MCQ Challenges (Pathway of The Pulp Ed 10) MCQs [PDF]

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Abdullah Aldehaithem



Chapter 1: Diagnosis Question: 1. Which of the following conditions is most likely to be interpreted as toothache by a patient? a. Temporomandibular joint (TMJ) dysfunction b. Inflammation of the parotid gland c. Acute angina pectoris d. Maxillary sinusitis Explanation: Refer to pg(s): 6 e. Otitis media



Question: 2. Sickle cell anemia may be confused with an odontogenic problem by: a. Tooth mobility b. Coronal discoloration c. Localized swelling d. Generalized facial swelling e. Radiographic loss of trabeculae Explanation: Refer to pg(s): 5



Question: 3. Swelling on the anterior palate usually is associated with an abscess originating from a (an): a. Central incisor b. Lateral incisor Explanation: Refer to pg(s): 11 c. Canine d. Nasopalatine duct e. Incisive canal



Question: 4. The pulp test most likely to have a delayed response is the: a. Refrigerant spray b. Test cavity c. Electric pump d. Heat test Explanation: Refer to pg(s): 17 e. Ice-water test



Question: 5. A medical history of coronary heart disease is significant for which of the following reasons? a. It contraindicates endodontic treatment. b. Some heart medications may affect dental treatment. Explanation: Refer to pg(s): 5



c. It indicates the need for premedication with antibiotics. d. It contraindicates use of a local anesthetic with epinephrine Question: 6. The bite test is most useful in diagnosis of which of the following? a. Pulp necrosis b. Irreversible pulpitis c. Periapical periodontitis Explanation: Refer to pg(s): 37 d. Periodontal abscess e. Vertical root fracture



Question: 7. Which of the following is most likely to cause referred pain? a. Irreversible pulpitis Explanation: Refer to pg(s): 36 b. Reversible pulpitis c. Acute periradicular periodontitis d. Chronic periradicular abscess



Question: 8. Which one of the following statements is false? a. A fistula is synonymous with a sinus tract. Explanation: Refer to pg(s): 13 b. The opening of a sinus tract is called a stoma. c. Most sinus tracts are not completely lined with epithelium. d. The source of an odontogenic infection may be identified by threading a #25 gutta-percha cone through the opening of a sinus tract until it meets resistance.



Question: 9. Which of the following statements about 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 pulp test findings are equivocal. Explanation: Refer to pg(s): 19 d. It should be performed using local anesthetic



Question: 10. When the patient cannot identify the arch that is the source of the pain, selective anesthesia is performed first in the: a. Posterior maxilla Explanation: Refer to pg(s): 20 b. Anterior maxilla c. Posterior mandible d. Anterior mandible



Question: 11. Comparison of the diagnostic quality of digital radiographs to conventional radiographs shows that: a. Digital is superior. b. Conventional is superior. c. In general, the two are comparable. Explanation: Refer to pg(s): 22 d. The data are conflicting and therefore inconclusive



Question: 12. Radiographically, which of the following statements about an acute periradicular abscess is most accurate? a. It generally is larger 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 radiographically. Explanation: Refer to pg(s): 20



Question: 13. Which one of the following statements is false? a. The electric pulp test (EPT) should not be conducted unless the probe can be placed directly or indirectly in contact with natural tooth structures. b. The EPT provides useful information on the histologic status of the pulp tissue. Explanation: Refer to pg(s): 15 c. The EPT will yield the most accurate response when the probe is placed on the incisal third of anterior teeth. d. Cold tests are more reliable than EPT testing, especially in younger children with immature apices



Question: 14. An advantage of cone-beam volumetric tomography over conventional dental radiography is: a. Less radiation b. Better control of scatter radiation to other structures c. Detection of irreversible pulpitis d. Earlier detection of periapical pathosis Explanation: Refer to pg(s): 23 e. Decreased cost



Question: 15. Laser Doppler flowmetry is a technique for measuring: a. Movement of red blood cells Explanation: Refer to pg(s): 23 b. Levels of inflammation in periradicular bone c. Levels of inflammation in pulp d. Sensory nerve activity in pulp e. Sensory nerve activity in dentin



Question: 16. Which one of the following statements is false? a. Pulse oximetry involves photoelectric detection of oxygenated hemoglobin. b. Laser Doppler flowmetry involves assessing blood flow in microvascular systems. c. The test cavity is a commonly used test to confirm pulp vitality on crowned teeth. Explanation: Refer to pg(s): 18 d. The diagnostic quality of digital radiography is comparable to conventional film-based radiographs



Question: 17. The treatment for craze lines is: a. Remove the craze lines with burs, and restore with a bonded restoration. b. Place a conventional class II restoration, and restore with amalgam or composite. c. Restore with a temporary crown. d. Restore with a temporary crown, and monitor for symptoms. e. No treatment is necessary. Explanation: Refer to pg(s): 24



Question: 18. Referred pain in the preauricular region is most likely from which tooth group with what diagnosis? a. Mandibular molars with acute periradicular periodontitis b. Mandibular molars with irreversible pulpitis Explanation: Refer to pg(s): 32 c. Maxillary molars with acute periradicular periodontitis d. Maxillary molars with irreversible pulpitis



Question: 19. The patient in the figure is asymptomatic. Tooth #30 responds to electric pulp testing (EPT) but not to cold. What course of action should be taken? a. Proceed with root canal treatment; EPT produced a false-positive response. b. Make a test cavity. Explanation: Refer to pg(s): 24 c. No additional tests and no treatment are needed; monitor upon recall. d. Perform an excisional biopsy



Question: 20. The best clinical description of the cracked tooth syndrome is: a. Biting causes sharp pain. b. Cold causes sharp, brief pain. c. Transmitted light is blocked at the crack. d. It is not a true syndrome. Explanation: Refer to pg(s): 25



Question: 21. Which one of the following is true about the cold test versus the electric pulp test (EPT)? a. Both assess the intactness and health of the pulpal vascular supply. Explanation: Refer to pg(s): 17 b. Cold does not require testing of a control tooth. c. The EPT is more accurate for determining pulp vitality. d. The EPT is more accurate for determining pulp necrosis. e. Cold is only useful when a patient reports severe pain with cold



Question: 22. Of the following, which is the most likely to be associated with a vertical root fracture? a. Heavy occlusal forces b. Wedging of an intracoronal restoration c. Trauma from impact d. Parafunctional habit e. Placement of a post Explanation: Refer to pg(s): 25



Question: 23. A patient reports prolonged pain upon drinking cold liquids. The most likely pathologic diagnosis is: a. Symptomatic irreversible pulpitis Explanation: Refer to pg(s): 18 b. Asymptomatic irreversible pulpitis c. Acute apical abscess d. Symptomatic apical periodontitis



Chapter 2: Management of Endodontic Emergencies Question: 1. Which of the following statements about the degree of pulp pathosis is correct? 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. Explanation: Refer to pg(s): 41 d. It does not correlate well with the level of pain a patient perceives



Question: 2. Which of the following is a key measure of the degree (intensity) of pain? a. Painful stimulus with cold b. Painful stimulus with heat c. Painful stimulus on biting d. Increasing pain e. Pain that adversely affects the patient’s lifestyle Explanation: Refer to pg(s): 40



Question: 3. In a true endodontic emergency, if the patient cannot localize the pain: a. More than one tooth is likely to be involved. b. The patient should be dismissed with instructions to return when the pain localizes. c. Pulp tests will be of little benefit. d. There is usually a prior history of pain with the offending tooth. Explanation: Refer to pg(s): 40 e. Treatment should be started on more than one tooth



Question: 4. Given adequate time constraints and operator ability, the recommended emergency management of a tooth having symptomatic irreversible pulpitis is: a. Initiate root canal treatment b. Complete removal of canal tissues c. Complete cleaning of canal spaces d. All of the above Explanation: Refer to pg(s): 41



Question: 5. When endodontic treatment is advised for emergency care: a. The patient should be advised of alternatives after anesthesia is given. b. Risks and benefits should be explained before any treatment. Explanation: Refer to pg(s): 41 c. Endodontics is always preferred over extraction. d. The clinician should be insistent to the patient about recommending endodontic treatment



Question: 6. The most important treatments to resolve a localized, nondiffuse, indurated swelling of acute apical abscess are: a. Canal débridement and antibiotics. Incise when the swelling becomes fluctuant. b. Incision and antibiotics. Débride at a subsequent appointment. c. Canal débridement, incision, and antibiotics d. Canal débridement and incision Explanation: Refer to pg(s): 42



Question: 7. A tooth that has the symptoms of an irreversible pulpitis: a. May have deep caries into the pulp. b. May have a fracture of the crown close to the pulp. c. Is sensitive to cold stimuli that lingers. d. requires endodontic treatment or extraction as soon as possible. e. All of the above Explanation: Refer to pg(s): 41



Question: 8. Administration of antibiotics is contraindicated in irreversible pulpitis because they: a. Are ineffective Explanation: Refer to pg(s): 41 b. Allow “superbugs” to mutate in the pulp c. Mask the symptoms but do not resolve the problem d. Suppress the immune system



Question: 9. In an emergency, a general practitioner should consider referring a patient to an endodontist under what circumstance? a. Previous endodontic treatment or other issues that may be considered technically challenging or time consuming for the clinician Explanation: Refer to pg(s): 45 b. Localized swelling c. Irreversible pulpitis in a second molar d. Acute apical abscess with a lesion that extends over adjacent teeth



Question: 10. What is the effect of prophylactic administration of antibiotics on incidence of flare-ups? a. Very effective b. Slightly effective c. Not effective Explanation: Refer to pg(s): 45 d. Associated with an increase in flare-ups



Question: 11. Treatment of severe, throbbing pain associated with irreversible pulpitis and acute apical periodontitis is best managed by: a. Pulpotomy b. Partial pulpectomy c. Pulpectomy Explanation: Refer to pg(s): 41 d. Analgesic agents e. Analgesic and antibiotic agents



Question: 12. Which of the following statements is accurate with regard to leaving a tooth open for drainage in cases of irreversible pulpitis? a. It is the recommended method of managing an emergency patient. b. It may adversely affect the outcome of treatment. Explanation: Refer to pg(s): 45 c. It is appropriate if antibiotic therapy is also started. d. It should be considered in addition to soft-tissue incision and drainage



Question: 13. With an acute apical abscess, administration of antibiotics is indicated: a. Primarily only when diffuse swelling is present Explanation: Refer to pg(s): 45 b. When swelling to any degree (localized or diffuse) is present c. For 2 or 3 days before treatment of the tooth is started d. Only if purulent drainage from an incision is noted



Question: 14. A patient requires emergency treatment of a fluctuant swelling over the facial alveolar process of the maxillary left lateral incisor (tooth #10). Which of the following statements is correct about performing incision and drainage? a. The incision should not go directly to bone. b. The incision should be made horizontally 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 incision should be made at the site of greatest fluctuance. Explanation: Refer to pg(s): 45



Question: 15. Incision for drainage of an indurated swelling: a. Should be delayed until the swelling becomes fluctuant b. Can reduce pain caused by tissue distention Explanation: Refer to pg(s): 42 c. Usually releases a purulent exudate for culture and sensitivity testing d. Is not indicated, because antibiotic treatment will resolve the lesion



Question: 16. Of the following intracanal medicaments, which is most effective at controlling pain after treatment of necrotic pulp/acute apical abscess? a. Formocresol b. Eugenol c. Camphorated monochlorophenol d. Calcium hydroxide e. None of these medicaments control pain. Explanation: Refer to pg(s): 45



Question: 17. For which of the following reasons is apical trephination through the faciobuccal cortical plate advocated? a. To release exudate when the lesion is close to perforating the cortical bone Explanation: Refer to pg(s): 42 b. As a routine procedure to relieve pain when the affected tooth has been obturated c. As a treatment for severe and persistent pain d. To prevent a flare-up between multiple-visit endodontic procedures



Question: 18. Leaving a tooth open for drainage: a. Is not recommended b. Has been historically popular c. Can allow foreign objects of enter the periapical spaces d. All of the above Explanation: Refer to pg(s): 45



Question: 19. A cusp fractures in a noncarious, unrestored premolar such that dentin is exposed. When the exposed dentin comes in contact with cold fluids, the patient experiences brief, sharp pain. This pulp status is likely which of the following? a. Normal and uninflamed b. Reversibly inflamed Explanation: Refer to pg(s): 41 c. Irreversibly inflamed d. Innervated only by A-delta fibers



Question: 20. Which of the following is the primary pharmacologic effect of nonsteroidal antiinflammatory drugs (NSAIDs)? a. Antimicrobial effect b. Analgesic effect Explanation: Refer to pg(s): 45 c. Antiinflammatory effect d. Reduction of swelling e. Prevention of the spread of infection



Question: 21. With which of the following situations should the patient be referred for hospitalization? a. Elevated temperature for more than 2 days b. A swelling that recurs following obturation c. Palatal swelling from a molar d. Canine space swelling e. None of the above Explanation: Refer to pg(s): 45



Chapter 3: Diagnosis of Nonodontogenic Toothache Question: 1. Which of the following is an example of a deep somatic (visceral) structure? a. Mucosa b. Gingiva c. Musculoskeletal structure Explanation: Refer to pg(s): 50 d. Skin e. Dental pulp



Chapter 3: Diagnosis of Nonodontogenic Toothache Question: 2. Of the following, the most common pain entity occurring in the facial region is: a. Maxillary sinusitis b. Muscles of mastication c. Toothache Explanation: Refer to pg(s): 50 d. Cluster headache e. Psychogenic pain



Chapter 3: Diagnosis of Nonodontogenic Toothache Question: 3. A-delta fibers differ from C fibers in that the A-delta fibers: a. Respond to inflammatory mediators b. Are limited to the dental pulp c. Respond to fluid movement Explanation: Refer to pg(s): 50-51 d. Do not innervate dentin but have nerve endings in the plexus of Raschkow e. Are polymodal myelinated fibers with cell bodies in the superior cervical ganglion



Question: 4. Projection neurons: a. Are excited only by primary nociceptors b. May synapse with many primary afferent neurons Explanation: Refer to pg(s): 52 c. Receive input from superficial and deep structures, with the deep structures predominating d. Cross to the contralateral side and descend from the cerebral cortex to the thalamus e. Provide sympathetic innervation of the pulp through the stellate ganglion



Question: 5. Tissue insult: a. Always produces pain to the degree of the level of insult b. Must be to the injury level to cause pain c. Must cause inflammation to result in pain d. May produce transient pain, even without injury Explanation: Refer to pg(s): 52 e. Activates C fibers but not A-delta fibers



Question: 6. Central sensitization after tissue injury: a. Results in secondary hyperalgesia and referred pain Explanation: Refer to pg(s): 52 b. Is a lowered pain threshold of peripheral nerves c. Is the direct result of the release of inflammatory mediators d. Raises the pain threshold as a protective mechanism and is a form of pain inhibition e. All of the above



Question: 7. Periapical pain is more easily localized than pulpal pain because: a. Of mechanoreceptors in the PDL Explanation: Refer to pg(s): 55 b. The PDL contains more A-delta receptors c. The PDL contains more C fibers d. The PDL responds more readily to inflammatory mediators e. It does not respond as readily to anesthetics



Question: 8. Which of the following best describes heterotopic pain? a. It is felt in an area other than its true source. Explanation: Refer to pg(s): 50 b. It occurs in a specific structure after actual tissue injury and inflammation. c. It results from vascular changes and decreased circulation to a tissue. d. An example is stimulation of mechanoreceptors in the periodontal ligament. e. It is myofascial pain.



Question: 9. Myofacial pain in the muscles of mastication often may be best diagnosed by: a. Injecting local anesthetic into trigger point foci in the affected muscle Explanation: Refer to pg(s): 56 b. Ruling out endodontic etiologies c. Determining whether occlusal equilibration would relieve the pain d. Having the patient lie on the back; if the pain subsides, it likely is myalgia



Question: 10. Acute maxillary sinusitis often: a. Causes referred pain to a single tooth b. Causes referred pain to the orbit and maxillary posterior teeth Explanation: Refer to pg(s): 56 c. Is exacerbated by cold testing d. May cause swelling in the maxillary posterior vestibule e. Subsides with anesthetic infiltration in the buccal vestibule



Chapter 3: Diagnosis of Nonodontogenic Toothache Question: 11. Tension-type headache is: a. Likely to mimic toothache b. Unlikely to have a musculoskeletal component c. Often a precursor to cluster headaches d. The most common type Explanation: Refer to pg(s): 57 e. Frequently aborted by triptan-type medications



Question: 12. Which of the following statements about trigeminal neuralgia is correct? a. This diagnosis in a patient younger than 40 years of age is an indication the patient should be screened for multiple sclerosis. Explanation: Refer to pg(s): 58 b. Trigger zones have sensory deficits such as dysesthesia. c. Treatment with antiinflammatory agents is beneficial. d. It seldom mimics odontogenic pain. e. Unlike with odontogenic pain, local anesthetics are ineffective at reducing symptoms



Question: 13. Which of the following statements about a neuroma is correct? a. Tinel’s sign is absent. b. It results from inflammation of a nerve or infection with a virus. c. Pain is constant and characterized as a constant burning sensation. d. A zone of anesthesia exists peripheral to the area of the neuroma. Explanation: Refer to pg(s): 58 e. Treatment is palliative and involves administration of corticosteroids.



Question: 14. Neuritis, when associated with oral herpes zoster: a. May be effectively treated with prednisolone b. Always is associated with mucosal vesicles c. Is a painful entity caused by secondary bacterial infection d. Is a painful entity that may occur only after vesicles appear e. Is best treated by acyclovir administration in the prevesicular stage Explanation: Refer to pg(s): 59



Question: 15. Psychogenic toothache: a. Occurs when a patient confuses nonodontogenic pain with toothache b. Often occurs when there is a tumor in the central nervous system c. Tends to focus on a tooth that has had a recent restoration d. Often occurs following tooth extraction e. Often does not fit a normal anatomic or physiologic pattern Explanation: Refer to pg(s): 61



Question: 16. Pain syndromes that are not organically based generally are characterized as: a. Short duration and sharp b. Short duration and dull (aching) c. Long duration and sharp d. Long duration and dull (aching) Explanation: Refer to pg(s): 61



Question: 17. A 50-year-old patient has a chief complaint of pain in the mandibular left jaw. He says the pain frequently occurs after his evening meal and walk. Recent root canal treatment of the mandibular left central and lateral incisors by his dentist did not relieve the pain. The most likely etiologic basis for the pain in this case is: a. TMD source b. Trigeminal neuralgia c. Cardiac Explanation: Refer to pg(s): 61 d. Cluster headaches e. Pulpal Question: 18. All of the following statements about trigeminal neuralgia are correct EXCEPT 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 pain than one division of the trigeminal nerve. Explanation: Refer to pg(s): 61 c. The pain is characteristically sharp, lasts for several hours, and is induced by a trigger point. d. The pain may mimic pain of pulpal origin in that thermal sensitivity and tingling often are experienced just before an attack. Question: 19. A method for differentiating a central from a peripheral neuropathy is that a peripheral neuropathy: a. Is relieved effectively by analgesics b. Is better relieved by local anesthetics Explanation: Refer to pg(s): 60 c. Has a wider area of pain d. Is more likely to become refractory (nonresolving) with time



Good Luck >>>> Abdullah AlDehaithem



Chapter 4: Case Selection and Treatment Planning



Question: 1. With regard to endodontic therapy, if the patient in the figure is diabetic, what factor arises that does not apply if the patient is not diabetic? a. The patient is more likely to have a flare-up. b. Treatment usually should include root-end surgery. c. Prophylactic antibiotics generally should be prescribed to prevent infection. d. The chance of success is diminished. Explanation: Refer to pg(s): 74



Question: 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 Explanation: Refer to pg(s): 73 d. Myocardial infarction e. Rheumatic fever



Question: 3. Elective endodontic treatment is contraindicated in which of the following situations? a. Patient is a type 2 diabetic. b. Patient has had a heart attack within the past 6 months. Explanation: Refer to pg(s): 72 c. Patient has had numerous opportunistic infections secondary to infection with the human immunodeficiency virus (HIV). d. Patient has an implanted pacemaker



Question: 4. Which of the following describes the preferred management of internal resorption? a. Untreatable b. Requires surgical treatment c. Antimicrobial intracanal medication d. Usually requires root canal treatment Explanation: Refer to pg(s): 85 e. Usually requires no treatment



Question: 5. Patients who are HIV positive: a. Cannot transmit the virus through a needle stick b. Are best treated in a hospital environment c. Require the same precautions as a patient with AIDS Explanation: Refer to pg(s): 76 d. Have been shown to heal less predictably after endodontic therapy e. Require prophylactic antibiotics



Question: 6. An effect of radiation therapy for cancer on bone is: a. Osteoclast activation b. Increase in cortical bone c. Increased blood supply d. Decreased blood supply Explanation: Refer to pg(s): 75 e. Burn injury to the periosteum



Question: 7. The best description of the combined endodontic-periodontic lesion is: a. An endodontic lesion progresses coronally and damages the periodontium. b. A periodontal lesion progresses apically and causes pulp necrosis and an apical lesion. c. Periapical disease advances coronally and joins with a periodontal pocket. Explanation: Refer to pg(s): 77 d. Irritants from a necrotic pulp diffuse through a coronal canal or lateral canal in the furcation and cause a periodontal pocket



Question: 8. For a surgical procedure in patients undergoing anticoagulation therapy, the dosage generally should be: a. Increased (possibly doubled) b. Decreased (approximately halved) c. Discontinued 2 days before the surgery and resumed immediately afterward d. Left unchanged Explanation: Refer to pg(s): 73



Question: 9. A patient on oral bisphosphonate therapy will undergo root-end surgery. Of the following, which is the most correct statement? a. The patient should not change the drug regimen or dosage. Explanation: Refer to pg(s): 75 b. The drug should be discontinued as far ahead of the surgery as possible. c. Antibiotic prophylaxis is indicated. d. The root-end surgery should be avoided; extraction is safer. e. The surgery outcome is less predictable



Question: 10. The safest period to provide dental care during pregnancy is which month(s)? a. First b. Second and third c. Fourth to sixth Explanation: Refer to pg(s): 74 d. Seventh and eighth e. No period during pregnancy is safe



Question: 11. Research has examined lesion size affecting the healing rate. Which is the most correct statement? a. Larger lesions healed more rapidly. b. Smaller lesions healed more rapidly. Explanation: Refer to pg(s): 78 c. There was no difference. d. All of the above



Question: 12. Regarding long-term prognosis of nonsurgical root canal treatment (NSRCT) versus single-tooth implants, the literature shows that overall: a. NSRCT is more successful. b. Implants are more successful. c. The two are generally equal. Explanation: Refer to pg(s): 86 d. There are no reliable data; studies are required



Question: 13. The best description of patient anxiety management on postoperative outcomes is: a. The more the procedure is described, the less favorable the outcome. b. Describing the procedure speeds recovery but does not decrease the need for analgesics. c. Good anesthesia is more effective than preemptive behavior management in lowering anxiety. d. With anxious patients, it is less likely pain would be well controlled without behavior management. Explanation: Refer to pg(s): 86



Chapter 5: Preparation For Treatment Question: 1. Transmission of human immunodeficiency virus (HIV): a. Is more likely than the hepatitis B virus b. Could not occur from a stick of a file used in a canal with necrotic tissue c. Is unlikely from a patient without symptoms d. Can occur via either blood or saliva Explanation: Refer to pg(s): 88



Question: 2. The American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC): a. Recommend all DHCP with potential occupational exposure to blood or other potentially infectious material be vaccinated against hepatitis B Explanation: Refer to pg(s): 89 b. Mandate employers must provide yearly tuberculin skin tests to employees having patient contact c. Recommend universal precautions only for bloodborne pathogens d. Recommend gloves be replaced after each clinic session or when torn or punctured



