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Fellowship Exam Study Guide 2020 Critiques

The Critiques section of the Fellowship Exam Study Guide has been designed to provide you with a means to review the
questions, answers, and descriptions of why the correct answer is correct and why the other answers are incorrect.

◊ To view a complete list of references, click on the References tab.

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Anesthesia, Sedation, Pain Management & Pharmacology

1. Anesthesia of mandibular teeth in adults by the infiltration method would be achieved best by the use of:

A. 1.8 mL of Prilocaine 4% + epinephrine 1:100,000.

B. 1.8 mL of Bupivacaine 0.5% + epinephrine 1:200,000.
C. 1.8 mL of Mepivacaine 2% + levonordefrin 1:20,000.
D. 1.8 mL of Articaine 4% + epinephrine 1:100,000.

Correct Answer: (D) 1.8 mL of Articaine 4% + epinephrine 1:100,000.

Articaine 4% with 1:100,000 epi was introduced in June 2000. Four well designed studies showed articaine to be
more successful in achieving adequate anesthesia than lidocaine in mandibular teeth. One theory is that articaine
is more effective due to it’s higher concentration. The second theory is that articaine has a thiophene ring that
enables it to diffuse more effectively than the other local anesthetics that have a benzene ring.

◊ Malamed, 6th ed., p. 272

2. Which of the following statements is true regarding an overdose of local anesthesia?

A. Injecting using a 30 gauge needle should be done to limit the rate of injection.
B. Most overdoses occur when using no vasoconstrictor.
C. Injection of a carpule of anesthetic should be done over a 30 second time frame.
D. Most overdoses occur in elderly patients.

Correct Answer: (B) Most overdoses occur when using no vasoconstrictor.

In most cases where local anesthetic overdose occurred in children being administered a “plain drug”, usually use
of epinephrine would delay the absorption of the anesthetic and decrease the risk of an overdose. The size of the
needle and the speed of the injection would not have an effect on overdosing.

◊ Malamed, 6th ed., p. 318

3. The ability to titrate medication, predictability, and the ability to provide amnesic properties best describes
__________ sedation.

A. intramuscular
B. oral
C. intravenous
D. subcutaneous

Correct Answer: (C) intravenous

Intravenous sedation is the most effective method of ensuring predictable & adequate sedation in patients. It has a
short latent period, it can be titrated, and drugs can be administered that will have an amnesic period of varying
duration. Intramuscular & subcutaneous both have slow rates of resorption & can’t be titrated. Intramuscular and
subcutaneous medication cannot be reversed quickly. Oral sedation can be unpredictable and not easily titrated in
some patients.

◊ Malamed, 6th ed., p. 19

4. Inhalation of N2O/O2 allows for cognitive recovery with 100% pure oxygen for a minimum of __________ minutes
after termination of the drug.

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A. five (5)
B. ten (10)
C. thirty (30)
D. sixty (60)

Correct Answer: (A) five (5)

Inhalation of N2O/O2 allows for cognitive recovery with 100% pure oxygen for a minimum of 5 minutes after
termination of the drug. Depending on patient assessment, individual recovery time may vary. Post operative
oxygenation remains an extremely important concept of recovery. Generally, emergence (recovery) is a mirror
image of induction. The mirror image includes patients returning to their original emotional state, as well as
recovering from the pharmacologic action of the drug. Physiologically, recovery occurs the same way for any
individual. N2O is principally exhaled unchanged from the lungs. N2O provides a rapid onset of clinical signs and a
correlated rapid emergence will occur.

◊ Clark & Brunick, 4th ed., pp. 29-30, 137

5. Pain control of the entire primary dentition can be achieved with approximately two cartridges of local anesthetic.
The most recommended drug in this case is:

A. 4% articaine + epinephrine.
B. 3% mepivicaine.
C. 2% lidocaine + epinephrine.
D. 2% mepivicaine + levonordephrine.

Correct Answer: (C) 2% lidocaine + epinephrine.

Pain control for the entire primary dentition can be achieved with approximately two cartridges of local anesthetic.
In the smaller child patient, there is rarely a compelling need to administer a 1.8 ml volume of local anesthetic in
any one injection. As a rule, the pediatric dentist administers anesthetic without vasoconstrictor only when
treatment is limited to one quadrant. If treatment extends to two or more quadrants in one visit, a vasopressor-
containing local anesthetic is selected. In many instances, where death resulted, a total of 5, 6 or 7 cartridges of
anesthetic without vasoconstrictor had been administered. The maximum recommended dose by the FDA of
lidocaine with or without epinephrine is 3.2 mg/lb or 7.0 mg/kg of body weight for the adult and pediatric patient.

◊ Malamed, 6th ed., p. 319

6. Diffusion hypoxia can be prevented by:

A. a gradual reduction of the nitrous oxide/oxygen concentration.

B. using a less than 20% nitrous oxide/oxygen concentration.
C. starting induction of sedation with 100% oxygen for 3-5 minutes.
D. administering 100% oxygen for 3-5 minutes after cessation of nitrous oxide.

Correct Answer: (D) administering 100% oxygen for 3-5 minutes after cessation of nitrous oxide.
High concentrations of nitrous oxide may result in a considerable accumulation of dissolved gas within the body,
and when the administration is stopped, large amounts of nitrous oxide diffuse from the blood into the lung alveoli,
diluting oxygen. This “diffusion hypoxia” can be prevented by administering 100% oxygen for 3-5 minutes after the
cessation of nitrous oxide.

◊ Yagiela, 6th ed., p. 283

7. The only vasoconstrictor used in local anesthetics that is contraindicated with concomitant MAO inhibitor therapy
is:

A. phenylephrine.
B. norepinephrine.
C. epinephrine.
D. levonordetrin.

Correct Answer: (A) phenylephrine.

Despite statements to the contrary in local anesthetic product information approved by the FDA, local anesthetics
containing epinephrine may be used without special reservation in patients taking monoamine oxidase (MAO)
inhibitors. Exogenous catecholamines are mostly degraded by the enzyme catechol-o-methyltransferase; inhibition
of MAO has little impact on their respective fates or cardiovascular actions. Of the vasoconstrictors used with local
anesthetics, only phenylephrine is contraindicated with concomitant MAO therapy.

◊ Yagiela, 6th ed., p. 258

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Biomaterials Top

8. All of the following statements about chemically activated (self cure) resins are true except one. Which is the
exception?

A. They have long term storage stability.

B. They can yellow with age.
C. The degree of cure is equal if mixed properly.
D. Marginal stress buildup is much higher than for photocured resins.

Correct Answer: (D) Marginal stress buildup is much higher than for photocured resins.
Advantages of self-cure resins: 1) convenience and simplicity - no equipment needed, hazard free; 2) long-term
storage stability; 3) manipulation of working/setting time by varying proportion; 4) degree of cure equal throughout
material if mixed properly; 5) marginal stress build-up during curing is much lower than for photocured resins
owning to relatively slower rates of cross-link formation.

Disadvantages of self-cure resins: 1) mixing causes air entrapment, leading to porosity that weakens the material
& increases susceptibility to staining. This has been reduced by the use of mixing syringes; 2) aromatic amine
accelerators oxidize and turn yellow with time - i.e., color instability; 3) difficult to mix evenly causing unequal
degree of cure & consequently poor mechanical properties.

◊ Anusavice, 12th ed., p. 287

9. There are extremely sensitive methods for detecting mercury in parts per trillion. There is no data to show that the
mercury released from dental amalgam is harmful to the general population.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

Humans are exposed to mercury from a variety of sources in addition to dental amalgams. There are extremely
sensitive methods for detecting mercury in parts per trillion; these methods have made it possible to analyze the
sources of mercury exposure to humans. Numerous studies have attempted to determine whether mercury
exposure from dental restorations or other sources contributes to any documentable health problem. Several
studies have estimated the number of amalgam surfaces needed to expose an individual to mercury
concentrations with a minimum observable effect (slightly impaired psychomotor performance, detectable tremor
and impaired nerve conduction velocity). Estimates are that several hundred amalgam surfaces would be
necessary to achieve these levels. Other studies have measured renal function in patients whom all of amalgam
was removed at the same time (the worst possible case). Despite markedly elevated blood plasma and urine
levels of mercury, no renal impairment was noted. There is simply no data to show that mercury released from
dental amalgam is harmful to the general population.

◊ Anusavice, 12th ed., p. 125

10. A dental bonding system has all of the following essential functions except one. Which is the exception?

A. Provides resistance to separation of a substrate from a restorative material.

B. Distributes stress along bonded interfaces.
C. Provides thermal insulation between materials.
D. Seals the interface.

Correct Answer: (C) Provides thermal insulation between materials.

Bonding and adhesion comprise a complex set of physical, chemical & mechanical mechanisms that allow the
attachment & binding of one substance to another.
3 Essential Functions of a Dental Bonding System:
1) Provides resistance to separation of an adherent substrate (i.e., enamel, dentin, metal composite, ceramic) from
a restorative or cementing material;
2) Distributes stress along bonded interfaces; and
3) Seals the interface via adhesive bonding between dentin and/or enamel and the bonded material, thus
increasing resistance to micro-leakage and decreasing the risk of postoperative sensitivity, marginal staining, and
secondary caries.

