2008 Dsce-Study Guide

2008 (updated) DSCE QUESTIONS & STUDY GUIDE 1
References & Editing by Jodi Pessoa, Marlin & Alan Walker
2008 DSCE
STUDY GUIDE
Self explanatory
1. IL-1 
2. Cyclosporine is an immunosuprressant used in transplant patients. This drug
is known to cause gingival hyperplasia
3. Perio diseases effect on glucose levels 
4. self explanatory
5. Before trimming teeth on a stone cast for immediate denture fabrication you must
first:
6. Patients with renal disease will be unable to take any of the following
analgesics:
 Aspirin
 NSAIDs like Ibuprofen and Naproxen
So, even at high levels renal effects may ensue< ACETOMINOPHEN is the only
one that will be safe to use in a patient with renal disease.
7. self explanatory
8. self explanatory
154. Best position for a finish line on a short clinical crown is: SUBGINGIVAL
Contraindication to hyperthyroidism is CATECHOLAMINES (epinephrine)
TETRACYCLINE STAINING – “The stain can be slight, appearing gray or yellow

without banding over all teeth; moderate, as a darker discoloration and again without
banding; or severe, with even darker discoloration of a gray and blue with possible
banding at the cervical area of the teeth.”
(Finkbeiner, Betty Ladley Finkbeiner. Comprehensive Dental Assisting. Elsevier, 1995. 36.8.4). <vbk:0-8151-3239-5#outline(36.8.4)>
Figure 16-45
Tetracycline stain. Note the yellow color (tetracycline) of the posterior teeth
and the gray color of the anterior teeth, in which there has been oxidation of
endogenous tetracycline.
(Regezi, Joseph A. Regezi. Oral Pathology: Clinical Pathologic Correlations, 4th Edition. Elsevier, 2002. 17.8.2). <vbk:0-7216-
9805-0#outline(17.8.2)>
 FLUOROSIS STAINING –
Figure 16-25 Fluorosis.
(Regezi, Joseph A. Regezi. Oral Pathology: Clinical Pathologic Correlations, 4th Edition. Elsevier, 2002. 17.4.1).
 <vbk:0-7216-9805-0#outline(17.4.1)>
 AMELOGENESIS IMPERFECTA – soft and thin enamel. Yellow- brown dut to
this thin enamel and dentin shows through
 DENTINOGENESIS IMPERFECTA- gray to brown OPALESCENT HUE.

Figure 16-30
(Regezi, Joseph A. Regezi. Oral Pathology: Clinical Pathologic Correlations, 4th Edition. Elsevier, 2002. 17.4.2).
<vbk:0-7216-9805-0#outline(17.4.2)>
 A pulp stone is a calcification that occurs in the coronal region of the pulp (Fig.
33-8) . A diffuse or linear calcification in the form of a spicule may occur in the
pulp canal and is usually aligned near a vessel or nerve. Typically, pulp stones
have no clinical significance; however, they may increase in frequency and size
with age or with irritation. Large pulp stones can complicate gaining access to a
canal during root canal therapy.
(Finkbeiner, Betty Ladley Finkbeiner. Comprehensive Dental Assisting. Elsevier, 1995. 33.2.11).
 Cracked tooth syndrome is transient acute pain experienced occasionally while
chewing. Difficult to locate and reproduce. Likely to occur among individuals
who crack nuts and crush ice with their teeth, and among popcorn eaters. Usually
a vertical crack or split in the tooth extends across a marginal ridge through the
crown and into the root, involving the pulp. Visible by transilluminated light or
with the use of disclosing dyes. (Mosby. Mosby's Dental Dictionary. Elsevier,
2004.). Occurs on minimally restored teeth and extends from the mesial to the
distal direction> you can use the tooth slooth to tell you about cracked tooth also.
 Tooth sloth is:
FIG. 9-19
A, The tooth Slooth is used to detect an incomplete fracture of a posterior tooth. The end
with the small divot or depression is placed on the suspected cusp. The patient is
instructed to close so that the opposite tooth engages the grooved, flat side of the Tooth
Slooth. B, The patient is instructed to apply biting pressure on the plastic instrument and
to move the mandible slowly side to side and then release quickly. C, Tooth that yielded a
positive response to the rubber wheel test, indicating a possible incomplete fracture. D,
Removal of existing restoration confirms diagnosis of an incomplete fracture.
(Roberson, Theodore Roberson. Sturdevant's Art and Science of Operative Dentistry, 4th Edition. Elsevier, 2002.). vbk:0-323-01087-
3#F350> Pontic Design
TABLE 20-1 Pontic Designs

