NBDE Remembered 2 New York

1
1. Best way to view maxillary sinus? Water’s view Secondary view PAN
The Waters projection is optimal for visualization of the maxillary sinuses, especially to
compare internal radiopacities, and the frontal sinuses and ethmoid air cells.
(White, Stuart C.. Oral Radiology: Principles and Interpretation, 6th Edition. Mosby, 092008.
27).
3. Lipid solubility and nonionized base. Nonionized is lipid soluble, ionized is water
soluble
4. Child has pain? Osteomyletis, chronic osteitis

Staph. Aureus is common organism.
Rarely, odontogenic infection may lead to osteomyelitis, most commonly involving the
mandible. Radiographically, the bone has a 'moth-eaten' appearance. Curettage of the area is
required to remove bony sequestra and antibiotics given for at least 6 weeks, dependent on the
results of microbiological culture and sensitivity test results.
(Cameron, Angus C.. Handbook of Pediatric Dentistry, 2nd Edition. Mosby Ltd., 062003. 6).
5. What do you check on bone graft to see if osseous integration worked? Post,
instant, Pre
6. Extraction sequence
The order in which multiple teeth are extracted deserves some discussion. Maxillary teeth
should usually be removed first for several reasons. First, an infiltration anesthetic has a
more rapid onset and also disappears more rapidly. This means that the surgeon can begin
the surgical procedure sooner after the injections have been given; in addition, surgery
should not be delayed because profound anesthesia is lost more quickly in the maxilla. In
addition, maxillary teeth should be removed first because during the extraction
process, debris such as portions of amalgams, fractured crowns, and bone chips may fall
into the empty sockets of the lower teeth if the lower surgery is performed first. In addition,
2
maxillary teeth are removed with a major component of buccal force. Little or no vertical
traction force is used in removal of these teeth, as is commonly required with mandibular
teeth. A single minor disadvantage for extracting maxillary teeth first is that if hemorrhage
is not controlled in the maxilla before mandibular teeth are extracted, the hemorrhage may
interfere with visualization during mandibular surgery. Hemorrhage is usually not a major
problem because hemostasis should be achieved in one area before the surgeon turns
attention to another area of surgery, and the surgical assistant should be able to keep the
surgical field free from blood with adequate suction.
Tooth removal usually begins with extraction of the most posterior teeth first. This
allows for the more effective use of dental elevators to luxate and mobilize teeth before the
forceps are used to extract the tooth. The two teeth that are the most difficult to remove,
the first molar and canine, should be extracted last. Removal of the teeth on either side
weakens the bony socket on the mesial and distal side of these teeth, and their subsequent
extraction is made more straightforward.
Thus, for example, if teeth in the maxillary and mandibular left quadrants are to be
extracted, the following order is recommended: (1) maxillary posterior teeth, leaving the
first molar; (2) maxillary anterior teeth, leaving the canine; (3) maxillary first molar;
(4) maxillary canine; (5) mandibular posterior teeth, leaving the first molar; (6)
mandibular anterior teeth, leaving the canine; (7) mandibular first molar; and (8)
mandibular canine.
(Hupp, James R.. Contemporary Oral and Maxillofacial Surgery, 5th Edition. Mosby, 032008.
8.3.2).
7. Horizontal overlap 2-4 mm of overjet
Overjet is defined as horizontal overlap of the incisors. Normally, the incisors are in
contact, with the upper incisors ahead of the lower by only the thickness of their incisal edges
(i.e., 2-3 mm overjet is the normal relationship). If the lower incisors are in front of the
upper incisors, the condition is called reverse overjet or anterior crossbite.
Overbite is defined as vertical overlap of the incisors. Normally, the lower incisal edges
contact the lingual surface of the upper incisors at or above the cingulum (i.e., normally
there is 1 to 2mm overbite). In open bite, there is no vertical overlap, and the vertical
separation of the incisors is measured to quantify its severity.
3
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006. 1.3).
? ??8. Which is harder to anesthesize? Mx molar IRP, chronic
9. Hemisection: cut molar into 2, premolar
Hemisection is the splitting of a two-rooted tooth into two separate portions. This process
has been called bicuspidization or separation because it changes the molar into two
separate roots. Hemisection is most likely to be performed on mandibular molars with
buccal and lingual class II or III furcation involvements.
(Newman, Michael G.. Carranza's Clinical Periodontology, 10th Edition. Saunders Book
Company, 072006. 68.6.2).
10. Mucopolysaccaride is answer Hunter Hurler
11. Undercut
12. 2 questions about reducing max tuberosity –denture wont fit because of undercut
The primary objective of soft tissue maxillary tuberosity reduction is to provide

adequate interarch space for proper denture construction in the posterior area and a
firm mucosal base of consistent thickness over the alveolar ridge denture-bearing
area. Maxillary tuberosity reduction may require the removal of soft tissue and bone to
achieve the desired result. The amount of soft tissue available for reduction can often be
determined by evaluating a presurgical panoramic radiograph. If a radiograph is not of the
quality necessary to determine soft tissue thickness, this depth can be measured with a
sharp probe after local anesthesia is obtained at the time of surgery.
13.5.1).
13. LED curing vs regular curing? Why is LED curing beter? Range, last longer
LED range 400-499nm or 460-490nm, causes damage of retina of eye, depth of 2mm
Most recently developed are the LED curing units. These units have a number of
advantages compared to other curing units, including a wavelength spectrum emission
that is closely matched to camphorquinone. In addition, these units are more energy
efficient, allowing them to be battery operated. The diodes have a life span that is
approximately 1,000 times longer than the typical halogen bulb. While the earlier
versions of LED curing units provided inadequate irradiance, the newer generation has
overcome this deficiency. About the only disadvantage to these units is their narrow
4
wavelength spectrum, limiting their usefulness in curing any materials that do not use
camphorquinone as the photoinitiator.
The practical consequence is that curing depth is limited to 2 to 3 mm unless excessively

long exposure times are used, regardless of lamp intensity.
(Anusavice, Kenneth J.. Phillips' Science of Dental Materials, 11th Edition. Saunders Book
(Summitt, James B.. Fundamentals of Operative Dentistry: A Contemporary Approach, 3rd

Edition. Quintessence Publishing (IL), 012006. 10.9.10).
14. Test for boy/girl-chi square

t-test is statistical difference bwtn 2 median, ex the diffr. Btwn the control group and
group receiving the tx.
Chi-square (χ2) test: the chi-square test measures the association between two
categorical variables.
(Mosby. Mosby's Review for the NBDE, Part II. Mosby, 042007. 6.3).
15. How do you know if it’s a non-odontogenic tumor, pain doesn’t subside
Non-odontogenic tumo. r toothache can often be differentiated from odontogenic

toothache by local provocation. Pulpal and periodontal pains are increased by local
provocation of the teeth such as percussion, hot, cold, or biting forces. When toothache
pain is not increased by provocation, one should be suspicious of nondental toothache.
Local anesthetic can be very helpful in differentiating true dental pain from pain
referred to the teeth.104-106 Local anesthetic applied in the region of a true dental toothache
will reduce or eliminate the pain. Local anesthetic at the site of the nonodontogenic
toothache often will not reduce the pain since the site of pain is not the true source of
pain.
???Odontogenic tumor relieved by _______________=osteoma

