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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 page 6
E) Otitis media
Question: 4. The pulp test most likely to have a delayed response is the
A) refrigerant spray
B) test cavity
C) electric pulp test
D) heat test
Explanation: Refer to page 17
E) ice water test
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Question: 6. The best approach for diagnosis of odontogenic pain is which of the
following
A) Radiographic examination
B) Percussion
Explanation: Refer to page 15
C) Visual examination
D) A step-by-step, sequenced examination and testing approach
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Question: 18. Pain in the preauricular region that is referred is most likely from
which tooth group with what diagnosis
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Question: 19. The patient in the figure above 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 page 21
C) No additional tests and no treatment are needed; monitor upon recall.
D) Perform an excisional biopsy.
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) Only one tooth likely is responsible.
Explanation: Refer to page 41
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Question: 6. Which of the following is true when a patient complains of severe pain
that cannot be localized
A) The pain is most likely periradicular in origin and likely to persist even when the
necrotic pulp is removed.
B) Treatment procedures should be delayed and the condition managed with
analgesic medications.
Explanation: Refer to page 41
C) The cause is most likely nonodontogenic in origin.
D) Selective administration of a local anesthetic can lead to a definitive diagnosis.
E) The pulp of more than one tooth is involved, and the pathoses produces a
synergistic hyperalgesia response in the central nervous system (CNS).
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Question: 10. A patient describes pain on chewing and sensitivity to cold that goes
away immediately with removal of the stimulus. The mandibular left
second molar (tooth 18) shows a mesioocclusal (MO) crack. The tooth
is caries free, and no restorations are present. Periodontal probing
depths are 3mm or less. Which of the following statements is correct
A) The pulpal diagnosis is normal pulp, and the tooth should be prepared and
restored with a MO-bonded amalgam.
B) The pulpal diagnosis is reversible pulpitis, and the tooth should be restored with a
crown.
Explanation: Refer to page 50
C) The pulpal diagnosis is irreversible pulpitis, and root canal treatment should be
performed, a bonded amalgam placed, and a crown fabricated.
D) A radiograph will probably will reveal a radiolucent area associated with the
mesial root.
E) The prognosis for the tooth is unfavorable.
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 page 52
C) It is appropriate if antibiotic therapy is also started.
D) It should be considered in addition to soft tissue incision and drainage.
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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 page 52
B) As a routine procedure to relieve pain when the affected tooth has been obturated
C) As a treatment for severe recalcitrant pain
D) To prevent a flare-up between multiple-visit endodontic procedures
Question: 18. A 22-year-old man requires root canal treatment for pain and swelling
in the mandibular anterior area. He notes that his dentist has been
treating teeth 25 and 26 for several months and that swelling has
occurred after each visit for cleaning and shaping. Clinical
examination reveals swelling on the alveolar process in the area of
the incisor teeth. Teeth 25 and 26 are tender to palpation and
percussion. Which of the following actions should the clinician
should take
A) Perform diagnostic tests on the other incisors
Explanation: Refer to page 41
B) Open teeth 25 and 26, debride them, and place calcium hydroxide as an
antimicrobial intracanal medicament
C) Open teeth 25 and 26, debride them, and perform incision and drainage
D) Open teeth 25 and 26, debride them, and leave the teeth open for drainage
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E) Perform incision and drainage and prescribe an antibiotic for supportive care
Question: 2. All of the following statements about A-beta fibers are correct except
one. Which is the exception
A) A-beta fibers are activated by high-intensity stimulation with low-frequency
output to the central nervous system.
B) Activation is interpreted as painless stimulation or prepain.
C) A-beta fibers can undergo phenotypic changes as a result of inflammatory
conditions.
D) A-beta fibers are primary efferent neurons located in the periodontal ligament
that transmit proprioception.
Explanation: Refer to pages 60/61
Question: 3. A-delta fibers differ from C fibers in that the A-delta fibers
A) Respond to inflammatory mediators
B) Are sensitized by inflammation
C) Respond to fluid movement
Explanation: Refer to page 61
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
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Question: 7. All of the following statements about the trigeminal nucleus are correct
except one. Which is the exception
A) It anatomically and functionally resembles the dorsal horn of the spinal cord.
B) It contains central terminals of afferents, local circuit neurons, projection neurons,
and descending neurons.
C) A-delta fibers and C fibers terminate primarily in the outer laminae of the
subnucleus caudalis.
D) Local circuit neurons modulate nociceptive transmission from the primary
afferents to projection neurons.
E) Descending neurons originate in the subnucleus caudalis and release serotonin,
which inhibits projection neurons.
Explanation: Refer to page 61
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Question: 14. All of the following are characteristics of central neuropathy except
one. Which is the exception
A) Allodynia and secondary hyperalgesia are present.
B) Treatment is directed at the central processing of pain.
C) Neural blockade breaks the pain cycle.
Explanation: Refer to page 70
D) Tricyclic antidepressants and opioids are beneficial.
E) Treatment is based on management and coping.
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Question: 16. Pain syndromes that are not organically based generally are
characterized a
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 page 72
Question: 17. A 50-year-old patient has a chief complaint of pain in the mandibular
left jaw. He says that 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) Odontalgia
B) Trigeminal neuralgia
C) Cardiogenesis
Explanation: Refer to pages 70/71
D) Cluster headaches
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 than one division of the
trigeminal nerve.
Explanation: Refer to page 68
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: 1. With regard to endodontic therapy, what factor arises if the patient in
the figure above is diabetic that does not obtain 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.
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Question: 9. 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 page 82
D) Seventh and eighth
E) No period during pregnancy is safe.