(Rosenstiel, Stephen F. Rosenstiel. Contemporary Fixed Prosthodontics, 3rd Edition. Elsevier, 2000.).
Replacement of #20 clearly would require a modified ridge lap pontic!
 Leukemia in the 14 y/o will probably present like this:
Clinically, the gingiva appears initially bluish red and cyanotic, with a rounding and
tenseness of the gingival margin; then it increases in size, most often in the
interdental papilla and partially covering the crowns of the teeth
(Newman, Michael G. Newman. Carranza's Clinical Periodontology, 9th Edition. Elsevier, 2002. 12.3.2).
 Autoclave: 121 degrees at 15-20 psi for 20 mins
o Check for b. Stearothermophillus
o Once a week testing must be done
 Staphne defect is also called lingual salivary gland defect. Remember this “lesion” will show up
on the radiograph below the IA canal indicating that it is not of odontogenic origin>
 Lab values:
White blood cell count 4,000 to 11,000 cells/ mm3
RBC count 45-60 million cell/mm3
Hgb Men: 14-18 g/dL Women: 12-16 g/dL
Platelets 150,0000- 440,000/ mm3
((Thrombocytopenia <150,0000 platelets/mm3))
((spontaneous bleeding < 20,000 platelets/mm3 ))
Bleeding time 4-9 mins [>15 mins abnormal]
PTT  Intrinsic and common pways 40-100 secs [120 secs abnormal]
aPTT PTT wt activator added to test tube25-35 secs
ACT Intrinsic and common pways 90-120 secs
PT  Extrinsic and common pways 10-12 secs
INR  Extrinsic and common pways 2.0-3.0 secs
2.5-3.5 secs (for pts on high dose
anticoags or with
__________________________________________mechanical heart valves)
 Sickle cell anemia- increase in bone trabeculation, hair on end in the skull x-ray
 Rectangular collimation – reduces radiation
 Increased film speed will reduce radiation exposure but decrease clarity; so don’t
use F speed use D or E.
 Varicose tongue / lingual varicosities
“Varicosities become progressively prominent with age; thus, lingual varicosities are
encountered in elderly individuals. Lingual varicosities appear as tortuous serpentine
blue, red, and purple elevations that course over the ventrolateral surface of the
tongue, with extension anteriorly. Even though they may be quite striking in some
patients, they represent a degenerative change in the adventitia of the venous wall and
are of no clinical consequence. They are painless and are not subject to rupture and
hemorrhage.” (Greenberg, Martin S. Greenberg. Burket's Oral Medicine Diagnosis and Treatment, 10th Edition. BC
Decker, 2002. 6.1.2).
FIG. 7-2
Varix; note multiple lingual varicosities. (From Wood NK, Goaz PM: Differential diagnosis of oral lesions ,
ed 3, St Louis, 1985, Mosby.) (Finkbeiner, Betty Ladley Finkbeiner. Comprehensive Dental Assisting. Elsevier, 1995.).<vbk:0-8151-
3239-5#F90>
 Vasotec is the rand name of enalapril (ace inhibitor) used in hypertension
 Loss of lamina dura:
o Hyperpituiatarism
o Hyperparathyroidism
o Osteomalacia
o Pagets
o Fibrous dysplasia
o Periapical and lateral radicular cysts
o Massive osteolysis
 Herpangina:
Figure 7-23 ♦ Herpangina. Numerous aphthouslike ulcerations of the soft palate. (From Allen CM, Camisa C:
Diseases of the mouth and lips. In Sams WM, Lynch P, editors: Principles of dermatology, New York, 1990, Churchill Livingstone.)
(Neville, Brad Neville. Oral and Maxillofacial Pathology, 2nd Edition. Elsevier, 2002.).
Herpangina begins with an acute onset of significant sore throat, dysphagia, and fever,
occasionally accompanied by cough, rhinorrhea, anorexia, vomiting, diarrhea, myalgia,
and headache. Most cases, however, are mild or subclinical. A small number of oral
lesions, usually two to six, develop in the posterior areas of the mouth, usually the soft
palate or tonsillar pillars (Figure 7-23). The affected areas begin as red macules, which
form fragile vesicles that rapidly ulcerate. The ulcerations average 2 to 4 mm in diameter.
The systemic symptoms resolve within a few days; as would be expected, the ulcerations
usually take 7 to 10 days to heal. (Neville, Brad Neville. Oral and Maxillofacial Pathology, 2nd Edition. Elsevier,
2002. 7.6.1). <vbk:0-7216-9003-3#outline(7.6.1)>
Because herpangina is self-limiting, is mild and of short duration, and causes few
complications, treatment usually is not required. (Regezi, Joseph A. Regezi. Oral Pathology: Clinical
Pathologic Correlations, 4th Edition. Elsevier, 2002. 2.1.4.3). <vbk:0-7216-9805-0#outline(2.1.4.3)>
 EAGLE”S SYNDROME
FIG. 9-70
EAGLE'S SYNDROME. A, An extremely long and calcified styloid process is

