Endodontics Old Textbook Qs Searchable

Challenge
Richard E. Walton, William T. Johnson, Lisa R. Wilcox

CHAPTER 1 : DIAGNOSTIC PROCEDURES
1 . Anesthetic testing is most efective in localizing pain to
which of the following?
a. Specifc tooth
b. Mandible or maxilla
c. Across the midline of the face
d. Posterior tooth
2. Areas of rarefaction are evident on radiographic exami
nation in which of the fol l owing?
a. When the tooth is responsive to cold
b. When the tooth is responsive to percussion
c. When a tooth fracture has been identified
d. When the cortical layer of bone has been eroded
3. Irreversible pulpitis is ofen defned by which of the fol
lowing?
a. Moderate response to percussion
P b. Painful, lingering response to cold
c. Short, painful response to cold
d. Short, painful response to heat
4. The majority of patients with symptoms of severe odon
togenic pain have a diagnosis of which of the following?
a. Periodontal abscess
. b. Irreversible pulpitis
c. Acute apical periodontitis
d. Acute apical abscess
5. Medical history of coronary heart disease is signifcant
for which of the following reasons?
a. It contra indicates endodontic treatment.
.. b. Many heart medications impact dental treatment.
c. It indicates the need for premedication with antibi
otics.
d. It contra indicates local anesthetic with epinepluine.
6. The best approach for diagnosis of odomogenic pain is
a. Radiographic examination
b. Percussion
c. Visual examination
. d. A step-by-step, sequenced examination and testing
approach
7. Of the following. which is the most likely to have
referred pain?
a. irreversible pulpitis
b. Reversible pulpitis
c. Acute apical periodontitis
d. Phoenix abscess
8. A sinus tract that drains out on the face (through skin) is
mostly likely from which of the following?
a. Nonodontogenic pathosis
b. A periodontal abscess
" c. Periradicular (i.e., endodontic) pathosis
d. Pericoronitis of a mandibular, third molar
9. Which of the following statements regarding a test
cavity is accurate?
a. it is the frst test in diagnostic sequence.
b. It often results in a dull-pain response.
M c. It is used when all other test fndings are equivocal.
d. It should be performed with local anesthetic.
10. Percussion ofa tooth is a test for which of the following?
a. Pulpal inflammation
b. Pulpal necrosis
# c. Acute periradicular infammation
d. Chronic peri radicular infammation
I I . Pulp stones are consistent indicators of which oflhe fol
lowing?
a. Periodontal inflammation impacting the pulp
b. Pulpal inflammation
c. Older patient
d. Pulp that has been injured i the past but has recov
ered
W e. None of the above
1 2. Radiographically, which of the following statements
regarding acute apical abscess is most accurate?
a. Tt is generally of larger size than other lesions.
b. It has more difse margins than other lesions.
c. It oft en contains radiopacities (i. e. , calcifcation).
` d. It may not be evident.
969
970 CHALLENGE A SelfAssessment Exam
1 3. In which of the following may a fal se-negative response
to the pulp tester occur"
a. Primarily in anterior teeth
9 b. 111 a patient with a history of trauma
c. Most ofen in teenagers
d. In the presence of periodontal disease
14. The lateral periodontal abscess is best diferentiated
from the acute apical abscess by which of the following?
a. Pulp testing
b. Radiographic appearance
c. Location of swelling
d. Probing patterns
1 5. The acute apical abscess is best diferentiated from the
acute apical periodontitis by which of the following?
a. Pulp resting
b. Radiographic appearance
i c. Presence of swelling
d. Degree of mobility
1 6. Chronic apical periodontitis is best diferentiated from
acute apical periodontitis by which of the following"
a. Pulp testing and radiographic appearance
b. Pulp testing and nature of symptoms
c. Radiographic appearance and nature of symptoms
Q d. Pulp testing. radiographic appearance. and nature of
symptoms
17. The abrupt change (arrow) in radiographic appearance
in the fol l owing illustration probably indicates which of
the following?
. Calcifc metamorphosis
b. A dense accumulation of difse calcifcation
c. An increased densit) of over\'ing bone
\ d. A bifurcation into two canals
1 8. The patient in the following illustration reports se\
throbbing pain in the mandibular right molar region.1
pain is exaggerated by cold. Which tooth and ^
tissue is likely the source of pain?
a. First molar and pulp
b. First molar and periapex
c. Second molar and pulp
d. Second molar and peri apex
19. Of the following cold-testing agents, which is the
effective in producing a response?
a. Bathing a tooth in ice water
b. Dicholorodifuoromethane (DDM)
c. CO, snow (i.e. , dry ice)
d. Ethyl chloride
20. \Vhich of the following statements regarding i
resorption is accurate?
a. The condition is usually accompanied by symp
b. It is continuous.
c. It is self-limiting.
d. It is usually visible in its early stages.
e. It is treated only if time shows it to be progressn
CHAPTER 2: OROFACIAL DENTAL PAIN
EMERGENCIES: ENDODONTIC
DIAGNOSES AND MANAGEMENT
1 . Which of the following statements regarding the
of pulp pathosi s is accurate?
a. It can be determined by the level of pain a
experiences.
b. It can be related to the level of response of the e_
trical pulp tester.
c. \t can be correlated best when a diagnosis of
versible pulpitis is established.
d. It does not correlate well with the level of
patient perceives.
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2. A key measure as to the degree (i.e., intensity) of pain is
to determine which of the fol l owing?
a. Painful stimulus with cold
b. Painfl stimulus with heat
c. Painful stimulus on biting
d. [ncreasing pain
"c. Pain affecting patient's lifestyle
3. In describing the sensory innervation of the dental pulp,
which of the following statements is accurate?
a. A-delta nbers are high-threshold, myelinated fbers
that transmit sharp, momentary pain.
b. C fbers are low-threshold, unmyelinated fbers that
produce pain in response to infammatory mediators.
c. The domination ofC-fber stimulation produces pain
that is not well localized.
d. The sharp, well-localized pain to cold testing is con
ducted by both A-delta and C-fber stimulation.
4. Which of the following induces hyperalgesia in local
nerve fbers?
# a. Prostaglandin and serotonin
b. Lysosomal enzymes
c. Calcitonin gene-related peptide
d. Substance P
5. Each of the following statements is correct regarding
trigeminal neuralgia, except/arone. Which is the ecep
lion?
a. The onset occurs in midlife and is unilateral in loca
tion.
4 b. The pain occurs unilaterally but often involves more
than one division of the trigeminal nerve.
c. The pain is characteristically sharp, lasts for several
hours, and is induced by a trigger point.
d. The pain mimics pain of pulpal origin in that thermal
sensitivity and tingling is often encountered just
before an attack.
6. A patient complains of dull and constant pain that lasts
3 days on the lef side of the face. The patient notes the
pain increases on positional changes, such as bending
over and when jogging. The most likely diagnosis is
a. Myocardial infarction
b. Maxillary sinusitis
c. Atypical facial pain
d. Irreversible pulpitis
7. Which of the following most likely indicates pain that is
not of pulpal origin?
a. Unilateral pain that radiates over the face to the ear
b. Pain that has paresthesia as a component
c. Pain that is described as throbbing and intermittent
d. Paio that is increased during mastication
Challenge
971
8. A complete medical history is essential when treating an
emergency dental patient for which of the following
reasons?
a. To identif patients with conditions that would con
traindicate root canal treatment
b. To determine conditions that might require modifca
tions in the approach to treatment
c. To protect the health care team from potential blood
bore pathogens and other infectious diseases the
patient may have
d. For medical and legal protection and to determine if
the medical status will afect the prognosis for root
canal treatment
9. When a patient complains of severe pain that cannot be
localized:
a. The pain is most likely periradicular in origin and
likely to persist even when the necrotic pulp is
removed.
&' b. Treatment procedures should be delayed and the con
dition managed with analgesic medications.
c. The cause is most likely nonodontogenic in origin.
d. Selective administration of local anesthesia can lead
to a defnitive diagnosis.
e. The pulp of more than one tooth will be involved and
the pathosis produce a synergistic-hyperalgesia
response within the central nervous system (eNS).
1 0. A patient's chief complaint is severe pain fom the
mandibular, right frst molar (tooth no. 30) when eating
ice cream and drinking iced tea. Clinical examination
reveals MOD amalgam restorations in all posterior
teeth. The margins appear intact and no cracks or caries
is detected. Pulp testing indicates all teeth in the quad
rant are responsive to electrical-pulp testing. Applica
tion of cold fails to reproduce the symptoms. Which of
the following actions should be taken?
a. The patient should be dismissed and asked to retur
when the symptoms increase and the pain to cold
becomes prolonged.
b. Initiate root canal treatment by performing a pulpot
omy or pulpectomy on tooth no. 30.
c. Place a rubber dam on individual teeth and apply ice
water.
d. Remove the restoration in tooth no. 30, place a seda
tive restoration, and prescribe a nonsteroidal, anti
infammatory agent.
972 CHALLENGE A SelAssessmen Exam
11. A patient complains cf pain to biting pressure and sensi
tivity to cold in the maxillary, left. posterior quadrant that
subsides within seconds of removal of the stimulus. Clin
ical examination reveals teeth nos. 2 and 3 exhibit occlu
sal amalgams. Which of the following test or actions is
most appropriate based on the chief complaint?
a. Periapical radiographs of the posterior teeth
,. b. Examination with transillumination
c. Electrical pulp testing
d. Percussion and palpation testing
12. A practitioner refers a patient for root canal treatment.
The clinician should obtain a new preoperative radio
graph during which of the following siruations?
a. \Vhen the flm from the referring dentist is more than
I month old
" b. In cases when an emergency treatment procedure was
performed
c. \Vhen the flm from the referring dentist reveals a
radiolucent area that has a "hanging drop" appearance
d. Immediately before examining the patient
13. Which of the following is true regarding the periodontal
ligameIH injection when treating a tooth with a pulpal
diagnosis of reversible pulpitis?
a. There will be a decrease in pulpal blood fow when
anesthetic agents with a vasoconstrictor are used.
b. Damage to the supporting structures can cause can
tinued symptoms.
c. The periodontal-ligament injection is conrraindicated
when block or infiltration injections are not efective.
d. The periodontal ligament injection can be used as pri
mary anesthesia in teeth that exhibit single roots,
regardless of the number of canals.
J 4. A patient describes pain on chewing and sensitivity to
cold that goes away immediately with removal of the
stimulus. The mandibular, lef. second molar (tooth no.
IS) exhibits a mesial, occlusal crack. The tooth is caries
free, and no restorations are present. Periodontal prob
ing depths are 3 mm or less. Which of the following
statements is correct?
a. The pulpal diagnosis is nor.mal pulp, and the lOath
should be prepared and restored with a MO-bonded
amalgam.
b. The pulpal diagnosis is reversible pulpitis, and the
tooth should be restored with a crown.
c. The pulpal diagnosis is irreversible pulpitis, and root
canal treatment should be performed, a bonded amal
gam placed, and a crown fabricated.
d. A radiograph will likely reveal a radiolucent area
associated with the mesial root.
e. The prognosis for the tooth is unfavorable.
15. Treatment of severe. throbbing pain associated
maxillary, left. frst molar (tooth no. 14) is best =
by which of the following?
C. Pulpotomy
b. Partial pulpectomy
' c. Pulpectomy
d. Analgesic agents
e. Analgesic and antibiotic agents
16. \hich of the following statements regarding 1_,
tooth open for drainage in cases of an ac.
abscess is accurate?
a. It is the recommended method of managing t
gency patient.
" b. It may adversely afect the outcome oftTea
c. It is appropriate, providing the patient is al- -
on an antibiotic.
d. It should be considered in addition to soft
sion and drainage.
17. \Vith acute. apical abscess, antibiotic admin u="'
indicated in which of the following?
a. Primarily only when there is difuse swelli
b. When there is swelling to any degree (i.e ..
or diffuse)
c. 2 to 3 days before beginning treatment of t
d. Only if there is purulence draining from li
18. A 21-year-old model requires emergency t=
soft, fuctuant swelling over the facial alve
of the maxillary, lef, lateral incisor (tooth 0
swelling is visible because of a high lip line.
the following statements is correct regarding
incision and drainage?
( a. The incision should be placed verticall
directly to bone.
b. The incision should be horizontal in the ''.
giva at the base of the swelling.
c. If drainage occurs with the initial incision. :
section is not necessary.
d. The placement of a drain is necessary f .
hours.
19. Which of the following statements reg
and drainage of an indurated swelling is a
a. They should be delayed until it becomes n=
.. b. They can reduce pain caused by tissue w:
c. They provide a purulent exudate for cuJ= _ ..
sitivity testing.
d. They are not indicated, because antibion: =
will result in resolution of the lesion.
20. Flare-ups during root canal treatment are more com
monly associated with which of the following?
a. Tecth with vital-pulp tissue when compared to teeth
with pulp necrosis
b. Teeth with apical radiolucent areas when compared
to teeth with normal periapical tissues
c. With single-visit endodontic procedures
.. d. Symptomatic teeth exhibiting pulp necrosis
e. Multirooted tceth
21. Of the following reasons, when is apical trephination
through the faciobuccal, cortical plate advocated?
a. To release exudate
b. As a routine procedure for relief of pain when the
offending tooth has been obturated
c. For treatment of severe, recalcitrant pain
d. Between multiple-visit endodontic procedures to pre
vent the occurrence of a fare-up
22. A 22-yea1old, white man requires root canal treatment
for pain and swelling in the mandibular, anterior area (see
illustration). He notes that his dentist has been treating
teeth nos. 25 and 26 for several months and that swelling
has occurred after each visit for cleaning and shaping.
Clinical examination reveals swelling located on the
alveolar process in the area of the incisor teeth. Teeth
nos. 25 and 26 are tender to palpation and percussion.
The clinician should perform which of the following?
Challenge
973
;. a. Diagnostic tests on the other incisor
b. Open teeth nos. 25 and 26, debride these teeth, and
place calcium hydroxide as an antimicrobial intr
canal medicament
c. Open teeth nos. 25 and 26, debride these teeth, and
perform incision and drainage
d. Open teeth nos. 25 and 26, debride these teeth, and
leave the teeth open for drainage
c. Perform incision and drainage and prescribe an anti
biotic for supportive care
23. A cusp fractures in a noncarious, nonrestored premolar
so that dentin is exposed. When this exposed dentin is
contacted by cold fuids, the patient experiences brief,
sharp pain. Which of the following pulp status is likely?
a. Normal and uninfamed
e b. Reversibly infamed
c. Irreversibly infamed
d. Innervated only by A-delta fbers
24. Corticosteroids have their major pharmacologic efect
as which of the following?
a. Antimicrobial agent
b. Analgesic
V c. Antiinfammatory agent
d. Agent to reduce swelling
e. Agent to prevent spread of infection
CHAPTER 3: NONODONTOGENIC OROFACIAL PAI N
AND ENDODONTICS: PAIN DISORDERS I NVOLVING
THE JAWS THAT SIMULATE ODONTALGIA
I . Peripheral pain impulses in the dental pulp are trans
mitted centrally via which of the following pathways?
. Peripheral nerve, trigeminal nucleus, trigeminal gan
glion, thalamus, cortex
b. Peripheral nerve, trigeminal ganglion, mesencephalic
nucleus, thalamus, cortex
c. Peripheral nerve, trigeminal ganglion, trigeminal
nucleus, mesencephalic nucleus, cortex
d. Peripheral nerve, trigeminal ganglion, trigeminal
nucleus, thalamus, cortex
2. Each of the following statements regarding trigeminal
neuralgia is correct, except/or one. Which is the excep
tion?
. The empiric evidence suggests vascular compression
of the trigeminal ganglion as a cause of trigeminal
neuralgia.
b. The pain involves all three divisions of the trigeminal
nerve equally.
c. There is an electrical quality of the pain.
d. The pain is severe, ofen shooting into the bone and
teeth.
e. The standard medical therapy is carbamazepine (i.e.,
Tegretol).
974 CHALLENGE A SelfAssessment Exam
3. Which of the following statements regarding cluster
headaches is correct?
a. Vessels that encircle nociceptive fbers compress the
fbers during vasoconstriction. causing pain.
b. The pain is usually unilateral and involves the max
illa, sinus, and fetro-orbital area.
c. Cluster headaches frequently involve females
between 40 and 60 years of age.
d. The pain, which is severe and lasts for 30 to 45 min
utes, can occur at anytime.
4. Each of the following has been shown to beneft patients
with cluster headaches, excepr jo}' olle. Which is the
exception?
a. Nifedipine
b. Prednisone in combination with lithium
c, Hyperbaric oxygen
d. Alcohol
e. Sumatriptin
5. A 57-year-old man complains af pain in the mandibular,
lef, posterior quadrant. The patient relates sporadic.
spontaneous pain during his waking hours for the past I
to 2 weeks. Upon examination no dental cause can be
identifed. Which of the following would be the most
likely cause of the painO
a. Cluster headache
b. Myalgia
c. Cardiogenic jaw pain
d. Temporal arteritis
e. Otitis media
6. Each of the following statements regarding maxil lary
sinusitis is correct, except for olle. 'hich is the excep
tion?
a. Pain is ofen referred to all teeth in the maxillary, pos
terior quadrant with percussion sensitivity being a
common fnding.
b. The maxillary sinusitis may be initiated by a tooth
with a necrotic pulp located in the maxillary, poste
rior area.
c. Treatment of the sinusitis requires referral to an oto
laryngologist and antibiotic therapy
.
d. The Waters view radiograph may be of diagnostic
value in demonstrating fluid.
e. An allergen-induced infammation of the sinus is an
immediate-type hypersensitivity reaction mediated
by IgE.
7. Which of the following statements regarding sialolithi
asis is correct?
a. The sialolith develops in patients that often exhibit
increased levels of serum calcium.
b. Pain may mimic pulpal pain in the maxillary, poste
rior teeth because sialolithiasis is most frequently
noted in parotid duct.
c. An occlusal radiograph provides more dia
information than a panoramic flm.
d. Sialolithiasis has been associated with kidney
and gallbladder stones, so patient's exhibiting t
order should be referred to a physician for eval
8. Which of the following statements regarding myot
pain is correct'
a. Trigger points found in the superfcial aspect 0:
masseter may refer pain the maxillary teet
mandibular teeth.
b. Trigger points have been noted only in the
muscles and temporalis muscles.
c. Initial treatment consists of fnding occlusal d
ancies and performing an equilibration.
d. Meniscus displacement and intraarticular ad"
are the cause, and corrective surgery provides
term success.
9. Each of the following statements regarding m:
lesions of the head and neck is correct, excepT
\Vhich i s the exception?
a. Although paresthesia is an ominous symptom. -
defcits are rare.
b. Metastatic lesions may develop from the lun!'
and colon.
c. Radiolucent areas detected on radiographs
quently poorly marginated.
d. Multiple myeloma may produce pain in the z:
bone.
1 0. \Vhich of the following statements regarding _" ,_ -
orofacial pain is false?
a. The pain is ofen chronic, difcult to I
there is no identifable cause.
b. The pain has no specifc symptoms that
diagnosis.
c. Patient's with atypical orofacial pain may
tory of having endodontic treatment that did
viate the pain.
d. Patient's with atypical orofacial pain co
pain in other areas orthe body.
e. Neuralgia-inducing cavitational os"'' .. "
(NICO) is distinct from atypical orofaci
orders.
I I . Which of the following statements accurateJ =:
phantom tooth pain?
a. It occurs in 10% of the patients having e
treatment.
b. It may be a form of deaferentation pain.
c. It has been shown to have a psychopath
ponent.
d. It has been associated with tooth extracri
not occur with extirpation of the pulp.
CHAPTER 4: CASE SElECTION
AND TREATMENT PLANNING
I. Which of the following statements regarding the lise of
electronic-apex locators is accurate?
a. The patient is physically impaired.
b. Anatomic structures overlay the root apex.
c. A pregnant patient wishes to avoi d exposure to x-rays.
d. All of the above statements are accurate.
2. Antibiotic prophylaxis is suggested for patients with a
history of which of the following?
a. Coronary bypass surgery
b. Atrial fbri l l ation
c. Artifi cial heart valve replacement
d. Myocardial infarction
e. Rheumatic fever
3. Elective endodontic treatment is contraindicated in
a. Patient is a borderline diabetic.
b. Patient has had a heart attack within the last 6 months.
c. Patient has had numerous opportunistic infections
secondary to HIV infection.
d. Patient has an implanted pacemaker.
4. Which of the following accurately describes external
resorptions?
a. They are untreatable.
b. They can only be distinguished surgically from
internal resorptions.
c. They appear to be superimposed over the root canal.
d. They always require root canal treatment.
5. Referral of difcult cases is indicated in which of the
following?
a. The general dentist does not have the indicated
equipment.
b. The general dentist does not have the indicated train
ing and experience.
c. The general dentist is not sure what procedures are
indicated.
d. All of the above
6. Which of the following statements regarding onc
appointment root canal treatment is accurate?
a. It is best performed in association with trephination
or root end surgery.
b. It may predispose the patient to postoperative fare
ups.
c. It is equally successful as multiple-appointment root
canal treatment.