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Question: 6. The recommended antibiotic for a patient who has had a total joint
replacement and who is allergic to penicillin or cephalosporin is
A) Amoxicillin
B) Erythromycin
C) Clindamycin
Explanation: Refer to page 107
D) Tetracycline
Question: 10. In which of the following situations would the dentist not need to
place a rubber dam
A) The clamp impinges on the gingiva, causing discomfort.
B) The chamber or canal may be difficult to locate on access.
C) The tooth is rotated, preventing placement of a clamp on the indicated tooth.
D) None; a rubber dam is always placed.
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Question: 13. Under the current guidelines of the Health Insurance Portability and
Accountability Act (HIPAA), patients have the right(s) to
A) Request access to, inspect, and copy their dental record
B) Request a restriction on disclosures and uses
C) Request an amendment to the dental record
D) All of the above
Explanation: Refer to page 101
Question: 14. Which of the following statements about posttreatment pain is true
A) It is rare.
B) Severe postoperative pain is common after root canal treatment.
C) Postoperative pain should be treated with a narcotic.
D) In most cases postoperative pain should be treated with over-the-counter
analgesics.
Explanation: Refer to page 108
Question: 15. Which of the following is true about various types of radiographic film
A) D-speed film is faster than E-speed film.
B) E-speed film reduces radiation by approximately 50 compared with D-speed film.
Explanation: Refer to page 106
C) D-speed film reduces radiation by approximately 50 compared with E-speed film.
D) Film speed has no effect on the radiation dose.
Question: 16. Two radiographs are made in an attempt to visualize the location of
the mandibular canal in relation to the molar root apices. One
radiograph is made with no angulation, and the other is made with an
increased vertical angulation of 20 degrees. On the angled radiograph,
the mandibular canal appears to move away from the root apices of
the molar. Where is the canal located
A) Buccal to the root apices
Explanation: Refer to page 116
B) Lingual to the root apices
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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 page 145
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 temperature
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 page 139
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Question: 3. The practitioner would consider all but one of the following factors
when evaluating the canal anatomy of the root canal system in a 26-
year-old woman who requires root canal treatment of the mandibular
right first premolar. Which is the exception
A) Age
Explanation: Refer to page 149
B) Gender
C) Ethnicity
D) Angled radiographs
E) Microscopy
Question: 4. When two canals are present in a single root and join
A) The buccal canal generally is the one with direct access to the apex.
Explanation: Refer to page 158
B) Both canals should be prepared to the apex.
C) Rotary nickel-titanium instrumentation is indicated to ensure that the proper
shape is developed.
D) The configuration is classified as type IV.
Question: 5. Which of the following statements about the apical anatomy is correct
A) The location of the apical constriction and the cementodentinal junction are the
same in approximately 75 of canals.
B) The cementodentinal junction is located at the apical foramen.
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C) The apical constriction usually is located 0.5 to 1.5mm short of the apical
foramen.
Explanation: Refer to page 159
D) The apical foramen remains static after tooth eruption.
E) Regardless of the number of accessory canals present, a main apical foramen can
be identified.
Question: 6. Which of the following statements about the apical anatomy of the
maxillary anterior teeth is correct
A) The apical foramen coincides with the apex in approximately 85 of cases.
B) The apical constriction mesiodistal diameter generally exceeds the labiolingual
diameter.
C) The labiolingual diameter of the apical constriction generally exceeds the
mesiodistal diameter.
Explanation: Refer to page 160
D) When the foramen deviates from the root apex, it usually does so in a
mesiolingual direction.
E) Accessory canals are a rare finding
Question: 7. Prognosis studies indicate that for teeth with pulp necrosis
A) The success rate was higher when root canal treatment terminated at or within
2mm of the radiographic apex.
Explanation: Refer to page 161
B) The success rate was higher when root canal treatment terminated at or within
3mm of 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 cementodentinal junction.
E) Termination more than 3mm short of the radiographic apex carries a poorer
prognosis than that for extension of the obturation beyond the apical constriction.
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Question: 10. All of the following statements about access openings in maxillary first
molars are correct except one. Which is the exception
A) The mesiobuccal canal is located mesial to the mesial cusp tip.
Explanation: Refer to page 179
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 orifices are always located at the junction of the chamber walls and
floor.
E) The orifices are located at the angles of the floor-wall junction.
Question: 11. All of the following statements about access openings in mandibular
molars are correct except one. Which is the exception
A) The orifices for all canals generally are found in the mesial two thirds of the
crown
B) When two separate distal roots are present, the distolingual root is smaller and
often curves buccally.
C) A C-shaped canal is a variation of molars with fused roots.
D) The incidence of C-shaped canals is higher in Japanese, Chinese, Lebanese, and
Korean patients.
E) A middle mesial canal is present in less than 1 of cases.
Explanation: Refer to page 220
Question: 12. By varying the radiographic angle 20, canal morphology can be
correctly identified in each of the following tooth groups except one.
Which is the exception
A) Maxillary first premolars
B) Maxillary second premolars
C) Mandibular first premolars
D) Mandibular second premolars
Explanation: Refer to page 148
Question: 13. Which of the following statements about the fast break is correct
A) A radiographic fast break identifies 95 of canals that bifurcate.
B) One third of canals that bifurcate do not appear as fast breaks on the radiograph.
Explanation: Refer to page 149
C) A radiographic fast break indicates calcific metamorphosis.
D) The term fast break is used for roots with dilacerations greater than 60 degrees.
Question: 14. Which of the following statements about 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 furcation canals.
D) Pulp necrosis and the presence of furcation canals may account for primary
endodontic lesions.