Not relieved by aspirin is osteoma, osteoblastoma
(American Academy Of Orofacial Pain, Jeffrey P. Okeson. Orofacial Pain: Guidelines for
Assessment, Diagnosis & Management, 3rd Edition. Quintessence Publishing (IL), 011996.
7.1.4).
16. Difference between 245 (inverted cone) and 330 (pear shape) bur 245 longer
5
17. What turns porcelain green? Copper or silver
Porcelain that is baked onto a high –fusing gold alloy may exhibit a green discoloration
due most likely to contamination of the metal by COPPER traces. (Dental Decks)
Examples of metallic oxides and their respective color contributions to porcelain include iron or
nickel oxide (brown), copper oxide (green), titanium oxide (yellowish brown), manganese oxide
(lavender), and cobalt oxide (blue). Opacity may be achieved by the addition of cerium oxide,
zirconium oxide, titanium oxide, or tin oxide.
Company, 072003. 24.7.4).
18. Referred pain
Referred pain: Pain experienced from a site other than the site of the stimulus or tissue
damage. Afferent fibers from several sites (possibly some distance from each other)
converge on second-order neurons; then central cognitive processes mistake the true
site.
(Walton, Richard E.. Principles and Practice of Endodontics, 3rd Edition. Saunders
Book Company, 012002. 29.2.1).
19. Warfarin, Coumadin, wha. t test do you use? INR (with in 24hrs presurgery)
INR of 1=normal
Warfarin can be monitored via PT (Extrinsic pathway) time. Patients who take
warfarin (Coumadin) for anticoagulation must have a current international
normalized ratio (INR) determined before any invasive procedure can be
performed. Most dental procedures, including minor surgery, may be performed safely
without discontinuation or alteration of the Coumadin dosage, as long as the INR is
within the therapeutic range (3.5 or less). Local hemostatic measures generally are
adequate to control bleeding and include the use of hemostatic agents in the sockets,
suturing, gauze pressure packs, and tranexamic acid or e-aminocaproic acid mouth rinses.
More extensive surgical procedures associated with anticipated significant blood loss
should be discussed with the patient's physician.
(Little, James W.. Dental Management of the Medically Compromised Patient, 7th Edition.
Mosby, 072007. 4.4.1.2)..:’
6
20. How far you place implants from tooth? 1mm from adjacent tooth
Recommended minimum distances (in millimeters) between implants and

between implants and natural teeth. (From Rosenstiel SF, Land MF, Fujimoto
J: Contemporary Fixed Prosthodontics, ed 4, St Louis, Mosby, 2006.)
21. Remove rampant caries from anterior

22. Curretage what part of blade do you use in perio? Lower third (apical 1/3 aka Toe)
Gracey curette blade divided into three segments: A, the lower one third of the blade,
consisting of the terminal few millimeters adjacent to the toe; B, the middle one third;
and C, the upper one third, which is adjacent to the shank.
If only the middle third of the working end is adapted on a convex surface so that the
blade contacts the tooth at a tangent, the toe or sharp tip will jut out into soft tissue,
causing trauma and discomfort. If the instrument is adapted so that only the toe or tip
is in contact, the soft tissue can be distended or compressed by the back of the
working end, also causing trauma and discomfort. A curette that is improperly
adapted in this manner can be particularly damaging because the toe can gouge or
groove the root surface. Only the lower third or half of the Gracey blade is in contact
7
with the tooth during instrumentation. Concentrate on using the lower third of the
cutting edge for calculus removal.
Company, 072006. 51.2.6.1).
23. Pregnant lady? Lay right side up, what is artery are you protecting?
During late pregnancy, a phenomenon known as supine hypotensive syndrome may occur
that manifests as an abrupt fall in blood pressure, bradycardia, sweating, nausea, weakness,
and air hunger when the patient is in a supine position. Symptoms are caused by impaired
venous return to the heart that results from compression of the inferior vena cava by the
gravid uterus. This leads to decreased blood pressure, reduced cardiac output, and
impairment or loss of consciousness. The remedy for the problem is to roll the patient
over onto her left side (right hip up), which lifts the uterus off the vena cava. Blood
pressure should rapidly return to normal. (Little, James W.. Dental Management of the
Medically Compromised Patient, 7th Edition. Mosby, 072007. 18.1.1).
24. If patient is laying backwards and going into syncope what is being smushed?
Abdominal aorta
(couldn’t find anything about abdominal aorta being smushed!!)
25. Periapical abcsess vs periapical radiolucency which do you do first? Endo then
perio
26. Mandibular incisor coming in crowded how do you make space? Interarch distance
from primitive space
Distal to canine for mandibular arch and mesial to canine for maxillary arch
27. Which do you gain back? Tooth mobility, bone, etc,
28. Neurapraxia
The three types of nerve injuries are (1) neurapraxia, (2) axonotmesis, and (3)
neurotmesis .
Neurapraxia, the least severe form of peripheral nerve injury, is a contusion of a

nerve in which continuity of the epineurial sheath and the axons is maintained.
Blunt trauma or traction (i.e., stretching) of a nerve, inflammation around a nerve, or
local ischemia of a nerve can produce a neurapraxia. Because there has been no loss in
axonal continuity, spontaneous full recovery of nerve function usually occurs in a
few days or weeks.
8
Three types of peripheral nerve injury. A, Neurapraxia. Injury to nerve causes

no loss of continuity of axon or endoneurium. Example shown is implant placed in
inferior alveolar canal, compressing the nerve. B, Axonotmesis. Injury to nerve causes
loss of axonal continuity but preserves endoneurium. Example shown is overly
aggressive retraction of mental nerve. C, Neurotmesis. Injury to nerve causes loss of
axonal and endoneurium continuity. Example is cutting of inferior alveolar nerve
during removal of deeply impacted third molar.
Axonotmesis has occurred when the continuity of the axons but not the epineurial sheath
is disrupted. Severe blunt trauma, nerve crushing, or extreme traction of a nerve can
produce this type of injury. Because the epineural sheath is still intact, axonal
regeneration can (but does not always) occur with a resolution of nerve dysfunction
in 2 to 6 months.
Neurotmesis, the most severe type of nerve injury, involves a complete loss of nerve
continuity. This form of damage can be produced by badly displaced fractures, severance
by bullets or knives during an assault, or by iatrogenic transection. Prognosis for
spontaneous recovery of nerves that have undergone neurotmesis is poor, except if
the ends of the affected nerve have somehow been left in approximation and properly
oriented.
4.3.6.1).
29. Key to RCT, cleaning and shaping, why did it fail
9
Most nonhealing (failures) of root canal treatments is directly or indirectly caused by bacteria
somewhere in the root canal system. In general, the most common causes of failure are (1)
errors in diagnosis and treatment planning, (2) coronal leakage, (3) lack of knowledge of pulp
anatomy, (4) inadequate débridement and/or disinfection of the root canal system, (5)
inadequate restorative protection, (6) operative errors, (7) obturation deficiencies or errors,
and (8) vertical root fracture.
(Walton, Richard E.. Principles and Practice of Endodontics, 3rd Edition. Saunders Book
Company, 012002. 19.8).
30. Manic depressive not taking medicine what will happen? Mood swings
Drug therapy is essential in bipolar disorder for achieving two goals: rapid control of
symptoms in acute episodes of mania and depression, and prevention of future episodes
or reduction of their severity and frequency. Mood disorders have a tendency to recur.
Affective episodes may occur spontaneously or may be triggered by adverse events.
Individuals with mood disorders and their families must become aware of the early signs
and symptoms of affective episodes, so that treatment can be initiated. These individuals
also must be made aware of the need for medication compliance and of the
medication's adverse effects and possible complications.
Mosby, 072007. 29).
31. Band and loop for 1st primary molar
A band and loop space maintainer. The placement of a space maintainer must not
compromise the permanent tooth. Bands should be cemented with a luting glass ionomer
as a protection against caries and the appliance reviewed regularly. As the premolar
erupts, the appliance is removed when there is interference with normal emergence. The
distal shoe is the appliance of choice when a primary second molar is lost before
eruption of the permanent first molar.
(Cameron, Angus C.. Handbook of Pediatric Dentistry, 2nd Edition. Mosby Ltd., 062003.
9.4.3.2).
10
32. 5 year old child having pain what do you give them? Asprin, ibuprofen, codeine,
acetominphen
Aspirin compounds and non-steroidal antiinflammatory agents are contraindicated because

