ENDODONTICS AND PERIODONTOLOGY

1. The likelihood that oral bacteria play an important role in gingival inflammation is evidenced by
which of the following?
A. An increase in salivary hyaluronidase
B. An increased number of bacteria in saliva.
C. An increase of neutralizing antibodies in saliva.
D. A reduction of inflammation with reduction of plaque.

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.
D. All of the above.

3. The epithelial root sheath (Hertwig) is characterized by:

1. the formation of cellrests in the periodontal ligament when the sheath’s functions have been
accomplished
2. progressive involution, thereby aiding in actual tooth movement during eruption
3. the absence of a stellate reticulum and a stratum intermedium
4. the absence of mitotic ability and thus, stretching as the root grow.
A. 1 and 3 B. 1 and 4 C. 2 and 3 D. 2 and 4

4. Chronic apical periodontitis is best differentiated from acute apical periodontitis by which of the
following?
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.

5. Piezoelectric, ultrasonic devices differs 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, SharperSonic, and TrioSonic file system
D. The piezoelectric unit vibrates at 2 to 3 kHz.

6. Normally, the free gingiva can be distinguished from the epithelial attachment because the:
A. Underlying connective tissue of the gingiva does not contain lymphoid cells. B.
Epithelium of the epithelial attachment does not have rete pegs
C. Epithelium of the gingiva is not keratinized.
D. Underlying connective tissue of the epithelial attachmentis less vascular.

7. Which of the following regarding acute apical periodontitis is/are accurate?

A. It is limited to the periodontal ligament (histologically).
B. It is detectable radiographically.
C. It may heal if induced by a nonintectious agent.
D. All of the above statements are accurate.

8. The majority of patients with symptoms of severe odontogenic pain have a diagnosis of :
A. periodontal abscess C. acute apical periodontitis
B. irreversible pulpitis D. acute apical abscess E. none of these.

9. The most likely source of bacteria found in diseased periodontal tissue is:
A. serum B. saliva C. subgingival plaque D. supragingival plaque.

10. In the older patient, the exit of the canal is:

A. Closer to the radiographic apex. C. easier to detect tactilely
B. Closer to the true apex D. More variable because of cementum formation
11. The likelihood that oral bacteria play an important role in gingival inflammation is evidenced
by: A. an increased number of bacteria in saliva
B. an increased in salivary hyaluronidase.
C. An increase of neutralizing antibodies in saliva
D. New pathogenic strains in the involved area.
E. A reduction of inflammatory states with antibiotic treatment.

12. A luxated tooth should be splinted in which of the following situations?

A. If the tooth is mobile after splinting. C. Until the RCT is completed. B. With the
composite as close to the gingiva as possible. D. All of the above.

13. Circular fibers are present in the:

A. Free gingiva and encircle the tooth. C. Free gingiva and encircle alveolar bone B.
Attached gingivl and encircle alveolar bone D.Periodontal ligament and encircle the tooth.

14. Used for anterior teeth:

A, Gracey 7/8 B. Gracey 13/14 C. Gracey 11/12 D. Gracey ½, 2/4 and 5/6 E. Gracey 9/10

15. Used for facial surfaces of posterior teeth:

A, Gracey 7/8 B. Gracey 13/14 C. Gracey 11/12 D. Gracey ½, 2/4 and 5/6 E. Gracey 9/10

16. Used for mesial surfaces of posterior teeth:

A, Gracey 7/8 B. Gracey 13/14 C. Gracey 11/12 D. Gracey ½, 2/4 and 5/6 E. Gracey 9/10

17. Used for lingual surfaces of posterior teeth:

A, Gracey 7/8 B. Gracey 13/14 C. Gracey 11/12 D. Gracey ½, 2/4 and 5/6 E. Gracey 9/10

18. Used for distal surfaces of posterior teeth:

A, Gracey 7/8 B. Gracey 13/14 C. Gracey 11/12 D. Gracey ½, 2/4 and 5/6 E. Gracey 9/10

19. Which of the following statements is accurate regarding gutta-percha points? A. They contain
40% to 50% pure gutta-percha. C. They adhere to dentin when compacted B. They can be
heat sterilized. D. They are not compressible.