Challenge 975
7. Single visit is equivalent in outcome to multiple visits
(to complete RCT) with what situation?
a. Vital pulp with acute pain
b. Necrotic pulp with acute pain
c. Necrotic pulp without pain
d. Necrotic pulp with a draining sinus tract
8. Root end surgery is indicated for endodontic failure i n
a. The dentist suspects a missed canal.
b. There has been coronal leakage.
c. A cast post and core and a well-ftting crown are
present.
d. All of the above
9. Prognosis for root canal treatment is worse when the
patient is experiencing which of the following?
a. Pain as a symptom
b. Interappointment fare-up
c. Class II I mobility and loss of bone support (i. e. , prob
ing defects)
d. Small, periradicular. radiolucent lesion
10. When is endodontic treatment is contraindicated?
a. The patient has no motivation to maintain the tooth.
b. The canal appears to be calcifed.
c. A large periapical lesion is present.
d. The tooth needs periodontal crown lengthening
before restoration.
I I. With pregnancy, the safest period to provide dental care
is during which month?
a. First
b. Second and third
c. Fourth to the sixth
d. Seventh and eighth
e. There is no period that is most safe.
12. A preoperative fnding that predisposes to a decreased
prognosis (i.e .. lower-success rate) is which of the fol
lowing?
a. The tooth is in hyperocclusion.
b. The pulp is vital.
c. The pulp is necrotic with no periradicular lesion.
d. The pulp is necrotic with a periradicular lesion
present.
e. Treatment is in an elderly patient.
CHAPTER 5: PREPARATION FOR TREATMENT
I. Which of the following statements describes human
immunodefciency virus (HIV)?
a. HIV is more easily transmissible than Hepatitis B.
b. HIV is more fragi l e than the Hepatitis B virus.
c. HIV is a good model for infection control practices.
2. Which of the following statements rcgarding Occupa
tional Safety and Health Administration (OSHA) stan
dards is accurate?
a. The standards are established to protect the dentist.
b. They mandate that employees be ofered the HIV
vaccine.
c. They include engineering and work practice controls.
d. They do not impose fnancial penalties.
3. \hich of the following statements regarding informed
consent infonnation for endodontic therapy is accurate?
a. It must be feely given.
b. It includes prognosis for the recommended treatment
and also the alternatives.
c. It includes the opportunity to ask questions.
d. All the above statements are accurate.
4. Which of the following statements regarding radiation
exposure from a single, full-mouth survey is accurate?
a. It is half that ofa single chest fi lm.
b. It is comparable to a barium study of the intestines.
c. It would be sufcient to cause skin cancer ifall expo
sures were at one site.
5. While exposing flms, dental personnel should do which
of the following?
a. Stand back at least 6 feet in an area that is 90 to 1 35
degrees from the beam
b. Stand behind a plaster, cinderblock, or I-inch drywal l
barrier
c. Wear a lead apron
6. The recommended antibiotics for a patient with a total
joint replacement who is allergic to penicillin or cepha
losporin is which of the following?
. Amoxicillin
b. Erythromycin
c. Clindamycin
d. Tetracycline
7. The most efective method for controlling pain that
often occurs after cleaning and shaping is to administer
a. Analgesic shortly before the procedure
b. Equal amounts of the analgesic before and during the
procedure
c. Analgesic at the conclusion of the procedure
d. Analgesic with instructions to the patient to take if
necessary
8. Which of the following statements regarding the long
cone paralleling technique is accurate?
a. It minimizes distortion of tooth dimension.
b. It minimizes superimposition of the infraorbital rim
for maxillary molars.
c. It requires the film be placed directly touc
tooth without bending the flm.
9. Radiographic contrast can be directly afected
ing which of the following?
a. Milliamperage
b. Exposure time
c. Kilovoltage
d. Angulation
10. An advantage of digitized radiography in eo
treatment is which of the fol l owing?
a. Image quality is better for working lengt
graphs.
b. X-ray generating source is not required.
c. Radiation exposure is reduced.
II. In which of the following situations is a rubbr
placed?
a. When the clamp impinges on the gingiva. c
discomfort
b. When the chamber or canal may be difcult
on access
c. When the tooth is rotated, preventing pIa
clamp on the indicated tooth
d. None; there are no situations in which a r:
is not placed.
1 2. To enhance crown preparation and retention
infrabony defect exists. crown lengthening is r:
by which of the following?
a. Electrosurgery
b. Gingivectomy
c. Laser surgery
d. Apically positioned fap, reverse bevel
1 3. Of the foHowing, which statement accuratel) o
radiograph units?
a. It should be optimally capable of using 70
b. It should be pointed (i.e., cone) in shape.
c. It should be collimated to reduce exposure
to exceed 7 em at the skin surface.
d. It should have a filtration equivalent of 10
rinum.
m
14. With the cone moved to the distal and dir=
the mesial, which of the following accurate =
the mesiobuccal root of the first molar?
a. It is projected mesially on the flm.
b. It is projected distally on the fi lm.
c. It does not move.
d. It is projected lingually on the flm.

-
- g =
1 5 . The cone angulation in the following illustration is
a. Mesial
b. Distal
c. Parallel
d. Bisecting
1 6. The radiopaque structure overlying the buccal roots in
the following illustration is which of the following?
a. Zygoma
b. Floor of the maxillary sinus
c. Coronoid process
d. Eyeglass frame
Challenge
977
17. Which of the following is the best way to "move" the
structure i n the previous illustration away from the
buccal apexes of both molars? Reposition the cone
a. Inferiorly (i.e., decrease the vertical angle)
b. Superiorly (i. e. , increase the vertical angle)
c. Mesially (i.e., the beam is directed more distally)
d. Distally (i.e., the beam is directed more mesially)
18. Why does the tooth in the following illustration appear
elongated?
a. There was excessive, positiveand-vertical angle to
the cone.
b. There was insufcient, positive-and-vertical angle to
the cone.
c. The flm was not parallel to the tooth.
d. The film was bent.
978 CHALLENGE A Se(fAssessmem Exam
19. The radiopaque structure (arroH') in the following illus
tration is which ofthe fol l owing?
a. Condensing osteitis
b. Trabeculation
c. Lamina dura
d. Root surface
20. The view in the following radiograph i s a mesially
angled (beam i s directed distally) flm. The unobturated
root i s which of the following?
a. Buccal root
b. Lingual root
21. Of the following, the best way to identify the so=
the radiolucency (arrow) in the following illustra
.
a. Pulp test
b. Incisional biopsy
c. Excisional biopsy
d. Observation over time to evaluate for changes
CHAPTER 6: ARMAMENTARIUM AND STERILIZ
I. The patient is exposed to the least amount of r
when which of the following is used?
a. Digital imaging
b. Ektaspeed film
c. Ultraspeed film
2. Patients with a latex allergy can be treated how?
a. Safely without a rubber dam
b. With a rubber dam if there is no direct skin
L. With a non latex, rubber dam
3. The temporary restorative material, Cavil, is *
the following?
a. Type of zinc oxide-eugenol (ZOE) material
b. Superior to other materials in in vitro res
bacterial leakage
c. Prepared by mixing a powder and liquid
d. More durable than intermediate restorative =
(IRM) or composite
4. The best way to clean dental instruments before steril
ization is by which of the following?
a. Ultrasonic cleaning for 5 minutes in a perforated
basket
h. Hand scrubbing, using a brush and heavy rubber
gloves
c. Rinsing under a forceful water spray
5. Steam sterilization is achieved when the load has
reached which of the fol lowing?
a. 250" C for 1 5 minutes
b. 250" F for 1 5 minutes
c. 250" C for 30 minutes
d. 250" F for 30 minutes
6. An advantage of rapid-steam autoclave over traditional
autoclave is which of the following?
a. Rapid-steam autoclave will not corrode steel instru
ments.
b. Rapid-steam autoclave is safe for all types of mate
rials.
c, Instruments do not have to be air dried at the end of
the cycle.
d. Rapid-steam autoclave has a shorter sterilization
cycle than traditional autoclave.
7. Of the following, which statement accurately describes
a chemical vapor sterilizer?
a. It uses a reusable chemical.
b. It requires adequate ventilation in the area where it is
used.
c. It achieves sterilization when heated to 270" F at 20
psi for 10 minutes.
d. It does not destroy heat-sensitive materials.
8. An approved method for reducing microorganisms i n
water output from dental units is which of the following?
a. Filters at the water source
b. Flushing thc watcr line beforc attaching it to the hand
piece or syringe
c. Retrograde (i. e. , reverse) fushing of all water lines
d. Careful sterilizalion of water lines within hand pieces
and syringes between patients
e. Installation of sterile water delivery systems
9. Gutta-percha is best sterilized by which of the following?
a. Immersion in full-strength sodium hypochlorite
b. Immcrsion in rubbing alcohol
c. Dry heat
d. Bead sterilizer
10. The effect of sterilization on endodontic fles is which of
the following?
a. Negative and proportional to the number of times
sterilized
b. Neutral; no effect is seen \1 physical properties
c. Positive; it restores to the fles flexibility lost over time
Challenge
979
I I . The most reliable agent for destroying microorganisms
is which of the following?
a. Chemical sterilizing agents
b. Hot water
c. Ultrasonics
d. X-ray irradiation
e. Heat
1 2. A good, two-stage technique (i. c. , two burs in sequence)
for access through a porcelain fxed-to-metal crown i s
a. Stainless steel (55), round-diamond, coated fssure
b. Diamond-coated, round-carbide, end-cutting fssure
c. SS fssure, carbide. end-cutting fssure
d. carbide, round-diamond, coated, round fssure
e. 55, round-carbide, end-cutting fssure
13. An advantage that nickel titanium (NiTi) has over 5S for
intra canal instruments is which of the following?
a. Lower cost
b. More resistance to breakage
c. Sharper
d. More uniform in shape
e. More fexibility
CHAPTER 7: TOOTH MORPHOLOGY
AND CAVITY PREPARATION
I . Which of the following statements describes dens-en
dente?
. a. It occurs primarily in maxillary, lateral, incisor teeth.
b. It requires the use of a long-shank bur for access
because the pulp chamber is located in the middle
portion of the root.
c. It results in an unrreatable, periodontal pocket.
d. It produces an evagination of dentin and enamel in
mandibular premolars.
2. The incidence of three roots and three canals in maxil
lary frst premolars is which of the following?
a. Less than 1 %
b. 3%
c. 6%
d. 10%
3. Vertucci noted i n maxillary second premolars which of
the following?
. a. \hen two canals were present and join at the apex,
the lingual canal is the straightest.
b. The incidence of t\vo canals at the apex was high,
approaching 75%.
c. The incidence of accessory canals found in the furca
tion was 59%.
d. Histologically, calcifcation correlated with the radio
graphic narrowing of the canal space.
980 CHALLENGE A Se(fAssessmenl Exam
4. In their study of maxillary molars, Kulild and Peters
noted which of the following?
a. Although two canals were ofen present in the mesio
buccal roots, the canals merged apically.
b. The use of magnifcation did not increase the number
of canals found clinically in this tooth group.
c. The orifce to a second canal in the mesiobuccal root
was distal to the main orifce in a line connecting the
mesiobuccal canal to the palatal canal.
W
d. A high incidence of two canals with separate foram
ina in the mesiobuccal root (71 %).
5. When treating a mandibular incisor with two canals evi
dent on the preoperative radiograph, which of the fol
lowing statements are true?
a. The internal morphology of the canals will be ribbon
shaped.
, b. A facial-access opening might be considered.
c. The canals ofen remain separate and distinct through
out the root.
d. The access opening should be triangular with the
apex at the cingulum.
6. Which of the following teeth is most likely to exhibit
C-shaped morphology?
a. Maxillary frst premolar
b. Maxillary frst molar
@ c. Mandibular frst premolar
d. Mandibular frst molar
7. In their study of mandibular molars, Skidmore and
Bjorndal noted which of the following?
Q a. The access opening should be rectangular.
b. When there were two canals in the distal root, they
remained distinct with separate apical foramina.
c. The incidence of four canals was over 50%.
d. The mesiobuccal canal was located under the mesio
buccal cusp tip and exhibited the straightest morph
ology.
8. The mandibular, second molar should be restored with a
crown after endodontic treatment for which of the fol
lowing reasons?
a. The pulp chamber is relatively large in comparison to
the crown, making the tooth susceptible to fracture.