about 4% of patients experience wheezing after taking these drugs. Acetaminophen is
recommended.
(McDonald, Ralph. Dentistry for the Child and Adolescent, 8th Edition. Mosby, 022004.
23.14.1).
33. PCOD
Periapical cemento-osseous dysplasia
1. A reactive process of unknown cause that requires no treatment.
2. Clinical features
a. Commonly seen at the apices of one or more mandibular anterior teeth.
b. No symptoms; teeth vital.
c. Most frequently seen in middle-aged women.
d. Starts as circumscribed lucency, which gradually becomes opaque.
e. An exuberant form that may involve the entire jaw is known as florid osseous
dysplasia.
Periapical cemento-osseous dysplasia.
34. Which least likely to have hepatitis B? café workers @ hospital, down syndrome,
diabetic
Hepatitis B virus (HBV)

11
(1) Etiology: the disease is produced by a highly infective virus known as the Dane
particle. This intact virus consists of an inner core antigen (HBcAg) and an outer
coat surface antigen (HBsAg).
(2) Risk of transmission: 30% after percutaneous injury from an infected patient. As
little as 1 × 10−8 mL of blood can transmit the disease.
(3) Diagnosis: HBV is diagnosed based on a physical examination, medical history,

and blood tests. HBV blood tests include hepatitis B antigens and antibodies, and
hepatitis B viral DNA (HBV DNA), which detects genetic material (DNA) from the
HBV.
(4) Prevention: a vaccine to immunize recipients against HBV is available. Three

doses are given to confer immunity: an initial dose, followed by a second dose at 1
month, and then a third dose 6 months after the first. Since HBV is highly infectious,
all dental personnel should be vaccinated against HBV.
35. Freeze dried bone: allograft
Several clinical studies by Mellonig, Bowers, and co-workers reported bone fill
exceeding 50% in 67% of the defects grafted with freeze-dried bone allograft
(FDBA) and in 78% of the defects grafted with FDBA plus autogenous bone.129,158,171
FDBA, however, is considered an osteo-conductive material, whereas decalcified
FDBA (DFDBA) is considered an osteoinductive graft. Laboratory studies have found
that DFDBA has a higher osteogenic potential than FDBA and is therefore
preferred. DFDBA in periodontal defects results in significant probing depth
reduction, attachment level gain, and osseous regeneration ; the combination of
DFDBA and GTR has also proved to be very successful. However, limitations of the
use of DFDBA include the possible, although remote, potential of disease transfer from
the cadaver.
FDBA= osteo-conductive- potential of graft material to serve as a scaffold that favors

outside cells to penetrate the graft and form new bone. (Mosby p260)
DFDBA= osteoinductive-the ability of the graft to contain molecules that convert

neighboring cells into osteoblast. (Mosby p260)
36. OKC-most likely to reoccur
The odontogenic keratocyst (OKC) is an important entity to differentiate from other

odontogenic cysts because of its potential to be aggressive. OKCs can be seen at any age
but are most often diagnosed in patients between ages 10 and 40. They occur most
commonly in males within the posterior mandible. Radiographically, OKCs present as
well-defined unilocular or multilocular radiolucencies. Histologically, the cyst lining
consists of a thin layer of parakeratinized or orthokeratinized stratified squamous
12
epithelium with a prominent basal cell layer and a corrugated appearance of the epithelial
surface. Treatment requires aggressive and complete removal of the lesion, as
recurrence rates for inadequately removed lesions can reach 60%. Multiple OKCs may
occur; these patients should be evaluated for nevoid basal cell carcinoma syndrome
(Gorlin syndrome)
(Kumar, Vinay. Robbins & Cotran Pathologic Basis of Disease, 7th Edition. Saunders Book
Company, 082004. 16.1.6).
37. Nevoid BC
Nevoid basal cell carcinoma syndrome (Gorlin syndrome) is an autosomal dominant

inherited condition that exhibits high penetrance and variable expressivity. The syndrome
is caused by mutations in patched (PTCH), a tumor suppressor gene that has been mapped
to chromosome 9q22.3-q31. Approximately 35% to 50% of affected patients represent new
mutations. The chief components are multiple basal cell carcinomas of the skin
odontogenic keratocysts(postr mandibule) , intracranial calcification ( calcification of
falx cerebri and frontal bossing) , and rib and vertebral anomalies. Many other
anomalies have been reported in these patients and probably also represent manifestations
of the syndrome. The prevalence of Gorlin syndrome is estimated to be about 1 in 60,000.
(Neville, Brad. Oral and Maxillofacial Pathology, 3rd Edition. Saunders Book Company,
062008. 15.1.7).
38. #8 Reduce @ gingival-need crown lengthening

13
Surgical crown-lengthening procedures are performed to provide retention form to allow

for proper tooth preparation, impression procedures,21 and placement of restorative margins
and to adjust gingival levels for esthetics.32,43 It is important that crown-lengthening

surgery is done in such a manner that the biologic width is preserved. The biologic
width is defined as the physiologic dimension of the junctional epithelium and
connective tissue attachment. This measurement has been found to be relatively constant
at approximately 2 mm (±30%).10 The healthy gingival sulcus has shown an average
depth of 0.69 mm.19 It has been the orized that infringement on the biologic width by the
placement of a restoration within its zone may result in gingival inflammation,
The biologic width has been estimated to be about 2 mm. Efforts should be made to
preserve its integrity.
pocket formation, and alveolar bone loss. Consequently, it is recommended that there be
at least 3.0 mm between the gingival margin and bone crest.12,38,39,41 This allows for
adequate biologic width when the restoration is placed 0.5 mm within the gingival
sulcus.
Surgical crown lengthening may include the removal of soft tissue or both soft tissue and
alveolar bone. Reduction of soft tissue alone is indicated if there is adequate attached
gingiva and more than 3 mm of tissue coronal to the bone crest. This may be
accomplished by either gingivectomy or flap technique. Inadequate attached gingiva and
less than 3 mm of soft tissue require a flap procedure and bone recontouring. In the
case of caries or tooth fracture, to ensure margin placement on sound tooth structure and
retention form, the surgery should provide at least 4 mm from the apical extent of the caries
or fracture to the bone crest.
Company, 072006. 71.4.3).
39. Material least to do impression with-irreverisble hydrocolloid, polyether
14
40. H2 histamine-gastric reflux