20. Which of the following statements regarding internal root resoprtion is accurate? A. It is
rare in deciduous tooth C. It is initiated by odontoblasts B. It is seldom confused with
external resoprtion. D. It is usually asymptomatic.

21. Pulp necrosis is most likely to occur after which of the following?
A. Midroot fracture C. Concussion
B. Intrusive luxation D. Complicated crown fracture

22. Which of the following statements regarding unltrasonic 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.

23. Which of the following statements regarding guided tissue regeneration (GTR) is false? A. GTE is
an effective adjuncts 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 margins.
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.

24. The normal gingival sulcus is bounded by the:

A. tooth surface and epithelial covering of attached gingiva.
B. Tooth surface and epithelial covering of free gingiva.
C. Epithelial covering of free and attached gingiva.
 D. Free gingival groove and mucogingival junction.
E. Tooth surface and gingival lamina propria.

25. The junctional epithelium of the dentogingival attachment is characterized

by: A. orthokeratinization. D. All of these
B. The presence of rete pegs E. None of these
C. Hemidesmosomes in the cells facing the tooth surface

26. The cribriform plate (alveolar bone proper) reveals minute openings which represent: A.
areas of osteoclastic activity. D. Regions of hematopoietic activity. B. Resoprtion sites
of the spongiosa. E. Attachment sites of Sharpey’s fibers. C. Regions for passage of
vascular and nerve elements.

27. The major reason for failure, requiring retreatment is:

A. persistent pain B. restorative indications C. draining sinus tract D. microleakage

28. Used to dislodge heavy supragingival calcular deposits:

A. sickles B. chisels C. Hoes D. Files E. curettes

29. Used to remove gross and supragingival calcular deposits on mandibular anterior
region: A. sickles B. chisels C. Hoes D. Files E. curettes

30. Used to crushed and removed heavy calcular deposits:

A. sickles B. chisels C. Hoes D. Files E. curettes

31. Instruments used for scaling, root planing and removal of soft lining of perio
pocket; A. sickles B. chisels C. Hoes D. Files E. curettes

32. Any tissue organ used for implantation or transplantation:

A. graft B. allograft C. Alloplast

33. The acute apical abscess is best differentiated from acute apical periodontitis by which of the
following?
A. pulp testing B. presence of swelling C. radiographic appearance D. degree of mobility

34. Which of the following cell types may be found in the periodontal
ligament? 1. fibroclasts 2. osteoblasts3. macrophages 4. cementoblasts
A. 1,2 and 3 B. 1 and 3 only C. 2 and 4 only D. 4 only E. all of them.

35. 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 C. Steroid formulations
B. Zinc oxide-eugenol D. none, there is no material that promotes healing

36. An inert foreign body used for implantation into tissue:

A. graft B. allograft C. Alloplast

37. 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. Patients has had numerous opportunistic infections secondary to HIV infection
D. Patient has an implanted pacemaker.

38. A tissue graft between individuals of the same species but with non-identical
genes: A. graft B. allograft C. Alloplast

39. Scalers
A. push stroke B. Pull stroke C. twisting stroke D. Sawing motion 40. The calcified bodies
sometimes found in the periodontal ligament are best described as which of the following?
A. Cementicles C. bone
B. Denticles D. enamel pearls E. mineralized interstitial tissue.

41. Although the exact mechanism of formation of calculus is not understood, it is known that the
 organic matrix of calculus in humans includes:
A. no living microorganisms C. an abundance of microorganisms B. a
fusospirochetal complex D. only by-products of bacterial metabolism

42. Area-specific curettes: B

A. push stroke B. Pull stroke C. twisting stroke D. Sawing motion.

43. Hoes: B
A. push stroke B. Pull stroke C. twisting stroke D. Sawing motion.

44. Chisels: A
A. push stroke B. Pull stroke C. twisting stroke D. Sawing motion.

45. Files; B
A. push stroke B. Pull stroke C. twisting stroke D. Sawing motion.

46. Universal curettes: B

A. push stroke B. Pull stroke C. twisting stroke D. Sawing motion.

47. From which of the following is the periodontal ligament derived?

A. dental sac C. dental papilla
B. enamel organ D. epithelial root sheath E. outer enamel epithelium

48. Which group of fibers of the periodontal ligament is the first to offer resistance to movement of the
tooth in an occlusal direction?
A. alveolar crest B. horizontal C. interradicular D. oblique E. apical