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Question: 15. Which of the following tooth groups may demonstrate all eight canal
configurations
A) Maxillary first premolars
B) Maxillary second premolars
Explanation: Refer to page 156
C) Maxillary first molars
D) Mandibular first premolars
E) Mandibular second premolars
Question: 17. Which of the following burs is recommended for making an access
opening through an existing metal crown
A) Round carbide burs (sizes 2, 4, and 6)
B) Carbide fissure burs
C) Mueller burs
D) LN bur
E) Transmetal bur
Explanation: Refer to page 170
Question: 18. If straight-line access is not achieved upon placement of a small file to
the corrected working length in a mandibular incisor, the clinician
should
A) Extend the access to the incisal edge
B) Reevaluate the adequacy of lingual shoulder removal
Explanation: Refer to page 175
C) Use a facial access approach
D) Prebend the instruments during cleaning and shaping procedures
Question: 19. The starting point for access preparation of first mandibular premolars
is
A) Midway between the mesial and distal marginal ridges in the central groove
B) Near the buccal cusp tip because of the lingual constriction and inclination of the
tooth
C) Halfway up the incline plane of the buccal cusp
Explanation: Refer to page 216
D) Midway between the mesial and distal marginal ridges one third the distance up
the buccal incline plane
Question: 20. The cross sectional shape of the maxillary first premolar in the coronal
portion of the root at the cementoenamel junction
A) Demonstrates two separate roots
B) Resembles a kidney bean, with the concavity on the mesial surface
Explanation: Refer to page 199
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Question: 22. A perforation during access preparation is more likely in which area
A) Maxillary premolar on the mesial aspect at the cementoenamel junction
Explanation: Refer to page 199
B) Mandibular molar on the distal aspect
C) Maxillary anterior on the lingual aspect
D) Mandibular anterior on the lingual aspect
Question: 23. In the figure above, the canal configuration in the access opening
most likely is from which of the following tooth groups
A) Maxillary central incisor
B) Maxillary first premolar
C) Maxillary first molar
D) Mandibular first premolar
E) Mandibular second molar
Explanation: Refer to page 157
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Question: 2. With regard to electrical pulp testing, which of the following is true
A) Positive responses can be used for differential diagnosis of pulp pathosis.
B) The device uses a pulsating, alternating current with a duration of 1 to 15msec.
C) The device uses a low current with a high-potential difference in voltage.
Explanation: Refer to pages 235/236
D) Gingival and periodontal tissues are more sensitive to testing than the pulp.
Question: 7. Which of the following statements about Hedstrm files are accurate
A) They are manufactured by machining a round, cross-sectional wire.
Explanation: Refer to page 240
B) They are effective when used with a reaming action.
C) They are safer than K-files because external signs of stress are more visible,
appearing as changes in flute design.
D) They are aggressive because they have a negative rake angle that is parallel to the
shaft.
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accurate
A) They are used at a range of 1500 to 2000rpm.
B) They are NiTi instruments manufactured in half sizes.
C) Their sizes are standardized according to International Standards Organization
(ISO) and American National Standards Institute (ANSI) requirements.
Explanation: Refer to page 248
D) They incorporate radial lands into the flute design.
Question: 9. Which of the following statements about the best apex locators is
accurate
A) They require training with the instrument to acquire proficiency.
B) They are sensitive to canal contents.
C) They measure the impedance between the file and the mucosa.
D) On average they are accurate to within 0.5mm of the apex.
E) All of the above
Explanation: Refer to pages 255/256
Question: 11. Which of the following statements about ultrasonic root canal
instrumentation is accurate
A) It should be performed in a dry environment.
B) It poses little risk of file breakage.
C) It is not very useful for dentin removal.
Explanation: Refer to page 252
D) It is most useful in small canals where file contact with the wall is maximized.
Question: 12. Which of the following statements about the use of sodium
hypochlorite as a root canal irrigating solution is accurate
A) It is buffered to a pH of 12 to 13, which increases toxicity.
Explanation: Refer to pages 258/259
B) It has a chelating action on dentin.
C) It should be used in higher concentrations because of the increased free chlorine
available.
D) It is a good wetting agent, which permits the solution to flow into canal
irregularities.
Question: 13. 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 page 260
C) It acts on both organic and inorganic components of the smear layer.
D) It penetrates deep into dentin, enhancing root canal preparation.
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Question: 17. N2, endomethasone, and Rieblers paste are sealers that do which of
the following
A) Produce liquefaction necrosis in the periradicular tissues
B) Induce healing in the apical pulp wound after vital pulp extirpation
C) Can cause periapical inflammation
Explanation: Refer to page 270
D) Do not produce a seal when used in combination with a core material
Question: 19. An ultrasonic technique is used to prepare the root end during
endodontic surgery for which of the following reasons
A) It results in apical cracks at low settings.
B) It results in larger but cleaner cavity walls.
C) It can produce a deeper cavity more safely than a bur.
D) It does not require as acute an angle of root resection.
Explanation: Refer to page 276
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Question: 22. Which of the following sterilization techniques is effective for gutta-
percha
A) Steam sterilization
B) Submersion in calcium hydroxide for one minute
C) Submersion in 5 sodium hypochlorite (NaOCl) for 1 minute.
Explanation: Refer to page 263
D) Disinfection is not required.
Question: 24. Mineral trioxide aggregate (MTA) has been advocated for use in
which of the following procedures
A) Pulp capping
B) Perforation repair
C) Retroseal
D) Nonsurgical apical closure
E) All of the above
Explanation: Refer to page 278
Question: 25. Which of the following is not a concern in the use of lasers
A) Temperature increase
B) Flexibility of the probe
C) Smear layer removal
D) Increased patient discomfort
Explanation: Refer to page 279
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Question: 26. Which of the following statements is correct about the file design
indicated by the arrow in the figure above
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 page 247
E) The cutting edge depicted is consistent with the ProTaper instruments.