observed in this panoramic projection. This patient is suffering from submandibular neck
pain, especially with head movement. B, In this panoramic projection, a very large
styloid process that has been fractured is visualized. Also note the large radiolucency in
the mandibular molar region secondary to a gunshot wound. (Okeson, Jeffery P. Okeson. Management
of Temporomandibular Disorders and Occlusion, 5th Edition. Elsevier, 2002. 12.3.8.1.4.3).
Even when extensive ossification of one or both stylohyoid ligaments is seen, more than
50% of patients are clinically asymptomatic. The ossified ligament usually can be
detected by palpation over the tonsil as a hard, pointed structure. Very little correlation
exists between the extent of ossification and the intensity of the accompanying
symptoms. One symptom is vague, nagging to intense pain in the pharynx on swallowing,
turning the head, or opening the mouth, especially on yawning. When this entity is
associated with discomfort and the patient has a recent history of neck trauma (e.g.,
tonsillectomy), the condition is called Eagle's syndrome. (White, Stuart C. White. Oral Radiology, 5th
Edition. Elsevier, 2003. 31.7.1.2). patient ay also complain of dizziness.
 CPR:
o Palm of hand placed on the lower part of sternum
o Fingers placed on ziphoid process
 Correction of recession on canine tooth:

o Lateral reposition/ sliding flap
 KAPOSI’S SARCOMA- HHV8. SEEN AS A SINGLE RED NODULE.
Kaposi's sarcoma (KS) is a rare, multifocal, vascular neoplasm; it was originally

described in 1872 as occurring in the skin of the lower extremities of older men of
Mediterranean origin. Its cause is unknown, although sexually transmitted viral infection
has been suspected. Recently, a new strain of herpes virus has been identified as closely
associated with KS. This virus was originally named the KS-herpes virus but has now
been designated as human herpes virus-8 (HHV-8). HHV-8 has been associated both with
AIDS-related and non-AIDS-related KS.114 However, HIV-infected individuals are 7000-
fold more likely to develop KS
Although KS is a malignant tumor, in its classic form it is a localized and slowly growing
lesion. The KS that occurs in HIV-infected patients presents different clinical features. In
these individuals, it is a much more aggressive lesion and the majority (71%) develop
lesions of the oral mucosa, particularly the palate and gingival. The oral cavity may often
be the first or only site of the lesion. GUESS it can occur on the tongue…
(Newman, Michael G. Newman. Carranza's Clinical Periodontology, 9th Edition. Elsevier, 2002. 29.4.3).
 AIDS and the oral cavity