49. The bacterial population in the gingival sulcus or the pocket that influences the course of
periodontal disease involves”
A. mostly aerobic bacteria
B. essentially a pure culture
C. bacteria not indigenous to the oral cavity
D. essentially the same organism found in the healthy sulcus.

50. Which of the following groups of periodontal ligament fibers has a cementum-to-cementum
attachment?
A. Oblique C. free gingival
B. Transseptal D. interradicular E. dentoalveolar crest

51. The alveolar bone proper usually consist of:

A. woven bone C. lamellar bone only
B. bundle bone only D. bundle bone and lamellar bone.

52. Gingiva is different from alveolar mucosa in that gingival is:

A. elastic fibers C. muscularis mucosa
B. simple epithelium D. stratified epithelium E. high connective tissue papillae

53. Which of the following species of streptococci is usually not found in human dental plaque? A.
S. mutans B. S. sanguis C. S. pyogenes D. S. salivarius E. S. mitior (S. mitis)

54. Blood vessels in interdental papillae anastomose freely with:

A. periodontal vessels only C. both periodontal and interalveolar vessels B.
interalveolar vessels only D. none of these.

55. Which of the following is not a “principal” collagenous fiber group of the periodontal ligament?
A. Apical B. horizontal C. Oblique D. Gingivodental E. none of these.
56. Which of the following organisms is least likely to be found among normal anaerobic flora of the
gingival sulcus?
A. Treponema C. Actinobacillus
B. Bacteroides D. Fusobacterium E. Mycobacteria

57. Percussion of a tooth is a test of:

 A. pulpal inflammation C. acute periradicular inflammation
B. pulpal necrosis D. chronic

58. 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.
D. All of the above
E. None of the above.

59. Which of the following regarding chronic, apical periodontitis is/are 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 has a predominance of B-cells over T-cells.

60. 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 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.

61. Which of the following statements best describe 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 , radioluscent lesion characterized by the
loss of the apical lamina dura.

62. Each of the following are direct advantages of pre-enlarging the radicular space, except: 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.
E. None of the above.

63. Paraformaldehyde-containing obturating materials results in which of the

following? A. Eliminate bacteria that remain in the canals.
B. Mummify tissue remnants in the canals.
C. Reduce post treatment pain.
D. Are below the standard of care for RCT
E. None of the above.

64. The root end is ultrasonically prepared during endodontic surgery for which of the following
reasons?
A. It results in apical cracks at low setting.
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.
E. None of these.
65. N2, Endomethasone, and Reibler,s paste are sealers that:
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.

66. Which of the following statements regarding pulp stimulation with cold is
accurate? A. It is best accomplished with cardon dioxide snow.
 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.

67. When is endodontic treatment is contraindicated?

A. The patient has no motivation to maintain the tooth.
B. The canal appears to be calcified.
C. Class III mobility and loss of bone support.
D. The tooth needs periodontal crown lengthening before restoration.
E. None of the above.

68. Based on instrument design and method of manufacturing, which 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. Hedstrom file fabricated from round SS blank.
D. Reamer fabricated from triangular SS blank.

69. Which of the following regarding gauging and tuning is correct?

A. Gauging is performed in the coronal portion of the canal to confirm if 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 f the apical portion of the canal. D.
Gauging and tuning produces a uniform, cylindric diameter to the canal in the apical 2 to 3mm
that enhances obturation and sealing.
E. None of these.

70. A preoperative finding that predisposes to a decreased prognosis is which of the

following: A. The tooth is in hyperocclusion.
B. The pulp is necrotic with no periradicular lesion
C. The pulp is necrotic with a periradicular lesion present.
D. The pulp is vital
E. Treatment is in an elderly patient.