◊ Anusavice, 12th ed., p. 258

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11. The success of endosseous dental implants is based on the biocompatibility of the implant surface and the
ingrowth of new bone into the surface through the process of osseointegration. There are many implant materials
or implant coatings that promote osseointegration.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (C) The first statement is TRUE; the second is FALSE.
The general process of bio-integration involves adaptation of bone or other tissue to the implanted materials
without any intervening space along the tissue-material interface. The success of endosseous dental implants is
based on the biocompatibility of the implant surface and the ingrowth of new bone at the tissue-material interface
through the process of osseointegration. Very few implant materials or implant surface coatings promote
osseointegration. The most common implant materials include:
1) Commercially Pure Titanium (CPT)
2) Titanium-Aluminum-Vanadium Alloy
3) Tantalum
4) Some types of Ceramics
Some materials, such as bio-glass ceramics, promote a perfect osseointegratoin of the bone.

◊ Anusavice, 12th ed., p. 123

12. Currently, the etching time for most 37% phosphoric acid etching gels is approximately _________ seconds.

A. 5
B. 10
C. 15
D. 20

Correct Answer: (C) 15

The etching time for most etching gels is approximately 15 seconds. The advantage of such short etching time is
that they yield acceptable bond strength while conserving enamel and reducing treatment time.

◊ Anusavice, 12th ed., p. 261

13. The opacity/translucency of a light-cured composite can affect curing times. The particle size of a light-cured
composite does not affect the curing time.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (C) The first statement is TRUE; the second is FALSE.
All optical modifiers affect light transmission through a composite. Darker shades and greater opacities have a
decreased depth of light-curing ability and require either an increased exposure time or a thinner layer when
cured. Above 100 nm, particles begin to scatter visible light and reduce the translucency and depth of cure of the
composite.

◊ Anusavice, 12th ed., pp. 285-291

14. Which dental cement exhibits the smallest film thickness?

A. Zinc Phosphate
B. Glass Ionomer
C. Zinc Polycarboxylate
D. Compomer

Correct Answer: (A) Zinc Phosphate

Cement Film Thickness:
1. Zinc phosphate (20 μm)
2. Glass ionomer (24 μm)
3. Zinc polycarboxylate (21 μm)
4. Compomer (36 μm)

◊ Anusavice, 12th ed., p. 311

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Dental Imaging Top

15. CBCT imaging is the preferred imaging modality to evaluate condylar fractures. This is because there is no
superimposition of adjacent structures and TMJ reformats provide images in customizable planes.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

CBCT imaging is the preferred imaging modality to evaluate condylar fractures because there is no
superimposition of adjacent structures and TMJ reformats provide images in customized planes. If CBCT imaging
is unavailable, multiple right-angle plain film skull projections from the lateral frontal and basilar aspects may be
used.

◊ White & Pharoah, 7th ed., p. 516

16. With pantomographs, magnification across the image is fairly equal with newer units. Therefore, linear
measurements could be used in some cases.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (B) Both statements are FALSE.

Disadvantages of panoramic images is magnification across the image is unequal making linear measurements
unreliable. Other disadvantages are lower resolution images that do not provide the fine details provided by
intraoral radiographs. It is important to have accurate patient positioning to avoid positioning errors and artifacts
and if the patient has severe maxillomandibular discrepancy to get an image of both jaws.

◊ White & Pharoah, 7th ed., p. 168

17. Which of the following is the most difficult to possibly eliminate radiographically in the differential diagnosis of a
dentigerous cyst?

A. Hyperplastic follicle
B. Ameloblastic fibroma
C. Keratocystic odontogenic tumor
D. Cystic amelobastoma

Correct Answer: (A) Hyperplastic follicle

Dentigerous cysts are the second most common type of cyst in the jaws. They develop around the crown of an
unerupted or supernumerary tooth. The patient typically has no pain or discomfort. One of the most difficult
diagnoses is between a small dentigerous cyst and a hyperplastic follicle. If uncertainty remains, the region should
be reexamined in 4 to 6 months to detect any increase in size. If the follicle space exceeds 5 mm, a dentigerous
cyst is more likely.

◊ White & Pharoah, 7th ed., p. 338

18. Differentiation of internal or external root resorption can best be determined by:

A. using a panoramic radiograph as the primary imaging modality.

B. noting that external resorption moves with respect to the canal with additional PA images.
C. evaluating an occlusal view for any mandibular teeth in question.
D. using an electric pulp tester to evaluate pulpal vitality.

Correct Answer: (B) noting that external resorption moves with respect to the canal with additional PA images.
Internal resorption characteristically appears as an expansion of the pulp chamber or canal. In the case of external
resorption, the image of the normal intact pulp chamber or canal may be traced through the radiolucent area of
external resorption. Also, projections made at different angles can be compared. The location of the radiolucency
caused by external resorption moves with respect to the pulp canal, whereas the image of internal resorption
remains fixed to the canal.

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◊ White & Pharoah, 7th ed., p. 605

19. A residual cyst is best defined as a/n:

A. growth from a dentingerous cyst completely removed.

B. radicular cyst left behind following an extraction.
C. aberrant keratocystic odontogenic tumor.
D. misinterpreted Stafne bone cyst.

Correct Answer: (B) radicular cyst left behind following an extraction.

A residual cyst is a cyst that remains after incomplete removal of the original cyst. The term residual is used most
often for a radicular cyst that may be left behind, most commonly after extraction of a tooth.

◊ White & Pharoah, 7th ed., pp. 336-338

20. A panoramic radiograph of a 15-year-old boy reveals an asymptomatic radiolucency between the mandibular
second premolar and first molar, unilaterally. The margin of the lesion is well defined and extends superiorly
between the roots of the teeth. There is no buccal expansion; all teeth are vital and noncarious. The radiographic
findings are most consistent with a(n):

A. complex odontoma.
B. lateral periodontal cyst.
C. traumatic bone cyst.
D. ameloblastoma.

Correct Answer: (C) traumatic bone cyst.

A complex odontoma has a well defined margin but contains tooth-like radiopaque structures. A lateral periodontal
cyst is well defined, but displaces roots and teeth and causes expansion of bone. An ameloblastoma can be
unilocular, slow growing, displaced teeth, thins and expands bone. A traumatic bone cyst is unusual for expansion,
margins are smooth, and scallops between roots and teeth. It has no effects on position of teeth.

◊ Neville, 4th ed., pp. 589-591, 645-647, 653-661, and 674

Endodontics Top

21. A patient presents for emergency treatment of pain associated with the permanent mandibular first molar. There is
a history of pain when drinking cold liquids. Mesial and distal caries appear radiographically to extend through the
dentino-enamel junction. Heat and cold stimuli both promote prolonged painful responses for at least a minute
following removal of the stimulus. The diagnosis is consistent with:

A. reversible pulpitis.
B. cracked tooth syndrome.
C. irreversible pulpitis.
D. physiologically normal pulp.

Correct Answer: (C) irreversible pulpitis.

Teeth with irreversible pulpitis exhibit intermittent or spontaneous pain, where extreme temperatures, especially
cold, elicit intense and prolonged episodes of pain, even after the stimulus is removed. Reversible pulpitis teeth
show sensitivity to cold or osmotic changes. Normal teeth are asymptomatic with no objective pathosis.

◊ Hargreaves, 11th ed., p. 707

22. In avulsed mature teeth, root canal therapy with calcium hydroxide should be initiated:

A. immediately after replantation and stabilization.

B. at the first evidence of root resorption.
C. before the teeth are replanted.
D. 7-10 days after the injury.

Correct Answer: (D) 7-10 days after the injury.

Root canal therapy should take place 1 to 2 weeks after the trauma. The focus of the root canal is prevention or
elimination of potential irritants from the root canal space. Semi-rigid fixation for 1-2 weeks is recommended. A
splint, that allows for physiological movement of the avulsed tooth during healing and is in place for a minimal
period, results in decreased incidence of ankylosis.

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◊ Hargreaves, 11th ed., p. 787

23. Infections causing swelling of the buccal space in the posterior cheek area are commonly associated with all of the
following teeth except one. Which is the exception?

A. Mandibular first molars

B. Mandibular second premolars
C. Maxillary first premolars
D. Maxillary canines

Correct Answer: (D) Maxillary canines

The buccal space is the potential space between the buccal cortical plate, the overlying mucosa, and the
buccinator muscle. The source of infection can be either a posterior mandibular or maxillary molar or premolar.
The infraorbital or canine space is defined as the potential space between the levator labii superioris muscle and
the levator anguli oris muscle. The source of infection of the infraorbital space is most often the maxillary canine or
the first maxillary premolar.

◊ Hargreaves, 11th ed., pp. 713-715

24. All of the following will potentially create failure in the instrumentation of an anterior root canal if straight line
access is not achieved except one. Which is the exception?

A. Separation of an instrument due to deflection

B. Creation of a ledge in the canal
C. Zipping of the canal at the apical foramen
D. Creation of a lingual shoulder in the canal

Correct Answer: (D) Creation of a lingual shoulder in the canal

Ledges may be created as a result of radicular transportation, which also causes zipping of the canal and possible
canal perforation. A ledge is an artificial irregularity created on the surface of the root canal wall that impedes the
placement of an instrument to the apex. A common cause for instrumentation separation is improper use, including
the use of a large instrument in a curved canal.