b. The tooth is in close to the insertion of the muscles of
mastication, and the percentage of preexisting frac
tures is high.
c. There is a tendency for the buccal CllSpS to shear of
under occlusal loading.
d. Providing a post can be placed in the distal root to
strengthen the rOOL
9. Which of the following statements regarding the
dibular. second molar exhibiting a C-shapcd ro
ogy is correct?
a. The root morphology varies with two separate
distinct roots being a common fnding.
b. Research indicates that the presence of a C-
canal is most common in Caucasians.
c. The C-shaped molar exhibits a ribbon-shaped
with a 180-degree arc beginning in the mesiL-
area and forming an arch extending lingually I
distobuccal.
" d. The mesiolingual canal is often noted to be S
and distinct, exhibiting a separate foramen.
I O. A 30-year-old male patient is being treated for a
lary cenrral incisor that he traumatized as a [<1
Radiographically, the canal appears calcifed and <:
evidence of apical pathosis. A fer attempting acces
canal cannot be located despite drilling into the
third of the root. Which of the following stal
regarding further treatment is false?
a. Radiographs may indicate the orientation
access opening within the root.
b. The risk of perforation will be greatest on the
surface. should the clinician continue.
c. The clinician should consider obturating the
segment and performing root end surgery.
d. Because canals become less calcifed as theY
apically, a pathfnder might be used to neg
residual canal space.
CHAPTER 8: CLEANING AND SHAPING
THE ROOT CANAL SYSTEM
1 . \Vhich of the following statements regarding 5:
procedures is false?
a. Shaping is performed after cleaning of the
third of the canal to ensure patency.
b. Shaping facil itates placement of instrur
working length by increasing the coronalm
c. Shaping permits the a more accurate a5''
the apical, cross-sectional canal diameter.
d. Shaping is a necessary procedure becaus
tion occurs from the coronal portion of t
the apex.
,
I
2. Which of the following statements best describes the
Profile Series 29 fles?
a. The Profle Series 29 fles conform to the !Hera
tional Standards Organization (ISO) specifcations
for instrument design.
q b. The instruments exhibit a constant percentage
change between successive instruments.
c. The Profle Series 29 fles were designcd to facilitate
preparation of the coronal portion of the radicular
space.
d. The instruments are most useful in the larger sizes
because there is a smaller change in diameter
between the fles.
3. Each of the following are direct advantages of pre
enlarging the radicular space, excepT for one. Which is
the e.rceplioll?
a. It provides better tactile control of instruments when
negotiating a small, curved canal.
b. It removes the bulk of tissue and contaminants before
apical preparation.
g c. It facil itates obturation.
d. It provides a reservoir for the irrigant.
4. The result of root canal treatment in establishing patency
a. Ilfevents procedural errors, such as canal blockage

and transportation.
b. It causes irritation of the periodontal attachment
apparatus and increased postoperative pain.
c. It enlarges the apical terminus and increases the
potential for extrusion of obturating materials.
d. It requires insertion ofa fle 1. 0 to 2. 0 mm beyond the
canal terminus.
5. Which of the foll owing statements regarding gauging
and tuning is correct?
a. Gauging is performed in the coronal portion of the
canal to confrm the coronal enlargement is complete.
b. Tuning identifes the most apical, cross-sectional
diameter of the canal.
c. Gauging and tuning verif the completed shaping of
the apical pOtion of the canal.
d. Gauging and tuning produces a uniform, cylindric
diameter to the canal in the apical 2 to 3 mm that
enhances obturation and sealing.
6. Which of the following statements best describes the
Quantec f les?
a. The instruments have a constant helical angle and
three futes.
b. The recommended rotational speed is 1 000 to 2000
RPM.
c. The instruments exhibit a constant rate of taper along
their length.
d. The instruments exhibit varied tapers with a constant

D
o
diameter of 0.25 mm.
- --------------------
Challenge
981
7. \hich of the following statements regarding the use of
cheiating agents in canal preparation is correct?
a. Aqueous solutions are preferred to viscous suspen
sions in canal preparation.
b. Viscous suspensions are more effective in preventing
accumulation of tissue and dentinal debris.
c. Viscous suspensions contain the highest concentra
tion of ethylenediaminetetracitic acid (EDTA) and
are most efective in removing the smear layer.
d. Aqueous solutions are most efcient as lubricants
and, therefore, preferred to viscous suspensions dur
ing canal preparation.
e_ EDTA. in concert with sodium hypochlorite, causes a
nascent release of oxygen, which kills anaerobic
organisms.
8. Which of the fol lowing statements regarding an en do
gram is false?
a. An endogram would provide information on the
extent of interal resorptive lesion.
b. The visualization of fractures and leaking restora
tions is attributed to the incorporation of Hypaque i n
the irrigating solution.
c. Conventional radiography and digital radiography
may both be used in producing an endogram.
" d. The endogram is used to confrm the correct working
length.
9. During the early phase of roor canal preparation, which
of the following is true?
a. The initial scouter fle that moves easily through the
canal should be advanced to the estimated working
length .
.. b. The initial scouter fle may not advance to the esti
mated working length because of the rate of instru
ment taper.
c. The initial scouter t ile should be advanced with a
reciprocating action using apical pressure when resis
tance is encountered.
d. The initial scouter fle is used before the introduction
of a viscous chelator in cases exhibiting vital tissue.
1 0. Which of the following statements is correct regarding
coronal canal preparation in endodontic treatment?
a. Nickel-and-titanium (NiTi) rotary instruments are
preferred to Gates-Glidden (GG) drills because they
remove dentin uniformly from the canal wall.
b. NiTi rotary instruments are best used in a stepback
fashi on.
c. Both GG drills and NiTi rotary instruments should be
used large to small, because this develops a prepara
tion that is centered i n the root.
d. GG drills used in a step-back technique can relocate
the canal away from the furcal wall.
982 CHALLENGE A Se/Assessl1Iem Exam
I I . When lIsing the balanced-force technique for canal
preparation, which of the following statements is accu
rate?
a. The cutting stroke involves apical pressure and a
counterclockwise rotation.
b. Clockwise rotation balances the tendency of the fle
to be drawn into the canal during the cutting stroke.
c. Dentin is engaged with a counterclockwise rotation
and cut with a 45- to 90-degree. clockwise rotation.
d. It requires the use of a crown down technique.
1 2. Extending a no. J 0 fle with a 0.02 taper 1 .0 mm beyond
the apical foramen will result in which of the following?
a. It opens the apical foramen to a minimum diameter of
0. 1 2 mm.
b. It increases postoperative discomfort to occlusal
forces.
c. It reduces the percentage of change from a no. 1 0 fle
to a no. 15 fle by 50%.
d. I t eliminates the natural constriction of rhe foramen
and increases thc chance for an overfl l .
CHAPTER 9: OBTURATION OF THE ClEANED
AND SHAPED ROOT CANAL SYSTEM
I . Of the following, the least important determinant ofroor
canal treatment success is which of the following?
a. Proper placed restoration afer root canal treatmcnt
b. Healthy periodontium
c. Three-dimensional (3-D) obturation of the root canal
system
2. Para formaldehyde-containing obnrating materials result
in which of the fol l owing?
a. Eliminate bacteria that remains in the canals
b. Mummify tissue remnants in the canals
c. Reduce posnreatment pain
d. Are below the standard of care for root canal treat
ment
3. It is preferable to not extrude sealer beyond the apex for
which of the following reasons?
@ a. The sealer usually does not resorb.
b. The sealer often stains or tattoos the tissue.
e. The sealer is a tissue irritant and may delay healing.
d. The sealer promotes bacterial growth.
4. Gutta-pereha in contact with connective tissue is which
of the following?
a. Relatively inert
b . Immunogenic
.
c. Unstable
d. Carcinogenic
5. The primary reason to use a sealer and cement is ^
of the following"
a. Attainment of an impervious seal
b. Canal disinfection
c. lubrication of the master cone
d. Adhesion to dentin
' e. All of the above
6. Considering lateral versus vertical condensation.
have shown which of the following?
a. Lateral condensation results in a better seal.
b. Vertical condensation results in a better seal.
c. Both consistently fll lateral canals.
d. Sealability with either largely depends on the
of the prepared canal.
7. A problem with nickel-and-titanium (NiTi) spread:
. a. Tendency to buckle under compaction pressue
b. Tendency to break during condensation
c. Creation of greater wedging forces, leading I
fracture
d. They do not penetrate as deeply as stainless e
spreaders under equal force
8. Moderate extrusion of obturating materials b
apex is undesirable because of which of the foil
a. There is more likelihood of postoperative ds.
b. Sealer and gutta-percha cause a severe, inf.a"
reaction in peri radicular tissue.
c. The prognosis is poorer.
d. A 1 1 of the above
9. In which of the following is one-visit root c
ment not recommended?
a. The pulp is necrotic and not symptomatic.
b. The pulp is necrotic and symptomatic .
> c. The pulp is necrotic and there is a draining s'
d. The pulp is vital and symptomatic.
1 0. When is an application of heater-injected g: _
potentially benefcial?
a. When there is an open apex
` b. When there are aberrations or irregulari:
canal
c. When the clinician cannot master lateral O:
d. When the canals are curved and small af:::
tion
1 1 . Which of the following statements accurate .
an adequate apical seal?
a. I t can only be achieved with lateral con="
b. It depends on placing the compactio_
close to the apical terminus.
c. It can be achieved in small, nontapering
rations.
1 2. Which of the following statements accurately describe
the continuous-wave technique?
a. It uses a heal carrier that can both compact and heat
gutta-percha.
b. I t is superior to other warm-compaction techniques.
c. It has been shown to provide a better prognosis than
cold-compaction techniques.
d. It has been shown to have 1\ adverse effects on the
periodontium.
1 3. An advantage of the continuous-wave technique over
warm, vertical compaction is which of the following?
" a. The continuous-wave technique is faster.
b. The continuous-wave technique adapts better to canal
irregularities.
c. The continuous-wave technique is not technique sen
sitive.
d. No special devices are necessary.
1 4. The most likely cause of a gross ovcrll is which of the
following?
a. Lack of an apical seat or stop
b. Use of excessive amounts of sealer
c. Use of excessive apical pressure on the spreader
d. Use of a master cone that is too small
15. The obturation of the incisor shown in the following
illustration is inadequate because of which of the fol
lowing?
" a. It appears short of the prepared length.
b. There is variable radiodensity (i. c. , incomplete con
densation) throughout its length.
c. There is a space between the temporary restoration
and the gutta-pereha.
d. The diagnosis was pulp necrosis and chronic apical
periodontitis; the canal should be flled to the apical
foramen.

Challenge 983
1 6. The dark tooth in the following illustration has a history
of trauma and root canal trcatment. It is likely that the
discoloration is primarily caused by which of the fol
lowing?
a. Remnants of necrotic tissue
b. A leaking restoration
L. Blood pigments in the dentinal tubules
" d. Obturating materials not removed from the chamber
1 7. Of the following, what is the most likely cause offailure
of root canal treatment on the lateral incisor in the illus
tration?
a. The silver point corrodes.
b. The canal is flled too close to the apex.
c. There is coronal leakage.
d. The silver point does not adapt to the prepared space.
984 CHALLENGE A Se/ssessmen Exam
CHAPTER 1 0: RECORDS AND LEGAL
RESPONSIBI LITIES
l . Concering making changes in a patient record, which
oflhe following statements i s accurate?
a. Any changes are forbidden.
h. Deletions are permitted if erased completely as soon
as they occur.
c. Corrections are permitted if dated.
2. Standard of care, as defned by the courts, is which of the
following?
a. Requires absolute perfection
b. Describes what any careful-and-prudent clinician
would do under similar circumstances
c. Does not allow for individual variations of treatment
d. Is equivalent to customary practice
3. The doctrine of informed consent does not require
a. Patients to be advised of reasonably foreseeable risks
of treatment
b. Patients to be advised of reasonable alternatives
c. Patients forfeit their right to do as they see ft with
their body.
d. Patients be advised of the consequences of nontreat
mcnt.
4. Which of the following statements accurately describe a
periodontal examination of a patient referred for endo
dontic treatment?
a. It should performed on the entire dentition.
b. It must be performed at least on the tooth to be treated.
c. It i s necessary only if there is evidence of periodontal
disease.
d. It is necessary only i f requested by the referring
dentist.
5. A dentist may legally do which of the following?
a. Refuse to treat a new patient, despite severe pain and
infection
b. Be bound to see a fonner patient on recall afer treat
ment i s completed
c. Discharge a patient from the practice at any time
d. Refse to treat a patient who has an outstanding
account balance
6. If a patient with human immunodefciency virus (HIV)
requests that the dentist not inform the staf of the con
dition, the dentist should do which of the following?
a. Refuse to treat the patient
b. rell the staffin private, and then treat the patient with
extra precautions
c. Not tell the staf but treat the patient with great cau
tion
d. Not tell the staf and require the patient to assume lia
bility should anyone contract the virus
7. A specialist may be held liable if which of the foil"
occurs?
a. Infomls the patient that the general practitioner p
formed substandard care
b. Fails to disclose to the patient or referring denti
dent pathosis on teeth other than those the sp
-
is treating
c. Fails to locate a small canal that is not evident r
graphically
d. Ilistakenly initiates treatment on the wrong to
a difcult diagnostic situation
8. Of the following, which is the best way for cl inic
avoid legal actions by patients?
a. Tell patients they have no malpractice insurance
b. Anend continuing education courses to
informed of current techniques.
c. Refer all major patient complaints to peer re\;
d. Demonstrate genuine interest in the welfare of
patient.
9. Computerized treatment records may not be signe.
tronically.
a. True
b. False
10. Suing to collect fees is a proven route to being "
sued for malpractice.
a. True
b. False
I I . Standard of care for routine endodontics is set
of the following?
a. The state's dental licensing agency
b. Endodontists
c. The community of general dentists
1 2. A patient continues to have pain after a dena
technique of Parafonnaldehyde paste pulpot
tooth with a necrotic pulp and apical pathosis
places a crown. In this situation, which of the f ..
.
"::
statements is true?
a. The dentisr is liable for malpractice b.
ceptable treatment procedures were followe
b. The dentist is not liable if the patient i s no
.
=
to the appropriate specialist who can treat t
\. The dentist is not liable if the dentist perf
tional treatment for no fee.
~
MMMM
CHAPTER 1 1 : STRUCTURE AND FUNCTIONS

OF THE DENTIN AND PULP COMPLEX
I . In the process of tooth development, which of the fol
lowing statements are true?
a. The basement membrane separating the inner dental
epithelium from the dental mesenchyme is composed
of type I and il collagen.
h. Blood vessels become established in the dental
papilla during the cap stage.
c. Mature ameloblasts appear before odontoblasts
mature. However, the fannation of enamel takes
place following the deposition of dentin.
d. Type II collagen mRNA increases with odontoblastic
differentiation.
e. Amcloblasts form enamel spindles near the future
dentinoenamel junction (DEJ).
2. von Korff fbers are best described as which of the fol
lowing?
a. The frst-formed col lagen fbers formed between pre
odontoblasts.
b. Unmyelinated sensory fbers in the cell-free zOlle of
Wei l
c. Odontoblastic processes interposed between amelo
blasts
d. Silver-stained ground substance located between
odontoblasts
3. Which of the following statements regarding rOOl devel
opment is false?
a. Root development begins after completion of enamel
formation.
b. The inner epithelium, the stellate reticulum. and
outer enamel epithelium form Hertwig's epithelial
root sheath.
c. The dental sac disintegrates upon induction of dentin
formation and remnants persist as the Epithelial
Rests of Malassez.
d. Accessory canals in the root are formed when there is
discontinuity in the root sheath.
4. Which of the following statements regarding delllin is
correct?
a. Mantle dentin is (he frst formed dentin and has col
lagen fbers that run perpendicular to the DEJ.
b. Dentin deposited after eruption i s termed secondary
dentin.
c. Dentinal tubules make up 50% of the dentin volume
and they exhibit extensive tenninal ramifcations.
d. Calcifcation of dentin results in an organic compo
nelll composed of noncol\agenous matrix compo
nents.
Challenge
985
5. Which of the following statements regarding the tubular
structure of dentin is correct?
a. Peri tubular dentin and intertubular dentin are the
same composition, except for the fact peri tubular
dentin lines the tubule.
. b. Peritubular dentin has a lower-collagen content when
compared to intertubular dentin and is more suscep
tible to removal by acids.
c. Intertubular dentin is more highly mineralized when
compared to peri tubular dentin.
d. Peri tubular dentin defines the tubule size and is com
mon to all mammals.
6. Which of the following statements regarding dentin per
meability is lYUe?
a. Remains constant regardless of the depth of a cavity
preparation because of a pulpal tissue pressure of
1 0. 3 mm Hg
b. Increases as the pulp and dentin border is approached
(primari ly because the tubular surface area increases)
c. Is lower in radicular dentin because of tubular scle
roSIS
d. I ncreases near the pulp and dentin border as the
hydrostatic pressure in the tubules decreases
7. Which of the following statements regarding tight junc
tions in the odontoblastic layer is true?
a. They regulate permeability of extracellular sub
stances between the odontoblastic layer and the pre
dentin.
b. They permit low-resistance pathways for electrical
excitation when the odontoblastic process is distorted.
c. They provide a mechanism for intracellular materials
to be exchanged.
d. They are infrequent but when found are located in rhe
basal portion of the cells.
8. Which of the following statements regarding production
of col lagen by the odontoblast is correct?
a. Type I collagen is manufactured in the cellular cyto
plasm, packaged by the Golgi complex, and released
by reverse pinocytosis.
b. Tropocollagen is synthesized in the rough endo
plasmic reticulum (RER) and packaged in the Golgi
complex. Vesicles consisting of collagen fbrils
migrate into the odontoblastic process and are
released.
c. The Golgi complex packages collagen precursors
(e.g., proline) into vesicles that are released into the
predentin. These then precipitate to form tropocol
lagen and, eventually. col lagen fbrils.
. d. Synthesis begins in the RER with procollagen being
packaged in the Golgi complex. Vesicles are formed
and release tropocollagen in the predentin matrix.
986 CHALLENGE A Se(fAs5ess!llenr Exam

