Challenge

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

CHAPTER 1 : DIAGNOSTIC PROCEDURES 7. Of the following. which is the most likely to have
referred pain?
1 . Anesthetic testing is most effective in localizing pain to � a. irreversible pulpitis
which of the following? b. Reversible pulpitis
a. Specific tooth c. Acute apical periodontitis
.SJ b. Mandible or maxilla d. Phoenix abscess
c. Across the midline of the face
d. Posterior tooth 8. A sinus tract that drains out on the face (through skin) is
mostly likely from which of the following?
2. Areas of rarefaction are evident on radiographic exami­ a. Nonodontogenic pathosis
nation in which of the following? b. A periodontal abscess
a. When the tooth is responsive to cold " c. Periradicular (i.e., endodontic) pathosis
b. When the tooth is responsive to percussion d. Pericoronitis of a mandibular, third molar
c. When a tooth fracture has been identified
• d. When the cortical layer of bone has been eroded 9. Which of the following statements regarding a test
cavity is accurate?
3. Irreversible pulpitis is often defined by which of the fol­ a. it is the first test in diagnostic sequence.
lowing? b. It often results in a dull-pain response.
a. Moderate response to percussion c c. It is used when all other test findings are equivocal.
o b. Painful, lingering response to cold d. It should be performed with local anesthetic.
c. Short, painful response to cold
d. Short, painful response to heat 10. Percussion ofa tooth is a test for which of the following?
a. Pulpal inflammation
4. The majority of patients with symptoms of severe odon­ b. Pulpal necrosis
togenic pain have a diagnosis of which of the following? if' c. Acute periradicular inflammation
a. Periodontal abscess d. Chronic periradicular inflammation
.. b. Irreversible pulpitis
c. Acute apical periodontitis I I . Pulp stones are consistent indicators of which oflhe fol­
d. Acute apical abscess lowing?
a. Periodontal inflammation impacting the pulp
5. Medical history of coronary heart disease is significant b. Pulpal inflammation
for which of the following reasons? c. Older patient
a. It contraindicates endodontic treatment. d. Pulp that has been injured in the past but has recov­
... b. Many heart medications impact dental treatment. ered
c. It indicates the need for premedication with antibi­ e e. None of the above

otics.
d. It contraindicates local anesthetic with epinepluine. 1 2. Radiographically, which of the following statements
regarding acute apical abscess is most accurate?
6. The best approach for diagnosis of odomogenic pain is a. Tt is generally of larger size than other lesions.
which of the following? b. It has more diffuse margins than other lesions.
a. Radiographic examination c. It oft e n contains radiopacities (i.e., calcification).
b. Percussion �, d. It may not be evident.

c. Visual examination
.,. d. A step-by-step, sequenced examination and testing
approach

969
970 CHALLENGE A Self-Assessment Exam

1 3 . In which of the following may a fal se-negative response 1 8. The patient in the following illustration reports se\�
to the pulp tester occur" throbbing pain in the mandibular right molar region.1b<
a. Primarily in anterior teeth pain is exaggerated by cold. Which tooth and \\
4' b. 111 a patient with a history of trauma tissue is likely the source of pain?
c. Most often in teenagers
d. In the presence of periodontal disease

14. The lateral periodontal abscess is best differentiated

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 differentiated 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
a. First molar and pulp
1 6 . Chronic apical periodontitis is best differentiated from b. First molar and periapex
acute apical periodontitis by which of the following" • c. Second molar and pulp
a. Pulp testing and radiographic appearance d. Second molar and peri apex
b. Pulp testing and nature of symptoms
c. Radiographic appearance and nature of symptoms 19. Of the following cold-testing agents, which is the
o d. Pulp testing. radiographic appearance. and nature of effective in producing a response?
symptoms a. Bathing a tooth in ice water
b. Dicholorodiftuoromethane (DDM)
17. The abrupt change (arrow) in radiographic appearance c. CO, snow (i.e., dry ice)
in the following illustration probably indicates which of • d. Ethyl chloride
the following?
20. \Vhich of the following statements regarding iot
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 pathosis is accurate?
a. It can be determined by the level of pain a
experiences.
3. Calcific metamorphosis b. It can be related to the level of response of the e'_
b. A dense accumulation of diffuse calcification trical pulp tester.
c. A.n increased densit)' of over\'jing bone c. \t can be correlated best when a diagnosis of
\ d. A bifurcation into two canals versible pulpitis is established.
• d. It does not correlate well with the level of
patient perceives.
 --

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Challenge 971

2. A key measure as to the degree (i.e., intensity) of pain is 8. A complete medical history is essential when treating an
to determine which of the fol l owing? emergency dental patient for which of the following
a. Painful stimulus with cold reasons?
b. Painful stimulus with heat a. To identify patients with conditions that would con­
c. Painful stimulus on biting traindicate root canal treatment
d. [ncreasing pain • b. To determine conditions that might require modifica­
"c. Pain affecting patient's lifestyle tions in the approach to treatment
c. To protect the health care team from potential blood­
3. In describing the sensory innervation of the dental pulp, borne pathogens and other infectious diseases the
which of the following statements is accurate? patient may have
a. A-delta nbers are high-threshold, myelinated fibers d. For medical and legal protection and to determine if
that transmit sharp, momentary pain. the medical status will affect the prognosis for root
b. C fibers are low-threshold, unmyelinated fibers that canal treatment
produce pain in response to inflammatory mediators.
� c. The domination of C-fiber stimulation produces pain 9. When a patient complains of severe pain that cannot be
that is not well localized. localized:
d. The sharp, well-localized pain to cold testing is con­ a. The pain is most likely periradicular in origin and
ducted by both A-delta and C-fiber stimulation. likely to persist even when the necrotic pulp is
removed.
4. Which of the following induces hyperalgesia in local­ &' b. Treatment procedures should be delayed and the con­
nerve fibers? dition managed with analgesic medications.
If) a. Prostaglandin and serotonin c. The cause is most likely nonodontogenic in origin.
b. Lysosomal enzymes d. Selective administration of local anesthesia can lead
c. Calcitonin gene-related peptide to a definitive diagnosis.
d. Substance P e. The pulp of more than one tooth will be involved and
the pathosis produce a synergistic-hyperalgesia
5. Each of the following statements is correct regarding response within the central nervous system (eNS).
trigeminal neuralgia, except/arone. Which is the e:rcep­
lion? 1 0. A patient's chief complaint is severe pain from the
a. The onset occurs in midlife and is unilateral in loca­ mandibular, right first molar (tooth no. 30) when eating
tion. ice cream and drinking iced tea. Clinical examination
.a b. The pain occurs unilaterally but often involves more reveals MOD amalgam restorations in all posterior
than one division of the trigeminal nerve. teeth. The margins appear intact and no cracks or caries
c. The pain is characteristically sharp, lasts for several is detected. Pulp testing indicates all teeth in the quad­
hours, and is induced by a trigger point. rant are responsive to electrical-pulp testing. Applica­
d. The pain mimics pain of pulpal origin in that thermal tion of cold fails to reproduce the symptoms. Which of
sensitivity and tingling is often encountered just the following actions should be taken?
before an attack. a. The patient should be dismissed and asked to return
when the symptoms increase and the pain to cold
6. A patient complains of dull and constant pain that lasts becomes prolonged.
3 days on the left side of the face. The patient notes the b. Initiate root canal treatment by performing a pulpot­
pain increases on positional changes, such as bending omy or pulpectomy on tooth no. 30.
over and when jogging. The most likely diagnosis is � c. Place a rubber dam on individual teeth and apply ice
which of the fo llowing? water.
a. Myocardial infarction d. Remove the restoration in tooth no. 30, place a seda­
J b. Maxillary sinusitis tive restoration, and prescribe a nonsteroidal, anti­
c. Atypical facial pain inflammatory agent.
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
972 CHALLENGE A Self-Assessment Exam

11. A patient complains cf pain to biting pressure and sensi­ 15. Treatment of severe. throbbing pain associated
tivity to cold in the maxillary, left. posterior quadrant that maxillary, left. first molar (tooth no. 14) is best ==;'!If
subsides within seconds of removal of the stimulus. Clin­ by which of the following?
ical examination reveals teeth nos. 2 and 3 exhibit occlu­ a. Pulpotomy
sal amalgams. Which of the following test or actions is b. Partial pulpectomy
most appropriate based on the chief complaint? '" c. Pulpectomy
a. Periapical radiographs of the posterior teeth d. Analgesic agents
,. b. Examination with transillumination e. Analgesic and antibiotic agents
c. Electrical pulp testing
d. Percussion and palpation testing 16. \\fhich of the following statements regarding 1"",_·,.
tooth open for drainage in cases of an acute..
12. A practitioner refers a patient for root canal treatment. abscess is accurate?
The clinician should obtain a new preoperative radio­ a. It is the recommended method of managing tfr­
graph during which of the following siruations? gency patient.
a. \Vhen the film from the referring dentist is more than "" b. It may adversely affect the outcome oftTea
I month old c. It is appropriate, providing the patient is al- -
" b. In cases when an emergency treatment procedure was on an antibiotic.
performed d. It should be considered in addition to soft
c. \Vhen the film from the referring dentist reveals a sion and drainage.
radiolucent area that has a "hanging drop" appearance
d. Immediately before examining the patient 17. \Vith acute. apical abscess, antibiotic admin.u
· ="'-''"'
indicated in which of the following?
13. Which of the following is true regarding the periodontal • a. Primarily only when there is d i ffuse swellin.;
ligameIH injection when treating a tooth with a pulpal b. When there is swelling to any degree (i.e..
diagnosis of reversible pulpitis? or diffuse)
• a. There will be a decrease in pulpal blood ftow when c. 2 to 3 days before beginning treatment of the
anesthetic agents with a vasoconstrictor are used. d. Only if there is purulence draining from an lOI:liiiil::
b. Damage to the supporting structures can cause can·
tinued symptoms. 18. A 21-year-old model requires emergency tr·==:s
c. The periodontal-ligament injection is conrraindicated soft, fluctuant swelling over the facial alveo
when block or infiltration injections are not effective. of the maxillary, left, lateral incisor (tooth 00.
d. The periodontal ligament injection can be used as pri­ swelling is visible because of a high·lip line.
mary anesthesia in teeth that exhibit single roots, the following statements is correct regarding �
regardless of the number of canals. incision and drainage?
e a. The incision should be placed verticall!'
J 4. A patient describes pain on chewing and sensitivity to directly to bone.
cold that goes away immediately with removal of the b. The incision should be horizontal in the '''''''00 .;_
stimulus. The mandibular, left. second molar (tooth no. giva at the base of the swelling.
IS) exhibits a mesial, occlusal crack. The tooth is caries c. If drainage occurs with the initial incision. :o-_t.C�
free, and no restorations are present. Periodontal prob· section is not necessary.
ing depths are 3 mm or less. Which of the following d. The placement of a drain is necessary for .:.­
statements is correct? hours.
a. The pulpal diagnosis is nor.mal pulp, and the lOath
should be prepared and restored with a MO-bonded 19. Which of the following statements reg�
amalgam. and drainage of an indurated swelling is a
� b. The pulpal diagnosis is reversible pulpitis, and the a. They should be delayed until it becomes n-==--",
tooth should be restored with a crown. ... b. They can reduce pain caused by tissue w.s=::.
c. The pulpal diagnosis is irreversible pulpitis, and root c. They provide a purulent exudate for cuJ= _.. .....
canal treatment should be performed, a bonded amal­ sitivity testing.
gam placed, and a crown fabricated. d. They are not indicated, because antibion.:: ==_
d. A radiograph will likely reveal a radiolucent area will result in resolution of the lesion.
associated with the mesial root.
e. The prognosis for the tooth is unfavorable.
 Challenge 973

20. Flare-ups during root canal treatment are more com­ ;. a. Diagnostic tests on the other incisor
monly associated with which of the following? b. Open teeth nos. 25 and 26, debride these teeth, and
a. Tecth with vital-pulp tissue when compared to teeth place calcium hydroxide as an antimicrobial intra­
with pulp necrosis canal medicament
b. Teeth with apical radiolucent areas when compared c. Open teeth nos. 25 and 26, debride these teeth, and
to teeth with normal periapical tissues perform incision and drainage
c. With single-visit endodontic procedures d. Open teeth nos. 25 and 26, debride these teeth, and
... d. Symptomatic teeth exhibiting pulp necrosis leave the teeth open for drainage
e. Multirooted tceth c. Perform incision and drainage and prescribe an anti­
biotic for supportive care
21. Of the following reasons, when is apical trephination
through the faciobuccal, cortical plate advocated? 23.A cusp fractures in a noncarious, nonrestored premolar
a. To release exudate so that dentin is exposed. When this exposed dentin is
b. As a routine procedure for relief of pain when the contacted by cold fluids, the patient experiences brief,
offending tooth has been obturated sharp pain. Which of the following pulp status is likely?
� c. For treatment of severe, recalcitrant pain a. Normal and uninftamed
d. Between multiple-visit endodontic procedures to pre­ e b. Reversibly inflamed
vent the occurrence of a flare-up c. Irreversibly inflamed
d. Innervated only by A-delta fibers
22. A 22-year old, white man requires root canal treatment
-

for pain and swelling in the mandibular, anterior area (see 24. Corticosteroids have their major pharmacologic effect
illustration). He notes that his dentist has been treating as which of the following?
teeth nos. 25 and 26 for several months and that swelling a. Antimicrobial agent
has occurred after each visit for cleaning and shaping. b. Analgesic
Clinical examination reveals swelling located on the ('l c. Antiinflammatory agent
alveolar process in the area of the incisor teeth. Teeth d. Agent to reduce swelling
nos. 25 and 26 are tender to palpation and percussion. e. Agent to prevent spread of infection
The clinician should perform which of the following?
CHAPTER 3: NONODONTOGENIC OROFACIAL PAI N
A N D 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?
3. 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?
3. 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, often shooting into the bone and
teeth.
e. The standard medical therapy is carbamazepine (i.e.,
Tegretol).
974 CHALLENGE A Self-Assessment Exam

3. Which of the following statements regarding cluster c. An occlusal radiograph provides more dia�
headaches is correct? information than a panoramic film.
a. Vessels that encircle nociceptive fibers compress the d. Sialolithiasis has been associated with kidney
fibers during vasoconstriction. causing pain. and gallbladder stones, so patient's exhibiting this -

b. The pain is usually unilateral and involves the max­ order should be referred to a physician for eval
illa, sinus, and fetro-orbital area.
c. Cluster headaches frequently involve females 8. Which of the following statements regarding myotE
between 40 and 60 years of age. pain is correct'?
d. The pain, which is severe and lasts for 30 to 45 min­ a. Trigger points found in the superficial aspect 0:
utes, can occur at anytime. masseter may refer pain the maxillary teeth
mandibular teeth.
4. Each of the following has been shown to benefit patients b. Trigger points have been noted only in the �
with cluster headaches, excepr jo}' olle. Which is the muscles and temporalis muscles.
exception? c. Initial treatment consists of finding occlusal dl3=:r­
a. Nifedipine ancies and performing an equilibration.
b. Prednisone in combination with lithium d. Meniscus displacement and intraarticular a,db"",=
c, Hyperbaric oxygen are the cause, and corrective surgery provides
d. Alcohol term success.
e. Sumatriptin
9. Each of the following statements regarding ma�.,.o::
5. A 57-year-old man complains af pain in the mandibular, lesions of the head and neck is correct, excepT
left, posterior quadrant. The patient relates sporadic. \Vhich is the exception?
spontaneous pain during his waking hours for the past I a. Although paresthesia is an ominous symptom.. -
to 2 weeks. Upon examination no dental cause can be deficits are rare.
identified. Which of the following would be the most b. Metastatic lesions may develop from the lun!l- '
likely cause of the painO and colon.
a. Cluster headache c. Radiolucent areas detected on radiographs __

b. Myalgia quently poorly marginated.

c. Cardiogenic jaw pain d. Multiple myeloma may produce pain in the z::;,:
d. Temporal arteritis bone.
e. Otitis media
1 0 . \Vhich of the following statements regarding _, ", --=1
_
6. Each of the following statements regarding maxillary orofacial pain is false?
sinusitis is correct, except for olle. 'Which is the excep­ a. The pain is often chronic, difficult to I�
tion? there is no identifiable cause.
a. Pain is often referred to all teeth in the maxillary, pos­ b. The pain has no specific symptoms that
terior quadrant with percussion sensitivity being a diagnosis.
common finding. c. Patient's with atypical orofacial pain may �
_+

b. The maxillary sinusitis may be initiated by a tooth tory of having endodontic treatment that did
with a necrotic pulp located in the maxillary, poste­ viate the pain.
rior area. d. Patient's with atypical orofacial pain co
c. Treatment of the sinusitis requires referral to an oto­ pain in other areas orthe body.
laryngologist and antibiotic therapy. e. Neuralgia-inducing cavitational ost""'''''...
' ",
d. The Waters view radiograph may be of diagnostic (NICO) is distinct from atypical orofaci�
value in demonstrating fluid. orders.
e. An allergen-induced inflammation of the sinus is an
immediate-type hypersensitivity reaction mediated I I . Which of the following statements accurateJ- =;:::::t.
by IgE. phantom tooth pain?
a. It occurs in 10% of the patients having eo;L-=-.
7. Which of the following statements regarding sialolithi­ treatment.
asis is correct? b. It may be a form of deafferentation pain.
a. The sialolith develops in patients that often exhibit c. It has been shown to have a psychopath
increased levels of serum calcium. ponent.
b. Pain may mimic pulpal pain in the maxillary, poste­ d. It has been associated with tooth extracri
rior teeth because sialolithiasis is most frequently not occur with extirpation of the pulp.
noted in parotid duct.
 - .