◊ Hargreaves, 11th ed., pp. 725-726, 733

25. All of the following statements are true of a tooth exhibiting pulpal necrosis except one. Which is the exception?

A. May respond to percussion

B. May be left open for drainage
C. May not respond to a vitalometer
D. May show a radiolucent area at the apex

Correct Answer: (B) May be left open for drainage

Necrotic Pulp Fundamentals:
The tooth will usually not respond to electric pulp testing.
After the pulp becomes necrotic, bacterial growth can be sustained.
The tooth may become symptomatic to percussion or exhibit spontaneous pain.
Radiographic changes may occur ranging from a thickening of the periodontal ligament space to the
appearance of a periapical radiolucent lesion.
Leaving teeth open between appointments is not recommended.

◊ Hargreaves, 11th ed., pp. 2 and 717

26. Sodium hypochlorite (NaOCL) can be diluted from 5.25% to 2.6% solution for endodontic irrigation. The weaker
solution is as effective in killing bacteria as the stronger solution.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

Sodium hypochlorite (NaOCL) is used in concentrations between 0.5% and 6% for root canal irrigation. Clinical
studies have indicated both low and high concentration to be equally effective in reducing bacteria from the root
canal system. NaOCL in higher concentrations has better tissue-dissolving ability. Higher concentrations of

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NaOCL are more toxic than lower concentrations. If lower concentrations are used, it is recommended that the
solution be used in higher volume.

◊ Hargreaves, 11th ed., p. 253

27. Considering the possible complications of removing a separated instrument with the ultrasonic technique, it is best
to:

A. not attempt a removal; obturate with a heated gutta percha and vertical condensation.
B. block or obturate the non-involved canals first.
C. fill the other canals with calcium hydroxide.
D. enlarge the orifice of the affected canal to a diameter three times that of the broken instrument.

Correct Answer: (B) block or obturate the non-involved canals first.

It is prudent to cover, block or obturate the orifices of the adjacent open canals with cotton or paper points to
prevent the removed file fragment from falling into them causing further case complication. It is the presence of
any necrotic & infected pulp tissue that remains in the apical canal that determines the prognosis so if present then
the file can be removed without excessive over enlargement of the canal or causing an additional iatrogenic
mishap.

◊ Hargreaves, 11th ed., pp. 364-365

28. Making an endodontic diagnosis can be difficult because there are several pain disorders that can refer pain to the
teeth. Which of the following groups of non-odontogenic disorders is most likely to cause tooth pain?

A. Neurovascular or headache pain

B. Neuropathic pain
C. Psychogenic pain
D. Myofascial pain

Correct Answer: (D) Myofascial pain

Characteristics of Non-Odontogenic Sources of Tooth Pain
1. Neurovascular pain has qualities similar to pulpal pain.
2. Neuropathic pain actually arises from abnormalities in the neural structures themselves.
3. Psychogenic pain is known to be precipitated by severe psychological stress. Structures most often
affected include headache, back pain, stomach pain.
4. Although any deep somatic tissue type pain in the head and neck has the propensity to evidence
central excitatory effects therefore cause referral of pain to the teeth.
5. Pains of muscular origin appear to be the most common.

◊ Hargreaves, 10th ed., pp. 55-56

29. Which of the following aids is most helpful in diagnosing irreversible pulpitis?

A. A good medical history

B. Electric vitality tests
C. Thermal stimulation
D. Examining for mobility

Correct Answer: (C) Thermal stimulation

Cold testing is the primary pulp testing used by clinicians. Frozen carbon dioxide has been found to be useful in
eliciting a positive response if vital tissue is present within the tooth. This is superior to electric testing. Mobility
does not indicate pulpal vitality. Heat testing is most useful when the chief complaint is intense pain upon contact
with any hot liquid or food. Medical history has no bearing on pulpal vitality.

◊ Hargreaves, 11th ed., pp. 15-17

Environmental, Workplace Safety & Infection Control Top

30. The bacterium that causes strep throat also causes necrotizing fascitis and:

A. tuberculosis.
B. diphtheria.

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C. scarlet fever.
D. chickenpox.

Correct Answer: (C) scarlet fever.

Streptococcus pyogenes causes streptococcal pharyngitis (strep throat) and scarlet fever. S. pyogenes is spread
by droplet infection from mouth to mouth. Certain protease-producing strains of S. pyogenes can cause a condition
called necrotizing faciitis which produces rapidly spreading damage to muscle tissue.

◊ Miller C. & Palenik, 5th ed., p. 61

31. For a patient receiving hemodialysis requiring dental treatment on an outpatient basis, all of the following should
be followed except one. Which is the exception?

A. Consider antimicrobial prophylaxis

B. Treatment should be performed on the same day as hemodialysis
C. Avoid use of acetaminophen
D. Have topical anticoagulants available for use

Correct Answer: (B) Treatment should be performed on the same day as hemodialysis
The dentist should provide dental treatment at the optimum time, usually on the day after hemodialysis because on
the day of dialysis, patients typically are fatigued and may have a tendency to bleed. The activity of heparin lasts
for 3-6 hours of infusion and delay of treatment is prudent until that medication is eliminated from the blood stream.

◊ Little, 8th ed., p. 198

Esthetics Top

32. When planning a CAD/CAM restoration in the anterior dentition, the minimal amount of incisal reduction necessary
to develop esthetics is __________ mm.

A. 1
B. 2
C. 3
D. 4

Correct Answer: (B) 2

The shared preparation principles in the anterior and posterior region for all CAD/CAM systems include an
incisal/occlusal reduction of 1.5 to 2.0 mm. These are the minimal amounts of reduction that are acceptable.
Increasing the amount of incisal reduction in the anterior region to 2 mm gives the dental technician more room to
develop esthetics.

◊ Terry, 3rd ed., p. 49

33. All of the following are indications for placement of direct composite veneers except one. Which is the exception?

A. Patient wishes minimal financial investment

B. Mild discoloration
C. Patient needs correction of significant tooth malpositioning
D. Small-to-moderate-sized carious lesions

Correct Answer: (C) Patient needs correction of significant tooth malpositioning

Advantages of Direct Composites Veneers versus Porcelain Veneers

1. More conservative option

2. Non-invasive
3. Immediate results
4. No lab expense
5. More predictable because they are done chairside.

◊ Freedman, pp. 406-407

34. The average incisal display of the maxillary central incisors of 20-year-old females in repose is__________ mm.

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A. 0.5
B. 1-2
C. 3-4
D. 5-6

Correct Answer: (C) 3-4

The average incisal display of the maxillary central incisors in young females is 3-4 mm. The average display of
young males is 1-2 mm. The average length of the maxillary incisor is 10-11 mm. The lip will lengthen 1 mm per
decade after the age of 40.

◊ Robbins, p. 4

35. Hue, value, and chroma are very important in shade determination. Value is the most important feature that the
eye picks up most readily.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

The true shade of a tooth is in the middle third and that is the principal area against which the shade guide is
matched. The hue is the color, the chroma is the intensity or saturation of the color, and the value is the amount of
darkness or lightness (lightness level). The value is the feature the eye picks up most readily.

◊ Freedman, p. 150

Implantology Top

36. The ideal minimum distance between an implant and the adjacent root is _____ mm.

A. 0.5
B. 1.0
C. 1.5
D. 2.0

Correct Answer: (C) 1.5

Implants positioned too close to a tooth risk damage to the periodontal ligament and surrounding structures. This
may cause displacement of bone into the periodontal ligament (PDL) space and result in altered blood supply to
the adjacent tooth, loss of tooth vitality, apical periodontitis, and internal or external resorption. Implants that are
placed too close to an adjacent tooth may fail due to infection or bone resorption. If more than 1.5 mm of space
exists between the implant and the adjacent tooth, any bony defect around an implant will remain a vertical defect
and will usually not cause bone loss on the adjacent natural tooth. If bone loss around an implant is less than 1.5
mm then the bone on the adjacent tooth will maintain the interdental papilla height.

◊ Resnick, 1st ed., p. 234

37. With immediate implant placement, the implant-bone interface is weakest and at most risk of overload at 3 to 6
weeks after surgical insertion. At 4 months the bone is still only _____ % mineralized, organized lamellar bone.

A. 20
B. 40
C. 60
D. 80

Correct Answer: (C) 60

The implant-bone interface is weakest and most at risk of overload at 3 to 6 weeks after surgical insertion because
the surgical trauma causes bone remodeling at the interface that is least mineralized and unorganized during this
time frame. A clinical report found immediately loaded implant failure occurred primarily between 3 and 5 weeks
after implant insertion from mobility without infection. At 4 months the bone is still only 60% mineralized, organized
lamellar bone. With time, bone formation and mineralization will lead to increased interlocking with the implant
surface and a stronger implant/bone interface.

◊ Resnick, 1st ed., p. 570

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38. Even under ideal conditions a dental implant or bone graft is basically placed into a contaminated field due to the
natural flora of the oral environment. The amount of bacteria required to cause an infection is far less than that
required in a clean surgical wound.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

By definition, elective dental implant surgery falls within the class 2 (clean contaminated) category. Class 2
medical and dental surgical procedures have been shown to have an infection rate of 10% to 15%. However, with
proper surgical technique and prophylactic antibiotics, the incidence of infection may be reduced to less than 1%.

◊ Resnick, 1st ed., p. 294

39. Factors that help to minimize micromotions during immediate loading include all of the following except one. Which
is the exception?

A. High primary stability

B. Rigid implant splinting
C. Implant design
D. Offset implant placement

Correct Answer: (C) Implant design

Micromotion (limited movements at the bone to implant interface) is an important factor for predictable implant
healing. Three factors are known to minimize micromotion during immediate implant loading. They are: 1) high
primary stability determined by insertion torque or by resonance frequency analysis; 2) off set implant placement
(tripod arrangement); and 3) rigid implant splinting.

