid where there is seperation of membrane and epethilium
from connective tissue whie in pemphigus there is blistering of skin due to
antibodies being direted against desmosomal adhesion molecules
..meaning only the epidermis is affacted
Pemphigoid -sub basilar cleft
Pemphigus- intra epidermal cleft
intenal: RCT, for external: if not self limitting than in most cases extraction
chi-square is the sum of the squared difference between observed (o) and
the expected (e) data (or the deviation, d), divided by the expected data in
all possible categories.
From best to worst for implantation ...
D1 Ant Mand,
D2 Post Mand,
D3 Ant Max,
D4 Post Max:)
ECC locations start with the most affected
1. Ant max
2. Post max
3. Post mand
4. Ant mand --> least because tongue cover them
unbundling is done by dentists and downcoding is done by insurance
bundling : all pricedures into one -by insurance
upcoding : dentist playing with codes to get more $$
If there was any other problem the margins wouldnt have fit....whenever we
are fitting a crown the first thing u check is proximal contacts...then margins
and then occlusion...so if the margins are ok it is understood tht the
proximal contacts are ok too
Its iv bisphosphonates its effect will not reduce on stopping the medication
just 3 months before that too when patient is taking from 2 years, I guess
second option will be best , we will definitely choose non invasive
procedure coz its IV bisphosphonates
Normal salivation rate is : It's 1.5 L/day = 1 ml/min
a pier abutment is a natural tooth located between 2 terminal abutments for
example..if u have a missing 1st premolar and missing 1st molar,the 2nd
premolar would be the pier abutment that is located between the canine
and 2nd molar.
condyle for both...only difference is second most common...symphysis is
2nd most common in children and angle is nd most ommn in adults
To make the crown narrower , Move line angles more facially and increase
interproximal embrasure
mental the most difficult one,platal the easiest but painful,The buccal block
is a successful injection because the buccal nerve is readily located on the
surface of the tissue and not within bone
In self cure: initiator- benzoyl peroxide, activator: toluidine. In heat cure:
initiator -benzoyl perxide , activator -heat.
Working cusp for amalgam is 2.5 to 3
Non working for amalgam is 2.o
W cusp for cast gold is 1.5
Non w cusp for cast gold is 1.0
W cusp for metal ceramic is 1.5 - 2.0
Non w cusp for metal ceramic is 1.5 -2.0
I read that people with CP have a 30-50% or 35-50% of seizure
development and mental retardation/learning disability.
Working side interference: reduce de lingual incline of the buccal cusps of
maxilary molars and inner incline of lingual cusps of mandibular molars.
Non working side interference: grind only the inner incline of the buccal
cusps of madibular molars. In reality u should never reduce the primary
centric holding cusps (lingual of max.) But in nbde u can reduce it if is high
in centric, protusive and lateral excursion movement.
Stieglitz pliers -- use for removing silver points
Implanted opened apex tooth regain blood, Ans is 20 days...it will be
regained within 20 days after replantation but nerve supply lags behind.
Cavicide disinfectant for dental chair
Is phenargan contraindicated in pregnancy
Animal reproduction studies have shown an adverse effect on the fetus and
there are no adequate and well-controlled studies in humans, but potential
benefits may warrant use of the drug in pregnant women despite potential
risks.
CATEGORY C-pregnancy
b . cheek bite with edge to edge relationship
A dentrifices have 20-40% abrasive particles. And a abrasive paste have
about 80% of abrasive particles. Also most dentrifices (tooth pastes) have
fluoride incorporated... most tooth pastes have 1450 ppm of fluoride.
300-200/1000 = 0.1, incidence define no. Of new cases- pasted from
another group.
April RQ 2018
Ayrton Senna
1- majority of unstimulated salivary flow comes from which gland? parotid- submand.- subling.?
2-cervical caries from radiation due to defect in enamel- dentin or salivary glands (ans.) due to
xerostomia (dry mouth) that associated with SG disease (Sjögren’s syndrome)
3- pulp testing for a tooth with crown? Cold

4-pain for few moments that goes away after removal of stimulus? Normal
5-alot of patient management questions
6- 2years old kid has fear of ... separation

7.4 years old .. fear of unknown
8-Speech difficulty in cleft palate pt..reason
9-maxillary tori that inteferes with pps

10- What is true regarding wheelchair transfers?
A- A wheelchair-bound patient is often the best source of how to do the transfer *
B- The patient should be asked to remove his/her catheter and collection bag before attempting
the transfer (no)
C- The patient’s belt should not be used during transfer process (no)
D- Sliding board transfers continue to be the best approach (no)
A is correct according the ADA management of wheelchair patients guidelines. It’s because
not all the patients need the sliding board, basically some patients maybe in a wheelchair
but some of them can walk, others can use their hands, others have back problems, etc, etc.
Manual says to ask them first how they feel comfortable, most of them have their preferred
method with their caregiver, and their own routines.
11.Which of the following is NOT an internal line angle found in a disto-occlusal (DO) class II
cavity preparation? Distoaxial
12- An HIV-infected patient’s viral load is 100,000 and T cell count is 30. Which of the following
statements is true?
A- There is no contraindication to providing treatment
B- The virus is under control suggesting improved ability to resist infection
C- The virus is almost under control and there is low risk for infection
D- The T cell count is low, putting the patient at risk for infection and complications
-- What is the most common form of wound healing after a periodontal flap surgery?
13-Which of the following is NOT a clinical presentation of oral Candidiasis? A- Erythematous
patch
D- Ulcerative patch
14- 25- Which of the following is used primarily as filter material in a dental X-ray machine?
A- Oil
B- Lead
C- Aluminum
D- Tungsten
E- Molybdenum
What structure can you not see on a PA radiograph

-Hamular process
-Mental Foramen
-Coronoid process
-Mandibular foramen
Pay attention guys , there is another q they put coronoid notch instead of coronoid process.
Coronoid notch also can not be seen on PA
15- most commonly used clasp material

16-medications that causes xerostomia? Cholinergic
17-sialothiasis on xray with given history of hard bony movable mass

18-patient profile q convex or concave
19-tooth eruption compared to patient's age and xrays

20-epulis fissuratum pic
21- pano errors

22- external auditory meatus on a pano.
Mohammad Anaam
23. Hepato toxic drugs-they will give a list of drugs ,u will have to select which causes
hepatotoxicity
24. Type of force applied to PDL during ortho? Direct and continuous
25 Least complication in upper and lower extraction
26. Where is the initial incision placed for FGG
27. Patient moves his head continuously during panoramic, results in?
28. Gas solubility

29. Internal attachment question on implant
30. Know about alpha and beta blockers. they will ask specific drugs
31. Incisal 1/3rd and the coronal part –in porcelain metal crown is by
A)internal coloring of porcelain,
B )External glazing,
C)polishing and grinding to change light reflection
D)firing under high temp
32. Stane’s defect -Diagram
33. Implant placement measurements in maxillary sinus
34. Which bone is best for implant :
35. Metastasis of cancer is seen in which part of the oral cavity

36 Diff between ANUG and HERPES
37. Treatment for geographical tongue
38. Finish line for PFM
39. Negative value calculation. ans=20
40. Wheel chair question

41. When do you remove tori
42. Tooth out of occlusion Reason? Ankylosed primary tooth
43. Block out teeth

44. Indicator for future caries risk
D. Altering the organism, its nutrients, and

its environment enhances prevention and
treatment objectives
45. In which condition, amalgam is replaced: secondary caries, corrosion etc
46. PEH ,where is it seen ? granular cell myoblastoma.
47. Probing is measured from the gingival margin to pocket base

48. Calcification of 2nd molar? 2.5-3 years
- Distal extension RPD? Class I and II kennedy

Class I & II RPDs are supported by abutment teeth, the residual ridges, subjacent tissues,
and fibrous C.T. overlying the alveolar
process.
49. For a researcher which is the best perio method for study? The Community Periodontal
Index of Treatment Needs (CPITN), developed by the World Health Organization to summarize
treatment needs, combines an assessment of gingival health, pocket depth, and the presence of
supragingival and subgingival calculus. Mosby.
50. Lots of endo questions: -asymptomatic pain, pain when eating, during sleeping, No pain, RL,
without RL all scenarios know well
51. Many patient management questions. Mostly related to child management during dental
treatment, aggressive child, uncooperative child etc
52. Dentist does some mistake in the procedure, he does the procedure incomplete what is it
called? Non maleficence
53. Child turns blue leads to when GA in process? Diffusion hypoxia
54. Treatment sequence

55. Hemangioma Diagram
56. Endo first or perio first -they will give you the scenario
57. Do trauma well, they will give scenario-based questions like after certain number of days or
hours Patient sees the dentist, what procedure will you do. They will specify the period example 5
hours after trauma what treatment
58. Dexterity both at what age,7,5,8
59. When do we do alveoplasty

60. Can we use tilted toot for abutment? T/F in posterior region
61. Management of Psychiatric patient
62. Perio revaluation
63. One ortho question from Mosby straight canine erupts first or premolar?
In max premolar erupts first, and in mandible canine erupts first
43. Maxillary growth type-Mosby
64. Efficacy question, they had mentioned some ratio ED50 something related to it
65. Hep A cause?
66. FDA study -ans RCT

67. Health care expense in the US is paid by: - Medicaid, Medicare, Self, Private Insurance
68. Furcation involved primary tooth treatment what is it for first molar? Pulpectomy
69. Attached gingiva measured from? Free gingival margin to mucogingival junction
70. Question on sensitivity and know the calculation. they will give the numbers.
71.Antibiotic for Non odontogenic Maxillary Sinusitis ? Augmentin/amoxicillin
72.local anesthetic for hyperthyroid patient? Mepivacaine
73.Exact MOA of H1 Histamine blocker ( physiological antagonism,block histamine receptor,other
option)b?
74.how to motivate the pt for proper oral hygiene, you do all except? c?
A - positive reinforcements
B - operant conditioning
C- motivational interviewing
D- carrot stick
75. Question about hydroxyzine – H1 blocker 1st generation
76. Tooth with a ledge- how to manage. Ans Bypass with smaller instrument
77.low sag factor ans Less deformation of bridge span during firing
78 side effect of clopidogrel? ans bleeding,Headache itching easy bruising,rash, neutropenia,

thrombocytopenia
79.oral cancer black, white. ( 5 years survival rate) Ans Black oropharyngial,White lower lip. 5
years for SSC
80. two implants in for denture gives?
1. implant gives support.and retention
2.implant gives support,tissue gives retention .
3 implant gives retention tissue support ans; 3
I think 3 because 2 implants. If they are 4 implants, then 1 is ans.
81. What you use for supporting bone? 1.osteoplasty 2 Osteotomy 3Osteoectomy 4resection
ANS 3
82. Purpose of making record of protrusion relation... something like this. A lot of
prosthodontics
ans To adjust horizontal condylar guidance
83. SJ file page 23 must know all pharma Q. I had

1. TCA
2. Interaction with Epi
3. Antibiotics!!!
4 asthma meds.
4 Ranitidine MOA
5.meperedin ( Demerol)
6. Beclomethasone.
84. Sedative Meds for pregnant and lactic mother ( Promethazine was in option)
85. ANUG treatment ans Debride h2o2 and antibiotics only if systemic involvement
86. Who LEAST affected by N/O 1. Dentist 2 Patient ...ans 2? Most – dentist, least – patient
87. Meds for pet mall.ans petit mal= absence seizure = ethosuximide(zarontoin)
88. Kids most having what type of seizure( febrile was in opt) ans Febrile or petit mal
depending on question
89. What meds not use in Angina . 1. Thiazide 2.Ca blockers 3 B block 4. Ans 1
90. Primary area to support Mx ans Alveolar ridge or palate?
91. GTR furcation , wall defects ans gtr for wide 3 walll and narrow 2 wall/ Best for class 2
furcation
92. Major connector function Stability and rigidity,Connect parts of the denture, opposite sides
93. Ca hypochlorite best use for 1. Primary steel crown caping 2 root canal perphoration 3
medical root canal feel ans 3
94. EDTA function Cheating agent
95. Hypochlorite function and what not is function ans function: lubricant, irrigant, tissue
solvent, antimicrobial effect . not function Not a chelating agent
96. Histodifferentiation what happening ans Amelogenesis imoerfecta and dentinogeneuss

imoerfecta dentin dysplasia - structural deformity
97. SLOB Same lingual opposite buccal used for interposed objects
98. Implants Q. Abutments , in day 2 cases a lot of implant Q . Can we plays or not according to X-
ray
99. Most radioresistant ( nerve , muscle) ans nerve
100. Why amalgam fracture? ( inadequate width prep, excess deep prep) 1
Not enough depth of cavity or too narrow
101. Why we stimulate the pulp for diagnosis... not sure about Q... 1 to relive paine 2 to make sure
that
EPT working and 2 more options ans stimulate nerve
102. Reason why people have supernumerary teeth. 1.Hereditary 2 calcium- phosphor
disbalance 3 endocrine problems 1
103. Who responsible for dental materials and technology? ADA

104. What not for metal crown? Shoulder, chamfer,shoulder bevel ...ans We don’t do shoulder
For metal it’s chamfer
105. Powder in ZOE ?Zinc oxide

Powder is zinc oxide and the liquid is eugenol.
106. Xcerostomia treatment ?Saliva substitutes, Xylitol gum, Pilocarpine, civemiline
107. All ⬇ salivation Except ( pilocarpine) true
108. For VDO ? S, F

109 Q about Allograft, autograft
110 X-Rey:
.1/ nutrient canal,
2. paget daisies,
3.ideopatic osteo.
4. Odontoma.
5. Ameloblastoma,
6 ossifying fibroma,
7. hyoid bone, #26
1. Coronoid process of the mandible.
2. Sigmoid notch.
3. Mandibular condyle
4. Subcondylar region.
5. Ramis of the mandible
7. Inferior border of the mandible. Evaluate #4 – 7 for cortical integrity.
8. Lingula
9. Inferior alveolar neurovascular bundle (mandibular canal).
10. Mastoid process.
11. External auditory meatus.
12. Gleaned fossa (temporal component of the TMJ).
13. Articular eminence.
14. Zygomatic arch.
15. Pterygoid plates.
16. Pterygomaxillary fissure.
17. Obit. Evaluate.
18. Inferior orbital rim.
19. Infraorbital canal.
20. Nasal septum.
21. Inferior turbinate/soft tissue concha covering.
22. Medial wall of the maxillary sinus.
23. Inferior border of the maxillary sinus.
24. Posterolateral wall of the maxillary sinus.
25. Malar process.
26. Hyoid bone.
27. Cervical vertebrae 1 – 4
28. Epiglottis.
29. Soft tissues of the neck 33. Nasal air.
30. Auricle (earlobe). 34. Bone of the maxilla.
31. Styloid process. 35. Carotid artery.
32. Oropharyngeal airspace.
8.X-ray artifact ,
9. root tips ,
10.normal tissue ,
11. J shape ,
12. Perecornitis
Chronic infection site causing pericoronitis (white arrows).
111 Patho pict. Herpetic stomatitis , varicosity, melanotic macule, exostosis .