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Challenge 975

CHAPTER 4: CASE SElECTION 7. Single visit is equivalent in outcome to multiple visits

AND TREATMENT PLANNING (to complete RCT) with what situation?
a. Vital pulp with acute pain
I. Which of the following statements regarding the lise of b. Necrotic pulp with acute pain
electronic-apex locators is accurate? c. Necrotic pulp without pain
a. The patient is physically impaired. d. Necrotic pulp with a draining sinus tract
b. Anatomic structures overlay the root apex.
c. A pregnant patient wishes to avoi d exposure to x-rays. 8. Root end surgery is indicated for endodontic failure i n
d. All of the above statements are accurate. which of the following?
a. The dentist suspects a missed canal.
2. Antibiotic prophylaxis is suggested for patients with a b. There has been coronal leakage.
history of which of the following? c. A cast post and core and a well-fitting crown are
a. Coronary bypass surgery present.
b. Atrial fibrillation d. All of the above
c. Artificial heart valve replacement
d. Myocardial infarction 9. Prognosis for root canal treatment is worse when the
e. Rheumatic fever patient is experiencing which of the following?
a. Pain as a symptom
3. Elective endodontic treatment is contraindicated in b. Interappointment flare-up
which of the following? c. Class I I I mobility and loss of bone support (i.e., prob·
a. Patient is a borderline diabetic. ing defects)
b. Patient has had a heart attack within the last 6 months. d. Small, periradicular. radiolucent lesion
c. Patient has had numerous opportunistic infections
secondary to HIV infection. 10. When is endodontic treatment is contraindicated?
d. Patient has an implanted pacemaker. a. The patient has no motivation to maintain the tooth.
b. The canal appears to be calcified.
4. Which of the following accurately describes external c. A large periapical lesion is present.
resorptions? d. The tooth needs periodontal crown lengthening
a. They are untreatable. before restoration.
b. They can only be distinguished surgically from
internal resorptions. I I. With pregnancy, the safest period to provide dental care
c. They appear to be superimposed over the root canal. is during which month?
d. They always require root canal treatment. a. First
b. Second and third
5. Referral of difficult cases is indicated in which of the c. Fourth to the sixth
following? d. Seventh and eighth
a. The general dentist does not have the indicated e. There is no period that is most safe.
equipment.
b. The general dentist does not have the indicated train­ 12. A preoperative finding that predisposes to a decreased
ing and experience. prognosis (i.e .. lower-success rate) is which of the fol ­
c. The general dentist is not sure what procedures are lowing?
indicated. a. The tooth is in hyperocclusion.
d. All of the above b. The pulp is vital.
c. The pulp is necrotic with no periradicular lesion.
6. Which of the following statements regarding onc­ d. The pulp is necrotic with a periradicular lesion
appointment root canal treatment is accurate? present.
a. It is best performed in association with trephination e. Treatment is in an elderly patient.
or root end surgery.
b. It may predispose the patient to postoperative flare­ CHAPTER 5: PREPARATION FOR TREATMENT
ups.
c. It is equally successful as multiple-appointment root I. Which of the following statements describes human
canal treatment. immunodeficiency virus (HIV)?
d. All of the above statements are accurate. a. HIV is more easily transmissible than Hepatitis B.
b. HIV is more fragile than the Hepatitis B virus.
c. HIV is a good model for infection control practices.
976 CHALLENGE A Self-Assessment Exam

2 . Which of the following statements rcgarding Occupa­ c. It requires the film be placed directly touc
tional Safety and Health Administration (OSHA) stan­ tooth without bending the film.
dards is accurate?
a. The standards are established to protect the dentist. 9. Radiographic contrast can be directly affected �
b. They mandate that employees be offered the HIV ing which of the following?
vaccine. a. Milliamperage
c. They include engineering and work practice controls. b. Exposure time
d. They do not impose financial penalties. c. Kilovoltage
d. Angulation
3. \Vhich of the following statements regarding informed
consent infonnation for endodontic therapy is accurate? 10. An advantage of digitized radiography in enooo.:_"
a. It must be freely given. treatment is which of the fol l owing?
b. It includes prognosis for the recommended treatment a. Image quality is better for working length
and also the alternatives. graphs.
c. It includes the opportunity to ask questions. b. X-ray generating source is not required.
d. All the above statements are accurate. c. Radiation exposure is reduced.

4. Which of the following statements regarding radiation II. In which of the following situations is a rubber
exposure from a single, full-mouth survey is accurate? placed?
a. It is half that ofa single chest film. a. When the clamp impinges on the gingiva.. cao_o;­
b. It is comparable to a barium study of the intestines. discomfort
c. It would be sufficient to cause skin cancer ifall expo­ b. When the chamber or canal may be difficult
sures were at one site. on access
c. When the tooth is rotated, preventing pIa
5. While exposing films, dental personnel should do which clamp on the indicated tooth
of the following? d. None; there are no situations in which a rtIt:.oe:
a. Stand back at least 6 feet in an area that is 90 to 1 35 is not placed.
degrees from the beam
b. Stand behind a plaster, cinderblock, or I-inch drywal l 1 2. To enhance crown preparation and retention
barrier infrabony defect exists. crown lengthening is ro_t::::�
c. Wear a lead apron by which of the following?
a. Electrosurgery
6. The recommended antibiotics for a patient with a total b. Gingivectomy
joint replacement who is allergic to penicillin or cepha­ c. Laser surgery
losporin is which of the following? d. Apically positioned flap, reverse bevel
3. Amoxicillin
b. Erythromycin 1 3 . Of the foHowing, which statement accuratel) o"c;z
c. Clindamycin radiograph units?
d. Tetracycline a. It should be optimally capable of using 70 , -

b. It should be pointed (i.e., cone) in shape.

7. The most effective method for controlling pain that c. It should be collimated to reduce exposure
often occurs after cleaning and shaping is to administer to exceed 7 em at the skin surface.
which of the following? d. It should have a filtration equivalent of 10
a. Analgesic shortly before the procedure rninum.
b. Equal amounts of the analgesic before and during the
procedure 14. With the cone moved to the distal and dir=
c. Analgesic at the conclusion of the procedure the mesial, which of the following accurate� =="=
d. Analgesic with instructions to the patient to take if the mesiobuccal root of the first molar?
necessary a. It is projected mesially on the film.
b. It is projected distally on the film.
8. Which of the following statements regarding the long­ c. It does not move.
cone paralleling technique is accurate? d. It is projected lingually on the film.
a. It minimizes distortion of tooth dimension.
b. It minimizes superimposition of the infraorbital rim
for maxillary molars.
 -- .

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Challenge 977

1 5 . The cone angulation in the following illustration is 17. Which of the following is the best way to "move" the
which of the following? 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. 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. There was excessive, positive�and-vertical angle to

the cone.
b. There was insufficient, positive-and-vertical angle to
the cone.
c. The film was not parallel to the tooth.
d. The film was bent.

a. Zygoma
b. Floor of the maxillary sinus
c. Coronoid process
d. Eyeglass frame
978 CHALLENGE A Se(f-Assessmem Exam

19. The radiopaque structure (arroH') in the following illus­ 2 1 . Of the following, the best way to identify the so=
.
tration is which of the following? the radiolucency (arrow) in the following illustra
which of the following?

a. Condensing osteitis
b. Trabeculation a. Pulp test
c. Lamina dura b. Incisional biopsy
d. Root surface c. Excisional biopsy
d. Observation over time to evaluate for changes
20. The view in the following radiograph i s a mesially
angled (beam is directed distally) film. The unobturated CHAPTER 6: ARMAMENTARIUM AND STERILIZA
root i s which of the following?
I. The patient is exposed to the least amount of r&z_
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
c. With a nonlatex, 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·­
a. Buccal root bacterial leakage
b. Lingual root c. Prepared by mixing a powder and liquid
d. More durable than intermediate restorative ==.,
(IRM) or composite
 ---

-�

Challenge 979

4. The best way to clean dental instruments before steril­ I I . The most reliable agent for destroying microorganisms
ization is by which of the following? is which of the following?
a. Ultrasonic cleaning for 5 minutes in a perforated a. Chemical sterilizing agents
basket b. Hot water
h. Hand scrubbing, using a brush and heavy rubber c. Ultrasonics
gloves d. X-ray irradiation
c. Rinsing under a forceful water spray e. Heat

5 . Steam sterilization is achieved when the load has 1 2. A good, two-stage technique (i.c., two burs in sequence)
reached which of the following? for access through a porcelain fixed-to-metal crown i s
a. 250" C for 1 5 minutes which o f the following?
b. 250" F for 1 5 minutes a. Stainless steel (55), round-diamond, coated fissure
c. 250" C for 30 minutes b. Diamond-coated, round-carbide, end-cutting fissure
d. 250" F for 30 minutes c. SS fissure, carbide. end-cutting fissure
d. carbide, round-diamond, coated, round fissure
6. An advantage of rapid-steam autoclave over traditional e. 55, round-carbide, end-cutting fissure
autoclave is which of the following?
a. Rapid-steam autoclave will not corrode steel instru­ 13. An advantage that nickel titanium (NiTi) has over 5S for
ments. intracanal instruments is which of the following?
b. Rapid-steam autoclave is safe for all types of mate­ a. Lower cost
rials. b. More resistance to breakage
c, Instruments do not have to be air dried at the end of c. Sharper
the cycle. d. More uniform in shape
d. Rapid-steam autoclave has a shorter sterilization e. More flexibility
cycle than traditional autoclave.
CHAPTER 7: TOOTH MORPHOLOGY
7. Of the following, which statement accurately describes AND CAVITY PREPARATION
a chemical vapor sterilizer?
a. It uses a reusable chemical. I . Which of the following statements describes dens-en­
b. It requires adequate ventilation in the area where it is dente?
used. .. a. It occurs primarily in maxillary, lateral, incisor teeth.
c. It achieves sterilization when heated to 270" F at 20 b. It requires the use of a long-shank bur for access
psi for 10 minutes. because the pulp chamber is located in the middle
d. It does not destroy heat-sensitive materials. portion of the root.
c. It results in an unrreatable, periodontal pocket.
8. An approved method for reducing microorganisms i n d. It produces an evagination of dentin and enamel in
water output from dental units is which o f the following? mandibular premolars.
a. Filters at the water source
b. Flushing thc watcr line beforc attaching it to the hand 2. The incidence of three roots and three canals in maxil­
piece or syringe lary first premolars is which of the following?
c. Retrograde (i.e., reverse) flushing of all water lines a. Less than 1 %
d. Careful sterilizalion of water lines within hand pieces b. 3 %
and syringes between patients • c. 6%

e. Installation of sterile water delivery systems d. 10%

9. Gutta-percha is best sterilized by which of the following? 3 . Vertucci noted in maxillary second premolars which of
a. Immersion in full-strength sodium hypochlorite the following?
b. Immcrsion in rubbing alcohol .. a. \Vhen two canals were present and join at the apex,
c. Dry heat the lingual canal is the straightest.
d. Bead sterilizer b. The incidence of t\vo canals at the apex was high,
approaching 75%.
10. The effect of sterilization on endodontic files is which of c. The incidence of accessory canals found in the furca­
the following? tion was 59%.
a. Negative and proportional to the number of times d. Histologically, calcification correlated with the radio­
sterilized graphic narrowing of the canal space.
b. Neutral; no effect is seen all physical properties
c. Positive; it restores to the files flexibility lost over time
980 CHALLENGE A Se(f-Assessmenl Exam

4. In their study of maxillary molars, Kulild and Peters 9. Which of the following statements regarding the
noted which of the following? dibular. second molar exhibiting a C-shapcd rno
a. Although two canals were often present in the mesio­ ogy is correct?
buccal roots, the canals merged apically. a. The root morphology varies with two separate­
b. The use of magnification did not increase the number distinct roots being a common finding.
of canals found clinically in this tooth group. b. Research indicates that the presence of a C-­
c. The orifice to a second canal in the mesiobuccal root canal is most common in Caucasians.
was distal to the main orifice in a line connecting the c. The C-shaped molar exhibits a ribbon-shaped
mesiobuccal canal to the palatal canal. with a 180-degree arc beginning in the mesi�L---r
t# d. A high incidence of two canals with separate foram­ area and forming an arch extending lingually IZ'
ina in the mesiobuccal root (71 %). distobuccal.
" d. The mesiolingual canal is often noted to be S"J=R
5. When treating a mandibular incisor with two canals evi­ and distinct, exhibiting a separate foramen.
dent on the preoperative radiograph, which of the fol­
lowing statements are true? I O. A 30-year-old male patient is being treated for a
a. The internal morphology of the canals will be ribbon lary cenrral incisor that he traumatized as a [<=11;'::
shaped. Radiographically, the canal appears calcified and <be::
, b. A facial-access opening might be considered. evidence of apical pathosis. Afier attempting access
c. The canals often remain separate and distinct through­ canal cannot be located despite drilling into the
out the root. third of the root. Which of the following stal
d. The access opening should be triangular with the regarding further treatment is false?
apex at the cingulum. a. Radiographs may indicate the orientation
access opening within the root.
6. Which of the following teeth is most likely to exhibit • b. The risk of perforation will be greatest on the
C-shaped morphology? surface. should the clinician continue.
a. Maxillary first premolar c. The clinician should consider obturating the
b. Maxillary first molar segment and performing root end surgery.
ii c. Mandibular first premolar d. Because canals become less calcified as theY�_='=1.
d. Mandibular first molar apically, a pathfinder might be used to neg
residual canal space.
7. In their study of mandibular molars, Skidmore and
Bjorndal noted which of the following? CHAPTER 8: CLEANING AND SHAPING
q. a. The access opening should be rectangular. THE ROOT CANAL SYSTEM
b. When there were two canals in the distal root, they
remained distinct with separate apical foramina. 1 . \Vhich of the following statements regarding 5itr::!=:£
c. The incidence of four canals was over 50%. procedures is false?
d. The mesiobuccal canal was located under the mesio­ • a. Shaping is performed after cleaning of the
buccal cusp tip and exhibited the straightest morph­ third of the canal to ensure patency.
ology. b. Shaping facilitates placement of instrurn
working length by increasing the coronalm,pe:.
8. The mandibular, second molar should be restored with a c. Shaping permits the a more accurate a5''''''==
crown after endodontic treatment for which of the fol­ the apical, cross-sectional canal diameter.
lowing reasons? d. Shaping is a necessary procedure because
a. The pulp chamber is relatively large in comparison to tion occurs from the coronal portion of the
the crown, making the tooth susceptible to fracture. the apex.
� 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 off
under occlusal loading.
d. Providing a post can be placed in the distal root to
strengthen the rOOL
,
I