Question: 3. Which of the following statements regarding OSHA guidelines and universal precautions is correct? a. Employees must be provided protective attire at the employers expense, but they may elect to not wear the equipment. b. Employees who refuse hepatitis B vaccination must be terminated by the employer. c. Only antimicrobial soap can be used for washing hands, wrists, and lower forearms. d. Unlined utility gloves used for cleaning instruments and surfaces may be reused. Explanation: Refer to pg(s): 89



Question: 4. OSHA standards are primarily established to protect the: a. Dental support personnel b. Patient c. Dentist treating patients d. Employees who have contact with blood or infectious materials Explanation: Refer to pg(s): 88



Question: 5. When handling contaminated endodontic files: a. The files should be placed in a nonphenolic disinfectant prior to sterilization. b. They should be immediately autoclaved. c. They should be immediately cleaned with in an ultrasonic unit with distilled water. Explanation: Refer to pg(s): 90 d. Ethylene oxide sterilization is recommended



Question: 6. 0.12% chlorhexidine gluconate pretreatment rinse: a. Is indicated when periodontal probing is anticipated b. Can reduce microbial content of aerosols produced Explanation: Refer to pg(s): 90 c. Reduces the incidence of posttreatment infections d. Can prevent posttreatment pain



Question: 7. Protected Health Information: a. Pertains only to medical records b. Only applies to patients who have third party payers c. Does not apply to disclosures made to the patient or another provider of treatment Explanation: Refer to pg(s): 90 d. Privacy Rule requires patient signature



Question: 8. Radiation exposure from a single full-mount survey: a. Is comparable to a single chest film b. Is comparable to a barium study of the intestines c. Is less with higher kilovoltages Explanation: Refer to pg(s): 90 d. Would be sufficient to cause skin cancer if all exposures were at one site



Question: 9. Radiation exposure can be reduced by each of the following EXCEPT ONE. Which is this EXCEPTION? a. Collimation of the central beam b. Filtration of the central beam c. Setting the machine to 70 kVp or below Explanation: Refer to pg(s): 91 d. Replacing film with direct digital sensors



Question: 10. Which of the following statements regarding the central x-ray beam is correct? a. Collimation of the central beam should be 6 to 8 inches to improve image quality and reduce radiation. b. A pointed cone source is ideal, since the chance of missing strategic structures is reduced and retakes are less frequent. c. Collimation of 12 to 16 inches reduces distortion of the image. Explanation: Refer to pg(s): 95 d. Report No. 145 of the National Council on Radiation Protection and Measurements mandates a circular column



Question: 11. Which of the following statements regarding infective endocarditis is correct? a. Penicillin is the drug of choice for prophylactic antibiotic coverage prior to dental treatment. b. Congenital heart murmur necessitates prophylactic antibiotic coverage for dental treatment. c. The potential risk of infective endocarditis justifies the risk of an adverse reaction to prophylactic antibiotics. d. Frequent bacteremias from daily exposure is a common cause. Explanation: Refer to pg(s): 95



Question: 12. The recommended antibiotics for a patient with a total joint replacement who is allergic to penicillin or cephalosporin is: a. Amoxicillin b. Erythromycin c. Clindamycin Explanation: Refer to pg(s): 96 d. Tetracycline



Question: 13. Which of the following statements regarding bisphosphonates is correct? a. Bisphosphonates have a high affinity for bone and following incorporation persist for years. Explanation: Refer to pg(s): 97 b. Pamidronate and zoledronate are common oral drugs. c. Bisphosphonates metabolically increase osseous deposition in cases where pathologic fracture is a sequelae to the disease or treatment. d. Will produce osteonecrosis in multiple myeloma patients that have concurrent radiation treatment



Question: 14. The most effective method for controlling the pain that often occurs after cleaning and shaping is to administer: a. An NSAID analgesic shortly before the procedure Explanation: Refer to pg(s): 97 b. Equal amounts of the analgesic before and during the procedure c. The analgesic at the conclusion of the procedure d. The analgesic with instructions to the patient to take it if necessary



Question: 15. The cone length/beam angulation that gives the most accurate tooth length is: a. Long cone, parallel Explanation: Refer to pg(s): 98 b. Long cone, bisecting c. Short cone, parallel d. Short cone, bisecting



Question: 16. Each of the following statements regarding the diagnostic radiograph is correct EXCEPT ONE. Which is this EXCEPTION? a. At least 3 mm of bone apical to the apex should be evident. b. A parallel two-dimensional image is accurate in determining root anatomy and morphology. Explanation: Refer to pg(s): 99 c. Periradicular lesions may be present that are not visible on a film or image. d. The center of the film or image is relatively distortion free



Question: 17. To project the buccal roots away from the zygoma, which technique would be recommended? a. The clinician should use a distal angle to move the roots mesially. b. A bisecting angle technique should be used as it is most predictable. c. A mesial angle should be employed so the roots are projected mesial. Explanation: Refer to pg(s): 99-100 d. An increased vertical angle should be used



Question: 18. Which of the following statements regarding film/image exposure is correct? a. Altering kilovoltage and time are primarily responsible for proper density. b. Density is the degree of darkening. Explanation: Refer to pg(s): 102 c. Milliamperage controls the penetrating ability of the central beam. d. A high kilovoltage provides the greatest contrast



Question: 19. Which of the following statements regarding digital imaging is correct? a. Resolution is significantly increased. b. Radiation to the patient is significantly reduced when compared to D-speed film. Explanation: Refer to pg(s): 102 c. Radiation is not necessary for image capture. d. Subtraction radiography can be employed on the diagnostic preoperative image of a new patient



Question: 20. Which of the following statements regarding endoscopy is correct? a. A disadvantage is the need to constantly refocus the image. b. The magnified image is adjustable using the binoculars. c. There is a nonfixed field of vision. Explanation: Refer to pg(s): 106 d. The probes provide a limited narrow depth of field



Question: 21. A situation in which a rubber dam need not be placed is: a. When the clamp impinges on the gingiva, causing bleeding and discomfort b. Initially, when the chamber or canal may be difficult to locate on access Explanation: Refer to pg(s): 109 c. A molar where the tooth is fractured below the free gingiva preventing placement of a clamp d. When chlorhexidine is to be used as an irrigant



Question: 22. Which of the following is a method of reducing salivary flow around a rubber dam? a. Administer an anticholinergic drug. Explanation: Refer to pg(s): 109-110 b. Use an anesthetic with a vasoconstrictor. c. Prescribe acetylcholine. d. Use chlorhexidine as a pretreatment rinse



Question: 23. Informed consent information for endodontic therapy excludes: a. Alternatives to recommended treatment b. Procedure and prognosis c. A description of OSHA regulations Explanation: Refer to pg(s): 114 d. Foreseeable and material risk



Question: 24. Radiographic contrast can be directly affected by altering: a. Milliamperage b. Exposure time c. Kilovoltage Explanation: Refer to pg(s): 95 d. Angulation



Question: 25. With the cone moved to the distal and directed toward the mesial, a file in the mesiobuccal canal of the mandibular first molar: a. Is projected mesially on the film b. Is projected distally on the film c. Remains superimposed on the mesiolingual canal Explanation: Refer to pg(s): 102 d. Appears to move lingually



Question: 26. Each of the following should be considered when a rubber dam clamp will not stay on a tooth EXCEPT ONE. Which is this EXCEPTION? a. Crown lengthening b. Acid-etching retentive beads on the facial and lingual surfaces c. Clamping the attached gingiva d. Orthodontic extrusion e. Isolation with cotton rolls and employing a localized intraoral suction tip Explanation: Refer to pg(s): 109



Chapter 6: Armamentarium and Sterilization Question: 1. By definition, disinfection is the killing of: a. All life forms b. Only pathogens c. All bacteria but not all viruses d. Most life forms but not spores Explanation: Refer to pg(s): 124 e. Selected pathogenic bacteria and all viruses



Question: 2. The biofilm that forms in dental water lines: a. Is rapidly removed by daily flushing of the lines b. May partly originate in municipal water supplies Explanation: Refer to pg(s): 130 c. Is not accurately identified by culturing d. Cannot form if any movement of water occurs in the lines



Question: 3. A common reason for inadequate sterilization is: a. Because many oral microorganisms resist sterilization techniques b. Allowing the packets of instruments to dry outside the sterilizer c. Loss of the seal on the door to the sterilizer d. Overpacking the sterilizer Explanation: Refer to pg(s): 125



Question: 4. Which of the following is the best way to clean dental instruments before sterilization? a. Ultrasonic cleaning in a perforated basket Explanation: Refer to pg(s): 132 b. Hand scrubbing using a brush and heavy rubber gloves c. Rinsing under a forceful water spray d. Soaking overnight in soapy water



Question: 5. Steam sterilization is achieved when the load has reached which of the following temperatures? a. 250°C (482°F) for 15 minutes b. 250°F (121°C) for 10 minutes c. 250°C (482°F) for 30 minutes d. 250°F (121°C) for 30 minutes Explanation: Refer to pg(s): 127



Question: 6. Which of the following is the most effective method of cleaning hands to reduce microbial contaminants? a. 70% Methanol b. Alcohol-based hand scrubs c. Surgical soap and water Explanation: Refer to pg(s): 132 d. All of the above



Question: 7. Which of the following statement(s) accurately describes a chemical vapor sterilizer? a. It uses a reusable chemical. b. It requires adequate ventilation in the area where it is used. Explanation: Refer to pg(s): 127 c. It achieves sterilization when heated to 270°F (132°C) at 20 psi for 10 minutes. d. It does not destroy heat-sensitive materials



Question: 8. Which of the following is an approved method of reducing the number of microorganisms in water output from dental units? a. Filters at the water source b. Flushing the water line before attaching it to the handpiece or syringe c. Retrograde (i.e., reverse) flushing of all water lines d. Careful sterilization of water lines in handpieces and syringes between patients Explanation: Refer to pg(s): 130 e. Installation of sterile water delivery systems



Question: 9. Gutta-percha is best sterilized by which of the following? a. Immersion in full-strength sodium hypochlorite Explanation: Refer to pg(s): 132 b. Immersion in rubbing alcohol c. Dry heat d. Gutta-percha is self-sterilizing



Question: 10. Contaminated droplets: a. Are not produced during endodontic procedures b. Are produced only when accessing with a high-speed handpiece into an infected pulp c. Are reduced when a rubber dam is used Explanation: Refer to pg(s): 131 d. Cannot pass into a mask wearer’s respiratory tract if the mask is sealed at the edges



Question: 11. Regulated medical waste in the dental office includes: a. Used gloves and items that can break the skin b. Only needles, scalpel blades, and files c. Only items that can break the skin Explanation: Refer to pg(s): 133 d. Any items that have been in contact with saliva or blood (or both)



Question: 12. A problem with using hand lotions is that they: a. May degrade rubber gloves Explanation: Refer to pg(s): 133 b. Often are contaminated with pathogens c. May cause the gloves to slide off during a procedure d. Make hand washing less effective



Question: 13. Prions, a cell surface glycoprotein: a. Are not predictably sterilized by conventional techniques Explanation: Refer to pg(s): 134 b. Are less likely to be found on stainless steel files than on the nickel-titanium type c. Are eliminated by autoclaving at increased pressures at similar temperatures for similar times as with conventional sterilization techniques d. Cannot be killed with any known chemical treatment



Chapter 7: Tooth Morphology and Access Cavity Preparation Question: 1. Radiographic evaluation of internal anatomy is: a. Influenced by the angle of exposure Explanation: Refer to pg(s): 151 b. An accurate reflection of canal morphology c. Most accurate with a straight on parallel exposure d. Adequate if a 20-degree angle is employed to detect a second canal in a single root



Question: 2. Each of the following is helpful in detecting a canal orifice EXCEPT ONE. Which is this EXCEPTION? a. Magnification b. Illumination c. Bleeding points d. Dye staining e. The anesthetic utilized Explanation: Refer to pg(s): 137



Question: 3. Which of the following statements regarding lateral/accessory canals is correct? a. When present they are a source of collateral circulation for the dental pulp tissue. b. They are formed by residual cells of Hertwig’s epithelial root sheath. c. Maxillary molars have the highest incidence of canals involving the pulp chamber floor and the furcation surface. d. There is a relationship between the occurrence of furcation canals and the presence of calcification and pulp stones in the pulp chamber. e. Approximately 75% are found in the apical third of the root. Explanation: Refer to pg(s): 138



Question: 4. Furcation canals in maxillary and mandibular molars: a. Are detectable clinically with the operating microscope b. May contribute to furcation bone loss following pulp necrosis Explanation: Refer to pg(s): 139 c. Are detectable with appropriate bitewing radiographs d. Are rare but significant when present



Question: 5. Which of the following statements is true when two canals are present in a single root? a. The closer the two canal openings are to each other, the more likely they have separate foramina at the apex. b. The wider the space between canals, the more curvature will be noted in the root. c. When a single orifice is located centrally in the chamber, there will always be one canal. d. The lingual canal generally provides direct access to the apex. Explanation: Refer to pg(s): 145



Question: 6. The cemento-enamel junction: a. Is a consistent defined point for terminating the root canal preparation and obturation b. Is variable in location Explanation: Refer to pg(s): 145 c. Correlates with the location of the apical constriction d. Remains constant with age



Question: 7. Which of the following statements is true regarding apical root anatomy? a. The primary dentinal tubules are regular but fewer in number when compared to the crown. b. The tubules can exhibit branching or be completely absent in areas. Explanation: Refer to pg(s): 147 c. Pulp stones are uniquely absent. d. The apical constriction is consistent and a predictable finding



Question: 8. Root resection during apical surgery: a. Should be minimal, exposing the canal but maintaining maximum tooth length b. Should be beveled for enhanced visualization c. Removes most anatomic variations if 3 mm are resected Explanation: Refer to pg(s): 149 d. Is not required if the root can be prepared adequately to receive a root-end filling



Question: 9. A type II canal is defined as: a. A single canal with one portal of exit at the apex b. Two canals in the chamber that join and have a common portal of exit at the apex Explanation: Refer to pg(s): 140 c. Two canals in the chamber that each has a portal of exit at the apex d. Two canals in the chamber that merge in the body of the root and divide short of the apex to exit as two distinct canals e. A single canal that divides within the root to exit as two distinct at the apex



Question: 10. When two canals are present in a single root and join: a. The lingual/palatal canal will generally be the one with direct access to the apex. Explanation: Refer to pg(s): 145 b. Both canals should be prepared to the apex. c. Rotary nickel titanium instrumentation is indicated to insure the proper shape is developed. d. It is classified as a type IV configuration



Question: 11. Which of the following statements regarding the apical anatomy is correct? a. The location of apical constriction and the cemento-dentinal junction are the same in approximately 75% of the canals. b. The cemento-dentinal junction is located at the apical foramen. c. The apical constriction is usually located 0.5 to 1.5 mm short of the apical foramen. Explanation: Refer to pg(s): 145 d. The apical foramen remains static following tooth eruption. e. Regardless of the number of accessory canals present, a main apical foramen can be identified.



Question: 12. Which of the following statements regarding the apical anatomy of the maxillary anterior teeth is correct? a. The apical foramen coincides with apex approximately 85% of the time. b. The apical constriction mesiodistal diameter generally exceeds the labiolingual diameter. c. The apical constriction labiolingual diameter generally exceeds the mesiodistal diameter. Explanation: Refer to pg(s): 145 d. When the foramen deviates from the root apex, it usually occurs in a mesiolingual direction. e. Accessory canals are a rare finding



Question: 13. Prognosis studies indicate that for teeth with pulp necrosis: a. The success rate was better when root canal treatment terminated at or within 2 mm from the radiographic apex. Explanation: Refer to pg(s): 146 b. The success rate was better when root canal treatment terminated at or within 3 mm from the radiographic apex. c. The success rate was highest with obturation at the radiographic apex or with extrusion. d. Root canal treatment should terminate at the cemento-dentinal junction. e. Termination more than 3 mm short of the radiographic apex had a poorer prognosis that when the obturation extended beyond the apical constriction



Question: 14. Which of the following statements regarding assessment (gauging) of the apical canal diameter is correct? a. The use of small hand files can accurately assess the diameter, because the canal configuration in the apical portion is generally round. b. The canal diameter is generally larger than the diameter of the instruments used in gauging. Explanation: Refer to pg(s): 147 c. Accuracy in maxillary first molar is greatest in the main mesiobuccal canal. d. Placing small instruments to the corrected working length until initial binding occurs determines the maximum size file to be used at length.



Question: 15. Each of the following statements regarding access openings in maxillary central incisors is correct EXCEPT ONE. Which is this EXCEPTION? a. The access is triangular in young individuals but becomes ovoid in older patients. b. A lingual shoulder extends several millimeters apical to the orifice and restricts the cleaning of the canal. c. Defective restorations should be removed prior to opening into the pulp chamber. d. Access through an existing crown may be difficult owing to the loss of anatomic landmarks. e. Ultrasonic tips should used to open into the chamber after a round bur is used to penetrate the enamel. Explanation: Refer to pg(s): 147



Question: 16. Each of the following statements regarding access openings in maxillary first molars is correct EXCEPT ONE. Which is this EXCEPTION? a. The mesiobuccal canal will be located mesial to the mesial cusp tip. Explanation: Refer to pg(s): 152, 168, 177 b. The distal extension should be mesial to the oblique ridge. c. Initial penetration into the chamber is accomplished toward the palatal canal orifice. d. The canal orifice is always located at the junction of the chamber walls and floor. e. The orifice is located at the angles in the floor-wall junction.



Question: 17. Each of the following statements regarding access openings in mandibular molars is correct EXCEPT ONE. Which is this EXCEPTION? a. The orifice to all canals will generally be found in the mesial two-thirds of the crown. b. When two separate distal roots are present, the distolingual will be the smallest and often curves to the buccal. c. A C-shaped canal is a variation of molars with fused roots. d. The incidence of finding a C-shaped canal increases in Japanese, Chinese, Lebanese, and Korean patients. e. A middle mesial canal is present in less than 1% of cases. Explanation: Refer to pg(s): 188



Question: 18. Varying the radiographic angle by 20% can correctly identify the canal morphology in each of the following tooth groups EXCEPT ONE. Which is this EXCEPTION? a. Maxillary first premolars b. Maxillary second premolars c. Mandibular first premolars d. Mandibular second premolars Explanation: Refer to pg(s): 209



Question: 19. Which of the following statements regarding the “fast break” is correct? a. The presence of radiographic fast break identifies 95% of the canals that bifurcate. b. One-third of the canals that bifurcate do not present as fast breaks on the radiograph. Explanation: Refer to pg(s): 136 c. The presence of radiographic fast break indicates calcific metamorphosis is occurring. d. The term fast break is applied to roots with dilacerations greater than 60 degrees



Question: 20. Which of the following statements regarding furcation canals in molars is correct? a. The presence of accessory canals correlates with the presence of pulp calcification. b. Maxillary molars have the highest incidence of foramina involving the pulp chamber floor and the furcation surface. c. Radiographs frequently indicate the presence of these entities. d. Pulp necrosis and the presence of furcation canals may account for primary endodontic lesions. Explanation: Refer to pg(s): 136-137



Question: 21. Which of the following tooth groups may demonstrate all eight canal configurations? a. Maxillary first premolars b. Maxillary second premolars Explanation: Refer to pg(s): 139 c. Maxillary first molars d. Mandibular first premolars e. Mandibular second premolars



Question: 22. Isthmi in the mesiobuccal root of maxillary molars: a. Have the highest occurrence rate in the apical 3 to 5 mm Explanation: Refer to pg(s): 141 b. Are located coronally near the orifice and extend apically for 3 to 5 mm c. Generally are complete, but partial isthmi can occur d. Have a uniform morphologic shape resembling a ribbon



Question: 23. Which of the following burs is recommended for making an access opening through an existing metal crown? a. Round carbide burs (size 2, 4, and 6) b. Carbide fissure burs c. Mueller burs d. LN bur e. Transmetal bur Explanation: Refer to pg(s): 150



Question: 24. If straight-line access is not achieved upon placement of a small file to the corrected working length in a mandibular incisor: a. The clinician should extend the access to the incisal edge. b. The clinician should reevaluate the adequacy of lingual shoulder removal. Explanation: Refer to pg(s): 150 c. A facial access approach should be employed. d. The clinician will need to pre-bend the instruments during cleaning and shaping procedures



Question: 25. The beginning point for access preparation of first mandibular premolars: a. Is a midpoint between the mesial and distal marginal ridges in the central groove b. Is near the buccal cusp tip, owing to the lingual constriction and inclination of the tooth c. Should begin halfway up the incline plane of the buccal cusp Explanation: Refer to pg(s): 161 d. Begins a midpoint between the mesial and distal marginal ridges one-third the distance up the buccal incline plane



Question: 26. The cross-sectional shape of the maxillary first premolar in the coronal portion of the root at the cemento-enamel junction: a. Demonstrates two separate roots b. Has the shape of a kidney bean, with the concavity located on the mesial surface Explanation: Refer to pg(s): 162 c. Exhibits a broad mesial distal dimension in comparison to the buccal lingual dimension d. Has the shape of a kidney bean, with the concavity located on the distal surface



Question: 27. A maxillary central incisor with calcific metamorphosis requires endodontic treatment. During access preparation, the canal is not evident clinically, and the preparation is 4 mm apical to the cemento-enamel junction. Which of the following statements regarding treatment of this case is correct? a. The greatest risk of perforation will be on the lingual surface as the preparation is extended. b. The canal will not be negotiated, because calcification proceeds from the apical region coronally. c. Removal of the rubber dam and exposing radiographs may help locate the canal. Explanation: Refer to pg(s): 184 d. The access should be extended using an extended #4 round bur in the high-speed handpiece.