112 Candida treatment not systemic ? nystatin
113 Cases . Ortho . ANB must know ans ANB - 0 -4 normal, more than 4 class 2, less than 0 class
3
114 Pt Irreversible pulpits , reversible pulpits and type of treatment for them.
115 3 years intrude incisors , not affect permanent. What you will do. Ans observe
116 . Pt with white spot on facial premolar , not cavitatet , not sensitive , your treatment ? 1. No
treatment, 2 GIC 3 composit ans 1
117 Pt has bad OH, calculus , gum bleeding. She wants prophylactic cleaning , what is your
treatment ?
1.you do prophy as Pt request.2 explain her that it can take 2 visits.3 tell her that she need to do
better job with OH 3 SRP ans 2
118.BULL , LUBL
119 Fusion, germination
120 When you need to use papoose blanket ans uncooperative patient
The Papoose board (sleeping bag): is passive

restraint used to immobilize patients during
dental treatment. The papoose benefits the
patient by safely keeping arms and legs still to
prevent injury during dental work without
forcibly holding patient down. The papoose is
routinely used during oral sedation procedures,
emergency dental procedures, and quick dental
care for the very young patient or patient with
special needs. The papoose is a type of restraint
and is not ever used as a punishment for
uncooperative patients. This may not be an ideal
choice for children with extensive dental
treatment needs.
121 Transillumination use for kids for what? Sialolith
122 Broken 3 molar root what space.

123 Elastomers know what is good what is bad with them.
124 Headgear applaenses. what treat? Class 2
125 Trauma in accident . Tmj problem

126 N/O q all contraindications ans NO is
contraindicated in nasal congestion and COPD, 1st
trimaster
127What age you can place implants. Ans 18
128 Success rate on Not surgical endo treatment %. 1. 60-70,70-80,80-90,90-100 ? 80-90

129 Sliding for elders. no belt was in options too... lol.) wheel chair
130 About positive reinforcement , and 3. Q about desensitization
The recognition and reinforcement of successive approximations of a behavior is called:
a. Shaping
b. Negative reinforcement
c. Extinction
d. Positive reinforcement
e. Desensitization
131 A new diagnostic test is evaluated against an independent “gold” standard” in 100 subjects
with the following results:
True positive = 48
True negative = 8
False positive = 12
What is the negative predictive value of this new diagnostic test? A- 20 percent
B- 40 percent C- 60 percent D- 80 percent
ANS: A
TN/TN+FN *100% = 8/8+32*100% = 20%
132 CPITN= Community Periodontal Index of treatment
133 Seemed distribution
Skewed Distribution . If is positive o negative
• Normal distribution - symmetrical and bell shaped
• Skewed distribution – assymetrical (Mosby p.226)
134 If you have two distribution that are asymmetrical that’s means a) normal b) skewed
c) bimodal(bimodal 2peaks and symmetric)
Ans b
135 Fetal alcoholic Syndrome What is not a
feature? I put nose long

136 Trisomy 21 was is not feature? Macroglosia, class 3
137 Ludwings angina doesn’t involve?Retropharyngeal

138 Troch – clotrimazole
139 Traumatic cyst – around the roots,Scalloped radiolucency
well-defined unilocular or multilocular radiolucency with scalloping around the roots
140 perforation- anteriors mesial?

141 hairy tongue. which papille? Filiform
142 NO2 is teratogenic and not recommend :

- 1st trimester
- 2nd
-3rd
-all
ANS 1st
143 epithelium - 0.5-1.0
144 transilumination. sialolith
145koplick. rash. eyes red - measles/mumps? Measles
147. frankfort line?Prion to orbitale
148 Chronic periodontitis common?

a. Male Hispanic
b. Female Hispanic
c. Male black
d. Female black
149 carcinoma in situ= leukoplakia?

150 class V doesn't have occlusal wall? pulpal wall
151in normal dentition 80% should consider: a. centric relation b. centric occlusion
152. in class 2 furcation what is not recommended?
a. hemi section
b. GTR
c. Extraction
153 battery? Without informed consent

154 what you can give with ischemic attack? Nitroglycerine
146 abscess - neutrophils/plasma cells? Acute – neutrophils, chronic - plasma
CASE
Case 1: old man , has MI, had adenocarcinoma before, took radiotherapy for that, hepatitis before
24b yrs, smokers, knee replacement before 6 months,
Oral findings: white patch on floor of mouth, anterior cross bite, missing maxillary molar and
exostosis on the buccal of mandibular premolar /molar area, melanotic macule on the palate
Quest:
3. Patch on the floor can be all except: STOMATITIS NICOTINA
4. Which lab test for the viral infection : HgSab ,/ HgcAb/, Transaminase ,/ no test
5. The patient is at increased risk for all except: Procedure related bleeding
Hyposalivation Osteoradionecrosis SCC
Related only to the anterior region ( on the left side he had a missing canine maxillary and the
posterior bite looked collapsed)
The premolar will function for the missing canine (smthg like this)
8. Most important to consider when deciding for the antibiotic prophylaxis: time elapsed
since the surgery
Case 2: 8 yr old girl with many missing teeth due to caries and poor oral hygiene.. anterior cross
bite and a supernumary tooth
Quest:
Injury to the nerve due to any previous accident can be increased(or somthg like that) during
ortho
2. All are negative sequel of extraction of the supernumary tooth except
Necrosis of 7
Non eruption of 7
Necrosis of 8
Necrosis of 6
3. Correction of the anterior cross bite will result in all except
Improve eruption of tooth 11
One more option
4. Correction of cross bite ASAP
Case 3:
Take albuterol
Quest:
3rd molar Occlusal trauma Caries
Steroid inhaler
B2 agonist inhaler
Give oxygen
Quest:
Poor oral care as a child Lack of fluoridated water Untreated periodontal disesese

2. All are risk of extraction of the upper teeth. Which is LEAST excepted
Dry socket Tuberosity fracture damage to adjacent tooth

Case 5
Another case where the patient had edentulous space in the mandibular teeth with 18 present.
Has radio opacities in that edentulous area.
What is least considered when planning for an implant. Extraction of 18
One more- don’t remeber( it was important consideration) Random true/false that remember
1. Smoking is a contributing factor for periodontal disease

2. Extraction of 32 causes damage to the lingual nerve

After extraction of 32 the soft tissue should be biopsied

Bharti Sharma
NBDE Part 2 RQ April 2018
Day 1
• Gingivectomy
• Cleft Lip/Palate
• LA Calculation 3 yo, 16kg child- Max Dose
• Mod Widman Flap
• AOT
• Dentigerous Cyst
• How many furcations without molar- 14
• Refer pain to ear- MD Molar
• Prevalence
• Cross sectional/cohort/clinical trial/longitudinal studies
• Multiple sclerosis first sign
• Cliedocranial is to clavicle!!
• Question number 58,60,37, 70,72,75,79,83,95,104,122,141,174,176,180,183,202,226, of
ASDA
test packet L
• C. Difficle/ Pseudomonas
• Varix
• Treacher Collin’s
• Ewing Sarcoma
• Thomas and chess Classification
• Types of bone for implants
• mA
• Overly opaque RG, why?
• EDTA- Chelation
• Silane
• Work Hardening
• Y resin better than Amalgam?
• Class V prep
• Weakest type of PMMA for fabrication of CD
• Lat. Periodontal Cyst
• Ludwig Angina
• Prostaglandins
• GABA
• Nicotinic Receptor
• Band and loop
• Child Hrt Arrest- Resp Depression
• Broken Orbit and side of nose what wall of MX sinus- Medial
• Leukotrienes
• LAP
• ANUG
• Cystic Hygroma
• AML
• Glutaraldehyde- sterilization for plastic
• Selective B1 adrenergic blocker( I got confused with 1 / 2 got this wrong)
• Tooth Agenesis
• Bisphosphonates/ osteomyelitis
• Pregnant lady which str is compressed IVC
• Laryngospasm/ Stridor
• Acute herpetic gingivitis
• Necrotizing Sialo metaplasia
• More Complete Cure
• Intra pulpal inj – suck back pressure
• RPD
• Ante’s Law
• Potassium sparring Diuretics- Spironolactone (I did Furosemide)
• Gypsum W: P ratio
• Coumarin blocks what? Something about hepatic
• Amide/ Veneer
• Tooth bud formation- 3-6 wk in utero
• Intrinsic activity/ INR/ Platelet Function
• Rheumatic heart disease
• Gardener’s syndrome
• Avulsed tooth/ ext root resorption
• Target to pt distance- 5 ft
• MPDS
• SCC
• Verrucous Carcinoma
• Q 73, 77 , of asda J
• Condensing Osteitis
• PCOD
• Osteoradionecrosis
• Trigeminal Neuralgia
• Le Fort 1
• Leeway Space
• Disadvantage LED
• F, V sounds
• Cracked Tooth
• Irreversible pulpitis
• Tooth necrosis
• Concussion
• Cracked Tooth Syndrome
• Apexogenesis/ Apexification
• A dental setting owned by 3 dentist and Hygeinist makes mistakes, who is responsible?
• Veracity, autonomy, modification, distraction, extinction, Voice control
• Distraction Osteogenesis
• Splinting
• Need of Helix
Day 2
• I don’t know hat it was. It was crazy, I felt like idiot. Dozens of crazy drug names I have never
heard of and I didn’t even remember. I really wish I pass this exam. Pray for me guys!!
• Extraction Forceps for Premolars
• Hodgkin’s Lymphoma
• RPD Designs
• FPD
• Thistle tube Tooth
• Alcoholic
• Kidney transplant, heart murmur, Valve relapse, Hodgkin, in a kid with gingival
hyperplasia? What medicine caused it, only brand names were given, what is the appropriate
treatment, what should be avoided in such a patient.
• Class II, Crossbite, ectopic canine eruptions, what’s the treatment, girl is 14 yo, shd expander
be used, shd there be simple orthodontics, extraction or disking of other teeth to accommodate
them in the space
• Asthma patient, albuterol and something related to it
• Regional odontodysplasia
• Ceph, Crown preps,
• Pt wants all teeth pulled out, though its not required, which two ethics are under conflict-
Beneficence, Justice, veracity, Maleficence, Autonomy. They all were paired in two. Select one,
{I chose Beneficence and autonomy thinking Do Good and That patient has a right and choice}
• I literally cant remember those drugs I got . 2-3 cases all related to pharma question, learn
brand names, learn dosage, immunosuppressants, cardiac drugs, Diuretics, Renal Failure,
• Geographic Tongue
That’s all guys. I hope all these points help you. Things will come confusing. Go in detail for
each topic in mango. Do asda paper, especially L. I tried remembering all I can. This group is
awesome. Stay active here. I just pray I pass.
NIKKI RQ
NEW Rqs
Day1
1.Dens invaginatus most commonly seen in MAXILLARY LATERAL INCISOR.
2. medication used in renal failure Oxycodone, acetaminophen
3. Test for alcohol abuse person
4.Test you do before surgery (PT/INR)
5 Difficult flossing area (mesial of max first pm & distal of max 1st molar)
6.Sore throat in pt havingMn CDdue to? impinging of (distolingually flange)
7,Pt had cl2 amalgam restoration for asymptomatic tooth after 2 days came to clinic with
severe excruciating pain
a acute pulpitis
b crack in teeth
c teeth high in function
8. Best amalgam a high cu
b conventinal
c high cu admixed+high cu spherical
9 Over trituration causes ( premature set of amalgam)
Fast setting, decrease strength.
10 Glass fiber post property
11 Fiber optic illumination for
12 Theophylline drug interactions
13 Central acting drugs you need to depress what (Q vague)(in desc lines)
a hypothalamus b cerebellm
c limbic system
14 No2 contraindication
15 Insulin (20units)pt takes controlled diabetes underwent extractions post treatment

a treat him like normal pt
b others are so irrelevant
16 Beclomethasone
17 which among is not acidogenic bacteria

a strep mutans
b lactobacillus
c act viscosus
17 dental matrix of plaque made up of dextrans + which is produced by
.a levan
b mucoproteins
18 discussion on consent done by dentist with pt when? Before treatment.
20 enamel hypoplasia seen in max ci during (options had diff timings)

21 SLOB rule 2 ques
one of IANB canal in RQ
Tube head inclination is closely stated to question
22 space infection of mand first premolar in?
23 same question asking in max third molar? Infratemporal space
24 IAN block in which space? Pterygomandibular space
25 40 yrs old unrestored teeth only had deep stained grooves on post teeth and grooves are
uncoalesced
a preventive resin restoration b observe
c topical fluoride
d pit and fissure sealant
26 aphthous stomatitis assoc with a herpes

b cmv c ebv
d tomato allergy
e human leucocyte count
27 property of x ray receptors that helts view the minor details of
a spatial resoluton
b detector c receptor
28 nerve invasion (no options for adenocarcinoma)

a PLGA Ans
29 which tumor exactly resembles as the anatomy of parotid gland a pleomorphic adenoma
b ACC C MCC
30 Neuropraxia a axon integrity
b axon disruption +epineurium
c dissociation of nerve stimulus
Neurapraxia is a disorder of the peripheral nervous system in which there is a temporary loss
of motor and sensory function due to blockage of nerve conduction, usually lasting an average
of six to eight weeks before full recovery.
31 Lack of eruption of teeth due to a abs of crown of teeth
b some theory name
32 wich dental operatory unit needs prior signature(
a UV light
b dental lasers
33 halogen adv over UV light curing? Better depth of curing
34 non odontogenic sinusitis treatment
35 aspirin burn causes? Necrosis of oral mucosa
36 prostaglandins (misoprostol) causes (histamine release)
37 anti inflammatory ineffective(thiazides in option) !?

38 methotrexate doesnot involve in
a thromboembolic disorders
b inc bleeding tendencies
39 cleft lip diff in speech (escape of air)
40 integrity of zygo arch (CT)]

41 Waters view for max sinus
42 MRI (tmj disc)
43 axial surface for cast crwon is contoured because to provide
a retention
b provide caries resistance c gingival integrity
44 Q on pt having 16mm of overbite (i think i opted surgical repositioning)

45 comb syndrone doesnot have a inc vertical dimension
46 clicking of dentures due to
47 THYROGLOSSAL duct cyst (midline of neck), non-odontogenic, move with swallow.