AIDS and the periodontium. A, Hairy leukoplakia on the lateral margin of the tongue,
causing a corrugated appearance. B, Painless ANUG-like lesion of several months'
duration. The patient had a second ANUG-like lesion that was painful. C-E, ANUG-like
lesion and candidiasis of the palate and tongue in a 29-year-old woman. F, Kaposi's
sarcoma involving the anterior hard palate and right and left palatal mucosa. Candidiasis
is also noted on the hard palate. G, Same patient as in F, with Kaposi's sarcoma of the
labial gingiva presenting as a small purple nodule next to a parulis. H, Kaposi's sarcoma
involving the anterior facial gingiva and producing a gingival enlargement. (Courtesy Dr.
Frank Lucatorto.)
(Newman, Michael G. Newman. Carranza's Clinical Periodontology, 9th Edition. Elsevier, 2002.). <vbk:0-7216-8331-2#P32>
 OSTEORADIONECROSIS
FIG. 18-2
Progressive course of osteoradionecrosis. A, Radiograph showing radiolucencies in
right mandible and around apex of molar tooth. B, Six months later, during which time
antibiotics and local irrigations were used, radiolucent process is spreading into ramus.
Molar was removed at this time. C, Five months after tooth removal, extraction site did
not heal and destructive process spread, resulting in pathologic fracture of mandible. D,
Radiograph after removal of devitalized bone, showing extent of process. (Courtesy Dr.
Richard Scoot, Ann Arbor, MI.)
(Peterson, Larry J. Peterson. Contemporary Oral and Maxillofacial Surgery, 4th Edition. Elsevier, 2002.).
Interval Between Preirradiation Extractions and Beginning of

Radiotherapy>>>No categorical answer exists to the question of how much time
should be allowed after extractions before beginning radiotherapy. Obviously, the sooner
radiotherapy is begun, the more beneficial it may be. Thus when the soft tissues have
healed sufficiently, radiotherapy may begin. Traditionally, 7 to 14 days between tooth
extraction and radiotherapy have been suggested.7,12,13 Most authors base their
recommendations on the clinical impression that reepithelialization has occurred in this
period. However, radiotherapy should be delayed for 3 weeks after extraction, if possible.
This helps to ensure that sufficient soft tissue healing has occurred. The radiotherapy
should be delayed further, if possible, if a local wound dehiscence has occurred. In this
instance daily local wound care with irrigations and postoperative antibiotics are
mandatory until the soft tissues have healed.
(Peterson, Larry J. Peterson. Contemporary Oral and Maxillofacial Surgery, 4th Edition. Elsevier, 2002. 23.1.9).
 BLOOD PRESSURE GUIDE
129-139/ 80-89 ok for dental care

140-159/ 90-99 ok for dental care; sedation; med consult
160-179/ 100-109 ok for dental care; sedation; med consult
(that’s only if they don’t have any med problems)
180-209/ 110-119 no dental tx
(that’s only id they don’t have any med problems)
>209/ >119 GO TO EMERGENCY ROOM; no dental tx
-----------------------------------------------------------------------------------------
 ECTODERMAL DYSPLASIA
FIGURE 5-10
A, a child with ectodermal dysplasia, in addition to the characteristic thin and
lightcolored hair, is likely to have an overclosed appearance because of lack of
development of the alveolar processes; B, panoramic radiograph of the same boy,
showing the multiple missing teeth. Oligodontia of this extent is almost pathognomonic
of ectodermal dysplasia.
(Proffit, William R. Proffit. Contemporary Orthodontics, 3rd Edition. Elsevier, 1999.).
NOTE ALSO: the periorbital hyperpigmentation, reduces density or eyebrow and

eyelash hair. The midface is also underdeveloped. Teeth also abnormally shaped:
>their crown shapes are characteristically abnormal (Figure 16-3). The incisor
crowns usually appear tapered, conical, or pointed, and the molar crowns are
reduced in diameter. Complete lack of tooth development (anodontia) has also
been reported, but this appears to be uncommon.
(Neville, Brad Neville. Oral and Maxillofacial Pathology, 2nd Edition. Elsevier, 2002. 16.1.1).
 Immediate denture things
Opposing premolars may be retained to preserve the vertical dimension of

occlusion, although canines or other anterior teeth may provide the required so-
called centric or vertical stops. Any other required hard and soft tissue operation is
also usually done at this first surgical visit. Examples include tori reduction,
tuberosity reduction, and frenectomy.
These posterior extraction and other operatedon areas are allowed to heal for a short
time, usually only 3 to 4 weeks, before the preliminary impressions are made.
(Zarb, George A. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th Edition. Elsevier, 2003. 9.5.1).
 MEDIAN RHOMBOID GLOSSITIS
Other forms of erythematous candidiasis are usually asymptomatic and chronic.