H2 histamine receptor blockers inhibit the action of histamine on the parietal cell of the
stomach. H2 treat Zollinger-Ellision Syndrome, GERD, acid reflux. Examples are
Cimetidine(Tagament), Ranitidine(Zantac), and Famotidine(Pepcid) and
Nizatidine(Axid), Omeprazole (Prilosec) and Lansoprazole(Prevacid)
(Mosby. Mosby's Review for the NBDE, Part II. Mosby, 042007. 8.6.4).
41. Hue, value, chroma which is in 100ths? HUE
42. Papilloma
(Langlais, Robert P.. Color Atlas of Common Oral Diseases, 3rd Edition. Lippincott Williams &
Wilkins, 012003. 10.3.5).
The squamous papilloma is a soft, painless, usually pedunculated, exophytic nodule

with numerous fingerlike surface projections that impart a “cauliflower” or wartlike
appearance
062008. 10.1.1).
43. Apexification-when do u use-nonvital want to close apex
Apexification is a method of treatment for immature permanent teeth in which root growth
and development ceased due to pulp necrosis. Its purpose is to allow the formation of an
apical barrier. Apexification is most often performed in incisors that lost vitality after a
traumatic injury. It may also be indicated in nonvital immature teeth after carious
exposures, and in certain anatomic variations such as dens invaginatus.
When a diagnosis of irreversible pulpitis, pulp necrosis, or acute or chronic apical

periodontitis has been established, treatment should be planned. The most important
consideration is whether the tooth can be restored to function and aesthetics. The
apexification procedure can be done in young patients with short roots. However, because
of the long duration of the treatment, patients’ and parents’ compliance is required.
Apexification is a predictable procedure, and an apical barrier will be formed in 74% to
15
100% of cases.75 The most common complication is cervical crown or root fracture because
the cervical portion of the tooth is very thin and may fracture easily.22
Apexification is traditionally performed using a calcium hydroxide dressing that disinfects

the root canal and induces apical closure. The high pH and low solubility of calcium
hydroxide keeps its antimicrobial effect for a long period.28 Siqueira and Lopes discussed
the mechanisms of its antimicrobial activity in detail.76 Calcium hydroxide assists in the
debridement of the root canal, as it increases the dissolution of necrotic tissue when used
alone or in combination with sodium hypochlorite.37 Apexification requires multiple visits
and could take a year or more52 to achieve a complete apical barrier that would allow root
canal filling using gutta-percha and sealer. The time needed for apexification depends on
the stage of root development and the status of the periapical tissue.
Root-end resection (periradicular surgery or apicoectomy)
(Pinkham, Jimmy R.. Pediatric Dentistry: Infancy Through Adolescence, 4th Edition. Mosby,
042005. 33.4.1).
44. Apicoectomy-when do you do it-ant get to apex
1. Indications
a. Persistent or enlarging periradicular pathosis following nonsurgical endodontic

treatment.
b. Nonsurgical endodontics is unfeasible when:
(1) A marked overextension of obturating materials is interfering with

healing.
(2) Biopsy is necessary.
(3) Access for root-end preparation and root-end filling is necessary.
(4) When the apical portion of the root canal system with periradicular
pathosis cannot be cleaned, shaped, and obturated.
45. Calcified canal what do you do-refer

46. When is it ok to do a temporary fixing on patient? Emergency
47. Incidence 100/1000
Incidence: indicates the number of new cases that will occur within a population
over a period of time (e.g., the incidence of people dying of oral cancer is 10% per year
in men aged 55 to 59 in our community).
16
Incidence = Number of new cases of the disease / Total number of people at risk
48. Principle of tell show do:
the great majority of children require minimal management efforts other than providing
information on what is going to happen (e.g., tell, show, and do). An important caveat is that
every child responds to his or her environment with an individualized style.
042005. 6.7).
49. How do you get a child acting out to act favorably? Let them watch another child
behaving
Many practitioners have long used modeling strategies by letting the younger child watch
“big sister” through the appointment if they perceive a positive relationship between a
confident sibling and the fearful child. A simple variation of the same strategy involves
scheduling an unrelated fearful child to watch another child patient during his appointment.
(Weinstein, Philip. Treating Fearful Dental Patients: A Patient Management Handbook, 2nd
Edition. University of Washington, Continuing Dental E, 091995. 10.3.2).
50. Fibroma
Wilkins, 012003. 10.2.7).
51. Cancer translocation p53 gene
52. Greatest degree of linear coefficient of expansion? Resin (Composite resin is 2.5x
greater than tooth structure when subjected to extreme changes in temp than other
materials. Direct Gold is similar to tooth but higher and Amalgam is 2x that of tooth)
17
53. Calcification sequence? 7mos-3yrs (Primary-14 wks (CI), 15 wks (1stM), 16 wks(LI),
17 wks (C), 18 wks (2nd Molar) all these weeks are in utero. And the sequence is A-B -D-
C-E- Permanent- Birth(1stM), 6 months(anterior teeth except max LI), 12 months (Max
LI), 18 months (1st PM), 24 months (2nd PM), 30 months (2nd M)- Mosby pg 176
54. Class 3- cleft palate and cleft lip
55. Sickle cell-trauma, infection-thrombocytopenia (also and
Patients with sickle cell anemia produce hemoglobin S instead of the normal hemoglobin A.
Hemoglobin S has a decreased oxygen-carrying capacity. Decreased oxygen tension causes
the sickling of cells. These patients are susceptible to recurrent acute infections, which
result in an “aplastic crisis” caused by decreased red blood cell production and in
subsequent joint and abdominal pain with fever. Over time there is a progressive
deterioration of cardiac, pulmonary, and renal function.
(McDonald, Ralph. Dentistry for the Child and Adolescent, 8th Edition. Mosby, 022004. 24.3).
56. Thyrotoxic crisis
thyrotoxic patients are usually treated with agents that block thyroid hormone synthesis and
release, with a thyroidectomy, or both. However, patients left untreated or incompletely treated
can develop a thyrotoxic crisis, caused by the sudden release of large quantities of preformed
thyroid hormones. Early symptoms of a thyrotoxic crisis include restlessness, nausea, and
abdominal cramps. Later symptoms are a high fever, diaphoresis, tachycardia, and, eventually,
cardiac decompensation. The patient becomes stuporous and hypotensive, with death resulting if
no intervention occurs due to Cardiac Heart Failure and pulmonary edema.
(Peterson, Larry J.. Contemporary Oral and Maxillofacial Surgery, 4th Edition. Mosby Elsevier
Health Science, 122002. 6.3.5.3).
7. Sequence for nausea , vomiting
58. Periostat and doxycycline. What does it do:
Subantimicrobial tetracycline (Periostat) is useful in treating moderate to severe chronic

periodontitis. The active ingredient in Periostat is doxycycline hyclate. In concert with
scaling and root planing, Mohammad et al.38 have shown this treatment to be effective in
institutionalized older adults. Periostat is contraindicated for those patients with an
allergy to tetracycline.
Company, 072006. 45.6.1.1).
59. Bevel for occlusal on a crown? structural integrity