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instruments
A) The cross-sectional diameter of the instruments increases by a constant 29.
B) The instrument shaft increases by 0.02mm per millimeter.
C) Cross sections through the cutting portion of the shaft reveal three U-shaped
depressions.
Explanation: Refer to page 306
D) The instruments require maximal torque at slow speeds because of the flute
design.
Question: 5. All of the following statements about GT-files are correct except one.
Which is the exception
A) The maximal diameter of the accessory file shaft is 1.5mm.
B) The accessory series of instruments have distinct tapers four tapers with tip
diameters of 35, 50, and 70.
Explanation: Refer to page 308
C) Radial lands and a central parallel core are evident on cross sections.
D) The standard set of instruments includes four distinct tapers and tip diameters
equivalent to sizes 20, 30, and 40 ISO files.
E) The flutes have a variable pitch.
Question: 8. Which statement best describes the physical and chemical properties of
nickel-titanium instruments
A) When stressed, the metal has an austenitic crystalline structure.
B) The instruments corrode when exposed to sodium hypochlorite.
C) The percentage of titanium by weight exceeds the percentage of nickel.
D) The instruments transition from a austenitic crystalline structure to a martensitic
structure when stressed.
Explanation: Refer to page 313
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Question: 13. All of the following statements about the use of sodium hypochlorite
as an endodontic irrigant are correct except one. Which is the
exception
A) Heating the solution can enhance the antimicrobial action but does not affect the
solvent capabilities.
Explanation: Refer to page 318
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 have severe detrimental effects on nickel-titanium
instruments.
Question: 14. Apical patency is maintained for all of the following reasons except
one. Which is the exception
A) To preserve the apical anatomy
B) To enhance the flushing action of the irrigant
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C) To loosen debris
D) To maintain obturating materials in the root
Explanation: Refer to page 324
Question: 15. Root canals should be cleaned, shaped, and obturated to the
constricture for all of the following reasons except one. Which is the
exception
A) The constriction is the narrowest diameter of the canal.
B) Lateral and accessory canals are common in the apical 1 to 2mm of the canal.
C) The clinician can easily identify the constriction.
Explanation: Refer to page 324
D) Obturating materials are maintained within the root canal system.
Question: 16. 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 page 330
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) The file is placed passively to a point of first binding and then rotated in
clockwise at least 180 degrees using apical pressure, followed by a
counterclockwise rotation to evacuate debris.
Question: 17. All 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 files previously used in cleaning and shaping procedures
C) Irrigation with sodium hypochlorite
D) Sterilization and disinfection of the radicular space
Explanation: Refer to page 331
Question: 18. Which of the following is most often responsible for short, underfilled
canals
A) Severe curvatures
B) Packing of debris
C) Canal ledging
Explanation: Refer to page 324
D) Calcification of the canal
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Question: 4. All of the following are advantages of completing root canal treatment
in one visit except one. Which is the 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 page 362
D) Patient compliance is not a factor in the treatment and the cost of providing
treatment is reduced.
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C) They have a consistent pattern of appearing on either the mesial or the distal
surfaces.
D) They are uncommon, and a root seldom has more than one.
E) They are serendipitously identified on postoperative radiographs.
Explanation: Refer to page 364
Question: 7. Which of the following has a significant negative effect on the long-
term prognosis after obturation
A) Obturation of vital cases 1 to 3mm short of the radiographic apex
B) Obturation of necrotic cases 0 to 2mm short of the radiographic apex
C) Extrusion of obturating materials
Explanation: Refer to page 364
D) Obturation at the time of cleaning and shaping
Question: 8. Which of the following statements about the smear layer is correct
A) It is a thick layer of inorganic debris on the canal wall that remains after 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 page 366
D) It forms when the pulp is necrotic and devoid of structure rather than in vital
cases, in which the pulp is easily removed.
Question: 9. MTAD
A) Contains an analog of tetracycline, an acid, and detergent
Explanation: Refer to page 366
B) Is composed of 17 citric acid
C) Unlike EDTA has no antimicrobial activity
D) Has been advocated as a replacement for sodium hypochlorite because of its low
toxicity
E) Removes organic components of the smear layer but is ineffective at removing
inorganic material
Question: 12. All of the following statements about gutta-percha are correct except
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Question: 16. All of the following statements about custom cones are 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 has softened.
D) The primary purpose is length control during compaction procedures.
E) Fabrication requires fitting the cone to length with tugback before softening.
Explanation: Refer to page 375
Question: 18. Which of the following statements about the use of heat in warm
vertical compaction is correct
A) The temperature of the external surface of the root must not rise more than 10C.
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Question: 19. All of the following statements about continuous wave compaction
are correct except one. Which is the exception
A) Pluggers are used that fit to within 5 to 7mm of the corrected working length.
Explanation: Refer to page 382
B) Heat is applied to the plugger, which is moved quickly to the binding point;
hydraulic pressure then is applied without heat for 5 to 10 seconds.
C) The technique cannot be used in oval canals because of the inability to develop
hydraulic pressure.
D) The pluggers have a uniform taper of size .06 but have variable tip diameters.
E) Standardized size .02 tapered gutta-percha cones fit with tugback are preferred.
Question: 21. All of the following statements about ThermaFil obturation are correct
except one. Which is the exception
A) Size verifiers are available to help determine the appropriate carrier.
B) Calibration rings on the carrier assist in placement of the carrier to length.
C) The carrier is inserted without rotation.
D) Preppi burs are specifically designed for sectioning the carrier at the canal orifice.
E) Although AH26 is a recommended resin sealer, Tubli-Seal and Wachs paste are
acceptable zinc oxideeugenol formulations.