Included in this category is the condition known as central papillary atrophy of
the tongue, or median rhomboid glossitis. In the past, this was thought to be a
developmental defect of the tongue, occurring in 0.01% to 1.00% of adults. The
lesion was supposed to have resulted from a failure of the embryologic tuberculum
impar to be covered by the lateral processes of the tongue. Theoretically, the
prevalence of central papillary atrophy in children should be identical to that seen in
adults; however, in one study in which 10,000 children were examined, not a single
lesion was detected. Other investigators have noted a consistent relationship
between the lesion and C. albicans, and similar lesions have been induced
experimentally on the dorsal tongues of rats.
(Neville, Brad Neville. Oral and Maxillofacial Pathology, 2nd Edition. Elsevier, 2002. 6.1.1).
 Middle third of root fracrure

FIG. 21-48.
A, Root fracture in middle third of root with a 5-mm separation of the parts. B,
Approximately 1 hour after the injury the coronal portion of the tooth had been
repositioned under local anesthesia with finger pressure. The mesial-incisal-labial areas
of both central incisors were etched and self-curing resin was applied to hold the tooth in
position while this radiograph was made to confirm proper reapproximation of the
fractured root surfaces. C, Appearance of stabilized left central incisor at the time
radiograph was made to confirm good reapproximation. After satisfactory repositioning
was confirmed, the tooth was further stabilized using the bonded resin and wire
technique. This injury did not result in significant soft tissue trauma, and hemorrhage was
controlled easily. D and E, Radiograph and photograph reveal satisfactory progress 2
weeks after the injury. F, Nine months after the injury the tooth was vital, sound in the
alveolus, and asymptomatic.
(McDonald, Ralph E. McDonald. Dentistry for the Child and Adolescent, 8th Edition. Elsevier, 2004.).
 Fracture in the apical portion of root
FIG. 21-47.
A, Root fracture is evident in the apical half of the central incisor, but parent did not seek
treatment until 2 weeks after the injury. The tooth was stabilized with a splint for 1
month. B, The tooth responded favorably to pulp testing and had this radiographic
appearance 1 month later. C, More than 2 years had elapsed when this radiograph
revealed a normal periapical appearance. The tooth responded normally to vitality tests,
and there was slight mobility but no sensitivity to percussion.
(McDonald, Ralph E. McDonald. Dentistry for the Child and Adolescent, 8th Edition. Elsevier, 2004.).
 Note that bruising is pften a sign of thrombocytopenia so we must do a bleeding

time test for a patient that has black and blue spots undr eyes.
 Telangiectasias on tongue
FIGURE 6-3 Multiple small purple papules of
hereditary hemorrhagic telangiectasia.
(Greenberg, Martin S. Greenberg. Burket's Oral Medicine Diagnosis and Treatment, 10th Edition. BC Decker, 2002. 6.1.5).
The lesions represent multiple microaneurysms, owing to a weakening defect in the

adventitial coat of venules. The lesions are so distinct as to be pathognomonic.
There may be more than 100 such purple papules on the vermilion and mucosal
surfaces of the lips as well as on the tongue and buccal mucosa. The facial skin and
neck are also involved. Examination of the nasal mucosa will reveal similar lesions,
and a past history of epistaxis may be a complaint. Indeed, deaths have been
reported in HHT attributable to epistaxis. The lesions may be seen during infancy
but are usually more prominent in adults.
 Basal cell carcinoma (seen here in plates 8,9,