Beveling provides structural integrity (you’ll have more metal in that area). That is the
need for the bevel to be placed on the functional cusp.
60. Closed panel go to specialist which would allow you to go to another dentist but
reimburse you-HMO,PPO, etc
18
In the closed model, also known as the Exclusive Provider Organization, the beneficiaries
have a limited choice of offices where they can go to obtain dental care. If they go to
offices not included in the panel, they receive no benefits. This model is often used in a
D-HMO or PPO plan.
61. Increase mucus from obstruction
Cystic fibrosis
a. Transmission: caused by a genetic mutation (nucleotide deletion) on chromosome

7, resulting in abnormal chloride channels.
b. The most common hereditary disease in Caucasians.
c. Genetic transmission: autosomal recessive.
d. Affects all exocrine glands. Organs affected include lungs, pancreas, salivary
glands, and intestines. Thick secretions or mucous plugs are seen to obstruct the
pulmonary airways and intestinal tracts.
e. Is ultimately fatal.
f. Diagnostic test: sweat test—sweat contains increased amounts of chloride.
(Mosby. Mosby's Review for the NBDE, Part I. C.V. Mosby, 072006. 3.4.2).
62. Patient has increase in salivation how does it affect denture? No affect, problem
seating, soft tissue reline, differing salivation
saliva lubricates the oral tissues and increases denture comfort.
(Zarb, George. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and
Implant-Supported Prostheses, 12th Edition. Mosby, 092003. 6.8).
19
63. Emergency phase, perio, reeval, fixed, maintenance
Company, 072006. 41.1.3).
64. How many canals in primary 2nd molar
Mandibular first molars: 3
Mandibular second molars: 4
Maxillary first molars: 3
Maxillary second molars: 3
65. Denture for 19years- relieve pain denture and have white spot what do you do
Relieve the denture in the area of the lesion and reevaluate in 1 week.
66. Patient has successful treatment for gum disease but still keeps poor oral hygiene.
What kind of study? Incomplete
67. Null hypothesis
the null hypothesis, which is the hypothesis that there is no real (true) difference between
means or proportions of the groups being compared or that there is no real association
between two continuous variables.
(Jekel, James F.. Epidemiology, Biostatistics and Preventive Medicine, 2nd Edition. W.B.
Saunders Company, 092001. 10.2.2).
68. Amoxicillin and clonavonic acid is combined to keep from degrading beta lactam ring and
forms AUGMENTIN
Amoxicillin is a bactericidal, semisynthetic penicillin that is effective against both

gram-positive and gram-negative microorganisms. It is susceptible to penicillinase (β-
20
lactamase). Amoxicillin combined with clavulanate potassium (Augmentin) is

resistant to a number of penicillinases.
69. How long do you take patient off of Coumadin before surgery? 2-3 days
The INR is used to gauge the anticoagulant action of warfarin. Most physicians will
allow the INR to drop to about 2.0 during the perioperative period, which usually allows
sufficient coagulation for safe surgery. Patients should stop taking warfarin 2 or 3
days before the planned surgery. On the morning of surgery, the INR value should be
checked; if it is between 2 and 3 INR, routine oral surgery can be performed. If the PT is
still greater than 3 INR, surgery should be delayed until the PT approaches 3 INR.
Surgical wounds should be dressed with thrombogenic substances, and the patient should
be given instruction in promoting clot retention. Warfarin therapy can be resumed the day
of surgery
1.3.6.2).
Warfarin and Coumadin are oral anticoagulants that inhibit the biosynthesis of the vitamin
K–dependent coagulation proteins (factors VII, IX, and X and prothrombin). These drugs
are bound to albumin, metabolized by hydroxylation by the liver, and excreted in the urine.
The PT is used to monitor warfarin therapy because it measures three of the vitamin K–
dependent coagulation proteins: factors VII and X, and prothrombin. The PT is particularly
sensitive to factor VII deficiency. Therapeutic anticoagulation with warfarin takes 4 to 5
days.1
Level of anticoagulation and need for altering dosage to avoid excessive bleeding
PTR (1.5 to 2.0) or INR (2.0 to 3.0): Dosage does not need to be altered
PTR (2.0 to 2.5) or INR (2.5 to 3.5): Dosage may be altered
PTR (2.5 or >) or INR (3.5 or >): Delay invasive procedure until dosage decreased
Decision is made to alter dosage of anticoagulation medication
Physician will reduce patient's dosage
Affect of reduced dosage takes 3 to 5 days
Dental appointment needs to be scheduled within 2 days once desired reduction in

PTR or INR has been confirmed
For patients taking more than 325 mg of aspirin per day, aspirin may need to be
discontinued 7 to 10 days before surgical therapy
21
Company, 072006. 44.10.1).
Mosby, 042002. 21.6.5.5.1).
70. Benzodiazepine affects gaba (Note: Benzo are minor tranquilizers that are used to
relieve anxiety and induce sleep, skeletal mm. relaxant. It depresses the limbic system
and inhibits the neurons GABA0(gamma amnio butyric acid) on the chloride channels. )
71. Albuterol –asthma ( is an expiratory wheezing- is treated by inhaler albuterol
which is a b2 adrenergic agonist other examples are metaproterenolo and salmeterol.
It is also tx by theophylline or the leukotriene called montelukast. In an office if inhaler
is not available one gcan use epinephrine to treat anaphylactic shock.) mosby pg 300-
301
72. If patient wants to last for 8 hours which is long acting drug? Aspirin, ibuprofen,
acetominaphine, n-something
Diflunisal is 3 to 4 fold more potent than aspirin as an analgesic and an anti-

inflammatory agent, but has no anti-pyretic properties.(p.504 lippincott
pharmacology)
Diflunisal ( DOLOBID ) is a difluorophenyl derivative of salicylic acid; it is not converted

to salicylic acid in vivo. Diflunisal is more potent than aspirin in antiinflammatory tests in
animals and appears to be a competitive inhibitor of cyclooxygenase. However, it is
largely devoid of antipyretic effects, perhaps because of poor penetration into the CNS.
The drug has been used primarily as an analgesic in the treatment of osteoarthritis and
musculoskeletal strains or sprains; in these circumstances it is about three to four times
more potent than aspirin. The usual initial dose is 500 to 1000 mg, followed by 250 to
500 mg every 8 to 12 hours. For rheumatoid arthritis or osteoarthritis, 250 to 500 mg is
administered twice daily; maintenance dosage should not exceed 1.5 g per day.
Diflunisal does not produce auditory side effects and appears to cause fewer and less
intense gastrointestinal and antiplatelet effects than does aspirin.
(Hardman, Joel G.. Goodman & Gilman's the Pharmacological Basis of Therapeutics, 10th
Edition. McGraw-Hill Professional Publishing, 082001. 29.2.4.4).
73. Glass ionomer placed on rampant caries
74. Epulis fissuratum-inflamed tissue in ridge area to put denture back in it is due to ill
fitting denture in the buccal flange area. It is flappy(hyperplastic) tissue on the ridge
area. Tx. Will be to adjust the denture border and use tissue conditioner. Mosby pg
322
75. Why do you take denture out at night
Patients should be told that dentures must be left out of the mouth at night to
provide needed rest from the stresses they create on the residual ridges. Failure to
allow the tissues of the basal seat to rest may be a contributing factor in the
22
development of serious oral lesions, such as inflammatory papillary hyperplasia, or