71. Calcium hydroxide is advocated as an interappointment medication primarily because of: A. Its
ability to dissolve necrotic tissue. D. Its antimicrobial activity. B. Its ability to stimulate
hard-tissue formation. E. Its ability to temporarily seal the canal. C. None of the above.

72. An advantage to AH26 as an endodontic sealer is:

A. The release of formaldehyde on setting.
B. Low toxicity.
C. Long working time, but quick setting at body temperature.
D. It can be distinguished from gutta-percha radiographcally.
E. None of these.

73. Pulpal and periradicular pathosis results primarily from:

A. Traumatic injury cause by heat during cavity preparation. C. Bacterial invasion. B.
Toxicity of dental materials. D. Immunologic reactions.

74. The highest incidence of pulp necrosis is associated with:

A. Class V preparation on root surface C. Partial veneer preparation
B. Inlay preparation D. Full-crown preparation.

75. Extending a no. 10 file with a 0.02 taper 1.0mm beyond the apical foramen will result in which of
the following?
A. It opens the apical foramen to a minimum diameter of 0.12mm.
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.

76. Which of the following statements regarding Hedstrom 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-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.
E. None of the above.

77. 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 cavity liner or base.
D. Its bactericidal activity acts against oral microorganisms.

78. 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.

79. Which of the following is an indication for RCT of primary teeth?

A. Radiographic evidence of internal root resorption
B. Periapical lesion
C. Dentigerous cysts
D. Mechanical or carious perforation of the chamber floor.

80. 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. E. All
of the above statements are accurate.

81. A barbed roach is most useful for:

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.
E. All of the above.

82. An increasingly popular technique for pulpotomy in primary teeth is:

A. Formocresol C. Electrosurgery
B. Calcium hydroxide D. Laser surgery

83. The following are true regarding shaping procedures, except:

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 a more accurate assessment of the apical, cross-sectional canal diameter. D.
Shaping is necessary procedure because calcification occurs from the coronal portion of the
canal to the apex.

84. The following statements are true regarding endogram, except:

A. Provide information on the extent of internal resoprtive lesion.
B. Visualization of fractures and leaking restoration 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. It is used to confirm the correct working length.
E. None of the above.

85. 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 canal are curved and small after preparation.

86. The mandibular, 2nd molar should be restored with crown after RCT 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 muscle 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.

87. 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.

88. The result of RCT in establishing patency is:

A. It prevents procedural errors, such as canal blockage and transportation. B. It causes
irritation of the periodontal attachment apparatus and increased post operative pain. C. It
enlarges the apical terminus and increases the potential for extrusion of obturating material.
D. It requires insertion of a file 1.0 to 2.0 mm beyond the canal terminus.

89. 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 spreaders under equal force.

90. The response of the pulp to a recently placed amalgam without cavity lining is usually A.
slight-to-moderate inflammation C. slight but increasing severe in time B.
moderate-to-severe inflammation D. none of these.

91. The primary reason/s in using a sealer and cement is/are:

A. Attainment of an impervious seal C. Lubrication of the master cone.
B. Canal disinfection. D. Adhesion to dentin. E. All of the above.

92. Which of the following teeth is most likely to exhibit C-shaped

morphology? A. Maxillary first premolar C. Mandibular first
premolar
B. Maxillary first molar D. Mandibular first molar.

93. Presence of gutta-percha beyond the apex is usually caused by which of the
following? A. Use of too small master cone.
B. Excessive heating and compaction during warm, vertical condensation.
C. Destruction of the natural apical constriction.
D. All of the above.

94. 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.
E. None of the above.

95. The most important route of bacteria into the dental pulp is from:
A. General circulation via anachoresis.
B. Exposure to the oral cavity via caries.
 C. The gingival sulcus.
D. None of these.

96. 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.

97. 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.
D. All of the above.

98. Direct pulp capping is recommended for primary teeth with which of the
following? A. Carious exposures C. Calcification in the pulp chamber
B. Mechanical exposures D. All of these.

99. 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 microscope is used.

100. Canals may be missed during treatment because of which of the following? A.
Calcification C. Inadequate access
B. Anomalous location D. All of the above.