◊ Schwartz-Arad, p. 13

40. The rate of resorption of a bone grafted site decreases considerably after implant placement. A physiologic,
dynamic strain or load is required to prevent a decline in bone mass after tooth extraction.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

The rate of resorption of the bone grafted site decreases considerably after implant placement. Several studies
found that implant placement into a grafted area resulted in graft persistence and implant stability, and these
studies concluded that implant placement can slow the resorption process.

◊ Block, 3rd ed., p. 109

41. Which of the following patient force factors is the most significant when considering the amount of stress
transmitted to an implant supported prosthesis?

A. Parafunction
B. Masticatory muscle dynamics
C. Crown height space
D. Opposing dentition

Correct Answer: (A) Parafunction

Patient Force Factors Transmitted to the Prosthesis (listed from greatest to least)
1. Parafunctional habits such as Bruxism and Clenching
2. Crown height space: Doubling the crown height will double the force with any angled load or cantilever.
3. Arch position
Anterior regions (low forces)
Canine and premolar (medium forces)
Posterior regions (high forces)
4. Masticatory muscle dynamics
Sex (men have greater force)

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Age (younger patients have greater force and live longer)

Size (larger patients have greater force)
5. Opposing dentition
Denture (lowest force)
Natural teeth (intermediate force)
Implant fixed prosthesis (higher forces)

◊ Misch, 1st ed., pp. 93-94

Occlusion, TMD, Orofacial Pain & Sleep Disorders Top

42. Which occlusal disharmony is considered most likely to produce painful muscular symptoms?

A. Cuspal interference during habitual closure

B. Cuspal interference during closure to centric relation
C. Excursive interference on the non-working side
D. Excursive interference on the working side

Correct Answer: (B) Cuspal interference during closure to centric relation

The type of occlusal interference is an important feature. The traditional types of interferences that were thought to
create TMD symptoms were the mediotrusive (nonworking), posterior laterotrusive (working), and posterior
protrusive contacts. Studies reveal, however, that these contacts are present in TMD patients as well as in controls
and are not strongly related to TMD symptoms. A significant centric relation slide may be related to TMD
symptoms if it adversely affects orthopedic stability. The centric slide must be significant (3-4 mm or greater). The
contacts that seem to have the major impact on muscle function are those that significantly alter the intercuspal
position. Experiments have demonstrated that the introduction of a high contact that interferes with closure into the
intercuspal position often produce muscle symptoms.

◊ Okeson, 7th ed., pp. 121-122

43. All of the followings are true of an giant cell arteritis (GCA) or temporal arteritis except one. Which is the
exception?

A. Constricted temporal artery with increased pulsatility

B. An aching cramp in the masseter or temporal muscle
C. Most serious complication is blindness
D. Temporal artery biopsy is indicated for definitive diagnosis

Correct Answer: (A) Constricted temporal artery with increased pulsatility

The pain associated with giant cell arteritis (GCA) or temporal arteritis is fairly distinct from that of other arterides.
GCA is an inflammatory vasculitis that involves the temporal artery as well as others and may rapidly lead to
blindness secondary to granulomatous occlusion of the carotid artery vasculature.

GCA should be suspected and ruled out in all individuals, especially women over the age of 50 who present with a
new headache and associated visual changes and/or jaw claudication. GCA can usually be distinguished from
temporomandibular disorders by palpation of enlarged, tender temporal arteries with reduced pulsatility, an
abnormal fundoscopic examination and an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein
(CRP). Temporal artery biopsy may often be required diagnosing GCA.

◊ de Leeuw, 6th ed., pp. 67, 232

44. Potential identifiers of nonodontogenic toothache include all of the following except one. Which is the exception?

A. Spontaneous multiple tooth pain

B. Stimulating, burning, non-pulsatile toothaches
C. Pain referral to region of tooth from muscle trigger points
D. Quick, sharp, hypersensitive response that subsides quickly

Correct Answer: (D) Quick, sharp, hypersensitive response that subsides quickly
Potential Identifiers of Non-Endodontogenic Toothache
Spontaneous multiple tooth pain

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Inadequate dental cause for the pain

Stimulating, burning, electrical/lancinating pain, non-pulsatile toothaches
Failure of local anesthesia to significantly reduce pain
Constant/persistent unremitting toothaches
Persistent, recurrent toothaches
Failure of the toothaches to respond to reasonable dental therapy
Pain referral to region of tooth from muscle trigger points
Associated autonomic symptoms such as tearing, conjunctival injection, regional seating, and other
vascular phenomenons
Regional pain and parasthesia
Severe headache
Recent cold, allergy, stuffiness, and coughing with pain on maxillary teeth

◊ de Leeuw, 5th ed., pp. 106-113

45. Fibromyalgia is a chronic systemic myalgic disorder that presents with TMD-like symptoms. It is not a masticatory
pain disorder, yet many patients with fibromyalgia are mistreated with TMD therapies.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

Chronic systemic myalgic disorders (fibromyalgia) must be recognized as such because therapy depends on it. It
is a global musculoskeletal pain disorder that can be confused with an acute masticatory muscle disorder. It is
important for the dentist to recognize that fibromyalgia is not a masticatory pain disorder yet many patients with
fibromyalgia often report complaints similar to those associated with TMD. This similarity of presentation may lead
some fibomyalgia patients to be mistreated with TMD therapies.

◊ Okeson, 7th ed., p. 136

46. Which masticatory muscle pulls the condyle forward every time the mandible leaves centric relation?

A. Deep masseter
B. Digastric
C. Temporalis
D. Inferior lateral pterygoid

Correct Answer: (D) Inferior lateral pterygoid

The inferior lateral pterygoid originates at the lateral pterygoid plate and extends backward, upward, and outward
to its insertion primarily on the neck of the condyle. When the right and left inferior lateral pterygoids contract
simultaneously, the condyles are pulled forward down the articular eminences and the mandible is protruded.
When the temporalis muscle contracts, it elevates the mandible and the teeth are brought into contact. As fibers of
the masseter contract, the mandible is elevated and the teeth are brought into contact. Deep portion of the
masseter consists of fibers that run in a predominately vertical direction. Although the digastric is not generally
considered a muscle of mastication, it does have an important influence on the function of the mandible. When the
right and left digastrics contract and the hyoid bone is fixed by the suprahyoid and infrahyoid muscles, the
mandible is depressed and pulled backward and the teeth are brought into contact.

◊ Okeson, 7th ed., p. 13

47. Which of the following statements is true of trigger points?

A. Their exact nature is well established.

B. They may present localized reduction in metabolic demand of muscle tissue and decreased blood flow to the
affected area.
C. They are a source of constant deep pain and therefore can produce central excitatory effects.
D. They present only as a latent state and therefore produce constant headache.

Correct Answer: (C) They are a source of constant deep pain and therefore can produce central excitatory effects.
An interesting clinical feature of a trigger point is that it produces central excitatory effects. When a trigger point is

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active, a headache is commonly felt. Since referred pain is wholly dependent on its original source, palpitation of
an active trigger point (local provocation) often increases the headache. Although this characteristic is not always
present, it is an extremely helpful diagnostic aid.

◊ Okeson, 7th ed., p. 134

Oral Medicine, Oral Pathology & Medical Emergencies Top

48. A compound odontoma:

A. has indistinct radiographic borders.

B. has a high rate of reoccurrence.
C. occurs almost always in the mandible.
D. exhibits some resemblance to normal tooth structure.

Correct Answer: (D) exhibits some resemblance to normal tooth structure.

Most odontomas are detected in the first two decades of life. The compound odontoma appears as a collection of
toothlike structures surrounded by a narrow radiolucent zone. The compound odontoma is seen most often in
anterior maxilla. The complex odontoma appears as a calcified mass most often in the molar region of either jaw.

◊ Neville, 4th ed., p. 674

49. Which component of a local anesthetic is most likely to elicit an allergic response?

A. Lidocaine
B. Epinephrine
C. Sodium bisulfate
D. Sodium chloride

Correct Answer: (C) Sodium bisulfate

Contents of a local anesthetic cartridge contain: local anesthetic agent for conduction blockage; a vasoconstrictor
to decrease circulation and thus increase the depth, duration, and decrease toxicity of the local anesthetic agent.
Sodium bisulfite as an antioxidant for the vasoconstrictor; sodium chloride provides isotonicity of the solution; and
sterile water is a dilutent. The allergic response is usually due to the sodium bisulfate.

Cartridges containing vasopressors also contain an antioxidant, most often sodium bisulfite. Sodium bisulfite
prevents oxidation of the vasopressor by oxygen, which can be trapped in the cartridge during manufacture or can
diffuse through the semipermeable diaphragm (or the walls of a plastic cartridge) after filling. Sodium bisulfite
reacts with oxygen before the oxygen is able to destroy the vasopressor. When oxidized, sodium sulfite becomes
sodium bisulfate, having an even lower pH. The clinical relevance of this lies in the fact that increased burning
(discomfort) is experienced by the patient on injection of an older cartridge of anesthetic with vasopressor
compared with a fresher cartridge. Allergy to bisulfites must be considered in the medical evaluation of all patients
before local anesthetic is administered.