may increase the opportunity for microbial infections, such as candidiasis. When
dentures are left out of the mouth, they should be placed in a container filled with water
to prevent drying and possible dimensional changes of the denture base material.
Implant-Supported Prostheses, 12th Edition. Mosby, 092003. 4.2.1.7).
76. Ectodermal dysplasia
Hereditary ectodermal dysplasia
1. An X-linked recessive condition that results in partial or complete anodontia.
2. Patients also have hypoplasia of other ectodermal structures, including hair, sweat
glands, and nails.
77. Ameloblastoma-dentigerous cysts

Ameloblastoma most likely develop in the wall of a dentigerous cyst( Mosby pg 118-
119. IT is a benign but aggressive odontogenic tumor with high recurrence.Cystic
variant is less aggressive and less likely to occur. The solid type occurs in adults 40
years old. Common location-mandibular molar ramus. It is unilocular or multiocular
radioluceny. 3 variants of solid type1. Follicular 2. Plexiform 3.desmoplastic- favor
anterior maxilla TX. Enucleation with curettage
78. Process of PCN-not wide range

79. Periostat n doxycycline inhibits what? collagenase

allergy to tetracycline. The semisynthetic compounds (e.g., doxycycline) were more
effective than tetracycline in reducing excessive collagenase activity in the gingival
crevicular fluid (GCF) of chronic periodontitis patients.
80. How do you clean furcation after perio surgery? Floss, toothbrush, water
Subgingival irrigation performed with an oral irrigator using chlorhexidine diluted to

one-third strength, performed regularly at home and after scaling, root planing, and in-
office irrigation therapy, has produced significant gingival improvement compared with
controls. Subgingival irrigation with specialized tips for deep pockets and furcation
areas is effective when used daily as part of the home care routine. Use chorahexadine.
The best view of bone defect is with a flap reflection.
23
Company, 072006. 50.8.2).
81. What type of reinforcement is smiling and praising a child
Positive reinforcement (i.e. 'behaviour shaping') at every stage of the treatment process is
recommended, to indicate to the child that he is making successful steps in the process of
receiving treatment. The frequent use of praise during a child's appointment — when the
child performs an appropriate behaviour — is essential.
(Humphris, Gerry. Behavioural Sciences for Dentistry. Churchill Livingstone, 022000. 9.10).
82. ANUG comes with spirochetes
Acute necrotizing ulcerative gingivitis (ANUG)
1. Characteristics
a. Painful, bleeding gingival tissues.
b. Blunting of interproximal papillae.
c. Pseudomembrane on the marginal gingiva. Sloughing off
d. Fetid breath.
e. High fever.
2. Caused by fusiform bacilli (spirochetes), Prevotella intermedia and other

anaerobes.
3. Most common in teenagers and young adults.
4. Responds well to debridement, oxidizing mouth rinses, and antibiotics.
ANUG(gingiva only, low grade fever ) must be distinguish form acute herpes infection
( ulcer on mucosa and gingival , high fever )
also Prevotella intermedia are seen in high levels in necrotizing disease pg. 243 Mosby
83. Pic of white spongy nevus

White sponge nevus: of buccal mucosa.
The lesions of white sponge nevus usually appear at birth or in early childhood, but
sometimes the condition develops during adolescence. Symmetrical, thickened, white,
corrugated or velvety, diffuse plaques affect the buccal mucosa bilaterally in most
instances. Other common intraoral sites of involvement include the ventral tongue, labial
mucosa, soft palate, alveolar mucosa, and floor of the mouth, although the extent of
involvement can vary from patient to patient. Extraoral mucosal sites, such as the nasal,
24
esophageal, laryngeal, and anogenital mucosa, appear to be less commonly affected.

Patients are usually asymptomatic.
TREATMENT AND PROGNOSIS

Because this is a benign condition, no treatment is necessary. The prognosis is good.
062008. 16.2.1).
84. Periodontitis and doxycycline (inhibit collgenase in clavicular fluid)
Effective against broad spectrum of microorganisms; used systemically and applied locally
(subgingivally). Doxycycline has the same spectrum of activity as minocycline and may be
equally as effective.18 Because doxycycline can be given only once daily (qd), however,
patients may be more compliant. Compliance is also favored because its absorption from
the gastrointestinal (GI) tract is only slightly altered by calcium, metal ions, or antacids, as
is absorption of other tetracyclines. The mechanism of action is by suppression of the
activity of collagenase, particularly that produced by polymorphonuclear leukocytes
(PMNs).
Company, 072006. 52.2.1).
85. Patient has hip replacement a year ago what kind of treatment can you render?
Antib iotic Prohphylaxis
“Given the potential adverse outcomes and costs of treating an infected joint
replacement , the AAOS recommends that clinicians consider antibiotic prophylaxis for
all total joint replacement patients prior to any invasive procedure that may cause
bacteremia” (dental drug booklet p.79) Kaplan pg 292. Premedication fo knee and hip
25
replacement is sometimes advised. They are more likely to be premedicated if recent

years (0-2 years) and the AHA antibiotic regimens are often used. However if in doubt,
send for medical consult.
86. What can you not give a patient with a heart condition
Drug considerations:
• For patients taking digitalis (CHF), avoid epinephrine ; if considered essential,

use cautiously (maximum 0.036 mg epinephrine or 0.20 mg levonordefrin); avoid
gag reflex; avoid erythromycin and clarithromycin, which may increase the
absorption of digitalis and lead to toxicity.
• For patients with NYHA class III and IV congestive heart failure, avoid use of
vasoconstrictors; if use is considered essential, discuss with physician.
• Avoid epinephrine-impregnated retraction cord. (use retraction chord with

aluminum potassium sulfate instead)
• Schedule short, stress-free appointments.
• Use semisupine or upright chair position.
• Watch for orthostatic hypotension, make position or chair changes slowly, and
assist patient into and out of chair.
• Avoid the use of nonsteroidal antiinflammatory drugs (NSAIDs).
• Watch for signs of digitalis toxicity (i.e., tachycardia, hypersalivation, visual

disturbances, etc.).
• Nitrous oxide/oxygen sedation may be used with a minimum of 30% oxygen.
Mosby, 072007. 6.4.1.1).
87. Contraindication for implant-myocardial infarct, smoking, bone loss
Or Adolesant
The implant team should advise potential implant patients of the detrimental effects that
smoking has on their oral and systemic health. Complications must be discussed and
highlighted in the informed consent. Patients should be encouraged to start a smoking
cessation program before implant treatment. Smoking is not an absolute
contraindication; however, the risks and possible morbidity on the respective
procedures must be evaluated. Note: Relative contraindications are ppl who have
uncontrolled diabetes and smokers. ABSOLUTE CONTRAINDICATIONS: mental or
physcho disorders, under age 16, ppl who are too critical, one cant please.
26
(Misch, Carl E.. Contemporary Implant Dentistry, 3rd Edition. Mosby, 122007. 20.7.1.4).
88. How long do you splint with avulsion. 7-10 days, bony fracture 2-8 weeks
(not sure where they got 2-8 weeks… bony fracture should be 3-4 weeks in children
!!!)
Splinting of avulsed teeth

• Composite resin and nylon fibre (0.6 mm diameter) such as fishing line (20 kg
breaking strain) or
• orthodontic brackets with arch wire (0.014" (0.4 mm)).
• Orthodontic appliances are particularly useful as the time taken to apply the
brackets is half that to set composite resin.
• Splints should be flexible to allow normal physiological movement of the tooth.