48 gingivectomy indication and contraindications
49 FGG (sta/reason ques in RQ

50 dental fear mostly due to
a personal exp
b from exp of family
51 fear of unknown 4-6yr
52 fear of sepa-2 yr
53 Q desensitization positive reinforcement (Inc exposure to fear + relaxation technique)
54 which study has control on fondness and cofondness

full crown test for vitality? Cold test
Q on chelitis granularis bells palsy CN assoc 7 bells palsy featurea
apex locator waht cannt it do a locat small perforations
b curvature of canals c apex location
GP points sterilization (solution-time) NaOHcl time (check this)
Q cleidocranial dysplasia ectodermal dysplasia gardener syn

treacher Collins
- which of the following not classified as craniofacial disorder options had teratology of fallot
surgical treatment done for 8mm of open bit
A lefort1 b BSSO
- Q where chlorohexidine is tried on different pt on basis of clinical trials but the results
showed no significant improvement in oral hygiene status of pt
a biass
b double blind
- pt came with red sore in mouth basically i had 4 ques on asking what the dentsit response
pt tells' i hate impressions'
response i opted "what abt impression material dat makes you feel uneasy" others are
a i hate it too
b u have to take it sorry
- dentist response on brushing techniques
- predicted value negative calculations ? TN / TN +FN*100 = Predict Value Negative
- scaling removes acq deposits on teeth? T
- scaling can be done on enamel and root (T/F)
- panoramic of 9-year-old child does not have which teeth (Q little vague)
options have tooth numbers a 7
b 20 c 15
(i opted congenital missing teeth)x ray not given to check
- smooth surface lesion design(tip to dej)
- pulpal response to teeth prepn
a heat
b remaining dental thickness
- pulpal response while preparing tooth cavity
a heat (no option for remineralized dentinal thick)
- accepted dentinal theory(hydrodynamic theory)
- occlusion in comb syndrome options are confusing
- while designs FPD/RPD for one or more upper teeth dentist keeps in mind esthetics and first
does what
a clinical exam b diag cast c shade selection
MWF flap incision not tme a reverse bevel
b submarginal incision replaced flap
- dapsone therapy causes wat
a osteoporosis
b osteopetrosisc osteosclerosis
- Q on condensing osteitis
- Amelobastoma
- blue sclera- OI
delayed exp of amalgam causes a esthetic

b shiny
c dec strength d inc strength
q on setting exp of plaster/stone/type 4

- LAP treatment'
a antibiotics +surgical therapy
- first thing we do when pt visits on recall after surgical treatment

a plaque index
b update med history
c. scaling
no option to check healing
- Q diphenhydramine xerostomia cholinergic/anticholinergic
Anticholinergic drug + cause xerostomia
- spontaneous pain seen in (irreversible pulpitis)

- Root surf caries tretment (RMGIC) (NOGIC IN OPTIONS)
- Endo/perio lesion treatment (endo first)
- tooth pain is similar to (Herpes Zoster)

- long addiction periods seen during? A&D
a valium b. midazalom d. diazepam (amnesia)
- immunosuppressant drug + (cyclosporin-gingival hyperplasia)
- Without epi (mepivacaine)

- epi effect in LA
- asthma attack stimulants
a sympt amines
b anti-inflammatory drugs
c theophylline
- diagnostic aids (chr apical abscess chr periodontal abscess)]

Is pulp test and radiographs
REVA Shah
1. K sparing drug
Spironolactone, Amiloride and triamterene.
2. Virax in oral cavity?
3. What procedures you cant do in AIDS? Implants, SRP?

4. Opioids effects
5. Papoose contraindication
Protective stabilization is contraindicated for:
• Cooperative non-sedated patients.
• Patients who cannot be immobilized safely due to associated medical, psychological,
or physical conditions.
• Patients with a history of physical or psychological
trauma due to restraint (unless no other alternatives are available).
• Patients with non-emergent treatment needs in order to accomplish full mouth or
multiple quadrant dental
rehabilitation
6. Battery
8. Which study doesn’t show cause and effect? Cross sectional
9. Drugs those blocks prostaglandins has increased effect on gastric mucosa? True
10. Bimaxillary protrusion
11. Combination syndrome

12. Chs of band and loop
13. Least fracture resitant ; lithium, feldspathic, zirconia
14. Pka has effect on what? onset
?
15. 16 kg of 3 year old how many mgs LA to give? 16x4.4 =70.2
16. What meds you give in osteomyelitis?
17. Pt with bizarre behavior and disorientation you
give what? ; insulin, glucose, thyroid
18. Initial stages of sedation what pt feels?

Tingling of hands, feet
19. Condensing ostetis?
20. 2 questions on Periapical Cemental ossifying
21. What cyst in roots of mandibular premolar?

22. What lesions are not radiopaque? ; AOT, Ameloblastic fibro odontoma,
23. Least likely to occur, AOT (recurrence is rare), odontogenic myxoma

25. RG pictures Rg ameloblastic fibro odontoma
26. 9 year old kid swollen gingiva, recurrent skin infections? Leukemia
27. what is complication of maxillary molar extractions
28. what is easily curable, macule, hematoma, or something?
Remember:
30. RPD I bar fractured what you do?
31. What does conjugation do to a drug?
32. Patient with flared maxillary incisors and diastema s, to improve esthetics what you evaluate
first?
; RG, DX wax up, probing depth
33. Downcoding and upcoding
* Upcoding: Assign an inaccurate billing code to (a medical procedure or treatment) to
increase reimbursement.
"Upcoding" means reporting a higher-level service or procedure or a more complex
diagnosis, than is supported by medical necessity, medical facts, or the provider's
documentation.
* Downcoding: designate (a medical procedure or insurance claim) with a lower value.
Downcoding is when a dental plan changes the procedure code to a less complex or lower
cost procedure than was reported by the dental office.
34. Brown tumors
“Brown” tumor of bone. Increase
hemosiderin deposit gives brown color
35. Conditions have macroglossia? (HAD: Hypothyroidism, Acromegaly, Down Syn.)

36. You don’t do RCT with PA radiolucency in which patients? Leukemia, Recent MI,
Uncontrolled diabetic
37. Systemic antifungal drugs
38. Why you clean tongue? ; esthetic or to prevent odor

39. What bacteria in chronic periodontitis
40. Nasal obstruction what sedation you cant give? Nitrous oxide...conscious sedation
41. Sulfonamide MOA
42. Traumatic neuroma
43. Patient wore denture for 10 years and there is 6*3 white lesion on buccal of mandible? Biopsy,
or observe
44. Treatment of concussion
45. Primary maxillary incisors intruded 5mm what you do?
46. Radiolucency in primary molar furcation area? Pulpectomy

47. Most common caries location? Pits and fissure
48. Features of arrested caries
49. Composite characteristics?

50. Opaque porcelain features?
51. Phelobith location? ; nerve, vein?

A phlebolith is a small local, usually rounded, calcification within a vein. These are very
common in the veins of the lower part of the pelvis, and they are generally of no clinical
importance. When located in the pelvis they are sometimes difficult to differentiate from
kidney stones in the ureters on X-ray
52. Lefort 3 fracture what side gaze is limited to? Laterally, medial or downward
53. Lefort 1?
54. Axillary freckling seen in?
55. Rg image of lateral wall of nasal fossa

lateral wall of nasal fossa and anterior border of maxillary sinus form an inverted Y known
as_____________? Y line of ennis
56. Too light Rg? Why?
57. If you take Rg 10 ma with 1 sec exposure and you take another x ray with .5 sec what MA will
you give you want same density rg? 5, 10 or 20
58. Serpentile lesion on the tongue- feature of? migratory glossitis
Geographic tongue:
This condition is also termed glossitis migrans, benign migratory
glossitis, erythema migrans or ‘wandering rash of the tongue’. It
presents as areas of depapillation and erythema with a heaped
‘serpentine-like’, keratinized margin on the lateral margins and dorsal
surface of the tongue. It can be associated with a fissured tongue. The
lesions appear as map-like areas (hence the ‘geographic’) and may
change in their distribution over a period of time (hence the ‘migratory’).
The areas affected may return to normal and new lesions appear at
different sites on the tongue. Sometimes symptomatic, topical
corticosteroids may be beneficial for those children in pain.
59. HIV infection feature? First stage is Acute

it has 3 stages
Clinical features of HIV infection depend on the stages of the disease:
•The acute HIV syndrome
• The asymptomatic stage – clinical latency
• AIDS (Symptomatic disease)
60. Normal skeletal and class 3 dental what could be the reason? Loss of primary mandibular 1st
molar or incisor crowding or thumb sucking
61. 3mm lack of mandibular arch how you treat? Disk distal of molar, I put lingual arch and observe
Stripping of interproximal enamel
62. max 2nd molar less keratinized tissue, which graft you will give?
to increase the keratinized gingiva CT graft
63. most common crown root fractured tooth
a. Maxillary anterior
b. Mandibular molar
c. Mand premolar
or the tooth that is not given in options?
64. Primary mandibular 2nd resembles to? mandibular first permanent molar
65. If you have ledge while doing RCT what you do?
66. Access opening of Mandibular molar? Trapezoidal
67. Modified widman flap?
68. When we don’t do gingivectomy?
69. Mouth breather features?
70. 7-8 questions on studies,

71. 2 questions on OSHA
73. Which options show that dentist least sympathetic( something like this, don't remember).
74. behavior shaping question, patient say I don’t want to quit smoking? Precontemplation
75. e.g. of secondary prevention
76. where you give GA? Answer was 2 year old kid needs lot of restoration
77. most common failure of periodontal failure? Max PM, Max molar, MAnd PM mand Molars
78. Twisted questions on Meperidine and MOA read it carefully
79. What pain killer drug safe in pregnant patient? Acetaminophen (Tylenol)
80. When does dental lamina starts, 2 weeks of uero, 6, 12, 10. I put 6
81. What stage supernumery occurs? initiation, histo, apposition
82. What % of community water fluoridation is recieved by US population- 74%

83. Mechanism of fluoride, options weren’t the regular one we read, very twisted terms they used
84. Multiple myeloma feature? I put bone pain
85. 2 question on best bone for implant? Type 1
86. what is implant abutment?
87. You making FPD and you see 1 prosthesis in RG is completely seating on implant what you do?
Screw the implant, take another RG, section the FPD
88. Disadvantages of cemented Implant restoration? require more intraocclusal space
89. Fearful patient how you respond? TSD and consistency
90. Leading question, open ended and reassurance
91. After successive trials, child goes thru instruments and hands an instrument to dentist. What
does it show? Desensitization, modeling...
92. Buccal limitation of mandibular denture? Buccinator muscle
93. Lingual limitation of Mandibular denture? Mylohyoid muscle
94. ANUG resembles to what? I put herpetic stomatitis
95. When you do elective RCT? Several tilted tooth, short crown
Elective RCT contraindications? Uncontrolled dm, recent mi, leukemia (mango)
96. Lefort 1 include what structure? Maxilla
97. Smokeless tobacco causes what? Verrucous Carcinoma, A type of SCC.
98. Max anterior teeth placed too superior and too anterior what sound will affect? F & V sounds
99. When you make rest on molar you make rest deep enough in marginal ridge, buccal incline,
lingual? Marginal ridge is lowered 1.5 mm to provide sufficient bulk of metal
100. What not included in the consent? Cost
101. Epinephrine contraindicate in thyroid? True, hyperthyrodism
102. Few questions on some Bullshit recent study questions. Never heard, don’t rem
103. Dental hygienist and 3 doctors in practice, dental hygienist screwed the case who will be
legally blamed? Dentist
104. Abscess include marginal and interproximal gingiva called? Gingival abscess, peri-coronal,
periapical
105. What’s the indication of half erupted third molar in 18 yo
Indication and contraindication of extraction?

106. Another question on complication of maxillary molar extraction,
107. You can avoid legde if canal is Small, large, short or curved
108. External bevel incision?
Gingivectomy: external bevel
Modified widman flap: internal bevel
109. Ear pain refer to? Mandibular molars
110. Lot of pharma questions

111. An athlete havin pain and soreness on tmj when he wake up? Myofacial pain syndrome
(MFPS)
112. Sublingual varicosities? Twisted options
113. Rg of dentigerous cyst
114. Distance bw two implants
115. # of granulocyte for sugery?
116. Periodontitis common in?
117. Nursing bottle caries? Options were so new and confusing never heard before sorry don’t
rem
118. Oral infections in what leukemia
119. TT of ranula?
120. What is mucocele? Stupid options
121. Too deep PPS? Gag I put
122. Beta 1 selctive actions
123. Some medicine name I don’t rem, it was something like, given in lung patients for better
functions and improve asthmatic effects. Mechanishm of it
124. LA mechanism include all except? Read everything about it
125. Exhale wheezing sign of what? Cops, asthma...I put asthma
126. Primary Central incisor eruption date
127. Why pregnant women kept on left lateral- relives pressure of inferior vena cava.
128. Adverse effect of codiene are all except- somnosolant, constipation, reap. Depression
129. MAO of sulfonamides, macrolides, nystatin. Know all
130. Common among aspirin and acetaminophen
131. Proprietary name of drug is? Brand name
132. Correct statement on clostridium diff.
133. Red complex bacteria
134. INR is measure of? Extrinsic, intrinsic or common pathway
135. Montelukast MAO
136. Death of a child having cardiac arrest is due to? (Don't remember properly).
137. Sensitivity to penicillin is due to?
138. Culture sensitivity test is done for?
139. HIV , 1st disease or symptom occurring is- no symptom, opportunistic infection.
140. Penicillins are bactericide like or static?
141. Cyst occurring inferior to the mandibular canal level- staffer bone cyst.
142. Ludwigs angina
1-What is the difference between primary & secondary trauma ? Both option was there occulsal
and helath of the perdoniom ☹

2- what is conjunction?
The addation of molcules is the Ans
3-periodontal problems mostly assoicted with
Hypertension Smoking, Deibetes plaque
4- freacture on the orbit of the left eyes which border of the maxillary sinus will it effect?
Superior Inferior Postier Anterior

5- What was Chess and Thomas categories of Childern Temprture?I don’t remember the answers
because I never heard of these people ☹
6-Pain on half of the face, that comes once a month and its?
I believe the answer was Migraine.

7- know the different btween granuloma and cyst histologialy they ask you like … the histology
content for each I had 2 Q for each like Periapical lesion biopsied after apicoectomy of RCT treated
tooth, tooth still sensitive tooth, with lymphocytes, plasma cells, and connective tissue�a.
abcess�b. granuloma�c. cyst,�
8- Pateint
9- Distance btween 2 implants? Answer 3mm
10- I had like 4 question on dental anatomy.
11- primary first molar and 2nd in compare to first molar and premolar of permentet teeth?
1-Greater then
2-Smaller the
12- Mucus retention cyst –
lower lip, ans upper lip, gingiva,
buccal mucosa
13- Most stable imprassion
– pvs,
– polyether�
Which impression has water as by product? Polyether

Hyrdrocoilled Silicon addation Condseation sillion
14- which mouth rinse you give to disabled chiled? NaF
Listerin
Chx
15- conical shape anterior teeth are related to ectodermal dysphasia�
16- which one is schedule 2?
1- Vidocn
2- hydroxycodon + Acet �
17- which one is nsaid selective cox 2 inhibitor celocoxib ans
18- bis-phosphate used in all except?
�A) Prostate cancer to bone b) breast cancer to bone
c) osteomyelitis (ans) D) metastatic
19- TEGDMA? I think the answer was makes better on restoration color
20- Herpangia test ?
serum�
21- leeway space
22- 4.4*16kg=72 �
23- Atropine lead to ? I think disorientation �
24- Veracity truthfulness �
Autonomy – consent �
25- cleft lip/palate percentage ? 74% not sure check it
26- Major conector-
1- support and retention �
2-rtention and rigidity
2- rigidity and support. I can’t remember the 4th option
27- Laryngospsam ans(stridor) �

28 ngled SRP instrumetns is (45-90) �
29-MOA of BNZ
30-Phontics problem associated with F,V and anther question problems with T, D
31- Gingivectomy contraindication (not enough keratinzed gingiva) �
32 Disability Act - you can’t refuse any patient to treat. The same act protects the right for HIV
�patient (true or false) both true, �
which antiviral you give patient wo has herpes and CMV?
33-a question about disability Act you can’t refuse any patient to treat. The same act protects
the right for HIV �patient (true or false) both true, �
34- Disability Act - you can’t refuse any patient to treat. The same act protects the right for HIV
�patient (true or false) both true, �
35- Ferrule for
1- retin the core
2- to hold the tooth and prevent fracture
3- for something about post and core
36- Sialolith most common in which gland submand gland
37- 132- Panic attack means -impedding doom
38-#212 Ivory function ?
39-Chronic inflammation – plasma cell, t-lymphocytes, mast cell, neutrophil
40- Recall appointments should be scheduled for children at?
a. 3 months b. 6 months
�c. 9 months
�d. 12 months�
40- How do you repair a porcelain veneer with composite?
a. microetch, etch and silane�b. sandblast, etch and pumice�c. pumice, silane, etch�
41- Dentist or surgeon perform surgery perform surgery without informed consent which
ethical principle obligate
Veracity�
Battry
41- High cyst recurrence –OKC�
42. More cutting blade on carbide bur
�a. Smooth surface and less cutting�

b. Smooth surface and more cutting�
c. Rough surface and less cutting�
42- Mn MB incline on MB cusp of stainless steel crown has wear, mvmt of WORKING AND
PROTRUSIVE�
what is the different btween endodontic absess and periodonc abscess in non-endodontic treated
tooth?
1- pulp vitiltiy
2- percussion
3- I can’t remember the other options
43- Reason for failure of replantation of avulsed tooth:�a. external resorption.�b. internal
resorption�
44- Cementation of band and loop common outcome All of the above, except�A. Creates space�B.
If leakage from cement – recurrent decay�C. Prevents tooth from super erupting with opposing�
45- What is reason for the altered cast technique when doing an distal extension rpd :�A.
Support�B. esthetics.�C. Retention.�d. resistance�
The dentist charges separately for core build up and the crown but the insurance company says
that the core build up is part of crown.what is this called? Bundling�
And had anthor question about unbundling Day 2: Based on everything you studied ? Case 1:
64 year old want to remove all his teeth” Iam so fed up with my teeth”
Dental history: couple restoration and are filling down inclusing I believe PFM or cermic crown
that fills down in tooth #9?
Medical history he was an alcoholic and stoped after being on consultion and now is taken Bupiron
and Actamohine for pain?
Quesitions were asking what Kenddy class he has? It was class 3 MOD 1
And which drug is safe to take for him.
Actamophine+ hydrocodin was among the option don’t remember the rest?
study kenddy class and the alchol and acta reaction..
Another question what code of eithics the doctor would break by extracting all the teeth? Varcity
and …
Benfince and.. Nonmelfinces and
14 year old girl she has Asthma and is taken Albutrol and Lukoterian, she has ectopic erupticed
canines both #6 & 12 what is the treatment ?
- what occlusion she had it was class 2 divison 1
- ANB = 6 Ans was Class 2 I believe
Another case
9 year old boy he had medical history of kidney dialysis and heart valve defect, question what
should we do the dental procedure. he also had enamel dysplasia
Another case where man is taken Bupropion what is the side effect. Chantix one question about it
too.
29 year old female had PFM on upper pm wants to cover the black line on the crwon what to do.
1- resion bond
2- redo the crown
3- put venter
4- I can’t remember
She had spots on the face options were
Basal cell
Melanocytes
POOJA’S RQ
1. Radiation caries
A. Cervical = answer
B. Interproximal C. Buccal lingual D. All
2. Cleft lip & palate A. Auto dominant B. Auto reccesive
C. Genetic something like that
3. Rheumatoid arthritis
A. Autoimmune
B. Auto dominant C. Auto recessive D. Other
4. 2 questions While Panaromic if pt move 1 second effects on image = answer given in oral path
colour pdf = read nicely got 3 to 4 questions specially last 3 to 4 pages from miscellaneous fact...
5. Geographic tongue picture
6. Fibrous dysplasia with RCT treated tooth x-ray
7. Erythroplakis image
8. Wash film with clean runnig tap water = Answer= get rid of the chemicals
9. kidney heart involvement, rashes on nose & cheek something like that = Lupus erythematous
10. Complex Odontoma x-ray
11. Colour property which give strength, intensity , saturation to hue
A. Value
B. Chrome
C. Others
12. Treatment of ranula
A. Marsuplization
B. Remove with submandibular gland
C. Other
13. Pleaomorphic adenoma mostly occur with which salivary gland
14. Drug Proscar use
15. Nephrotoxicity associated with
A. Erythromycine
B. Naproxen
C. Aspirin
D. Lidocaine
16. Cervical noncavited lesion due to all except... A. Parafunction occlusion
B. Perio disease
C. Erosion
D. Abrasion
18. White lesion Diffential Diagnosis
19. While giving CPR = what to check
A. Eyes constricted
B. Eyes dilated
C. Carotid pulse
D. Peripheral pulse
20. While conscious sedation
A. Eyes must be open
B. Verbal response must be present
C. Physical reflex must be present
21. Only 1 question from cuspal interinference

22. Facebow transfer what relationship
23. Maxi Denture covers all the area except = fovea palatine
24. Maxi buccal flange too thick affected by what
25. Maxi & mandi Denture not retain while function on Distobuccal flange , what is the reason ?
what muscle are responsible? Masseter muscle
26 . Bells palsy usually associated with
A. Protid gland tumor something
B. Multiple sclerosis
C. Other
27. Impression from Impression compound has good detail due to which property
28. Don't put instrument whith in steam sterilization
A. Plastic bag
B. Plastic & paper
C. Cloth
D. Heavy metal?
29. Sharp instrument NOT require
didn't recognize correct words but something like
A. Upper lower lid
C. Metal container
30. 2 times same question with twist distance between 2 implants

Day 2
1 case with bipolar disease & question on Amitryptaline side effect
• know when to do incisional, excisional biopsy , exfoliative cytology [ pigmented and white
lesion one question is there about biopsy]
2. Pt on Aspirin need to stop or extract n all ....
Hopefully it will help you guys....All the very Best....More rqs I will post as I will recognize....I
don't no
About my result...
But want to tell you do Mango , tuft pharma, oral path color PDF nicely & Mastery App if
possible...! Thank you...!

ο ο
1.Most common odontogenic cyst? Periapical cyst or also called radicular cyst
2.Most common developmental odontogenic cyst? Dentigerous cyst
Gracey and universal curette

SAIRAJA CHOUDARY RQs…….May 9-10 /2018
1.periodontal disease most nearly fulfill Koch’s postulates. a LAP b. chronic periodontitis
c. NUP
2. fremitus
Fremitus is a palpable pathologic occlusion bite typically found on one upper front tooth
when a patient closes their teeth. This tooth vibration is considered an occlusal trauma.
3.which teeth are most frequently involved in root amputation. Max 1st and 2nd
molars
a. maxillary 1st molar b mand first molar 3 max 1st premolar 4. mand
3rd molar
4.which miller defect respond best to mucogingival surgery. Class I & II
Miller proposed a classification system for recession that has an influence on the success
of surgical procedures:
Class I: recession not extending to the MGJ. No loss of interdental bone or soft tissue.
Class II: recession extends to or beyond the MGJ. No loss of interdental bone or soft
tissue.
Class III: recession extends to or beyond the MGJ. Loss of interdental bone or soft tissue
that is coronal to the apical extent of the marginal tissue recession.
Class IV: recession to or beyond the MGJ. Loss of interdental tissue to a level apical to the
recession.
Complete root coverage can be achieved in Class I and II defects with only partial
coverage possible in Class III. However, Class IV defects cannot be successfully treated.
5. bone sagging?
6. osseointegration.
7.bacteria associated with peri implants

8. surgical technique for ridge augmentation? some confused choices
9.inverse bevel incison
10 inflammatory mediators may be indicator of disease activity

1.interleukin 2
2. tissue necrosis factor
3. IL6
4. All
11.which enzyme and cytokine is secreted by a macrophage

a. TNF b. transforming growth factor c. protease d. all the above
12. allograft has following characteristics except
a osteoconductive b osteogenic c osteoinductive d demineralized
13. typical dose of nitroglycerin

NITROSTAT is a stabilized sublingual compressed nitroglycerin tablet that contains 0.3 mg,
0.4 mg, or 0.6 mg nitroglycerin
One tablet should be dissolved under the tongue or in the buccal pouch at the first sign
of an acute anginal attack. The dose may be repeated approximately every 5 minutes
until relief is obtained. If the pain persists after a total of 3 tablets in a 15-minute period, or
if the pain is different than is typically experienced, prompt medical attention is
recommended. NITROSTAT may be used prophylactically 5 to 10 minutes prior to
engaging in activities that might precipitate an acute attack.
During administration the patient should rest, preferably in the sitting position.
No dosage adjustment is required in patients with renal failure.
14. which is not a feature of primary resistance form in amalgam preparation

a. adequate thickness b. rounded axiopulpal line angle c vertical wall
convergence
15. Minimum film thickness is the important property of:
a. Silicates
b. Zinc phosphate
c. Glass ionomers
d. ZOE
16. the asbestos liner is used in casting ring to

a permit extension of the mold b prevents movement of the ring c retard the
heating of the mold d. facilitate venting of the mold e all of the above
17. ferrule effect? Increase resistance to fracture

18. 19 chemical used for test vitality
a methyl alcohol b ethyl chloride c methyl chloride d ethyl alcohol
gingivectomy
20. conservative treatment of hypersensitive erosion areas? apply NaF paste?

21 moa of meprobamate
Meprobamate binds to GABAA receptors which interrupt neuronal communication in the
reticular formation and spinal cord, causing sedation and altered perception of pain.
Wiki.
22 metal ceramic restoration may fail due to fracture of ceramic material
this can avoided by..
adequate thickness of metal framework, proper tooth reduction
23. Inflamed capillary hemangioma of oral cavity microscopically resembles
1)squamous carcinoma 2) neurofibroma3) angiofibroma 4) pyogenic granuloma
24. MWF
25. Pellicle formation involves which of the following?
Selective adsorption of acidic glycoprotein from human saliva
Focal areas of mineralization
Bacterial colonization
None of the above
26. what kind of response do recently erupted permanent teeth usually give
to pulp test
a very reliable b very unreliable c always respond d better than young adult
permanent teeth e same as young adult permanent teeth
27 an asymptomatic sinus tract is adjacent to the mesiofacial root of tooth,

probable diagnose is
a acute apical abcess b suppurative apical periodontitis c chronic apical
periodonttis d periapical granuloma
Suppurative apical periodontitis, also AKA Chronic apical abscess:
continuously or intermittently draining sinus tract, usually drains into the oral mucosa.
28. in a radiograph ground glass appearance, loss of trabecular pattern and
complete loss of lamina dura . diagnose is Fibrous dysplasia
29. burning tongue is a symptom of? BTS
30developing tooth bud is damaged so that the tooth erupts with defective
enamel . this condition is
31. sialolith
32 a common gutta percha solvent is chloroform
33. when the free margin of the gingiva is enlarged as result of inflammation
its crest moves
a apically b distally c cervically d occlusally e mesially
34. Trauma from occlusion is least likely to affect which of the following?
(a) Enamel (b) Cementum (c) Periodontal ligament (d) Epithelial attachment
35. the least common cyst in the oral cavity
36. Selective grinding for equilibrating complete dentures is best accomplished after
processing when the dentures are:
a. Rearticulated using original jaw relation record
b. Rearticulated using new jaw relation record
c. Equilibrated in the patients mouth
37. early movement following surgery for tmj joint ankylosis is B

a harmful b desirable c unimportant d indicated only when ankylosis is
limited to one side
38. the presence of ecchymosis in the sulci, the floor of mouth or hard palte
is usually indicative of Facial fracture
39. obstructive sialedenitis may result from? Infection of salivary gland or viral
infection or bacterial infection
40. the base of the pyramid shaped maxillary sinus is? Nasal wall (Base of the
maxillary sinus forms the inferior part of the lateral wall of the nasal cavity)
41. implant in congestive cardiac failure? Not contraindicated
42. picture q Leukoplakia and which
biopsy (incisional)
43. Smokers palate and treatment

44. Melanosis and treatment no treatment
45. X rays Fibro odontoma Stafnes cyst
46. Girl with sna 87 and snb 82 they gave a lateral ceph and had a few q
on this Prognathic both jaws
47. Defn of couple and movement by it

48. Got a q about a periapical cyst and xray had no periapex
49. Ameloblastomaxray and treatment
50. Distal extension ptbest combination of implants fpd and rpd don’t
remember this one
51, Q about ferrule? 1.5-2 mm
Q about how much ortho extrusion for ferrule ?4mm. google search
52. 1 xray with poor obturation and asked reason for failure
53. Cracked amalgam and reason for failure options had both to wide and
less deep
54. Direction of regeneration in implants like coronally connective tissue or
pdl or apically connective tissue or pdl
55. Which study uses questionnaires? Cross sectional
56. Do least common side effect of drugs (not most)
57. Least common reasons for choosing any treatment for pt
58. Least common effect of LA with beta blockers
59. Oro antral fistula 8 mm treatment
60. Q about early loss of second molars and this was least common effect
as well
61. And which space maintainer at what age
62. Do the worst quality xrays from google. The xrays are hopeless
63. Pt on aspirin and clopidogrel and q about implants for this pt
64. Weird q on bisphosphonates and rct and extraction
65. Least common type of study used for different population
66. 1 q on cartridges of la required for 64lb child
1 q on negative percentage
1 on amount of la for 16kg child
Asa classification q
I got 1 occlusion q about non working interference
Selective grinding
ASA classification:
Scatter Blanch Mitigate
1. Implant/ endo? Succes?

Exceed
Dependent on operato
2. Odontoblast nuclei within dentinal tubules

Desiccation Chemical Mechanical Thermal
3. Amalgam redo
Veracity (truthfulness)
Justice (fairness)
Beneficence (do good)
Autonomy (self-governance)
4. Acute status epilepticus

Midazolam Phenytoin Epinephrine
5. Ept correct Except

More reliable than cold in pulp necrosis ? true
Cold is more reliable in necrosis
6. Radiolucent
Nares
Mid-palatine suture
Turbinates
Mylohyoid ridge
Genial tubercles
Nasal fossa
7. Enamel demineralized
Tenancious
Rough cavitated
More resistant to acid
Softer
Smaller apatits
8. Radiation
9. Radionecrosis mostly in
More common in mandible. Occur mostly in patients taking IV Bisphosphonate
10. Insurance for kids smth XXI in 1997

Medicaid
Health children insurance (CHILD HEALTH INSURANCE PROGRAM) CHIP
11. Burkitt’s Lymphoma

EBV?
Wharton’s duct
Mandibular duct
12. Smth inflammation? I forgot

IL1
IL2
IL6
IL10
pro-inflammatory mediators like IL-1 beta, IL4, TNF-alpha, and PGE2 in response
to bacterial byproducts.
13. C factor periodontitis?
14. Nytro adverse effect Headache flushing sweating I chose
15. Radiopaque? or lucent
Osteopetrosis opaque Osteoporosis lucent Paget’s Disease lucent OsteoSmthelse

Osteopetrosis opaque
Osteoporosis lucent
Paget’s Disease opaque
16. GIC advantages than composite
Abrasion resistant Compression resistant Chemical bonding
Composite by micromechanical bonding, GI by chemical bonding
17. Radiation of mri

Magnetic resonance imaging (MRI) is a test that uses powerful magnets, radio
waves, and a computer to make detailed pictures inside your body.
18. Soft tissue complication while extracting

Tearing? True. heals by secondary intention
19. Earlobe x ray

A
20. Geographic tongue photo
Erythtoplakia
Migratory glossitis
21. On cephalometric looks single

Sella turcica
Orbitale
Pterygomax fissure
Man
22. For radiation Q

Maximum permissible dose what is that
23. Giant cell granuloma

Pseudo epithelial surroundingsmth
May RQs

the following are the effects and signs:
2. Tt of ranula- marsupialization. The treatment of ranula (option had excision of

submandibular gland …that’s wrong)
3. Feature of muscle weakness disorders- long lower facial height
5. Aspirin does not increase what?- bleeding time, prothrombin time, acidosis, renal
prostaglandins
7. How to obtain confidence of child- positive reinforcement, tell show do
8. Biotransformation of drugs? Drug becomes more water soluble , less lipid souble,
more ionized ,decreases with age
9. Coumarin effects decreased by?