- ------------------- -

Challenge 981

2. Which of the following statements best describes the 7. \Vhich o f the following statements regarding the use o f
Profile Series 29 files? cheiating agents in canal preparation is correct?
a. The Profile Series 29 files conform to the !tHerna­ a. Aqueous solutions are preferred to viscous suspen­
tional Standards Organization (ISO) specifications sions in canal preparation.
for instrument design. I b. Viscous suspensions are more effective in preventing
It b. The instruments exhibit a constant percentage accumulation of tissue and dentinal debris.
change between successive instruments. c. Viscous suspensions contain the highest concentra­
c. The Profile Series 29 files were designcd to facilitate tion of ethylenediaminetetracitic acid (EDTA) and
preparation of the coronal portion of the radicular are most effective in removing the smear layer.
space. d. Aqueous solutions are most efficient as lubricants
d. The instruments are most useful in the larger sizes and, therefore, preferred to viscous suspensions dur­
because there is a smaller change in diameter ing canal preparation.
between the files. e_ EDTA. in concert with sodium hypochlorite, causes a
nascent release of oxygen, which kills anaerobic
3. Each of the following are direct advantages of pre­ organisms.
enlarging the radicular space, excepTfor one. Which is
the e.rceplioll? 8. Which of the fol lowing statements regarding an endo­
a. It provides better tactile control of instruments when gram is false?
negotiating a small, curved canal. a. An endogram would provide information on the
b. It removes the bulk of tissue and contaminants before extent of internal resorptive lesion.
apical preparation. b. The visualization of fractures and leaking restora­
o c. It facil itates obturation. tions is attributed to the incorporation of Hypaque i n
d. It provides a reservoir for the irrigant. the irrigating solution.
c. Conventional radiography and digital radiography
4. The result of root canal treatment in establishing patency may both be used in producing an endogram.
is which of the following? " d. The endogram is used to confirm the correct working
•
a. Ilfevents procedural errors, such as canal blockage length.
and transportation.
b. It causes irritation of the periodontal attachment 9. During the early phase of roor canal preparation, which
apparatus and increased postoperative pain. of the following is true?
c. It enlarges the apical terminus and increases the a. The initial scouter file that moves easily through the
potential for extrusion of obturating materials. canal should be advanced to the estimated working
d. It requires insertion ofa file 1.0 to 2.0 mm beyond the length .
canal terminus. ... b. The initial scouter file may not advance to the esti­
mated working length because of the rate of instru­
5. Which of the following statements regarding gauging ment taper.
and tuning is correct? c. The initial scouter ile
t should be advanced with a
a. Gauging is performed in the coronal portion of the reciprocating action using apical pressure when resis­
canal to confirm the coronal enlargement is complete. tance is encountered.
b. Tuning identifies the most apical, cross-sectional d. The initial scouter file is used before the introduction
diameter of the canal. of a viscous chelator in cases exhibiting vital tissue.
• c. Gauging and tuning verify the completed shaping of
the apical pOition of the canal. 1 0. Which of the following statements is correct regarding
d. Gauging and tuning produces a uniform, cylindric coronal canal preparation in endodontic treatment?
diameter to the canal in the apical 2 to 3 mm that a. Nickel-and-titanium (NiTi) rotary instruments are
enhances obturation and sealing. preferred to Gates-Glidden (GG) drills because they
remove dentin uniformly from the canal wall.
6. Which of the following statements best describes the b. NiTi rotary instruments are best used in a step·back
Quantec fi les? fashion.
a. The instruments have a constant helical angle and c. Both GG drills and NiTi rotary instruments should be
three flutes. used large to small, because this develops a prepara­
b. The recommended rotational speed is 1 000 to 2000 tion that is centered i n the root.
R.PM. • d. GG drills used in a step-back technique can relocate
c. The instruments exhibit a constant rate of taper along the canal away from the furcal wall.
their length.
(\ d. The instruments exhibit varied tapers with a constant
Do diameter of 0.25 mm.
982 CHALLENGE A Se/f-Assessl1Iem Exam

I I . When lIsing the balanced-force technique for canal 5. The primary reason to use a sealer and cement is \\
preparation, which of the following statements is accu­ of the following"
rate? a. Attainment of an impervious seal
! a. The cutting stroke involves apical pressure and a b. Canal disinfection
counterclockwise rotation. c. lubrication of the master cone
b. Clockwise rotation balances the tendency of the file d. Adhesion to dentin
to be drawn into the canal during the cutting stroke. ' e. All of the above
c. Dentin is engaged with a counterclockwise rotation
and cut with a 45- to 90-degree. clockwise rotation. 6. Considering lateral versus vertical condensation. �
d. It requires the use of a crown down technique. have shown which of the following?
a. Lateral condensation results in a better seal.
1 2. Extending a no. J 0 file with a 0.02 taper 1 .0 mm beyond b. Vertical condensation results in a better seal.
the apical foramen will result in which of the following? c. Both consistently fill lateral canals.
� a. It opens the apical foramen to a minimum diameter of � d. Sealability with either largely depends on the �

0. 1 2 mm. of the prepared canal.

b. It increases postoperative discomfort to occlusal
forces. 7. A problem with nickel-and-titanium (NiTi) spread!::>
c. It reduces the percentage of change from a no. 1 0 file which of the following?
to a no. 15 file by 50%. .. a. Tendency to buckle under compaction pressure
d. It eliminates the natural constriction of rhe foramen b. Tendency to break during condensation
and increases thc chance for an overfill. c. Creation of greater wedging forces, leading ID
fracture
CHAPTER 9: OBTURATION OF THE ClEANED d. They do not penetrate as deeply as stainless ec-�
AND SHAPED ROOT CANAL SYSTEM spreaders under equal force

I. Of the following, the least important determinant ofroor 8. Moderate extrusion of obturating materials be
canal treatment success is which of the following? apex is undesirable because of which of the foil
a. Proper placed restoration after root canal treatmcnt a. There is more likelihood of postoperative discr..:;;;ijoc
b. Healthy periodontium b. Sealer and gutta-percha cause a severe, infi.an:="""�
� c. Three-dimensional (3-D) obturation of the root canal reaction in peri radicular tissue.
system c. The prognosis is poorer.
e d. A1 1 of the above

2. Paraformaldehyde-containing obnrrating materials result

in which of the following? 9. In which of the following is one-visit root c�
a. Eliminate bacteria that remains in the canals ment not recommended?
b. Mummify tissue remnants in the canals a. The pulp is necrotic and not symptomatic.
c. Reduce posnreatment pain b. The pulp is necrotic and symptomatic .
d. Are below the standard of care for root canal treat­ .J c. The pulp is necrotic and there is a draining s'
ment d. The pulp is vital and symptomatic.

3. It is preferable to not extrude sealer beyond the apex for 10. When is an application of heater-injected gu::t:!-_-"
which of the following reasons? potentially beneficial?
(Ia. The sealer usually does not resorb. a. When there is an open apex
b. The sealer often stains or tattoos the tissue. 1'.1 b. When there are aberrations or irregulari:

e. The sealer is a tissue irritant and may delay healing. canal

d. The sealer promotes bacterial growth. c. When the clinician cannot master lateral OOIU::o:=::r
d. When the canals are curved and small afu:::- :;:cy;::;=o
4. Gutta-pereha in contact with connective tissue is which tion
of the following?
a. Relatively inert 1 1 . Which of the following statements accurate .
b. Immunogenic an adequate apical seal?
., c. Unstable a. It can only be achieved with lateral con="",,;...::�
d. Carcinogenic • b. It depends on placing the compactio_

close to the apical terminus.

c. It can be achieved in small, nontapering
rations.
 ------- -
- ---- -
- --

Challenge 983

12. Which of the following statements accurately describe 1 6 . The dark tooth in the following illustration has a history
the continuous-wave technique? of trauma and root canal trcatment. It is likely that the
� a. It uses a heal carrier that can both compact and heat discoloration is primarily caused by which of the fol­
gutta-percha. lowing?
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 110 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.

14. The most likely cause of a gross ovcrfill is which of the a. Remnants of necrotic tissue
following? b. A leaking restoration
b a. Lack of an apical seat or stop c. Blood pigments in the dentinal tubules

b. Use of excessive amounts of sealer " d. Obturating materials not removed from the chamber
c. Use of excessive apical pressure on the spreader
d. Use of a master cone that is too small 1 7 . Of the following, what is the most likely cause offailure
of root canal treatment on the lateral incisor in the illus­
15. The obturation of the incisor shown in the following tration?
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. a. The silver point corrodes.
c. There is a space between the temporary restoration b. The canal is filled too close to the apex.
and the gutta-pereha. c. There is coronal leakage.
d. The diagnosis was pulp necrosis and chronic apical • d. The silver point does not adapt to the prepared space.
periodontitis; the canal should be filled to the apical
foramen.
984 CHALLENGE A Se/fAssessment Exam

CHAPTER 1 0: RECORDS AND LEGAL 7. A specialist may be held liable if which of the foil"" _

RESPONSIBILITIES occurs?
a. Infomls the patient that the general practitioner pe:-­
l . Concerning making changes in a patient record, which formed substandard care
oflhe following statements is accurate? b. Fails to disclose to the patient or referring denti �­
a. Any changes are forbidden. dent pathosis on teeth other than those the sp -
h. Deletions are permitted if erased completely as soon is treating
as they occur. c. Fails to locate a small canal that is not evident ra6c­
c. Corrections are permitted if dated. graphically
d. Ivlistakenly initiates treatment on the wrong tooc;
2. Standard of care, as defined by the courts, is which of the a difficult diagnostic situation
following?
a. Requires absolute perfection 8. Of the following, which is the best way for clinician:s­
b. Describes what any careful-and-prudent clinician avoid legal actions by patients?
would do under similar circumstances a. Tell patients they have no malpractice insurance
c. Does not allow for individual variations of treatment b. Anend continuing education courses to
d. Is equivalent to customary practice informed of current techniques.
c. Refer all major patient complaints to peer re\;�
3. The doctrine of informed consent does not require d. Demonstrate genuine interest in the welfare of
which of the following? patient.
a. Patients to be advised of reasonably foreseeable risks
of treatment 9. Computerized treatment records may not be signee.
b. Patients to be advised of reasonable alternatives tronically.
c. Patients forfeit their right to do as they see fit with a. True
their body. b. False
d. Patients be advised of the consequences of nontreat­
mcnt. 10. Suing to collect fees is a proven route to being ""''''''',.
sued for malpractice.
4. Which of the following statements accurately describe a a. True
periodontal examination of a patient referred for endo­ b. False
dontic treatment?
a. It should performed on the entire dentition. I I . Standard of care for routine endodontics is set �
b. It must be performed at least on the tooth to be treated. of the following?
c. It i s necessary only if there is evidence of periodontal a. The state's dental licensing agency
disease. b. Endodontists
d. It is necessary only if requested by the referring c. The community of general dentists
dentist.
1 2 . A patient continues to have pain after a dena
5. A dentist may legally do which of the following? technique of Parafonnaldehyde paste pulpot
a. Refuse to treat a new patient, despite severe pain and tooth with a necrotic pulp and apical pathosis
infection places a crown. In this situation, which of the f.... ""'::::;;
b. Be bound to see a fonner patient on recall after treat­ statements is true?
ment i s completed a. The dentisr is liable for malpractice beca..u5
c. Discharge a patient from the practice at any time ceptable treatment procedures were followec_
d. Refuse to treat a patient who has an outstanding b. The dentist is not liable if the patient i s nov. ."
�=
account balance to the appropriate specialist who can treat tht
e. The dentist is not liable if the dentist perfi

6. If a patient with human immunodeficiency virus (HIV) tional treatment for no fee.
requests that the dentist not inform the staff of the con­
dition, the dentist should do which of the following?
a. Refuse to treat the patient
b. rell the staff in private, and then treat the patient with
extra precautions
c. Not tell the staff but treat the patient with great cau­
tion
d. Not tell the staff and require the patient to assume lia­
bility should anyone contract the virus
 --

- --
----- -------_.

Challenge 985

CHAPTER 1 1 : STRUCTURE AND FUNCTIONS 5. Which of the following statements regarding the tubular
OF THE DENTIN AND PULP COMPLEX structure of dentin is correct?
a. Peri tubular dentin and intertubular dentin are the
I . In the process of tooth development, which of the fol· same composition, except for the fact peritubular
lowing statements are true? dentin lines the tubule.
a. The basement membrane separating the inner dental . b. Peritubular dentin has a lower-collagen content when
epithelium from the dental mesenchyme is composed compared to intertubular dentin and is more suscep­
of type I and ill collagen. tible to removal by acids.
h. Blood vessels become established in the dental c. I.ntertubular dentin is more highly mineralized when
papilla during the cap stage. compared to peritubular dentin.
c. Mature ameloblasts appear before odontoblasts d. Peri tubular dentin defines the tubule size and is com­
mature. However, the fannation of enamel takes mon to all mammals.
place following the deposition of dentin.
d. Type II collagen mRNA increases with odontoblastic 6. Which of the following statements regarding dentin per­
differentiation. meability is lYUe?
e. Amcloblasts form enamel spindles near the future a. Remains constant regardless of the depth of a cavity
dentinoenamel junction (DEJ). preparation because of a pulpal tissue pressure of
1 0.3 mm Hg
2. von Korff fibers are best described as which of the fol­ • b. Increases as the pulp and dentin border is approached
lowing? (primari ly because the tubular surface area increases)
a. The first-formed col lagen fibers formed between pre­ c. Is lower in radicular dentin because of tubular scle­
odontoblasts. roSIS
b. Unmyelinated sensory fibers in the cell-free zOlle of d. I ncreases near the pulp and dentin border as the
Wei l hydrostatic pressure in the tubules decreases
c . Odontoblastic processes interposed between amelo­
blasts 7. Which of the following statements regarding tight j unc­
d. Silver-stained ground substance located between tions in the odontoblastic layer is true?
odontoblasts • a. They regulate permeability of extracellular sub­
stances between the odontoblastic layer and the pre­
3. Which of the following statements regarding rOOl devel­ dentin.
opment is false? b. They permit low-resistance pathways for electrical
a. Root development begins after completion of enamel excitation when the odontoblastic process is distorted.
formation. c. They provide a mechanism for intracellular materials
b. The inner epithelium, the stellate reticulum. and to be exchanged.
outer enamel epithelium form Hertwig's epithelial d. They are infrequent but when found are located in rhe
root sheath. basal portion of the cells.
c. The dental sac disintegrates upon induction of dentin
formation and remnants persist as the Epithelial 8. Which of the following statements regarding production
Rests of Malassez. of col lagen by the odontoblast is correct?
d. Accessory canals in the root are formed when there is a. Type I collagen is manufactured in the cellular cyto­
discontinuity in the root sheath. plasm, packaged by the Golgi complex, and released
by reverse pinocytosis.
4. Which of the following statements regarding delllin is b. Tropocollagen is synthesized in the rough endo·
correct? plasmic reticulum (RER) and packaged in the Golgi
a. Mantle dentin is (he first formed dentin and has col­ complex. Vesicles consisting of collagen fibrils
lagen fibers that run perpend icular to the DEJ. migrate into the odontoblastic process and are
b. Dentin deposited after eruption i s termed secondary released.
dentin. c. The Golgi complex packages collagen precursors
c. Dentinal tubules make up 50% of the dentin volume (e.g., proline) into vesicles that are released into the
and they exhibit extensive tenninal ramifications. predentin. These then precipitate to form tropocol­
d. Calcification of dentin results in an organic compo­ lagen and, eventually. col lagen fibrils.
nelll composed of noncol\agenous matrix compo­ . d. Synthesis begins in the RER with procollagen being
nents. packaged in the Golgi complex. Vesicles are formed
and release tropocollagen in the predentin matrix.