This helps to reduce the development of ankylosis; however, if there is a bone or root
fracture present, then a rigid splint must be used so that there is no movement of the teeth
and bony segments.
• Splints should generally stay in place for 7–10 days if there are no
complicating factors such as alveolar or root fractures. The occlusion may need to be
relieved when the degree of overbite or luxation is such that the tooth receives unwanted
masticatory force. This can be achieved by minimal removal of enamel, or construction
of an upper removable appliance, or placement of composite resin on the molars to open
the bite. Some physiological movement is necessary.
Close reduction with plastic tooth ( with fingers).
Dento-alveolar fractures
With luxation of teeth, the alveolar plate can be fractured or deformed. Use firm finger
pressure on the buccal and lingual plates to reposition. It should be remembered that
alveolar fractures can occur without significant dental involvement. These alveolar
fractures should be splinted for 3–4 weeks in children (6–8 weeks in adults). Luxated
or avulsed teeth usually result in alveolar bone fracture and/or displacement. Firm pressure
is needed to realign bony fragments. Splinting will be required for 3–4 weeks. Dental
Secrets pg 242. Splinting times for root and alveolar fractures used to be 2-4 months but
recent studies have shown splinting for 3 weeks is sufficient.
5.16.4).
89. Why is core better than another-lets out fibers
27
90. Ppm in water-1

1 ppm = 1 gm/L
91. How much do you take off facial for veneer? .5-1mm Note Cervical is 0.3 mm,
Facial is 0.5 mm and incisal is .7mm-1mm
Average facial reduction for enamel-bonded veneer. (Illustrations for chapter 16 by

John Bonfardeci, Studio Giovanni.)
(Summitt, James B.. Fundamentals of Operative Dentistry: A Contemporary Approach, 3rd

Edition. Quintessence Publishing (IL), 012006. 16.3.1.1).
92. Capping-2mm for caoh2 (Liners are 0.5 mm and bases are 2-4 mm)
93. Pics of chronic osteitis, myleits, bells palsy, gingival hyperplasia
94. Child with asthma-inspire vs expire
Childhood asthma is an extremely common condition throughout the world. Children

with acute asthma present with varying severity and often have increased work of
breathing. Expiratory wheezing and a prolonged expiratory phase, caused by reversible
broncho-spasm, can be heard without the stethoscope and are apparent on auscultation.
Stridor is inpirtory asthma
(Bickley, Lynn S.. Bates' Guide to Physical Examination and History Taking, 9th Edition.
Lippincott Williams & Wilkins, 122005. 18.6.10).
95. Contraindication for diazepam-diabetic, pregnancy, etc

(Tetracycline, Benzodiazepine, and Barbiturates AVOID AVOID AVOID during
pregnancy)
Can give tyenol , codeine, proxyfine (darvon),
96. Child with gum disease-chronic, acute herpetic gingivitis Mosby pg 193. Primary is
seen in children less than 6 years old. Viral , bleed tendor gingfiva, oral mucosa , less
that 5yr,
97. Ging recession 5-6mm on #4 & 20, Hemoglobin of 12. Wht do you do? Treat, refer
to dr, scaling n root planning
Hemoglobin (male)
13.5-17.5 g/dL
28
Hemoglobin (female)
12.3-15.3 g/dL
Mosby, 072007. 1.4).
98. What muscle covers denture? Buccinators, masseter, lat & med pterygoid
Functional unit of the buccinator. This muscle (1) and the orbicularis oris muscle (2) depend on
the position of the upper denture for their proper action. (3) is the pterygomandibular raphe, and
(4) is the superior constrictor of the pharynx.
29
Diagram shows the relationship of the medial pterygoid muscle to the superior
constrictor muscle. B, Buccinator muscle; M, masseter muscle; MP, medial pterygoid
muscle; PR, pterygomandibular raphe; RM, ramus of the mandible; RMC, posterolateral
portion of the retromylohyoid curtain formed by the mucous membrane covering the
superior constrictor muscle (SC).
99. What provides lingual retention? Mylohyoid
Relationships of the mylohyoid muscle in various regions. The letters with prime
signs denote cross sections of the designated areas. A, Canine region. B, Premolar
region. C, First molar. D, Third molar. At point D, notice that the mylohyoid ridge
approaches the level of the alveolar crest. The angle of the posterior lingual flange in
30
the molar region is affected by this muscle; anteriorly, only the length of the flange is
affected.
The posterior part of the mylohyoid muscle in the molar region affects the lingual
impression border in swallowing and in moving the tongue. During swallowing, the
mylohyoid muscles contract, raising the floor of the mouth. During impression taking, it
is very easy to carry the impression material into the undercut below the mylohyoid ridge
because the mylohyoid muscle is a thin sheet of fibers that, in a relaxed state, will not
resist the impression material. Extension of the lingual flange under the mylohyoid ridge
cannot be tolerated in function because it will interfere with the action of the mylohyoid
muscle when it contracts, and this will displace the denture, causing soreness. For the
denture to be successful, the flange must be made parallel to the mylohyoid muscle
when it is contracted.
Fortunately, in this posterior region, the lingual flange can go beyond the mylohyoid
muscle's attachment to the mandible because the mucolingual fold is not in this area.
Thus the impression may depart from the stress-bearing area of the lingual surface of the
ridge, moving away from the body of the mandible to be suspended under the tongue in
soft tissue on both sides of the mouth, thereby reaching the mucolingual fold of soft
tissue for a border seal. The distance that these lingual borders can be away from the
bony areas will depend on the functional movements of the floor of the mouth and by the
amount that the residual ridge has resorbed.
An extension of the lingual flange well beyond the palpable position of the mylohyoid
ridge, but not into the undercut, has other advantages. The lack of direct pressure on the
sharp edge of the ridge will eliminate a possible source of discomfort. If the impression is
made with pressure on or slightly over this ridge, displacement of the denture and
soreness are sure to result from lateral and vertical stresses. On the other hand, if the
border stops above the mylohyoid ridge, vertical forces will cause soreness, and the
border seal will be easily broken. If the flange is properly shaped and extended, it will
provide border seal and guide the tongue to rest on top of the flange.
100. Neurofibromatosis- axiallary freckling, café- au-late, lesch nodules
Neurofibromatosis Type I (von