◊ Malamed, 7th ed., p. 387

50. Elective dental care for a patient with a history of a stroke should be delayed for 30 days. The maximum amount of
epinephrine should not exceed 0.2 mg.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (B) Both statements are FALSE.

A patient who suffers a stroke is at a greater risk of suffering another stroke within 1 month of the initial event.
Patient dental treatment should be delayed up to 6 months. Of the 14% who survive the original incident will
experience reoccurrence within a year. Patients who have history of stroke should limit the epinephrine to less
than .04 mg and not use any epinephrine containing retraction cord.

◊ Little, 9th ed., pp. 520-521

51. A generalized pigmentation of the skin is seen in Addison’s disease. This is due to the increased production of
erythropoietin from the kidneys.

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A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (C) The first statement is TRUE; the second is FALSE.
The clinical features of Addison’s disease or hypoadrenocorticism do not appear until 90% of the glandular tissue
has been destroyed. Symptoms can include fatigue, irritability, depression, & hypotension over a period of months.
A generalized hyperpigmentation also occurs and is known as ‘bronzing’. This is due to the increased levels of
beta-lipotropin or adrenocorticotropic hormone which stimulate melanocytes to produce melanin.

◊ Neville, 3rd ed., pp. 841-842

◊ Neville, 4th ed., p. 784

52. Which of the following symptoms may be present for a patient experiencing hyperglycemia?

A. High blood pressure

B. Fruity breath odor
C. Moist skin
D. Decreased pulse rate

Correct Answer: (B) Fruity breath odor

Hyperglycemia occurs when a patient’s glucose level remains elevated over a long period of time because of a
lack of insulin (type I) or lack of response to circulating insulin (type II). The following signs serve as diagnostic
clues to the presence of hyperglycemia and its emergency manifestations: blood pH decreases (pH 7.3), dry,
warm skin, fruity, sweet breath odor, rapid weak pulse, normal to low blood pressure and altered level of
consciousness. If a patient is suffering from hyperglycemia, he may lose consciousness.

◊ Malamed, 7th ed., p. 274

53. A healing time of two weeks between extensive oral surgery and the initiation of radiotherapy will avoid bone
necrosis. Osteoradionecrosis does not happen in the mandible because of the bone density.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (B) Both statements are FALSE.

A healing time of at least 3 weeks is recommended between extensive dental procedures and initiation of radiation
therapy to decrease the risk of osteonecrosis. Most cases occur in patients who received greater than 60 Gy with
the majority of cases occurring between 4 months and 3 years after radiation. The mandible is affected 24 times
more frequently than the maxilla. Although the risk is low, it increases dramatically if a local surgical procedure is
performed within 21 days of therapy initiation or within 12 months after therapy. Although most instances of
osteoradionecrosis arise secondary to local trauma, a minority appear spontaneous. The mandible is involved
most frequently, although a few cases have involved the maxilla. The radiation dose is the main factor associated
with bone necrosis.

◊ Neville, 3rd ed., pp. 296-297

◊ Neville, 4th ed., p. 269

54. A patient who had root planing and scaling done with local anesthetic two days ago returns to your office
complaining of pain on his palate. Upon exam you see small ulcerations present on his hard palate. The most
likely diagnosis would be:

A. recurrent apthous ulcers.

B. herpangina.
C. recurrent herpes.
D. allergic reaction.

Correct Answer: (C) recurrent herpes.

On some occasions herpetic lesions arise almost immediately after a known trigger & appear without any
prodromal symptoms. They can occur on keratinized tissue after trauma in cases such as local anesthesia or
extractions. Herpangina begins with an acute onset & lesions develop on the soft palate or tonsillar pillars.
Recurrent aphthous ulcers are located on nonkeratinized tissue. Allergic reaction usually is related to use of a
specific agent at the time of resultant eruption.

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◊ Neville, 4th ed., p. 221

55. The patient presents with a history of drainage about a month in duration from an area that is close to the angle of
the mandible. Upon exam you see small yellowish granules in the drainage. Your most likely diagnosis would be:

A. histoplasmosis.
B. cat-scratch disorder.
C. scrofula.
D. actinomycosis.

Correct Answer: (D) actinomycosis.

Actinomycosis is an infection of filamentous, branching gram-positive anaerobic bacteria. 55% of the cases are
diagnosed in the cervico-facial region. The suppurative reaction may discharge large yellowish flecks that
represent bacterial colonies, called sulfur granules. Diagnosis is achieved ideally by culture. Treatment is
prolonged doses of antibiotics along with abscess drainage. Early actinomycosis cases may respond to a 5-6
week course of penicillin. A deep seated infection may require up to 12 months antibiotic treatment.

◊ Neville, 3rd ed., p. 203

56. The most common location for the adenomatoid odontogenic tumor (AOT) is:

A. anterior maxilla.
B. posterior maxilla.
C. anterior mandible.
D. posterior mandible.

Correct Answer: (A) anterior maxilla.

Adenomatoid odontogenic tumors (AOT) are largely limited to young patients and uncommon in patients over 30.
They occur in the anterior portion of the jaws. They are found twice as often in the maxilla. Females are affected
about twice as often as males. They seldom exceed 3 cm in diameter. Most are asymptomatic and are found
during routine radiographic examinations. Most cases appear as a circumscribed, unilocular radiolucency involving
the crown of an unerupted tooth (usually a canine).

◊ Neville, 4th ed., p. 664

57. The goal of warfarin therapy for acute myocardial infarction patients is to maintain an INR of 2.5. A patient with an
INR of 2.5 needs to be taken off warfarin with the consent of the patient’s physician prior to simple surgical
procedures.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (C) The first statement is TRUE; the second is FALSE.
If the patient’s INR is greater than 3.5, significant bleeding may occur after invasive dental and surgical
procedures. There is little risk of significant bleeding if the INR is between 2 and 3.5.

◊ Little, 8th ed., p. 432

Oral & Maxillofacial Surgery Top

58. All of the following procedures have proven to lessen the occurrence of osteitis except one. Which is the
exception?

A. Oral antibiotics at surgery

B. Chlorhexidine rinse
C. Intrasocket antibiotic
D. Minimal tissue trauma

Correct Answer: (A) Oral antibiotics at surgery

Prevention of the dry socket syndrome requires that the surgeon minimize trauma & bacterial contamination in the
area of surgery. The surgeon should perform atraumatic surgery with clean incisions and soft tissue reflection.
After the surgical procedure, the wound should be irrigated thoroughly with large quantities of saline delivered
under pressure. Small amounts of antibiotics placed in the socket alone or on a gelatin sponge decrease the

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incidence of dry socket. The incidence of dry socket can also be decreased by pre-operative & post-operative
rinses with antimicrobial mouth rinses such as chlorhexidine.

◊ Hupp, 6th ed., pp. 186-187

59. Aspirin interferes with clot formation by:

A. inactivating plasminogen.
B. activating fibrinolysis.
C. decreasing platelet production.
D. inhibiting platelet aggregation.

Correct Answer: (D) inhibiting platelet aggregation.

Aspirin irreversibly inhibits platelet aggregation which can prolong bleeding. Upon discontinuation, normal platelet
function returns only when new platelets are released. However, in the case of dental surgery, there is no scientific
evidence to support discontinuation of aspirin. Risk is dependent on multiple agents which alter hemostasis and
patient susceptibility. Many adverse effects of aspirin are dose related and are rare at low doses.

◊ Wynn, 21st ed., p. 161

60. While luxating the right maxillary third molar, you inadvertently displace the tooth and it is no longer clinically
visible. What is the most appropriate action and where is the tooth most likely located?

A. Use a Caldwell-Luc approach to remove from the maxillary sinus.

B. Close the access and refer to an oral surgeon for removal from the maxillary sinus.
C. Extend the incision and remove the tooth from the infratemporal fossa.
D. Close the access and refer to an oral surgeon for removal from the infratemporal fossa.

Correct Answer: (D) Close the access and refer to an oral surgeon for removal from the infratemporal fossa.
Impacted maxillary third molars are occasionally displaced into the maxillary sinus (from which they are removed
via a Caldwell-Luc approach). But if displacement occurs, it is more commonly into the infratemporal fossa. During
elevation of the tooth, the elevator may force the tooth posteriorly through the periosteum into the infratemporal
fossa. The tooth is usually lateral to the lateral pterygoid plate and inferior to the lateral pterygoid muscle. If the
tooth is not visible, blind probing usually results in further displacement. The incision should be closed and patient
informed that the tooth has been displaced and will be removed later by an oral-maxillofacial surgeon after
radiographic location.

◊ Hupp, 6th ed., p. 177

61. When bilateral submandibular, sublingual and submental spaces are involved with cellulitis, this condition is known
as Ludwig’s angina. What is the primary concern of treatment?

A. Ability to access area of infection origin

B. Extraction of offending tooth
C. Maintenance of patient’s airway
D. Selection of appropriate antibiotic

Correct Answer: (C) Maintenance of patient’s airway

Ludwig’s angina is a rapidly spreading cellulitis that can obstruct the airway & commonly spreads posteriorly to the
deep facial spaces of the neck. Severe swelling is almost always seen with elevation & displacement of the
tongue, tense, hard bilateral induration of the submandibular region superior to the hyoid bone. The patient usually
has trismus, drooling & difficulty in swallowing and breathing.

◊ Hupp, 6th ed., p. 326

62. The most common site or region of all mandibular fractures is:

A. angle.
B. body.
C. condylar.
D. parasymphyseal.

Correct Answer: (C) condylar.