9. vhich of the following statements regarding dendritic
cells is false?
. Dendritic cells are similar to Langerhans' cells and
play a signifcant role in induction ofT-cell immunity.
b. Although not nonnally present in the healthy pulp,
dendritic cells appear during i nfammation and, like
macrophages, are phagocytic.
c. Considered accessory cells, the dendritic cell partici
pates in antigen recognition and presentati on.
d. Dendritic cells are primarily found i n lymphoid tis
sues.
1 0. Which of the following statements regarding the extra
cellular matrix of the pulp is false?
a. The extracellular matrix changes with eruption of the
tooth as the chrondroitin sulfate concentration
decreases and the hyaluronic acid and dermatan sul
fate fractions increase.
b. The proteoglycans regulate the dispersion of intersti
tial solutes.
c. The state of polymerization of the ground substance
regulates osmotic pressures.
d. The water content of the extracellular matri x is rela
tively low, giving the tissue a colloidal consistency
and limiting movement of components within the
tissue.
11 . Teeth with immature root development ofen are unre
sponsive to electrical pulp testing because which of the
following?
a. Myelinated fbers are the last structures to appear in
the developing pulp.
b. Predentin and intratubular fbers are not present until
root formation is complete.
c. There is a relative hypoxic condition of the pulp
during developmental glycolysis.
d. Electrical stimulation of autonomic fibers decreases
blood fow and depresses A-delta fber activity.
12. Each of the following statements support the hydrody
namic theory for pain, ecept for one. vhich is the
exception?
a. Odontoblasts have a low-membrane potential and do
not respond to electrical stimulation.
b. Placement of local anesthetics on dentin does not
alter the pain response.
c. There is a positive correlation between fui d move
ment in the tubules and the discharge of intradental
nerves.
d. Forty percent of the tubules in the area of pulp hors
contain intratubular nerve endings.
e. The presence of a smear layer decreases dentinal sen
sitivity.
1 3. Which of the following statements regarding a pali
that has a sharp, short sensation to cold that reoh'
immediately with removal of the stimulus i s correct'
a. The patient's response indicates inflammation a
tissue damage.
b. A-delta and C fibers are responsible for the pa.
sensation.
~ c. A-delta and A-beta fbers are being stimulated.
d. C-fbers are responding to the release of infa
tory mediators, such as bradykinin and substanc?
1 4. \Vhich of the following statements regarding
blood fow is correct?
a. Blood fow within the pulp is homogenous with =-
riovenous anastomoses maintaining an even fO
# b. Unmyelinated, sympathetic fibers innervating
arterioles and venules produce vasoconstriction.
c. The pulpal blood fow is the highest of oral
because of the relatively high metabolic acti
the pulp.
d. Accessory and lateral canals provide adequate
eral circulation.
1 5. Which of the following statements outlines the mI
nifcant factor influencing the pulp's response to _
and compromised healing?
a. I nfammatory cells, such as polymorpbo
leukocytes and B-Iymphocytes, are not found -
normal pulp.
, b. There is a lack of a collateral circulation.
c. Odontoblasts are end line cells incapable of =
tion.
d. The fact that the pulp may not have a IYl "co
system.
e. The environment of the dental pulp is low co
1 6. Which of the following statements regari
changes in the pulp are false?
a. There is a decrease in the cellularity and col
fbers, especially in the radicular pulp.
b. Odontoblasts decrease i n size and may d
completely in some areas, particularly te
floor of multirooted teeth.
c. There is a reduction in the nerves and VaC
the pulp.
d. There is an increase i n perirubular dentin.
e. The pulp demonstrates an increased resistan
action of proteolytic enzymes.

CHAPTER 1 2: PATHOBI OlOGY OF THE PER
I . Infammation of the periapical
a. Stagnant tissue fuid
b. Necrotic tissue
-' c. Microorganisms
d. All of the above
m

2. Acute, apical periodontitis is characterized by which of
the following?
a. A focus ofneutrophils within the lesion
b. A focus of granulomatous tissue i n the lesion
c. A focus of lymphocytes, plasma cells, and macro
phages in the lesion
3. A periapical, true cyst communicates with the root
canal; however, a periapical-pocket cyst does not.
a. True
, b. False
4. The most important route of bacteria into the dental pulp
is from which of the following?
a. The general circulation via anachoresis
% b. Exposure to the oral cavity via caries
c. The gingival sulcus
5. The least important factor infuencing the pathogenicity
of endodontic fora is which of the following?
a. Microbial interaction
b. Endotoxins released after bacterial death
? c. Exotoxins released by living bacteria
d. Enzymes produced by bacteria
6. Which of the following statements regarding neutrophils
is accurate?
a. They are nonspecifc phagocytes.
b. They have a single pathway for intracellular killing.
c. They are mobilized primarily to neutralize bacterial
endotoxins.
d. All of the above are accurate.
7. Which of the fol l owing statements regarding T-lympho
cytes arc accurate?
a. They are thyroid-derived cells.
b. They concentrate in the cortical area of lymph nodes
and also circulate in the blood.
, c. They are responsible for the cell-mediated arm of the
immune system.
8. Which of the following statements regarding B-Iympho
cytes are accurate?
* a. They were originally discovered in an avian gut-asso
ciated organ.
b. They account for the majority of circulating lympho
cytes.
c. They produce antibodies.
9. The function(s) of macro phages include(s) which of the
following?
a. Phagocytosis of microorganisms
b. Removal of small foreign particles
c. Antigen processing and presentation
d. All of the above
Challenge
987
1 0. \hich of the fol l owing statements regarding osteocytes
is accurate?
) a. They originate as monocytes in the blood.
b. They respond only to mediators released by osteo
blasts.
c. They are mononuclear cells capable of bone demin
eralization.
d. They form a rumed border away ITom the bone sur
face.
I I . Which of the following statements regarding acute
apical periodontitis is accurate?
a. It is limited to the periodontal ligament (histologi
cally).
b. It is detectable radiographically.
P c. It may heal if induced by a noninfectious agent.
d. Al l of the above statements are accurate.
1 2. Which of the following statements regarding chronic,
apical periodontitis is accurate?
a. It is a neutrophil-dominated lesion encapsulated in a
collagenous connective tissue.
-b. It may contain epithelial arcardes or rings.
c. It represents a continuous, slow process that i s
asymptomatic.
d. It as a predominance of B-cells over T-cells.
1 3. Which of the following statements regarding cholesterol
crystals is accurate?
a. They may induce granulomatous lesions.
b. They are potentially associated with nonresolving
apical periodontitis.
They are difcult for macro phages and multinucle
ated giant cells to remove.
14. Which of the following statements regarding periapical
actinomycosis is accurate?
a. It is caused by gram-negative organisms exhibiting
branching flaments that end in clubs or hyphae.
b. It is a fungal disease characterized by flamentous
colonies called sulphur granules.
~ c. it is most commonly an endodontic infection result
ing from dental caries.
15. Extraradicular infections are not found in which of the
following?
a. Solid, apical granulomas
b. Periapical-pocket cysts with cavities open to the root
canal
c. Periapical actinomycosis
d. Acute, apical periodontitis
CHAPTER 1 3: ENDODONTIC MICROBIOLOGY
AND TREATMENT OF I NFECTIONS
I . Pulpal and peri radicular pathosis results primarily from
which of the fol lowing?
a. Traumatic injury caused by heat during cavity prepa
ration
b. Bacterial invasion
c. Toxicity of dental materials
* d. Immunologic reactions
2. Which of the following statements regarding the organ
ism producing pulpal pathosis is correct?
a. The organisms are pri marily facultative streptococci.
b. Single isolates (i. e. , mono infection) produce the most
severe reactions.
c. Isolates tend to be polymicrobial and anaerobic.
d. Organisms infecting the pulp tend to be aerobic.
compared to organisms infecting the peri apex.
3. Which of the following best describes anachoresiso
a. The attraction of bloodbome microorganisms to
inflamed tissue during a bacteremia
b. The process of carious invasion, cavitation, and expo
sure of the pulp from bacteria
c. Bacteria located in dentinal rubules, and the pulp that
are seeded to the systemic circulation. inducing dis
ease in other areas of the body
4. Which of the following statements regarding strict
anaerobes is accurate?
a. They arc missing enzymes, catalase. and superoxide
dismutase.
b. They function best at high oxidation-reduction
potentials.
c. They can grow in the presence of oxygen.
5. The most common black-pigmented bacteria cultivated
from endodontic infections is which of the following?
a. Bacteroides melaninogaster
b. Fusobacterium nuclearum
" c. Prevotella nigrescens
d. Porphyromonas intermedia
6. Treatment of actinomycosis israelii may include which
of the foliowingO
a. Root canal treatment
b. Root end surgery
.
. c. Antibiotics
- d. All of the above
7. Which is true regarding microbial virulence factors?
a. Fimbriae assist in bacterial aggregation .
b. Pili break of and form extracellular vesicles fl
with enzymes.
c. Lipopolysaccharides is found in the Iiposore
gram-positive bacteria.
d. All of the above.
8. Which of the following statements regarding
amincs \s accurate'
a. They are produced by bacteria and host cells.
b. They may be found in infected root canals.
c. They are more concentrated in teeth with s
neous pain.
. d. All of the above statements are accurate.
9. \Vhich of the following statements regarding
space infections is accurate?
a. They are associated with radiographicall), ,
peri radicular lesions .
b. They occur in potential spaces between f
underlying tissue.
c. They occur when a 100th apex is located co
muscle attachment.
1 0. \Vhich of the following statements regarding LU
angina is accurate?
a. It ilwolves the submental, sublingual, and su".
space of the right or lef side.
b. It can progress into the canine and infraorbital
Q c. It can result in airway obstruction.
1 1 . Antibiotics arc recommended for which of the
ing?
a. Sinus tracts
b. Acute, apical periodontitis
c. After root end surgery
d. None of the above
12. Incision and drainage is indicated which of the .
ing?
a. For sinus tracts
b. When the swelling is difuse and indurated
c. For aCllte, apical periodontitis
d. All of the above
13. Incision and drainage of cellulitis is effective b
a. It provides a pathway of drainage to prevent sp
infection.
b. It relieves increased tissue pressure.
c. It provides relief of pain.
d. It increases circulation to the area and
delivery of antibiotics.
c. All of the above statements are accurate.
14. Which of the following statements regarding potassium
penicillin V is accurate?
a. It has a broader spectrum than amoxicillin.
b. It may be dosed at 4-hour intervals for severe infec
tion.
c. It will select for resistant organisms, especially in the
GI tract.
d. It has up to a 25% allergy rate.
1 5 . Which of the following statements regarding metronida
zole is accurate?
a. It is effective against facultative and anaerobic bac
teria.
b. It cannot be given with penicillin because of disul
furam reaction.
.
.
c. It cannot be taken with lithium or alcohoL
1 6. Which of the fol lowing statements regarding clindamy
cin is accurate?
a. It is an alternative to potassium penicillin V in aller
gic individuals.
b. It is effective against facultative and anaerobic bac
teria.
c. It is rarely associated with pseudomembranous colitis
in doses recommended for endodontic infections.
17. Which of the fol lowing statements regarding the Amer
ican Heart Association (AHA) guidelines for prophy
lactic antibiotic coverage is accurate?
a. They are the standard of care for clinicians.
b. They are based on controlled clinical studies.
' c. They are not a substitute for clinical judgment.
1 8. The AHA recommends antibiotic prophylaxis for which
of the fol lowing?
a. Surgery
b. Instrumentation beyond the apex
c. Periodontal-ligament injection
d. All of the above
19. Which of the fol lowing statements regarding he theory
of focal infection is accurate?
a. It was propounded by Dr. William Hunter in 1 91 0.
b. It was referred to infections found around poorly
made restorations.
c. it was used to explain diseases for which there was no
cure.
d. It results in needless tooth extraction.
" e. All of the above statements are accurate.
M
Challenge
989
20. Wich of the fol lowing is correct in relation to the peri
radicular lesion formed in response to dental caries and
subsequent pulp necrosis?
a. Bacteria are commonly found in the granuloma .
b. T-helper cells predominate over T-suppressor cells.
c. Formation of the granuloma is mediated through a
specifc immunologic response.
d. The release of interleukins can mediate bone resorp
tion.
CHAPTER 1 4: INSTRUMENTS,
MATERIALS, AND DEVICES
J . Which of the following statements regarding pulp stim
ulation with cold is accurate?
- a. It is best accomplished with carbon dioxide snow
(i.e., dry ice).
b. Jt is an accurate assessment of pulp vital ity.
c. I t directly stimulates the pain fbers in the pulp.
d. It is best determined with a blast of air.
2. With regard to electrical pulp testing, which of the fol
lowing is true?
a. Positive responses can be used for diferential diag
nosis of pulp pathosis.
b. The device lIses a pulsating, alternating current with
a duration of I to 1 5 ms.
, c. The device uses a low current with a high-potential
diference in voltage.
d. Gingival and periodontal tissues arc more sensitive to
testing than the pulp.
3. Which of the fol lowing statements regarding digital
radiographs is accurate?
a. They are produced by a charged coupled device and
do not require x-rays.
b. They have the advantage of being manipulatable,
which facilitates interpretation.
c. They have greater resolution than traditional flm.
d. They are captured by a sensor that has a greater sur
face area than traditional flm.
4. Which of the following statements regarding nickel and
titanium (NiTi) instruments is accurate?
.
, a. They exhibit a high elastic modulus, which provides
flexibility.
b. When stressed, they exhibit transformation from the
austenitic crystalline phase to a martensitic structure.
c. They cannot be strained to the same level as stainless
steel (SS) without pennanent deformation.
d. They are easier to prebend before placement in the
canal than 5S.
m
,
\
5. A barbed broach is most usefl for which of the follow
ing?
, . .
a. Removal of cotton, paper pomts, and other objects
from the canal
b. Removal of vital tissue from fne canals
c. Initial planing of the canal walls
d. Coronal-orifce enlargement before establishing the
correct working length
6. In comparing K-type fles with reamers, which of the
rotlawing statements regarding K-type fles is accurate?
.
a. They have more futes per millimeter, which increase
fexibility.
b. They differ, because the fle i s manufactured by twist
ing a tapered, square blank.
c. They are more efective in removing debris.
d. They are the least fexible when comparing instru
ments of the same size.
7. Based on instrument design and method of manufacrur
jng, which of the following is most susceptible to frac
ture?
a. K-type fle fabricated fom tapered, square SS blank
b. K-fex fle fabricated from rhomboidal SS blank
c. Hedstrom fle fabricated from round SS blank
d. Reamer fabricated from triangular SS blank
8. Which of the following statements regarding Hedstrom
fles are accurate?
G
a. They are manufactured by machining a round cross
sectional wire.
b. They are efective when used in a reaming action.
c. They are safer than K-type fles, because external
signs of stress are more visible as changes in fute
design.
d. They are aggressive because of a negative-rake angle
that is parallel to the shaft.
9. Which of the following statements regarding the Profile
rotary instruments is accurate?
,
1 0.
a. They are used at a range of 1 500 to 2000 rpm.
b. They are NiTi instruments manufactured in half sizes.
c. They exhibit sizes that are I SO and ANSI standard
ized.
d. They incorporate radial lands in the fute design.
Which of the following statemems regarding the best
apex locators is accurate?
a. They require training ith the instrument to become
profcient.
b. They are sensitive to canal contents.
c. They measure the impedance between the fle and the
mucosa.
d. On average, they are accurate to within 0.5 mm of the
apex.
e. All of the above statements are accurate.
I I . Piezoelectric, ultrasonic devices differ from magneto
strictive devices in which of the following?
- a. The piezoelectri c unit transfers more energy to
fles.
b. The piezoelectric unit produces heat that requires +
coolant.
c. The piezoelectric unit uses a RispiSonic, Shap
Sonic, and TrioSonic fle system.
d. The piezoelectric unit vibrates at 2 to 3 kHz.
1 2. Which of the following statements regarding ult
root canal instrumentation is accurate?
a. It should be performed in a dry environment.
b. It poses little risk offl e breakage.
c. It is not very useful for dentin removal.
c. It is most usefl in small canals where fle co"
with the wall is maximized.
1 3 . Which of the following statements regarding st
hypochlorite used as a root canal irrigating soIu
accurate?
. a. It is bufered to a pH of 1 2 to 13, which increas
i city.
b. It exhibits a chelming action on dentin.
c. 11 should be used in higher concentrations becau
the increased free chlorine available.
d. It is a good wetting agent that permits the solu
.
fow into canal irregularities.
1 4. When ethylenediaminetetraacetic acid (EDTA) i
as an endodontic irrigant, which of the following
ments is accurate?
a. It must be completely removed after use to p
continued action and destruction of dentin.
b. It is a rapid-and-efcienr method of remmi:,:
smear layer.
c. It acts on organic-and-inorganic components .
smear layer.
d. It penetrates deep into dentin and enhances I
preparation.
15. Calcium hydroxide is advocated as an interapp''
medication primarily because of which of the fo"
a. Its ability to dissolve necrotic tissue
b. Its antimicrobial activity
c. Its ability to stimulate hard-tissue formation
d. Its ability to temporarily seal the canal
16. \Vhich of rhe following statements is accurate _ --.-
gutta-percha points is accurate?
a. They contain 40% to 50% pure gutta-perch..
b. They adhere to dentin when compacted.
c. They can be heat sterilized.
g d. They are not compressible.
1 7. An advantage toAH26 as an endodontic sealer is which
orthe following?
a. The release offormaldehyde on setting
b. Low toxicity
c. Long working time, but quick setting (i. e. , I to 2
hours) at body temperature
d. It can be distinguished from gutta-percha radiograph
ically
1 8. N2, Endomethasone, and Reibler's paste are sealers that
do which of the fol lowing?
a. Produce liquefaction necrosis in the peri radicular tis
Slles
b. Induce healing in the apical pulp wound after vital
pulp extirpation
9 c. Can cause periapical inflammation
d. Do not produce a seal when used in combination with
a core material
1 9. Which of the following statements is accurate regarding
TERM is accurate?
a. It seals as well as Cavil.
b. rt is the material of choice when strength is C require
ment.
" c. It is a zinc oxide-reinforced material that can be light
cured.
d. It has a eugenol component that is antibacterial.
20. The root end is ultrasonically prepared during endodon
tic surgery for which of the following reasons?
a. It results in apical cracks at low settings.
b. It results in larger, but cl eaner, cavity walls.
c. It can make a deeper cavitY more safely than a bur.
- d. It does not require as acute an angle of root resection.
CHAPTER 1 5: PULPAL REACTION TO CARIES AND
DENTAL PROCEDURES
1 . The most common response in the dentin deep to caries
a. Increased permeability
b. Alteration of collagen
c. Dissolution of peritubular dentin
d. Dentinal sclerosis
2. Relatively few bacteria are found in a pulp abscess
because of which of the following?
a. Immune response of pulp tissue
b. High tissue pH in the adjacent infammation
c. Mechanical blockage of sclerotic dentin
d. Antibacterial products of neutrophils
Challenge
991
3. A periodontal l igament injection of 2% lidocaine with
I : 1 00,000 epinephrine causes which of the following?
a. The pulp circulation ceases for about 30 minutes.
b. The pulp circulation remains the same.
c. The pulp circulation increases markedly.
d. The pulp circulation decreases slightly.
4. The highest incidence of pulp necrosis is associated with
a. Class V preparations on root surface
b. In lay preparations
c. Partial veneer restorations
d. Full -crown preparations
5. A disadvantage of acid etching dentin (regarding efects
on the pulp) is which of the following?
a. Dentinal tubules are opened, thereby increasing per
meability.
b. Acid penetrates to the pulp and kills large numbers of
cells.
c. Acid penetrates to the pulp and damages the vessels.
d. Acid softens the dentin and increases micro leakage at
the restoration dentin interface.
6. The response of the pulp to a recently placed amalgam
without a cavity lining is usually which orthe following?
a. Slight-to-moderate infammation
b. Moderate-to-severe infammation
c. Slight but increasingly severe with time
d. None
7. The smear layer on dentin walls acts to prevent pulpal
injury for which of the following?
a. It reduces difsion of toxic substance through the
tubules.
b. It resists the efects of acid etching of the dentin.
c. It eliminates the need for a cavity liner or base.
d. Its bactericidal activity acts against oral microorgan
Isms.
8. A reaction that tends to protect the pulp from injury
from dentinal caries is which of the fol l owing?
a. A predictable stimulation of sensory nerves resulting
1 pam
b. A decrease in pemleability of dentin
c. An increase in numbers of odontoblasts under the
tubules affected by the caries
d. A bufering (i. e. , neutralization) by ground substance
of bacterial tax ins
e. A decrease in pulpal metabolism
9. Hypersensitivity is best relieved or controlled by which
of the following?
. Opening the tubules to permit release of imrapulpal
pressure
h. Root planing to remove surface layers that are hyper
sensitive
c. Applying antiinfammatory agents to exposed dentin
d. Blocking exposed tubules on the dentin surface
1 0. Deeper cavity preparations have more potential for
pulpal damage because of which of the following?
1 . Tubule diameter and density increases; therefore
there is increasing permeability.
2. There i s more vibration to pulp cells.
3. Odontoblastic processes are more likely to be severed.
a. I only
b. 3 only
c. 1 and 3
d. 2 and 3
e. I and 2
I I . Agents that clean, dry, or sterilize the cavity are which of
the following?
. Best used in deep cavities
b. Indicated when a patient repons symptoms
c. Generally very damaging to the pulp
d. Generally not useful
1 2. Of the following, which is the best way to prevent pulp
damage during cavity preparation?
. Retain the smear layer
b. Use sharp burs with a brush stroke
c. Use adequate air coolant
d. Use adequate water coolant
1 3. Which is the major reason why Class II restorations with
composite are damaging [0 the pulp?
a. Microleakage occurs at the occlusal surface.
b. Microleakage occurs at the gingival margin.
c. Toxic chemicals are released from the composite and
difuse into the pulp.
d. Polymerization shrinkage distorts cusps and opens
gaps.
1 4. A pulp has been damaged and is infamed because of
deep caries and cavity preparation. \haI material placed
on the foor of the cavity aids the pulp in resolving the
infammation?
a. Calcium hydroxide
b. Zinc oxide--eugenol
c. Steroid formulations
d. None; there is no material that promotes healing.
1 5. A cusp fractures and exposes dentin but not the
What is the probable response in the pulp?
a. Severe damage with irreversible infammation
b. Mild-to-moderate infanunation
c. Pain but no infammation
d. No pulp response
1 6. The following ill ustration shows a section of pulp
dentin underlying an area of cavity preparation. ^
was done 1 day previous. The best description of
pulp reaction is which of the following?
J
:: : " 41
'
, If" . .
f ,
,
* , t
- ; . .
, . .
..
\ .
: w `
I-
i,_ I "
"
.
.
. , '"
:
..
' " , t, t
, " . ;
,
, .
, \ ' . if I 'I
. ''
f
l '\ j' . I M ''' .
;J' . t ' .
t,
4
i l