Explanation: Refer to page 387
Question: 23. Each of the following has been advocated as an apical barrier
material. Which is preferable
A) Calcium hydroxide
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B) Dentin chips
C) Collagen
D) Mineral trioxide aggregate
Explanation: Refer to page 390
E) Tricalcium phosphate
Question: 24. Which following methods would be best for reducing 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 page 391
C) Obturating the coronal 2 to 3mm with thermoplastic injection of gutta-percha
D) Leaving a layer of gutta-percha covering the chamber floor
Question: 25. Which of the following statements is correct about obturation of the
maxillary right canine shown in the figure above
A) The canal should be obturated with a custom cone and lateral compaction.
B) Continuous wave vertical compaction should be used after two master cones
have been placed to within 0.5mm of the apex.
C) An apical mineral trioxide plug should be placed before obturation.
Explanation: Refer to page 390
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.
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Question: 6. If a patient with human immunodeficiency virus (HIV) asks the dentist
not to inform the staff of the condition, the dentist should do which of
the following
A) Refuse to treat the patient
Explanation: Refer to page 452
B) Tell the staff in private and then treat the patient with extra precautions
C) Not tell the staff but treat the patient with great caution
D) Not tell the staff and require the patient to assume liability should anyone
contract the virus
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Question: 10. Suing to collect fees is a proven route to being countersued for
malpractice.
A) True
Explanation: Refer to page 446
B) False
Question: 11. Standard of care for routine endodontics is set by which of the
following
A) The states dental licensing agency
B) Endodontists
Explanation: Refer to page 420
C) The community of general dentists
Question: 14. A clinician may deny a patients request for his or her records if
A) The patient has an outstanding balance
B) The clinician has severed the patient-clinician relationship
C) Treatment is incomplete
D) A clinician is never allowed to deny a patients request for the records.
Explanation: Refer to page 416
Question: 15. You have started root canal treatment on the uppe r left first molar,
tooth 14, for Ms. Smith. She is delinquent in paying her outstanding
account balance. Legally you are
A) Not responsible for completing her root canal treatment
B) Obligated to finish the root canal treatment regardless of the account status
Explanation: Refer to page 434
C) Required to refer her to another practitioner
D) Obligated to complete all treatment in her comprehensive treatment plan
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Question: 4. All of the following statements about the dentinal tubules are correct
except one. Which is the exception
A) The tubule diameter near the pulp-dentin interface is approximately 2 to 3m.
B) In the coronal dentin, the tubules have an S-shaped curvature.
C) The intertubular spacing remains constant, because the deposition of peritubular
dentin is internal.
D) Lateral microtubules contain branches of the odontoblastic process.
Explanation: Refer to page 467
E) No peritubular dentin is present in the predentin area.
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Question: 15. Which of the following statements about innervation of the pulp is
correct
A) Myelinated fibers are the last major structures to appear in the developing pulp.
Explanation: Refer to page 483
B) Autonomic fibers are afferent neurons that regulate microcirculation.
C) A-beta and A-delta fibers 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 have separate functions.
Question: 17. All of the following reasons, except one, could explain why a necrotic
pulp might respond to testing or mechanical manipulation. Which is
the exception
A) The nerve fibers may be resistant to necrosis.
B) Nerve bundles are more resistant to autolysis.
C) C fibers remain active despite hypoxia.
D) The cell body of the neuron lies outside the pulp.
E) A-delta fibers have a lower stimulation threshold for stimulation with hypoxia.
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Question: 18. All of the following statements about deafferentation are correct
except one. Which is the exception
A) It is the process of degeneration of neurons centrally after 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 as a result
of application of a local anesthetic to the nerve.
Explanation: Refer to page 487
Question: 19. Which of the following statements about pulp testing is correct
A) C fibers are normally stimulated by electrical 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
electrical pulp testing.
C) C fibers normally have a high threshold and require a more intense stimulus than
A-delta fibers.
Explanation: Refer to page 487
D) A-delta fibers normally respond to thermal stimulation better than C fibers;
however, the two fiber groups respond the same to electrical pulp testing.
Question: 20. Which of the following statements about dentinal sensitivity is correct
A) The movement in the tubules is translated into electrical signals by sensory
receptors in the tubules or the pulp.
Explanation: Refer to page 487
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) A change in temperature must occur at the pulp-dentin interface to produce for a
sensory response.
E) Application of heat causes expansion of the dentin; this widens the dentinal
tubules, drawing fluid from the pulp into the dentin and producing sensory
stimulation.
Question: 22. All of the following statements about pulpal hyperalgesia are correct
except one. Which is the exceptioQuestion: 22. All of the following
statements about pulpal hyperalgesia are correct except one. Which is
the exception
A) The condition is marked by a decreased pain threshold and an increased
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response to stimulation.
Explanation: Refer to pages 491/492
B) An enhanced response to a stimulus results, but spontaneous pain is not a
characteristic.
C) Increased pressure may be a contributing factor.
D) 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: 23. Which of the following statements about the vascular supply of the
pulp is correct
A) Arteries enter the pulp and give rise to arterioles, which 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 page 494
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 in most tissues,
approaching 25.
E) The pulp has the highest volume of blood flow of oral tissues and most visceral
organs.
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B) Cell-free zone
C) Mantle dentin
D) Predentin
Explanation: Refer to page 466
E) Artifact separation of the odontoblastic layer
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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 page 526
Question: 8. Which of the following is a reaction that tends to protect the pulp from
injury caused by dentinal caries
A) A predictable stimulation of sensory nerves, resulting in pain
B) A decrease in the permeability of the dentin
Explanation: Refer to page 515
C) An increase in the number of odontoblasts under the tubules affected by the
caries
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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 pages 525-527
D) a and c
E) b and c
F) a and b
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 page 524
Question: 12. The major reason Class II restorations with composite 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.
