Challenge
Richard E. Walton, William T. Johnson, Lisa R. Wilcox
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.
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 by which of the following?
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 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
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. CO2snow (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 C-fiber 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.
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?
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
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
for one. Which is the exception?
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. d. All of the above statements are accurate.
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., lower-success 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 which of the following?
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)
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
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 which of the following?
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.
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,
except for one. Which is the exception?
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 D0diameter 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
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 is which of the following?
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.
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
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 A-delta 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
3. A periapical, true cyst communicates with the root canal; however, a periapical-pocket 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 which of the following?
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.
d. All of the above statements are accurate.
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.
d. All of the above statements are accurate.
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. d. All of the above statements are accurate.
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. d. All of the above statements are accurate.
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. d. All of the above statements are accurate.
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
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.
d. All of the above statements are accurate.
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. d. All of the above statements are accurate.
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.
d. All of the above statements are accurate.
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. d. All of the above statements are accurate.
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.