, y # ''' ',
P " . , ..
, . , , " .
. .
I

4
~
. :';
t
* ,
r
,
a
,
a. There is no reaction; the pulp appears normal
b. The odontoblast layer is disrupted, and there
.
infammation.
c. Odontoblasts are aspirated into tubules, ad .
mild infammation.
d. Odontoblasts are absent, and there is extr.,
erythrocytes.
I
~
*****-0:
17. This is an area of pulp close to a carious exposure (see
the following i llustration). Thc infammatory response is
primarily which of the following?
a. Acute
b. Chronic
c. Giant cell
d. Vascular
1 8. The early infammatory cell infltrate response of the
pulp to caries i_volves primarily which of the following?
a. Neutrophils
b. Macrophages
c. Neutrophils, plasma cells, and lymphocytes
d. Macrophages and lymphocytes
e. Lymphocytes, plasma cells, and macrophagcs
1 9. Hypersensitivity of the pulp after restoration placement
indicates which of the following?
a. Acute infammation in the pulp
b. Chronic infammation in the pulp
c. MicroJeakage at the restoration and tooth interface
d. Stimulation of sensory nerves by hydrodynamics
e. Tubules are blocked by restorative material or smear
layer or both
CHAPTER 1 6: TRAUMATIC INJURIES
1. If several teeth are out of alignment after trauma, the
most reasonable explanation is which of the following?
. Luxation
b. Subluxation
. c. Alveolar fracture
d. Root fracture
Challenge
993
2. Initial vitality testing oftraumatized teeth is most useful
to which of the following?
. . a. It establishes a baseline for comparison with future
testing.
b. It detennines whether root canal treatment is indi
cated.
c. It determines if the blood supply to the pulp is com
promised.
d. It predicts the prognosis.
3. A nonnal periapical radiograph ora traumatized tooth is
useful for which of the following?
a. It visualizes most root fractures.
b. It visualizes concussion injuries.
* L. It gathers baseline information.
d. It locates foreign objects.
4. Which of the following statements regarding crown
infraction is accurate?
5.
a. It may indicate luxation injuries.
b. It is rarely seen on transillumination.
c. It seldom requires a follow-up examination.
d. It describes the process of coronal pulp necrosis.
Which of the following statements regarding uncompli
cated crown fracture is accurate?
a. It is an indication for a dentin-bonded restoration.
b. It requires baseline pulp testing.
c. It involves root canal treatment if the exposed dentin
is sensitive to cold stimulus.
d. It has a questionable long-term prognosis.
e. It is managed differently in young versus older
patients.
6. Which of the fol l owing statements regarding compli
cated crown factures is accurate?
. Exposure to the oral cavity permits rapid bacterial
penetration through the pulp.
b. Infammation is limited to the coronal 2 mm of the
exposed pulp for the frst 24 hours.
c. The tooth is nonnally managed by root canal treat
ment and restoration.
7. Which of the following statements regarding replace
ment resorption is accurate?
+
a. It results from direct contact between root, dentin,
and bone.
b. It is managed by surgical exposure and repair with a
biocompatible material.
c. It results when at least 75% of the root surface is
damaged.
d. It can be avoided by timely endodontic intervention.
8. Pulp necrosis is most likely to occur after which of the
following?
a. Midroot fracture
b. Intrusive luxation
c. Concussion
d. Compl icated crown fracture
9. Which of the following statements regarding cervical
root resorption is accurate?
a. It is a common. self-limiting result ofluxation injury.
b. It causes signifcant pulpal symptoms.
c. It can be arrested by root canal treatment.
' d. It may extend coronally to present as a pink spot on
the crown.
10. Which of the following statements regarding internal
a. It is more common in permanent than deciduous
teeth.
b. It is simple to differentiate fom other types of
resorption.
, c. It is characterized histologically by infammatory
tissue with multinucleated giant cells.
d. It is ruled out when there is no response to pulp
testing.
I I . A luxated 100th should be splinted in which of the fol
lowing sinttions?
*
a. If the tooth is mobile after spl inting
b. Until the root canal treannent is completed
c. With the composite as close to the gingiva as possible
d. All orthe above
12. Which medium of storage for an avulsed tooth is best for
prolonged extraoral periods?
a. Hanks balanced salt solution
b. Milk
c. Disrilled water
d. Saliva
1 3. The most important factor for managing avulsions is
a. Extraoral time
b. Decontamination of the root surface
c. Prompt initiation ofroat canal treatment
d. Proper preparation of the socket
1 4. Tooth mobility after trauma may be because of which of
the following"
a. Displacement
b. Alveolar fracture
c. Root fracture
d. Crown fracture
e. All of the above
1 5 . Which of the following is true about thermal and
trical tests after trauma?
a. Sensitivity tests evaluate the nerve and eire
condition of the tooth.
b. False-positive tests are more likely than false-
live tests.
"" c. It may take up to 9 months for normal blood f
renlfll.
d. None of the above statements are accurate.
1 6. \Vhich of the following statements regarding i
a. It is rare in deciduous teeth.
b. It is initiated by odontoblasts.
c. It is seldom confused with exteral resorption.
d. It is usually asymptomatic.
1 7. Which of the following statements regarding av
teeth is accurate?
a. They can be treated endodontically outside the
in limited circumstances.
b. They should be rigidly spl inted for 3 to 4 wek
allow periodontal support to mature.
c. They generally do not require antibiotic treatm=
the time of replantation.
d. They should have apexifcation attempted when
apex is not closed.
CHAPTER 1 7: ENDODONTIC AND PERIODONTIC
INTERRELATIONSHIPS
I . According to Gutmann, molar teeth are most like
have accessory and lateral canals:
a. Branching from the main canal to form an apical d
b. In the apical one third of the root
c. On the lateral surface of the root
d. In the fllrcation
2. Which of the following statements regarding palat
gival grooves is false?
a. The incidence of palata gingival grooves ranges f
1 0% to 20% of the population.
b. The maxillary lateral incisor is afected more that t
central incisor.
c. The grooves extend apically in varying distance
with less than 1 % reaching the apex.
d. Pulp necrosis frequently occurs in teeth with pal2
gingival grooves because of the lack of cemenn=
covering the dentin.
3. The prognosis for a tooth with a perforation is affected
by all of the following factors, except Jor ole. Which i s
the exception?
a. Location of the perforation
b. The time of repair
c. The ability to seal the defect
d. The ability to perform root canal treatment on the
remaining canals
e. The placement ofa poSt to retain the core afer perfo
ration repair
4. Which of the following statements best describes retro
grade periodontitis?
a. Inflammation from the periodontal sulcus migrates
apically, causing pulp infammation and eventually
pulp necrosis.
b. Pulp necrosis occurs, and the toxic irritants cause
infammation that migrates to the gingival margin,
creating a periodontal pocket.
c. Irritants gain access to the periodontal tissues at the
site of a vertical-root fracture, producing tissue
destruction that mimics periodontitis.
d. Pulp necrosis results in the formation of an apical,
radiolucent lesion characterized by the loss of the
apical lamina dura.
5 . Which of the following statements best describes the
efect periodontal disease has on the dental pulp?
a. There i s a direct correlation between the severity of
the periodontal disease and the percentage of pulps
that become necrotic.
b. When periodontal disease or the treatment of the dis
ease exposes a lateral or accessory canal. complete
pulp necrosis will result.
c. Although periodontitis can cause pulp infammation
and necrosis, treatment procedures have little efect
on the pulp.
d. Periodontal disease that does not expose the apical
foramen is unlikely to produce signifcant damage to
the pulp.
W MMMMMMMMMMMMM
Challenge
995
6. Which of the following statements regarding the pri
mary endodontic lesion with secondary periodontic
involvement is correct?
O Pulp necrosis occurs initially and an apical lesion
forms. Apical migration of periodontal disease
results in communication between the two lesions.
b. Treatment consists of pClforming endodontic treat
ment, which is followed by a 6-month recall exami
nation. If the periodontal component is still present,
periodontal therapy is initiated.
c. The primary endodontic lesion with secondary peri
odontic involvement exhibits a poorer prognosis
when compared with the primary periodontal lesion
with secondary endodontic involvement.
d. Pulp necrosis occurs and forms a sinus tract through
the periodontal ligament that, over time, permits the
accumulation of plaque and calculus on the root.
7. Which of the following statements regarding root resec
tion is false?
a. Success depends primarily on treatment planning and
case selection.
b. Failures occur primarily because of continued peri
odontal breakdown.
c. The long-term prognosis for the pulp in teeth with
vital-root resection is poor.
d. Endodontic treatment should precede resection of a
root.
8. Which of the following statements regarding guided
tissue regeneration (GTR) is false?
a. GTR is an effective adjunct to treatment of peri
odomal disease but has limited value in treating
endodontic pathosis.
b. The combined endodontic periodontic lesion has the
least favorable prognosis for GTR because of the
relationship of the lesion to the gingival margin.
c. Bioresorbable membranes exhibit results similar to
nonresorbable membranes.
d. Evidence suggest that GTR enhances bone formation
by preventing contact of connective tissue with the
bone.
996 CHALLENGE A SelAssessmem Exam