Explanation: Refer to page 525
Question: 13. The pulp has been damaged and is inflamed because of 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 oxideeugenol
C) Steroid formulations
D) None; no material promotes healing
Explanation: Refer to page 527
Question: 14. What is the history of symptoms of irreversible pulpitis that results in
necrosis
A) Seldom symptomatic
B) Usually marked by moderate symptoms
C) Usually marked by an absence of severe symptoms
Explanation: Refer to page 519
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Question: 15. The figure above shows a section of pulpdentin underlying an area of
cavity preparation, which 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 page 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
involves primarily which of the following
A) Neutrophils
B) Macrophages
C) Neutrophils, plasma cells, and lymphocyte
D) Macrophages and lymphocytes
E) Lymphocytes, plasma cells, and macrophages
Explanation: Refer to page 516
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 page 523
Question: 19. The evidence on the use of lasers to treat hypersensitivity indicates
that
A) They are very effective.
B) They are effective only in severe cases.
C) Only the Nd:YAG laser is effective.
D) Other techniques are recommended.
Explanation: Refer to page 531
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Question: 20. Which of the following statements is correct about the effect of
orthognathic surgery on the pulp
A) The canal space sometimes is obliterated.
Explanation: Refer to page 534
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: 3. A periapical true cyst communicates with the root canal, and a
periapical pocket cyst does not.
A) True
B) False
Explanation: Refer to page 542
Question: 4. Which of the following is the most important route by which bacteria
are able to invade the dental pulp
A) The general circulation through anachoresis
B) Exposure to the oral cavity through caries
Explanation: Refer to page 543
C) The gingival sulcus
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Question: 10. Which of the following statements about acute apical periodontitis is
accurate
A) It histologically is limited to the periodontal ligament.
B) It is detectable radiographically.
C) It may heal if induced by a noninfectious agent.
Explanation: Refer to page 560
D) All of the above
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Question: 14. 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 page 558
D) Activation of prostaglandin production
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 page 581
D) Organisms that infect the pulp tend to be aerobic, unlike organisms that infect
the periapex.
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Question: 10. Which of the following statements about Ludwigs angina is accurate
A) It involves the submental, sublingual, and submandibular spaces of the right or
left side.
B) It can progress into the canine and infraorbital spaces.
C) It can cause airway obstruction.
Explanation: Refer to page 593
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Question: 12. An incision and drainage procedure is indicated for which of the
following
A) For sinus tracts
B) When swelling is diffuse and indurated
Explanation: Refer to page 596
C) For acute, apical periodontitis
D) All of the above
Question: 13. An incision and drainage procedure is effective for cellulitis because
A) It provides a pathway of drainage, preventing the spread of infection.
B) It relieves increased tissue pressure.
C) It provides pain relief.
D) It increases circulation to the area and improves delivery of antibiotics.
E) All of the above
Explanation: Refer to page 596
Question: 17. Which of the following statements about the American Heart
Association (AHA) guidelines for prophylactic antibiotic coverage is
accurate
A) They are the standard of care for clinicians.
B) They are based on controlled clinical studies.
C) They are not a substitute for clinical judgment.
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Question: 18. The AHA recommends antibiotic prophylaxis for which of the
following
A) Surgery
B) Instrumentation beyond the apex
C) Periodontal ligament injection
D) All of the above
Explanation: Refer to page 598
Question: 19. Which of the following statements about the theory of focal infection
is accurate
A) It was propounded by Dr. William Hunter in 1910.
B) It referred to infections found around poorly made restorations.
C) It was used to explain diseases for which no cure existed.
D) It results in needless tooth extraction.
E) All of the above
Explanation: Refer to page 599
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 page 591
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) RT-PCR
D) Multiplex PCR
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E) Broad-range PCR
Explanation: Refer to page 585
Question: 24. Which of the following is the most sensitive identification method
A) DNA-DNA checkerboard
B) Microbial cultivation
C) PCR
Explanation: Refer to page 584
D) Scanning electron microscopy (SEM)
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Question: 7. Pulp necrosis is most likely to occur after which of the following
A) Midroot fracture
B) Intrusive luxation
Explanation: Refer to page 633
C) Concussion
D) Complicated crown fracture
Question: 9. Which medium of storage for an avulsed tooth is best for prolonged
extraoral periods
A) Hanks Balanced Salt Solution
Explanation: Refer to page 641
B) Milk
C) Distilled water
D) Saliva
Question: 12. Which of the following statements is true about thermal and electrical
tests after trauma
A) Sensitivity tests evaluate the nerve and circulatory condition of the tooth.
B) False-positive test results are more likely than false-negative results.
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Question: 13. 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 page 636
Question: 14. Which of the following statements about avulsed teeth is accurate
A) They can be treated endodontically outside the mouth in limited circumstances.
Explanation: Refer to page 642
B) They should be rigidly splinted for 3 to 4 weeks to allow periodontal support to
mature.
C) They generally do not require antibiotic treatment at the time of replantation.
D) Apexification should be attempted if the apex is not closed.
Question: 16. 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 for retention is hopeless, and the tooth should be extracted.
D) Pulp tissue in the apical segment frequently remains vital.