-
986 CHALLENGE A Se(f�As5ess!llenr Exam

9. vVhich of the following statements regarding dendritic 1 3 . Which of the following statements regarding a paliauii:
cells is false? that has a sharp, short sensation to cold that resoh'!S
3. Dendritic cells are similar to Langerhans' cells and immediately with removal of the stimulus is correct':'
play a significant role in induction ofT-cell immunity. a. The patient's response indicates inflammation aa!:
b. Although not nonnally present in the healthy pulp, tissue damage.
dendritic cells appear during i nflammation and, like b. A-delta and C fibers are responsible for the paini:...
macrophages, are phagocytic. sensation.
c. Considered accessory cells, the dendritic cell partici­ •. c. A-delta and A-beta fibers are being stimulated.
pates in antigen recognition and presentation. d. C-fibers are responding to the release of inflarm:n­
d. Dendritic cells are primarily found in lymphoid tis­ tory mediators, such as bradykinin and substance ?
sues.
1 4. \Vhich of the following statements regarding
1 0. Which of the following statements regarding the extra­ blood flow is correct?
cellular matrix of the pulp is false? a. Blood flow within the pulp is homogenous with =--.­.
a. The extracellular matrix changes with eruption of the riovenous anastomoses maintaining an even flO"
tooth as the chrondroitin sulfate concentration J' b. Unmyelinated, sympathetic fibers innervating
decreases and the hyaluronic acid and dermatan sul­ arterioles and venules produce vasoconstriction..
fate fractions increase. c. The pulpal blood flow is the highest of oral '­

b. The proteoglycans regulate the dispersion of intersti­ because of the relatively high metabolic acti� -__

tial solutes. the pulp.

c. The state of polymerization of the ground substance d. Accessory and lateral canals provide adequate
regulates osmotic pressures. eral circulation.
d. The water content of the extracellular matrix is rela­
tively low, giving the tissue a colloidal consistency 1 5 . Which of the following statements outlines the mIlS
and limiting movement of components within the nificant factor influencing the pulp's response to _ __
-

tissue. and compromised healing?

a. I nflammatory cells, such as polymorpbo
1 1 . Teeth with immature root development often are unre­ leukocytes and B-Iymphocytes, are not found -
sponsive to electrical pulp testing because which of the normal pulp.
following? , b. There is a lack of a collateral circulation.
a. Myelinated fibers are the last structures to appear in c. Odontoblasts are end line cells incapable of =
the developing pulp. tion.
b. Predentin and intratubular fibers are not present until d. The fact that the pulp may not have a IYl _ "",
ce:o;:
root formation is complete. system.
c. There is a relative hypoxic condition of the pulp e. The environment of the dental pulp is low con;:
during developmental glycolysis.
d. Electrical stimulation of autonomic fibers decreases 1 6. Which of the following statements regarcii.u,g
blood flow and depresses A-delta fiber activity. changes in the pulp are false?
'> a. There is a decrease in the cellularity and col�
12. Each of the following statements support the hydrody­ fibers, especially in the radicular pulp.
namic theory for pain, e:rcept for one. vVhich is the b. Odontoblasts decrease i n size and may dis.!;
exception? completely in some areas, particularly the �
a. Odontoblasts have a low-membrane potential and do floor of multirooted teeth.
not respond to electrical stimulation. c. There is a reduction in the nerves and VasiCUh:=
b. Placement of local anesthetics on dentin does not the pulp.
alter the pain response. d. There is an increase in perirubular dentin.
c. There is a positive correlation between fluid move­ e. The pulp demonstrates an increased resistance ­
ment in the tubules and the discharge of intradental action of proteolytic enzymes.
nerves.
d. Forty percent of the tubules in the area of pulp horns CHAPTER 1 2: PATHOBIOlOGY OF THE PERIAPEJ.
contain intratubular nerve endings.
e. The presence of a smear layer decreases dentinal sen­ I. Inflammation of the periapical
sitivity. which of the following?
a. Stagnant tissue fluid
b. Necrotic tissue
:c. c. Microorganisms
d. All of the above
 -

- ------- �

Challenge 987

2. Acute, apical periodontitis is characterized by which of 1 0. \Vhich of the fol l owing statements regarding osteocytes
the following? is accurate?
a. A focus of neutrophils within the lesion ) a. They originate as monocytes in the blood.
b. A focus of granulomatous tissue i n the lesion b. They respond only to mediators released by osteo­
c. A focus of lymphocytes, plasma cells, and macro­ blasts.
phages in the lesion c. They are mononuclear cells capable of bone demin­
eralization.
3. A periapical, true cyst communicates with the root d. They form a rumed border away ITom the bone sur­
canal; however, a periapical-pocket cyst does not. face.
a. True
, b. False I I . Which of the following statements regarding acute
apical periodontitis is accurate?
4. The most important route of bacteria into the dental pulp a. It is limited to the periodontal ligament ( histologi­
is from which of the following? cally).
a. The general circulation via anachoresis b. I t is detectable radiographically.
c b. Exposure to the oral cavity via caries £> c. It may heal if induced by a noninfectious agent.
c. The gingival sulcus d. A l l of the above statements are accurate.

5. The least important factor influencing the pathogenicity 1 2. Which of the following statements regarding chronic,
of endodontic ftora is which of the following? apical periodontitis is accurate?
a. Microbial interaction a. It is a neutrophil-dominated lesion encapsulated in a
b. Endotoxins released after bacterial death collagenous connective tissue.
'0 c. Exotoxins released by living bacteria -7b. It may contain epithelial arcardes or rings.
d. Enzymes produced by bacteria \ c. It represents a continuous, slow process that i s
asymptomatic.
6. Which of the following statements regarding neutrophils d. It as a predominance of B-cells over T-cells.
is accurate?
• a. They are nonspecific phagocytes. 1 3 . Which ofthe following statements regarding cholesterol
b. They have a single pathway for intracellular killing. crystals is accurate?
c . They are mobilized primarily to neutralize bacterial a. They may induce granulomatous lesions.
endotoxins. � b. They are potentially associated with nonresolving
d. All of the above are accurate. apical periodontitis.
c. They are difficult for macrophages and multinucle­
7. Which of the fol l owing statements regarding T-lympho­ ated giant cells to remove.
cytes arc accurate? d. All of the above statements are accurate.
a. They are thyroid-derived cells.
b. They concentrate in the cortical area of lymph nodes 14. Which of the following statements regarding periapical
and also circulate in the blood. actinomycosis is accurate?
, c. They are responsible for the cell-mediated arm of the a. It is caused by gram-negative organ isms exhibiting
immune system. branching filaments that end in clubs or hyphae.
d. All of the above statements are accurate. b. It is a fungal disease characterized by filamentous
colonies called sulphur granules.
8. Which of the following statements regarding B-Iympho­ \. c. it is most commonly an endodontic infection result­
cytes are accurate? ing from dental caries.
:> a. They were originally discovered in an avian gut-asso­ d. A l l of the above statements are accurate.
ciated organ.
b. They account for the majority of circulating lympho­ 15. Extraradicular infections are not found in which of the
cytes. following?
c. They produce antibodies. � a. Solid, apical granulomas
d. All of the above statements are accurate. b. Periapical-pocket cysts with cavities open to the root
canal
9. The function(s) of macrophages include(s) which of the c. Periapical actinomycosis
following? d. Acute, apical periodontitis
a. Phagocytosis of microorganisms
b. Removal of small foreign particles
c. Antigen processing and presentation
d. All of the above
988 CHALLENGE A Self-Assessment Exam

CHAPTER 1 3: ENDODONTIC MICROBIOLOGY 7. Which is true regarding microbial virulence factors?

AND TREATMENT OF INFECTIONS a. Fimbriae assist in bacterial aggregation .
• b. Pili break off and form extracellular vesicles fillo:

I . Pulpal and peri radicular pathosis results primarily from with enzymes.
which of the following? c. Lipopolysaccharides is found in the Iiposornes
a. Traumatic injury caused by heat during cavity prepa­ gram-positive bacteria.
ration d. All of the above.
b. Bacterial invasion
c. Toxicity of dental materials 8. Which of the following statements regarding
oJ d. Immunologic reactions amincs \s accurate'?
a.They are produced by bacteria and host cells.
2. Which of the following statements regarding the organ­ b. They may be found in infected root canals.
ism producing pulpal pathosis is correct? c. They are more concentrated in teeth with spa:�
a. The organisms are primarily facultative streptococci. neous pain.
b. Single isolates (i.e., monoinfection) produce the most .. d. All of the above statements are accurate.
severe reactions.
� c. Isolates tend to be polymicrobial and anaerobic. 9. \Vhich of the following statements regarding
d. Organisms infecting the pulp tend to be aerobic. space infections is accurate?
compared to organisms infecting the periapex. a. They are associated with radiographicall), ,
peri radicular lesions .
3. Which of the following best describes anachoresiso .'f b. They occur in potential spaces between fi

a. The attraction of bloodbome microorganisms to underlying tissue.

inflamed tissue during a bacteremia c. They occur when a 100th apex is located co
b. The process of carious invasion, cavitation, and expo­ muscle attachment.
sure of the pulp from bacteria d. All of the above statements are accurate.
c. Bacteria located in dentinal rubules, and the pulp that
are seeded to the systemic circulation. inducing dis­ 1 0. \Vhich of the following statements regarding LUG
ease in other areas of the body angina is accurate?
a. It ilwolves the submental, sublingual, and sub"",...';:
4. Which of the following statements regarding strict space of the right or left side.
anaerobes is accurate? b. It can progress into the canine and infraorbital
� a. They arc missing enzymes, catalase. and superoxide II c. It can result in airway obstruction.
dismutase. d. All of the above statements are accurate.
b. They function best at high oxidation-reduction
potentials. 1 1 . Antibiotics arc recommended for which of the
c. They can grow in the presence of oxygen. ing?
d. All of the above statements are accurate. a. Sinus tracts
b. Acute, apical periodontitis
5. The most common black-pigmented bacteria cultivated c. After root end surgery
from endodontic infections is which of the following? • d. None of the above
a. Bacteroides melaninogaster
b. Fusobacterium nuclearum 12. Incision and drainage is indicated which of the .fi
" c. Prevotella nigrescens ing?
d. Porphyromonas intermedia a. For sinus tracts
tJ b. When the swelling is diffuse and indurated

6. Treatment of actinomycosis israelii may include which c. For aCllte, apical periodontitis
of the foliowingO d. All of the above
a. Root canal treatment
b. Root end surgery 13. Incision and drainage of cellulitis is effective beca=se
... c. Antibiotics which of the following?
--) d. All of the above 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.
10 c. All of the above statements are accurate.
 -

� ---------
-

Challenge 989

14. Which of the following statements regarding potassium 20. Which of the fol lowing is correct in relation to the peri­
penicillin V is accurate? radicular lesion formed in response to dental caries and
a. It has a broader spectrum than amoxicillin. subsequent pulp necrosis?
iY b. It may be dosed at 4-hour intervals for severe infec­ a. Bacteria are commonly found in the granuloma.
tion. • b. T-helper cells predominate over T-suppressor cells.
c. It will select for resistant organisms, especially in the c . Formation of the granuloma is mediated through a
GI tract. specific immunologic response.
d. It has up to a 25% allergy rate. d. The release of interleukins can mediate bone resorp­
tion.
1 5 . Which of the following statements regarding metronida­
zole is accurate? CHAPTER 1 4: INSTRUMENTS,
a. It is effective against facultative and anaerobic bac­ MATERIALS, AND DEVICES
teria.
b. It cannot be given with penicillin because of disul­ J . Which of the following statements regarding pulp stim­
furam reaction. ulation with cold is accurate?
.. c. It cannot be taken with lithium or alcohoL - a. It is best accomplished with carbon dioxide snow
d. All of the above statements are accurate. (i.e., dry ice).
b. Jt is an accurate assessment of pulp vital ity.
1 6. Which of the following statements regarding clindamy­ c. I t directly stimulates the pain fibers in the pulp.
cin is accurate? d. It is best determined with a blast of air.
a. It is an alternative to potassium penicillin V in aller­
gic individuals. 2 . With regard to electrical pulp testing, which of the fol­
b. It is effective against facultative and anaerobic bac­ lowing is true?
teria. a. Positive responses can be used for differential diag­
r:t c. It is rarely associated with pseudomembranous colitis nosis of pulp pathosis.
in doses recommended for endodontic infections. b. The device lIses a pulsating, alternating current with
d. All of the above statements are accurate. a duration of I to 1 5 ms.
'.t. c. The device uses a low current with a high-potential
17. Which of the fol lowing statements regarding the Amer­ difference in voltage.
ican Heart Association (AHA) guidelines for prophy­ d. Gingival and periodontal tissues arc more sensitive to
lactic antibiotic coverage is accurate? testing than the pulp.
a. They are the standard of care for clinicians.
b. They are based on controlled clinical studies. 3. Which of the fol lowing statements regarding digital
'" c. They are not a substitute for clinical judgment. radiographs is accurate?
• a. They are produced by a charged coupled device and
1 8 . The AHA recommends antibiotic prophylaxis for which do not require x-rays.
of the fol lowing? b. They have the advantage of being manipulatable,
a. Surgery which facilitates interpretation.
b. Instrumentation beyond the apex c. They have greater resolution than traditional film.
c. Periodontal-ligament injection d. They are captured by a sensor that has a greater sur­
• d. All of the above face area than traditional film.

19. Which of the fol lowing statements regarding he theory 4. Which of the following statements regarding nickel and
of focal infection is accurate? titanium (NiTi) instruments is accurate?
a. It was propounded by Dr. William Hunter in 1 9 1 0. ., a. They exhibit a high elastic modulus, which provides
b. It was referred to infections found around poorly flexibility.
made restorations. b. When stressed, they exhibit transformation from the
c. it was used to explain diseases for which there was no austenitic crystalline phase to a martensitic structure.
cure. c. They cannot be strained to the same level as stainless
d. It results in needless tooth extraction. steel (SS) without pennanent deformation.
" e. All of the above statements are accurate. d. They are easier to prebend before placement in the
canal than 5S.
 990 CHALLENGE A Self-Assessment Exam

5. A barbed broach is most useful for which of the follow­ I I . Piezoelectric, ultrasonic devices differ from magneto­
ing? strictive devices in which of the following?
, , . .
� a. Removal of cotton, paper pomts, and other objects -- a. The piezoelectric unit transfers more energy to �
\ from the canal files.
b. Removal of vital tissue from fine canals b. The piezoelectric unit produces heat that requires _

c. Ini ti al planing of the canal walls coolant.

d. Coronal-orifice enlargement before establishing the c. The piezoelectric unit uses a RispiSonic, Shape:-­
correct working length Sonic, and TrioSonic file system.
d. The piezoelectric unit vibrates at 2 to 3 kHz.
6. In comparing K-type files with reamers, which of the
rotlawing statements regarding K-type files is accurate? 1 2. Which of the following statements regarding ultrasocr
.. a. They have more flutes per millimeter, which increase root canal instrumentation is accurate?
flexibility. a. It should be performed in a dry environment.
b. They differ, because the file is manufactured by twist­ b. It poses little risk offile breakage.
ing a tapered, square blank. • c. It is not very useful for dentin removal.
c. They are more effective in removing debris. ct. It is most useful in small canals where file co""",,""
d. They are the least flexible when comparing instru­ with the wall is maximized.
ments of the same size.
1 3 . Which of the following statements regarding sottr:=
7. Based on instrument design and method of manufacrur­ hypochlorite used as a root canal irrigating soIutiori
jng, which of the following is most susceptible to frac­ accurate?
ture ? ., a. It is buffered to a pH of 1 2 to 13, which increas
a. K-type file fabricated from tapered, square S S blank icity.
b. K-flex file fabricated from rhomboidal SS blank b. It exhibits a chelming action on dentin.
• c. Hedstrom file fabricated from round SS blank c. 11 should be used in higher concentrations because­
d. Reamer fabricated from triangular SS blank the increased free chlorine available.
d. It is a good wetting agent that permits the solu .
8. Which of the following statements regarding Hedstrom flow into canal irregularities.
files are accurate?
<; a. They are manufactured by machining a round cross­ 1 4. When ethylenediaminetetraacetic acid (EDTA) is
sectional wire. as an endodontic irrigant, which of the following
b. They are effective when used in a reaming action. ments is accurate?
c. They are safer than K-type files, because external a. It must be completely removed after use to pre"i'
signs of stress are more visible as changes in flute continued action and destruction of dentin.
design. • b. I t is a rapid-and-efficienr method of remmi:&,;::
d. They are aggressive because of a negative-rake angle smear layer.
that is parallel to the shaft. c. It acts on organic-and-inorganic components .:
smear layer.
9. Which of the following statements regarding the Profile d. It penetrates deep into dentin and enhances I"()(X
rotary instruments is accurate? preparation.
a. They are used at a range of 1 500 to 2000 rpm.
b. They are NiTi instruments manufactured in half sizes. 15. Calcium hydroxide is advocated as an interappo''''''''
, c. They exhibit sizes that are ISO and ANSI standard­ medication primarily because of which of the fo,""....=
.