Frequency of Mandibular Fracture Sites
1. Condylar (29%)
2. Angle (24%)
3. Symphysis (22%)

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4. Body (16%)
5. Alveolar (3.2%)
6. Ramus (1.7%)
7. Coronoid (1%)

◊ Hupp, 6th ed., p. 497

63. Which of the following scenarios is the most difficult and technically challenging surgical extraction?

A. An 18-year-old with partial bony impaction of the maxillary right third molar
B. A 75-year-old with partial bony impaction of the maxillary left third molar
C. An 18-year-old with disto-angular partial bony impaction of the mandibular left third molar
D. A 75-year-old with disto-angular partial bony impaction of the mandibular right third molar

Correct Answer: (D) A 75-year-old with disto-angular partial bony impaction of the mandibular right third molar
In the distoangular impaction, the long axis of the tooth is distally or posteriorly angled away from the second
molar. Its withdrawal pathway usually runs into the mandibular ramus. If partially erupted, the tooth is difficult to
extract as the roots are in close proximity to the second molar. Older patients will have much denser bone with
decreased flexibility to expand. An older patient will experience a longer period of recovery.

◊ Hupp, 6th ed., pp. 153-157

Orthodontics & Dentofacial Development Top

64. Serial extraction is a sequential extraction of primary teeth followed by extraction of permanent teeth to resolve
space deficiency. Serial extraction does not facilitate eruption of permanent teeth or replace mechanical tooth
movement.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (C) The first statement is TRUE; the second is FALSE.
When all clinical and paraclinical evaluations show a severe space deficiency & a tooth size-arch size discrepancy
is confirmed, the best solution might be elimination of some tooth units. This kind of treatment during the mixed
dentition is termed serial extraction. Serial extraction is a sequential extraction of primary teeth followed by
extraction of permanent teeth to resolve space deficiency, facilitate eruption of remaining permanent teeth and
reduce the need for mechanical tooth movement. Early extraction of teeth can facilitate eruption of the remaining
dentition in the dental arch, depending on the available basal bone, accommodation and perioral neuro-muscular
balance, but removal of some teeth does not replace mechanotherapy. However, it certainly can reduce
significantly the time and effort of final mechanotherapy.

◊ Bahreman, pp. 115-116

65. Dental age 8 is characterized by eruption of the mandibular lateral incisors. After dental age 8, there is a delay of
2-3 years before any additional permanent teeth appear.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (D) The first statement is FALSE; the second is TRUE.
The most common sequence of eruption of the permanent teeth at dental age 6 is the mandibular central incisor,
closely followed by the mandibular first permanent molar and the maxillary first permanent molar.

In the second stage of eruption at dental age 7, the maxillary central incisors and the mandibular lateral incisors
erupt. The maxillary central incisor is usually a year behind the mandibular central incisor, but erupts
simultaneously with the mandibular lateral incisor.

Dental age 8 is characterized by eruption of the maxillary lateral incisors. After these teeth come into the arch,
there is a delay of 2 to 3 years before any more permanent teeth appear.

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◊ Proffit, 6th ed., pp. 74-76

66. The best space maintainer for early loss of a primary mandibular canine is a:

A. Nance arch.
B. lingual arch.
C. lingual arch with coil springs.
D. band and loop space maintainer.

Correct Answer: (B) lingual arch.

Lingual arch, the most common type of bilateral fixed maintainer, can be used as a passive application to preserve
tooth position. Passive applications include space maintenance, anchorage reinforcement to minimize side effects,
and as a base structure for attaching auxiliary coil springs. Adding coil springs to the lingual arch can make it an
active appliance that can be used for minor uprighting. The lingual arch is also used when there is bilateral
posterior tooth loss, when more than two unilateral units of posterior teeth are missing, or in situations of anterior
tooth loss. Nance arch is a bilateral holding arch applied in the maxillary arch. Band and loop is a commonly used
unilateral fixed non-functional space maintainer.

◊ Bahreman, pp. 80-82

Pediatric Dentistry Top

67. Characteristics of odontomas in children include all of the following except one. Which is the exception?

A. Are usually symptomatic

B. May cause impaction of permanent teeth
C. Can cause bony expansion
D. May have calcified structures

Correct Answer: (A) Are usually symptomatic

Odontomas are the most frequently occurring odontogenic tumors seen in pediatric patients. They are frequently
discovered when the patient presents for evaluation of an unerupted tooth or incidentally during routine
radiographic examination. Treatment for an odontoma involves simple enucleation and curettage. An impacted
tooth is one that fails to erupt. It may be caused by insufficient space in the dental arch, mechanical obstruction,
secondary to a pathologic lesion such as odontoma or supernumerary tooth.

◊ Dean, 10th ed., p. 637

68. Early exfoliation of teeth before five years of age may be caused by all of the following except one. Which is the
exception?

A. Cherubism
B. Trauma
C. Localized aggressive periodontitis
D. Immune deficiency

Correct Answer: (C) Localized aggressive periodontitis

Exfoliation of teeth in the absence of trauma in children younger than 5 years of age merit special attention
because it can be related to local or systemic pathology. Cherubism is usually inherited as an autosomal-dominant
trait. Characteristically there is a symmetric enlargement of the jaws. Radiographically the conditions present
multilocular areas of bone destruction. Teeth in the involved area may exfoliate prematurely because of the loss of
support or root resorption. Periodontitis secondary to immune deficiency or dysfunction appears to be the most
common cause of premature exfoliation of the primary teeth. LAP is commonly first diagnosed during the late
primary dentition.

◊ Dean, 10th ed., p. 44 and 257

69. How much root development should there be before an impacted tooth is surgically exposed for orthodontic
treatment?

A. Furcation area completed

B. Half of root completed
C. Cervical area completed
D. Almost completely formed

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Correct Answer: (D) Almost completely formed

The ideal time for surgical intervention to expose an impacted tooth is when the root of the impacted tooth is
almost completely formed and the apex is not yet closed. Exposure of a palatally impacted tooth is frequently
accomplished by making a sulcular incision between the palatal tissue and teeth and reflection of a full-thickness
mucoperiosteal flap. When a labially impacted canine is exposed, a critical component of the surgical outcome is
the maintenance of a cervical margin of attached mucosa on the erupted impacted tooth. Two surgical techniques
exist: 1) apical positioned flap and 2) closed technique.

◊ Dean, 9th ed., p. 679

◊ Dean, 10th ed., p. 634

70. When the mandibular permanent central incisors are found to be erupted lingually to the primary incisors, the
primary central incisors should:

A. be extracted at ages 6-7.

B. be extracted at ages 6-7 with the primary lateral incisors.
C. be considered for extraction if they are firm with full roots, by age 7 ½-8 ½.
D. be extracted if they are loose by age 7 ½-8 ½.

Correct Answer: (C) be considered for extraction if they are firm with full roots, by age 7 ½-8 ½.
Gellin has emphasized anxiety is created when parents discover a double row of teeth. He suggested that if the
condition is identified before 7.5 years of age, it is unnecessary to subject the child to the trauma of removing the
primary teeth. However, if seen in an older child with radiographs that show no root resorption of the primary teeth,
the teeth should be removed. Extraction of other primary teeth in the area is not recommended because it will only
temporarily relieve the crowding.

◊ Dean, 10th ed., pp. 352-353

71. A child with asthma needs pain medication following dental procedures. What is the drug of choice?

A. Narcotics
B. Aspirin
C. NSAIDs
D. Acetaminophen

Correct Answer: (D) Acetaminophen

Barbiturtes and narcotics are not indicated because of their potential for histamine release leading to
bronchospasms. Aspirin compounds and non-steroidal anti-inflammatory agents are contraindicated because
about 4% of patients experience wheezing after taking these drugs. Acetaminophen is recommended.

◊ Dean, 10th ed., pp. 532

Periodontics Top

72. Which of the following choices definitively supports the diagnosis of an acute periodontal abscess?

A. Lack of spontaneous drainage

B. Sensitivity to percussion
C. Swelling localized to the apex with a fistulous tract
D. A non-vital pulp

Correct Answer: (A) Lack of spontaneous drainage

The gingival abscess is a localized acute inflammatory lesion that may arise from a variety of sources. Clinical
features include a red, smooth, sometimes painful, often fluctuant swelling. Influencing factors include increased
number & virulence of bacteria combined with lowered tissue resistance and lack of spontaneous drainage.

◊ Newman, 13th ed., p. 493

73. All of the following statements concerning localized aggressive periodontitis (LAP), formerly juvenile periodontitis,
are true except one. Which is the exception?

A. Normally it is generalized, but when it occurs in the primary dentition, it is localized.

B. Premature loss of teeth is common and all teeth may be lost by the age of three.
C. Gingival inflammation from plaque/bacterial infection is central to its pathogenicity.
D. Loss of attachment and bone loss in the primary dentition are located in the molar and incisor regions.

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Correct Answer: (C) Gingival inflammation from plaque/bacterial infection is central to its pathogenicity.
Localized aggressive periodontitis (LAP), formerly juvenile periodontitis, is characterized by the loss of attachment
and bone around the permanent incisors and first permanent molars. Generalized aggressive periodontitis (GAP)
sometimes occurs in adolescents and teenagers. Unlike LAP, GAP may affect the entire dentition and is not self-
limiting. Heavy plaque and calculus are found in GAP and inflammation may be severe.