Question: 28. A perforation during access preparation is more likely in which area? a. Maxillary premolar on the mesial at the cemento-enamel junction Explanation: Refer to pg(s): 184 b. Mandibular molar on the distal c. Maxillary anterior on the lingual d. Mandibular anterior on the lingual



Question: 29. In the figure, the canal configuration in the access opening depicted above is most likely from which of the following tooth groups? a. Maxillary lateral incisor b. Maxillary first premolar c. Maxillary first molar d. Mandibular first premolar e. Mandibular second molar Explanation: Refer to pg(s): 184



Question: 30. Caries removal is critical for all of the following reasons EXCEPT ONE. Which is this EXCEPTION? a. It provides an aseptic operating field. b. It permits the operator to assess tooth restorability. c. Visualization is enhanced. d. Unsupported tooth structure is removed. e. Rubber dam isolation is enhanced. Explanation: Refer to pg(s): 152



Question: 31. Preparing an access opening through a Zirconia crown is best accomplished with a(n): a. Diamond bur Explanation: Refer to pg(s): 155 b. Carbide bur c. Transmetal bur d. Munce bur e. Ultrasonic tip



Question: 32. Ultrasonic instruments: a. Aggressively remove dentin and are not indicated for internal preparation of dentin b. Results in larger preparations when compared to conventional burs c. Are used primarily to trough internal developmental grooves and locate canal orifice Explanation: Refer to pg(s): 156-157 d. Should be used with caution due to the decreased visibility and lack of illumination



Question: 33. Which of the following statements regarding removal of the lingual shoulder is correct? a. Root strength is compromised. b. Stainless steel hand files are the ideal method for removing this structure. c. Failure to remove the lingual shoulder prevents files from contacting the canal wall. Explanation: Refer to pg(s): 159 d. Undercuts are created which make fabrication of a cast post and core difficult



Question: 34. Which of the following statements regarding calcified canals is correct? a. Calcification occurs in a coronal-to-apical direction. Explanation: Refer to pg(s): 171 b. The radicular space is often completely calcified apically. c. Surgical treatment of these cases is considered aggressive and should be a last resort. d. 17% EDTA will selectively remove the calcified dentin and open the canal for preparation



Chapter 8: Instruments, Materials, and Devices Question: 1. The ability of a test to identify teeth with disease is called: a. Sensitivity Explanation: Refer to pg(s): 223 b. Predictive value c. Specificity d. Probability



Question: 2. With regard to electric pulp testing, which of the following is true? a. The readout is a quantitative measurement of the pulp health b. The initial intensity should be high c. It produces a pulsating electrical stimulus Explanation: Refer to pg(s): 225 d. Tooth isolation is not essential



Question: 3. Which of the following methods is particularly effective when testing teeth with full coverage restorations? a. Carbon dioxide snow stick Explanation: Refer to pg(s): 224 b. Electric pulp test c. Frozen-water cold test d. Refrigerant spray on a cotton pledget



Question: 4. Which of the following statements about nickel-titanium (NiTi) instruments is accurate? a. They have a high elastic modulus that provides flexibility. b. When stressed they transform from the austenitic crystalline phase to a martensitic structure. Explanation: Refer to pg(s): 233 c. They cannot be strained to the same level as stainless steel instruments without permanent deformation. d. All of the above



Question: 5. A barbed broach is most helpful for which of the following? a. Removal of cotton, paper points, and other objects from the canal Explanation: Refer to pg(s): 231 b. Removal of vital tissue from fine canals c. Initial planing of canal walls d. Coronal-orifice enlargement before establishment of corrected working length



Question: 6. In comparison of K-files with reamers, which of the following statements about K-files is accurate? a. They have more flutes per millimeter, which increases flexibility. Explanation: Refer to pg(s): 231 b. They are different because the file is manufactured by twisting a tapered, square blank. c. They are more effective at removing debris. d. They are the least flexible of instruments of the same size



Question: 7. Based on instrument design and method of manufacturing, which of the following is most susceptible to fracture? a. K-file fabricated from a tapered, square SS blank b. K-Flex file fabricated from a rhomboid SS blank c. Hedström file fabricated from a round SS blank Explanation: Refer to pg(s): 231 d. Reamer fabricated from a triangular SS blank



Question: 8. Which of the following is the more difficult to perform? a. Thermal test Explanation: Refer to pg(s): 224 b. Electric pulp test c. Cold test d. None of the above



Question: 9. Which of the following regarding laser Doppler flowmetry is true? a. It is especially effective in teeth with necrotic pulps. b. The technique is subjective and invasive. c. It may be particularly effective in young, traumatized teeth. Explanation: Refer to pg(s): 226 d. It is cost effective and easy to use clinically



Question: 10. Which of the following statements about electronic apex locators is accurate? a. They are considered an accurate tool for determining working length b. They are sensitive to canal contents c. Immature roots can affect their accuracy d. Caution should be taken when used on patients with pace makers e. All of the above Explanation: Refer to pg(s): 243



Question: 11. Which of the following are helpful in detecting incomplete crown fractures? a. A Tooth Slooth Explanation: Refer to pg(s): 227 b. A periodontal probe c. A sharp explorer d. Percussion



Question: 12. Which of the following statements about ultrasonic root canal instrumentation is accurate? a. It should be performed in a dry environment. b. It poses very little risk of file breakage. c. It is not very useful for dentin removal. Explanation: Refer to pg(s): 239 d. It is most useful in small canals where file contact with the root canal wall is maximized



Question: 13. Which of the following statements about the use of sodium hypochlorite as a root canal irrigant is accurate? a. It is the most commonly used irrigating solution Explanation: Refer to pg(s): 246-247 b. Allergic reactions are common c. It is a poor antibacterial agent d. Effectiveness can be improved by decreasing the temperature of low concentration NaOCl solutions



Question: 14. Which of the following statements is accurate concerning the use of ethylenediamine tetra-acetic acid (EDTA) as an endodontic irrigant? a. It must be completely removed after use to prevent continued action and destruction of dentin. b. It is a quick, efficient means of removing the smear layer. Explanation: Refer to pg(s): 252 c. It acts on both organic and inorganic components of the smear layer. d. It penetrates deep into dentin, enhancing root canal preparation



Question: 15. Calcium hydroxide is advocated as an interappointment medicament primarily because of which of the following characteristics? a. Ability to dissolve necrotic tissue b. Antimicrobial activity Explanation: Refer to pg(s): 249, 253, 264 c. Ability to stimulate hard tissue formation d. Ability to temporarily seal the canal



Question: 16. Which of the following statements about gutta-percha points is accurate? a. They contain 40% pure gutta-percha. b. They adhere to dentin when compacted. c. They can be heat sterilized. d. They are not compressible. Explanation: Refer to pg(s): 260



Question: 17. What is the diameter of a .02 taper #30 SS K-file 16 mm from the tip? a. 0.50 mm b. 0.62 mm Explanation: Refer to pg(s): 240 c. 0.86 mm d. 1.20 mm



Question: 18. Endomethasone, N2, and Riebler’s paste are sealers that do which of the following? a. Have low toxicity b. Cause minimal tissue irritation c. Contain substantial paraformaldehyde additives Explanation: Refer to pg(s): 268-269 d. Gain volume when exposed to fluid



Question: 19. Which of the following statements is accurate regarding TERM? a. It is light activated Explanation: Refer to pg(s): 271 b. It sets upon contact with water c. It is a zinc oxide-reinforced material d. It is more resistant to leakage than Cavit



Question: 20. Which of the following is accurate regarding Self-Adjusting Files (SAFs)? a. They are made from stainless steel. b. They rely on an aggressive cutting tip to clean the canal. c. They do not require a glide path. d. The file is hollow, allowing for continuous irrigation through the file. Explanation: Refer to pg(s): 257



Question: 21. When is the Apexum procedure applied? a. After completion of cleaning, shaping, and disinfection of the canal system Explanation: Refer to pg(s): 242 b. Before the corrected working length is established c. After root canal obturation d. When Enterococcus faecalis has been identified from the canal



Question: 22. Which of the following statements about MTAD is accurate? a. It is a combination of tetracycline, citric acid, and a detergent (Tween). Explanation: Refer to pg(s): 249 b. It is more effective than NaOCl. c. It leaves the smear layer intact. d. It is now considered the standard of care.



Question: 23. Which of the following irrigants is most effective against a biofilm of E. faecalis? a. NaOCl Explanation: Refer to pg(s): 251 b. Calcium hydroxide c. Chlorhexidine d. NaOCl + calcium hydroxide



Question: 24. Which of the following statements about Resilon is accurate? a. It provides a superior seal compared to gutta-percha. b. It is difficult to remove from the canal space. c. It may provide improved resistance to root fracture. Explanation: Refer to pg(s): 267 d. It does not require sealer



Question: 25. What is one of the greatest strengths for using laser irradiation in root canal treatment? a. It is easy to use. b. It alters the dentin by melting and resolidifying it, thereby closing the dentin tubules. Explanation: Refer to pg(s): 273 c. It increases root surface temperature. d. It has an inherent ability to bend around curves



Question: 26. Which of the following statements is correct about the file design indicated by the arrow in the figure? a. The cutting edge is consistent with a file manufactured by twisting triangular stock. b. The arrow identifies a positive rake angle. c. The flute ensures active cutting during rotation. d. This arrow designates a radial land. Explanation: Refer to pg(s): 234-235 e. The cutting edge depicted is consistent with the ProTaper instruments



Chapter 9: Cleaning and Shaping of the Root Canal System Question: 1. Which of the following is a factor in the prognosis for success in nonsurgical root canal treatment? a. The intensity of symptoms b. The presence of a periradicular radiolucent lesion Explanation: Refer to pg(s): 283 c. The size of a periapical lesion d. The patient’s gender e. The use of nickel-titanium instruments for providing treatment



Question: 2. Each of the following is an objective of cleaning and shaping EXCEPT ONE. Which is this EXCEPTION? a. Remove infected soft and hard tissue. b. Allow access of disinfecting irrigants to apical canal space. c. Create space for medicament delivery and subsequent obturation. d. Retain integrity of radicular structures. e. Maintain the initial apical canal diameter. Explanation: Refer to pg(s): 289



Question: 3. Which of the following statements best describes Batt-tips? a. They are the sharp, angulated barbs found on broaches. b. They exhibit a sharp transition angle, making negotiation around curves difficult. c. The term describes the noncutting tip on burs used in endodontic access preparations. d. They exhibit a smooth transition angle and are noncutting. Explanation: Refer to pg(s): 291



Question: 4. Which of the following statements regarding ISO standardized files is correct? a. D 0 is the cross-sectional diameter at the first rake angle. R



R



Explanation: Refer to pg(s): 291 b. The rake angle is set at 45 degrees. c. The diameter of a #25 file at D 16 is 0.41 mm. R



R



d. D 1 is the cross-sectional diameter at the instrument tip. R



R



e. The greatest magnitude of change in tip diameter occurs in transitioning from a #55 file to a #60 file.



Question: 5. Which of the following statements best describe LightSpeed instruments? a. The cross-sectional diameter of the instruments increases by a constant 29%. b. The instrument shaft increases by 0.02 mm per millimeter. c. Cross-sections through the cutting portion of the shaft reveals three U-shaped depressions. Explanation: Refer to pg(s): 296 d. The instruments require maximal torque at slow speeds because of the flute design



Question: 6. Which of the following statements best describes Golden Medium files? a. Cross-sectional diameter of the instruments increases by a constant 29% b. Instrument shaft increases by 0.04 mm per millimeter c. Have intermediate tip sizes between traditional ISO-stipulated diameters Explanation: Refer to pg(s): 291 d. Are milled from round cross-sectional stainless steel blanks



Question: 7. Which of the following statements best describes Gates-Glidden drills? a. They are side-cutting instruments with a safety tip. Explanation: Refer to pg(s): 293 b. The instruments cut on the inward stroke. c. The instruments are most effective when used in an air-driven slow speed handpiece. c. Can only be used sequentially in a step-back technique



Question: 8. Which of the following statements regarding GT-Files and GTX files is correct? a. The GTX instruments are manufactured using the M wire. Explanation: Refer to pg(s): 307 b. The operational speed is 500 rpm. c. Cross-sections of the instruments reveals a triangular form. d. The instruments in each set have a constant taper and varied tip diameters. e. The pitch is constant along the cutting portion of the instruments



Question: 9. A positive rake angle is associated with which of the following instruments? a. K 3 R



Explanation: Refer to pg(s): 302 b. Profile Series 29 c. LightSpeed d. Profile e. GT-Files



Question: 10. Finishing files in the ProTaper series: a. Have partially active cutting tips with diameters of 0.185 and 0.20 mm b. Have tapers of .04, .05, .07, .08, and .09 between D0 and D 3 R



R



R



Explanation: Refer to pg(s): 299 c. Are rhomboidal in cross-section and have a constant helical angle d. Should be used at 1000 to 1500 rpm d. Exhibit radial lands that keep the instruments centered



Question: 11. RaCe files: a. Are made from square stainless steel blanks b. Have flutes, reverse flutes, and alternating straight areas Explanation: Refer to pg(s): 303 c. Are rhomboidal in cross-section d. Should be used at 1500 to 2000 rpm



Question: 12. The Twisted file: a. Is manufactured by unique thermal processing involving the R-phase of nickel titanium Explanation: Refer to pg(s): 304 b. Exhibits varied tip diameters c. Are uniformly more stiff when compared to ProFiles d. Have demonstrated improved healing rates in clinical studies e. Have radial lands that keep the instruments centered



Question: 13. What statement is accurate concerning a flexural fracture? a. It occurs when an instrument tip is locked in a canal while the shank continues to rotate b. It occurs when instrument rotation is sufficiently slowed in reaction to the cross-sectional diameter c. It occurs when cyclic loading lead to metal fatigue Explanation: Refer to pg(s): 307 d. All of the above



Question: 14. A crown-down approach to instrumentation with rotary nickel-titanium files: a. Has been advocated to decrease the area of surface contact and friction Explanation: Refer to pg(s): 308 b. Decreases flexural fatigue c. Requires the apical application of force similar to that required to place amalgam d. Requires using instruments with varying tapers and a constant tip diameter e. Is best accomplished with instruments having a consistent taper and variable tip diameter



Question: 15. The use of electric motors in rotary nickel-titanium preparation: a. Reduces the risk of fracture due to cyclic fatigue but not torsional fatigue b. Produces a constant rpm below the torque required for instrument fracture c. Are manufactured with torque control that prevents instrument fracture due to cyclic fatigue d. Permits variable rpm settings and torque adjustments Explanation: Refer to pg(s): 294, 308-309



Question: 16. Nickel-titanium instruments are: a. Manufactured by twisting because of the super-elastic nature of the metal b. Weakened by routine cleaning and sterilization procedures c. Adversely affected by sodium hypochlorite, which contributes to fracture d. Weakened clinically by work hardening Explanation: Refer to pg(s): 306



Question: 17. The crown-down method of rotary canal preparation is recommended primarily because it: a. Decreases torsional friction Explanation: Refer to pg(s): 308, 320 b. Increases visibility for instrument placement c. Provides space for lubricants d. Increases the taper of the preparation to accommodate stainless steel hand files



Question: 18. Sodium hypochlorite used as an endodontic irrigant: a. Is an organic tissue solvent Explanation: Refer to pg(s): 312 b. Has a narrow spectrum of antimicrobial activity c. Is most effective clinically in the higher concentrations d. Has the advantage of only affecting necrotic tissue



Question: 19. The use of chlorhexidine as an endodontic irrigant: a. May be advantageous because of the ability of the chemical to bind to hydroxyapatite and possibly sustain antimicrobial activity Explanation: Refer to pg(s): 312 b. Is advocated owing to the ability of the chemical to inhibit cellular division c. Is not indicated in cases where calcium hydroxide is to be used for treating pulp necrosis and chronic apical periodontitis d. Is contraindicated because of its narrow spectrum of activity and possible development of resistance and allergenicity



Question: 20. Iodine potassium iodide is used in endodontics: a. Because it is a reducing agent for bacterial enzymes Explanation: Refer to pg(s): 314 b. Because of its low allergenicity c. As a chelator d. Because of its low toxicity and wide spectrum of activity



Question: 21. MTAD: a. Is a combination of an acid, detergent, and doxycycline Explanation: Refer to pg(s): 314 b. Has a synergistic anesthetic action with lidocaine c. Is only used in vital cases because of the action of Tween 80 d. Is an effective intracanal medicament because of the action of the antibiotic component e. Employs oxidative potential water as the active agent



Question: 22. Each of the following statements regarding the use of sodium hypochlorite as an endodontic irrigant is correct EXCEPT ONE. Which is this EXCEPTION? a. Heating the solution can enhance the antimicrobial action but does not affect the solvent capabilities. Explanation: Refer to pg(s): 337 b. In higher concentrations (5.25%), it can dissolve both vital and necrotic tissues. c. Free chlorine breaks down proteins into amino acids. d. The irrigating solution serves as a lubricant and mechanically removes debris. e. Heating the solution may cause may have severe detrimental effects on nickel-titanium instruments



Question: 23. Which of the following statements regarding cleaning and shaping is correct? A. Shaping procedures facilitate obturation. Explanation: Refer to pg(s): 288, 289, 319 B. A primary objective of shaping is removing bacteria and necrotic tissue. C. Cleaning is accomplished prior to shaping procedures. D. A canal is clean when there is a uniform taper



Question: 24. Cleaning and shaping should be terminated: a. At the cemento-dentinal junction b. 0.5 to 1 mm short of the radiographic apex for necrotic cases Explanation: Refer to pg(s): 317 c. At the radiographic apex d. At the major diameter of the foramen



Question: 25. Apical patency in endodontic treatment is best described as placing a small file: a. Through the apical foramen prior to beginning the canal cleaning and shaping procedures b. To the corrected working length following the use of each instrument to prevent packing of debris and loss of length c. Through the apical foramen following the use of each instrument Explanation: Refer to pg(s): 318 d. To working length, followed by successively larger files until binding occurs



Question: 26. Root canals should be cleaned, shaped, and obturated to the constricture for each of the following reasons EXCEPT ONE. Which is this EXCEPTION? a. The constriction is the narrowest diameter of the canal. b. Lateral and accessory canals are common in the apical 1 to 2 mm of the canal. c. The clinician can easily identify the constriction. Explanation: Refer to pg(s): 318 d. Obturating materials are maintained within the root canal system



Question: 27. The standardized technique: a. Utilizes the same working length for all files Explanation: Refer to pg(s): 321 b. Facilitates the use of standardized cones and compaction of gutta-percha c. Establishes a standard working length but requires larger instruments be used at incremental lengths that are shorter d. Requires a reaming action for file manipulation



Question: 28. The balanced force technique is best described by which of the following statements? a. The file is passively placed to the point of first binding and then rotated one to two turns in a counterclockwise direction. b. Dentin is engaged with the file rotating in a clockwise direction for a quarter turn, followed by a counterclockwise rotation with inward pressure for at least one-third of a revolution. Explanation: Refer to pg(s): 323-324 c. The file is oscillated back and forth 30 to 60 degrees as it is positioned apically, followed by a clockwise rotation of 180 degrees before removal. d. A file is placed passively to a point of first binding and then rotated in a clockwise rotation of at least 180 degrees using apical pressure, followed by a counterclockwise rotation to evacuate debris



Question: 29. Each of the following are components of recapitulation EXCEPT ONE. Which is the EXCEPTION? a. Loosening of debris and tissue in the apical portion of the canal, which could produce blockage b. Reintroduction of small files previously used in cleaning and shaping procedures c. Irrigation with sodium hypochlorite d. Sterilization and disinfection of the radicular space Explanation: Refer to pg(s): 322-323



Question: 30. RC-Prep and Glyde: a. Have lubricating properties Explanation: Refer to pg(s): 316 b. Are used during the later stages of shaping the canal to reduce ledge formation c. Digest collagenous components of the dental pulp d. Prevent the formation of the smear layer during canal preparation



Question: 31. Which of the following is most responsible for short, underfilled canals? a. Severe curvatures b. Packing debris Explanation: Refer to pg(s): 317 c. Canal ledging d. Calcification of the canal



Question: 32. The LightSpeed LSX: a. Should be used in a pecking motion and requires 12 pecks to reach the corrected working length for optimum cleaning b. Increases the degree of canal taper during use c. Experiences resistance 4mm short of working length which determines the final apical size Explanation: Refer to pg(s): 325-326 d. Has an active cutting tip, so rotational speeds of 150 to 300 rpm are advocated



Question: 33. Which of the following is a benefit of using a combination of instruments? a. Instruments can be used in a manner that promotes their individual strengths and avoids their weaknesses b. Hand instrument secure a patent glide path c. Tapered rotary instruments efficiently enlarge coronal canal areas d. Less tapered instruments allow additional apical enlargement e. All of the above Explanation: Refer to pg(s): 330



Question: 34. Which factor is most significant in eliminating bacteria from the apical portion of the canal? a. The depth of needle penetration during irrigation b. The use of a size #15 patency file c. Use of the apex locator to establish the working length d. Significant apical enlargement Explanation: Refer to pg(s): 316



Question: 35. Which statement regarding ultrasonic canal preparation is correct? a. Compared to rotary instruments, ultrasonic preparation shows superior cleaning but no difference in shaping. b. The use of a size #15 patency file is needed. c. Ultrasonic preparation results in a higher incidence of procedural errors. Explanation: Refer to pg(s): 330 d. The instruments preserve dentin and therefore the strength of the root



Question: 36. Which statement regarding irrigation of the canal during cleaning and shaping is correct? a. Volume is proportional to cleansing efficiency but not speed of flow. b. Intermittent agitation of the irrigant with a small file is an important factor. Explanation: Refer to pg(s): 332 c. Depth of needle penetration is an important factor but not the diameter. d. Time of contact is more important than the volume administered



Question: 37. Which of the following irrigation solutions exhibit a proteolytic effect? a. Sodium hypochlorite Explanation: Refer to pg(s): 336 b. Chlorhexidine c. Hydrogen peroxide d. EDTA



Question: 38. Ethylenediamine tetra-acetic acid: a. Acts a chelator of calcium and facilitates removal of the inorganic portion of the smear layer Explanation: Refer to pg(s): 314-315, 338 b. Acts synergistically with sodium hypochlorite in killing bacteria c. Dissolves collagen and therefore disrupts the smear layer d. Decalcifying effect is ongoing; failure to completely remove the solution results in a decrease in root strength



Question: 39. Which of the following statements regarding root canal treatment on this mandibular right second molar, tooth #31, is correct? a. The presence of a periapical lesion decreases the prognosis. Explanation: Refer to pg(s): 283 b. Treatment will be routine; the chamber appears visible, is exposed, and the canals are evident. c. Accessory canals are the most likely etiology for the lesion noted on the distal root. d. Pretreatment crown lengthening should be performed to aid in isolation. e. The mesial portion of amalgam should be left in place to aid in RD placement



Question: 40. Which of the following statements best describes the file pictured? a. The file design is consistent with a rhomboidal cross-sectional design. b. The file represents a square or triangular cross-sectional design. Explanation: Refer to pg(s): 303 c. The file design is consistent with a Hedström file. d. The flutes exhibit radial lands. e. The file has a U-shape design



Chapter 10: Obturation of the Cleaned and Shaped Root Canal System Question: 1. Each of the following is a radiographic criterion for assessing obturation, with one EXCEPTION. Which is this EXCEPTION? a. Length b. Taper c. Density d. Apical seal Explanation: Refer to pg(s): 350 e. Adequate provisional restoration



Question: 2. A hermetic seal is best described as a(n): a. Airtight seal Explanation: Refer to pg(s): 352 b. Fluid-tight seal c. Fluid-tight seal that permits passage of air d. Seal that prevents bacterial penetration e. Seal that prevents leakage of bacteria and their byproducts



Question: 3. Which of the following statements regarding the time of obturation is correct? a. Obturation of cases with pulp necrosis and acute apical abscess is best accomplished at the initial visit. b. Cases of irreversible pulpitis obturated at the initial visit have the best prognosis. Explanation: Refer to pg(s): 353 c. Cases exhibiting necrosis are best treated in two visits, because the incidence of postoperative pain is increased when compared to single-visit treatment. d. Obturation of cases with pulp necrosis and chronic apical periodontitis can be treated in one visit, providing antibiotics are prescribed to eliminate residual bacteria



Question: 4. Each of the following is an advantage to completing root canal treatment in one visit EXCEPT ONE. Which is this EXCEPTION? a. Recontamination of the canal from coronal leakage is prevented. b. The definitive restoration can be placed. c. Management of continued postoperative problems is facilitated. Explanation: Refer to pg(s): 352-353 d. Patient compliance is not a factor in the treatment, and the cost of providing treatment is reduced



Question: 5. Obturation should be: a. To the radiographic apex b. At the cemento-dentinal junction c. At the major diameter of the foramen d. At the minor diameter of the constriction Explanation: Refer to pg(s): 355-356



Question: 6. Which of the following statements regarding accessory canals is correct? a. They are effectively cleaned by sodium hypochlorite in concentrations exceeding 1%. b. They play a major role in periradicular pathosis. c. They exhibit a consistent pattern of appearing either on the mesial or distal surfaces. d. They are an uncommon finding, and a root will seldom have more than one. e. They are serendipitously identified on postoperative radiographs. Explanation: Refer to pg(s): 355



Question: 7. Which of the following significantly decreases the long-term prognosis following obturation? a. Obturation of vital cases 1 to 3 mm short of the radiographic apex b. Obturation of necrotic cases 0 to 2 mm short of the radiographic apex c. Extrusion of obturating materials Explanation: Refer to pg(s): 355 d. Obturation at the time of cleaning and shaping



Question: 8. Which of the following statements regarding the smear layer is correct? a. It is a thick layer of inorganic debris on the canal wall following cleaning and shaping. b. It provides a complete barrier to bacterial invasion of the tubules. c. It contains organic debris that might serve as a substrate for bacterial growth. Explanation: Refer to pg(s): 356 d. Unlike vital cases where the pulp is easily removed, it forms in cases where the pulp is necrotic and devoid of structure