ized. a. Its ability to dissolve necrotic tissue

d. They incorporate radial lands in the flute design. � b. Its antimicrobial activity
c. Its ability to stimulate hard-tissue formation
1 0. Which of the following statemems regarding the best d. Its ability to temporarily seal the canal
apex locators is accurate?
a. They require training with the instrument to become 16. \Vhich of rhe following statements is accurate ��
_ --.-
proficient. gutta-percha points is accurate?
b. They are sensitive to canal contents. a. They contain 40% to 50% pure gutta- perch!..
c. They measure the impedance between the file and the b. They adhere to dentin when compacted.
mucosa. c. They can be heat sterilized.
d. On average, they are accurate to within 0.5 mm of the N d. They are not compressible.

a pex.
� e. All of the above statements are accurate.
 Challenge 991

1 7 . An advantage toAH26 as an endodontic sealer is which 3. A periodontal l igament injection of 2 % lidocaine with
orthe following? I : 1 00,000 epinephrine causes which of the following?
a. The release o f formaldehyde on setting a. The pulp circulation ceases for about 30 minutes.
ow b. Low toxicity b. The pulp circulation remains the same.
c. Long working time, but quick setting (i.e., I to 2 c. The pulp circulation increases markedly.
hours) at body temperature d. The pulp circulation decreases slightly.
d. It can be distinguished from gutta-percha radiograph­
ically 4. The highest incidence of pulp necrosis is associated with
which of the following?
1 8. N2, Endomethasone, and Reibler's paste are sealers that a. Class V preparations on root surface
do which of the fol lowing? b. In lay preparations
a. Produce liquefaction necrosis in the peri radicular tis­ c. Partial veneer restorations
Slles d. Full-crown preparations
b. Induce healing in the apical pulp wound after vital
pulp extirpation 5. A disadvantage of acid etching dentin (regarding effects
!j} c. Can cause periapical inflammation on the pulp) is which of the following?
d. Do not produce a seal when used in combination with a. Dentinal tubules are opened, thereby increasing per­
a core material meability.
b. Acid penetrates to the pulp and kills large numbers of
1 9. Which of the following statements is accurate regarding cells.
TERM is accurate? c. Acid penetrates to the pulp and damages the vessels.
�a. It seals as well as Cavil. d. Acid softens the dentin and increases microleakage at
b. rt is the material of choice when strength is a require­ the restoration dentin interface.
ment.
8 c. It is a zinc oxide-reinforced material that can be light 6. The response of the pulp to a recently placed amalgam
cured. without a cavity lining is usually which orthe following?
d. It has a eugenol component that is antibacterial. a. Slight-to-moderate inflammation
b. Moderate-to-severe inflammation
20. The root end is ultrasonically prepared during endodon­ c. Slight but increasingly severe with time
tic surgery for which of the following reasons? d. None
a. It results in apical cracks at low settings.
b. It results in larger, but cleaner, cavity walls. 7. The smear layer on dentin walls acts to prevent pulpal
c. It can make a deeper cavitY more safely than a bur. injury for which of the following?
-:) d. It does not require as acute an angle of root resection. a. It reduces diffusion of toxic substance through the
tubules.
CHAPTER 1 5 : PULPAL REACTION TO CARIES AND b. It resists the effects of acid etching of the dentin.
DENTAL PROCEDURES c. It eliminates the need for a cavity liner or base.
d. Its bactericidal activity acts against oral microorgan­
1 . The most common response in the dentin deep to caries Isms.
is which of the following?
a. Increased permeability 8. A reaction that tends to protect the pulp from injury
b. Alteration of collagen from dentinal caries is which of the following?
c. Dissolution of peritubular dentin a. A predictable stimulation of sensory nerves resulting
d. Dentinal sclerosis 111 pam
b. A decrease in pemleability of dentin
2. Relatively few bacteria are found in a pulp abscess c. An increase in numbers of odontoblasts under the
because of which of the following? tubules affected by the caries
a. Immune response of pulp tissue d. A buffering (i.e., neutralization) by ground substance
b. High tissue pH in the adjacent inflammation of bacterial tax ins
c. Mechanical blockage of sclerotic dentin e. A decrease in pulpal metabolism
d. Antibacterial products of neutrophils
992 CHALLENGE A Self-Assessment Exam

9. Hypersensitivity is best relieved or controlled by which 1 5 . A cusp fractures and exposes dentin but not the
of the following? What is the probable response in the pulp?
3 . Opening the tubules to permit release of imrapulpal a. Severe damage with irreversible inflammation
pressure b. M ild-to-moderate inftanunation
h. Root planing to remove surface layers that are hyper­ c. Pain but no inftammation
sensitive d. No pulp response
c. Applying antiinflammatory agents to exposed dentin
d. Blocking exposed tubules on the dentin surface 1 6 . The following illustration shows a section of pulp
dentin underlying an area of cavity preparation. \\
1 0 . Deeper cavity preparations have more potential for was done 1 day previous. The best description of �
pulpal damage because of which of the following? pulp reaction is which of the following?
1 . Tubule diameter and density increases; therefore
• . ' ; \ � J
there is increasing permeability. :: :" � 41 '
2 . There is more vibration to pulp cells. , If" .� . •
" , ,
t
3. Odontoblastic processes are more likely to be severed. .t'� � ,
-;, ; .- .�
a. I only
b. 3 only , . ..
•
'
, . ...
c. 1 and 3
d. 2 and 3 : ' ....
\. '
e. I and 2 I- i,_ I "
.
" "
.. ;.
. , 1'-
'
�
" :
I I . Agents that clean, dry, or sterilize the cavity are which of ' " , t"', t, "t . ;,
... ,
the following? , .
• ,. \ ' . if I � ' I
3. Best used in deep cavities f,
•." 'h'
b. Indicated when a patient repons symptoms "l '!f\ j '.. �• '''''•
<p • .I
c. Generally very damaging to the pulp ;J�' •. I. t ' .
�t�, ...
410 \.
-'
S ,.
�
d. Generally not useful 4 '. i l'
•
�

, ' ',yj # •
r'''' •

... . ", ..,,, " ...�

,.. . . ...
1 2 . Of the following, which is the best way to prevent pulp · \
I
damage during cavity preparation?
3. Retain the smear layer
.:'; t,.� ,
.... .
. "'" ,
.�.
b. Use sharp burs with a brush stroke
. ,
c. Use adequate air coolant
d. Use adequate water coolant
a. There is no reaction; the pulp appears normal
1 3 . Which is the major reason why Class II restorations with b. The odontoblast layer is disrupted, and there .
composite are damaging [0 the pulp? inflammation.
a. Microleakage occurs at the occlusal surface. c. Odontoblasts are aspirated into tubules, and .'
b. Microleakage occurs at the gingival margin. mild inflammation.
c. Toxic chemicals are released from the composite and d. Odontoblasts are absent, and there is extra\cas...". ,e
diffuse into the pulp. erythrocytes.
d. Polymerization shrinkage distorts cusps and opens
gaps.

1 4 . A pulp has been damaged and is inflamed because of

deep caries and cavity preparation. \VhaI material placed
on the floor of the cavity aids the pulp in resolving the
inflammation?
a. Calcium hydroxide
b. Zinc oxide--eugenol
c. Steroid formulations
d. None; there is no material that promotes healing.
I
-

__ __________ ��-
00::!1

Challenge 993

17. This is an area of pulp close to a carious exposure (see 2. Initial vitality testing of traumatized teeth is most useful
the following i llustration). Thc inflammatory response is to which of the following?
primarily 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.
,. c. It gathers baseline information.
d. It locates foreign objects.

4. Which of the following statements regarding crown

infraction is accurate?
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.

5 . Which of the following statements regarding uncompli­

cated crown fracture is accurate?
a. Acute a. It is an indication for a dentin-bonded restoration.
b. Chronic b. It requires baseline pulp testing.
c . Giant cell c. It involves root canal treatment if the exposed dentin
d. Vascular is sensitive to cold stimulus.
d. It has a questionable long-term prognosis.
1 8. The early inflammatory cell infiltrate response of the e. It is managed differently in young versus older
pulp to caries i_nvolves primarily which of the following? patients.
a. Neutrophils
b. Macrophages 6. Which of the fol l owing statements regarding compli­
c. Neutroph ils, plasma cells, and lymphocytes cated crown fractures is accurate?
d. Macrophages and lymphocytes 3. Exposure to the oral cavity permits rapid bacterial
e. Lymphocytes, plasma cells, and macrophagcs penetration through the pulp.
b. Inflammation is limited to the coronal 2 mm of the
1 9. Hypersensitivity of the pulp after restoration placement exposed pulp for the first 24 hours.
indicates which of the following? c. The tooth is nonnally managed by root canal treat­
a. Acute inflammation in the pulp ment and restoration.
b. Chronic inflammation in the pulp
c . MicroJeakage at the restoration and tooth interface 7. Which of the following statements regarding replace­
d. Stimulation of sensory nerves by hydrodynamics ment resorption is accurate?
e. Tubules are blocked by restorative material or smear -' a. It results from direct contact between root, dentin,
layer or both and bone.
b. It is managed by surgical exposure and repair with a
CHAPTER 1 6: TRAUMATIC INJURIES biocompatible material.
c. It results when at least 75% of the root surface is
1. If several teeth are out of alignment after trauma, the damaged.
most reasonable explanation is which of the following? d. It can be avoided by timely endodontic intervention.
3. Luxation
b. Subluxation
. c. Alveolar fracture
d. Root fracture
994 CHALLENGE A Self-Assessment Exam

8. Pulp necrosis is most likely to occur after which of the 1 5 . Which of the following is true about thermal and
following? trical tests after trauma?
a. Midroot fracture a. Sensitivity tests evaluate the nerve and eire
� b. Intrusive luxation condition of the tooth.
c. Concussion b. False-positive tests are more likely than false-�
d. Complicated crown fracture live tests.
"" c. It may take up to 9 months for normal blood fl
9. Which of the following statements regarding cervical renlfll.
root resorption is accurate? d. None of the above statements are accurate.
a. It is a common. self-limiting result of luxation injury.
b. It causes significant pulpal symptoms. 1 6. \Vhich of the following statements regarding im
c. It can be arrested by root canal treatment. root resorption is accurate?
'. d. It may extend coronally to present as a pink spot on a. It is rare in deciduous teeth.
the crown. b. It is initiated by odontoblasts.
c. It is seldom confused with external resorption.
10. Which of the following statements regarding internal d. It is usually asymptomatic.
root resorption is accurate?
a. It is more common in permanent than deciduous 1 7. Which of the following statements regarding avuL<.<I
teeth. teeth is accurate?
b. It is simple to differentiate from other types of a. They can be treated endodontically outside the
resorption. in limited circumstances.
, c. It is characterized histologically by inflammatory b. They should be rigidly spl inted for 3 to 4 weeks
tissue with multinucleated giant cells. allow periodontal support to mature.
d. It is ruled out when there is no response to pulp c. They generally do not require antibiotic treatm=
testing. the time of replantation.
d. They should have apexification attempted when
I I . A luxated 100th should be splinted in which of the fo l­ apex is not closed.
lowing sintations?
, a. If the tooth is mobile after spl inting CHAPTER 1 7: ENDODONTIC AND PERIODONTIC
b. Until the root canal treannent is completed INTERRELATIONSHIPS
c. With the composite as close to the gingiva as possible
d. All o r the above I . According to Gutmann, molar teeth are most like�
have accessory and lateral canals:
12. Which medium of storage for an avulsed tooth is best for a. Branching from the main canal to form an apical deb.
prolonged extraoral periods? b. In the apical one third of the root
a. Hanks balanced salt solution c. On the lateral surface of the root
b. Milk d. In the fllrcation
c . Disrilled water
d. Saliva 2. Which of the following statements regarding palat �

gival grooves is false?

1 3. The most important factor for managing avulsions is a. The incidence of palatagingival grooves ranges frtx:;
which of the following? 1 0% to 20% of the population.
a. Extraoral time b. The maxillary lateral incisor is affected more that the
b. Decontamination of the root surface central incisor.
c. Prompt initiation of roat canal treatment c. The grooves extend apically in varying distances.
d. Proper preparation of the socket with less than 1 % reaching the apex.
d. Pulp necrosis frequently occurs in teeth with pal2.h..�
1 4 . Tooth mobility after trauma may be because of which of gingival grooves because of the lack of cemenn=
the following" covering the dentin.
a. Displacement
b. Alveolar fracture
c. Root fracture
d. Crown fracture
e. All of the above
 -- -

- -- -- -------------�-�

Challenge 995

3 . The prognosis for a tooth with a perforation is affected 6. Which of the following statements regarding the pri­
by all of the following factors, exceptJor olle. Which is mary endodontic lesion with secondary periodontic
the exception? involvement is correct?
a. Location of the perforation 8. Pulp necrosis occurs initially and an apical lesion

b. The time of repair forms. Apical migration of periodontal disease

c. The ability to seal the defect results in communication between the two lesions.
d. The ability to perform root canal treatment on the b. Treatment consists of pClforming endodontic treat­
remaining canals ment, which is followed by a 6-month recall exami­
e. The placement ofa poSt to retain the core after perfo­ nation. If the periodontal component is still present,
ration repair periodontal therapy is initiated.
c. The primary endodontic lesion with secondary peri­
4. Which of the following statements best describes retro­ odontic involvement exhibits a poorer prognosis
grade periodontitis? when compared with the primary periodontal lesion
a. Inflammation from the periodontal sulcus migrates with secondary endodontic involvement.
apically, causing pulp inflammation and eventually d. Pulp necrosis occurs and forms a sinus tract through
pulp necrosis. the periodontal ligament that, over time, permits the
b. Pulp necrosis occurs, and the toxic irritants cause accumulation of plaque and calculus on the root.
inflammation that migrates to the gingival margin,
creating a periodontal pocket. 7. Which of the following statements regarding root resec­
c. Irritants gain access to the periodontal tissues at the tion is false?
site of a vertical-root fracture, producing tissue a. Success depends primarily on treatment planning and
destruction that mimics periodontitis. case selection.
d. Pulp necrosis results in the formation of an apical, b. Failures occur primarily because of continued peri­
radiolucent lesion characterized by the loss of the odontal breakdown.
apical lamina dura. c. The long-term prognosis for the pulp in teeth with
vital-root resection is poor.
5 . Which of the following statements best describes the d. Endodontic treatment should precede resection of a
effect periodontal disease has on the dental pulp? root.
a. There is a direct correlation between the severity of
the periodontal disease and the percentage of pulps 8. Which of the following statements regarding guided
that become necrotic. tissue regeneration (GTR) is false?
b. When periodontal disease or the treatment of the dis­ a. GTR is an effective adjunct to treatment of peri­
ease exposes a lateral or accessory canal. complete odomal disease but has limited value in treating
pulp necrosis will result. endodontic pathosis.
c. Although periodontitis can cause pulp inflammation b. The combined endodontic periodontic lesion has the
and necrosis, treatment procedures have little effect least favorable prognosis for GTR because of the
on the pulp. relationship of the lesion to the gingival margin.
d. Periodontal disease that does not expose the apical c. Bioresorbable membranes exhibit results similar to
foramen is unlikely to produce significant damage to nonresorbable membranes.
the pulp. d. Evidence suggest that GTR enhances bone formation
by preventing contact of connective tissue with the
bone.
996 CHALLENGE A Self-Assessmem Exam