◊ Casamassimo, 5th ed., pp. 374-375

◊ Nayak, 2nd ed., p. 202

74. All of the following are reasonable treatment options for a periodontal abscess except one. Which is the
exception?

A. Incision and drainage

B. Local delivery of antibiotics
C. Scaling and root planing
D. Systemic antibiotics

Correct Answer: (B) Local delivery of antibiotics

Treatment options for a periodontal abscess are: 1) drainage through pocket retraction or incision; 2) scaling and
root planing; 3) perio surgery; 4) systemic antibiotics; and 5) tooth removal. Local delivery antibiotics should only
be used after nonresolution following failed debridement.

◊ Newman, 13th ed., pp.493, 561

75. For a diagnosis of desquamative gingivitis, all of the following are techniques used to make the diagnosis, except
one. Which one is the exception?

A. A thorough history and clinical exam

B. Peri-lesional incisional biopsy with formalin
C. Microscopic examination using immunofluorescence
D. Empiric use of an immunosuppressant drug

Correct Answer: (D) Empiric use of an immunosuppressant drug

Desquamative gingivitis (DG) describes a reaction characterized by intense erythema, desquamation and
ulceration of the free and attached gingiva. It has been suggested that DG is not a specific disease entity, but a
gingival response associated with a variety of conditions. A series of laboratory procedures should be used.
Clinical history, exam, and biopsy are mandatory.

◊ Newman, 12th ed., pp. 261-265

76. Resective osseous surgery may be difficult or impossible in the area of mandibular second or third molars because
of which anatomic structure?

A. Anterior border of the ramus

B. Retromolar triangle
C. Mylohyoid ridge
D. External oblique ridge

Correct Answer: (D) External oblique ridge

Distal to the third molar, the external oblique ridge circumscribes the retromolar triangle. This region is occupied by
glandular and adipose tissue and is covered by unattached, nonkeratinized mucosa. If sufficient space exists distal
to the last molar, a band of attached gingiva may be present; only in such a case can a distal flap procedure by
performed effectively.

◊ Newman, 12th ed., pp. 606-609

77. The primary therapeutic action of bisphosphonates is to inhibit osteoclast metabolism. Bisphosphonate half-life in
bone is estimated to be ten years or more.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

Bisphosphonates are primarily used to treat cancer and osteoporosis. They act by inhibiting osteoclastic activity,
which leads to less bone resorption, bone remodeling and bone turnover. Bisphosphonates play a key role in

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management of osteolytic bone disorders, including osteoporosis, Paget disease, bone metastasis and multiple
myeloma. Currently there is no treatment for bisphosphonate-associated osteonecrosis, and the discontinuance of
BP is not helpful, because these compounds tend to reside in the bone for ten years or more.

◊ Newman, 12th ed., pp. 197-200

78. All of the following are categories of drugs that have been associated with gingival enlargement except one. Which
is the exception?

A. Anticonvulsants
B. MAO inhibitors
C. Immunosuppressants
D. Calcium channel blockers

Correct Answer: (B) MAO inhibitors

The first drug-induced gingival enlargements reported were those produced by phenytoin (Dilantin), a hydantoin
used to treat epilepsy. Gingival enlargement occurs in about 50% of patients receiving the drug cyclosporine, a
potent immunosuppressive agent. Calcium channel blockers induce gingival enlargement in 20% of patients.
Calcium channel blockers are used in combination cyclosporine in kidney transplant recipients. The combined use
of both drugs induces larger overgrowths. MAO inhibitors do not cause gingival enlargement.

◊ Newman, 12th ed., p. 232

79. Which of the following is a periodontal manifestation of primary trauma from occlusion?

A. Horizontal interseptal bone loss

B. Vertical interseptal bone loss
C. Gingival inflammation with increased gingival fluid flow
D. Generalized narrowing of the periodontal ligament

Correct Answer: (B) Vertical interseptal bone loss

Marginal gingiva is unaffected by occlusal trauma because its blood supply is not affected. Trauma from occlusion
occurs in the supporting tissue and does not affect the gingiva. Occlusal trauma changes the shape of the alveolar
crest. The shape change consists of a widening of the marginal periodontal ligament space, a narrowing of the
interproximal alveolar bone, and a shelf-like thickening of the alveolar margin. Radiographic signs of trauma from
occlusion include: 1) increased width of periodontal space, thickening of the lamina dura; 2) vertical rather than
horizontal destruction of the interdental septum; 3) radiolucency and condensation of the alveolar bone; and 4)
root resorption.

◊ Newman, 11th ed., pp. 155-156

80. As opposed to one of pulpal origin, all of the following diagnostic findings would point toward a diagnosis of a
periodontal abscess except one. Which is the exception?

A. Sensitivity to percussion
B. Dull and localized pain
C. Swelling including gingival tissue
D. Radiographs showing angular bone loss

Correct Answer: (A) Sensitivity to percussion

With differential diagnosis of periodontal and pulpal abscess:

Periodontal abscess:

associates with pre-existing periodontal pocket;

radiographs show periodontal angular bone loss and furcation radiolucency;
tests show vital pulp swelling usually includes gingival tissue with occasional fistula;
pain usually is dull and localized; and
sensitivity to percussion may or may not be present.

Pulpal abscess:

tests show nonvital pulp;

pain severe and difficult to localize;

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may have no periodontal pocket;

sensitive to percussion; and
swelling often localized to apex with a fistulous tract.

◊ Newman, 11th ed., pp. 444-445

Prosthodontics Top

81. The triple-tray impression technique (also known as the dual-arch or closed-mouth technique) is a popular one. All
of the following statements are correct except one. Which is the exception?

A. Uses one tray, which captures an impression of the prepared tooth, the adjacent and opposing teeth, and the
relationship between them in maximal intercuspation.
B. It is used when uncomplicated circumstances require a single cast restoration be made.
C. Contralateral guidance is captured without the need for a separate interocclusal record.
D. Despite the potential interference to closure from a distal connecting bar on the tray, this technique produces
extremely accurate occlusion in the mounted casts.

Correct Answer: (C) Contralateral guidance is captured without the need for a separate interocclusal record.
Dual arch impression tray does not register any contralateral teeth and therefore has no contralateral guidance.
Ideally the triple tray is used for a patient with intact mutually protected Angle Class I occlusion. There should be
no interference in closure to maximum intercuspation.

◊ Shillingburg, 4th ed., p. 302

82. The shade is too light for a porcelain metal ceramic crown for the maxillary right central incisor. What is a possible
modification to idealize the shade?

A. Increase chroma by adding more complimentary color

B. Decrease chroma by adding the complimentary color
C. Increase value by adding the more complimentary color
D. Decrease value by adding the complimentary color

Correct Answer: (D) Decrease value by adding the complimentary color

Attempting to increase value is not as successful as reducing value. Value can be increased if the dominant color
has a higher lightness ranking. Value can be decreased by adding a complimentary color. Increasing the chroma is
the simplest shade alteration to make.

◊ Rosenstiel, 4th ed., pp. 733-734

83. All of the following muscle groups are considered to be the elevator muscles for the masticatory movement except
one. Which is the exception?

A. Masseter
B. Orbicularis oris
C. Internal pterygoid
D. Major part of temporal muscle

Correct Answer: (B) Orbicularis oris

Masseter, internal pterygoid and temporalis are muscles responsible for elevation. The orbicularis oris muscle is
composed of 4 components. The action of the obicularis oris functions in closure, protrusion, and pursing of the
lips.

◊ Dawson, p. 53

84. Occasionally, the mandible cannot be manipulated satisfactorily after an anterior deprogramming device has been
in place for 30 minutes. If this occurs, the patient is likely to have marked neuromuscular dysfunction.

A. Both statements are TRUE.

B. Both statements are FALSE
C. The first statement is TRUE; the second is FALSE
D. The first statement is FALSE; the second is TRUE.

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Correct Answer: (A) Both statements are TRUE.

In patients in whom centric relation does not coincide with maximum intercuspation, the patient cannot be easily
manipulated. One needs to prevent tooth contact. This can be done with cotton balls, a plastic leaf gauge or a
small anterior programming device. If the patient still can’t be satisfactorily manipulated then the patient most likely
has a marked neuromuscular dysfunction.

◊ Rosenstiel, 5th ed., pp. 46-48

85. The primary purpose of an occlusal rest in a removable partial denture is to provide:

A. unification.
B. counter-leverage.
C. vertical support.
D. proper seating.

Correct Answer: (C) vertical support.

The primary purpose of the rest is to provide vertical support for the partial denture. In doing so, it maintains
components in the planned positions, prevents impingement of soft tissues, and directs and distributes occlusal
loads to the abutment teeth.

◊ Carr, 12th ed., p. 56

86. Which is the most esthetic pontic design for a maxillary anterior bridge?

A. Saddle
B. Modified saddle
C. Ovate
D. Conical

Correct Answer: (C) Ovate

A pontic should be interpreted as “growing” out of the gingival tissue. If the pontic is poorly adapted to the ridge, it
creates a shadow or a food trap. The ovate design eliminates these issues in the esthetic zone.

◊ Rosenstiel, 5th ed., pp. 546-556

87. All of the following factors are directly linked to anterior guidance except one. Which is the exception?

A. Condylar inclination
B. Vertical overlap of the anterior teeth
C. Horizontal overlap of the anterior teeth
D. Posterior teeth contacting more heavily than anterior teeth

Correct Answer: (D) Posterior teeth contacting more heavily than anterior teeth
The anterior teeth (canine to canine) help to guide the mandible in the right and left lateral excursive movements
and in protrusive movements.