Explanation: Refer to page 626
Question: 18. When should root canal treatment be initiated for a serious injury in
which regeneration is impossible
A) Immediately
B) Seven to 10 days after injury
Explanation: Refer to page 644
C) Three to 4 weeks after injury
D) The next day
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Question: 19. 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 increases the chance of revascularization
A) Aqueous calcium hydroxide
B) Penicillin
C) Citric acid
D) Doxycycline
Explanation: Refer to page 642
Question: 20. The appearance of the root of tooth 8 in the figure above is likely a
result of
A) Inflammatory resorption
B) Replacement resorption
Explanation: Refer to page 632
C) Internal resorption
D) Surface resorption
Question: 21. For the figure above, which of the following descriptions is most likely
accurate
A) Coronal pulp vitalapical pulp necrotic
B) Coronal pulp necroticapical pulp necrotic
C) Coronal pulp necroticapical pulp vital
Explanation: Refer to page 626
D) Coronal pulp vitalapical pulp vital
Question: 22. The figure above is a postoperative radiograph made 1 year after
avulsion of tooth 9. Which of the following statements is accurate
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Question: 7. Pulp necrosis is most likely to occur after which of the following
A) Midroot fracture
B) Intrusive luxation
Explanation: Refer to page 633
C) Concussion
D) Complicated crown fracture
Question: 9. Which medium of storage for an avulsed tooth is best for prolonged
extraoral periods
A) Hanks Balanced Salt Solution
Explanation: Refer to page 641
B) Milk
C) Distilled water
D) Saliva
Question . 12. Which of the following statements is true about thermal and
electrical tests after trauma
A) Sensitivity tests evaluate the nerve and circulatory condition of the tooth.
B) False-positive test results are more likely than false-negative results.
C) It may take up to 9 months for normal blood flow to return.
Explanation: Refer to page 612
D) None of the above
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Question: 13. 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 page 636
Question: 14. Which of the following statements about avulsed teeth is accurate
A) They can be treated endodontically outside the mouth in limited circumstances.
Explanation: Refer to page 642
B) They should be rigidly splinted for 3 to 4 weeks to allow periodontal support to
mature.
C) They generally do not require antibiotic treatment at the time of replantation.
D) Apexification should be attempted if the apex is not closed.
Question: 16. 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 for retention is hopeless, and the tooth should be extracted.
D) Pulp tissue in the apical segment frequently remains vital.
Explanation: Refer to page 626
Question: 18. When should root canal treatment be initiated for a serious injury in
which regeneration is impossible
A) Immediately
B) Seven to 10 days after injury
Explanation: Refer to page 644
C) Three to 4 weeks after injury
D) The next day
Question: 19. 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 increases the chance of revascularization
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Question: 20. The appearance of the root of tooth 8 in the figure above is likely a
result of
A) Inflammatory resorption
B) Replacement resorption
Explanation: Refer to page 632
C) Internal resorption
D) Surface resorption
Question: 21. For the figure above, which of the following descriptions is most likely
accurate
A) Coronal pulp vitalapical pulp necrotic
B) Coronal pulp necroticapical pulp necrotic
C) Coronal pulp necroticapical pulp vital
Explanation: Refer to page 626
D) Coronal pulp vitalapical pulp vital
Question: 22. The figure above is a postoperative radiograph made 1 year after
avulsion of tooth 9. Which of the following statements is accurate
about the irregular radiolucent pattern
A) Inflammatory resorption has occurred.
B) Replacement resorption has occurred.
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Question: 5. All of the following are indications for root resection except one.
Which is the 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
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Question: 8. All of the following statements about forced eruption are correct except
one. Which is the 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
after the procedure.
C) Extrusions of less than 4mm are most successful.
D) It is an alternative to surgical crown lengthening.
E) Prognostic studies indicate that forced eruption is not a predictable treatment
technique.
Explanation: Refer to page 663
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Question: 10. Which of the following statements is correct with regard to a primary
endodontic lesion with secondary periodontic involvement
A) Pulp necrosis occurs initially, and an apical lesion forms. Apical migration of
periodontal disease results in communication between the two lesions.
B) Treatment consists of performing endodontic treatment, which is followed by a 6-
month recall examination. If the periodontal component is still present,
periodontal treatment is initiated.
C) A primary endodontic lesion with secondary periodontic involvement has a
poorer prognosis than a primary periodontal lesion with secondary endodontic
involvement.
D) Pulp necrosis occurs, forming a sinus tract through the periodontal ligament; over
time, this tract allows plaque and calculus to accummulate on the root over time.
Explanation: Refer to page 655
Question: 11. Which of the following statements best describes the effect of
periodontal disease on the pulp
A) A direct correlation exists between the severity of the periodontal destruction and
the percentage of pulps that become necrotic.
B) If periodontal disease or the subsequent treatment exposes a lateral or accessory
canal, complete necrosis results.
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 page 653
Question: 12. A 24-year-old woman has drainage from a gingival sulcus in the
maxillary left central incisor (tooth 9). Three years ago, she states, a
porcelain fused to metal bridge was placed because of congenitally
missing lateral incisors. Clinical 9. Additional probing depths are
3mm or less. Pulp testing reveals that teeth 8 and 11 are responsive to
carbon dioxide (CO2) snow, but tooth 9 is not responsive. No
tenderness is noted with percussion or palpation. Which of the
following conditions is the most likely cause of this lesion
A) Vertical root fracture
Explanation: Refer to page 657
B) CPalatogingival groove
C) Pulp necrosis
D) Periodontitis
E) Osteogenic sarcoma
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Question: 14. A 51-year-old woman is seeing the dentist for evaluation of swelling
of the buccal tissue opposite her mandibular right second molar (tooth
31). She states that 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 6mm on the mesial aspect, and a 9mm
defect is present in the distal area of tooth 31. Teeth 28, 29, and 30
respond to pulp testing with CO2 snow. Tooth 31 does not respond.