Question: 9. MTAD: a. Contains tetracycline, an acid, and detergent Explanation: Refer to pg(s): 357 b. Is composed of 17% citric acid c. Unlike EDTA has no antimicrobial activity d. Has been advocated as a replacement for sodium hypochlorite, owing to its low toxicity e. Will remove organic components of the smear layer but is ineffective in removing inorganic material



Question: 10. Calcium hydroxide sealers: a. Have been demonstrated to induce apical hard-tissue formation b. Are antimicrobial and kill residual bacteria c. May be zinc oxide eugenol or catalyst/resin based Explanation: Refer to pg(s): 359 d. Bond to dentin but release formaldehyde upon setting



Question: 11. Medicated sealers with paraformaldehyde: a. Are acceptable provided appropriate cleaning and shaping procedures are performed b. Are resin based and have minimal toxicity c. Should only be used in vital cases where “mummification” of tissue is desirable d. When extruded, produce paresthesia that is reversible with time e. Are below the standard of care Explanation: Refer to pg(s): 362



Question: 12. Each of the following statements regarding gutta-percha is correct EXCEPT ONE. Which is the EXCEPTION? a. Gutta-percha cones are composed of 60% gutta-percha, 20% zinc oxide, 10% radiopacifiers, 5% plasticizers. b. Standardized cones seldom exhibit uniformity in dimensions. c. When heated, it becomes pliable. d. The alpha and beta forms exhibit the same mechanical properties. e. When in the beta form, shrinkage occurs. Explanation: Refer to pg(s): 363



Question: 13. Sterilization of gutta-percha is best accomplished with: a. Autoclave sterilization b. Placing the cones in 5.25% sodium hypochlorite for 1 minute Explanation: Refer to pg(s): 363 c. Cold sterilization with 2% glutaraldehyde d. Wiping the cones with 70% ethyl alcohol e. Wiping the cones with 2% chlorhexidine



Question: 14. Resilon is: a. A resin core alternative to gutta-percha Explanation: Refer to pg(s): 364 b. Nontoxic but has mutagenic properties c. A material with cross-latex allergenicity d. A material that requires a light cure to set e. Not compatible with thermoplasticized injection



Question: 15. A proposed advantage to the “monoblock” is that: a. Bonding to the smear layer occurs. b. Sodium hypochlorite enhances the attachment to dentin. c. A core obturation material is not necessary. d. It eliminates the core sealer interface. Explanation: Refer to pg(s): 364-365



Question: 16. Each of the following statements regarding custom cones is correct EXCEPT ONE. Which is the EXCEPTION? a. The seal may be improved. b. The master cone adapts to the canal preventing extrusion. c. The cone is placed in solvent until the external surface is softened. d. The primary purpose is length control during compaction procedures. e. Fabrication requires fitting the cone to length with “tugback” prior to softening. Explanation: Refer to pg(s): 366



Question: 17. A major advantage to lateral compaction is: a. Lamination of the accessory cones during compaction b. The ability to fill canal irregularities c. Master cones can be adapted to fit the apical morphology d. Length control Explanation: Refer to pg(s): 367-368



Question: 18. Which of the following statements regarding the use of heat in warm vertical compaction is correct? a. The temperature of external surface of the root must not increase more than 10°C. Explanation: Refer to pg(s): 371 b. The internal canal wall surface must not increase more than 10°C. c. System B and the Touch ’n Heat pose an equal greater risk for injury to the periodontium. d. Ultrasonic warm lateral compaction does not pose a risk to damaging the periodontium. e. Heat should only be used to sear the excess material at the orifice when using Resilon, because the setting reaction of this material is exothermic



Question: 19. Each of the following statements regarding continuous wave compaction is correct EXCEPT ONE. Which is the EXCEPTION? a. Pluggers are selected which fit to within 5 to 7 mm of the corrected working length. Explanation: Refer to pg(s): 371-372 b. Heat is applied to the plugger, and it is moved quickly to the binding point, where hydraulic pressure is applied without heat for 5 to 10 seconds. c. The technique cannot be used in ovoid canals, owing to the inability to develop hydraulic pressure. d. The pluggers exhibit a uniform taper of .06 but have variable tip diameters. e. Standardized .02 tapered gutta-percha cones fit with “tugback” are preferred Question: 20. The Obtura II differs from UltraFil in which of the following ways?



a. The Obtura II cannulas can be heat sterilized. b. Resilon can be used with the UltraFil unit. c. The Obtura II heats the gutta-percha to a higher temperature. Explanation: Refer to pg(s): 376 d. The Obtura II requires a more tapered canal preparation



Question: 21. Each of the following statements regarding Thermafil obturation is correct EXCEPT ONE. Which is this EXCEPTION? a. Size verifiers are available to assist in determining the appropriate carrier. b. Calibration rings on the carrier assist in placing the carrier to length. c. Insertion of the carrier is accomplished without rotation. d. Preppi burs are specifically designed for sectioning the carrier at the canal orifice. e. While AH 26 is a recommended resin sealer, Tubliseal and Wachs’ Paste are acceptable zinc oxide eugenol formulations. Explanation: Refer to pg(s): 378



Question: 22. The SimpliFill obturation system: a. Consists of a plastic carrier upon which gutta-percha is fused b. Requires passively fitting the carrier to length prior to backfilling with lateral compaction c. Is designed for obturation of canals prepared with LightSpeed instruments Explanation: Refer to pg(s): 380 d. Requires coating the carrier with gutta-percha expressed from a syringe e. Should not be employed in teeth that will require a post for retention of the crown



Question: 23. Each of the following has been advocated as an apical barrier material. Which is preferred? a. Calcium hydroxide b. Dentin chips c. Collagen d. Mineral trioxide aggregate Explanation: Refer to pg(s): 382 e. Tricalcium phosphate



Question: 24. Which of the following methods would be best for decreasing coronal microleakage in posterior teeth? a. Heating the coronal gutta-percha and vertically compacting the material b. Bonding a resin-modified glass ionomer cement over the pulpal floor Explanation: Refer to pg(s): 382 c. Obturation of the coronal 2 to 3 mm with thermoplastic injection of gutta-percha d. Leaving a layer of gutta-percha covering the chamber floor



Question: 25. Which of the following methods of obturation employ vibration?



a. System B b. UltraFil 3D c. Endotec II d. DownPak Explanation: Refer to pg(s): 375-376



Question: 26. Which of the following is true of the Activ GP system? a. It employs a glass-ionomer impregnated gutta-percha cone. Explanation: Refer to pg(s): 364 b. It is used in a variation of continuous wave obturation. c. It employs a bioceramic sealer that is hydrophilic. d. It consists of a cold, flowable matrix of polydimethylsiloxane filled with very finely ground gutta-percha



Question: 27. Which of the following statements regarding obturation of this maxillary right canine is correct? a. The canal should be obturated with a custom cone and lateral compaction. b. Continuous wave vertical compaction should be used after placing two master cones to within 0.5 mm of the apex. c. An apical mineral trioxide aggregate plug should be placed prior to obturation. Explanation: Refer to pg(s): 360 d. The Obtura system should be used to eliminate stress on the root. e. A calcium hydroxide seal should be used to induce apical closure



Question: 28. The obturation of the incisor shown in the illustration is inadequate because: a. It appears short of the prepared length. Explanation: Refer to pg(s): 356 b. There is variable radiodensity (incomplete condensation) throughout its length. c. There is a space between the temporary restoration and the gutta-percha. d. The diagnosis was pulp necrosis and chronic apical periodontitis; the canal should be filled to the apical foramen



Question: 29. Which of the following is an advantage of gutta-percha? a. removal with heat or solvents b. minimal toxicity c. ease of manipulation d. radiopacity e. All of the above Explanation: Refer to pg(s): 363



Question: 30. Of the following, what is most likely the primary 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. Silver points do not allow for proper healing d. Inadequate cleaning and shaping of the canal of coronal leakage. Explanation: Refer to pg(s): 363



Chapter 12: Structure and Functions of the Dentin-Pulp Complex Question: 1. The dental lamina: a. Consists of dental mesenchyme b. Is also known as the basal lamina c. Is composed of type I and type III collagen d. Initiates the formation of the enamel organ Explanation: Refer to pg(s): 454



Question: 2. The stellate reticulum: a. Lies between the inner and outer epithelium Explanation: Refer to pg(s): 454 b. Gives rise to the odontoblastic layer c. Gives rise to the periodontal ligament and attachment apparatus d. Is a neural network that controls innervations of the dental pulp



Question: 3. During tooth development, neural innervation: a. Takes place in the bud stage b. Occurs after the crown shape is defined by the enamel Explanation: Refer to pg(s): 455 c. Follows sympathetic innervations d. Is necessary for histodifferentiation of ameloblasts and odontoblasts



Question: 4. Mantle dentin: a. Underlies enamel and is highly mineralized to support adhesion b. Is composed of calcospherites that failed to fuse during mineralization c. Is located adjacent to cementum d. Is the first layer of primary dentin Explanation: Refer to pg(s): 458



Question: 5. Hertwig’s epithelial root sheath: a. Is derived from the enamel organ and forms cementum b. Consists of the inner and outer enamel epithelium Explanation: Refer to pg(s): 457 c. Is derived from the epithelial rests of Malassez d. Is composed of cells that differentiate into cementoblasts e. Separates the root from the connective tissues prior to eruption



Question: 6. Which of the following statements regarding the structure of dentin is correct? a. The percentage of dentinal tubules per surface area is constant. b. No peritubular dentin is present when the tubules reach the predentin and pulp. Explanation: Refer to pg(s): 459 c. Dentin varies considerably from the human in cats, dogs, and monkeys. d. Sclerosis of the tubules occurs coronally but is uncommon in the apical portion of the tooth



Question: 7. Dentinal fluid: a. Resembles blood plasma, but the protein content is higher b. Has a high concentration of calcium in the predentin area Explanation: Refer to pg(s): 460 c. Prevents embrittlement of dentin d. Has collagenolytic properties that assist in the dentinal remodeling



Question: 8. Von Korff fibers are thought to be: a. Remnants of the lateral lamina persisting near the basement membrane following the initiation of ameloblasts b. Terminal nerve fibers entering the predentin and regulating the calcification front c. The terminal odontoblastic processes prior to initial calcification d. The first formed collagen fibers located between the preodontoblasts and extending toward the basal lamina Explanation: Refer to pg(s): 456



Question: 9. Each of the following statements regarding the dentinal tubules is correct EXCEPT ONE. Which is this EXCEPTION? a. The tubule diameter near the pulp/dentin interface is approximately 1 to 2.5 μm. b. In the coronal dentin, the tubules exhibit an S-shaped curvature. c. Intertubular dentin lines the inner walls of tubules Explanation: Refer to pg(s): 459 d. Lateral microtubules contain branches of the odontoblastic process. e. Peritubular dentin, when present, lines the tubule



Question: 10. The structure of peritubular dentin: a. Is similar to intertubular dentin in collagen and mineral content b. Exhibits a lower content of collagen when compared to intertubular dentin Explanation: Refer to pg(s): 459 c. Restricts removal by acids, owing to the low sulfated proteoglycans and mineral content d. Adds strength and structural support to the intertubular dentin e. Is formed only in the presence of a vital odontoblastic process



Question: 11. Which of the following statements best describes dentinal fluid? a. Plasma proteins are present in concentrations similar to blood plasma. b. The fluid in dentin is homogeneous and uniform. c. The fluid is an ultrafiltrate of blood in the pulpal capillaries. Explanation: Refer to pg(s): 460 d. Slow outward movement of dentinal fluid activates mechanoreceptors, producing pain. e. Dentinal fluid is responsible and necessary for maintaining the physical properties of dentin



Question: 12. The odontoblast differs from other mesenchymal cell lines because of: a. Secretion of phosphophoryn Explanation: Refer to pg(s): 466 b. Production of type I collagen c. Production of sialoprotein d. Production of alkaline phosphatase e. The presence of multiple nucleoli



Question: 13. The lamina limitans is: a. An electron-dense membrane lining the dentinal tubule Explanation: Refer to pg(s): 467 b. Another term for the vital odontoblastic process c. The peripheral peritubular dentin d. Composed of microfilaments and microtubules e. A layer between the predentin and dentin which regulates calcification



Question: 14. Odontoblastic production of: a. Proteoglycans takes place in the Golgi complex prior to secretion at the base of the odontoblastic process b. Collagen consists of synthesis of procollagen, secretion of tropocollagen, and aggregation of fibrils on the outer odontoblastic membrane Explanation: Refer to pg(s): 468 c. Proteoglycans increases calcification of predentin by increasing transport of calcium through the microtubules d. Lysosomal enzymes are an important first line defense against microbial invasion



Question: 15. Pulpal fibroblasts: a. Are equally distributed throughout the pulp b. Synthesize type I and type III collagen Explanation: Refer to pg(s): 468 c. Are end-line cells incapable of differentiation d. Exhibit a polygonal morphologic shape when mature



Question: 16. Dendritic cells: a. Are similar to Langerhans cells found in the epidermis and mucous membranes Explanation: Refer to pg(s): 469 b. Are primarily phagocytic cells that are centrally located in the pulp c. Provide a population of replacement cells for disintegrating odontoblasts d. Are specialized cells that transmit pain impulses toward the central nervous system via the spinothalamic pathway e. Present antigens to polymorphonuclear leukocytes



Question: 17. Which of the following statements regarding lymphocytes is correct? a. Lymphocytes are not found in normal pulp tissues. b. B lymphocytes are usually found in the pulp and are responsible for antigen presentation to macrophages. c. T4 (helper) lymphocytes predominant in the normal pulp. d. T8 (suppressor) lymphocytes are the predominant subset in the normal pulp. Explanation: Refer to pg(s): 469



Question: 18. The principle proteoglycans of the dental pulp: a. Are fibronectin, laminin, and tenascin b. Are hyaluronic acid, dermatan sulfate, heparin sulfate, and chondroitin sulfate Explanation: Refer to pg(s): 472 c. During active dentinogenesis are hyaluronic acid and dermatan sulfate d. When mineralization activity is low is chondroitin sulfate e. Are not affected during inflammation, because of their hydrophilic nature and colloidal state



Question: 19. Type IV collagen is typically: a. Absent from the pulp b. A component of the ground substance and provides structure for the body of the pulp c. Found in basement membranes Explanation: Refer to pg(s): 453, 472 d. Synthesized by odontoblasts at the mineralization front and regulates calcification rates e. Synthesized by osteoclasts and is absent from the dental pulp



Question: 20. Which of the following statements regarding innervation of the pulp is correct? a. Myelinated fibers are the last major structures to appear in the developing pulp. Explanation: Refer to pg(s): 474 b. Autonomic fibers are afferent neurons which regulate microcirculation. c. A-beta and A-delta exist in equal numbers and are stimulated by fluid movement in the dentinal tubules. d. The dental papilla contains both myelinated and unmyelinated fibers. e. A-delta and C fibers are exhibit separate and distinct functions



Question: 21. Electric pulp testing in young teeth: a. May be unreliable because of the late development of A-delta fibers Explanation: Refer to pg(s): 475 b. Results in a sharp, rapid response because of the predominance of the C fibers in the pulp c. Does not differ from more mature normal teeth that are without calcific metamorphosis d. Is best accomplished with cold, owing to the predominance of the A-delta fibers in the pulp



Question: 22. Each of the following might explain why a necrotic pulp might respond to testing or mechanical manipulation EXCEPT ONE. Which is this EXCEPTION? a. The nerve fibers may be resistant to necrosis. b. Nerve bundles are more resistant to autolysis. c. C fibers remain active in the presence of hypoxia. d. The cell body of the neuron lies outside the pulp. e. A-delta fibers exhibit a lower threshold for stimulation in hypoxia. Explanation: Refer to pg(s): 477



Question: 23. Each of the following statements regarding deafferentation is correct EXCEPT ONE. Which is this EXCEPTION? a. It is the process of degeneration of neurons centrally following nerve resection. b. Pain may be a result of this process. c. Transsynaptic degenerative changes may be reflected in the sensory cortex. d. With pulp extirpation, degeneration of nerves can extend beyond the trigeminal ganglion. e. It is the elimination of pain transmission to the central nervous system resulting from the application of a local anesthetic on the nerve. Explanation: Refer to pg(s): 478



Question: 24. Which of the following statements regarding pulp testing is correct? a. C fibers are normally stimulated by electric pulp testing but do not respond to thermal pulp testing. b. C fibers are normally stimulated by thermal pulp testing but do not respond to electric pulp testing. c. C fibers normally have a high threshold and require a more intense stimulus when compared to A-delta fibers. Explanation: Refer to pg(s): 475 d. A-delta fibers normally respond to thermal stimulation better than C fibers, but both fiber groups respond the same to electric pulp testing



Question: 25. Which of the following statements regarding dentinal sensitivity is correct? a. The movement in the tubules is translated into electrical signals by sensory receptors within tubules or the pulp. Explanation: Refer to pg(s): 478 b. The rate of fluid flow is not a factor in producing an electrical stimulus. c. The inward flow of fluid produces a more pronounced sensory nerve response. d. There must be a change in temperature at the pulp/dentin interface for a sensory response to occur. e. The application of heat causes expansion of the dentin, widens the dentinal tubules, draws fluid from the pulp into the dentin, and results in sensory stimulation



Question: 26. Which of the following statements regarding neuropeptides is correct? a. Sympathetic agents used in local anesthesia can modify the release of calcitonin gene-related peptide. Explanation: Refer to pg(s): 480-481 b. The primary function of these peptides is the production of pain. c. The release of neuropeptides occurs only in the presence of tissue injury, and their actions contribute to tissue damage, creating a vicious cycle of inflammation. d. These agents are released by odontoblasts and fibroblasts following sensory stimulation, and efferent messages are received from the central nervous system



Question: 27. Each of the following statements regarding pulpal hyperalgesia is correct EXCEPT ONE. Which is this EXCEPTION? a. There is a decreased pain threshold and an increased response to stimulation. b. An enhanced response to a stimulus results, but spontaneous pain is not characteristic of this phenomenon. Explanation: Refer to pg(s): 482 c. Increased pressure may be a contributing factor. d. The upregulation of tetrodotoxin-resistant sodium channels in inflamed tissues makes local anesthesia more difficult. e. Silent nerve fibers in the pulp become sensitized and may be activated



Question: 28. Which of the following statements regarding the vascular supply of the pulp is correct? a. Arteries enter the pulp and give rise to arterioles that branch and form a capillary network in the subodontoblastic zone. b. Capillary blood flow in the coronal portion of the pulp is twice that in the radicular portion of the pulp. Explanation: Refer to pg(s): 483 c. Arteriovenous anastomoses are present throughout the pulp but are more common in the coronal tissue. d. The volume of pulp occupied by vessels is higher than most tissues and approaches 25%. e. The pulp has the highest volume of blood flow of oral tissues and most visceral organs



Question: 29. Reactionary dentin is best described as: a. Atubular and amorphous as seen in calcific metamorphosis b. Tertiary dentin formed by the original odontoblasts Explanation: Refer to pg(s): 458 c. An area of tubule sclerosis below an advancing carious lesion d. Reparative dentin formed by cells replacing the original odontoblasts e. Dentin exhibiting decalcification due to the selective removal of peritubular dentin



Question: 30. Which of the following best describes pulpal calcification? a. The radiographic appearance of pulp stones in the chamber indicates pathosis. b. Idiopathic pulpal pain has been demonstrated to be caused by laminated pulp stones which produce an alteration of blood flow. c. Calcific metamorphosis results in a high incidence of necrosis when canal obliteration is complete. d. Calcifications typically consist of carbonated hydroxyapatite. Explanation: Refer to pg(s): 494



Question: 31. The structure indicated by the arrow labeled A is: a. The periodontal ligament b. The cell-free zone c. Mantle dentin d. Predentin Explanation: Refer to pg(s): 459,464 e. Artifact separation of the odontoblastic layer



Question: 32. The structure indicated by the arrow labeled B is a(n): a. Vascular channel Explanation: Refer to pg(s): 483 b. Lymphatic c. Myelinated nerve fiber d. Unmyelinated nerve fiber e. Autonomic nerve fiber



Question: 33. The structure indicated by the arrow labeled C is: a. The odontoblastic layer b. The cell-rich zone Explanation: Refer to pg(s): 464-466 c. von Korff’s fibers d. Chronic inflammatory infiltration e. Mast cells



Question: 34. The basal dental lamina: a. Is composed of an elastic network of type IV collagen Explanation: Refer to pg(s): 453 b. Is formed by dental mesenchymal cells c. Contains von Korff’s fibers d. Differentiates to form odontoblasts e. Is an extracellular matrix



Question: 35. Epithelial enamel knots: a. Induce the dental papilla to produce odontoblasts b. Control morphogenesis Explanation: Refer to pg(s): 455 c. Result in the formation of enamel pearls during root formation d. Are developmental defects in the incisal and cusp areas and occur during morphodifferentiation



Question: 36. Which of the following is correct regarding the physiology of the dental pulp? a. The rate of oxygen consumption is low compared to most tissues. Explanation: Refer to pg(s): 470 b. The phosphogluconate (pentose phosphate) shunt is absent in the dental pulp. c. Ischemia is not well tolerated by the tissue. d. The glycolytic pathway is an alternate energy pathway for respiration



Question: 37. Which of the following is primarily involved in active dentinogenesis? a. Hyaluronic acid b. Chondroitan sulfate Explanation: Refer to pg(s): 472 c. Dermatan sulfate d. Heparan sulfate



Question: 38. Pulpectomy: a. Results in deafferentation and total cessation of symptoms b. Produces neurochemical changes in the cell bodies of neurons located in the Gasserian ganglia Explanation: Refer to pg(s): 478 c. Has no effect on central projection neurons of the spinal nucleus d. Produces complete axonal degeneration of the cell body



Question: 39. Antidromic stimulation is best described by which of the following? a. An afferent barrage of signals centrally to the spinal tract of V b. Sympathetic stimulation resulting in vasoconstriction of arterioles c. An action potential that travels toward the periphery, resulting in neuropeptide release Explanation: Refer to pg(s): 481 d. Parasympathetic stimulation of C fibers, resulting in vasodilatation



Chapter 13: Pulpal Reactions to Caries and Dental Procedures Question: 1. The most common defensive response in the dentin deep to caries is which of the following? a. Increased permeability b. Alteration of collagen c. Dissolution of peritubular dentin d. Dentinal sclerosis Explanation: Refer to pg(s): 505



Question: 2. Tertiary dentinogenesis in the pulp in response to caries may be from stimulation of odontoblasts by: a. Caries bacteria invading the pulp b. Salivary proteins diffusing through tubules c. Fractions of dentin matrix proteins diffusing across dentin Explanation: Refer to pg(s): 505 d. Pulpal inflammatory cell cytokines



Question: 3. An infiltration injection of 2% lidocaine with 1:100,000 epinephrine causes which of the following? a. Pulpal circulation is reduced significantly for about 60 minutes. Explanation: Refer to pg(s): 510 b. Pulpal circulation remains the same. c. Pulpal circulation increases markedly. d. Pulpal circulation decreases slightly



Question: 4. The highest incidence of pulp necrosis is associated with which of the following? a. Class V preparations on the root surface b. Inlay preparations c. Partial veneer restorations d. Full crown preparations Explanation: Refer to pg(s): 516



Question: 5. Which of the following is a disadvantage of acid etching dentin with regard to effects on the pulp? a. Dentinal tubules are opened, increasing permeability. Explanation: Refer to pg(s): 517 b. Acid penetrates to the pulp and kills large numbers of cells. c. Acid penetrates to the pulp and damages the vessels. d. Acid softens the dentin and increases microleakage at the restoration/dentin interface