9. A 24-ycar-old female patient has drainage from the gin­ 2. Which of the following best describes the neural inru:r­
gival sulcus of her maxillary, right. central incisor (tooth vation of the dental pulp?
no. 8 ) . Three years ago she relates a porcelain fused-lo­ a. A-delta fibers transmit pain to the trigeminal nucI
metal bridge (nos. 6 to 8 ) was placed because of a con­ b. C fibers transmit pain to the superior cervical g<m­
genitally missing, lateral incisor. Clinical examination glion.
reveals a 1 2 mm probing defect on the lingual aspect of c. Sympathetic fibers are not blocked with applica .
tooth no. 8. Additional probing depths are 3 mm or less. of local anesthetic agents.
Pulp testing reveals that no. 6. no. 8, no. 9, no. 10 are d. A-delta fibers play the predominant role in enc
responsive to CO2 snow. Radiographic examination inflammatory pain.
reveals a diffuse radiolucent area along the mesial lateral
root surface extending from the cfestal tissue to the 3. Nociceptive signals are transmitted primarily to \\

apex. Which of the following is the most likely cause of of the following?
this lesion'? a. Nucleus caudalis
a. Vertical-root fracture b. Limbic system
b. Palatogingival groove c. Reticular system
c. Pulp necrosis d. Superior cervical ganglion
d. Periodontitis
c. Osteogenic sarcoma 4. Pain that refers from an inflamed maxillary SinU5
maxillary molars is likely to the phenomenon of
1 0. A 5 1 -year-old woman seeks evaluation of swelling of of tile following?
the buccal tissue opposite her mandibular, right, first a. Convergence
molar (tooth no. 30). She relates a h istory of having a b. Sublimation
full-gold crown placed 2 months ago. She states that she c. Nociception
has had pain for the past week and that the swelling d. Information transfer
began yesterday. Clinical examination reveals swelling e. Projection
in the buccal furcation area of tooth no. 30. Probing
depths are 3 to 4 mm, except for a 6-mm defect in the 5. Which of the following statements is true reg
furcal area of tooth no. 30. Pulp testing with CO2 snow descending fibers?
reveals teeth nos. 28, 29, and 3 1 respond. Tooth no. 30 is a. They inhibit transmission of nociceptive infortnaIJO&.
not responsive. Radiographic examination reveals b. They are not affected by endogenous opioid pepri""'-
normal apical struculres, however, there is a radiolucent c. They transmit information from the cerebral corta
area in the furcation of tooth no. 30. This area \vas nor the thalamus.
evident on the film taken before placement of the crown. d. They are sympathetic fibers that modulate blood '
Based on this information what diagnostic classification i n the pulp after sensory stimulation.
is most appropriate?
a. Primary endodontic lesion 6. Hyperalgesia is characterized by the following. e:rrer
b. Primary periodontic lesion for one. \Vhich is the exception?
c. Primary endodontic lesion with secondary periodon­ a. Hyperalgesia is primarily a central mechanism.
tic involvement b. Spontaneous pain is present.
d. Primary periodontic lesion with secondary cndodon­ c. The pain threshold is reduced.
tic involvement d. Hyperalgesia produces an increased pain perc
e. Concomitant endodontic and periodontic lesion to a noxious stimuli.

CHAPTER 1 8 : ENDODONTIC PHARMACOLOGY 7. Regarding etodolac (i.e., Lodine). which of the fo

ing statements is correct?
1 . Odontogenic pain is usually caused by which of the fol­ a. The drug exhibits minima\ gastrointestlna\ ="",..
lowing? when compared to ibuprofen.
a. Noxious physical stimuli b. When compared with ibuprofen, etodolac
b. The release of inflammatory mediators profound analgesic action.
c. Stimulation of sympathetic fibers in the pulp c. Studies indicate etodolac is unique, because ­
d, Edema produced in a ridged, noncompliant root canal does not have a peripheral analgesic med"'_a;
system action.
d. This drug can be prescribed for adult �
aspirin hypersensitivity.
 -- -

Challenge 997

8. \Vhich of the following statements regarding activation 1 3 . J onsteroidal, antiinflammatory agents administered in
of the opiate receptor is accurate? combination with cyclosporine may result in which of
a. It blocks nociceptive signals from the trigeminal the following?
nucleus to higher brain centers. a. They increase the risk of nephrotoxicity.
b. It blocks transmission of signals from the thalamus to b. They induce bone marrow suppression.
the cerebral cortex. c. They decrease the activity of the cyclosporine.
c. It induces the release of endorphins. d. They result in increased concentrations of the non­
d. It blocks the release of dynorphins. steroidal agent in the blood plasma.

9. Opioids arc frequently used in combination with other 1 4. Nonsteroidal, antiinflammatory agents administered in
drugs because which of the following? combination with anticoagulants may result in which of
a. The nonsteroidal, antiinHammatory drugs in combi­ the following?
nation with the opioid act synergistically on the a. Increase the prothrombin time
opiate receptor. b. Result in a decreased bleeding time
b. The combination permits a lower dose of the opioid. c. Increase the bioavailability of the anticoagulant
which can reduce side effects. d. Produce no adverse effect
c. Opioids do not act peripherally.
d. Opioids are not antipyretic. 1 5 . Indomethacin administered in combination with sympa­
thomimetic agents results in which of the following?
1 0. Which of the following is frue for the use of codeine as a. Decreased blood pressure
an analgesic agent? b. Increased blood pressure
a. Codeine prescribed in 60-mg doses is more effective c. Decreased water retention
than 650 mg of aspirin. d. Decreased absorption of indomethacin, requiring a
b. Codeine prescribed in 3D-mg doses is more effective higher dose
than 600 mg of acetaminophen.
c. C ode ine prescribed in 30-mg doses is more effective 1 6 . Peripheral afferent nerve fibers in an inftamed pulp may
than a placebo. respond to mediators by which of the following?
d. Codeine prescribed in 60-mg doses is more effective a. Reducing the concentration of those mediators
than a placebo. b. Decreasing responsiveness to nociceptive stimuli
c. Decreasing the number of anesthetic molecule recep­
I I . Management of pain of endodontic origin should focus tors
on which of the following? d. Decreasing numbers of ion channels
a. Removing the peripheral mechanism of hyperalgesia e. Sprouting of terminal fibers
b. Providing an adequate level of nonsteroidal. anti­
inflammatory analgesic agent 1 7. Two nonsteroidal antiinftammatory drugs (NSAlDs)
c. Prescribing an appropriate antibiotic in cases where that have minimal adverse gastrointestinal side effects
pain is the result of infection are which of the following?
d. Using long-acting, local anesthetic agents to break a. Etodolac and ibuprofen
the pain cycle b. Etodolac and rofecoxib
c. Ibuprofen and ketoprofen
1 2 . Which of the following best describes a "ftexible plan" d. Ketoprofen and etodolac
for prescribing analgesic agents? e. Ibuprofen and rofecoxib
a. A maximal dose of an opioid is administered. I f pain
persists, the opioid is supplemented with a non­ 1 8. To minimize posttreatment pain, when are analgesics
steroidal, antiinflammatory agent or acetaminophen. most effective when administered?
Doses are then alternated. a. As a pretreatment
b. A maximal dose of a nonsteroidal, antiinflammatory b. Immediately after treatment
agent or acetaminophen is administered. If pain per­ c. When the anesthetic begins to wear off
sists, the drug is supplemented with an opioid. Doses d. When the patient first perceives pain
are then alternated. e. When the pain is the most intense
c. Patients are advised to take the maximal dose of a
nonsteroidal, antiinflammatory agent a day before the
appointment and then as necessary for postoperative
pain.
d. Patients are advised to take an opi oi d agent a day
before the appointment and then as necessary for
postoperative pain .
998 CHALLENGE A Self-Assessment Exam

19. Prophylactic administration of antibiotics to control 5. The primary beneficial action of epinephrine when per­
adverse posttreatment symptoms in prospective, con­ forming root end surgery is which of the following?
trolled, clinical trials on asymptomatic patients has been a. It effects the drug on alpha- I receptors in the alveo
shown to be which of the following? mucosa.
a. Ineffective b. It effects the drug on beta- l receptors of skele......
b. E ffective if given in high doses muscle.
c. Effective only if given pretreatment c. It decreased systemic uptake of the anesthetic so _­

d. Effective if given in conjunction \I.lith intracanal tion.

antibiotics d. It prolonged the duration of anesthesia.

CHAPTER 1 9: ENDODONTIC MICROSURGERY 6. Which of the following statements regarding flap refl
tion is correct?
I . A 45-year-old man has a radiolucent area associated a. The horizontal incision for the mucogingivaJ flap 1.5
with his maxillary, right, central incisor (tooth no. 8) and madc perpendicular to the cortical bone.
facial swelling. He relates traumatic injury as a child b. The rectangular flap design is most appropriate in tl:r
with root canal treatment during his teenage years. Sub­ posterior areas.
sequent to this treatment he fractured tooth no. 8 playing c. The l11ucogingival flap with an anterior-releasing

basketball in his early thirties. Root canal retreatmcnt incision is preferred in posterior areas.
was necessary and the tooth was restored with a cast d. The type of vertical-releasing incisions distingui
post, core and crown. \Vhich of the following is the most the mucogingival flap from the Luebke-Oschsenbelii.
appropriate treatment sequence? flap.
a. Incision and drainage followed by nonsurgical e. The semilunar flap has the advantage of providing an
retreatment and fabrication of a new restoration esthetic result without scar formation.
b. Root end surgery and a postsurgical antibiotic
c. Management of the infection and performance of 7. \Vhich of the following hemostatic agents activates the
root end surgery when the swelling subsides intrinsic coagulation pathway?
d. incise and drain the swelling, prescribe an antibiotic, a. Ferric sulfate
and follow the patieTIl on recall examinations b. Calcium sulfate paste
e. Tooth extraction and implant placement c. Microfibrillar collagen

d. Bone wax
2. Each of the following statements on the reasons two e. Epinephrine pellets
radiographs are reconunended for evaluation of a tooth
to be treated surgically is correct. excepT/or aile. Which 8. Which of the following is the recommended hemostatic
is the exception? technique to control bleeding during root end surgery?
a. Two films permit the evaluation and location of a. Local anesthesia with 2% lidocaine I :50,000 epi­
normal anatomic structures. nephrine. epinephrine saturated pellets, ferric sulfate.
b. The root length can be assessed. calcium sulfate paste
c. The size of the lesion can be determined. b. Local anesthesia with 2% lidocaine I :50,000 epi­
d. Root curvatures can be view·ed. nephrine, ferric sulfate, microfibrillar collagen, bone
e. The depth of the overlying bone can be determined. wax
c. Local anesthesia with 2% lidocaine l : l 00,000 epi­
3. When a vessel is severed initial hemostasis results from nephrine, ferric sulfate, microfibrillar collagen, Telra
which of the following? pad
a. Contraction of the vessel wall d. Local anesthesia with 0.5% marcaine I :200,000 epi­
b. Formation of a platelet plug nephrine. ferric sulfate, calcium sulfate paste
c. The conversion of prothrombin to thrombin
d. The conversion of fibrinogen to fibrin 9. Each of the following statements is correct regarding the
use of the H 161 Lindemann bone cutter for root end
4. The anesthetic of choice when performing endodontic surgery is correct, except Jor one. Which is the exce�
root end surgery on a patient with mild cardiovascular tion?
disease is which of the following? a. It reduces frictional heat when resecting bone.
a. 1 .5% etidocaine I :200,000 epinephrine b. It has more flutes that conventional burs, so cutting is
b. 0.5% marcaine I :200,000 epinephrine faster and more efficient.
c. 2%, lidocaine I : I 00,000 epinephrine c . When used with the Impact Air45 hand piece splatter

d. 2% lidocaine I :50,000 epinephrine is decreased.

e. 4% prilocaine plain d. It has fewer Rutes and is less likely to clog.
 Challenge 999

1 0. Which of the following statements regarding root end 1 5 . Which of the following statements is correct regarding
resection is correct? Uea\men\ fDr a 73-year-o\d woman W\,O develops ecchy­
a. The root should be resected at a 45-degree angle to mosis after root end surgery?
ensure adequate access and visibility. a. Instruct the patient to place warm compresses over
b. The apical 2 mm should be removed to ensure that the area three to four times daily.
apical ramifications are not present. b. Place the patient on an antibiotic to prevent infection
c. Root end resection should precede apical curettage. of the area.
d. Resection of the root should be as perpendicular to c. Prescribe an antiinflammatory analgesic to enhance
the long access of the root as possible. the healing process.
d. Explain the cause of the problem to the patient and
I I . Which of the following statements regarding the isthmus provide reassurance.
between canals is correct?
a. Although often noted between canals, failure to CHAPTER 20: MANAGEMENT OF PAIN AND ANXIETY
include this area in the preparation does not affect the
prognosis of a tooth. 1 . The majority of l i fe-threatening systemic complications
b. The incomplete isthmus should be prepared with a arise in which of the following?
tracking groove before ultrasonic preparation. 3. During or immediately after injection of local anes­
c. Isthmus incidence is not affected by the amount of thetics
the root resection but increases as thc bevel b. In conjunction with surgical procedures, such as
approaches 45 degrees. tooth extraction
d. When using a surgical operating microscope, the c. During the pulp extirpation phase of root canal treat­
absence of an istlunus at 1 6 X to 25 x is evidcnce that ment
no connection between canals exist. d. As a result of bleeding from patients with known
bleeding disorders
1 2 . Which of the following statements regarding ferric sul­
fate is correct? 2. Which of the following tooth groups is the most difficult
a. Ferric sulfate acts by producing a tamponade effect to anesthetize?
and is absorbed by the body over 2 to 3 weeks. a. Mandibular premolars
b. Ferric sulfate exhibits an alkaline pH. b. Maxillary premolars
c. Applied to the osseous surface, ferric sulfate causes c. Maxil lary molars
agglutination of blood proteins. d. Mandibular molars
d. Ferric sulfate induces osseous tissue formation.
3. Which of the following is not a factor affecting the onset
1 3 . Which of the fol l owing statements regarding root end of local anesthesia?
preparation is false? a. Diffusion of the local anesthetic through the Iipid-
a. The ideal preparation should extend 3 mm into the rich nerve sheath
root and fol low the long axis of the tooth. b. The pKa for the anesthetic agent
b. The lingual wall of the preparation is the most diffi­ c. The pH of the tissue
cult area to evaluate. d. The protein-binding ability of the local anesthetic
c. Ultrasonic preparation has the potential to induce
micafractures in the dentin. 4. A decrease in the tissue pH causes which of the follow­
d. KiS tips have enhanced cutting efficiency for root end ing?
preparations because of a zirconium nitride coating. a. It increases the free base of the local anesthetic agents.
e. Ultrasonic root end preparation may thermoplasticize b. It results in fewer anesthetic molecules entering the
the remaining gutta-percha. nerve sheath.
c. It changes the pKa value for a given local anesthetic.
14. Which of the following statements regarding root end d. It cecreases the protein-binding of the local anes­
filling materials is false? thetic.
a. Super EBA is preferred as a root end filling 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 field can be maintained.
1 000 CHALLENGE A Self-Assessment Exam

5 . Failure to obtain adequate anesthesia after an appropri­ I I . The 5tabident local anesthesia system is used for "
ately administered nerve block is most likely the result one of the following reasons?
in which of the following? a. As a true intraosscous injection
a. pH changes in the pulp tissue caused by inflamma­ b. As a modified periodontal ligament injcction
tions c. To limit the adverse reactions to vasopressor co'lllpQ'­
b. Morphologic neurodegenerative changes and inflam­ nents of local anesthetic cartri dges
matory mediators d. As a method to administer intrapu\paJ inj ec:oo
c. Insufficient volume of local anesthetic injected painlessly
d. Tolerance to the anesthetic agent
1 2. Prescriptions for analgesic agents should provide \\
6 . Wt\"�\.\ cG\\\\)at\ng, anlide. and ester local anesthetic of the following?
agents, which of the following is true? a. Instructions for administration at regular interval
a. Esters are more likely to produce systemic toxicity b. Instructions for taking the medication when pari
,"vhen compared to amides. experience pain
b. Amides are more allergenic when compared to esters. c. Administration instructions for patients in pain
c. Amides are more effective than esters. day before initiating root canal treatment to e�
d. Esters and amides are equally effective. adequate blood levels
d. Immediate preoperative administration of opia:.::5
7. A patient is anesthetized using a posterior superior alve­ when pulpal pain is present
olar (PSAl nerve block to perform endodontic treatment
on the maxillary, first molar. Adequate anesthesia is nO[ 1 3 . For emergency treatment of patients with pulp pathoszs..
obtained. In this siruation the clinician should consider oral sedation should be considcred during which of
which of the following? following?
a. Anesthetizing the anterior, superior nerve a. When deep sedation of the fearful patient is des�
b. Anesthetizing the middle, superior nerve b. When barbiturates with oral sedation should be
c. Performing a palatal infiltration sidered
d. Repeating the P5A c. When oral sedation with midazolam may provid("
amnesia effect
8. An infiltration injection is given for a maxillary, second d. When a short-acting agent permits the patient -
premolar. Adequate anesthesia is not obtained. Which leave without an escort
injection should be considered?
a. Anterior superior alveolar (ASAl block 1 4 . Which of the following statements regarding the =

b. PSA block nitrous oxide inhalation sedation is accurate?