◊ Shillingburg, 4th ed., pp. 19-20

88. Loosening of a maxillary complete denture during yawning usually occurs if the distobuccal surface of the
prosthesis interferes with the:

A. hamular notch.
B. vibrating line.
C. masseter muscle.
D. coronoid process.

Correct Answer: (D) coronoid process.

Moving hard tissue will loosen maxillary prosthetics. The coronoid process moves down and forward in opening or
yawning and can displace the denture.

◊ Zarb, 13th ed., pp. 267-269

Restorative Dentistry Top

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89. All of the following forms of treatment are effective for patients with chronic salivary hypofunction except one.
Which is the exception?

A. Salivary flow stimulation

B. Placing crowns on all teeth for protection
C. Selective use of saliva substitutes
D. Oral candidiasis recognition and treatment

Correct Answer: (B) Placing crowns on all teeth for protection

Saliva is nature’s first line of defense against dental caries. Saliva works by diluting acid produced in plaque
biofilm, washing the acid away, buffering the produced acid and assisting in remineralization and by forming a
pellicle. One important strategy for the prevention of caries in such patients is increasing the salivary flow rates
and concomitant buffering capacity. Another strategy to improve salivary flow rates include chewing sugar-free
candies or mints. Preparation of teeth for full coverage crowns might reduce occlusal or esthetic risk but at the cost
of increasing risk for future caries or tooth fracture.

◊ Heymann, 6th ed., pp. 51, 70-81, 106

90. Advantages of porcelain veneers versus direct composite veneers include all of the following except one. Which is
the exception?

A. Less sensitive to operator technique

B. More expeditious placement
C. Longevity
D. Multiple appointment requirements

Correct Answer: (D) Multiple appointment requirements

Indirect veneers require two appointments but typically offer three advantages over directly placed full veneers.
Indirect fabricated veneers are less sensitive to operator techniques. They are made by a laboratory technician
and are typically more esthetic. If multiple teeth are to be veneered, indirect veneers usually can be placed much
more expeditiously. Indirect veneers typically last much longer, especially if they are made of porcelain or pressed
ceramic.

◊ Heymann, 6th ed., p. 317

91. Which of the following statements is true of xylitol?

A. It is a five chain sugar obtained from birch trees.

B. It allows the sucrose molecule to bind with cariogenic bacteria.
C. It stimulates salivary flow, which decreases oral pH.
D. It is fermented by mutans streptococci.

Correct Answer: (A) It is a five chain sugar obtained from birch trees.
Xylitol is a natural five-carbon sucrose obtained from birch trees. Xylitol keeps the sucose molecule from binding
with mutans streptococci. Mutans streptococci cannot metabolize xylitol. There is some suggestion that xylitol may
enhance remineralization and help arrest dental caries. It helps stimulate salivary flow which improves the
buffering of the pH drop that occurs after eating.

◊ Heymann, 6th ed., p. 79

92. The pulp is circumscribed peripherally by a specialized odontogenic area composed of all of the following except
one. Which is the exception?

A. Fibroblasts
B. Odontoblasts
C. The cell free zone
D. The cell rich zone

Correct Answer: (A) Fibroblasts

The pulp is circumscribed by the dentin and is lined peripherally by a cellular layer of odontoblasts adjacent to
dentin, the cell-free zone and the cell-rich zone. Odontoblasts in the intact pulp-dentin complex are easily identified
based on their location and distinct morphologic characteristics.

◊ Hargreaves, 11th ed., p. 451

◊ Heymann, 6th ed., p. 6

93. Which of the following regarding partial caries removal and indirect pulp capping is true?

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A. Partial removal of carious dentin had no effect on the risk of pulp exposure.
B. Partial removal of carious dentin has been shown to increase the incidence of pulpitis.
C. Partial removal of carious dentin has been shown to decrease restoration longevity.
D. Partial removal of carious dentin is acceptable if the restoration is well sealed.

Correct Answer: (D) Partial removal of carious dentin is acceptable if the restoration is well sealed.
The type of liner is less important to the success than the placement of a well sealed restoration. Two systemic
reviews concluded that: 1) partial removal of carious dentin reduced the risk of pulp exposure by 98% compared to
complete removal; 2) no evidence that partial removal of carious dentin is detrimental in terms of signs, symptoms,
pulpitis occurrence or restoration longevity; and 3) there is substantial evidence that complete removal of carious
dentin is not needed provided the restoration is well sealed.

◊ Hilton, 4th ed., p. 142

94. Marginal staining is a long-term problem with porcelain veneers and is most apparent at the proximal margins. The
current trend in veneer preparation is to extend the preparation through the interproximal contacts except for the
distal aspect of the canines.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

Marginal staining is a long term problem with veneers and the staining is most apparent at the proximal margin.
The current trend is to extend the preparation through the interproximal contact from the mesial aspect of the
canine to the mesial aspect of the contralateral canine.

There is no need to extend through the contact areas on the distal surfaces of the canines. By extending though
the interproximal areas of other than the canine distal contacts, any proximal margin staining is concealed.

◊ Hilton, 4th ed., pp. 456-457

95. All of the following statements regarding Class III interproximal lesions are true except for one. Which is the
exception?

A. Caries in these lesions is usually apical to the interproximal contact.

B. The lingual approach is generally preferred for cavity preparation.
C. Unsupported facial enamel may be left for internal bonding to composite.
D. Unsupported facial enamel should be removed.

Correct Answer: (D) Unsupported facial enamel should be removed.

In Class III preparations, there is no need to extend the preparation to gain micromechanical retention. Caries is
usually located gingivally to the contact point. The incisal portion of the contact should not necessarily be removed.
The lingual approach is preferred for larger Class III restorations. The appearance of true enamel is more natural
and esthetic and the facial enamel should be preserved unless necessitated by caries or missing enamel.
Unsupported facial enamel may be left for internal etching and bonding to resin composite.

◊ Hilton, 4th ed., p. 256

96. As you go posteriorly from incisors to molars in both the maxillary and mandibular arches, the proximal contact
area moves:

A. gingivally and lingually.

B. occlusally and lingually.
C. gingivally and bucally.
D. occlusally and bucally.

Correct Answer: (A) gingivally and lingually.

The proximal contact area is located in the incisal third of the approximating surface of the incisors. Proceeding
posteriorly through all the remaining teeth, the contact area is located near the junction of the incisal/occlusal and
middle third of the tooth. Contacts are larger in the posterior area.

◊ Heymann, 6th ed., pp. 12-13

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Risk Management Top

97. According the 2005 ADA survey of fifteen dental malpractice insurance companies, all the following were
considered to be the most significant dentist-patient communication problems except one. Which is the exception?

A. Critical comments of the insured’s work made to a patient by another dentist

B. Professional liability claims filed in retaliation for billing or collection problems.
C. Lack of or poor communication between a primary dentist and a specialist.
D. Lack of following proper HIPPA procedures between child and parent.

Correct Answer: (D) Lack of following proper HIPPA procedures between child and parent.

The 2005 ADA survey of 15 malpractice insurance companies uncovered the top 3 dentist-patient communication
problems: 1) critical comments; 2) professional liability; and 3) lack or poor communication.

Communication with the patient begins in external marketing/advertising. Dental staff is very much a part of the
risk management effort.

◊ Graskemper, pp. 98-99

98. Just because someone considers himself or herself a dental specialist does not make that person an expert
witness. A general dentist with knowledge and familiarity with a procedure may be found competent to testify as an
expert witness against a specialist.

A. Both statements are TRUE.

B. Both statements are FALSE.
C. The first statement is TRUE; the second is FALSE.
D. The first statement is FALSE; the second is TRUE.

Correct Answer: (A) Both statements are TRUE.

To qualify as an expert, the courts look to his or her skill, training and experience. Just because someone
considers him or herself a dental specialist does not make that person an expert witness. The relevant criteria are
knowledge & familiarity with the procedure in question.

◊ Graskemper, p. 80

Special Care Dentistry Top

99. Symptoms of mania include:

A. sleepiness.
B. insecurity.
C. concentration.
D. elation.

Correct Answer: (D) elation.

The essential feature of a manic episode is a distinct period during which the affected person’s mood is elevated
and expansive. Symptoms include inflated self-esteem, grandiosity, a decreased need for sleep, excessive
speech, flight of ideas, distractibility, and agitation.

◊ Little, 9th ed., p. 952

100. All of the following terms are commonly used to identify vulnerable older adults except one. Which is the
exception?

A. Frailty
B. Progeria
C. Comorbidity
D. Disability

Correct Answer: (B) Progeria

Three terms are commonly used to identify vulnerable older adults: frailty, comorbidity, and disability. Frailty is a

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physiological state of increased vulnerability to stressors. Comorbidity is defined as the concurrent presence of two
or more medically diagnosed diseases in different organ systems in the same patient. Disability is difficulty or
dependency in carrying out activities essential to independent living, including activities important to one’s quality
of life.

Progeria is a premature aging condition.

◊ Holm-Pederson, 3rd ed., p. 119

Duplication or distribution of any portion of this manual is strictly prohibited without the express written approval of the AGD and
may be prosecuted to the full extent of the law. Requests for permission to reprint any portion of this manual should be directed
to the AGD Examination Council, 560 W. Lake St, Sixth Floor, Chicago, IL 60661-6600.

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