9. A 24-ycar-old female patient has drainage from the gin
gival sulcus of her maxillary, right. central incisor (tooth
no. 8) . Three years ago she relates a porcelain fused-lo
metal bridge (nos. 6 to 8) was placed because of a con
genitally missing, lateral incisor. Clinical examination
reveals a 1 2 mm probing defect on the lingual aspect of
tooth no. 8. Additional probing depths are 3 mm or less.
Pulp testing reveals that no. 6. no. 8, no. 9, no. 10 are
responsive to CO2 snow. Radiographic examination
reveals a difse radiolucent area along the mesial lateral
root surface extending from the cfestal tissue to the
apex. Which of the following is the most likely cause of
this lesion'
a. Vertical-root fracture
b. Palatogingival groove
c. Pulp necrosis
d. Periodontitis
C. Osteogenic sarcoma
1 0. A 5 1 -year-old woman seeks evaluation of swelling of
the buccal tissue opposite her mandibular, right, frst
molar (tooth no. 30). She relates a history of having a
full-gold crown placed 2 months ago. She states that she
has had pain for the past week and that the swelling
began yesterday. Clinical examination reveals swelling
in the buccal furcation area of tooth no. 30. Probing
depths are 3 to 4 mm, except for a 6-m defect in the
furcal area of tooth no. 30. Pulp testing with CO
2
snow
reveals teeth nos. 28, 29, and 3 1 respond. Tooth no. 30 is
not responsive. Radiographic examination reveals
normal apical struculres, however, there is a radiolucent
area in the furcation of tooth no. 30. This area \vas nor
evident on the flm taken before placement of the crown.
Based on this information what diagnostic classifcation
is most appropri ate?
a. Primary endodontic lesion
b. Primary periodontic lesion
c. Primary endodontic lesion with secondary periodon
tic involvement
d. Primary periodontic lesion with secondary cndodon
tic involvement
e. Concomitant endodontic and periodontic lesion
CHAPTER 18: ENDODONTIC PHARMACOLOGY
1 . Odontogenic pain is usually caused by which of the fol
lowing?
a. Noxious physical stimuli
b. The release of infammatory mediators
c. Stimulation of sympathetic fbers in the pulp
d, Edema produced in a ridged, noncompliant root canal
system
2. Which of the following best describes the neural i
vation of the dental pulp?
a. A-delta fbers transmit pain to the trigeminal nucI
b. C fibers transmit pain to the superior cervical g<
glion.
c. Sympathetic fbers are not blocked with applica .
of local anesthetic agents.
d. A-delta fbers play the predominant role in enc
infammatory pain.
3. Nociceptive signals are transmitted primarily to ^
of the following?
a. Nucleus caudalis
b. Limbic system
c. Reticular system
d. Superior cervical ganglion
4. Pain that refers from an infamed maxillary SinU5
maxillary molars is likely to the phenomenon of
of tile following?
a. Convergence
b. Sublimation
c. Nociception
d. Information transfer
e. Projection
5. Which of the following statements is true reg
descending fbers?
a. They inhibit transmission of nociceptive infor.
b. They are not afected by endogenous opioid pep"
c. They transmit i nformation from the cerebral corta
the thalamus.
d. They are sympathetic fbers that modulate bloo '
i n the pulp afer sensory stimulation.
6. Hyperalgesia is characterized by the following. er
for one. \hich is the exception?
a. Hyperalgesia is primarily a central mechanism.
b. Spontaneous pain is present.
c. The pain threshold is reduced.
d. Hyperalgesia produces an increased pain perc
to a noxious stimuli.
7. Regarding etodolac (i . e. , Lodine). which of the fo
ing statements is correct?
a. The drug exhibits minima\ gastrointestlna ="
when compared to ibuprofen.
b. When compared with ibuprofen, etodolac
profound analgesic action.
c. Studies indicate etodolac is unique, because
does not have a peripheral analgesic m
action.
d. This drug can be prescribed for adult
aspirin hypersensitivity.
8. \hich of the following statements regarding activation
of the opiate receptor is accurate?
a. It blocks nociceptive signals from the trigeminal
nucleus to higher brain centers.
b. It blocks transmission of signals from the thalamus to
the cerebral cortex.
c. It induces the release of endorphins.
d. It blocks the release of dynorphins.
9. Opioids arc frequently used in combination with other
drugs because which of the following?
a. The nonsteroidal, antiinHammatory drugs in combi
nation with the opioid act synergistically on the
opiate receptor.
b. The combination permits a lower dose of the opioid
which can reduce side efects.
c. Opioids do not act peripherally.
d. Opioids are not antipyretic.
1 0. Which of the following is frue for the use of codeine as
an analgesic agent?
a. Codeine prescribed in 60-mg doses is more efective
than 650 mg of aspirin.
b. Codeine prescribed in 3D-mg doses is more effective
than 600 mg of acetaminophen.
c. Codeine prescribed in 30-mg doses is more effective
than a placebo.
d. Codeine prescribed in 60-mg doses is more efective
than a placebo.
I I . Management of pain of endodontic origin should focus
on which of the following?
a. Removing the peripheral mechanism of hyperalgesia
b. Providing an adequate level of nonsteroidal. anti
infammatory analgesic agent
c. Prescribing an appropriate antibiotic in cases where
pain is the result of infection
d. Using long-acting, local anesthetic agents to break
the pain cycle
1 2. Which of the following best describes a "fexible plan"
for prescribing analgesic agents?
a. A maximal dose of an opioid is administered. I fpain
persists, the opioid is supplemented with a non
steroidal, antiinfammatory agent or acetaminophen.
Doses are then alternated.
b. A maximal dose of a nonsteroidal, antiinfammatory
agent or acetaminophen is administered. If pain per
sists, the drug is supplemented with an opioid. Doses
are then alternated.
c. Patients are advised to take the maximal dose of a
nonsteroidal, antiinfammatory agent a day before the
appointment and then as necessary for postoperative
pain.
d. Patients are advised to take an opi oid agent a day
before the appointment and then as necessary for
postoperative pain.
Challenge
997
1 3. J onsteroidal, antiinfammatory agents administered in
combination with cyclosporine may result in which of
the following?
a. They increase the risk of nephrotoxicity.
b. They induce bone marrow suppression.
c. They decrease the activity of the cyclosporine.
d. They result in increased concentrations of the non
steroidal agent in the blood plasma.
1 4. Nonsteroidal, antiinfammatory agents administered in
combination with anticoagulants may result in which of
the following?
a. Increase the prothrombin time
b. Result in a decreased bleeding time
c. Increase the bioavailability of the anticoagulant
d. Produce no adverse efect
1 5 . Indomethacin administered in combination with sympa
thomimetic agents results in which of the following?
a. Decreased blood pressure
b. Increased blood pressure
c. Decreased water retention
d. Decreased absorption of indomethacin, requiring a
higher dose
1 6. Peripheral aferent nerve fbers in an infamed pulp may
respond to mediators by which of the following?
a. Reducing the concentration of those mediators
b. Decreasing responsiveness to nociceptive stimuli
c. Decreasing the number of anesthetic molecule recep
tors
d. Decreasing numbers of ion channels
e. Sprouting of terminal fbers
1 7. Two nonsteroidal antiinfammatory drugs (NSAl Ds)
that have minimal adverse gastrointestinal side efects
are which of the following?
a. Etodolac and ibuprofen
b. Etodolac and rofecoxib
c. Ibuprofen and ketoprofen
d. Ketoprofen and etodolac
e. Ibuprofen and rofecoxib
1 8. To minimize posttreatment pain, when are analgesics
most efective when administered?
a. As a pretreatment
b. Immediately afer treatment
c. When the anesthetic begins to wear of
d. When the patient frst perceives pain
e. When the pain is the most intense

=
998 CHALLENGE A SelAssessment Exam
19. Prophylactic administration of antibiotics to control
adverse posttreatment symptoms in prospective, con
trolled, clinical trials on asymptomatic patients has been
shown to be which of the following?
a. Ineffective
b. Efective if given in high doses
c. Efective only if given pretreatment
d. Efective if given in conjunction \.lith intracanal
antibiotics
CHAPTER 1 9: ENDODONTIC MICROSURGERY
I . A 45-year-old man has a radiolucent area associated
with his maxillary, right, central incisor (tooth no. 8) and
facial swelling. He relates traumatic injury as a child
with root canal treatment during his teenage years. Sub
sequent to this treatment he fractured tooth no. 8 playing
basketball in his early thirties. Root canal retreatmcnt
was necessary and the tooth was restored with a cast
post, core and crown. \hich of the following is the most
appropriate treatment sequence?
a. Incision and drainage followed by nonsurgical
retreatment and fabrication of a new restoration
b. Root end surgery and a postsurgical antibiotic
c. Management of the infection and performance of
root end surgery when the swelling subsides
d. incise and drain the swelling, prescribe an antibiotic,
and follow the patieTl on recall examinations
e. Tooth extraction and implant placement
2. Each of the following statements on the reasons two
radiographs are reconunended for evaluation of a tooth
to be treated surgically is correct. excepT/or LL. Which
is the exception?
a. Two flms permit the evaluation and location of
normal anatomic structures.
b. The root length can be assessed.
c. The size of the lesion can be determined.
d. Root curvatures can be viewed.
e. The depth of the overlying bone can be determined.
3. When a vessel is severed initial hemostasis results from
a. Contraction of the vessel wall
b. Formation of a platelet plug
c. The conversion of prothrombin to thrombin
d. The conversion of fibrinogen to fbrin
4. The anesthetic of choice when performing endodontic
root end surgery on a patient with mild cardiovascular
disease is which of the following?
a. 1 .5% etidocaine I : 200,000 epinephrine
b. 0.5% marcaine I :200,000 epinephrine
c. 2%, lidocaine I : I 00,000 epinephrine
d. 2% lidocaine I :50,000 epinephrine
e. 4% prilocaine plain
5. The primary benefcial action of epinephrine when p
forming root end surgery is which of the following?
a. It effects the drug on alpha- I receptors in the alveo
mucosa.
b. It effects the drug on beta- l receptors of skele ..
muscle.
c. It decreased systemic uptake of the anesthetic s @
tion.
d. It prolonged the duration of anesthesia.
6. Which of the following statements regarding fap ref
tion is correct?
a. The horizontal incision for the mucogingivaJ fap
madc perpendicular to the cortical bone.
b. The rectangular fap design is most appropriate in t
posterior areas.
L. The l11ucogingival fap with an anterior-releasing
incision is preferred in posterior areas.
d. The type of vertical-releasing incisions distingui
the mucogingival fap from the Luebke-Oschsenbeli
fap.
e. The semilunar fap has the advantage of providing a
esthetic result without scar formati on.
7. \Vhich of the following hemostatic agents activates t
intrinsic coagulation pathway?
a. Ferric sulfate
b. Calcium sulfate paste
L. Microfbrillar collagen
d. Bone wax
e. Epinephrine pellets
8. Which of the following is the recommended hemostatic
technique to control bleeding during root end surgery?
a. Local anesthesia with 2% lidocaine I :50,000 epi
nephrine. epinephrine saturated pellets, ferric sulfate.
calcium sulfate paste
b. Local anesthesia with 2% lidocaine I :50,000 epi
nephrine, ferric sulfate, microfibrillar collagen, bone
wax
c. Local anesthesia with 2% lidocaine l : l 00,000 epi
nephrine, ferric sulfate, microfbrillar col lagen, Telra
pad
d. Local anesthesia with 0. 5% marcaine I :200,000 epi
nephrine. ferric sulfate, calcium sulfate paste
9. Each of the following statements is correct regarding te
use of the H 161 Lindemann bone cutter for root end
surgery is correct, except Jor one. Which is the exce
tion?
a. It reduces frictional heat when resecting bone.
b. It has more futes that conventional burs, so cutting i
faster and more efcient.
L. When used with the Impact Air45 hand piece splatter
is decreased.
d. It has fewer Rutes and is less likely to clog.
1 0. Which of the following statements regarding root end
resection is correct?
a. The root should be resected at a 45-degree angle to
ensure adequate access and visibility.
b. The apical 2 mm should be removed to ensure that
apical ramifications are not present.
c. Root end resection should precede apical curettage.
d. Resection of the root should be as perpendicular to
the long access of the root as possible.
I I . Which of the following statements regarding the isthmus
between canals is correct?
a. Although ofen noted between canals, failure to
include this area in the preparation does not afect the
prognosis of a tooth.
b. The incomplete isthmus should be prepared with a
tracking groove before ultrasonic preparation.
c. Isthmus incidence is not afected by the amount of
the root resection but increases as thc bevel
approaches 45 degrees.
d. When using a surgical operating microscope, the
absence of an istlunus at 1 6 X to 25 7 is evidcnce that
no connection between canals exist.
1 2. Which of the following statements regarding ferric sul
fate is correct?
a. Ferric sulfate acts by producing a tamponade effect
and is absorbed by the body over 2 to 3 weeks.
b. Ferric sulfate exhibits an alkaline pH.
c. Applied to the osseous surface, ferric sulfate causes
agglutination of blood proteins.
d. Ferric sulfate induces osseous tissue formation.
1 3. Which of the fol l owing statements regarding root end
preparation is false?
a. The ideal preparation should extend 3 mm into the
root and fol low the long axis of the tooth.
b. The lingual wall of the preparation is the most dif
cult area to evaluate.
c. Ultrasonic preparation has the potential to induce
mica fractures in the dentin.
d. KiS tips have enhanced cutting efciency for root end
preparations because of a zirconium nitride coating.
e. Ultrasonic root end preparation may thermoplasticize
the remaining gutta-percha.
14. Which of the following statements regarding root end
flling materials is false?
a. Super EBA is preferred as a root end flling material
over IRM because it lacks eugenol.
b. I RM is preferred over amalgam.
c. Mineral trioxide aggregate (MTA) is not adversely
affected by contamination with blood.
d. Periapical healing with MIA results in cementum
formation over the material.
c. Composite resins appear to be acceptable, providing
a dry-operating feld can be maintained.
Challenge
999
1 5. Which of the following statements is correct regarding
Uea\men\ fDr a 73-year-o\d oman W\O develops ecchy
mosis afer root end surgery?
a. Instruct the patient to place warm compresses over
the area three to four times daily.
b. Place the patient on an antibiotic to prevent infection
of the area.
c. Prescribe an antiinfammatory analgesic to enhance
the healing process.
d. Explain the cause of the problem to the patient and
provide reassurance.
CHAPTER 20: MANAGEMENT OF PAIN AND ANXIETY
1 . The majority of l i fe-threatening systemic complications
arise in which of the following?
3. During or immediately after injection of local anes
thetics
b. In conjunction with surgical procedures, such as
tooth extraction
c. During the pulp extirpation phase of root canal treat
ment
d. As a result of bleeding from patients with known
bleeding disorders
2. Which of the following tooth groups is the most difcult
to anesthetize?
a. Mandibular premolars
b. Maxillary premolars
c. Maxil lary molars
d. Mandibular molars
3. Which of the following is not a factor afecting the onset
of local anesthesia?
a. Diffusion of the local anesthetic through the Iipid-
rich nerve sheath
b. The pKa for the anesthetic agent
c. The pH of the tissue
d. The protein-binding ability of the local anesthetic
4. A decrease in the tissue pH causes which of the follow
ing?
a. It increases the free base of the local anesthetic agents.
b. It results in fewer anesthetic molecules entering the
nerve sheath.
c. It changes the pKa value for a given local anesthetic.
d. It cecreases the protein-binding of the local anes
thetic.
1 000 CHALLENGE A SelAssessment Exam
5. Failure to obtain adequate anesthesia afer an appropri
ately administered nerve block is most likely the result
in which of the following?
a. pH changes in the pulp tissue caused by infamma
tions
b. Morphologic neurodegenerative changes and infam
matory mediators
c. Insufcient volume of local anesthetic injected
d. Tolerance to the anesthetic agent
6. Wt\\ cG\\\\at\ng a and ester local anesthetic
agents, which of the following is true?
a. Esters are more likely to produce systemic toxicity
,hen compared to amides.
b. Amides are more allergenic when compared to esters.
c. Amides are more efective than esters.
d. Esters and amides are equally efective.
7. A patient is anesthetized using a posterior superior alve
olar (PSAl nerve block to perform endodontic treatment
on the maxillary, frst molar. Adequate anesthesia is nO[
obtained. In this siruation the clinician should consider
a. Anesthetizing the anterior, superior nerve
b. Anesthetizing the middle, superior nerve
c. Performing a palatal infltration
d. Repeating the P5A
8. An infltration injection is given for a maxillary, second
premolar. Adequate anesthesia is not obtained. Which
injection should be considered?
a. Anterior superior alveolar (ASAl block
b. PSA block
c. Palatal infltration
d. Maxillary (division II) block
e. Greater palatine nerve block
9. Infltration in the mandible may be an effective tech
nique in treating the which of the following?
a. Central incisor
b. Canine
c. First premolar
d. Second molar
1 0. In performing the Akinosi technique, which of the fol
lowing are accurate?
a. The needle is inserted at the height of the l11ucogin
gival junction of the most posterior, maxillary tooth.
b. The needle is passed lingual to the mandibular
ramous until is bone is contacted.
c. Injection at the neck of the mandibular condyle is the
objective.
I I . The 5tabident local anesthesia system is used for "
one of the following reasons?
a. As a true intraosscous injection
b. As a modifed periodontal ligament injcction
c. To limit the adverse reactions to vasopressor co'l
nents oflocal anesthetic cartri dges
d. As a method to administer intrapu\paJ injeo
painlessly
1 2. Prescriptions for analgesic agents should provide
of the following?
a. Instructions for administration at regular interval
b. Instructions for taking the medication when pari
experience pain
c. Administration instructions for patients in pain
day before initiating root canal treatment to e
adequate blood levels
d. Immediate preoperative administration of opia:
when pulpal pain is present
1 3. For emergency treatment of patients with pulp patho.
oral sedation should be considcred during which of
following?
a. When deep sedation of the fearful patient is des
b. When barbiturates with oral sedation should be
sidered
c. When oral sedation with midazolam may provid(
amnesia efect
d. When a short-acting agent permits the patient -
leave without an escort
1 4. Which of the following statements regarding the
nitrous oxide inhalation sedation is accurate?
a. It produces signifcant analgesic efect when ue
conjunction with local anesthetics.
b. It is difcult in managing endodontic pari
because of the application ofthe rubber dam.
c. It should be considered if oral sedation cannO
used.
d. It should be used only when an auxiliary of the
sex as the patient is present to assist.
1 5. Which of the following statements regarding
periosteal injection (infltration) is accurate?
a. It is efective for most maxillary teeth.
b. It is more efective in the presence of infection.
e. It is inefective for both adults and children i ,.
thetizing mandibular teeth.
d. It is targeted mesial and distal to the apex of
invol ved tooth.
1 6. Which of the following statements regarding regional
nerve block is accurate?
a. It achieves anesthesia by blocking efferent nerve
impulses.
b. It may be morc effective because it is deposited i n
normal, rather than infamed, tissue.
c. It is exemplifed by the long buccal nerve block.
d. It requires use of an agent without vasoconstrictors.
1 7. Which of the following statements regarding the anterior
middle superior alveolar (AM SA) nerve block is accu
rate?
a. It anesthetizes all branches of the maxillary nerve.
b. It can be delivered by a computer-controlled system
or by traditional needle and syringe.
c. It anesthetizes buccal and palatal bone, but not sof
tissue.
d. It occasionally anesthetizes the orbicularis oris.
1 8. If the dentist thinks there may be considerable posttreat
ment pain, the clinician may do which of the following?
a. Prescribe antibiotics
b. Reanesthetize with a long-acting anesthetic
c. Prescribe antianxiety medications
d. All of the above
1 9. Which of the following statements regarding oral seda
tion is accurate?
a. It has a quick onset of action.
b. It has a signifcant number of adverse reactions.
c. It has a reasonably short duration.
d. It is difcult to titrate to ideal levels.
CHAPTER 21 : TOOTH-WHITENING MODALITIES
FOR PULPLESS AND DISCOLORED TEETH
I . The whitening mechanism for bleaching teeth is thought
to be which of the following?
a. A result of the degradation organic molecules of high
molecular weight that refect a specifc wavelength of
light
b. Related to changes in the inorganic hydroxyapitite
crystals
c. Related to the dissolution of the stain
d. A result of removal of free-metal ions, such as iron
and copper
Challenge
1001
2. Which of the following statements is correct regarding
the incidence of cervical resorption afer internal
bleaching?
a. Cervical resorption can be as high 25% when Super
oxyl and heat are used.
b. Lesions develop rapidly and can be detected I to 2
months after bleaching.
c. The incidence of cervical resorption increases
patients who are 25 years old and older.
d. Although cervical resorption is often attributed to
bleaching, it is more l ikely caused by a previous trau
matic injury to the involved tooth.
3. Each of the following is an intrinsic form of tooth dis
coloration, excepf Jar one. Which is the exception?
a. Endemic fuorosis
b. Hereditary opalescent dentin
c. Tetracycline staining
d. Peridex staining
4. Which of the following statements regarding microabra
sion is correct?
a. The agent used in the technique is 30% hydrogen per
oxide, which can be obtained in proprietary products,
such > Prem3.
b. The technique is useful in treating white-and-brown
spot surface lesions.
c. Microabrasion should not be used before placement
of bonded restorations.
d. Requires a local anesthetic and frequently produces
postoperative thermal sensitivity.
5. When performing a walking bleach procedure, which of
the following statements is accurate?
a. The dentin should be etched before placement of the
bleaching agent to increase permeability of the
tubules and enJ3nce the bleaching action.
b. The sodium perborate paste should be covered by a
minimum of2 ofCavit or IR.
c. A barrier over the obturating material is not required.
d. The defnitive bonded restoration should be placed at
the visit in which the sodium perborate paste is
removed.
6. Which of the following statements regarding power
bleaching is false?
a. Power bleaching ofen uses a liquid rubber dam com
posed of a light cured resin gel.
b. Vitamin E can be used to neutralize the oxidizing
effects of hydrogen peroxide that comes in contact
with sof tissues.
c. Power bleaching can often be performed by trained
dental auxiliary personnel.
d. After fabrication of custom trays with appropriate
reservoirs, patients apply a bleaching gel every 2
hours during their waking hours.
1002 CHALLENGE A Se(fAssessmem Exam