Correction 3 months, happens 6 weeks
11. 5-6 q on flaps and gingivectomy which were easy- they play around with indications
12. q about 22 yr old girl with fever , malaise, lymphadenopathy, multiple ulcers on
tongue, palate with swollen gingiva- anug, acute herpetic gingivostomatitis, marginal
gingivitis, herpangina
False - people with HIV are at a higher risk of having kaposi's sarcoma but the cause is
Herpes virus 8 (HHV8)

15. Lymphoma in jaws- Hodgkin’s, non –Hodgkin’s
16. Q about not a topical drug delivery sytem in perio- I discussed it with someone I
remember, ans was metronidazole gel
17. Symptoms of pedal edema, persistent cough, obese, raises end diastolic pressure,
guess disease- I marked CHF
18. Which antihistamine for peptic ulcer- diphenhydramine, citrezine, ranitidine (zantac)
Ranitidine (Zantac) is a drug prescribed for promoting the healing, and prevention
recurrence of ulcers of the stomach and duodenum. It is also used to treat occasional
heartburn, and in healing ulcers and inflammation of the esophagitis; and Zollinger Ellison
syndrome.
21. Q about man with good oral hygiene and stained buccal groove- observe
22. Collimation purpose? to reduce the size of the x-ray beam and
the volume of irradiated patient tissue.
23. How to prevent gonadal exposure during mand iopa- e films, lead apron, thyroid
collar
remember:
25. Which impression material gives off h2 gas? Addition silicone (vinyl polysiloxane)
26. Which impression material not for cast impressions?
Irreversible hydrocolloid - Alginate
May RQs
27. Connector in fpd should be greatest in which dimension- mesio-distal, buccolingual,

occluso-gingival
28. P<0.01 , reject null hypothesis- option had both correct decision and type 1 error

30. Q on cleidocranial dysplasia about open sutures
large fontanelles, delayed closure of sutures... skull maturation is delayed...
31. Neurogenic sarcoma? malignant peripheral nerve sheath tumour. ... It is the most
common malignancy of peripheral nerves, and represents 5 to 10% of all soft-tissue
tumours
32. Calcified falk cerebri-?
33. Distobuccal flange extended in max denture and mand denture which structures
obstructed
Max - Coronoid
Mandible - massater
34. While recording pps what is kept in mind except- fovea palatine, vibrating line,
pterygoid notch, throat form and tuberosity
35. Kid was taking Ritalin- which disease ADHA
36. Local vasoconstrictor which la- cocaine, benzocaine, lignocaine, procaine

37. Lithium toxicity affecting renal function, which analgesic to be given? Acetaminophen
38. Recovering from alchoholism, which analgesic to be given except- ibuprofen,
Percocet, vocodin, tylenol3
39. Child in pre something stage of cognitive behavior- what is problem- establishing
communivation
40. Child is uncooperative is 2 yrs old, retrain by- parents, papoose, assistant, sedate
They afraid of separation
41. Fail proof mechanism of nitrous oxide cylinder 70%
42. Conscious sedation- verbal response, pain response, eye response, touch response
43. Pregnant woman in syncope due to which structure Inferior vena cava - Vasovagal
syncope
44. Short crown premolar as abutment in fpd- inlay,onlay, pfm, all ceramic crown
45. Why wait for 1 week between bleaching and veneering
to ensure the color change is complete
46. Porcelain veneers frequently changed due to- chipping or discoloration ?
47. 3 q on hue, value , chroma each asking known rqs
- Clinician can most easily change
A. Hue
B. Chroma
C. Value
- most critical factor matched first in porcelain matching?
1. value
2. hue
48. sealants bond to teeth by? micromechanical
49. 2 statements about ethics.. q like which are true or false- individuals can discuss about
ethics and come
50. 2 q on sibilant sounds- how are teeth touching or contacting…are they supposed to
be different?!!!
51. Implant template what for? For implant placement. as a guide
54. Max 3rd molar root displaced into which space? Infratemporal
56. old man had a lot of carious class v lesions, ideal material for restoration- amalgam,
direct gold, gic, composite
57. for gingivectomy incision directed where? Apical to the pocket depth
58. In tooth supported rpd, which part prevents movement of abutment? Direct retainer
(Clasps)
59. Which is poorest form of temporary restoration- zoe, composite with zn phosphate,
cold cure set in mouth cemented with zoe, cold cure set in cast cemented with zoe
60. Bruxer had old mod amalgam with sec caries, which material to be replaced with-
composite, amalgam, all ceramic
61. Effect of norepi prolonged by- moa , neuronal uptake inhibitor
62. Cholinesterase inhibitors- sympatholytic, sympathomimetic, parasympatholytic,
parasympathomimetic
63. Doesn Lisinopril cause k+ depletion?

66. 1 pathetic rf of fibrous dysplasia m guessing because I saw to different conclusions
something like that no boundaries of the lesion
68. filtration in x-rays? Aluminum
69. High voltage kvp resultant xrays will have?

70. Palatal tori reaching pps, how to construct cd? Remove tori
71. Features of dementia?
72. Elderly patients have lesser effect to cns drugs, t/f
73. Which tumor has enamel, dentin, pulp, cementum? Compound and complex
odontoma
* COMPOUND ODONTOMA – a tumor of enamel and
dentin common in the ANTERIOR MAXILLA (incisorcanine
area)
* COMPLEX ODONTOMA- amorphous RADIOPAQUE mass
with a thin, radiolucent rim at the junction of surrounding
bone (has varying densities). Most common in the
POSTERIOR mandible
74. Defining rapport in fancy terms …sounded like an English exam
a close and harmonious relationship in which the people or groups concerned
understand each other's feelings or ideas and communicate well.
75. Gracey curette for mesial surface 11-12

76. Angulation of scaler tip
79. organism which can produce metabolic products from estradiol? P. intermedia
80. interocclusal record of 1mm was taken with facebow, options asking whether its
possible or not
82. hyperpyrexia, tachycardia, nervousness, diarrhea, tachypnea-
pheochromocytoma, thyroid storm
83. primary side effect of albuterol- xerostomia, candidiasis, caries, dysguesia

84. if pt had gum boil, you do rct, what tt for gum boil- curettage, excision, local
antibiotics, no tt
87. movement during extraction of mand molars Luxation
88. forceps for fractured tooth at level of furcation- 23
- For maxilla #65 MAXILLARY OVERLAPPING ANTERIORS AND ROOT TIPS
FUNCTION: To remove teeth, tooth fragments, and root tips from bony socket
FEATURES: Bayonet design
Universal (both beaks same design-fit equally well on facial and lingual) for right
and left quadrants
- For mandible #74 MANDIBULAR ROOT TIPS
FUNCTION: To remove tooth fragments and root tips from bony socket
FEATURES: Bird beak design
Universal (both beaks same design-fit equally well on facial and lingual) for right
and left quadrants
89. vital tooth radiolucency at mand premolar roots? Mental foramen
90. periapical radiopacity not related to inflammation, neoplasm, fibro-osseous lesion
or systemic disease- idiopathic osteosclerosis
91. which tooth not suitable for occlusal seat placement- canine, lateral incisor,
premolar, molar
92. patient taking amitriptyline, what happens when administered la with epi
High fever, convulsions and even death can occur when these two types of drugs are
used together. Epinephrine should not be used with amitriptyline, since together they
can cause severe high blood pressure.
93. epi reversal results in hypotension in the patients who are taking large doses of
phenothiazines due to - 1)alpha receptor blockade 2) dopamine rec blockade
3)seratonin rec bloc
Phenothiazines may cause hypotension because of central effects and an α-
adrenergic receptor-blocking action resulting in arteriolar vasodilation
94. about proscar- option did not have bph had prostatic cancer something about
inhibiting 5 alpha reductase
95. emphysema pt- what considerations in dental set up- I had options regarding
nitrous oxide, reclining in supine position, administration of epi
N2O is contraindicated.
96. transillumination helps identify what by illuminating tooth- craze line, vertical tooth
fracture, microleakage and another option
May RQs
97. a weird q about in pa radiograph, bone defect of osseous crater is underestimated,

overestimated, undiagnosed, remains the same something like that…find out
98. q on unbundling, bundling and up and down coding where they confuse you with
similar sounding terms
99. iopa shows patent coronal pulp chamber which changes appearance in the middle
of root indicates what?- calcification, internal resorption, canal bifurcation, pulp stones
100. clearance btw occlusal seat on marginal ridge and opposing cusp
101. chronic burning mouth in- merkelson Rosenthal, candidiasis, lichen planus,
pemphigus
102. in chronic perio all are risk factors except- smoking, age, diet and saliva
104. Which antihypertensive causes orthostatic hypotension
105. Pt had asymptomatic apical periodontitis, histopath shows plasma cell,

macrophages, mast cells- apical granuloma, cyst, abscess, neoplasm
106. Which mediator produced by plaque bacteria induces bone loss- endotoxin
107. Which mediator found in areas of bone loss- IL-1,IL3,IL2,IL8
109. Antifungal used both in topical and systemic forms- options had fluconazole and
miconazole
110. Test correctly identifies 95 diseased individuals of 100, characteristic of test- 95%
sensitivity, 95%specificity, 95% ppv, 5%npv
112. Young woman with shiny cervical lesions on cervical third on palatal surfaces of
maxillary anterior- erosion, abrasion, attrition, abfraction
113. Intensive drug therapy of diabetes mellitus has following objectives- 1. Home
blood sugar eval 2. type 1 and 2 dm control 3. home urine glucose analysis
something else
114. Size and shape which stage of dental development? Bell stage
(morphodiffrentiation)
May RQs
MAY 3 218 RQ
EPT:
I got 4 Q on EPT, two of them were asking about how EPT works, these were a little pit
confusing
all are true about EPT except ?

It is more reliable than cold testing for necrotic teeth
give relative health status of pulp
Tells if there are vital nerve fibers
( or some words similar to conductivity of nerve)
Note: EPT only tells if there is conduction of nerve or not ..

VITALITY OF TOOTH IS DETEWRMINED BY BLOOD SUPPLY,, as long as it has blood supply ,, it
is vital it does not matter weather it is responsive or not ,, that is why ept is not accurate in
open apex or recently traumatized tooth
Another q about percution ,, I don’t remember the exact q but they also asked about the
basic concept of percution - It indicate PDL inflammation
Xray tech : maxillary sinus appears closer to roots? Bisecting technique
Minimum width of the maxillary palatal strap? 8 mm width & thickness 1.5 mm
For treatment planning for an implant what is NOT considered? Age / Bone
quality/Region /Smoking
Most important feature in a single implant placement: Antirotational element in the

implant(HEX) Internal connection in the implant: cementing the pontic to abutment (
they used these exact word in
the exam CEMENTING ,,, in files they used word attaching the abutment to the implant )
Which drug works by mechanism other than acting on receptors; Osmotic diuretics
2ry hyperparathyroidism caused by : Renal failure
Route of spread of Hepatitis A Food and beverages ( this the only option given comply
with feco-oral route ,, other options were respiratory ,, blood porne…etc)
Two factors that will decide the placement of the posterior composite
size of cavity and type of resin
Support for kennedy class 3 with modificaƟon one

Indirect retainers / Occlusal rest / Denture base / Major connector
Acute Herpetic gingivostomatitis is common in

4 month
2 yrs
6 yrs
8 yrs
Histologic or microscopic feature of Herpes Lipschultz bodies
Longest LA agent lidocaine

Articane
Bupvicane
Fixed partial denture , the palatal cusp tips interfere in all excursive movement. What is ur
next step
Make the prosthesis
Occlusion in which all the posterior teeth disarticulate during right excursive movement
- Group function
- Mutually protected
Which is least important in causing root caries?

Low salivary rate
S. sanguis present in plaque
Site for caries initiation Pit and fissure enamel
Rubber dam does NOT protect against

Exhaled nitrous oxide
Mercury vapor inhalation during amalgam removal
Aspiration of inlay
Laceration of tissue
Unecessary chemical exposure
(( this Q had been debated in the Fb group and we came up with nothing,, I picked Hg
vapor because N2o is not harmful ))
Fetal alcohol syndrome :: cleft lip / midface deficiency / anencephaly
I got some Q about smoking, alcohol and cancer relationship, I don’t remember weather
they combined these 3 in a two statements T/F q or they had been asked separately,,
anyways, U HAVE TO KNOW THE FOLLWING FACTS: and u will be able to answer any Q
regarding this topic.
- smoking is the most approved worldwide material that cause oral cancer ( they used word
worldwide )
- Alcohol predispose cancer ( notice the difference because they used this word predispose
in the exam )
- alcohol when combined with smoking synergetic effect ,,,i.e the probability of
developing cancer is much higher than smoking alone or consuming alcohol alone
which of the following is in charge of dental materials and devices FDA is true
Border molding for the masster what movement is done Close mandible against pressure
To capture the masseter under function ask the pt to clinch during border molding
To record lingual flange FUNCTIONAL movement of tongue (be cautious :: there is another
option - full movement of tongue – don’t chose it )
candida albicans will increase in chemotherapy
What make age 11 characteristic

- all 2nd premolar
- all 2nd molar
headgear used to move the maxillary dentition forward face mask (reverse pull head
gear)
( I am not sure weather they used the word protraction in this q or not ,, anyways be careful
because they will through words like protraction / retraction to confuse u )
not found in trisomy 21 macroglossia

Class 3
Rampant decay
Delayed eruption
intraoral + skin nodules + macular pigmentation , no other clinical sign or symptom

peutzjegher
Mc Albright
Neurofibromatosis
Hereditary familial
Dentition in achondroplasia
Normal (but crowed)
Macrodontia
Supernumary
least desirable in making a crown seat completely

Use die spacer
Use disclosing agent to identydiscrpencies
what will happen when u increase the powder in zinc phosphate cement
Decrease viscosity
Decrease solubility
Initial treatment for gingival bleeding , loss of strippling and rolled margins
SRP
radiographic feature of sickle cell anemia
Step ladder trabeculation Multiple radiolucency Multiple radiopacities
Pt has von will brand disease desmopressin

( this q was a quite long ,, ,,, once u c von will brand disease ,,, go to the answers and find
desmopressin even if they put it with other drug name like (desmopressin and clooting factor
)
Desmopressin is a medication used to treat diabetes insipidus, bedwetting, hemophilia A,
von Willebrand disease, and high blood urea levels. In hemophilia A and von Willebrand
disease, it should only be used for mild to moderate cases. It may be given in the nose, by
injection into a vein, by mouth, or under the tongue. Wiki
handing out questionnaire at the end of a evalution . what type of study Cross sectional
First pass metabolism Enterohepatic circulation

Metabolism in liver
34. a quesƟon on drug response and drug percent graph. What they have in common. ( I
don’t remember exactly)
Clinical attachment loss is seen is which stage

Intial / Early / Established / Advanced
Dentifrice for dentin hypersensitivity

5% Cacl2
5% KnO4
White spot on facial surface non cavitated and has matte finish. Treatment
5% fluoride varnish
No treatment
10% chlorhexidine is used in

Pit and fissures
Secondary caries prevention
Ideal material to replace the loss of large alveolar bone

Autologous / Dried freeze decalcified
According to the options, Autograft or BMP + Autograft are used to reconstruct large bone defects
Side effect of allkylating anticancer agents Bone marrow suppression

which orofacial pain will you refer the patient to a physician Temporal arthritis another Q
about Temporal arthritis the most serious complication blindness
Temporal arteritis is a condition in which the temporal arteries, which supply blood to the
head and brain, become inflamed or damaged. It is also known as cranial arteritis or giant
cell arteritis. Although this condition usually occurs in the temporal arteries, it can occur in
almost any medium to large artery in the body.
The symptoms of temporal arteritis can include:

double vision
sudden, permanent loss of vision in one eye
a throbbing headache that’s usually in the temples
fatigue
weakness
loss of appetite
jaw pain, which sometimes can occur with chewing
fever
unintentional weight loss
shoulder pain, hip pain, and stiffness
tenderness in the scalp and temple areas
which of the following is not part of scientific article
Interpretation
Method Result Introduction
Best method to deliver xylitol Chewing gum
child with ortho ttt is completed ,,, he has poor oral hygiene, best retainer Removable
Avulsion is classified according to WHO? Soft tissue
in relaƟon to the marginal ridge , height of matrix band for class 2 should be
Below
At same level
1mm higher
3 mm higher
You did a large MOD amalgam . after 2 days pt complains of sensiƟvity and pain of 2 sec on
cold . Thin liner thickness- observe
GIC linear- redo
hypoxia in a patient under GA. First sign
Increase pulse rate
all of the following affect the base thickness except

Size of tooth
Base thickness
Pt present with moderate cellulitis and fever of 100.8 . after incision and drainage what will u
do
Penicillin VK – 1g followed by 500mg 4-6 hrs for 7-10 days, penicillin drug of choice
interdental bone is apical to redicular bone. Its called

Reverse architecture
What test not used for type of bacteria and metabolic products?
DNA test
Enzyme test
Interlukein test
Dark field microscopy
Antibiotic for nonodontogenic Maxillary sinusitis?