Question: 6. With chronic inflammation, pulpal dendritic cells: a. Increase in density Explanation: Refer to pg(s): 507 b. Suppress the inflammatory response c. Convert the inflammation from chronic to acute d. Phagocytose bacteria as they enter the pulp



Question: 7. The long-term outcome of pulp capping of carious exposures: a. Depends primarily on the capping material used b. Depends on whether bacteria have invaded the pulp c. Is affected by the severity of symptoms d. Is unfavorable Explanation: Refer to pg(s): 519



Question: 8. The incidence of painless pulpitis that leads to pulp necrosis is: a. Approximately 50% Explanation: Refer to pg(s): 509 b. Infrequent c. Most cases d. Unknown



Question: 9. Hypersensitivity is best relieved or controlled by which of the following? a. Opening the tubules to permit release of intrapulpal pressure b. Root planing to remove hypersensitive surface layers c. Applying antiinflammatory agents to exposed dentin d. Blocking exposed tubules on the dentin surface Explanation: Refer to pg(s): 510



Question: 10. Deeper cavity preparations have more potential for pulpal damage because of which of the following? a. Tubular diameter and density increase, therefore permeability increases. b. There is more vibration to pulp cells. c. Odontoblastic processes are more likely to be severed. Explanation: Refer to pg(s): 513 d. a and c e. b and c



Question: 11. Which of the following is the best way to prevent pulp damage during cavity preparation? a. Retain the smear layer. b. Use sharp burs with a brush stroke. c. Use adequate air coolant. d. Use adequate water coolant. Explanation: Refer to pg(s): 516



Question: 12. The major reason class II composites damage the pulp is: a. Composite chemicals supply substrate to bacteria. b. The setting reaction produces a damaging amount of heat. c. Toxic chemicals are released from the composite and diffuse into the pulp. d. Polymerization shrinkage distorts cusps and opens gaps (microleakage). Explanation: Refer to pg(s): 515



Question: 13. The pulp has been damaged, and inflammation is due to deep caries and cavity preparation. What material, when placed on the floor of the cavity, aids resolution of the pulpal inflammation? a. Calcium hydroxide b. Zinc oxide eugenol c. Steroid formulations d. None; no material promotes healing. Explanation: Refer to pg(s): 513



Question: 14. Comparing young versus old pulps, the regeneration capacity of odontoblasts is: a. Similar in both Explanation: Refer to pg(s): 516 b. Greatly reduced in old pulps following cavity preparation c. Greatly reduced in old pulps in carious teeth d. Greater in old pulps when steroids are placed in the cavity e. Greater in old pulps following carious exposure



Question: 15. The figure shows a section of pulp/dentin underlying an area of cavity preparation that was done the preceding day. Which of the following best describes the pulp reaction? a. No reaction has occurred; the pulp appears normal. b. The odontoblast layer has been disrupted, and mild inflammation is present. Explanation: Refer to pg(s): 517 c. Odontoblasts have been aspirated into tubules, and mild inflammation is present. d. Odontoblasts are absent, and extravasation of erythrocytes has occurred



Question: 16. The early inflammatory cell infiltrate response of the pulp to caries primarily involves which of the following? a. Neutrophils b. Macrophages c. Neutrophils, plasma cells, and lymphocytes d. Macrophages and lymphocytes e. Lymphocytes, plasma cells, and macrophages Explanation: Refer to pg(s): 507



Question: 17. Hypersensitivity of the pulp after restoration placement indicates which of the following? a. Acute inflammation in the pulp b. Chronic inflammation in the pulp c. Microleakage at the restoration/tooth interface d. Stimulation of sensory nerves by hydrodynamics Explanation: Refer to pg(s): 510 e. Tubules blocked by restorative material or smear layer or both



Question: 18. With severe pulp damage from excessive heat during cavity preparation, the patient response usually is: a. Extreme sensitivity to heat b. Spontaneous pain c. Pain on mastication d. No symptoms Explanation: Refer to pg(s): 513



Question: 19. A factor that is critical for success in pulp capping with MTA is that: a. The pulp be uninflamed b. A well-sealed restoration be placed Explanation: Refer to pg(s): 519 c. The material stimulates formation of dentin d. Grey MTA be used in posterior teeth



Question: 20. Which of the following statements is correct about the effect of orthodontic surgery on the pulp? a. The canal space sometimes is obliterated (markedly reduced). Explanation: Refer to pg(s): 523 b. Pulpal blood flow is seldom affected. c. Pulpal blood flow is reduced and never recovers. d. Inflammation or necrosis of the pulp is rare



Question: 21. Comparing laser versus high-speed bur cavity preparation: a. Only bur preparations require water coolant. b. Bur preparations show more pulp damage. c. Overall, there are not significant differences between the two as to pulp damage. Explanation: Refer to pg(s): 520 d. Most laser types protect the pulp by sealing tubules



Question: 22. What is the best description of pulp response to periodontal disease with loss of attachment and exposure of lateral canals? a. Severe, acute inflammation b. Mild, chronic inflammation Explanation: Refer to pg(s): 522-523 c. Microabscess formation in the adjacent pulp d. No response e. Pulp necrosis



Question: 23. Studies show that periapical lesions that develop on teeth adjacent to implants: a. Have no effect on the osseointegration of the implant Explanation: Refer to pg(s): 524 b. Adversely effect the osseointegration, causing increased mobility of the implant c. Must be removed surgically following RCT d. Are less likely to resolve following RCT



Question: 24. Regeneration of the dental pulp: a. Has shown to be very successful in a variety of situations b. Is only possible in immature teeth c. Is possible because of stem cells in dental papillae Explanation: Refer to pg(s): 525 d. Is not possible unless an immature tooth is transplanted following an extraction



Chapter 14: Pathobiology of the Periapex Question: 1. What is the cellular source for radicular cyst formation? a. Hertwig’s epithelial root sheath b. Cementum c. Bloodstream d. Epithelial rests of Malassez Explanation: Refer to pg(s): 530



Question: 2. Symptomatic apical periodontitis is characterized by a focus of: a. Neutrophils in the lesion Explanation: Refer to pg(s): 536 b. Granulomatous tissue in the lesion c. Lymphocytes, plasma cells and macrophages in the lesion d. All of the above



Question: 3. How does a periapical true cyst differ from a periapical pocket cyst? a. A true cyst does not communicate with the root canal. Explanation: Refer to pg(s): 545 b. A true cyst shows more rapid healing than a pocket cyst. c. A true cyst is more painful than a pocket cyst. d. A true cyst contains higher numbers of bacteria than a pocket cyst



Question: 4. Which of the following is the most important route by which bacteria are able to invade the pulp? a. The general circulation through anachoresis b. Exposure to the oral cavity through caries Explanation: Refer to pg(s): 530 c. The gingival sulcus d. None of the above



Question: 5. Which of the following statements is true regarding posttreatment apical periodontitis? a. It may be due to the persistence of microbial biofilms in the root canal space. Explanation: Refer to pg(s): 530 b. It is usually caused by careless cleaning and shaping procedures. c. It does not occur if sodium hypochlorite was used as an irrigant. d. It is typically more painful than primary apical periodontitis



Question: 6. Which of the following statements regarding neutrophils is accurate? a. They are nonspecific phagocytes. Explanation: Refer to pg(s): 533 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



Question: 7. Which of the following statements about T lymphocytes is accurate? a. They are thyroid-derived cells. b. They concentrate in the cortical area of lymph nodes and circulate in the blood. c. They are responsible for the adaptive immune response. Explanation: Refer to pg(s): 533 d. All of the above are accurate.



Question: 8. Which of the following statements about B lymphocytes is accurate? a. A large quantity of antibody is secreted when B cells terminally differentiate into plasma cells Explanation: Refer to pg(s): 534 b. They account for the majority of circulating lymphocytes. c. They produce antibodies. d. All of the above are accurate



Question: 9. The function(s) of macrophages include which of the following? a. Phagocytosis of microorganisms b. Removal of small foreign particles c. Antigen processing and presentation d. All of the above Explanation: Refer to pg(s): 542



Question: 10. Which of the following statements about osteocytes is accurate? a. They originate as monocytes in the blood. Explanation: Refer to pg(s): 540 b. They respond only to mediators released by osteoblasts. c. They are mononuclear cells capable of bone resorption. d. The form a ruffled border away from the bone surface



Question: 11. Which of the following statements about symptomatic apical periodontitis is accurate? a. It is histologically limited to the periodontal ligament. b. It is detectable radiographically. c. It may heal if induced by a noninfectious agent. Explanation: Refer to pg(s): 542 d. All of the above are accurate



Question: 12. Established asymptomatic apical periodontitis is characterized by the predominance of which of the following cells? a. Epithelial cells b. Macrophages c. Macrophages and lymphocytes Explanation: Refer to pg(s): 542 d. T lymphocytes



Question: 13. Apical periodontitis can be caused by which of the following exogenous factors? a. Urate crystals b. Mechanical irritation Explanation: Refer to pg(s): 530 c. Cholesterol crystals d. Tumor necrosis factor



Question: 14. Which of the following is a function of opsonins? a. They present antigen. b. They facilitate phagocytosis. Explanation: Refer to pg(s): 538 c. They kill bacteria. d. They activate the complement system



Question: 15. Which of the following is an example of an extraradicular infection? a. Apical granuloma b. Periapical pocket cyst c. Periapical actinomycosis Explanation: Refer to pg(s): 551 d. Symptomatic apical periodontitis



Question: 16. Apical inflammation is a tissue reaction that manifests by all but which one of the following? a. Tissue damage Explanation: Refer to pg(s): 531 b. Vasodilation c. Increased vascular permeability d. Exudation



Question: 17. Effects of interleukin 1 (IL-1) include all of the following except: a. Stimulation of lymphocytes b. Leukocyte adhesion c. Stimulation of bone formation Explanation: Refer to pg(s): 543 d. Activation of prostaglandin production



Question: 18. Which of the following is an exogenous cause of apical periodontitis? a. microbes b. mechanical irritation c. foreign bodies d. trauma e. all of the above Explanation: Refer to pg(s): 530



Question: 19. Prostaglandins are formed by which of the following? a. Metabolism of arachidonic acid via the lipoxygenase pathway b. The hydrogen peroxide-halide-myeloperoxidase system c. Metabolism of arachidonic acid via the cyclooxygenase pathway Explanation: Refer to pg(s): 538 d. None of the above



Question: 20. There is no correlation between infection and clinical symptoms except in cases of: a. Asymptomatic apical periodontitis b. Acute apical abscess Explanation: Refer to pg(s): 532 c. Chronic apical abscess d. Condensing osteitis



Question: 21. What is the primary nonspecific innate immune defense mechanism? a. Antigen presentation b. Natural killer cells c. Respiratory burst d. Phagocytosis of microbes by polymorphonuclear leukocytes and macrophages Explanation: Refer to pg(s): 533



Question: 22. Adaptive immunity is regulated primarily by what cell type? a. Macrophages b. Multinucleated giant cells c. B and T lymphocytes Explanation: Refer to pg(s): 533 d. Mast cells



Question: 23. Which of the following diagnostic tests most accurately reflects the histologic diagnosis? a. Diagnostic testing results do not correlate to histologic findings. Explanation: Refer to pg(s): 535 b. Cold test c. Percussion d. Electrical pulp testing



Question: 24. What is the function of mast cells? a. Phagocytosis b. Antigen presentation c. Induce vasodilation and increase vascular permeability Explanation: Refer to pg(s): 537 d. Activation of the complement cascade



Question: 25. Which of the following is not a function of platelets? a. Increase vasodilation Explanation: Refer to pg(s): 538 b. Blood clotting c. Hemostasis d. Fibrinolysis



Question: 26. Which of the following is a hallmark of asymptomatic apical periodontitis? a. Pain b. Bone resorption Explanation: Refer to pg(s): 543 c. Cholesterol crystals d. Sinus tract formation



Question: 27. Which of the following is not a theory for apical cyst development? a. Riegler’s theory of cyst formation Explanation: Refer to pg(s): 547 b. The nutritional deficiency theory c. The abscess theory d. The theory of merging epithelial strands



Question: 28. Condensing osteitis is more likely to occur in which of the following? a. In a maxillary molar b. In a patient in his mid-60s c. In a mandibular molar Explanation: Refer to pg(s): 551 d. In a mandibular premolar



Question: 29. Which of the following statements is true? a. Condensing osteitis occurs only with a necrotic pulp. b. Condensing osteitis will usually resolve after successful root canal treatment. Explanation: Refer to pg(s): 551 c. Condensing osteitis is a painful inflammatory condition of the bone. d. Condensing osteitis is easily transmitted from one tooth to an adjacent tooth



Chapter 15: Microbiology and Treatment of Endodontic Infections Question: 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 Explanation: Refer to pg(s): 559



Question: 2. Which of the following statements about the organism that causes pulpal pathosis is correct? a. The organisms are primarily facultative streptococci. b. Single isolates (i.e., monoinfection) produce the severest reactions. c. Isolates tend to be polymicrobial and anaerobic. Explanation: Refer to pg(s): 560 and 565 d. Organisms that infect the pulp tend to be aerobic, unlike organisms that infect the periapex



Question: 3. Which of the following best describes anachoresis? a. The attraction of bloodborne microorganisms to inflamed tissue during a bacteremia Explanation: Refer to pg(s): 561-562 b. The process of carious invasion, cavitation, and exposure of the pulp caused by bacteria c. Seeding of bacteria in the dentinal tubules and pulp into the systemic circulation, inducing disease in other areas of the body d. All of the above



Question: 4. Which of these microorganisms is implicated in apical periodontitis? a. Bacteria Explanation: Refer to pg(s): 559 b. Fungi c. Arachnia d. Viruses



Question: 5. The first recorded observation of bacteria in root canals was made by which of the following? a. Robert Koch b. Antony van Leeuwenhoek Explanation: Refer to pg(s): 560 c. Willoughby Dayton Miller d. Samuel Kakehashi



Question: 6. Which of the following is true? a. Bacteria are found in root canals of teeth with no evidence of apical periodontitis. b. Necrotic pulp tissue itself cannot induce apical periodontitis. Explanation: Refer to pg(s): 560 c. Apical periodontitis can occur only in the permanent dentition. d. Aerobic bacteria account for the majority of organisms found in root canals of teeth showing radiographic evidence of apical periodontitis.



Question: 7. With a vital pulp, dentin tubules represent a significant route of pulpal infection when: a. Dentin permeability is decreased. b. Antibodies are present in the dentinal fluid. c. Dentin thickness is considerably reduced. Explanation: Refer to pg(s): 561 d. A base is placed under a restoration



Question: 8. The point at which bacteria from carious lesions reach the pulp is: a. When there is a frank exposure b. As soon as the caries enter the dentin c. Prior to frank exposure Explanation: Refer to pg(s): 561 d. When there is a “clean” mechanical exposure



Question: 9. When can periodontal disease cause pulpal necrosis? a. Anytime a periodontal probing depth of greater than 6 mm exists b. When calculus is present subgingivally c. When a periodontal pocket reaches the apical foramen Explanation: Refer to pg(s): 561-562 d. After scaling and root planing



Question: 10. Which of the following statements about Ludwig’s angina is accurate? a. It involves the submental, sublingual, and submandibular spaces of the right or left side. Explanation: Refer to pg(s): 593 b. It can progress into the canine and infraorbital spaces. c. It does not cause airway obstruction. d. All of the above are accurate



Question: 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 Explanation: Refer to pg(s): 594



Question: 12. An incision-for-drainage procedure is indicated for which of the following? a. Sinus tract b. Diffuse and indurated swelling Explanation: Refer to pg(s): 590 c. Acute apical periodontitis d. All of the above



Question: 13. Why is an incision and drainage procedure effective for cellulitis? a. It provides a pathway for drainage, preventing spread of infection. b. It provides pain relief. c. It increases circulation to the area and improves delivery of antibiotics. d. All of the above are correct reasons. Explanation: Refer to pg(s): 594



Question: 14. During treatment, which of the following does not cause microbial introduction into the canal? a. Calculus on the crown b. Access with a sterile bur Explanation: Refer to pg(s): 562 c. Leaking rubber dam d. Contaminated endodontic instruments



Question: 15. Microorganisms can enter the root canal system between appointments in each of the following ways except: a. Tooth fracture b. Loss of temporary restoration c. From a site of distant infection Explanation: Refer to pg(s): 562 d. From a tooth left open for drainage



Question: 16. The ability of a microorganism to cause disease is called: a. Virulence b. Symbiosis c. Parasitism d. Pathogenicity Explanation: Refer to pg(s): 562



Question: 17. Most bacteria involved in endodontic infections are considered what kind of pathogen? a. Opportunistic Explanation: Refer to pg(s): 563 b. Primary c. Virulent d. None of the above



Question: 18. “All complex systems can be understood in terms of their individual components” is an example of: a. Holism b. Community evaluation c. Individualism d. Reductionism Explanation: Refer to pg(s): 565



Question: 19. What is “quorum sensing”? a. Cell-to-cell communication that regulates gene expression Explanation: Refer to pg(s): 566 b. The ability of a single organism to form a biofilm c. The rate of growth of a biofilm d. A technique used to identify specific bacterial species



Question: 20. Which of the following statements is false? a. Gram-negative bacteria have been associated with endodontic infections. b. Facultative anaerobic bacteria can grow in the presence or absence of oxygen. c. Obligate anaerobic bacteria lack catalase. d. Cultures of root canals reveal that obligate anaerobes make up approximately 60% of the total bacterial count. Explanation: Refer to pg(s): 560



Question: 21. Which of the following statements is false? a. DNA-DNA hybridization uses DNA probes. b. The polymerase chain reaction (PCR) method involves in vitro replication of DNA. c. A low percentage of anaerobic gram-negative bacteria are found in primary root canal infections. Explanation: Refer to pg(s): 572-573 d. Enterococcus faecalis is the primary microbe in root canals undergoing retreatment.



Question: 22. Which of the following organisms have been detected in periapical lesions? a. Spirochetes b. Human cytomegalovirus (HCMV) c. Epstein-Barr virus (EBV) d. Candida albicans e. All of the above Explanation: Refer to pg(s): 560;570



Question: 23. Which of the following polymerase chain reaction (PCR) techniques is not used to target specific microorganisms? a. Real-time PCR b. Nested PCR c. Multiplex PCR d. Broad-range PCR Explanation: Refer to pg(s): 569



Question: 24. Which of the following is the most sensitive identification method? a. DNA-DNA checkerboard b. Microbial cultivation c. PCR Explanation: Refer to pg(s): 569 d. Scanning electron microscopy (SEM)



Question: 25. The most common form of extraradicular infection is: a. Acute apical abscess Explanation: Refer to pg(s): 584 b. Chronic apical abscess c. Apical cyst d. Apical granuloma



Question: 26. Antibiotics are indicated for which of the following? a. Irreversible pulpitis b. To prevent flare-ups c. After endodontic surgery d. When systemic signs and symptoms are present Explanation: Refer to pg(s): 594



Question: 27. In cases of necrotic pulp, why are antibiotics not effective? a. Host resistance b. Lack of blood supply to the pulp Explanation: Refer to pg(s): 595 c. Presence of multiple bacterial species d. Lack of oxygen



Good Luck Abdullah AlDehaithem



Chapter 16: Regenerative Endodontics Question: 1. Embryonic stem cells are an example of which type of cell? a. Pluripotent b. Totipotent Explanation: Refer to pg(s): 603 c. Unipotent d. Multipotent



Question: 2. Which of the following is not required for pulp tissue regeneration? a. Stem cells b. Scaffold c. Growth factors d. Triple antibiotic paste Explanation: Refer to pg(s): 602



Question: 3. Pulpal mesenchymal stem cells are located in: a. The cell-rich zone of Hohl Explanation: Refer to pg(s): 603 b. The odontoblastic cell layer c. The epithelial rests of Malassez d. Dentin tubules



Question: 4. Which of the following may be a sequela of statin therapy? a. Increase in blood pressure b. Increase in serum cholesterol levels c. Increase in dentin deposition Explanation: Refer to pg(s): 604 d. Decrease in pulp responsiveness



Question: 5. Which of the following is a function of a scaffold? a. Spatial positioning of cells b. Regulation of cell differentiation c. Regulation of cell metabolism d. All of the above Explanation: Refer to pg(s): 605



Question: 6. Revascularization is indicated in which of the following situations? a. A patient presents with a permanent tooth with an incompletely formed apex and is non responsive to pulpal testing. Explanation: Refer to pg(s): 614 b. A patient presents with a necrotic pulp in a primary tooth. c. A patient presents with a permanent tooth with an incompletely formed apex and is responsive to pupal testing. d. A patient presents with a permanent tooth with a completely formed apex and a necrotic pulp



Question: 7. Triple antibiotic paste consists of all of the following except: a. Minocycline b. Penicillin Explanation: Refer to pg(s): 608 c. Ciprofloxacin d. Metronidazole



Question: 8. The appropriate length of time to leave triple antibiotic paste in the canal is: a. 1 week b. 2 weeks c. 2 months d. 3 weeks Explanation: Refer to pg(s): 614



Question: 9. The material of choice to be placed over the blood clot in a revascularization case is which of the following? a. Immediate restorative material b. Calcium hydroxide c. Mineral trioxide aggregate Explanation: Refer to pg(s): 608 d. Glass ionomer



Question: 10. What is the appropriate anesthetic to use during the second appointment in a revascularization case? a. 3% Mepivacaine without vasoconstrictor Explanation: Refer to pg(s): 614 b. 2% Lidocaine with 1:100,000 epinephrine c. 50% Bupivacaine with 1:200,000 epinephrine d. 4% Articaine with 1:100,000 epinephrine



Question: 11. What is the earliest time point that should be considered for recall evaluation of a revascularization case? a. 6 months b. 12 months Explanation: Refer to pg(s): 614 c. 24 months d. 3 months



Chapter 17: The Role of Endodontics After Dental Traumatic Injuries Question: 1. Initial vitality testing of traumatized teeth is most useful for: a. Establishing a baseline for comparison with future testing Explanation: Refer to pg(s): 621 b. Determining whether root canal treatment is indicated c. Determining whether the blood supply to the pulp has been compromised d. Predicting prognosis



Question: 2. A normal periapical radiograph or digital image of a traumatized tooth is useful for: a. Visualizing most root fractures b. Visualizing concussion injuries c. Gathering baseline information Explanation: Refer to pg(s): 621 d. Locating foreign objects



Question: 3. Which of the following statements about crown infraction is accurate? a. It may indicate a luxation injury has occurred. Explanation: Refer to pg(s): 623-624 b. It is rarely seen on transillumination. c. It seldom requires a follow-up examination. d. It frequently requires semirigid splinting



Question: 4. Which of the following statements about uncomplicated crown fracture is accurate? a. It is an indication for a dentin-bonded restoration. b. It requires baseline pulp testing. Explanation: Refer to pg(s): 624 c. It has a questionable long-term prognosis. d. The pulp is always involved



Question: 5. Which of the following statements about complicated crown fractures is accurate? a. Exposure to the oral cavity permits rapid bacterial penetration through the pulp. b. Inflammation is limited to the coronal 2 mm of exposed pulp for the first 24 hours. Explanation: Refer to pg(s): 624 c. A partial pulpectomy is indicated. d. All of the above



Question: 6. Which of the following statements about replacement resorption is accurate? a. It results from direct contact between root, dentin, and bone. Explanation: Refer to pg(s): 640, 647 b. It is managed by surgical exposure and repair with a biocompatible material. c. It results when over 75% of root surface is damaged. d. It occurs frequently in avulsed teeth which have been out of the mouth for less than 60 minutes



Question: 7. Pulp necrosis is most likely to occur after which of the following? a. Horizontal root fracture b. Intrusive luxation Explanation: Refer to pg(s): 637, 639 c. Concussion d. Subluxation