c. Palatal infiltration a. It produces significant analgesic effect when usee.
d. Maxillary (division II) block conjunction with local anesthetics.
e. Greater palatine nerve block b. It is difficult in managing endodontic pari
because of the application ofthe rubber dam.
9. Infiltration in the mandible may be an effective tech­ c. It should be considered if oral sedation cannOi
nique in treating the which of the following? used.
a. Central incisor d. It should be used only when an auxiliary of the
b. Canine sex as the patient is present to assist.
c. First premolar
d. Second molar 1 5 . Which of the following statements regarding
periosteal injection (infiltration) is accurate?
1 0 . In performing the Akinosi technique, which of the fol­ a. It is effective for most maxillary teeth.
lowing are accurate? b. It is more effective in the presence of infection.
a. The needle is inserted at the height of the l11ucogin­ e. It is ineffective for both adults and children in ,.,.",..
gival junction of the most posterior, maxillary tooth. thetizing mandibular teeth.
b. The needle is passed lingual to the mandibular d. It is targeted mesial and distal to the apex of ­
ramous until is bone is contacted. involved tooth.
c. Injection at the neck of the mandibular condyle is the
objective.
d. All of the above statements are accurate.
 ---�
-

-------

Challenge 1001

1 6 . Which of the following statements regarding regional 2. Which o f the following statements is correct regarding
nerve block is accurate? the incidence of cervical resorption after internal
a. It achieves anesthesia by blocking efferent nerve bleaching?
impulses. a. Cervical resorption can be as high 25% when Super­
b. It may be morc effective because it is deposited in oxyl and heat are used.
normal, rather than inflamed, tissue. b. Lesions develop rapidly and can be detected I to 2
c. It is exemplified by the long buccal nerve block. months after bleaching.
d. It requires use of an agent without vasoconstrictors. c. The incidence of cervical resorption increases 111

patients who are 25 years old and older.

1 7 . Which of the following statements regarding the anterior d. Although cervical resorption is often attributed to
middle superior alveolar (AM SA) nerve block is accu­ bleaching, it is more l ikely caused by a previous trau­
rate? matic injury to the involved tooth.
a. It anesthetizes all branches of the maxillary nerve.
b. It can be delivered by a computer-controlled system 3 . Each of the following is an intrinsic form of tooth dis­
or by traditional needle and syringe. coloration, excepf Jar one. Which is the exception?
c. It anesthetizes buccal and palatal bone, but not soft a. Endemic fluorosis
tissue. b. Hereditary opalescent dentin
d. It occasionally anesthetizes the orbicularis oris. c. Tetracycline staining
d. Peridex staining
1 8. If the dentist thinks there may be considerable posttreat­
ment pain, the clinician may do which of the following? 4. Which of the following statements regarding microabra­
a. Prescribe antibiotics sion is correct?
b. Reanesthetize with a long-acting anesthetic a. The agent used in the technique is 30% hydrogen per­
c. Prescribe antianxiety medications oxide, which can be obtained in proprietary products,
d. All of the above such as Prem3.
b. The technique is useful in treating white-and-brown­
1 9 . Which of the following statements regarding oral seda­ spot surface lesions.
tion is accurate? c. Microabrasion should not be used before placement
a. It has a quick onset of action. of bonded restorations.
b. It has a significant number of adverse reactions. d. Requires a local anesthetic and frequently produces
c. It has a reasonably short duration. postoperative thermal sensitivity.
d. It is difficult to titrate to ideal levels.
5. When performing a walking bleach procedure, which of
CHAPTER 21 : TOOTH-WH ITENING MODALITIES the following statements is accurate?
FOR PULPLESS AND DISCOLORED TEETH a. The dentin should be etched before placement of the
bleaching agent to increase permeability of the
I . The whitening mechanism for bleaching teeth is thought tubules and enJ13nce the bleaching action.
to be which of the following? b. The sodium perborate paste should be covered by a
a. A result of the degradation organic molecules of high minimum of2 mm ofCavit or IRM.
molecular weight that reflect a specific wavelength of c. A barrier over the obturating material is not required.
light d. The definitive bonded restoration should be placed at
b. Related to changes in the inorganic hydroxyapitite the visit in which the sodium perborate paste is
crystals removed.
c. Related to the dissolution of the stain
d. A result of removal of free-metal ions, such as iron 6. Which of the following statements regarding power
and copper bleaching is false?
a. Power bleaching often 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 soft 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(f-Assessmem Exam

CHAPTER 22: RESTORATION OF THE 5. A tooth requires a post, core, and crown for ad
ENDODONTICAllY TREATED TOOTH restorative treannent. \Vhich of the fol lowing is the
important factor in the restorative equation?
I . Which of the following statements regarding the density a. Dowel length
of dentinal tubules (per square millimeter) is accurate? b. Dowel width
a. It remains constant as they progress from the c. The surface configuration of the dowel
periphery to the pulpal dentin junction with a d. The core material
decreasing diameter. e. An adequate ferrule
b. It remains constant as they progress from the
periphery to the pulpal dentin junction with an 6. A patient requires a post and core for restoration 0: _

increasing diameter. narrow, mandibular, central incisor tooth with 1 mm _

c. It decreases as they progress from the periphery to struenlre above the gingival level. Which ofthe follm' _

the pulpal dentin junction, maintaining a constant would be the most appropriate dowel for this situarioi:. -
diameter. a. Cast post and core
d. It increases as they progress from the periphery to the b. Carbon fiber post with a composite core
pulpal dentin junction with an increase in diameter. c. Parallel stainless steel (S5) post with an amalgam
e. I t increases as they progress from the periphery to the d. Threaded dowel with a composite core
pulpal dentin junction, maintaining a constant diam­
eter. 7. Which of the following statements regarding the e
fiber dowels is false?
2. Which of the following statements regarding teeth a. They are radiolucent.
restored with crowns is correct? b. They have a modulus of elasticity similar to dentn:..
a. When teeth exhibiting no caries. fracture. or other c. Thcy provide esthetic qualities similar to
causative factors are restored with crowns. those dowels.
serving as abutments exhibit a higher rate of necrosis. d. The carbon fiber dowels are more resistant to fra
b. The periodontal status of teeth restored with crowns
is not a significant factor in the pUlpal prognosis. 8. Which of the following statements regarding the ZI:­
c. Should pulp necrosis occur in teeth restored with conia dowel is accurate?
crowns, the process occurs rapidly, usually within {he a. It is easily removed from the canal by ultrasonic z:::..:
first 3 years after cementation. special burs.
d. The amount of occlusal reduction is a more signifi­ b. It is readily seen on radiographs.
cant factor in inducing pulpal pathosis when com­ c. It requires a composite core.
pared to axial reduction. d. It is similar to dentin in elasticity.
e. Pulpal pathosis becomes significant when the
remaining thickness of dentin is less than 1 . 5 mm. 9. The most appropriate time to determine the precis.!
method for restoring the endodontically treated toOth l!
3. Whieh of the following would best fit the definition of which of the following?
the "stressed pulp syndrome"? a. \\'hen the initial diagnosis and treatment plan
a. A tooth recently prepared for a porcelain fused-to­ established
metal crown that (with placement of a provisional b. During the endodontic treatment procedures
crown) exhibits severe pain to thermal stimulation c. After completion of the root canal treatment
b. A tooth that is asymptomatic but has had numerous d. After the initial-crown preparation
restorations placed over a period of years because of
recurrent caries 10. Which of the following statements regarding post
c. A nonresrored tooth that exhibits probing depths of 4 is correct?
to 5 mm a. The post space for passive dowels must provide in=­
d. A tooth that is not responsive to pulp testing with CO2 mate contact between the dowel and the dentin \\alL
and EPT b. Post space should extend into the root to a depth 3 .

5 mm from the apex.

4. Each of the following is a concern when restoring an c. The post space required for fabrication of a d()'\\:
endodontically treated molar with minimal remaining and core using a direct technique requires removal
tooth structure, excep tJor one. Which is the exception? more tooth structure than the proprietary dowel sys­
a. Increased chance for root fracture tems because of the need to remove undercuts.
b. Greater potential for recurrent caries d. Direct composite-reinforced systems require dr
c. Infringement on the biologic width least amount of preparation.
d. The altered light refraction
e. Changes in collagen cross linking
 Challenge 1 003

CHAPTER 23: PEDIATRIC ENDODONTICS: 7. A calcium hydroxide pulpotomy performed on a young,

ENDODONTIC TREATMENT FOR THE PRIMARY permanent tooth is judged to be successful during which
AND YOUNG, PERMANENT DENTITION of the following?
a. When the patient is asymptomatic
I . The basic morphologic difference between primary and b. When the tooth responds to pulp testing
pennanent teeth is which of the following? c. When normal root development continues
a. Thickness of dentin between pulp and enamel is d. All of the above statements are accurate.
greater in primary teeth
h. Enamel is thicker in primary teeth 8. Fonnocresol pulpotomy on a primary tooth is indicated
c. The pulp chamber is comparatively smaller in pri­ during which of the following?
mary teeth a. When there is a history of spontaneous toothache
d. The pulp horns are higher in primary molars b. When the inflammation or infection is confined to the
coronal pulp
2. Radiographically, which of the following statements c. When the pulp does not bleed
regarding primary teeth is accurate? d. When there is only apical pathosis
a. Pathologic changes in the periradicular tissues are
most often apparent at the apexes than the furcation 9. The effect offormocresol on the pulp tissue is controlled
of molars. by which of the following"
b. The presence of calcified masses within the pulp is a. Concentration used
indicative of acute pulpal disease. b. Method of application
c, By the time internal resorption is visible the only c. Length of time applied
treatment is extraction. d. All of the above
d. Pathologic bone-and-root resorption is always indica­
tive of nanvita! pulp. 1 0. An increasingly popular technique for pUlpotomy in pri­
mary teeth is which of the following?
3. Which of the following diagnostic tests is usually reli­ a. Formocresol
able for determining pulpal status of primary teeth? b. Calcium hydroxide
a. Thermal pulp tests c. Electrosurgery
b. Electrical pulp tests d. Laser surgery
c. Percussion
d. None are reliable in children. I t . Glutaraldehyde may be preferred to formocresol for pri­
mary pulpotomy because of which of the following rea­
4. Which of the following statements regarding indirect sons?
pulp therapy is accurate? a. It has less systemic distribution beyond the pulp.
a. It is indicated only in the treatment of teeth with deep b. It has a better prognosis.
carious lesions in which there is no clinical evidence c. [t is not antigenic.
of pulpal degeneration or periapical pathosis. d. It is less readily metabolized.
b. It removes much of the bacteria present in dentin.
c. It includes placing calcium hydroxide or zinc oxide­ 1 2 . Which of the following is an indication for root canal
eugenol (ZOE) over the remaining caries and penn3- treatment of primary teeth?
nently restoring the tooth with amalgam. a. Radiographic evidence of internal root resorption
d. It involves all of the above. b. Periapical lesion
c. Dentigerous cyst
5. Direct pulp capping is recommended for primary teeth d. Mechanical or carious perforation of the chamber
with which of the following? floor
a. Carious exposures
b. Mechanical exposures 1 3 . Which of the following statements regarding access
c. Calcification in the pulp chamber opening on primary incisors is accurate?
d. All of the above a. They are from the facial surface.
b. They are from the lingual surface.
6. Symptoms of pulp abnormalities in primary teeth c. They are from the incisal edge.
include which of the following? d. They are different for maxillary teeth and mandibular
a. Pain to percussion teeth.
b. History of spontaneous pain
c. Variations in mobility
d. All of the above
1004 CHALLENGE A Se(fAssessmenr Exam

1 4 . Which of the following is true in placing zinc oxide­ 6. In the older patient (as compared with the yo
eugenol in a primary tooth? patient) the exit of the canal (i.e., apical foramen
a. Technique is not important. which of the following?
b. The overfill has a poorer prognosis than a flush fill. a. Closer to the radiographic apex
c . The paste should be mixed to a thick consistency. b. Closer to the true apex
d. A l l are true. c. Easier to detect tactilely
d. More variable because of cementum formation
CHAPTER 24: GERIATRIC ENDODONTICS
7. Which of the fo llowing statements regarding single-.
1 . As related to dental visits by the older patient, which of root canal treatment in an older patient is ac curate'?
the following statements are accurate? a. It should be avoided because there is more like:
a. Older patients have fewer visits per year than younger be an increase in postappointment pain.
patients. b. It should be avoided because it decreases sue
b. The number of visits by older patients should prognosls.
decrease in the future. c. It is acceptable ifit is more convenient for the �
c. Most visits are for comprehensive procedures. d. It should be avoided to place an intracanal m�
d. Dental visits of older patients are for less-complicated ment.
procedures \vhen compared to younger patients.
8. Success of root canal treatment in older patients (as
2. Which of the following statements regarding secondary pared with younger patients) is which of the follo\\""�
dentin formation in the radicular pulp in an older patient a. Better
is accurate? b. Poorer
a. It is less likely to occur in response to abrasion than c. Equivalent
in younger patients. d. Unknown (has not been investigated)
b. It may result in complete pulp obliteration.
c. It may compromise the blood supply and cause pulp 9. In the older patient root canal treatment (as compaf'f.'C
necrosis. extraction) is which of the following?
d. It does not require an irritant. a. Usually more emotionally traumatic
b. Usually more tissue traumatic
3 . In the older patient (as compared \vith a younger c. Often less expensive in the long run
patient), regarding pulpal inflammation from caries. d. More likely to result in postappointment cornplicaricc.
which of the following statements is accurate?
3. It is less likely to be as painful as in a younger patient. 1 0. A postsurgical condition that tends to occur more fre.­
b. It usually progresses more slmvly. quently in older patients is which of the fol lowing?
c. It is less likely to occur. a. Ecchymosis (i.e., discoloration) ofs.oft tissues
d. It is more likely to be acute than chronic. b. Infection of the surgical site
c. Loss of sunlres because of more friable tissues
4. Pulps in older patients tend to be less responsive to d. Continued hemorrhage of the incision site
thermal stimuli because of which of the following rea­ e. Loss of consciousness
sons?
a. Sensory nerves in dentin degenerate with time. 1 1 . \Vhen should periapical radiographs be prescribed?
b. Sensory nerves in pulp lose their myelin sheath as 3 a. Before discussion of the chief complaint
result of long-term, repeated injuries. b. After discussing the chief complaint with the patie::ll
c. With age, patients become less alert and, therefore. c. Just before the clinical examination
less responsive to external stimuli. d. After completing the c l inical examination
d. Pulpal calcifications block external stimuli from
reaching receptors. 12. \Vith aging, which of the following statements are acCL�
e. Pulps tend to have less sensory innervation in older rate?
teeth. a. Lateral canals enlarge and become more clinic�­
significant.
5. An abrupt midroot radiographic disappearance of a b. Gingival recession exposes cementum and dentin.
canal usually indicates which of the following? which is less resistant to caries.
a. Bifurcation in the canal c. The cementodentinal j unction locates progressively
b. Secondary dentin formation apically more coronally.
c. Concentrations of dystrophic calcifications apically d. A l l of the above occur.
d. Diminished (oflen unnegotiable) sized canal
 Challenge 1005