Augmentin
amoxicillin
Clavulanic acid
Amox+clavulanic acid
local anesthetic for hyperthyroid patient? Mepivacaine

MOA of H1 Histamine blocker??competitive antagonism of histamine binding to cellular
receptors (specifically, the H1-receptors)
how to motivate the pt for proper oral hygiene, you do all except? carrot & stick
hydroxyzine?? Antihistamine used to treat anxiety, used with anesthesia before medical
procedures. True
Hydroxyzine is a first-generation antihistamine.
Because of its antihistamine effects, it can be used for the treatment of severe cases of itching,
hyperalgesia, and motion sickness-induced nausea; it has also been used in some cases to
relieve the effects of opioid withdrawal. Even though it is an effective sedative, hypnotic, and
anxiolytic, it shares virtually none of the abuse, dependence, addiction, and toxicity potential
of other drugs used for the same range of therapeutic reasons.
Hydroxyzine has also been used to potentiate the analgesia of opioids and to alleviate some
of their side effects, such as itching, nausea, and vomiting.
Today it is used primarily for the symptomatic relief of anxiety and tension associated with
psychoneurosis and as an adjunct in organic disease states in which anxiety is manifested.
………….
Tooth with a ledge- how to manage? Bypass with smaller instrument
sag factor low deformity

Lower sag = less deformation
clopidogrel? antiplatlet & increase bleeding time

BOTH
Purpose of making record of protrusion relation... To adjust horizontal condylar guidance
Sedative Meds for pregnant and lactic mother ; Promethazine
ANUG Debride h2o2 and antibiotics only if systemic involvement
Who LEAST affected by N/O (nitrous oxide ) patient ( dentist and other dental staff are
exposed to n2o frequently)
Meds for pet mall(absence seizure) Ethosuximide
Kids most having what type of seizure? FEBRILE

What meds not use in Angina diuretics
Major connector function? Stability and rigidity
Ca hypochlorite ( 3 or 4 q) , u have to know what ca hypo does

don’t remove smear layer , only necrotic tissue ,
no cleations
antimicrobial effect
lubricant, irrigant
EDTA function Chelating agent ( remove smear layer and hard tissue)
Hystodifferention what happening Amelogenesis imperfecta dentinogenesis imperfecta
,dentin dysplasia - structural deformity
SLOB ??Same lingual opposite buccal used for interposed objects
Most radioresistant muscle
Reason why people have supernumerary teeth Genetic

Who responsible for dental materials and technology?? FDA
Powder in ZOE?? Zinc oxide
Xerostomia treatment??Pilocarpine, civemiline
Pilocarpine does not increase xerostomia ,,, it does treat xerostomia

Pt has bad oral hygiene calculus gum bleeding. She wants prophylactic Cleaning what is the
tt??
1) you do prophylaxis at or request
2)explain it can take 2 visit
3) tell her she needs to do better job with Oh?
4) SRP
Fusion, germination
When you need to use papoose blanket? Uncooperative patient
Translumination use for kids for? Sialolithiasis

N/O q all contraindications? NO is contraindicated in nasal congestion and COPD,+ 1st
trimester
What age you can place implants.?? over 18
Q about pt transfer
A new diagnosƟc test is evaluated against an independent “gold” standard” in 100 subjects
with the following results: NPV=TN/(FN+TN) 8/(32+8)
True posiƟve = 48
True negaƟve = 8
False posiƟve = 12
False negative = 32
What is the negative predictive value of this new diagnostic test? A- 20 percent
B- 40 percent C- 60 percent D- 80 percent
Ludwings angina doesn’t involve? Retropharyngeal space
Antifungal Troche – clotrimazole

Effect of traumatic cyst on roots Scalloping around roots ◄ resorb roots
displace roots
…………
what is the radiolucency in the pic:

it is stafne bone cyst but in the exam they gave other name : salivary gland depression or
something like idiopathic salivary gland depression
it is same cyst ,, it is very rude Q because there is many nomenclature for this cyst
The Stafne defect (also termed Stafne's idiopathic bone cavity, Stafne bone cavity, Stafne
bone cyst (misnomer), lingual mandibular salivary gland depression, lingual mandibular
cortical defect, latent bone cyst, or static bone cyst) is a depression of the mandible on the
lingual surface (the side nearest the tongue). The Stafne defect is thought to be a normal
anatomical variant, as the depression is created by ectopic salivary gland tissue associated
with the submandibular gland and does not represent a pathologic lesion as such. Wiki
perforation- anteriors? mesial,anterior teeth are inclined distally,, so there is a great chance to
perforate the mesial wall of canal during instrumention
Mesial. all central lateral and canine have distal axial inclination, so we must be careful, and
put the but a bit distally if not
Mesial perforation risk in all 3
hairy tongue. which papilla? filiform
what cell predominate? – neutrophils

chronic perio? Common in black male
The wall absent in class v Pulpal
Battery ttt without consent
You are going to remove palatal tori from a pt`s palate,, which drug regimen you don’t have
to modify before proceeding in ur surgery?
Methotrixate (rheumatrex) 15 mg per week for 18 monthDenosumab (Prolia) 2% 60 mg for 2
months
Bevacizumab ( AvasƟn) 70% or 6 month
Alendronate sodium (fosamax)
Another 5th drug ,, I don’t remember it but is was belong to Denosumab family
I picked 1st choice Methotrixate because the rest of drugs are bone stabilizer and could
induce MRONJ
optimum reduction for buccal cusp in PFM crown :
0.5
1.0
1.5
2.0
frankfort line?Prion to orbitale
hex in implant for antirotational

abutment feldspar main ingredient??
silica
alumina
which medicine is not good to give in patients with kidney disease? ibuprofen, aspirin,
codeine
melasma is seen in - preganant.

Melasma is a very common patchy brown, tan, or blue-gray facial skin discoloration, usually
seen in women in the reproductive years. ... Melasma is most common among pregnant
women, especially those of Latin and Asian descents.
alveolar bone graft whole mandible area what should be used??

autograft decalcified freezed
Disadvantage of using elastomeric impression material in taking occlusal record? Rebounding

of material occur
How deos wrought wire loose its elasticity.??Overadjustment

use of arcan articulator?? record condylar guidance in the maxilla and axial rotation in
mandible
Note: Arcon are more accurate for fabricating fixed restorations,

while nonarcon provide easier control in setting teeth for complete and partial dentures.
pt suffering from bone disease , ( pic below) , want new denture because his old one is no
longer fit
Ans: pagets disease ,,, u can notice that his bone is extremely opaque
what is the error in the pic :: ( the xray they gave in the exam was extremely white
options were related to exposure time,,too warm developer
MAY 14TH RQS
Q1) Curette angle?

-20
-30
-45 – 90
q2) Bulimia is more common in?

-black males
-young Caucasian females
-young black female
q3) Clindamycin MOA?

-30s ribosome
-50s ribosome
q4) After IV injection of antibiotic, pt started to wheeze on inspiration, hypotension,
tachycardia etc.
-hypoglycemia
-anaphylaxis
- adenoid crisis
q5) Causality (cause and effect) is not seen in which study? Cross-sectional
q6) Zinc polycarboxylate powder ? zinc oxide
Powder is zinc oxide and the liquid is eugenol.
q7) Self drilling pin is used on?

-large tooth only
-flat surface
-curved surface
q8) Tachycardia is seen in all except?

- hyperthyroidism
-anemia
- obstructive jaundice (bradycardia)
q9) Defiant kid, how do you control?

- TSD
-physical restraint
-voice control
q10) Autogenous bone for large volume of graft is taken from?

- Ilium
- Ribs
- Ramus
q11) Researcher wants to study the efficacy of two mouthwashes in two groups.
What type of study?
- Cohort
- Cross sectional
- Clinical trial
- Longitudinal
q12) a 3 year old kid was given 2 ml of lidocaine. He develops a reaction, swelled
lips and hives. What emergency drug will u give?
-Diazapam
-Epinephrine
-Nalaxone
q13) Sulfonamide MOA
q14) Which antibiotic in NUG (penicillin V was not there)

-metronidazole
-clindamycin
q15) Primary teeth lost prematurely in? (choose only one option)
-hypophosphatasia
-papillon levefre
q16) Gingivectomy incision?

q17) Film is too light? Cause?

-developer temp too high
- less exposure time
q18) Least associated with lip/cheek biting?
-dec horizontal overlap in posterior teeth
-dec vdo
-teeth set up too lingually. This lead to tongue biting
q19) Least useful retention/resistance form in crown?

-parallelism
-path of insertion
-length of axial walls
-total area of 2 axial walls
q20) What type of movement would cause contact on buccal incline of maxillary
lingual cusp?
- protrusion
-working side
-non working side
q21) In human subject research, many elements should be considered, most

important being:
-have a positive outcome
-obtain informed consent from participants
-participant pose no risk
q22) Zirconia is strong because?

- covalent bonding between zirconia and oxygen
- phase transformation under stresses
q23) Best test for pulp necrosis?

- ice stick
-endo ice
- EPT
q24) Placebo drugs are effective in 25% cases. False, 50% is true
Dentist’s attitude will effect the outcome of placebo drug ?
- true and false type question for both statements

q25) Which muscle effects the shape/form of lingual flange in molar area?
-palatoglossus
-mylohyoid
-genioglossus
q26) What will you not do at a perio maintenance visit?

q27) Which drug is used for mucocutaneous and systemic fungal infections?
-miconazole
-fluconozole
According to the options, Fluconozole is systemic only
q28) Most common complication of extraction of maxillary teeth?

-dry socket
-sinus perforation
-hemorrhage
q29) Class 2 inlay design?

q30) Selective grinding is done to?
-restore bilaterally balanced occlusion
-to direct the forces along the long axis of teeth
q31) Vertical releasing incision starts from midfacial area. F

It is often given to provide proper access. T
-True and False question about both statements
Similar Q: Vertical releasing incisions should be placed on midfacial aspects of

teeth because vertical incisions are often necessary for access or apical
positioning.
A- both statement and reason are correct and related
B- both statement an reason are correct but not related
C- statement is correct but reason is not
D- statement is not correct but reason is an accurate statement
E- neither statement not reason is correct
q32) Midfacial injury, lower eyelid is numb and theres bruising on skin lateral to the
nose. Which sinus wall is affected?
-upper
-medial
-lateral
-floor
q33) Blow to lower orbit, eye movement limited to?

-upper
-lower
-lateral
q34) Onlay indication?
-because upper tooth is restored
-reduced dentinal support
-some other options I forgot
q35) Grade 3 furcation, endo treated mandibular molar. Best tx option?

- GTR
-hemisection, extract one root and give 3 unit
-hemisection with 2 crowns
- exctract entire tooth
q36) What is used to adjust a porcelain crown?

-carbide bur
-diamond bur
-green stone
q37) Feature of cherubism? (only choose one option)
-early childhood
q38) Scrap amalgam is stored in? (no sulphide option)
-biohazard bag
-sealed container
-ethyl chloride
q39) Seizures are more common in?

-encephalo-angiomatosis
-hereditary telengectasia
q40) For ideal class V, the retention form should have:

q41) A 3 unit bridge for replacing maxillary canine is :

- it is a simple bridge, as all 3 unit bridges are simple
- it is a simple bridge, it follows the Ante’s law
- it is a complex bridge as the inter abutment axis is not parallel (something like
tht)
q42) 3mm crowding in 8 year old, tx options:

- disking of canines
-extract the canines
-extract and provide lingual arch
q43) Disadvantage of implant using cement retained abutment?
- only option that seemed right was ‘cement in sulcus’
q44) Patient complains of headache and jaw pain. She says it gets better when
she lies down away from light and loud noises. Condition is ?
-tinnitus
-migraine
-mpds
q45) Healing of periapical radiolucency will be slowest in?

-diabetic pt
-aids/hiv pt
-hypertensive pt
q46) Patient is diagnosed with BCC. He says “just throw it to me doctor, do I have
the cancer or NOT?” What will be your first response?
q47) Patient comes one month after you placed the crown, there’s discoloration
in cervical area. What is it?
-microcracks in porcelain
-amine in resin cement
-caries
q48) Retentive clasp tip is located in?

-middle third
-gingival third
q49) For CaOH in pulp capping to be successful, it should be:

-atleast 2mm in thickness
-covered by gic base
q50) Disadvantage of fillers in compostite?

- some options regarding the refractive index
-it is opaque
q51) Disadvantage of sedation?

q52) Buccally erupted (ectopic) canine have what greater chance?

-hypoplasia
-gingival recession
-deep bite
q53) What is reciprocal anchorage?

-tipping
q54) Effect of Coumarin will be reduced by
q55) What will you not do for aids/hiv patient?

q56) Elective RCT is done in?

-pulp exposure
q57) What is true about subgingival varicosities?

- more common in young age
- rarely may become problematic if theres thrombosis
-not associated with any systemic condition
q58) Combination (kelly’s) syndrome:

-occlusal plane is tipped downward anteriorly
-resorption of posterior ridges in maxilla
-can be improved with implants in posterior mandible
q59) Healing after occlusal trauma is removed, what is seen?

-resorption of bone
-resoprtion of cementum
-narrowing of PDL
q60) Active stabilization/immobilization is done in?

-patient who was previously cooperative suddenly becomes unco-operative
(there were other options, I didn’t know anything abt this!)
q61) Sign on injecting anesthesia intravascularly?