Question: 8. Which of the following is the best source of cold for a thermal sensitivity test? a. A water ice pencil b. A blast of cold air from the air/water syringe c. A carbon dioxide snow stick Explanation: Refer to pg(s): 621 d. All of the above



Question: 9. Which of the following radiographs is not required in cases of traumatic dental injury? a. A straight-on radiograph b. A radiograph made with an increased vertical angulation c. An anterior-posterior skull film Explanation: Refer to pg(s): 622 d. An occlusal radiograph



Question: 10. Which of the following storage media is best to keep an avulsed tooth in for prolonged extraoral periods? a. Hank’s Balanced Salt Solution Explanation: Refer to pg(s): 648 b. Milk c. Saliva d. Water



Question: 11. The most important factor in management of avulsions is: a. Extraoral dry time Explanation: Refer to pg(s): 648 b. Decontamination of the root surface c. Prompt initiation of root canal treatment d. Socket preparation



Question: 12. Which of the following statements about a Cvek pulpotomy is accurate? a. It is performed on a fully developed tooth with a carious exposure. b. Pulp tissue is removed to the level of the canal orifice. c. Sensitivity testing is a critical tool for determining pulpal status. d. Removal of 1 to 2 mm of coronal pulp tissue is followed by an appropriate capping material. Explanation: Refer to pg(s): 627



Question: 13. Which of the following is considered the most important factor for successful vital pulp therapy? a. Incomplete root formation b. Pulp capping material c. Patient age Explanation: Refer to pg(s): 624-25 d. Coronal seal



Question: 14. Which of the following statements about internal root resorption is accurate? a. It is rare in deciduous teeth. b. It is initiated by odontoblasts. c. It is seldom confused with external resorption. d. It is usually asymptomatic. Explanation: Refer to pg(s): 644



Question: 15. Which of the following should be adhered to during vital pulp therapy? a. Pulp dressing b. Treatment of non-inflamed pulp c. Bacteria-tight seal d. All of the above Explanation: Refer to pg(s): 625-626



Question: 16. Which of the following instruments should be used to amputate the pulp in a Cvek pulpotomy? a. A sterile diamond bur in a high-speed handpiece Explanation: Refer to pg(s): 627 b. A sharp spoon excavator c. A large, sterile round bur in a slow-speed handpiece d. Any sharp, sterile instrument is acceptable



Question: 17. Which of the following statements about horizontal root fractures is accurate? a. Pulp necrosis always occurs. b. Root canal treatment is indicated within 7 to 10 days. c. The prognosis is hopeless, and the tooth should be extracted. d. Pulp tissue in the apical segment often remains vital. Explanation: Refer to pg(s): 635



Question: 18. Which of the following is a disadvantage of a “full pulpotomy”? a. Discoloration of coronal tooth structure b. Lack of apical development c. Inability to control bleeding of the pulp stump d. Sensitivity testing is unhelpful Explanation: Refer to pg(s): 629



Question: 19. Pulp regeneration can be considered only if a(n): a. Mature tooth has been avulsed b. Immature permanent tooth with incomplete root development has been avulsed Explanation: Refer to pg(s): 633 c. Deciduous tooth has been avulsed d. Patient is asymptomatic



Question: 20. A young tooth with an immature apex has been avulsed, with a dry time of less than 60 minutes. Placement of the tooth into which of the following has been shown to increase revascularization? a. Aqueous calcium hydroxide b. Penicillin c. Citric acid d. Doxycycline Explanation: Refer to pg(s): 648



Question: 21. A tooth has sustained a horizontal root fracture. Which of the following splinting methods is appropriate? a. Rigid splint for 2 to 4 months b. Semirigid splint for 2 to 4 weeks Explanation: Refer to pg(s): 635 c. No splinting necessary d. Flexible splint with memory for 2 weeks



Question: 22. Which of the following is true of external inflammatory root resorption? a. It is always accompanied by root resorption and resorption of the adjacent bone. Explanation: Refer to pg(s): 639 b. Healing is indicated by reformation of root structure. c. Treatment with intracanal penicillin will halt the process. d. It is a uniform enlargement of the canal space



Question: 23. In the case of avulsion, which of the following is accurate? a. Extraoral dry time is not important as long as the storage medium used is appropriate. b. The tooth should be vigorously scrubbed prior to replantation. c. Systemic antibiotics are indicated until splint removal. Explanation: Refer to pg(s): 650 d. Root canal treatment should be initiated within 3 days.



Chapter 18: Endodontic and Periodontal Interrelationships Question: 1. Which of the following statements regarding the palatogingival groove is correct? a. The incidence of occurrence is highest for the maxillary central incisor. b. Palatogingival grooves extend from the cingulum to the root apex when they occur. c. The developmental radicular grooves are only found on the lingual surface. d. The palatogingival groove is an etiology for periodontal probing defects but does not contribute to endodontic pathosis. e. The incidence ranges from 2% to 9%, with the maxillary lateral incisor being the most common tooth involved. Explanation: Refer to pg(s): 656



Question: 2. The concomitant pulpal and periodontal lesion: a. Consists of two distinct and separate disease processes involving the same tooth Explanation: Refer to pg(s): 661 b. Is characterized by pulp necrosis and the formation of a draining sinus tract through the attachment apparatus c. Is best described as a periodontal lesion that exposes lateral or accessory canals resulting in pulpal inflammation or necrosis d. Is an endodontic and periodontal lesion that coalesce



Question: 3. Which of the following statements regarding the concomitant endodontic periodontic lesion is correct? a. It is the most common form of endodontic-periodontic lesion. b. The two entities have different causative factors. Explanation: Refer to pg(s): 661 c. The periodontic component influences the endodontic inflammatory response. d. The endodontic component must be treated prior to periodontic intervention



Question: 4. Which of the following statements about cervical projections is correct? a. The prevalence ranges from 18% to 45%. Explanation: Refer to pg(s): 662 b. They result from failure of the enamel and cementum to meet at the cemento-enamel junction. c. They are invaginations in teeth that have a palatogingival groove and prevent tissue attachment to the root. d. They are initial calcifications in the periodontium and are a direct result of inflammatory periodontal pathosis



Question: 5. Each of the following is an indication for root resection EXCEPT ONE. Which is this EXCEPTION? a. Vertical root fracture involving the mesial root of a mandibular first molar b. Internal root resorption perforating the mesial root of a mandibular first molar in the cervical area c. Lateral perforation of the distal canal in a mandibular second molar with a C-shaped configuration Explanation: Refer to pg(s): 663 d. Isolated bone loss around the distobuccal root of a first maxillary molar e. A furcation perforation in a mandibular molar



Question: 6. Which of the following statements regarding the treatment of a vital maxillary first molar with isolated vertical bone loss and a 9 mm probing depth associated with the distobuccal root is correct? a. The distobuccal root should be resected, and the pulp stump can be capped with a calcium hydroxide base and amalgam. b. Removal of the distobuccal root can be accomplished prior to endodontic treatment, but root canal treatment should be completed as soon as feasible. c. Ideally the clinician should resect the root prior to performing root canal treatment. d. Root canal treatment should be completed prior to resection of the root. Explanation: Refer to pg(s): 666



Question: 7. Which of the following statements regarding guided tissue regeneration (GTR) is correct? a. The GTR barrier prevents contact of the connective tissue and the osseous walls protecting the clot. Explanation: Refer to pg(s): 668 b. The combined endodontic-periodontic lesion has the most favorable prognosis when a membrane is used. c. The standard of care dictates osseous grafting and membrane placement for osseous defects in root-end surgery cases. d. Bioresorbable membranes eliminate the need for a second surgery for membrane removal but have decreased success rates.



Question: 8. Each of the following statements regarding forced eruption is correct EXCEPT ONE. Which is this EXCEPTION? a. Forced eruption in the presence of inflammation may cause osseous defects to become deeper. b. Esthetics may be compromised by the presence of an immature-appearing tissue following the procedure. c. Extrusions of less than 4 mm are the most successful. d. It is an alternative to surgical crown lengthening. e. Prognosis studies indicate that forced eruption is not a predictable treatment technique. Explanation: Refer to pg(s): 668-669



Question: 9. Which of the following statements best describes retrograde periodontitis? a. Inflammation from the periodontal sulcus migrates apically, causing pulp inflammation and eventually necrosis. Explanation: Refer to pg(s): 656 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 formation of an apical radiolucent lesion characterized by the loss of the lamina dura



Question: 10. Which of the following statements regarding the primary endodontic lesion with secondary periodontic involvement is correct? a. Pulp necrosis occurs initially, and an apical lesion forms. Apical migration of periodontal disease results in communication between the two lesions. b. Treatment consists of performing endodontic treatment, which is followed by 6-month recall examination. If the periodontal component is still present, periodontal treatment is initiated. c. The primary endodontic lesion with secondary periodontic involvement exhibits a poor prognosis when compared to the primary periodontal lesion with secondary endodontic involvement. d. Pulp necrosis occurs, forming a sinus tract through the periodontal ligament that over time permits the accumulation of plaque and calculus on the root. Explanation: Refer to pg(s): 658



Question: 11. Which of the following statements best describes the effect periodontal disease has on the pulp? a. There is a direct correlation between the severity of the periodontal destruction and the percentage of pulps that become necrotic. b. When periodontal disease or the subsequent treatment exposes a lateral or accessory canal, complete necrosis will result. c. Although periodontitis can cause pulp inflammation and necrosis, treatment procedures have little effect on the pulp. d. Periodontal disease that does not expose the apical foramen is unlikely to produce significant damage to the pulp. Explanation: Refer to pg(s): 657



Question: 12. An isolated deep periodontal probing is most indicative of each of the following EXCEPT ONE. Which is this EXCEPTION? a. A vertical root fracture b. A palatogingival groove c. A draining sinus tract d. Occlusal trauma Explanation: Refer to pg(s): 656



Question: 13. In which of the following endodontic-periodontic classifications will the pulp be vital? a. Primary endodontic lesion b. Primary periodontic lesion Explanation: Refer to pg(s): 659 c. Primary endodontic lesion with secondary periodontic involvement d. Primary periodontic lesion with secondary endodontic involvement e. Concomitant endodontic and periodontic lesion



Question: 14. Which of the following is true regarding a forced eruption procedure? a. It is a frequently used treatment method b. It cannot maintain adjacent tooth structures c. It serves as an alternative to the sacrifice of the natural root system Explanation: Refer to pg(s): 667 d. Fractured teeth will not be good candidate for a forced eruption procedure



Question: 15. Which of the following is true for a lateral periodontal cyst? a. The lesion is a form of primary periodontal disease and is lined by keratinized epithelium. b. The lesion is found at the cervical margin of the involved tooth. c. It develops in the proliferation phase of tooth development and manifests in the second and third decades of life. d. It may have an endocrine etiology, since there is a predilection for males. e. The lesion is slow growing and frequently located in the mandibular canine and premolar region. Explanation: Refer to pg(s): 662



Question: 16. A 24-year-old female patient exhibits drainage from the gingival sulcus of her maxillary left central incisor, tooth #9. She relates that 3 years ago, a porcelain-fused-to metal bridge was placed because of congenitally missing lateral incisors. Clinical #9. Additional probing depths are 3 mm or less. Pulp testing reveals that #8 and #11 are responsive to CO 2 snow, but #6 and #9 are not responsive. There is no tenderness to percussion or palpation. Which of the following is the most likely cause of this lesion? R



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a. Vertical root fracture Explanation: Refer to pg(s): 661 b. Palatogingival groove c. Pulp necrosis d. Periodontitis e. Osteogenic sarcoma



Question: 17. This figure shows an example of a: a. Primary endodontic lesion Explanation: Refer to pg(s): 658 b. Primary periodontic lesion c. Primary endodontic lesion with secondary periodontic involvement d. Primary periodontic lesion with secondary endodontic involvement e. Concomitant endodontic and periodontic lesion



Question: 18. A 51-year-old woman seeks evaluation of swelling of the buccal tissue opposite her mandibular right second molar, tooth #31. She relates the swelling comes and goes periodically. She notes that she has had no pain, and that the swelling began yesterday. Clinical examination reveals swelling in the buccal furcation area of tooth #31. Probing depths are 6 mm on the mesial, and there is a 9-mm defect in distal area of tooth #31. Pulp testing with CO 2 snow reveals teeth #28, #29, and #30 respond. Tooth #31 is not responsive. Based on this information what diagnostic classification is most appropriate? R



a. Primary endodontic lesion b. Primary periodontic lesion c. Primary endodontic lesion with secondary periodontic involvement d. Primary periodontic lesion with secondary endodontic involvement Explanation: Refer to pg(s): 660 e. Concomitant endodontic and periodontic lesion



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Question: 19. A 51-year-old woman seeks evaluation of swelling of the buccal tissue opposite her mandibular right second molar, tooth #31. She relates the swelling comes and goes periodically. She notes that she has had no pain, and that the swelling began yesterday. Clinical examination reveals swelling in the buccal furcation area of tooth #31. Probing depths are 6 mm on the mesial, and there is a 9-mm defect in distal area of tooth #31. Pulp testing with CO 2 snow reveals teeth #28, #29, and #30 respond. Tooth #31 is not responsive. Which of the following statements regarding this case is correct? R



a. The prognosis for treating this case is based on the ability to perform root canal treatment. b. The periodontal prognosis is the determining factor for treatment options. Explanation: Refer to pg(s): 660 c. The pattern of bone loss is consistent with endodontic pathosis. d. Osseous regeneration following endodontic treatment is likely to occur. e. Periodontal treatment to include osseous grafting and GTR should be initiated and if successful, root canal treatment can be performed.



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Chapter 19: Endodontic Pharmacology Question: 1. Processing of a painful stimulus involving the trigeminal nerve occurs in the: a. Ganglia b. Medullary dorsal horn c. Cerebellum d. Cerebral cortex Explanation: Refer to pg(s): 671



Question: 2. Which of the following is a nociceptor? a. A-α fiber b. A-β fiber c. A-γ fiber d. A-δ fiber Explanation: Refer to pg(s): 671



Question: 3. Which of the following is true of C fibers? A. There are 3 to 8 times more unmyelinated fibers when compared to A-δ fibers. Explanation: Refer to pg(s): 671 B. They are only considered nociceptors. C. They conduct proprioceptive sensations and touch. D. They are responsible for localization of pain emanating from the dental pulp.



Question: 4. Stimulation and the subsequent propagation of a pin impulse in the trigeminal system: a. Occurs only centrally to the postcentral gyrus of the brain b. Can result in the release of proinflammatory neuropeptides Explanation: Refer to pg(s): 672 c. Raises the pin threshold d. Results in desensitization within the thalamus



Question: 5. Allodynia refers to: a. A noxious stimulus producing an even greater increase in pain intensity b. Pain from a previous non-noxious stimulus Explanation: Refer to pg(s): 672 c. Antidromic nerve conduction d. Vasoconstriction induced by unmyelinated fibers



Question: 6. During inflammation, C fibers innervating the dental pulp: a. Contain increased proinflammatory neuropeptides Explanation: Refer to pg(s): 673 b. Undergo a process of peripheral nerve sprouting c. Exhibit a decrease in TTX-R sodium channels d. Are sensitized to the effects of local anesthetic agents such as lidocaine



Question: 7. Which of the following is true of inflammatory pain of pulpal origin? a. There is a correlation between the histologic condition of the pulp tissue and the degree of pain. b. Inflammatory pain is the result of molecular substances interacting with nociceptors. Explanation: Refer to pg(s): 674 c. Analgesic agents are only effective when acting centrally. d. Endogenous pain modification occurs only within the central nervous system



Question: 8. Painful nociceptive input is received in which portion of the brainstem? a. Subnuclei oralis b. Subnuclei interpolaris c. Subnuclei rostralis d. Subnuclei caudalis Explanation: Refer to pg(s): 674



Question: 9. Convergence of neurons from cutaneous structures and deep structures of the body occurs: a. In the trigeminal ganglion b. Medullary dorsal horn Explanation: Refer to pg(s): 674 c. Through the modulating effects of glial cells d. Cerebral cortex



Question: 10. Which of the following is a sign of hyperalgesia? a. Spontaneous pain b. Reduced pain threshold c. Increased response to pain stimulus d. All of the above Explanation: Refer to pg(s): 674



Question: 11. Perceptual processes of pain are manifest in the: a. Medullary dorsal horn b. Limbic system c. Subnuclei oralis and interpolaris d. Cerebral cortex Explanation: Refer to pg(s): 671-672



Question: 12. Which of the following is true regarding postoperative endodontic pain? a. Preoperative pain is a positive predictor. Explanation: Refer to pg(s): 679 b. The incidence of flare-ups is high and approaches 60%. c. It correlates with the pulpal status: vital versus necrotic. d. Symptoms generally develop 3 to 4 days post treatment



Question: 13. Management of endodontic pain: a. Should be directed toward peripheral mechanisms b. Is best controlled with an antibiotic in conjunction with a centrally acting analgesic c. Is multifactorial Explanation: Refer to pg(s): 679 d. Should place emphasis on centrally acting agents



Question: 14. What is a difference between nonsteroidal analgesic agents (NSAIDs) and acetaminophen? a. Acetaminophen exhibits liver toxicity, and NSAIDs do not. Explanation: Refer to pg(s): 680 b. Acetaminophen is an antiinflammatory with COX-2 inhibition. c. NSAIDs do not exhibit thrombic activity. d. Acetaminophen does not have antipyretic activity



Question: 15. Glucocorticosteriods act by: a. Suppressing migration of polymorphonuclear leukocytes b. Increasing cellular phagocytosis c. Inhibiting arachidonic acid production Explanation: Refer to pg(s): 683 d. Inhibiting sodium channel (Na v ) conduction of nociceptive afferents R



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Question: 16. Since pulp and periradicular pathosis are microbial diseases, which of the following is true regarding antibiotics in managing posttreatment pain? a. Research supports their use correlating with the severity of the pain. b. Overprescribing results in bacterial resistance and sensitization. Explanation: Refer to pg(s): 684 c. Prophylactic administration results in significant reduction in posttreatment pain. d. Penicillin is the antibiotic of choice for endodontic pathosis.



Question: 17. Pain management strategy should include all of the following EXCEPT ONE. Which is this EXCEPTION? a. A clinical focus of removing peripheral causative factors b. Includes pretreatment with NSAIDs c. Involves the use of long-acting local anesthetics for block anesthesia d. Employs intracanal medications Explanation: Refer to pg(s): 685



Chapter 20: Local Anesthesia in Endodontics Question: 1. Which of the following tooth groups is the most difficult to anesthetize? a. Mandibular premolars b. Maxillary premolars c. Maxillary molars d. Mandibular molars Explanation: Refer to pg(s): 712



Question: 2. An intermediate duration anesthetic typically gives ___ minutes of pulpal anesthesia. a. 30 b. 45 c. 60 Explanation: Refer to pg(s): 693 d. 90



Question: 3. Patients with irreversible pulpitis often show increased responsiveness to electric pulp testing (EPT), probably because: a. More sensory nerves respond to the stimulus. b. Elevated prostaglandin levels sensitize tetrodotoxin-resistant voltage-gated sodium channels (VGSCs). Explanation: Refer to pg(s): 692 c. Sodium channels in sensory nerves become less resistant to stimuli. d. The patient’s pain threshold often is higher



Question: 4. A suggested means of determining adequate pulpal anesthesia on the mandible is to: a. Ask the patient if the lip and chin and tongue are numb. b. Stab the anterior gingival with a sharp explorer. c. Begin the access preparation. d. Pulp test with cold or EPT. Explanation: Refer to pg(s): 695 Question: 5. The anesthetic reversal agent, phentolamin e mesylate: a. Shortens the duration of oral soft tissue anesthesia Explanation: Refer to pg(s): 697 b. Shortens the duration of pulpal tissue anesthesia c. Shortens the duration of pulpal and soft tissue anesthesia d. Is most effective if the patient presents in pain



Question: 6. Allergic reactions to amide local anesthetics: a. Might be due to the rubber latex stopper Explanation: Refer to pg(s): 694 b. Have occurred with intradermal injections c. Have been shown to be caused by the amide molecule d. Are more common in patients with pollen allergies



Question: 7. What is the best description of local anesthetic use in pregnant women? a. Articaine should be avoided. b. Vasoconstrictors should not be used. c. They are safe. Explanation: Refer to pg(s): 695 d. Long-acting are preferred. e. Short-acting are preferred



Question: 8. The intraosseous local anesthesia system is used for which one of the following reasons? a. As a supplementary injection Explanation: Refer to pg(s): 705 b. As a modified periodontal ligament injection c. To limit the adverse reactions to vasopressor components of local anesthetic cartridges d. As a method of administering intrapulpal injections painlessly



Question: 9. The effectiveness of topical anesthetics depends primarily on the: a. Duration of contact with the mucosa b. Solubility of the anesthetic molecule c. Pressure of the cotton swab d. Power of suggestion by the dentist Explanation: Refer to pg(s): 696



Question: 10. Compared with the mandible, anesthesia in the maxilla: a. Is more difficult to achieve b. Depends more on the site of anesthetic deposition c. Cannot be obtained with a nerve block d. Has a shorter duration Explanation: Refer to pg(s): 713 e. Is more dependent on the addition of vasoconstrictors



Question: 11. With an IAN block, comparing 2% lidocaine with 1:100,000 epinephrine versus 4% articaine with 1:000,000 epinephrine: a. Both produce similar levels of anesthesia. Explanation: Refer to pg(s): 698 b. Articaine provides a faster onset of anesthesia. c. Articaine is safer (i.e., has fewer side effects). d. Articaine is more effective with irreversible pulpitis



Question: 12. There are three suggested techniques for IAN anesthesia: conventional, Gow-Gates (G-G), and Vazirani-Akinosi (V-A). Studies of effectiveness of pulpal anesthesia show: a. Conventional is superior to G-G and V-A. b. G-G is superior to conventional and G-G. c. V-A is inferior to conventional and G-G. d. Conventional is inferior to G-G and V-A. e. The three techniques are equally effective. Explanation: Refer to pg(s): 699



Question: 13. Supplemental buccal infiltration of articaine following IAN block with lidocaine: a. Does not increase success b. Gives a high rate of success (>80%) c. Is less successful than supplemental intraosseous injection Explanation: Refer to pg(s): 705 d. Is most successful if placed on the lingual



Question: 14. Failure to predictably achieve profound pulpal anesthesia with the inferior alveolar nerve block may be due to: a. Accessory innervation b. Failure to deposit the anesthetic close to the nerve c. Insertion of the needle with the bevel oriented away from the ramus d. Failure of the anesthetic to diffuse throughout the trunk to reach all nerves Explanation: Refer to pg(s): 701



Question: 15. Why are long-acting anesthetics contraindicated for intraosseous injection? a. Possible cardiotoxic effects Explanation: Refer to pg(s): 711 b. Less effective than lidocaine c. Toxicity to alveolar bone d. Excessively long duration of anesthesia



Question: 16. With regard to safety, an intraligamentary injection: a. Often produces a periodontal abscess b. Reduces blood flow to the pulp, resulting in damage to the pulp during cavity preparation c. Creates transient local minor damage to the periodontium Explanation: Refer to pg(s): 707 d. Should not be used in sites with gingivitis



Question: 17. Which of the following is a consideration with intrapulpal injections? a. They are often of short duration. Explanation: Refer to pg(s): 712 b. Backpressure is not required in making the injection. c. They are not painful if administered quickly. d. They tend to have a slow onset of effect. e. They are more effective when special pressure syringes are used



Question: 18. A recommendation to manage postsurgical pain is to: a. Prescribe analgesics and antibiotics. b. Recommend over the counter or prescribe analgesics. Explanation: Refer to pg(s): 713 c. Inject a long-acting anesthetic post-surgery. d. Infiltrate methylprednisolone near the surgical site pre-operatively



Question: 19. In making decisions on local anesthesia, which of the following is the best descriptions? a. There is a significant lack of clinical trials. b. Most recommendations are based on manufacturers’ research. c. This discipline is not applicable to evidence-based research. d. Research findings do not involve randomized, controlled trials. e. Most information is based on quality clinical trials. Explanation: Refer to pg(s): 714



Chapter 21: Periradicular Surgery Question: 1. Which of the following statements regarding periradicular surgery is correct? a. Surgical treatment in typical endodontic practice comprises approximately 20% of procedures performed. b. Oral surgeons, periodontists, and general dentists perform 40% of root-end surgical procedures. c. The goals and objectives of periradicular surgery are similar to nonsurgical root canal treatment. Explanation: Refer to pg(s): 721 d. Periradicular surgery was not a viable treatment technique until the introduction of lidocaine by Nils Lofgren in 1943



Question: 2. Which of the following statements regarding treatment failures is correct? a. The organisms associated with treatment failures are polymicrobial mixed anaerobic organisms with no specific species involved. b. Enterococcus faecalis is a common isolate in cases of failing treatment. Explanation: Refer to pg(s): 721 c. The presence of extraradicular microorganisms are an infrequent occurrence. Treatment failures are the result of leakage. d. Organisms that form biofilms are more easily eliminated by the host defense mechanisms. e. Overfilling with gutta-percha results in toxicity and predictably produces failure



Question: 3. Healing of periradicular lesions secondary to pulp necrosis will be delayed following nonsurgical root canal treatment in patients with: a. Diabetes Explanation: Refer to pg(s): 737 b. Hypertension c. Hemophilia d. Tuberculosis



Question: 4. Which of the following statements regarding nonhealing lesions following nonsurgical root canal treatment is correct? a. Organisms are frequently mixed, and the colonies are polymicrobial. b. Bacteria may exist on the external root surface as a biofilm. Explanation: Refer to pg(s): 721 c. Viruses and yeasts play only a secondary role in persistent pathosis. d. Overextension of obturation materials is the primary etiology for persistent disease



Question: 5. Which of the following statements best reflects the process of wound healing following root-end surgery? a. The phases of healing are inflammatory, proliferative, and maturation. Explanation: Refer to pg(s): 723 b. The incisional blunt dissectional wound heals by secondary intention. c. The early inflammation is characterized by lymphocytes. d. Fibroblasts produce type I collagen in the inflammatory stage and type III collagen in the proliferative stage. e. An epithelial seal develops on the third or fourth day



Question: 6. Which of the following statements is correct regarding epithelial healing? a. Cell mitosis begins in the stratum corneum. b. Epithelial closure precedes angiogenesis. c. Fibrin inhibits cellular migration. d. With healing by primary intention, the epithelial seal occurs in 21 to 28 hours. Explanation: Refer to pg(s): 726



Question: 7. Which of the following statements best describes the reasons for the reported low success rates following root-end surgery? a. The studies cited do not reflect contemporary techniques. Explanation: Refer to pg(s): 723 b. More teeth are being extracted and replaced with implants. c. With the population aging, older patients are being treated when their healing potential is diminished. d. Studies are more sophisticated, and the standards for evaluating success rates have become more stringent.