Based on this information, what diagnostic classification is most
appropriate
A) Primary endodontic lesion
B) Primary periodontic lesion
C) Primary endodontic lesion with secondary periodontic involvement
D) Primary periodontic lesion with secondary endodontic involvement
Explanation: Refer to page 655
E) Concomitant endodontic and periodontic lesion
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Question: 15. A 51-year-old woman is seeing the dentist for evaluation of swelling
of the buccal tissue opposite her mandibular right second molar (tooth
31). She states that 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 6mm on the mesial aspect, and a 9mm
defect is present in the distal area of tooth 31. Teeth 28, 29, and 30
respond to pulp testing with CO2 snow. Tooth 31 does not respond.
Which of the following statements about this case is correct
A) The prognosis for treatment depends on whether root canal treatment can be
performed.
B) The periodontal prognosis is the determining factor for treatment options.
Explanation: Refer to page 655
C) The pattern of bone loss is consistent with endodontic pathosis.
D) Osseous regeneration is likely to occur after endodontic treatment.
E) Periodontal treatment, including osseous grafting and GTR, should be initiated; if
this is successful, root canal treatment can be performed.
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E) The caries should be removed, the teeth restored with IRM, and the patients
symptoms reevaluated.
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Question: 2. Prostaglandins are related to pain production in that when released, they
A) Directly stimulate free nerve endings
B) Increase the release of mediators of vasodilation
C) Sensitize peripheral nociceptors
Explanation: Refer to page 670
D) Reduce the responsiveness of sodium channels on sensory nerves
Question: 4. Pain that is referred from an inflamed maxillary sinus to maxillary molars is likely to
the phenomenon of which of the following
A) Convergence
Explanation: Refer to page 673
B) Sublimation
C) Nociception
D) Information transfer
E) Projection
Question: 6. All of the following are characteristics of hyperalgesia except one. Which is the
exception
A) Hyperalgesia is primarily a central mechanism.
Explanation: Refer to page 673
B) Spontaneous pain is present.
C) The pain threshold is lowered.
D) Hyperalgesia results in an increased pain perception with noxious stimuli.
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Question: 8. Which of the following statements about activation of opiate receptors is accurate
A) It blocks nociceptive signals from the trigeminal nucleus to higher brain centers.
B) Opiate receptors are activated peripherally.
C) It induces the release of endorphins.
Explanation: Refer to page 678
D) 1 and 2
E) 1 and 3
Question: 9. Opioids are frequently used in combination with other drugs because
A) When nonsteroidal antiinflammatory drugs (NSAIDs) are used with an opioid, the two act
synergistically on the opiate receptor.
B) The combination permits a lower dose of the opioid, resulting in fewer or diminished side
effects.
Explanation: Refer to page 678
C) Opioids do not act peripherally.
D) Opioids are not antipyretic.
Question: 10. Which of the following statements is true with regard to the use of codeine as an
analgesic agent
A) Codeine prescribed in 60 mg doses is more effective than 650 mg of aspirin.
B) Codeine prescribed in 30 mg doses is more effective than 600 mg of acetaminophen.
C) Codeine prescribed in 30 mg doses is more effective than a placebo.
D) Codeine prescribed in 60 mg doses is more effective than a placebo.
Explanation: Refer to page 678
Question: 11. Management of pain of endodontic origin should focus on which of the following
A) Removing the peripheral mechanism of hyperalgesia
Explanation: Refer to page 669
B) Providing an adequate level of a nonsteroidal, antiinflammatory analgesic agent
C) Prescribing an appropriate antibiotic when pain is the result of infection
D) Using long-acting, local anesthetics to break the pain cycle
Question: 12. Which of the following best describes a flexible plan for prescribing analgesic
agents
A) A maximal dose of an opioid is administered. If pain persists, the opioid is supplemented
with an NSAID or acetaminophen. Doses are then alternated.
B) A maximal dose of an NSAID or acetaminophen is administered. If pain persists, the NSAID
is supplemented with acetaminophen; acetaminophen is supplemented with an opioid.
Explanation: Refer to page 683
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C) Patients are advised to take the maximal dose of an NSAID a day before the appointment
and then as necessary for postoperative pain.
D) Patients are advised to take an opioid agent a day before the appointment and then as
necessary for postoperative pain.
Question: 13. Administration of an NSAID in combination with cyclosporine may result in which
of the following
A) A higher risk of nephrotoxicity
Explanation: Refer to page 680
B) Bone marrow suppression.
C) A decrease in the activity of cyclosporine
D) Higher concentrations of the NSAID in blood plasma
Question: 15. The patients perception of pain with irreversible pulpitis is primarily at the
A) Level of the spinothalamic tract
B) Thalamic level
C) Peripheral nociceptive C fibers
D) Cortical level
Explanation: Refer to page 669
Question: 16. Peripheral afferent nerve fibers in an inflamed pulp may respond to mediators by
A) Reducing the concentration of those mediators
B) Reducing responsiveness to nociceptive stimuli
C) Reducing the number of anesthetic molecule receptors
D) Reducing the number of ion channels
E) Sprouting of terminal fibers
Explanation: Refer to page 671
Question: 17. An orally administered drug that has shown anxiolytic properties in dental
patients is
A) Codeine
B) Triazolam
Explanation: Refer to page 674
C) Tramadol
D) Oxycodone in combination with acetaminophen
Question: 18. To minimize posttreatment pain, analgesics are most effective when
administered
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A) As a pretreatment
Explanation: Refer to page 683
B) Immediately after treatment
C) When the anesthetic begins to wear off
D) When the patient first perceives pain
E) When the pain is the most intense
Question: 20. Cyclooxygenase-2 (COX-2) inhibitors currently are not recommended for
treatment of routine endodontic pain because they are
A) Less effective for pain control than other NSAIDs
B) Associated with frequent gastrointestinal irritation
C) Poorly absorbed from the gastrointestinal tract and do not reach therapeutic blood levels
D) Associated with an increased risk for prothrombic events
Explanation: Refer to page 675
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