-no anesthesia
-inc heart rate/palpitation
q62) Function of ferrule?

- prevents rotation of core
-prevents fracture
q63) You made a zirconia crown on right mandibular molar. When patient bites, it
shifts to the right. What area is affected?
-buccal – buccal
-lingual – buccal
-buccal – lingual
Lingual incline of buccal cusp

q64) A radiograph of lower mandibular area, shows an unerupted 3rd molar that
has a unilocular radiolucency next to 2nd molar. Histology says it is lined by
nonkeratinized stratified sq epithelium. Dentigerous cyst
pic was something like this:

q.65) A radiograph showed mandibular posterior area. There was a radiolucency
with some diffuse radiopaque structure in the middle. Question was asked to
identify radiolucent-radiopaque lesion. I chose ameloblastic fibro-odontoma as
other options were radiolucent.
pic was something like this but 100 times bad quality
q.66) A panoramic xray was given to identify a landmark:
it was marked where point C is at – zygomatic process of maxilla

q67) Day 2 bacteria in plaque?
-Gram positive cocci and rods
-Gram positive cocci and filaments
q68) Drug that potentiates GABA neurotransmitter? Benzodiazepines. Idk if its in

options
- Triazolam
- Cholral hydrate
- Meperedine
q69) Difference between primary trauma and secondary trauma?

- Duration of force
- Amount of force
----------------------------------------------
q70) Idiopathic osteosclerosis and condensing osteitis look similar

First is vital but the latter is non-vital
True and false type of question for both statements

q71)Least useful impression material for cast impression?
- Reversible hydrocolloid
- Irreversible hydrocolloid
- PVS
- other elastomers
q72) Illusion to make tooth appear narrower?

q73) Nitrous oxide may not be effective in defiant children. T
Nitrous oxide is useful for anxiety relief. T
True and False type of question for both statements
q74) A patient has undergone scaling and root planing in all 4 quadrants. The oral
hygiene of the patient is excellent but generalized 5 mm and 6 mm pockets
remain that bleed upon probing. What is the next step and the best treatment for
the patient?
- Periodontal surgery
- Maintenance therapy
- local drug delivery
- additional round of scaling and root planning
q75) A 25 year old girl wants a filling but in composite. Its class 2. When you
prepare the proximal wall, it extends below the CEJ. What material will you use in
the gingival increment?
- Dual cure resin
- RMGIC
- some other resin or composite options
q76) What is seen in cellulitis?
-Lymphocytosis
- Lymphopenia
- Neutrophilia
- Neutropenia
Chemical cauterization in odontogenic keratocyst is done by

- Hydrogen peroxide
- Carnoy's solution
- Superoxide solution
- Betadine
* Carnoy's solution is a substance used as a complementary treatment after the

conservative excision of odontogenic keratocyst. The application of Carnoy's
solution promotes a superficial chemical necrosis and is intended to reduce
recurrence rates.
NBDE PART2 RQs 10-11 may (RINA KELKAR)
1- sealants most beneficial on which teeth? ANS- 1st molars
2- wch represents initial consideration in the treatment planning process?

a) Medical/systemic evaluation
b) B- Periodontal evaluation
c) C- Radiographic evaluation
d) D- Elimination of pain and discomfort had this questiom
3- RQ: What ASA classification: someone who has DM, hepatitis C, hypertension,
renal transplant 2 years ago.
A,ASA 3
B.ASA 4
C.ASA 5
D,ASA 6
4: To extract 4 upper anterior teeth you need to do infiltration and greater palatine
and block for
1- incisive
2-anterior palatine
3-superior anterior alveolar
4- greater palatine
5- A Patient who has been wearing a maxillary denture for 15 years notices
multiple, reddened, nodular lesions on his palate. The lesions are soft and painless.
The most likely diagnosis is
A- Torus palatinus
6- When establishing a balanced occlusion, lingual cusp of ,maxillary posterior

teeth on the balancing side should contact
a) Central fossa of mandibular posterior teeth
b) Facial inclines of the lingual cusp of mandibular posterior teeth
c) Li inclines of the facial cusp of mandibular post teeth
d) Li incline of li cusp of mand post teeth
**** I marked C for this one please someone confirm
7- not true about MWF??
a)reverse bevel
b)sub marginal incision
c)replaced flap
DONT KNOW TH ANSWER
8- Position of mand foramen relative to occlusal plane

in kids?----i don't know what i marked...but i had read it day before my exam
fromDD----
9- drug for petit mal (Absence seizure)? ans- ethosuximide
10- max 2nd molar less keratinized tissue, which graft you will give?
i think i chose apically displaced for this one coz options were modified widman,
free connective tissue graft, apically displaced and last one was i don't remember
11- i was given clinical features of CROHN DISEASE, HYPERPARATHYROIDISM,

TREACHER COLLINS SYNDROME AND WAS ASKED to identify the disease
---------------------------------------------------------------------------------------------
12- pt. has asthma and currently has cardiac disease what drug will u give?
ans- theophylline
13- Epi works in which receptors? The answer should be All !

A1
A2
B1
B2
DONT HAVE THE ANSWER
14- Recovering from alchoholism, which analgesic to be given except-

ibuprofen, Percocet, vocodin, tylenol3
i didn't have this straight forward question----it gave me hydrocodone+ codeine
option A, then acetaminophen+codiene option B and so on...so it was not that
straight forward...
15- 22 yr old girl with fever , malaise, lymphadenopathy, multiple ulcers on tongue,
palate with swollen gingiva-?
A)anug,
b)acute herpetic gingivostomatitis,
c)marginal gingivitis,
d)herpangina
16- Tooth with 2 pulp chambers? A. Fusion

B. Germination ans- fusion
17- Aspirin does not increase what?-
a)bleeding time,
b)prothrombin time,
c)acidosis,
d)renal prostaglandins
ans-D
18- Pat had mand incisors only. Needs upper denture with lower rpd. What type of
occlusion willprefered?
1. Balances in centric
2.balanced on working
3. Group function
4.canine protect i chose 3—
19- How to differentiate incipient white on smooth surface with remineralized

caries? Transillumination
Enamel illumination
Using explorer on surface
Better lighting and air drying
ans-D
20- Signs and symptoms of alveolar osteitis include all of the following except:
a. pain commencing 2 - 5 days following the extraction b. accompanied by a foul
taste or smell
c. self limiting condition that will improve and resolve with time
d. treat with antibiotics and pain medications
21- What do we write the consult for?

1.to gain certain inform
2. To gain clearance
3. To have better relationship with pt (picked 1 coz i had asked my husband who
is a doctor he said we do consult to get information)
22- What is the best indicator of periodontal stability over time for the patient on
periodontal maintenance therapy?
A- Plaque control
C- Probing depths
23- Which of the following would be the first step to perform during a reevaluation
appointment?
24- In removing a torus palatinus, the practioner inadvertently removed the

midportion of the palatine process of the maxilla. One would expect to see:
A. The nasolacrimal duct
B. The inferior nasal concha
C. An opening into the nasal cavity
D. An opening into the maxillary sinus
25- What pathogenic microbiota is most likely associated with a failing implant?
26- Which of the following is used primarily as filter material in a dental X-ray
machine?
A- Oil
B- Lead
C- Aluminum
D- Tungsten
E- Molybdenum
27- Which of the following is NOT true regarding orthodontic tooth movement?
D- Oxygen tension is increased in some areas of the PDL
and decreased in other areas
*** I chose D, DON’T know wats the right answer
28- Which of the following is NOT a clinical presentation of oral Candidiasis?

D- Ulcerative patch
29- In arranging the patient’s maxillary anterior teeth, the dentist should create a
pleasant, smile line. This can be done by contouring the incisal edge to follow the
A- Lower lip when smiling B- Upper lip when smiling C- Lower lip without smile D-
Upper lip without smile
30- Dental waterline should be flushed at the beginning of the day

30 sec
45 sec
60 sec i chose 30 sec
31- most common benign odontogenic tumor....something like this its given in
mango- answer is ODONTOMA
- For Epithelial tumor is Ameloblastoma
32- Which material has the highest coefficient of thermal expansion?

Gold
Amalgam
Filled Resin
Unfilled resin
33- treatment of leukoplakia
34- toxic and lethal dose of flouride...learn it

35- bur used to polish porcelain- DIAMOND
36- how to measure pocket depth?? They give u options from where to where
Free Margin to base of pocket
37- Opiates do NOT produce which of the following effects?

A- Diuresis
B- Euphoria
C- Mental clouding
38- The dentist places a MOD amalgam restoration on tooth 30. The patient bites
down immediately after carving, and the marginal ridge fractures easily. Which
amalgam properties contributed to this failure?
A- Creep
B- Resilience
C- Edge strength
D- Setting time
39- T/t of gingivostomatitis and herpetic stomatitis
40- difficult to put matrix on wch tooth? max 1st PM

41- painkiller safe in pregnant women- Acetaminophen or Tylenol 3
42- How do we determine arch length for primary?

Ans- Primary: Distal of 2nd Molar to distal of 2nd molar
43- most rapid loss in anteroposterior distance in an arch is due to mesial tipping
and rotation of which tooth?
a: permanent 1st molar
b: permanent 2nd molar
c: 1st premolar
d: 2nd premolar
e: permanent canines
44- :In which of the following situations can topical corticosteroids be used?
A. Angular cheilitis. B. Candidiasis.
C. Herpes labialis.
D. Erosive lichen planus.
E. Necrotizing ulcerative gingivitis
45- What can't you change? Hue, Chroma, or Value-

ANS-hue
46- delayed expansion from amalgam causes a. aesthetic

b. shiny c. decrease strength d. increase strength
47- dental matrix made of plaque made up of dextran
+_ ? ans- LEVANS
48- when should the consent be done ? ANS-after discussing the treatment
planning and before the procedure
49- space infection of mandibular PM 1 where to ? SUBLINGUAL
50- MAX 3rd molar space infection where to?

infratemporal
51- IAN block which space given ?— PTERYGOMANDIBULAR
52- mandibular 3rd molars roots disappear into wch space? SUBMANDIBULAR
53- 40 year old , 32 unrestored teeth only has deep stained grooves on posterior
teeth and grooves are uncoalesced
a. PRR
b. observe c. topical fl
d. pit and fissure sealants
54- aphthous stomatitis is associated with what ?

a. herpes b. cmv
c. EBV
d. tomato allergy
e. human leukocyte count
55 : What lesions are not radiopaque? AOT

Ameloblastic fibro odontoma ameloblastic fibromA
PLEASE LOOK THIS ONE IN MANGO
56- why do you do triangular access on incisors (max central incisor?)

a. to help with straight line access b. help expose pulp horn
57- What property of rpd framework will limit adjustments of clasps?

a. Yield strength?
b. Ductility c. Stiffness
d. Modulus of elasticity
58- Where are the majority of supernumerary teeth located?

Posterior maxilla
Posterior mandible
Anterior mandible
Anterior maxilla
None of the above
59- warfarin wch test- PT
60- Alcoholic wch test- INR
For Warfarin...INR is the first choice, Next better option is PT

For Heparin...first better option is PTT ( partial thromboplastin time), Second is INR
Hemophilia, Vwb disease Heparin...PTT
Warfarin/Coumadin, alcohol...INR
Bleeding time...Aspirin
Do not confuse with this picture: Go with PT only if INR is not in option.
61- symptoms of thyrotoxic crisis?

bradychardia tachychardia hypotension
62- network model- HMO
63- flouride in community what kind of prevention?

ans- PRIMARY
64- transillumination for what- i picked CRAZE line

Fractured cusp , Vertical root fracture, Craze line
65- caries are triangular at the DEJ what type of caries are they? ans- chronic
66- Anterior teeth class 4 big composite done few weeks ago. The filling is
acceptable but
too light. What to do? Re do
Observe
67- Bisphosphonates contraindicated in osteomyelitis and multiple myeloma? T/F---

False used in multiple myeloma but not in osteomyelitis
You can use them in MM there is no contraindication but contraindicated in
Osteomyelitis so FALSE
68- to motivate patient for proper OH u do al EXCEPT: ANS- CARROT STICK

69- wch flouride best for handicapped kid? NaF
70- Acc to WHO classification, avulsion in classified as

Dental hard tissue
Luxation
Soft tissue
71- most abundant in gingival sulcus? ans- MAST CELL?
72- most abundant in gingival sulcus? ans- IgG **** I

had both the versions….
73- The penetrating quality of x-ray beams is influenced by which of the following?
A kilo voltage B.Milliamperage C.Exposure time D.Focal- film distance
E Filament temperature
74- Each of the following is known to contribute to orofacial clefting EXCEPT

one.Which one is the Exception?
A.Valium
B.Poor diet
C Acetaminophen
D Vitamin deficiency or excess
75- steps involved in placing veneer? Ans- microetch, etch, silane, bonding
76- partner dentist and hygienist hurts patient, who will be involved in law suit??
77- bilateral enlargement of the parotid glands characterizes each of the following
conditions EXCEPT one. which one is the EXCEPTION:
a. malnutrition
b. sialolithiasis
c. Sjogren syndrome
d. benign lymphoepithelial lesion e. acute epidemic parotitis
ASDA Q. ans. B
78- Tooth extraction, 3 days later starts to hemorrhage what is the cause?
Fibrinolysis t/f...I CHOSE ITS true...100% dry socket starts happening after 3 days of
extraction sourced
79- :Pain associated with of the following mimic tooth ache

1. Herpes
2.shingles
3. Maxillary sinusitis
ANS-herpers zoster
80- Which treatment has least successful long term prognosis on deep caries on
tooth #3
A DPC
B IPC
C pulpotomy
D RCT
81- If implant with width of 4 mm is used ,what should be the buccolingual width of
the ridge?
A. 6 mm B.8 mm C. 4 mm
D. 10 mm ANS-A
82- Both cleft lip and cleft palate needs to be corrected on baby---like how many
months of weeks later after birth
Correction cleft lip 3 months
Palate 10-14 months
83- which stage of syphilis most infectious? ans- SECONDARY
84- which mandible fracture site is most common? ans- condyle
85- drug for epinephrine reversal? ans-phentolamine mesylate
86- drug for benzodiazepine reversal- FLUMAZENIL

87- radiographic feature of sickle cell anemia? Large Radiolucent marrow spaces.
Ans- STEP LADDER TRABECULATIONS
88- while anterior teeth arrangement where should the incisors touch---something
like that----vermilion border of lower lip
89- maximum dosage of acetaminophen in a day- ans- 4 gram

Oral:
Immediate-release: 325 mg to 1 g orally every 4 to 6 hours
Minimum Dosing Interval: every 4 hours
Maximum Single Dose: 1000 mg
Maximum Dose: 4 g per 24 hours
90- most common medication accepted

SUBGINGIVALLY? ANS- 2% doxycycline
91- slow set and fast set alginate what is the difference in their compositions?
Sodium phosphate is the answer
92- Most commonly used TCA drugs- ans AMYTRIPTYLLINE

93- perio t/T most unsuccessful in wch teeth? Ans- maxillary molars
94- flossing difficult wch tooth? Mesial of Maxillary 1st PM
95- calculation of the number of bifurcations and trifurcations when 3rd molars are
absent??
Max 16
Mand 8
96- posterior tooth has large carious lesion extending subgingivally which of the
following is the best initial treatment?/
a) endo therapy
b) crown lengthening c) caries excavation d) crown fabrication
Blocking the synthesis of prostaglandins does NOT produce which of the following
conditions?
A- Antipyresis
98- activity worked on to work as ANTIPLATELETS?? Ans- block thromboxane A2
99- wear on mesio marginal ridge of MB of mand molar?