Question: 8. Which of the following statements best describes osseous regeneration following root-end surgery? a. Lamellar bone formation involves the production of matrix vesicles. b. In woven bone, osteoblasts produce matrix vesicles via exocytosis of their plasma membranes. Explanation: Refer to pg(s): 726 c. The pH decreases with the release of acid phosphatases. d. Filling of the osseous defect occurs after the cortical plate is completely established. e. Deposition of calcified osseous tissue begins at 8 weeks and is 80% complete at 16 weeks.



Question: 9. Which of the following statements best describes cementogenesis following root-end surgery? a. Osseous regeneration must precede cementogenesis. b. Evidence indicates cementocytes develop from osteoprogenitors. c. Migration of precementoblasts is regulated by alkaline phosphatase, with attachment being mediated by pyrophosphate. d. Cementum forms over the resected root end, but attachment of Sharpey’s fibers does not occur. e. Cementum covers the resected root end at approximately 28 days. Explanation: Refer to pg(s): 727



Question: 10. Which of the following statements best describes the reaction to the application of a gauze ice pack immediately after surgery? a. There is a decrease in the number of polymorphonuclear leukocytes present. b. Cytokine release by macrophages is reduced. c. The thickness of the fibrin clot is minimized. Explanation: Refer to pg(s): 724 d. Fibroblast differentiation is diminished, permitting rapid epithelial closure



Question: 11. Each of the following are reasons glucocorticoids induce bone loss EXCEPT ONE. Which is this EXCEPTION? a. There is a decrease in the lifespan of the osteoblast. b. The mineralization rate is reduced. c. Synthesis of osteocalcin and bone-specific alkaline phosphatase is increased. Explanation: Refer to pg(s): 728 d. Osteoclast numbers and activity are increased



Question: 12. Which of the following statements is correct regarding patients requiring periradicular surgery who are on warfarin anticoagulant therapy? a. Patients must discontinue warfarin therapy 2 days prior to surgery to prevent bleeding during and following the procedure. b. Normal therapeutic INR values do not return to normal values for a considerable period of time following cessation of the medication. c. The INR assesses the tissue thromboplastin time and must be assessed the day of surgery. d. Patients who discontinue warfarin therapy are placed at risk for a thromboembolic event. Explanation: Refer to pg(s): 729 e. INR values must be below 2.0 for oral surgical procedures in this patient population



Question: 13. Each of the following statements regarding periradicular surgery involving the mandibular premolars is correct EXCEPT ONE. Which is this EXCEPTION? a. The anterior releasing incision is typically located at the mesial-line angle of the canine. b. The location of the mental foramen varies horizontally but remains constant vertically. Explanation: Refer to pg(s): 730 c. A shallow vestibule usually indicates a thick buccal cortex. d. The mental nerve is encased in a relatively tough sheath and difficult to damage with blunt dissection. e. A periapical film placed parallel and vertically gives the most accurate depiction of apical structures



Question: 14. Which of the following statements regarding bisphosphonates is correct? a. Intravenous bisphosphonates are associated with osteonecrosis of bone. Explanation: Refer to pg(s): 727 b. Periradicular pathosis does not increase the incidence of osteonecrosis in bisphosphonate patients. c. Bisphosphonates induce osteonecrosis by stimulating osteoclasts. d. Discontinuing bisphosphonate therapy 1 month prior to dental treatment is recommended to reduce the risk of osteonecrosis



Question: 15. Root-end surgery involving a mandibular second molar is complicated by each of the following factors EXCEPT ONE. Which is this EXCEPTION? a. The thickness of the buccal cortical bone b. The lingual inclination of the roots c. The buccal location of the mandibular canal d. The increased vascular supply to the area Explanation: Refer to pg(s): 731 e. The variable canal and root anatomy and morphology



Question: 16. Which of the following statements regarding nonsteroidal antiinflammatory drugs (NSAIDs) is correct? a. NSAIDs stimulate osteoblast proliferation and protein synthesis. b. The mineralization rate is increased. c. NSAIDs inhibit the cyclooxygenase enzyme. Explanation: Refer to pg(s): 728 d. Osteoclast numbers and activity are increased



Question: 17. Each of the following statements regarding surgical exposure of the maxillary sinus is correct EXCEPT ONE. Which is this EXCEPTION? a. Exposure of the sinus during periradicular surgery results in delayed healing. Explanation: Refer to pg(s): 731 b. The sinus membrane will regenerate and is more predictable than osseous regeneration. c. Palatal root surgery can be accomplished from the facial using a trans-sinus approach. d. Sinus exposures can result in inoculation of the cavity with infected debris.



Question: 18. Which of the following has been shown to be the most effective as a premedication prior to endodontic surgical intervention in healthy patients? a. Clindamycin b. Penicillin c. Ibuprofen Explanation: Refer to pg(s): 737 d. Acetaminophen with codeine e. Chlorhexidine



Question: 19. Pulse oximetry: a. Is used to monitor blood pressure in surgical cases b. Monitors blood oxygen saturation Explanation: Refer to pg(s): 737 c. Determines the vascular flow rate d. Measures the patient’s respiration rate e. Is used primarily for patients that are undergoing general anesthesia



Question: 20. Low-dose aspirin therapy: a. Should be discontinued prior to surgical procedures b. Is a subclinical dose and does not affect the bleeding time c. Increases the vascular flow rate d. Increases bleeding and can be assessed on the day of surgery by the INR level e. May increase bleeding time, and herbs, dietary supplements, and vitamins may be synergistic Explanation: Refer to pg(s): 729-730



Question: 21. Which of the following statements regarding the use of vasoconstrictors in root-end surgery is correct? a. Except for severe cardiac patients, two to three cartridges of anesthetic with 1:100,000 epinephrine should be safe. Explanation: Refer to pg(s): 728 b. Vasoconstrictors are optional, and surgical procedures can usually be performed without their use. c. Only refractory arrhythmias are a contraindication. d. The maximum dosage is determined by the patient’s INR level if they are on anticoagulants



Question: 22. Which of the following statements regarding the submarginal flap is correct? a. A minimum of 2 mm of attached gingiva is required. Explanation: Refer to pg(s): 741 b. This horizontal incision will reduce scar formation, because the incision parallels the vasculature. c. It is made in the alveolar mucosa, so hemorrhage is a disadvantage. d. The most common location for using this incision is the mandibular incisor region. e. The periosteum is not incised and will not be reflected with the flap



Question: 23. Which of the following statements regarding the intrasulcular flap is correct? a. The initial reflection should be in a horizontal direction beginning in the vertical releasing incision. Explanation: Refer to pg(s): 742 b. Reflection of this full-thickness mucoperiosteal flap is accomplished by using a coronal-to-apical approach beginning in the sulcus. c. Two millimeters of keratinized gingival tissues are required. d. Reflection of the complete papilla should be accomplished to reduce the potential for attachment loss and recession



Question: 24. Which of the following statements regarding patients taking ginkgo is correct? a. The partial thromboplastin time will be increased. b. Prothrombin is not converted to thrombin properly. c. Liver function is depressed. d. The bleeding time may be increased. Explanation: Refer to pg(s): 730



Question: 25. Which of the following statements regarding apical curettage is correct? a. Complete removal of the lesion is required for the reparative process. b. It is always accomplished after preparation of the osseous window and resection of the root-end. c. Histologically, the tissue associated with the apex is inflammatory and does not require histopathologic examination. d. The inflammatory periradicular lesion is similar to healing granulation tissue, and removal is not as critical to success as eliminating the etiology. Explanation: Refer to pg(s): 745



Question: 26. Which of the following statements regarding localized hemostasis is correct? a. Collagen-based materials may act by stimulating platelet adhesion and aggregation. Explanation: Refer to pg(s): 745 b. Surgicel stimulates the clotting cascade because of its basic pH. c. Gelfoam stimulates the extrinsic clotting pathway and platelet aggregation. d. Calcium sulfate inhibits bone formation and delays healing until it can be resorbed. e. Ferric sulfate has a high pH that stimulates alkaline phosphatase and bone formation



Question: 27. Each of the following factors influences the amount of root resection EXCEPT ONE. Which is this EXCEPTION? a. Presence of a fenestration b. Presence of accessory canals in the apical 3 mm c. Presence of a root dehiscence Explanation: Refer to pg(s): 747-748 d. Proximity to the mental foramen or inferior alveolar nerve e. Convenience



Question: 28. Angled root resection: a. Increases the number of tubules that communicate with the external surface Explanation: Refer to pg(s): 748 b. Reduces the potential for apical microfractures by evenly distributing the forces during root-end preparation c. Is required for visual inspection of the root end d. Should be made with the handpiece moving across the root face in the opposite direction of the bur rotation



Question: 29. Each of the following statements regarding root-end surface conditioning is correct EXCEPT ONE. Which is this EXCEPTION? a. Fibroblast attachment is enhancement. b. Citric acid exposes and denatures the collagenous matrix of dentin. c. Solutions with a low pH may damage adjacent vital tissue. d. Extended applications of citric acid may discourage alveolar bone growth. e. Citric acid is preferred for demineralization because of its neutral pH. Explanation: Refer to pg(s): 749



Question: 30. Which of the following statements regarding root-end preparation is correct? a. Coated ultrasonic tips with diamonds or zirconium nitride produce less smear layer when compared to stainless steel tips. b. Root-end fractures with ultrasonics are the result of heat generation and subsequent sudden expansion of dentin. c. Root-end preparations with the microhandpiece are generally deeper than ultrasonic preparation; however, they produce a significant smear layer. d. Ultrasonic preparation with a high power setting is recommended to kill bacteria through cavitation and for smear layer removal. e. Clinical and cadaver studies do not support the concept that root fractures occur with ultrasonic preparation. Explanation: Refer to pg(s): 751



Question: 31. Mineral trioxide aggregate has been advocated as a root-end filling material because: a. Of its induction of cementoblastic cells to produce cementum immediately adjacent to the material Explanation: Refer to pg(s): 755 b. The initial low pH activates alkaline phosphatases inducing bone formation c. The bonding to dentin reduces leakage, and the material is biocompatible d. It is easily placed, and contamination with fluids such as blood will not effect the setting



Question: 32. In closing the surgical site: a. The free end of the flap should be connected to the attached tissues. Explanation: Refer to pg(s): 756 b. A continuous suture is advocated so uniform tension can be applied to the tissues. c. The knot should be positioned directly over the incision line to insure complete adaptation. d. Resorbable sutures are recommended over synthetic nonresorbable materials, because they do not promote bacterial growth. e. Synthetic nonresorbable sutures should be covered with cyanoacrylate and fibrin glues to seal the incision line



Question: 33. Guided tissue regeneration would be beneficial during root-end surgery in each of the following situations EXCEPT ONE. Which is this EXCEPTION? a. Through-and-through bone defects involving the lateral maxillary incisors b. Buccal apicomarginal type defects c. Large periradicular defects d. When an apical osteotomy is made through the buccal cortical bone to locate the root Explanation: Refer to pg(s): 760 e. When a bone graft is used



Question: 34. In determining the position of the mandibular canal in relation to the mesial root of a mandibular first molar, you expose a second preoperative radiograph from the a 20-degree inferior (negative) angulation. Which of the following statements is correct? a. The mandibular canal is positioned lingually if the distance from the root tips to the canal increases. Explanation: Refer to pg(s): 731 b. The mandibular canal is positioned buccally if the distance from the root tips to the canal increases. c. A distal angulation should have been obtained. d. A mesial angulation should have been obtained.



Question: 35. Cone-beam volumetric tomography in patient evaluation: a. Provides improved resolution over traditional film and digital images b. Does not provide adequate area for clinical surgical assessment c. Provides data useful in treatment planning but is not as accurate as film in assessing the outcome of treatment d. Provides a three-dimensional image Explanation: Refer to pg(s): 732



Question: 36. Collagen acts as a hemostatic agent by each of the following EXCEPT ONE. Which is this EXCEPTION? a. Stimulation of platelet adhesion b. Platelet aggregation c. Activation of the Hageman factor d. Mechanical tamponade e. Activation of the von Willebrand factor Explanation: Refer to pg(s): 745



Question: 37. Which of the following statements regarding ferric sulfate is correct? a. It is a substitute bone-grafting material that does not alter osseous regeneration. b. It is a necrotizing agent with a low pH. Explanation: Refer to pg(s): 746 c. It activates the intrinsic coagulation pathway. d. It is gelatin based and resorbable when left in the osseous crypt



Question: 38. Which of the following statements regarding bone wax is correct? a. It produces a foreign body reaction when left in the osseous crypt. Explanation: Refer to pg(s): 746 b. It is composed primarily of isopropyl palmitate and oxycellulose. c. It is indicated for hemostasis in large lesions. d. It activates both the intrinsic and extrinsic coagulation pathways



Question: 39. Which of the following statements regarding Super-EBA is correct? a. It is osteoinductive. b. Compared to intermediate restorative material (IRM), it has less eugenol. Explanation: Refer to pg(s): 753 c. Aqueous polymeric acids replace the eugenol found in IRM. d. It bonds to dentin, owing to the presence of polyacrylic acid and aluminosilicate. e. Its advantage over IRM is that it can be light cured



Question: 40. Which of the following statements regarding intentional replantation is correct? a. Elevators can be used, but extraction forceps should not contact the root surface during removal of the tooth. b. A splint is necessary for several weeks to stabilize the replanted tooth. c. The procedure is often indicated for mandibular molars with a thick cortical plate. Explanation: Refer to pg(s): 762 d. Root-end resection is not indicated prior to placing a root-end filling



Question: 41. Which of the following statements regarding postoperative surgical care is correct? a. Pain frequently is moderate to severe and lasts for several days. b. Sutures should be removed at 7 days. c. Antibiotic administration is indicated. d. NSAIDs should be given immediately after surgery and continued postoperatively for several days as necessary. Explanation: Refer to pg(s): 766



Question: 42. The initial step for controlling postoperative bleeding is: a. Apply pressure for 20 to 30 minutes. Explanation: Refer to pg(s): 767 b. Administer a local anesthetic with 1:50,000 epinephrine. c. Reflect a flap and cauterize the involved vessel or vessels. d. Reflect a flap and pack the osseous crypt with calcium sulfate



Chapter 22: Restoration of the Endodontically Treated Tooth Question: 1. Which of the following statements is accurate with regard to the density of dentinal tubules (per mm2)? P



P



a. Density remains constant with progression from the periphery to the pulpal dentin junction, with a decrease in diameter. b. Density remains constant with progression from the periphery to the pulpal dentin junction, with an increase in diameter. c. Density decreases with progression from the periphery to the pulpal dentin junction, with no change in diameter. d. Density increases with progression from the periphery to the pulpal dentin junction, with an increase in diameter. Explanation: Refer to pg(s): 778 e. Density increases with progression from the periphery to the pulpal dentin junction, with no no change in diameter.



Question: 2. Which of the following may be the main cause of decrease in tooth strength after root canal treatment? a. There are changes in the collagen cross-linking in dentin. b. Nonvital dentin is more brittle. c. Decrease in tooth strength is related to dentin aging. Explanation: Refer to pg(s): 778 d. Decrease in tooth strength is related to decreased moisture content in dentin



Question: 3. Desirable characteristics of core materials include: a. High compression and flexural strength b. Ease of manipulation c. Short setting time d. Dimensional stability e. All of the above Explanation: Refer to pg(s): 784



Question: 4. All of the following EXCEPT ONE are concerns in the restoration of an endodontically treated molar with minimal remaining tooth structure. Which is the EXCEPTION? a. Increased chance of root fracture b. Greater potential for recurrent caries c. Violation of the biologic width d. Altered light refraction Explanation: Refer to pg(s): 788



Question: 5. A tooth requires a post, core, and crown for adequate restorative treatment. Which of the following is the most important factor in the restorative equation? a. Post length b. Post width c. Surface configuration of the post d. Core material e. Adequate ferrule Explanation: Refer to pg(s): 781



Question: 6. Posts should provide all of the following clinical features EXCEPT ONE. Which one is NOT appropriate? a. Maximal protection of the root from fracture b. Maximal retention of the core and crown c. Maximal width for post retention Explanation: Refer to pg(s): 782 d. High radiopacity



Question: 7. Which of the following is NOT a requirement for a crown and crown preparation? a. The ferrule must be at least 2 to 3 mm. b. The axial walls must demonstrate a 10-degree taper. Explanation: Refer to pg(s): 781 c. The margin must be on solid tooth structure. d. The crown and crown preparation must not impinge on the biologic width.



Question: 8. Which of the following is a concern regarding the use of threaded posts? a. Threaded posts are passive posts. b. Threaded posts increase root strength. c. Threaded posts provide better retention. d. Threaded posts increase the risk of vertical root fracture. Explanation: Refer to pg(s): 784



Question: 9. Desirable properties of a core include which of the following? a. High compressive strength b. Dimensional stability c. Ease of manipulation d. Short setting time e. All of the above Explanation: Refer to pg(s): 784



Question: 10. Which of the following statements is false? a. The ferrule is a band that encircles the external dimensions of the remaining tooth structure. b. The ferrule should rest on 2 to 3 mm of sound tooth structure. c. A longer ferrule increases fracture resistance. d. The ferrule walls do not necessarily have to be parallel. Explanation: Refer to pg(s): 781



Question: 11. In which of the following situations is a post required? a. Remaining dentin walls provide at least 3 to 4 mm height (from pulpal chamber floor). b. Remaining dentin walls are a minimum of 1 to 2 mm thick. c. Remaining dentin walls are less than 1 mm thick on more than three-fourths of the tooth circumference. Explanation: Refer to pg(s): 792 d. Both marginal ridges (posterior tooth) are intact



Question: 12. A patient requires a post, core, and crown for restoration of tooth #24. Which of the following would strengthen the fragile root? a. Light-transmitting post and bonded composite Explanation: Refer to pg(s): 784 b. Cast post c. Prefabricated stainless steel post d. Zirconia post



Question: 13. Following intracoronal bleaching (nonvital bleaching), when is it appropriate to restore an anterior tooth with a composite restoration? a. Immediately after bleach removal b. A minimum of 1 to 2 weeks after bleach removal Explanation: Refer to pg(s): 794 c. An anterior tooth should never be restored with a composite resin after internal bleaching d. 24 hours after bleach removal



Good Luck Abdullah AlDehaithem



Chapter 23: Pediatric Endodontics: Endodontic Treatment for the Primary, Young, and Permanent Dentition Question: 1. Which of the following is the basic morphologic difference between primary and permanent teeth? a. The dentin between the pulp and the enamel is thicker in primary teeth. b. Enamel is thicker in primary teeth. c. The pulp chamber is comparatively smaller in primary teeth. d. The pulp horns are higher in primary molars. Explanation: Refer to pg(s): 813



Question: 2. Radiographically, which of the following statements about primary teeth is accurate? a. Pathologic changes in the periradicular tissues are most often observed at the apices of molars. b. Calcified masses in the pulp indicate acute pulpal disease. c. By the time internal resorption is visible radiographically, the only treatment is extraction. Explanation: Refer to pg(s): 819 d. Pathologic bone and root resorption are always indicative of nonvital pulp



Question: 3. Which of the following diagnostic tests is usually reliable for determining the pulpal status of primary teeth? a. Thermal pulp test b. Electric pulp test c. Percussion d. None are reliable in children. Explanation: Refer to pg(s): 820



Question: 4. Which of the following statements about indirect pulp therapy is accurate? a. It is indicated only in the treatment of teeth with deep carious lesions in which there is no clinical evidence of pulpal degeneration or periapical pathosis. b. It removes many of the bacteria present in dentin. c. It involves placing calcium hydroxide or zinc oxide eugenol (ZOE) over the remaining caries and permanently restoring the tooth with amalgam. d. All of the above are accurate. Explanation: Refer to pg(s): 821-822



Question: 5. Direct pulp capping is recommended for primary teeth with which of the following? a. Carious exposures b. Mechanical exposures Explanation: Refer to pg(s): 822 c. Calcification of the pulp chamber d. All of the above



Question: 6. Symptoms of pulp abnormalities in primary teeth include which of the following? a. Pain with percussion b. History of spontaneous pain c. Variations in mobility d. All of the above Explanation: Refer to pg(s): 817-818



Question: 7. A calcium hydroxide pulpotomy performed on a young, permanent tooth is judged to be successful when the: a. Patient is asymptomatic b. Tooth responds to pulp testing c. Normal root development continues Explanation: Refer to pg(s): 845 d. All of the above



Question: 8. With respect to “dentin bridge formation,” which of the following is accurate? a. Calcium hydroxide hardens, and new dentin is laid down below it. b. Calium ions from a calcium hydroxide pulp cap are responsible for dentin bridge formation. c. Calcium hydroxide promotes bridge formation by creating a low-grade irritation in the underlying pulpal tissue. Explanation: Refer to pg(s): 812 d. All forms of calcium hydroxide produce identical results when used as a direct pulp cap



Question: 9. When comparing primary and permanent teeth, there are several basic differences. Which of the following is NOT true? a. Primary teeth are smaller in all dimensions than permanent teeth. b. Pulp chambers in primary teeth are comparatively smaller than in permanent teeth. Explanation: Refer to pg(s): 813 c. Primary teeth are markedly more constricted at the DEJ than permanent teeth. d. The roots of primary molars are comparatively more slender and longer than the roots of permanent molars.