CHAPTER 22: RESTORATION OF THE
ENDODONTICAllY TREATED TOOTH
I . Which of the following statements regarding the density
of dentinal tubules (per square mi l limeter) is accurate?
a. It remains constant as they progress from the
periphery to the pulpal dentin junction with a
decreasing diameter.
b. It remains constant as they progress from the
periphery to the pulpal dentin junction with an
increasing diameter.
c
.
It decreases as they progress from the periphery to
the pulpal dentin junction, maintaining a constant
diameter.
d. It increases as they progress from the periphery to the
pulpal dentin junction with an increase in diameter.
e. I t increases as they progress from the periphery to the
pulpal dentin junction, maintaining a constant diam
eter.
2. Which of the following statements regarding teeth
restored with crowns is correct?
a. When teeth exhibiting no caries. fracture. or other
causative factors are restored with crowns. those
serving as abutments exhibit a higher rate of necrosis.
b. The periodontal status of teeth restored with crowns
is not a signifcant factor in the pUlpal prognosis.
c. Should pulp necrosis occur in teeth restored with
crowns, the process occurs rapidly, usually within {he
frst 3 years after cementation.
d. The amount of occlusal reduction is a more signifi
cant factor in inducing pulpal pathosis when com
pared to axial reduction.
e. Pulpal pathosis becomes signifcant when the
remaining thickness of dentin is less than 1 . 5 mm.
3. Whieh of the following would best ft the defnition of
the "stressed pulp syndrome"?
a. A tooth recently prepared for a porcelain fused-to
metal crown that (with placement of a provisional
crown) exhibits severe pain to thermal stimulation
b. A tooth that is asymptomatic but has had numerous
restorations placed over a period of years because of
recurrent caries
c. A nonresrored tooth that exhibits probing depths of 4
to 5 mm
d. A tooth that is not responsive to pulp testing with CO2
and EPT
4. Each of the following is a concer when restoring an
endodontically treated molar with minimal remaining
tooth structure, except Jor one. Which is the exception?
a. Increased chance for root fracture
b. Greater potential for recurrent caries
c. Infringement on the biologic width
d. The altered light refraction
L. Changes in collagen cross linking
5. A tooth requires a post, core, and crown for ad
restorative treannent. \Vhich of the fol lowing is the
important factor in the restorative equation?
a. Dowel length
b. Dowel width
c. The surface confguration of the dowel
d. The core material
e. An adequate ferrule
6. A patient requires a post and core for restoration 0:
narrow, mandibular, central incisor tooth with 1 M %
struenlre above the gingival level. Which ofthe follm'
would be the most appropriate dowel for this situari
.
-
a. Cast post and core
b. Carbon fber post with a composite core
c. Parallel stainless steel (S5) post with an amalgam
d. Threaded dowel with a composite core
7. Which of the following statements regarding the e
fber dowels is false?
a. They are radiolucent.
b. They have a modulus of elasticity similar to dentn.
c. Thcy provide esthetic qualities similar to
dowels.
d. The carbon fber dowels are more resistant to f
8. Which of the following statements regarding the Z"
conia dowel is accurate?
a. It is easily removed from the canal by ultrasonic z:
special burs.
b. It is readily seen on radiographs.
c. It requires a composite core.
d. It is similar to dentin in elasticity.
9. The most appropriate time to determine the pre
method for restoring the endodontically treated t
a. \hen the initial diagnosis and treatment plan
established
b. During the endodontic treatment procedures
c. After completion of the root canal treatment
d. After the initial -crown preparation
1 0. Which of the following statements regarding post
is correct?
a. The post space for passive dowels must provide i
mate contact between the dowel and the dentin \\a
b. Post space should extend into the root to a depth 3
5 mm from the apex.
c. The post space required for fabrication of a d(\
and core using Q direct technique requires removal
more tooth structure than the proprietary dowel s
tems because of the need to remove undercuts.
d. Direct composite-reinforced systems require d
least amount of preparation.
CHAPTER 23: PEDIATRIC ENDODONTICS:
ENDODONTIC TREATMENT FOR THE PRIMARY
AND YOUNG, PERMANENT DENTITION
I . The basic morphologic difference between primary and
pennanent teeth is which of the following?
a. Thickness of dentin between pulp and enamel is
greater in primary teeth
h. Enamel is thicker in primary teeth
c. The pulp chamber is comparatively smaller in pri
mary teeth
d. The pulp horns are higher in primary molars
2. Radiographically, which of the following statements
regarding primary teeth is accurate?
a. Pathologic changes in the peri radicular tissues are
most ofen apparent at the apexes than the furcation
of molars.
b. The presence of calcifed masses within the pulp is
indicative of acute pulpal disease.
c, By the time internal resorption is visible the only
treatment is extraction.
d. Pathologic bone-and-root resorption is always indica
tive of nanvita! pulp.
3. Which of the following diagnostic tests is usually reli
able for determining pulpal status of primary teeth?
a. Thermal pulp tests
b. Electrical pulp tests
c. Percussion
d. None are reliable in children.
4. Which of the following statements regarding indirect
pulp therapy is accurate?
a. It is indicated only in the treatment of teeth with deep
carious lesions in which there is no clinical evidence
of pulpal degeneration or periapical pathosis.
b. It removes much of the bacteria present in dentin.
c. It includes placing calcium hydroxide or zinc oxide
eugenol (ZOE) over the remaining caries and penn3-
nently restoring the tooth with amalgam.
d. It involves all of the above.
5. Direct pulp capping is recommended for primary teeth
with which of the following?
a. Carious exposures
b. Mechanical exposures
c. Calcifcation in the pulp chamber
d. All of the above
6. Symptoms of pulp abnormalities in primary teeth
include which of the following?
a. Pain to percussion
b. History of spontaneous pain
c. Variations in mobility
d. All of the above
Challenge
1 003
7. A calcium hydroxide pulpotomy performed on a young,
permanent tooth is judged to be successful during which
of the following?
a. When the patient is asymptomatic
b. When the tooth responds to pulp testing
c. When normal root development continues
8. Fonocresol pulpotomy on a primary tooth is indicated
during which of the following?
a. When there is a history of spontaneous toothache
b. When the infammation or infection is confined to the
coronal pulp
c. When the pulp does not bleed
d. When there is only apical pathosis
9. The efect offormocresol on the pulp tissue is controlled
by which of the following"
a. Concentration used
b. Method of application
c. Length of time applied
d. All of the above
1 0. An increasingly popular technique for pUlpotomy in pri
mary teeth is which of the following?
a. Formocresol
b. Calcium hydroxide
c. El ectrosurgery
d. Laser surgery
I t . Glutaraldehyde may be preferred to formocresol for pri
mary pulpotomy because of which of the following rea
sons?
a. It has less systemic distribution beyond the pulp.
b. It has a better prognosis.
c. [t is not antigenic.
d. It is less readily metabolized.
1 2. Which of the following is an indication for root canal
treatment of primary teeth?
a. Radiographic evidence of internal root resorption
b. Periapical lesion
c. Dentigerous cyst
d. Mechanical or carious perforation of the chamber
foor
1 3. Which of the following statements regarding access
opening on primary incisors is accurate?
a. They are from the facial surface.
b. They are from the lingual surface.
c. They are from the incisal edge.
d. They are different for maxillary teeth and mandibular
teeth.
1004 CHALLENGE A Se(Assessmen Exam
1 4. Which of the following is true in placing zinc oxide
eugenol in a primary tooth?
a. Technique is not important.
b. The overfll has a poorer prognosis than a fush fll.
c. The paste should be mixed to a thick consistency.
d. Al l are true.
CHAPTER 24: GERIATRIC ENDODONTICS
1 . As related to dental visits by the older patient, which of
the following statements are accurate?
a. Older patients have fewer visits per year than younger
patients.
b. The number of visits by older patients should
decrease in the future.
c. Most visits are for comprehensive procedures.
d. Dental visits of older patients are for less-complicated
procedures \vhen compared to younger patients.
2. Which of the following statements regarding secondary
dentin formation in the radicular pulp in an older patient
is accurate?
a. It is less likely to occur in response to abrasion than
in younger patients.
b. It may result in complete pulp obliteration.
c. It may compromise the blood supply and cause pulp
necrosis.
d. It does not require an irritant.
3. In the older patient (as compared \vith a younger
patient), regarding pulpal infammation from caries.
which of the following statements is accurate?
. It is less likely to be as painful as in a younger patient.
b. It usually progresses more slmvly.
c. It is less likely to occur.
d. It is more likely to be acute than chronic.
4. Pulps in older patients tend to be less responsive to
thermal stimuli because of which of the following rea
sons?
a. Sensory nerves in dentin degenerate with time.
b. Sensory nerves in pulp lose their myelin sheath as
result of long-term, repeated injuries.
c. With age, patients become less alert and, therefore.
less responsive to external stimuli.
d. Pulpal calcifcations block external stimuli from
reaching receptors.
e. Pulps tend to have less sensory innervation in older
teeth.
5. An abrupt midroot radiographic disappearance of a
canal usually indicates which of the following?
a. Bifurcation in the canal
b. Secondary dentin formation apically
c. Concentrations of dystrophic calcifcations apically
d. Diminished (oflen unnegotiable) sized canal
6. In the older patient (as compared with the yo
patient) the exit of the canal (i.e., apical for
a. Closer to the radiographic apex
b. Closer to the true apex
c. Easier to detect tactilely
d. More variable because of cementum formation
7. Which of the following statements regarding single-.
root canal treatment in an older patient is accurate'
a. It should be avoided because there is more like:
be an increase in postappointment pain.
b. It should be avoided because it decreases sue
prognosls.
L. It is acceptable ifit is more convenient for the
d. It should be avoided to place an intracanal m
ment.
8. Success of root canal treatment in older patients (as
pared with younger patients) is which of the follo\
a. Better
b. Poorer
c. Equivalent
d. Unknown (has not been investigated)
9. In the older patient root canal treatment (as compa
extraction) is which of the following?
a. Usually more emotionally traumatic
b. Usually more tissue traumatic
c. Ofen less expensive in the long run
d. More likely to result in postappointment corplicarc .
1 0. A postsurgical condition that tends to occur more fr
quently in older patients is which of the fol lowing?
a. Ecchymosis (i. e. , discoloration) ofs.f tissues
b. Infection of the surgical site
c. Loss of sunlres because of more friable tissues
d. Continued hemorrhage of the incision site
e. Loss of consciousness
1 1 . \Vhen should periapical radiographs be prescribed?
C. Before discussion of the chief complaint
b. Afer discussing the chief complaint with the patiel
c. Just before the clinical examination
d. Afer completing the cl inical examination
12. \ith aging, which of the following statements are acCL
rate?
a. Lateral canals enlarge and become more clinic
significant.
b. Gingival recession exposes cementum and dent
which is less resistant to caries.
c. The cementodentinal j unction locates progressivel
more coronally.
d. Al l of the above occur.
1 3 . In geriatric patients, which of the following statements
are accurate?
a. There is a direct correlation between the nature of
response to electrical-pulp testing and the degree of
infammation.
h. There is a reduced volume and increased neural com
ponent of the pulp.
c. Tooth discoloration usually is not indicative ofpuJpal
death.
d. Di ffuse pain of vague origin is unlikely to be odonto
genic.
14. In evaluating success and failure of endodontic treat
ment in aged patients, a consideration is which of the
following?
a. The bone of the aged patient is more mineralized than
that of a younger patient.
b. Overlooked canals are seldom a problem because
they are usually calcified.
c. There may be failure even though the patient has no
symptoms.
d. Cold sensitivity is the usual symptom that indicates a
missed canal.
I S. Which of the following statements regarding endodontic
surgery in older patients is accurate?
a. It requires more anesthetic and vasoconstrictor than
in younger patients.
b. It may be somewhat easier because the vestibule i s
deeper.
c. It is risky because inadequate blood supply may
result in postsurgical osteomyelitis.
d. It has been demonstrated to be much less successful
than in younger patients.
1 6. The radiolucent structure at the periapex of the premolar
in the following illustration is likely which of the fol
lowing?
Challenge
1005
a. A maxillary sinus
b. An endodontic apical pathosis
c. A fbroosseous lesion
d. A bony trabecular pattern
1 7. The elevated structure facial to the crowned frst molar
in the following illustration is likely which of the fol
lowing?
a. Acute apical abscess
b. Periodontal abscess
c. Fibroma
d. Exostoses
CHAPTER 25: NONSURGICAL
ENDODONTIC RETREATMENT
1 . Canals may be missed during treatment because of
which of the fol l owing?
a. Calcification
b. Anomalous location
c. Inadequate access
d. All of the above
2. Radiographically, which of the following statements
regarding canals that appear calcifed are accurate?
a. They are seldom able to be instrumented.
b. They have a diferent appearance than the surround
ing dentin.
c. They should be opened up with rotary rather than
ultrasonic instruments.
3. The major reason for failure, requiring retreatment, i s
which of the fol l owing?
a. Persistent pain
b. Draining sinus tract
c. Restorative indications
d. Microleakage
4. Presence of excess gutta-percha beyond the apex is usu
ally caused by which of the following?
3. Use of too small a master cone
b. Excessive heating and compaction during warm, ver
tical condensation
c. Destruction of the natural apical constriction
5. Lateral or furcal canals are which of the fol l owing?
a. Commonplace
b. Not able to be mechanically cleaned
c. Not routinely obturated
d. Seldom the sole cause of endodontic failure
e. All of the above
6. Retreatment has the most favorable prognosis during
a. When the cause offailure is identifed and is correct-
able
b. When the patient is asymptomatic
c. When gutta-percha was used instead of paste
d. When a surgical microscope is used
7. For silver point removal , ultrasonics are used for which
of the following reasons?
a. To break up cement surrounding the point
b. To reduce the level of dentin on the foor of the
chamber to expose the point
c. To break up the silver point into small pieces, \vhich
can then be fushed out
d. To loosen the silver point by applying the vibrating
instrument directly to the silver cone
8. How should rotary instruments be used for the removal
of gutta-percha?
a. To remove all the gutta-percha the length of the canal
b. At the highest speeds
c. In reverse of the canal preparation direction
d. In portions ofthe canal where the instruments ft pas
sively
e. In portions of the canal where the instruments ft
snugly
9. If a cervical root perforation occurs during the treatment
and the canal preparation is incomplete, the generally
preferred time for repairing the defect is which of the
foll owing?
a. Immediately, that is, before proceeding with frther
preparation
b. After cleaning and shaping is complete but before
obturation
c. Immediately after obturation
d. Afer an appropriate recall period, to assess the status
of the tissues
1 0. Removal of objects can be facilitated by:
a. Straight-line access
b. A good l ight source
c. Magnification
d. All of the above
1 1 . Carrier-based guna-percha removal and retreatJ
. Generally easy, because all components are s -
b. Very difcult, because the gutta-percha is u", =c
c. Usually by using a combination oftechniqu -
d. Impossible
1 2. Type III transportation is best managed by:
a. Extraction
b. Apexification with calcium hydroxide
c. Forming an artifcial barrier with a materiaL
MTA
d. Obturation, as best as possible, then surgery
CHAPTER 26: DIGITAL TECHNOLOGIES
IN ENDODONTIC PRACTICE
I . A disadvantage of digital cameras relative to f
cameras i s that the digital cameras:
a. Are very expensive to purchase
h. Are more expensive to operate
c. Have inferior image resolution
d. Have a greater delay in obtaining images
C. Are vcry complicated to operate
2. An advantage of conventional radiographic flm
to digital radiographic imaging is that flm:
a. Generally produces an image of superior q
b. Is easier to duplicate (reproduce)
c. Requires less radiation exposure
d. Accurately depicts the extent of caries
e. Produces an image more quickly
3. The Interet is usable in dentistry for all of the 1"
except:
a. Inter-doctor consultations
b. Online scheduling of patients
c. Patient access to his/her dental records
d. Online ordering of supplies
e. Transmission of insurance claims
4. The Clinical Chairside Workstation is used for:
a. Storing and displaying clinical information
b. Electronically determining shades for p
crowns
c. Selecting and mixing cements
d. Communicating by voice with the front desk
5. Thc pre-registration specialized system is designed to:
a. Obtain early registration for professional meetings
b. Remind patients of recall appointments
c. Automatically contact insurance companies to deter
mine coverage limits of a patient
d. Record pertinent data on a referred patient prior to
any appointment
e. Any of the above are possibilities
TEST YOUR KNOWLEDGE
Questions I to 3 relate to the following radiograph.
The patient does not have symptoms. Al l teeth shown in the
radiograph respond to pulp testing, except the canine.
I . The radiolucent structure (arrow) at the apex of the
canine is likely which of the following?
a. Maxillary fracture
b. Apical pathosis
c. Nasopalatine duct
d. Nutrient canal
2. The radiographic appearance internally indicates which
of the fol l owing?
a. Two likely superimposed canals
b. Dentinogenesis imperfecta
c. Dense accumulations of linear calcifcations
d. Calcifc metamorphosis
Challenge
1007
3. The recommended treatment and reason for the treat
mcnt is which of the following?
a. Root canal treatment; there is pulp pathosis.
b. Root end resection and root end flling; there 1b
pathosis, but the pulp space is too small to attempt
root canal treatment.
c. No treatment; there is no pathosis.
d. Extraction is prescribed.
Questions 4 to 8 relate to the following i llustration.
Tooth no. 30 (fitst molar) causes the patient prolonged pain
to cold and episodes of spontaneous pain. The tooth responds
to probing with an explorer into the carious lesion. There is
no pain to percussion or palpation and no swelling, Peri
odontal probing is within normal limits.
4. What is the pulpal diagnosis?
a. Reversible pulpitis
b. Irreversible pulpitis
c. Necrosis
d. Unknown, pending frther information
5. What is the periapical diagnosis?
a. Normal
b. Acute apical periodontitis
c. Chronic apical periodontitis
d. Acute apical abscess
6. What is the likely appearance of the pulp histologically?
a. Coronal pulp is necrotic; radicular pulp is infamed.
b. Coronal pulp is infamed; radicular pulp is normal.
c. The entire pulp is infamed.
d. The entire pulp is necrotic.
7. What is the likely appearance of the peri apex histologi
cally?
a. Normal structures
b. Acute infammation; no bone resorption
c. Acute inAammation; bone resorption
d. Chronic infammation; bone resorption
8. What minimal immediate treatment is indicated?
a. None. Schedule the patient for future evaluation.
b. Complete canal preparation at this visit.
c. Remove the caries and place a sedative temporarily.
d. Perform pulpotomy or partial pUlpectomy.
Questions 9 to 13 relate to the following photograph and
radiograph+
A 50-year-old woman comes to the clinic compla
sharp sensitivity with chewing on the lower lef secon
She reports a period of cold sensitivity 6 months prior
not had any cold tenderness for several months. The t.
frst molars respond to pulp testing; the second mola
not respond. There is no pain to palpation_ but the
tender to percussion on the cusps and tender to birg _
bite stick. There is an isolated 6-mm probing defect on
(P/IO{ograph: The shallow occlusal alloy has been ro_
9. What is the pulpal diagnosis for tooth no. 1 8?
a. Normal
b. Hypersensitive
c. Irreversible pulpitis
d. Necrosis
1 0. What type of bacteria would likely be found i te
a. Gram-positive aerobes
b. Gramnegatie anaerobes
c. Mixed flora
d. l one
I I . What is the likely cause of the patient's pain?
a. Infamed pulp
b. Apical abscess
c. Cracked tooth
d. Periodontal abscess
12. What additional tests are indicated?
a. Cold test
b. Heat test
c. Test cavity
d. Transillumination
1 3. \hat type of permanent restoration is indicated?
a. Occlusal amalgam
b. Occlusal bonded composite
c. Pin-retained amalgam
d. Full-cast crown
Questions 1 4 to 20 relate to the following photograph and
radiograph.
The patient reports "a bad toothache for 2 days. I can't bite
on these lower, right, front teeth." There is pain on pressure
and palpation in the region of the lateral incisor and canine.
The premolar (small amalgam) is asymptomatic. The lateral
and premolar respond to pulp testing; the canine does not
respond. There is no swelling. There is an aphthous ulcer on
the facial attached gingiva of the lateral. All probings are
normal. The lateral and canine have moderate mobility.
Challenge 1009
14. Which tooth and tissue are the probable source of pain?
a. Lateral incisor and pulp
b. Canine and pulp
c. Canine and periapical tissue
d. Lateral incisor, canine, and periapical tissue
1 5. What is the likely pulpal and periapical diagnosis for the
lateral incisor?
a. Irreversible; phoenix abscess
b. Normal; chronic apical periodontitis
c. Necrosis; phoenix abscess
d. Reversible; normal
1 6. What is the likely pulpal and periapical diagnosis for the
canine?
a. lrreversible pulpitis; phoenix abscess
b. Normal; chronic apical periodontitis
c. Necrosis; phoenix abscess
d. Necrosis; suppurative apical periodontitis
1 7. Which teeth (tooth) require(s) endodontic treatment?
a. Lateral incisor only
b. Canine only
c. Both the lateral incisor and canine
d. Neither at present
1 8. Which bacteria have been related to this pathosis?
a. Gram-negative rods; anaerobic
b. Gram-positive rods; anaerobic
c. Gram-negative cocci; aerobic
d. Gram-positive cocci; aerobic
1 9. Of the following infammatory cells, which would likely
predominate periapically?
a. Lymphocytes
b. Polymorphonuclear neutrophilic leukocytes
c. Plasma cells
d. Macrophages
20. Looking at the radiograph and clinical photograph, what
is the likely cause of the pulpal and periapical pathosis?
a. Incisal attrition
b. Cervical erosion
c. Caries
d. Impact trauma
Questions 21 to 25 relate to the following radiograph.
The patient reports severe, continuous pain in the mandibu
lar, right quadrant. She states that the pain began when she
was drinking iced tea last evening and the pain has not sub
sided. She slept poorly last night. Medical history is noncon
tributory.
Amalgams were placed a few months earlier afer removal
of deep caries on both molars. She has increased pain on
lying down. The pain is not relieved with analgesics. She
cannot localize the pain to an individual tooth. Pulp testing
shows response on the premolar and second molar. The frst
molar does not respond. Cold-water application causes
intense, difse pain in the region. Percussion and palpation
are not painful. Probings are normal.
2 1 . Which tooth (teeth) is (are) the most likely cause of her
pain?
a. Premolar
b. First molar
c. Second molar
d. First and second molars
22. What is the pulpal and periapical diagnosis for the frst
molar?
a. Necrosis; chronic apical periodontitis
b. Necrosis; phoenix abscess
c. Irreversible pulpitis; chronic apical periodontitis
d. Irreversible pulpitis; acute apical periodontitis
23. What is the pulpal and periapical diagnosis for the sec
ond molar?
a. Irreversible pulpitis; normal
b. Irreversible pulpitis; acute apical periodontitis
c. Irreversible pulpitis; acute apical abscess
d. Nonnal; normal
24. What should be the minimal emergency treatment on te
ofending tooth (teeth)?
a. Remove the amalgam and place a sedative dressin_
Prescribe analgesics and antibiotics.
b. Do a complete canal preparation. Place a conn
pellet of formocresol.
c. Reduce the occlusion and prescribe antibiotics.
d. Perform pulpotomy and place a dry-cotton peUeL
25. Inferior alveolar injection is indicated. If the ofending
tooth (teeth) i s (are) not anesthetized, what is the likely
reason?
a. There is a decreased pH in the region favoring for
mation of cations.
b. The anesthetic solution is diluted by the inf -
tory fuids.
c. There may be morphologic changes i n the nerves t
originate in the infamed areas; these nerves becomes
more excitable.
d. Because of infammation, there is increased circula
tion in the area; this carries away the anesthetic n
rapidly.
Questions 26 to 28 relate to the following radiograph.
The patient has no adverse signs or symptoms. Surgery
several years ago. There are no probing defects. The canin
responds to pulp testing.
26. What diagnosis is likely?
a. Chronic apical periodontitis
b. Foreign-body reaction
c. Apical radicular cyst
d. Scar tissue
27. What is the likely cause?
a. Continued irritation from an undebrided, unsealed
canal
b. Adverse reaction to corrosion of the amalgam
c. Coronal leakage
d. Perforation of both cortical plates.
28. What should the treatment plan be?
a. Replace the crown; retreat the canal.
b. Perform another surgery and place another root end
material.
c. Place the patient on antibiotics to resolve the lesion.
d. No treatment is needed.
Questions 29 to 35 relate to the following clinical photo
graph and radiograph.
Challenge
1 01 1
A 58-year-old woman has swelling i n the maxillary anterior
area that has steadily increased for 2 days. She denies thermal
sensitivity and tenderness to biting pressure. The swelling is
between teeth nos. 9 (cenlral incisor) and 1 0 (l ateral incisor).
There is normal mobility, and probing depths are 4 to 5 m
with the distofacial surface of tooth no. 9 probing 8 mm.
There is no tenderess to percLission, but there is tenderess
to palpation. Pulp tests reveal Ihat teeth nos. 8, 9, 1 0, and I I
are responsive to electrical-pulp testing and to thermal stim
ulation with carbon dioxide snow (i . e. , dry ice).
29. Based on this information, the clinical photograph, and
the radiograph, what is the pulpal diagnosis for tooth no
.
9?
a. Normal
b. Reversible pulpitis
d. Necrotic
30. Based on this information, the clinical photograph, and
the radiograph, what is the pulpal diagnosis for tooth no.
1 0'>
a. Normal
b. Reversible pUlpit is
d. Necrotic
3 1 . What is the periradicular diagnosis for tooth no. 9?
a. Normal
b. Chronic apical periodontitis
c. Chronic suppurative, apical periodontitis
d. Acute apical periodontitis
e. Acute periodontal abscess
1012 CHALLENGE A Se/Assessmen Exam
32. Which of the following is the most likely the cause of
swelling associated with teeth nos. 9 and 1 0?
a. Pulp necrosis
b. Periodontal disease
c. A developmental groove defect
d. Vertical-root fracture
e. Peripheral giant-cell granuloma
33. Which of the following is most important in determining
if this lesion is of periodontal origin or of pulpal origin?
a. Percussion
b. A periapical radiograph
c. Periodontal mobility and mobility assessment
d. Pulp testing
e. Periodontal probing
34. Treatment of this case requires which of the following?
a. Periodontal scaling, root planing of the area. and
drainage
b. Root canal debridement of tooth no. 9, followed by
incision and drainage
c. Analgesic treatment and antibiotic treatment until the
involved tooth can be localized
d. Flap refection to inspect the root for a vertical root
fracture or lateral canal
e. Surgical excision and biopsy
35. Which of the following statements is 'rue regarding the
effects of periodontal treatment procedures on the dental
pulp?
a. Scaling and root-planing procedures remove cemen
tum, expose dentinal tubules, which are invaded and
result in pulp infammation.
b. Citric acid application appears to produce pulpal
infammation when used i n conjunction with reat
tachment procedures.
c. Hypersensitivity may result from scaling but is a sign
of pulpal pathosis or infammation or both.
d. Scaling and root-planing procedures may produce
deposition of tertiary dentin.
ANSWER KEY
Chapter 1
I . b; 2. d; 3. b; 4. b; 5. b; 6. d; 7. a; 8. c; 9. c; 1 0. c; I I . e; 1 2.
d; 1 3. b; 1 4. a; 1 5 . c; 1 6. d; 1 7. d; 1 8. c; 1 9. d: 20. b.
Chapter 2
I . d; 2. e; 3. c: 4. a; 5 . b; 6. b; 7. b: 8. b; 9. b; 1 0. c; I I . b; 1 2.
b; 1 3. a; 1 4. b; 1 5 . c; 1 6. b; 1 7. a; 1 8. a; 1 9. b; 20. d: 2 I . c; 22.
a; 23. b; 24. c.
Chapter 3
I . d; 2. b; 3. b; 4. d; 5 . c; 6. c; 7. c; 8. a; 9. a; 1 0. e; I I . b.
Chapter 4
I . d; 2. c; 3. b; 4. c; 5. d; 6. c; 7. d; 8. c; 9. c; 1 0. a; I I . L. 1:"
d.
Chapter 5
I . b; 2. c; 3. d; 4. b; 5. a; 6. c; 7. d; 8. a; 9. c; 1 0. c; I I . L. 1 2
d; 1 3. c; 1 4. a; 1 5. c; 1 6. a; 1 7. a; 1 8. d; 1 9. c; 20. b; 21 .
Chapter 6
I . a; 2. c; 3. b; 4. a; 5. b; 6. d; 7. b; 8. c; 9. a; 1 0. b; I I . C. t:
b; 1 3. c.
Chapter 7
1 . a; 2. c; 3. a; 4. d; 5. b; 6. c; 7. a; 8. b; 9. d; 1 0. b.
Chapter 8
I . a; 2. b; 3. c; 4. a; 5. c; 6. d; 7. b; 8. d; 9. b; 1 0. d; I I . < L
a.
Chapter 9
I . c; 2. d; 3. a: 4. c; 5. e; 6. d; 7. a; 8. d; 9. c; 1 0. b; I I . b:
a; 1 3 . a; 1 4. a; 1 5. a; 1 6. d; 1 7. d.
Chapter 1 0
I . c; 2. b; 3 . c; 4. b; 5 . a; 6 . a; 7 . b; 8 . d; 9. b; 10. a; I I . b:
a.
Chapter 1 1
I . c; 2. a; 3. b; 4. a; 5. b; 6. b; 7. a; 8. d; 9. b; 1 0. d; I I . M. C
d; 1 3. c; 1 4. b; 1 5 . b; 1 6. a.
Chapter 1 2
I . c ; 2 . a; 3 . b; 4. b; 5 . c; 6 . a; 7 . c ; 8 . a; 9. d; 1 0. a; I I . r:
-
b; 1 3 . b; 1 4. c; 1 5. a.
Chapter 1 3
I . d 2. c 3 . a 4. a 5 . c 6 . d 7 . b; 8 . d 9. b; 1 0. e l l . d 1 2. b: :3
e 1 4. b; 1 5. c; 1 6. c; 1 7. c; 1 8. d; 1 9. e; 20. b.
Chapter 1 4
1 . a; 2 . c; 3 . a; 4. b; 5 . a; 6 . a; 7 . c; 8 . a; 9. c; 1 0. e; 1 1 . I':
c; 1 3. a; 14. b; 1 5 . b; 1 6. d; 1 7. b; 1 8. c; 1 9. a; 20. d.
Chapter 1 5
I . d; 2 . d; 3. a; 4 d; 5 . a; 6. a; 7 . a; 8 . b; 9. d; 1 0. c; I I . I r:.
d; 1 3 . b; 14. d; 1 5. b; 1 6. b; 1 7. a; 1 8. e; 1 9. d.
Chapter 1 6
1 . c; 2. a; 3. c ; 4. a; 5 . b; 6. b; 7. a; 8. b; 9. d; 1 O. c; 1 1 . ! 2
a; 1 3. a; 1 4. e; 1 5. c; 1 6. d; 1 7. b.
Chapter 1 7
I . b; 2. a; 3. e; 4. b; 5. d; 6. d; 7. b; 8. a; 9. b; 10. a.
..
Chapter 1 8
I . a ; 2 . a ; 3 . a ; 4. a; 5. a ; 6. a; 7 . a; 8 . a ; 9. b; 1 0. d; I I . a; 1 2.
b; 1 3. a; 1 4. a; I S. b; 1 6. e; 1 7. b; 1 8. a; 1 9. a.
Chapter 19
I . e; 2. e; 3. a; 4. d; 5. a; 6. d; 7. c; 8. a; 9. b; 1 0. d; I I . b; 1 2.
e ; 1 3 . b; 1 4. a ; I S. d.
Chapter 20
I . a; 2. d; 3. d; 4. b; S. c; 6. c; 7. b; 8. a; 9. d; 1 0. a; I I . a; 12.
a; 1 3. c; 1 4. d; I S. a; 1 6. b; 1 7. c; 1 8. b; 1 9. d.
Chapter 21
I. a; 2. a; 3. d; 4. b; S. b; 6. d.
Chapter 22
l . d; 2. a; 3. b; 4. d; S. e; a; 7. d; 8. b; 9. d; 1 0. d.
Chapter 23
I . d; 2. e; 3. d; 4. d; S. b; 6. d; 7. e; 8. b; 9. a; 1 0. e; I I . a; 1 2.
b; 1 3. b; 14. d.
Chapter 24
Challenge
1013
I . e; 2. d; 3. a; 4. e; 5. a; 6. d; 7. e; 8. e; 9. e; 1 0. a; I I . d; 1 2.
b; 1 3. e; 1 4. c; 1 5. b; 1 6. a; 1 7. d.
Chapter 25
I . d; 2. b; 3. d; 4. c; 5. e; 6. a; 7. a; 8. d; 9. a; 1 0. d; I I . c; 1 2.
d.
Chapter 26
I . c; 2. a; 3. c; 4. a; 5. d
Test Your Knowled
g
e
I . d; 2. d; 3. c; 4. b; S. a; 6. b; 7. a; 8. d; 9. d; 1 0. e; I I . e;
1 2. d; 1 3. d; 14. e; 1 5 . d; 1 6. e; 1 7. b; 1 8. a; 1 9. b; 20. a; 2 1 .
e; 22. a; 23. a; 24. d; 25. e. 26. d; 27. d; 28. d; 29. a; 30. a;
3 1 . e; 32. b; 33. d: 34. a; 35. d.

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