and 10)
Plate I.
1, Squamous cell carcinoma. 2, Same lesion as 1. 3, Squamous cell carcinoma. 4,
Squamous cell carcinoma. 5, Squamous cell carcinoma. 6, Squamous cell carcinoma. 7,
Squamous cell carcinoma. 8, Basal cell carcinoma. 9, Basal cell carcinoma. 10, Basal cell
carcinoma. 11, Adenoid cystic carcinoma. 12, Malignant mixed tumor of the parotid
gland. (5 courtesy S. Silverman, San Francisco; 11 courtesy D. Smith, North Conway, NH.) (Wood, Norman K. Wood.
Differential Diagnosis of Oral & Maxillofacial Lesions, 5th Edition. Elsevier, 1997.).
Rinn system
Rinn XCP film-holding instrument. (Courtesy Dentsply Rinn, Elgin, Ill.)

(White, Stuart C. White. Oral Radiology, 5th Edition. Elsevier, 2003.).
a film-positioning device with aiming capability made from a combination of plastic

and stainless steel that is especially suited to the paralleling technique.
(Mosby. Mosby's Dental Dictionary. Elsevier, 2004.).

2008 Dsce-Study Guide

Uploaded by

Copyright:

Available Formats

You might also like

2008 Dsce-Study Guide

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

2008 Dsce-Study Guide

Uploaded by

Copyright:

Available Formats

2008 (updated) DSCE QUESTIONS & STUDY GUIDE 1

References & Editing by Jodi Pessoa, Marlin & Alan Walker

2. Cyclosporine is an immunosuprressant used in transplant patients. This drug

is known to cause gingival hyperplasia

3. Perio diseases effect on glucose levels 

 NSAIDs like Ibuprofen and Naproxen

one that will be safe to use in a patient with renal disease.

Contraindication to hyperthyroidism is CATECHOLAMINES (epinephrine)

TETRACYCLINE STAINING – “The stain can be slight, appearing gray or yellow

Figure 16-25 Fluorosis.

 AMELOGENESIS IMPERFECTA – soft and thin enamel. Yellow- brown dut to

this thin enamel and dentin shows through

 DENTINOGENESIS IMPERFECTA- gray to brown OPALESCENT HUE.

3#F350> Pontic Design

TABLE 20-1 Pontic Designs

Replacement of #20 clearly would require a modified ridge lap pontic!

 Leukemia in the 14 y/o will probably present like this:

 Autoclave: 121 degrees at 15-20 psi for 20 mins

o Check for b. Stearothermophillus

o Once a week testing must be done

 Rectangular collimation – reduces radiation

 Varicose tongue / lingual varicosities

 Vasotec is the rand name of enalapril (ace inhibitor) used in hypertension

 Loss of lamina dura:

o Periapical and lateral radicular cysts

EAGLE'S SYNDROME. A, An extremely long and calcified styloid process is

o Palm of hand placed on the lower part of sternum

o Fingers placed on ziphoid process

 Correction of recession on canine tooth:

 KAPOSI’S SARCOMA- HHV8. SEEN AS A SINGLE RED NODULE.

Kaposi's sarcoma (KS) is a rare, multifocal, vascular neoplasm; it was originally

 AIDS and the oral cavity

Interval Between Preirradiation Extractions and Beginning of

 BLOOD PRESSURE GUIDE

129-139/ 80-89 ok for dental care

160-179/ 100-109 ok for dental care; sedation; med consult

(that’s only if they don’t have any med problems)

180-209/ 110-119 no dental tx

(that’s only id they don’t have any med problems)

>209/ >119 GO TO EMERGENCY ROOM; no dental tx

NOTE ALSO: the periorbital hyperpigmentation, reduces density or eyebrow and

Opposing premolars may be retained to preserve the vertical dimension of

 MEDIAN RHOMBOID GLOSSITIS

Other forms of erythematous candidiasis are usually asymptomatic and chronic.

 Middle third of root fracrure

 Fracture in the apical portion of root

 Note that bruising is pften a sign of thrombocytopenia so we must do a bleeding

The lesions represent multiple microaneurysms, owing to a weakening defect in the

 Basal cell carcinoma (seen here in plates 8,9,

Rinn XCP film-holding instrument. (Courtesy Dentsply Rinn, Elgin, Ill.)

a film-positioning device with aiming capability made from a combination of plastic

You might also like