A) working interference
B) NW interference
C) Protrusive interference
D) Centric interference
100- in wch teeth malocclusion teeth gets injured most?

Ans- class II div I
101- Wch test to see if patient is maintaing his blood sugar for past 2 years…
something like that??
a) fasting plasma glucose b) oral glucose tolerance c) random plasma glucose d)
I don’t know this option
Glycated hemoglobin
Hemoglobin A1c (HbA1c) is the sugar coated form of hemoglobin and can be
measured in a blood test to determine long-term high blood glucose levels (over
the last 90–120 days depending on how fast the red blood cells are replaced)
Tip of the nose (soft tissue)
103- perineural invasion seen in wch condition??

2 associated conditions:
1. ACC (adenoid cystic carcinoma)
2. POLYMORPHOUS LOW GRADE ADENOCARCINOMA (PLGA)
104- flexure of the teeth seen in?? ABFRACTION

105- my first question on screen- patient is taking IV biphosphnate from 2 years has
non restorable carious tooth what should be the t/T?
ANS- endo of teeth
106- component of ADA accepted dentrifice? Ans- KNO4 (potassium nitrate)
107- do D1-D2 endo file calculation- I had 1 question----

108- most commonly ectopic tooth? Max 1st molar
109- congenitally missing primary tooth? Ans- maxillary lateral incisor
------------------
110- “w” in the rubber dam clasp means what?? WINGLESS

Clamps with "W" prefixes, such as the #W8A or W3, indicate that the clamps are
without wings on the outer portions opposite the holes.
111- narrowest zone of attached gingiva? Between mand 1st premolar and canine
facially, between mand incisors and canine lingually.
112- radiation therapy, caries most common site- ? CERVICAL
113- Rheumatoid arthritis

A. Autoimmune
B. Auto dominant
C. Auto recessive
D. Other ****
114- Don't put instrument whith in steam sterilization
A. Plastic bag
B. Plastic & paper
C. Cloth
D. Heavy metal
115- Sharp instrument NOT require

A. Upper lower lid
C. Metal container
116- 2ry hyperparathyroidism caused by : Renal failure
117- Two factors that will decide the placement of the posterior composite
118- Acute Herpetic gingivostomatitis is common in

4 month
2 yrs
6 yrs
8 yrs
MIA JONES – RQs (May 24-25)
- Bisphosphonates – 4 questions (please study this thoroughly, the basics)
Some important points about bisphosphonate. mosby
1* patients treated with intravenous bisphosphonates (e.g., for treatment of bone

malignancies or severe osteoporosis) are at increased risk of osteonecrosis of the jaw.
2. bisphosphonate medications inhibit osteoclast activities, resulting in decreased
bone resorption.
3. used primarily to treat cancer (intravenous administration) and osteoporosis
(usually oral administration).
4. bisphosphonates have been used in treating bony diseases such as multiple
myeloma, Paget’s disease of bone, and metastatic diseases.
5. postoperative complications associated with bisphosphonate use, including
chronic bony exposure that does not heal and spontaneous exposure of alveolar
bones. This process is known as bisphosphonate-related osteonecrosis of the jaws
(BRONJ).
6. Oral versus intravenous bisphosphonates—oral bisphosphonates have been used to
manage milder bony diseases such as osteoporosis, whereas intravenous
bisphosphonates have been effective in treating bone metastases and
hypercalcemia resulting from malignancy. BRONJ has a greater association with
intravenous bisphosphonate use than with oral therapy.
7. Before initiating bisphosphonate therapy, patients should have a thorough dental
evaluation and plan to extract teeth that are nonrestorable or with guarded prognosis,
to remove tori, and to perform alveoloplasty. The goal is to reduce factors that can
initiate BRONJ. When possible, bisphosphonate therapy should be delayed to allow
adequate healing time after oral surgery, usually about 2 to 3 weeks
8. If possible, surgeries and dental implant placement should be avoided, and
endodontic treatments should be considered before extractions.
9. the risk of BRONJ is increased as duration of bisphosphonate therapy exceeds 3
years.
No treatment adjustments are needed for patients who take oral bisphosphonates
less than 3 years and who have no comorbid risk factors. A 3-month drug holiday is
recommended for patients taking oral bisphosphonates for longer than 3 years.
- 14 y/o boy – X ray – Fibrous dysplasia
Ground glass appearance
- Identify the soft tissue – Nose

- Calculation of Negative prediction value. Simple calculation with the formula
- Salivary secretions (3 questions) – when is it 0.1, when 0.5 and when 1
- Adenoma with the same histology of parotid gland
- 4 questions on working interferences
- Mandibular spaces- 2 questions, drainage of PM and drainage of Molars
- Unbundling
- Same Wheel chair question
- Inter implant distance
- Null hypothesis
- Cross sectional study 2 questions
- Diff between pulpal and periodontal disease – EPT JE attachment
- Asthma medication
- Additional anchorage in ortho
- 75 y/o 6 week ago heart attack, transported to the clinic in wheelchair. –
classification
- 3 questions on active listening and paraphrasing
- 4 Q on appropriate response to patients
- Lithium used in – manic phase of bipolar disorder
- Nitrous oxide side effects
- Moisture contamination – Delayed expansion and failure
- Thyroid crisis symptoms – all except
- Short crowns
- Antibiotic for Myasthenia Gravis
- Mao and TCA depressor
- Mech. of action of phetolamine
- Osteosclerosis – 2
- Ectodermal dysplasia – oligodontia, sparse hair
- Battery and autonomy View for TMJ disc Oxycodone – side effect Neuropraxia
- Gingivectomy – incisions and contraindications
- Prone to fracture crown
- Relapse on its own – hematoma, freckle, macule, varix
- Plaque control in a 5 y/o medical compromise – NaF, CHX, Listerine
- Abfraction Erosion Attrition
- Tetracycline in 5 year old
PJ syndrome
Pemphigus lesions
Epidermolysis Bullosa- lesions
Dens in Dente – which teeth
Macroglossia seen in – amyloidosis or Hyperparathyroidism
Loss of arch space due to exfoliation of which teeth
5%, 35%, 55% - non verbal
6 y/o refuses to sit on the chair, what do you do
furcal radiolucency – occlusal trauma, cervical enamel eruptions
Taurodontism – which stage of development
12 y/o Max central Incisor obliterated – what is the treatment etiology of rubella
embryomyopathy
Pt needs bleaching and porcelain veneers, what is done first and in which order
Veneer broken- steps to repair
4 VDO questions hemophilia tests
Coumadin and alcohol tests Q on erosive lichen planus Anticancer drugs side effects
Cisplatin Q
Troche – antifungal
AIDS symptoms – 1st stage
Linear gingival erythema Spontaneous bleeding gums HZV – mimics tooth pain
H stomatitis
SE of Antibiotics on kids
Root caries
Margin of porcelain and degree – 1 mm 120 deg, 1.5 mm 120 deg, 1mm 90 deg,
1.5mm 90 deg
Modelling
Behavior questions – 2Q
Which Periodontitis do you do SRP and systemic antibiotic
16mm overbite – treatment
Misprostol uses
staff wants to verify if instruments are clean – do you check the bag for the color
change or bio test
palatal tori – 2 Q Condyloma acuminatum Coxscakie virus
2 Mx PM questions
Metamerism
sensitization for a patient who is in pain or fearful disinfect GP
combination syndrome
Area of class II on composite restoration commonly recurrent decay
Porcelain 2 Q – firing, condensed improperly
Adv of glass fibreposts
What in saliva helps remineralization
Adv of base metal alloy over high noble
2 questions on Alpha1 and B2 receptor
Day 2
1. 2 pediatric cases
1 exclusively featured on ortho issues (all 9 questions)
2nd was more about plaque control, marginal gingivaitis, assessing need for Space
maintainers
2. Lady with a H/O of smoking, drug usage needs a complete Upper and lower
partial.
Prostho questions.
I will add the other cases in the comments, soon.
Hi everyone
I want to share my experience in the exam with all of you
I took the exam in the middle of may after 3 months of studying and it was not very
difficult exam as I thought and the time was very enough for both day one and day two
If you have any questions regarding the exam or how to prepare for the exam i will be
more than happy to help all of you guys
My RQ :
• If implant 4 mm diameter, how much mm MD you need?
• Informed consent
• Battery
• Radio resistant cells – nerve or muscle
• Pt with dialysis, when do treatment? One day after dialysis
• Lithium treats what? bipolar
• Unbundling
• Amalgam failure – moisture contamination.
• Porcelain porosity
• If allergy to lidocaine, which anesthetic to give?
• Osteoradionecrosis what true? More in mandible/ more in maxilla/ more of 42 gray?
• How treat root caries? Composite, amalgam, modified resin (no option for GIC)
• treatment of Ranula
• Supernumerary teeth, whict disease?
• Dental lamina. Week utero? 6th week
• Age of calcification ant max teeth?
• Dry socket treatment.
• Know in which cases we can to damage lingual and IAN.
• AB for severe periodontitis. In option penicillin and amoxicillin + clavulanic acid
( augmentin)
• Pain in tmj area.?
• Calculus in x ray
• Fear and axiety
• Mandibular and maxillary torus in x ray
• Recognize some artifacts in x rays and pano
• Recognize cervical burnouts in x rays.
• Best area for implants.
• Flared anterior maxillary teeth. Which class?
• Contra indication N2O2 nasal congestion disease
• Forceps for upper premolar tooth except 23
• DD b/w DI, AI, dental displasia with pic
• Antiviral drug works on all of them – HIV
• Know all about working/ non working sides. many questions
• INR- extrinsic, intrinsic pathways?
• fungal drugs. Local and systemic!!!
• BDZ Antagonist - Flumazenil
• Face division vertically- vertical 3rds
• Disease more common in men : hemophilia
• Pt came in for a 3 month recall, initial therapy doesn’t show any significant changes,
little improvement in pdl status but plaque control is efficient. What will be the next step?
Periodontal surgery.
• Pt with mid face deficiency- Lefort 1
• Lefort 1 involves maxillary sinus.
Endo case presentations with questions on diagnosis (many ques)
• Supra basilar split and pemphigus
• Traumatic neuroma
• Location of the tip of the retentive clasp – at the junction of middle and gingival third
• Voice control- not a mild form of punishment.
• Mesiolateral border of the mandible- Mylohyoid (no option of sup constrictor)
• Buccal frenum of the mandible- triangularis
• indication for apexification – immature non vital tooth
• Cellulitis- lymphocytosis.
• Epithelium comesfromthedonorsite.
• Diabetes commonlyfound- blackmales.
• Safe analgesic in children – Acetaminophen.
• Antibiotic in bone- CLINDAMYCIN
• What is themost commonpsych disorder in elderly? Depression
• Most common emergency in dental clinic - Syncope
Function of major connector- Support and rigidity both in option.
• Incisal edge of anterior teeth touch
• Bur for finishing porcelain -Diamond
• Sodium hypochloride do all except - Chelation
• Tooth mostly involved in perio relapse – Max 1st molar.
• Sialolithiasis- in Wathin’s duct. Antiretraction valve- prevents cross infection.
• 20mg for 2 weeks 2year- corticosteriod
• Osteosarcoma – sunrays or sun burst appearance.
• Xerostomia due to medications.
• Sulfur granules associated with actinomycosis and sulfur granules.
• Multiple myeloma- bonepain
• Implant placement- High torque and low speed.
• Frankfortline orbitale to porion
• Mouth guard for athlete with muscle spasm. Important notes :
• Rita + mango +SJ Files very very important I recommended to do them more than one
time
• Many weird questions on patient management (that’s my weakness point in the exam)
• Many long true & false Q
• Easy and direct pharma Q ( tuft cover all of them )
• Many pathology Q in day one and in day two
• The x ray and the clinical photo was very clear in day 2
• I got 12 cases in day two ( 2 ortho / one of them was very difficult , 2 perio , one pedo
& the rest was collection of endo and prostho and surgery and all the cases contain one
Q for patient management and one Q for pharma and also Q on patho lesions )
• Day 2 depend on your previous clinical experience and your basic information
• The perio chart very helpful and very important in solve many Q and sometime there
was small notes in the side of the chart / pay attention for those notes and for the
furcation involvement and depth of pocket

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16 aug exam.

1.Laryngospasm: stridor, treatment is succinyl choline administration..

2.midozolam or methohecxital for prolonged sedation midozolam

3.implant distane from structure s, another implant , mental nerve

Implant to anterior loop is 2mm

4.modelling demonstration by elder sibling to the kid

5.Shaping modification of habit

7.candidiasis does not cause ulcerative patch

8 .angels malocc is based on molar relationship

9.working non working contacts qs from rita

10. Erosive lichen planus -CF

H/f- loss of rete pegs

11.thiazides indications Hypertension

12.patient needs an interpreter q

14.paraphrasing q repeat what pt said in summarized way

15.composite in posterior should match

1.. bcz if its 3 it will not occlude

16.identity tip of nose in radio graph

17.fibrous dysplasia in radiograph Ground glass

18.first q from rita

19.rests vertical support

20.moisture contamination in amalgam Failure

22.suprabasilar split in phemphigus T

23.neurofibromatosis Cafe au lait, lisch nodules, freckles, Brown pigmentation

24.inc vdo = clicking

27.polymerisation shrinking is higher in cavities witha high c factor as class 1

28.inadeq frame work= repeated # w

30.fibrous dysp in radiograph ground Glass appearance

32.apex locater q cannot locate minor perforation

34.phenytoin= grand mal rx T

36.micro etch etch silane q

37.thyroglossal cyst midline in neck

38.ameloblaastoma= local invasion T

39.cirrhosis tests Bilirubin test, Ift, PT, test

41.Gardner's syndrome intestinal polyps

43, TMj= MRI T

44.INR levels 1 healthy/2-3 cardiac patient. Extrinsic pathway/PT

46.ludwigs angina submental, sub mandibular, sublingual

47.HLA antigens and RAS

51.taurodontism large pulp chamber square shaped towards apical

53.least and most in every single thing lol

54.eruption sch is very imp 4-5 qs in this

55.PFM reductions functional= 2mm, nonfunctional= 1.5mm

58.moa asprin irreversible inhibition of cox-1 enzyme

59.doxy advantages = ext half life more water soluble

60.all the qs on p value din mango

61.null hypothesis qs two of them

65.anug organisms spirocheta and fusobacteria

67.no antobiotics in Chr Periodontitis T

69.perineural invasion q ACC

71.carbenicillin = indole positive proteus q T

79.diff between gingivitis and periodontitis Clinical attachment loss

81.tori= All the qs we have ever seen on tori

83.antiobiotics made from= bacteria fungi q T

85.bells palsy due to facial nerve paralysis

86.candidiasis alllllll the qs in alll the files lol

88.hypotensive eff of oxycodone due to release of histamine

89.leukemia- spontaneous haemorrhage

90.disadvantage of oral sedation slow absorotion by GIT

91.disadvantage of fillers in composite less polishable, more polymerization shrinkage

92.migraine -triptans . serotonin uptake agonists

93.indicatuons for RMGIC subgingival caries

94. dry socket irrigation then sedative dressing

100. macroglossia seen in down syndrome, acromegaly