Question: 10. Which of the following is an increasingly popular technique for pulpotomy in primary teeth? a. Formocresol b. Calcium hydroxide c. Electrosurgery Explanation: Refer to pg(s): 831 d. Laser surgery



Question: 11. Why may glutaraldehyde be preferred over formocresol for primary pulpotomy? a. It shows less systemic distribution beyond the pulp. Explanation: Refer to pg(s): 827 b. It has a better prognosis. c. It is not antigenic. d. It is less readily metabolized



Question: 12. Which of the following is an indication for root canal treatment on primary teeth? a. Radiographic evidence of internal root resorption b. Periapical lesion Explanation: Refer to pg(s): 833 c. Dentigerous cyst d. Mechanical or carious perforation of the chamber floor



Question: 13. Which of the following statements about access openings on primary incisors is accurate? a. They are made from the facial surface. b. They are made from the lingual surface. Explanation: Refer to pg(s): 833 c. They are made from the incisal edge. d. They are made differently for maxillary and mandibular teeth



Question: 14. Which of the following is true regarding the placement of zinc oxide eugenol in a primary tooth? a. Technique is not important. b. An overfill has a poorer prognosis that a flush fill. c. The paste should be mixed to a thick consistency. d. All of the above are true. Explanation: Refer to pg(s): 836



Question: 15. Which of the following statements about reactionary dentin is accurate? a. It is formed throughout life as part of the normal aging process. b. It is also called secondary dentin. c. As the depth of the remaining dentin decreases below 0.5 mm, the quality of reactionary dentin decreases. Explanation: Refer to pg(s): 811 d. Excessive drying during operative procedures does not affect reactionary dentin.



Question: 16. Which of the following statements about primary root formation is correct? a. Root length is completed upon eruption. b. Root length is completed faster in permanent teeth. c. Root length completion depends on available calcium. d. Root length may be complete 2 years after eruption. Explanation: Refer to pg(s): 814



Question: 17. Which of the following statements about pulp caps is correct? a. Mineral trioxide aggregate (MTA) causes a zone of necrosis. b. Formocresol induces dentin bridge formation. c. MTA is dentinogenic and cementogenic. Explanation: Refer to pg(s): 830 d. Direct pulp capping is indicated for carious exposures in primary teeth



Question: 18. Which of the following statements is accurate with regard to restoration of an immature root after immediate apical barrier technique? a. After MTA placement, the root should be obturated immediately with gutta-percha. b. For barrier formation, 1 to 2 mm of MTA is adequate. c. Amalgam should be placed for barrier formation and then used to fill the canal. d. Composite resin should be bonded to the canal walls to the depth of the MTA to strengthen the roots. Explanation: Refer to pg(s): 851



Question: 19. Which of the following statements about MTA is accurate? a. Setting time is decreased in a dry field. b. It requires moisture to set. Explanation: Refer to pg(s): 851 c. Placement as an apical barrier is technically simple. d. A hard set requires 1 to 2 days



Question: 20. Calcific masses in primary teeth are: a. Always associated with pulpal inflammation Explanation: Refer to pg(s): 819 b. A result of normal aging c. Considered secondary dentin d. Required to be removed before direct pulp capping



Question: 21. In both primary and young permanent teeth, spontaneous and provoked pain which is lingering is usually associated with what? a. Irreversible pulpitis Explanation: Refer to pg(s): 817 b. Reversible pulpitis c. Acute apical abscess d. Pulp necrosis



Question: 22. Pathologic changes in the periapical tissues associated with primary molars are most often apparent: a. At the root apex b. In the bifurcation or trifurcation Explanation: Refer to pg(s): 819 c. On the lateral root surface at the level of the CEJ d. At the apical area of the developing permanent tooth



Question: 23. Following trauma in primary teeth, which of the following is true? a. Yellow discoloration indicates pulp necrosis. b. Dark grey discoloration is typically transient. c. Pulp necrosis occurs in approximately 80% of cases. d. Dark grey discoloration usually indicates pulp necrosis. Explanation: Refer to pg(s): 821



Question: 24. Which of the following is the proper restorative treatment after indirect pulp therapy in a primary tooth? a. Amalgam b. Porcelain fused to metal crown c. Bonded restoration or stainless steel crown Explanation: Refer to pg(s): 822 d. Indirect pulp therapy is not indicated in primary teeth



Question: 25. In which of the following circumstances is a direct pulp cap indicated in primary teeth? a. With a small mechanical or traumatic exposure Explanation: Refer to pg(s): 822 b. With a minimal carious exposure c. In teeth which are minimally symptomatic d. In teeth with a necrotic pulp



Question: 26. What is apexogenesis? a. A procedure used to create an artificial barrier at the root end b. A procedure in which necrotic pulp tissue is removed to the level of the canal orifice c. A procedure designed to preserve vital pulp tissue to allow for complete root formation Explanation: Refer to pg(s): 845 d. A procedure indicated only in teeth with completely formed roots



Question: 27. Which of the following is not a contraindication for pulpectomy in the primary dentition? a. A restorable tooth Explanation: Refer to pg(s): 833 b. The presence of a dentigerous or follicular cyst c. Internal resorption of the roots visible radiographically d. Teeth with carious or mechanical perforation of the pulpal floor



Chapter 24: Effects of Age and Systemic Health on Endodontics Question: 1. Compared with other age groups, older patients generally visit the dentist: a. More often Explanation: Refer to pg(s): 858 b. Less often c. About as often d. Unknown; no survey data are available



Question: 2. Which of the following statements is accurate with regard to secondary dentin formation in the radicular pulp in an older patient? a. It is less likely to occur in response to abrasion than in younger patients. b. It may result in complete pulp obliteration. Explanation: Refer to pg(s): 863 c. It may compromise the blood supply and cause pulp necrosis. d. It does not require an irritant



Question: 3. Which of the following statements is accurate with regard to pulpal inflammation from caries in older patients compared with younger ones? a. It is less likely to be as painful. Explanation: Refer to pg(s): 861 b. It usually progresses more slowly. c. It is less likely to occur. d. It is more likely to be acute than chronic



Question: 4. Why do pulps in older patients tend to be less responsive to thermal stimuli? a. Sensory nerves in dentin degenerate with time. b. Sensory nerves in pulp lose their myelin sheath as a result of long-term, repeated injury. c. With age, patients become less alert and therefore less responsive to external stimuli. d. Pulpal calcifications block external stimuli, preventing them from reaching receptors. e. Pulps tend to have less sensory innervation in older teeth. Explanation: Refer to pg(s): 867, 869



Question: 5. What should be taken into consideration when dealing with older patients? a. They tend to be less likely to report symptoms. Explanation: Refer to pg(s): 861 b. They are more likely to report symptoms. c. They report similarly to younger patients. d. There is no definite pattern, so all reporting should be in writing.



Question: 6. In older patients (compared with younger ones), the exit of the canal (i.e., the apical foramen) is: a. Closer to the radiographic apex b. Closer to the true apex c. Easier to detect tactilely d. More variable because of cementum formation Explanation: Refer to pg(s): 870



Question: 7. Which of the following statements about single-visit root canal treatment in an older patient is accurate? a. It should be avoided because the patient is more likely to have greater postappointment pain. b. It should be avoided because it diminishes a successful prognosis. c. It is acceptable if it is more convenient for the patient. Explanation: Refer to pg(s): 875, 870 d. It should be avoided, and an intracanal medicament should be placed between appointments



Question: 8. The outcome of root canal treatment in older patients, compared with younger ones, is: a. Better b. Poorer c. Equivalent Explanation: Refer to pg(s): 860 d. Unknown (has not been investigated)



Question: 9. Compared with extraction, root canal treatment in older patients is: a. Usually more emotionally traumatic b. Usually more tissue traumatic c. Often less expensive in the long run Explanation: Refer to pg(s): 860 d. More likely to result in postappointment complications



Question: 10. Following surgery, which is a postoperative condition that tends to occur more often in older patients? a. Ecchymosis (i.e., discoloration) of soft tissues Explanation: Refer to pg(s): 883 b. Infection of the surgical site c. Loss of sutures because tissues are more friable d. Continued hemorrhage at the incision site e. Loss of consciousness



Question: 11. Which of the following is an accurate statement concerning quality, comprehensive care to older patients? a. They usually do not desire root canal treatment b. They cannot afford this care. c. They usually do not have third-party coverage. d. Social issues are a modivator Explanation: Refer to pg(s): 860



Question: 12. What often occurs with lateral canals in the teeth of older patients? a. They enlarge because of resorption. b. They occlude because of pulp stones. c. They become more vascular. d. They may calcify. Explanation: Refer to pg(s): 864



Question: 13. In older patients, arteriosclerosis of the dental pulp: a. Precedes the condition in coronary vessels b. Will often occlude venules c. May totally block circulation d. Does not occur Explanation: Refer to pg(s): 867



Question: 14. Which of the following is an accurate statement regarding the success and failures of endodontic treatment in older patients? a. The bone of older patients is more mineralized than that of younger patients. b. Overlooked canals are seldom a problem, because they usually are calcified. c. Altered viscosity of connective tissue makes repair more difficult. Explanation: Refer to pg(s): 882 d. Cold sensitivity is the usual symptom that indicates a missed canal



Question: 15. Which of the following statements about endodontic surgery in older patients is accurate? a. It requires more anesthetic and vasoconstrictor than in younger patients. b. It may be somewhat easier because the vestibule is deeper. Explanation: Refer to pg(s): 882 c. It is risky because inadequate blood supply may result in postoperative osteomyelitis. d. It has been shown to be much less successful than in younger patients



Question: 16. In patients with pacemakers, electric pulp testing: a. Has been shown to accelerate the pacemaker b. Has been shown to temporarily inhibit the pacemaker rhythm c. Is not recommended, although no adverse effects have yet been demonstrated Explanation: Refer to pg(s): 867 d. Is recommended; the benefits outweigh the risks



Question: 17. Overall, what is the most limiting aspect of root canal treatment in older patients? a. Obtaining adequate anesthesia b. Enlarging canals because of more calcified dentin c. Accessing (locating) canals Explanation: Refer to pg(s): 875 d. Identifying the location of the apical foramen e. Locating the chamber



Question: 18. The incidence of diabetes tends to increase with advancing age. Which of the following is a consideration when performing endodontic procedures in diabetic patients? a. They must be premedicated with antibiotics. b. The chance of success is lessened if a preoperative periradicular lesion is present. Explanation: Refer to pg(s): 865 c. The likelihood of severe postoperative pain is greater. d. These patients are more difficult to anesthetize. e. These patients tend to have increased tertiary dentin



Question: 19. A good choice for intraosseous anesthesia on older patients with cardiac or other medical conditions is: a. 2% Lidocaine with 1:100,000 epinephrine b. Lidocaine with 1:50,000 epinephrine c. 3% Mepivacaine Explanation: Refer to pg(s): 875 d. 4% Articaine with 1:200,000 epinephrine



Question: 20. Many older patients undergo continuous anticoagulant therapy. Generally, for endodontic surgery, anticoagulant dosages should be: a. Increased before surgery and returned to the usual dosage after surgery b. Reduced before surgery and returned to the usual dosage after surgery c. Increased before surgery, reduced after surgery, and eventually returned to normal d. Reduced before surgery, increased after surgery, and eventually returned to normal e. Left unchanged Explanation: Refer to pg(s): 882



Question: 21. After root canal treatment on a posterior tooth with periradicular pathosis, placement of the permanent restoration: a. Should be done as soon as possible Explanation: Refer to pg(s): 882-883 b. Should be delayed for at least 6 months so that healing can be assessed c. Should always be done using a full cast crown d. Ideally should be done with a stainless steel crown to reduce the cost e. Unchanged



Chapter 25: Non-Surgical Retreatment Question: 1. Which of the following is not a category of described etiologic factors for posttreatment disease? a. Persistent or reintroduced intraradicular microorganisms b. Extraradicular infection c. Foreign-body reaction d. True cysts e. Morphologic aberration Explanation: Refer to pg(s): 891



Question: 2. Which of the following statements regarding nonsurgical retreatment is correct? a. Coronal leakage is a common etiology for failure. Explanation: Refer to pg(s): 890 b. Procedural complications are commonly corrected by retreatment procedures. c. Posttreatment disease usually takes years to identify. d. Histologically, nonhealing lesions can usually be classified as true cysts



Question: 3. Which of the following statements regarding failing nonsurgical root canal treatment is correct ? a. Any organisms present result from coronal leakage. b. The organisms are predominantly polymicrobial and anaerobic in cases where the apical third of the canal is not obturated. Explanation: Refer to pg(s): 892 c. Most failures can be attributed to fungi. d. Damage created by procedural errors is the primary reason for failure



Question: 4. Bitewing radiographs are beneficial in determining: a. Cracked teeth b. The etiology of sinus tracts c. Missed canals d. The periodontal crestal bone height Explanation: Refer to pg(s): 894



Question: 5. Which of the following statements regarding treatment planning of this previously endodontically treated mandibular first molar exhibiting clinically evident recurrent caries and coronal leakage is correct? a. Nonsurgical retreatment is cost effective and preferred. Explanation: Refer to pg(s): 890 b. Extraction and fabrication of a fixed partial denture should be performed. c. Extraction and replacement with an implant is the best treatment option. d. The tooth should be restored with a post, core, and crown. e. Surgical treatment to include a root-end filling



Question: 6. Which of the following is a cause of posttreatment disease? a. True cysts b. Foreign-body reaction c. Intraradicular microorganisms d. Extraradicular infections e. All of the above Explanation: Refer to pg(s): 891



Question: 7. Which of the following statements regarding the decision to perform nonsurgical retreatment or root-end surgery is correct? a. If the etiology is due to ledge formation, surgical treatment is the only method of eliminating the etiology. b. Nonsurgical retreatment performed prior to surgery can enhance success. Explanation: Refer to pg(s): 898 c. Previously treated surgical cases should not be retreated. d. Surgical treatment is preferred so etiologies such as vertical root fractures can be determined.



Question: 8. Coronal access in nonsurgical retreatment: a. Is complicated by loss of original tooth structure and misrepresentation of anatomy Explanation: Refer to pg(s): 999 c. Can routinely be accomplished, since the procedure has already been performed once c. Is accomplished after removing all the existing definitive restorative materials d. Requires internal landmarks be evident for successful canal location



Question: 9. The degree of difficulty in post removal in retreatment is influenced most significantly by: a. The material used for the post b. The cementing medium Explanation: Refer to pg(s): 902 c. The cross-sectional configuration d. Adequate coronal access



Question: 10. A potential problem of using ultrasonics for removal of objects from the canal includes all of the following EXCEPT ONE. Which is this EXCEPTION? a. Excessive heat generation with damage to the periodontium b. Extrusion of canal contents through the apical foramen c. Shock waves set up by the oscillation of the instrument tip Explanation: Refer to pg(s): 903 d. Excessive removal of internal tooth structure



Question: 11. Of the following, the most frequent reason for endodontic post treatment disease requiring retreatment is: a. Inadequate cleaning and shaping of the canals b. Inadequate obturation c. A poor apical seal and percolation of fluids d. Coronal bacterial microleakage e. All of the above Explanation: Refer to pg(s): 890



Question: 12. Comparing rotary with hand instruments to remove gutta-percha and sealer: a. Rotary instruments are slower. b. The two techniques are similar as to canal cleanliness. Explanation: Refer to pg(s): 914 c. Rotary instrumentation results in better cleanliness. d. Rotary instruments are more likely to extrude materials out the apex



Question: 13. The most popular solvent used to dissolve gutta-percha is: a. Xylene b. Halothane c. Chloroform Explanation: Refer to pg(s): 911 d. Eucalyptol



Question: 14. Retreatment has the most favorable prognosis when: a. The cause of failure is identified and is correctable. Explanation: Refer to pg(s): 898 b. The patient is asymptomatic. c. Gutta-percha was used instead of paste. d. A surgical microscope is used



Question: 15. If the apical portion of a silver point separates during retreatment, what procedure should be followed? a. Perform root canal treatment coronally, then surgical removal of apical portion of root. b. Perform root canal treatment coronally, then recall and reevaluate. Explanation: Refer to pg(s): 924 c. Enlarge canal space coronally with Gates-Glidden burs to allow grasping the fragment with a special forceps. d. Place EDTA to soften surrounding dentin, then try to bypass and remove the segment with Hedström files



Question: 16. If a root perforation occurs during the post removal, the generally preferred time for repairing the defect is which of the following? a. Immediately before proceeding with further preparation Explanation: Refer to pg(s): 907 b. After cleaning and shaping is complete but before obturation c. Immediately after obturation d. After an appropriate recall period, to assess the status of the tissues



Question: 17. Geristore is indicated: a. For repair of perforations at the furcation b. For repair of perforations at or above the gingival attachment Explanation: Refer to pg(s): 941 c. To maintain hemostasis in perforation repairs d. As an antimicrobial irrigant when perforations occur in necrotic teeth



Question: 18. The root surface on which a perforation has occurred during post preparation is best determined by: a. Interpreting an angled radiograph Explanation: Refer to pg(s): 940 b. Tactile sensation with a curved file c. An apex locator d. Visualization in the canal with a microscope



Question: 19. An advantage that MTA (mineral trioxide aggregate) has over most materials for perforation repair is that it: a. Exhibits a quick setting time b. Does not wash out when in contact with blood or saliva c. Very biocompatible and induces hard tissue formation d. Is biocompatible and induces hard-tissue formation Explanation: Refer to pg(s): 941 e. Is an astringent that induces a coagulum



Question: 20. Of the following, which has the most adverse effect on the prognosis of retreatment? a. The patient presents in pain. b. There is apical periodontitis. Explanation: Refer to pg(s): 944 c. A post and core are present. d. Retreatment is accompanied by surgery. e. An instrument separates, and the apical segment cannot be removed



Question: 21. Which of the following statements regarding retreatment of an endodontic case obturated with guttapercha is accurate? a. Heat is advocated for removing the apical portion of the core obturation material. b. Ideally, the apical portion of the gutta-percha should be removed with files. Explanation: Refer to pg(s): 913 c. If the canal orifice has visible pink gutta-percha, the initial step is application of heat. d. When using heat, the instrument should not be permitted to cool prior to removal from the canal. e. Halothane is preferred to chloroform because it does not exhibit toxicity.



Question: 22. Which of the statements regarding solvents is correct? a. Chloroform is carcinogenic and banned by the Food and Drug Administration. b. Rectified turpentine has an offensive odor but is less toxic than chloroform. c. An adverse reaction to halothane is idiosyncratic hepatic necrosis. Explanation: Refer to pg(s): 911 d. Xylene acts faster than chloroform but is slower than eucalyptol. e. Halothane does not affect the composition of dentin and enhances bond strength



Question: 23. Which of the following statements regarding the use of apex locators in retreatment is correct? a. These devices are accurate and indicated for retreatment because they prevent extrusion of material beyond the apex. b. They should not be used with Resilon; electrical interferences occur. c. The devices are accurate with the use of larger files in rotary handpieces. d. Radiographs are recommended for initial length control; apex locators are accurate only after root canal filling materials are removed. Explanation: Refer to pg(s): 913



Question: 24. Which of the following statements regarding retreatment of cases obturated with Resilon is correct? a. The polycaprolactone polymer core is resistant to the actions of solvents. b. Retreatment procedures are less effective because of the internal dentin bonding monoblock developed by the resin sealer. Explanation: Refer to pg(s): 914 c. Since chloroform and heat are ineffective in removing resins, Endosolv-R is necessary. d. Resilon that is heated is transformed to the alpha phase and can then be easily removed with solvents and files



Question: 25. Which of the following statements regarding retreatment of carrier-based obturation is correct? a. Vectra cores were used in small carriers and therefore needed to be soluble in chloroform for removal. b. Polysulfone carriers are insoluble, but since they are used only in larger sizes, (greater than #40) they are removed easily with Hedström files. c. Metal carriers are retrieved with Peet or Steiglitz forceps. Explanation: Refer to pg(s): 916 d. The plastic carriers are not affected by heat, so removing the surrounding gutta-percha in the canal orifice can be accomplished with a System-B set at 225°C.



Question: 26. Which of the following statements regarding retreatment of pastes is correct? a. Access is necessary to visually determine the type of paste used and the most effective solvent for removal. b. Pastes are easy to retreat, owing to the presence of voids and poor length control. c. Formaldehyde and heavy metal oxides are often components and can cause dysesthesia. Explanation: Refer to pg(s): 919-920 d. Endosolv-E is an effective solvent for resin-based pastes



Question: 27. Which one of the following statements is false? a. Endocal 10 is a hard setting calcium oxide paste know to cause root fracture b. Silver points eventually corrode inside root canals, producing noxious byproducts, including silver sulfate, silver carbonate, and silver amine hydrate. c. N2 (RC-2B) is a root canal paste that is used frequently with no potential of danger Explanation: Refer to pg(s): 919 d. Ethylenediamine tetra-acetic acid (EDTA) is used as a chelating agent in endodontic therapy



Question: 28. Silver point retreatment:



a. Is complicated by the corrosion products Explanation: Refer to pg(s): 921 b. Is complicated because the standardized point mimicked the canal preparation, and placement eliminated lateral space c. With ultrasonics is not indicated; the points are made of pure silver and are flexible d. Is enhanced by using the Caufield silver point retrievers, which resemble Steiglitz pliers but have narrow, curved beaks



Question: 29. The Masserann technique: a. Employs a 25-gauge needle with a 0.14-mm ligature wire looped through the end to grab a separated instrument b. Requires the clinician to braid two or three Hedström files around a file to engage the instrument for removal c. Utilizes cyanoacrylate to bond a hollow tube to a separated instrument d. Employs trephine burs for removal of separated instruments, silver points, and posts Explanation: Refer to pg(s): 923, 930, 931 e. Involves removing the tip of Gates-Glidden drills to provide coronal space down to a separated instrument



Question: 30. Which of the following regarding heat used in endodontic retreatment is correct? a. The greatest danger is related to the use of ultrasonics in removal of metallic objects. Explanation: Refer to pg(s): 934-935 b. Heat is safe so long as the temperature rise in the periodontal ligament does not exceed 15°C. c. Care must be taken to insure that the internal temperature does not rise more than 10°C. d. Damage is transient because of the periradicular blood flow, and healing occurs uneventfully.



Chapter 29: Cone Beam Imaging for Endodontic Procedures Question: 1. What is a difference between medical CT and cone-beam volumetric tomography (CBVT)? a. Medical CT has better resolution. b. CBVT requires less radiation. Explanation: Refer to pg(s): 1008 c. CBVT imaging is limited to an area equal to a quadrant. d. CBVT requires that the patient is moved during exposure



Question: 2. An advantage of cone-beam volumetric tomography over a conventional radiographic technique is which of the following? a. Less radiation b. Three-dimensional image produced Explanation: Refer to pg(s): 1007 c. Less expense d. Endodontic pathosis can be differentiated from nonendodontic pathosis



Question: 3. A problem with CBVT is that the image usually overestimates the size of a periapical lesion. a. True b. False Explanation: Refer to pg(s): 1012



Question: 4. An advantage of a small field of view (FOV) is that extraneous structures do not have to be interpreted (less diagnostic responsibility). a. True Explanation: Refer to pg(s): 1011 b. False



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Though the key answers of the edition 10 is much better than edition 9 But I still have some reservations on some answers, So please if you have any doubt in some answers go back to the book and Make sure you get the right answer



Good Luck All Abdullah Aldehaithem