1 3 . In geriatric patients, which of the following statements a. A maxillary sinus

are accurate? b. An endodontic apical pathosis
a. There is a direct correlation between the nature of c. A fibroosseous lesion
response to electrical-pulp testing and the degree of d. A bony trabecular pattern
inflammation.
h. There is a reduced volume and increased neural com­ 1 7 . The elevated structure facial to the crowned first molar
ponent of the pulp. in the following illustration is likely which of the fol­
c. Tooth discoloration usually is not indicative ofpuJpal lowing?
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. a. Acute apical abscess
b. Periodontal abscess
I S. Which of the following statements regarding endodontic c. Fibroma
surgery in older patients is accurate? d. Exostoses
a. It requires more anesthetic and vasoconstrictor than
in younger patients. CHAPTER 25: NONSURGICAL
b. It may be somewhat easier because the vestibule i s ENDODONTIC RETREATMENT
deeper.
c. It is risky because inadequate blood supply may 1 . Canals may be missed during treatment because of
result in postsurgical osteomyelitis. which of the fol l owing?
d. It has been demonstrated to be much less successful a. Calcification
than in younger patients. b. Anomalous location
c. Inadequate access
1 6 . The radiolucent structure at the periapex of the premolar d. All of the above
in the following illustration is likely which of the fol­
lowing? 2 . Radiographically, which of the following statements
regarding canals that appear calcified are accurate?
a. They are seldom able to be instrumented.
b. They have a different 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 o f the fol l owing?
a. Persistent pain
b. Draining sinus tract
c. Restorative indications
d. Microleakage
1006 CHALLENGE A Self-Assessment Exam

4. Presence of excess gutta-percha beyond the apex is usu­ 1 0. Removal of objects can be facilitated by:
ally caused by which of the following? a. Straight-line access
3. Use of too small a master cone b. A good l ight source
b. Excessive heating and compaction during warm, ver­ c. Magnification
tical condensation d. All of the above
c. Destruction of the natural apical constriction
1 1 . Carrier-based guna-percha removal and retreatJJ:Je::.
5. Lateral or furcal canals are which of the fol l owing? 3. Generally easy, because all components are so -
a. Commonplace b. Very difficult, because the gutta-percha is u
· "",,
= c
b. Not able to be mechanically cleaned c . Usually by using a combination oftechniqu -
c. Not routinely obturated d. Impossible
d. Seldom the sole cause of endodontic failure
e. All of the above 1 2 . Type III transportation is best managed by:
a. Extraction
6. Retreatment has the most favorable prognosis during b. Apexification with calcium hydroxide
which of the following? c. Forming an artificial barrier with a materiaL � •

a. When the cause o f failure is identified and is correct- MTA

able d. Obturation, as best as possible, then surgery
b. When the patient is asymptomatic
c. When gutta-percha was used instead of paste CHAPTER 26: DIGITAL TECHNOLOGIES
d. When a surgical microscope is used IN ENDODONTIC PRACTICE

7. For silver point removal , ultrasonics are used for which I . A disadvantage of digital cameras relative to film-t­
of the following reasons? cameras i s that the digital cameras:
a. To break up cement surrounding the point a. Are very expensive to purchase
b. To reduce the level of dentin on the floor of the h. Are more expensive to operate
chamber to expose the point c. Have inferior image resolution
c. To break up the silver point into small pieces, \vhich d. Have a greater delay in obtaining images
can then be flushed out c. Are vcry complicated to operate
d. To loosen the silver point by applying the vibrating
instrument directly to the silver cone 2. An advantage of conventional radiographic film 1
to digital radiographic imaging is that film:
8. How should rotary instruments be used for the removal a. Generally produces an image of superior q
of gutta-percha? b. Is easier to duplicate (reproduce)
a. To remove all the gutta-percha the length of the canal c. Requires less radiation exposure
b. At the highest speeds d. Accurately depicts the extent of caries
c. In reverse of the canal preparation direction e. Produces an image more quickly
d. In portions ofthe canal where the instruments fit pas­
sively 3. The Internet is usable in dentistry for all of the 101.,.""",,­
e. In portions of the canal w·here the instruments fit except:
snugly a. Inter-doctor consultations
b. Online scheduling of patients
9. If a cervical root perforation occurs during the treatment c. Patient access to his/her dental records
and the canal preparation is incomplete, the generally d. Online ordering of supplies
preferred time for repairing the defect is which of the e. Transmission of insurance claims
following?
a. Immediately, that is, before proceeding with further 4. The Clinical Chairside Workstation is used for:
preparation a. Storing and displaying clinical information
b. After cleaning and shaping is complete but before b. Electronically determining shades for pa=
obturation crowns
c. Immediately after obturation c. Selecting and mixing cements
d. After an appropriate recall period, to assess the status d. Communicating by voice with the front desk
of the tissues
 Challenge 1007

5. Thc pre-registration specialized system is designed to: 3. The recommended treatment and reason for the treat­
a. Obtain early registration for professional meetings mcnt is which of the following?
b. Remind patients of recall appointments a. Root canal treatment; there is pulp pathosis.
c. Automatically contact insurance companies to deter­ b. Root end resection and root end filling; there 1S

mine coverage limits of a patient pathosis, but the pulp space is too small to attempt
d. Record pertinent data on a referred patient prior to root canal treatment.
any appointment c. No treatment; there is no pathosis.
e. Any of the above are possibilities d. Extraction is prescribed.

TEST YOUR KNOWLEDGE Questions 4 to 8 relate to the following i llustration.

Questions I to 3 relate to the following radiograph.

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
The patient does not have symptoms. All teeth shown in the b. Irreversible pulpitis
radiograph respond to pulp testing, except the canine. c. Necrosis
I . The radiolucent structure (arrow) at the apex of the d. Unknown, pending further information
canine is likely which of the following?
a. Maxillary fracture 5. What is the periapical diagnosis?
b. Apical pathosis a. Normal
c. Nasopalatine duct b. Acute apical periodontitis
d. Nutrient canal c. Chronic apical periodontitis
d. Acute apical abscess
2. The radiographic appearance internally indicates which
of the following? 6. What is the likely appearance of the pulp histologically?
a. Two likely superimposed canals a. Coronal pulp is necrotic; radicular pulp is inflamed.
b. Dentinogenesis imperfecta b. Coronal pulp is inflamed; radicular pulp is normal.
c. Dense accumulations of linear calcifications c. The entire pulp is inflamed.
d. Calcific metamorphosis d. The entire pulp is necrotic.
1008 CHALLENGE A Self-Assessment Exam

7 . What i s the likely appearance of the peri apex histo l ogi ­

A 50-year-old woman comes to the clinic complaini=:5:
cally? sharp sensitivity with chewing on the lower l eft second
a. Normal structures She reports a period of cold sensitivity 6 months prior
b. Acute inflammation; no bone resorption not had any cold tenderness for several months. The thi..
�
c. Acute inAammation; bone resorption first molars respond to pulp testing ; the second molar �
d. Chronic inflammation; bone resorption not respond. There is no pain to palpation but the
,

tender to percussion on the cusps and tender to biring _

8. What minimal immediate treatment is indicated? bite stick. There is an isolated 6-mm probing defect on
a. None. Schedule the patient for future evaluation. (P/IO{ograph: The shallow occlusal alloy has been remoo _
b. Complete canal preparation at this visit.
c. Remove the caries and place a sedative temporarily. 9. What is the pulpal diagnosis for tooth no. 1 8?
d. Perform pulpotomy or partial pUlpectomy. a. Normal
b. Hypersensitive
Questions 9 to 13 relate to the following photograph and c. Irreversible pulpitis
radi ograph . d. Necrosis

-
1 0. What type of bacteria would likely be found in the _

a. Gram-positive aerobes
b. Gram negative anaerobes
-

c. Mixed flora
d. l one

I I . What is the likely cause of the patient's pain?

a. Inflamed 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 . \Vhat type of permanent restoration is indicated?

a. Occlusal amalgam
b. Occlusal bonded composite
c. Pin-retained amalgam
d. Full-cast crown
 Challenge 1009

Questions 1 4 to 20 relate to the following photograph and 14. Which tooth and tissue are the probable source of pain?
radiograph. 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 inflammatory cells, which would likely

The patient reports "a bad toothache for 2 days. I can't bite
predominate periapically?
on these lower, right, front teeth." There is pain on pressure
a. Lymphocytes
and palpation in the region of the lateral incisor and canine.
b. Polymorphonuclear neutrophilic leukocytes
The premolar (small amalgam) is asymptomatic. The lateral
c. Plasma cells
and premolar respond to pulp testing; the canine does not
d. Macrophages
respond. There is no swelling. There is an aphthous ulcer on
the facial attached gingiva of the lateral. All probings are
20. Looking at the radiograph and clinical photograph, what
normal. The lateral and canine have moderate mobility.
is the likely cause of the pulpal and periapical pathosis?
a. Incisal attrition
b. Cervical erosion
c. Caries
d. Impact trauma
1010 CHALLENGE A Self-Assessment Exam

Questions 21 to 25 relate to the following radiograph. 24. What should be the minimal emergency treatment on the
offending tooth (teeth)?
a. Remove the amalgam and place a sedative dressin_
Prescribe analgesics and antibiotics.
b. Do a complete canal preparation. Place a conon
pellet of formocresol.
c. Reduce the occlusion and prescribe antibiotics.
d. Perform a pulpotomy and place a dry-cotton peUeL

25. Inferior alveolar injection is indicated. If the offending

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 inflaffiIl-l2
tory fluids.
The patient reports severe, continuous pain in the mandibu­ c. There may be morphologic changes in the nerves thaI
lar, right quadrant. She states that the pain began when she originate in the inflamed areas; these nerves becomes
was drinking iced tea last evening and the pain has not sub­ more excitable.
sided. She slept poorly last night. Medical history is noncon­ d. Because of inflammation, there is increased circula­
tributory. tion in the area; this carries away the anesthetic n!��
Amalgams were placed a few months earlier after removal rapidly.
of deep caries on both molars. She has increased pain on
lying down. The pain is not relieved with analgesics. She Questions 26 to 28 relate to the following radiograph.
cannot localize the pain to an individual tooth. Pulp testing
shows response on the premolar and second molar. The first
molar does not respond. Cold-water application causes
intense, diffuse 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 first
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

The patient has no adverse signs or symptoms. Surgery \\-as

several years ago. There are no probing defects. The canine
responds to pulp testing.
 Challenge 1011

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.

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 (lateral incisor).
There is normal mobility, and probing depths are 4 to 5 mm
with the distofacial surface of tooth no. 9 probing 8 mm.
There is no tenderness to percLission, but there is tenderness
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
c. Irreversible 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 pUlpitis
c. Irreversible pulpitis
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/f-Assessmenr Exam

32. Which of the following is the most likely the cause of Chapter 4
swelling associated with teeth nos. 9 and 1 0? I . d; 2. c; 3 . b; 4. c; 5. d; 6. c; 7. d; 8. c; 9. c; 1 0. a; I I . c: 1 :"
a. Pulp necrosis d.
b. Periodontal disease
c. A developmental groove defect Chapter 5
d. Vertical-root fracture I . b; 2. c; 3. d; 4. b; 5. a; 6. c; 7. d; 8. a; 9. c; 1 0. c; I I . c: 1 2-
e. Peripheral giant-cell granuloma d ; 1 3 . c; 1 4. a ; 1 5 . c ; 1 6. a ; 1 7. a ; 1 8 . d ; 1 9 . c; 20. b ; 2 1 . a.

3 3 . Which ofthe following is most important in determining Chapter 6

if this lesion is of periodontal origin or of pulpal origin? I . a; 2. c; 3. b; 4. a; 5. b; 6. d; 7. b; 8. c; 9. a; 1 0 . b; I I . e: t::..
a. Percussion b; 1 3 . c.
b. A periapical radiograph
c. Periodontal mobility and mobility assessment Chapter 7
d. Pulp testing 1 . a; 2. c; 3. a; 4. d; 5. b; 6. c; 7. a; 8. b; 9. d; 1 0. b.
e. Periodontal probing
Chapter 8
34. Treatment of this case requires which of the following? I . a; 2 . b; 3. c; 4. a; 5. c; 6. d; 7. b; 8. d; 9. b; 1 0. d; I I . a: L.
a. Periodontal scaling, root planing of the area. and a.
drainage
b. Root canal debridement of tooth no. 9, followed by Chapter 9
incision and drainage I . c; 2. d; 3 . a: 4. c; 5. e; 6. d; 7. a; 8. d; 9. c; 1 0. b; I I . b: -

c. Analgesic treatment and antibiotic treatment until the a; 1 3 . a; 14. a; 1 5. a; 1 6 . d; 1 7 . d.

involved tooth can be localized
d. Flap reflection to inspect the root for a vertical root Chapter 1 0
fracture or lateral canal I . c; 2 . b; 3 . c; 4. b ; 5 . a; 6 . a; 7 . b; 8 . d; 9 . b ; 10. a; I I . b: -

e. Surgical excision and biopsy a.

3 5 . Which of the following statements is 'rue regarding the Chapter 1 1

effects of periodontal treatment procedures on the dental I . c; 2. a; 3 . b; 4. a ; 5 . b; 6. b; 7. a; 8. d; 9. b; 1 0. d; I I . a: C
pulp? d; 1 3. c; 1 4. b; 1 5 . b; 1 6. a.
a. Scaling and root-planing procedures remove cemen­
tum, expose dentinal tubules, which are invaded and Chapter 1 2
result in pulp inflammation. -
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. Citric acid application appears to produce pulpal b; 1 3 . b; 1 4 . c; 1 5. a.
inflammation when used in conjunction with reat­
tachment procedures. Chapter 1 3
c. Hypersensitivity may result from scaling but is a sign 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
of pulpal pathosis or inflammation or both. e 1 4. b; 1 5. c; 16. c; 1 7. c ; 18. d; 19. e; 20. b.
d. Scaling and root-planing procedures may produce
deposition of tertiary dentin. 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 . a: I '::
ANSWER KEY c; 1 3 . a; 1 4 . b; 1 5 . b; 1 6. d; 1 7. b; 1 8. c; 1 9. a; 20. d.

Chapter 1 Chapter 1 5
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 . I . d; 2 . d; 3 . a; 4 d; 5 . a; 6. a; 7 . a; 8 . b; 9. d; 1 0. c; I I . II: r:
.
d ; 1 3 . b ; 1 4. a ; 1 5 . c; 1 6. d ; 1 7. d ; 1 8. c ; 1 9. d : 20. b. d; 1 3 . b; 14. d; 1 5. b; 1 6. b; 1 7. a; 1 8. e; 1 9 . d.

Chapter 2 Chapter 1 6
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 . 1 . c; 2. a; 3. c ; 4. a; 5 . b; 6. b; 7. a; 8. b; 9. d; 1 O. c; 1 1 . a: ! 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 ; 1 3 . a ; 1 4 . e ; 1 5 . c ; 1 6. d ; 1 7. b.
a; 23. b; 24. c.
Chapter 1 7
Chapter 3 I . b; 2. a; 3. e; 4. b; 5 . d; 6. d; 7. b; 8 . a; 9. b; 10. a.
I . d; 2. b; 3 . b; 4. d; 5 . c; 6. c; 7. c; 8. a; 9. a; 1 0. e; I I . b.
 --
-- -- -

Challenge 1013

Chapter 1 8 Chapter 24
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 . 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 . a; 1 4 . a; I S. b; 1 6. e ; 1 7 . b; 1 8. a ; 19. a . b; 1 3 . e; 1 4 . c; 1 5 . b; 1 6. a; 1 7. d.

Chapter 1 9 Chapter 25
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 . 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 .
e ; 1 3 . b ; 1 4. a ; I S . d. d.

Chapter 20 Chapter 26
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. I. c; 2. a; 3. c; 4. a; 5. d
a; 1 3 . c; 1 4 . d; I S . a; 1 6. b; 1 7. c; 1 8 . b; 1 9. d.
Test Your Knowledge
Chapter 21
I. a; 2. a; 3. d; 4. b; S. b; 6. d. 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 .
Chapter 22 e; 22. a; 23. a; 24. d; 25. e. 26. d; 27. d; 28. d; 29. a; 30. a;
l . d; 2. a; 3. b; 4. d; S. e; � a; 7. d; 8. b; 9. d; 1 0. d. 3 1 . e; 32. b; 33. d: 34. a; 35. 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.