Recklinghausen Disease)
31
Neurofibromatosis, type I. Multiple cutaneous neurofibromas are noted on the face and
trunk.
(Rubin, Emanuel Rubin. Rubin's Pathology: Clinicopathologic Foundations of Medicine, 4th

Edition. Lippincott Williams & Wilkins, 042004.). Mosby pg 113
Neurofibromatosis type I (NF1) is characterized by (1) disfiguring neurofibromas, (2)

areas of dark pigmentation of the skin (café au lait spots), and (3) pigmented lesions
of the iris (Lisch nodules). It is one of the more common autosomal dominant
disorders, affecting 1 in 3500 persons of all races.
• Café au lait spots: Although normal persons may exhibit occasional light brown
patches on the skin, more than 95% of persons affected by NF1 display six or more
such lesions. These are over 5 mm before puberty and greater than 1.5 cm thereafter.
Café au lait spots tend to be ovoid, with the longer axis oriented in the direction of a
cutaneous nerve. Numerous freckles, particularly in the axilla, are also common.
• Lisch nodules: More than 90% of persons with NF1 display pigmented nodules
of the iris, which consist of masses of melanocytes. These raised lesions are believed
to be hamartomas.
• Skeletal lesions: A number of bone lesions occur frequently in NF1. These

include malformations of the sphenoid bone and thinning of the cortex of the long
bones, with bowing and pseudarthrosis of the tibia, bone cysts, and scoliosis.
• Mental status: Mild intellectual impairment is frequent in patients with NF1, but
severe retardation is not part of the syndrome.
• Leukemia: The risk of malignant myeloid disorders in children with NF1 is 200
to 500 times the normal risk. In some patients, both alleles of the NF1 gene are
inactivated in the leukemic cells.
(Rubin, Emanuel Rubin. Rubin's Pathology: Clinicopathologic Foundations of Medicine, 4th

Edition. Lippincott Williams & Wilkins, 042004. 6.5.8.4.1).
101. Most impacted tooth? Mx k9 (Note. Mosby pg 177 what is the most
congenitally missing tooth 3rd molars, mand 2pm, Max LI, max 2PM)
102. Least likely to graft? Mn 1st premolar (thinnest tissue around this tooth),
Mx k9 ??????
Thiniest Mand. 1pm –ca, thicket max 2pm and Mand Ci
Facial Max LI, Mandibular central and maxillary 2 premolar: widest keratinized gingival
Facial of Mand. C, Mandibular first premolar, and lingual surfaces adjacent to mand.
Incisors and canines and MB of Max 1st Molar and Mand. 3rd Molar: narrowest
keratinized gingival
32
I would think that the least likely area would be mand central or maxillary 2 pre-
molar if that’s an answer choice !
103. Purpose of hex implant :
in an internal hex implant, the antirotational feature of the abutment is designed within
the implant body. As a result, the implant body is lower in profile and easier to cover with
soft tissue during surgery. In addition, the antirotational feature is often deeper within the
body compared with external hex implants.
(Misch, Carl E.. Contemporary Implant Dentistry, 3rd Edition. Mosby, 122007. 11.4.6).
104. Push on rest seat it comes up? Base doesn’t come up bc of resin
Need indirect retention, could
105. 2nd to s. mutan-L. bacillus
106. RCT done on a big RL a year ago, assymptomatic and bigger 2 years later?
Necrotic or actinomyces ???
107. Pt gets a injection few days later have lateral bilateral swelling tongue-
ludwigs angina Sublingual, submental, submand
108. Base metal vs noble metal-single crown-3 unit bridge Base metal Bridge ,
Crown high nobal metal.
Boney wall defect which is better for graft . = # 3 walled defect

109. Papillon le fever ( Pt. has palmar/plantar keratosis, floating teeth on xray,
severe periodontitis and erythematous gingival
In most cases, the dermatologic manifestations become clinically evident in the first 3 years of
life. Diffuse transgredient (first occurs on the palms and soles and then spreads to the dorsa of
the hands and feet) palmarplantar keratosis develops, with occasional reports of diffuse
follicular hyperkeratosis and keratosis on the elbows and knees. The oral manifestations consist
of dramatically advanced periodontitis that is seen in both the deciduous and permanent
dentitions and develops soon after the eruption of the teeth. Extensive hyperplastic and
hemorrhagic gingivitis is seen. A rapid loss of attachment occurs, with the teeth soon lacking
osseous support and radiographically appearing to float in the soft tissue). Without aggressive
therapy, the loss of the dentition is inevitable.
(Neville, Brad W.. Oral & Maxillofacial Pathology, 2nd Edition. Saunders Book Company,
012002. 4.10).
110. Oligiodontia-ectodermal dysplasia
Anodontia or oligodontia may occur in patients with ectodermal dysplasia. This

genetically inherited autosomal dominant disorder results in the absence of at least two
ectodermally derived structures such as sweat glands, hair, skin, nails, and teeth.
33
ectodermal dysplasia
19.1.2).
<vbk:978-0-323-04983-2#outline(19.1.2)>uart C.. Oral Radiology: Principles and

Interpretation, 6th Edition. Mosby, 092008. 19.1.1.11).
111. Collimation-tube Circular to rectangular 48%
A collimator is a metallic barrier with an aperture in the middle used to reduce the
size of the x-ray beam and thereby the volume of irradiated tissue. Round and
rectangular collimators are most frequently used in dentistry. Dental x-ray beams are
usually collimated to a circle Use of collimation also improves image quality. When an x-
ray beam is directed at a patient, the hard and soft tissues absorb about 90% of the photons
and about 10% pass through the patient and reach the film.
1.5.5).
112. Erosion of Teeth – bullemia on max lingual s
Patients with bulimia may present with severe erosion of the lingual and occlusal
surfaces of the teeth Severe erosion can cause increased tooth sensitivity to touch and to
cold temperature. Dental caries may be more prevalent in these patients. The amount of
saliva produced may be decreased. Patients often report dry mouth. Those with poor oral
hygiene have increased periodontal disease. The parotid gland may become enlarged, and
patients with anorexia nervosa may have decreased salivary flow, dry mouth, atrophic
mucosa, and an enlarged parotid gland.3
34
Mosby, 072007. 28.3.4.6).
113. Patient gets 25% home bleaching. Wrong its 10% but 2nd part is true
The current home bleaching technique, employing a custom-fit tray containing 10%
carbamide peroxide solution, was first used by Klusmier in the late 1960s.6 In-office
bleaching materials are usually supplied in concentrations of 35% hydrogen
peroxide, although some concentrations may be as high as 50%. The caustic nature of
35% to 50% hydrogen peroxide mandates that the soft tissues be isolated from any
possible contact with the bleaching material. Note in Endo: Intracoronal bleaching is with
sodium perborate (walking bleach).Superoxol used to be used with contained 30%
hydrogen peroxide but the complication was external cervical resorption bc irritation
diffuses through tubules to cementum and PDL. Heat combined with it may cause
necrosis of cementum and PDL. Mosby pg. 27
(Summitt, James B.. Fundamentals of Operative Dentistry: A Contemporary Approach, 2nd

Edition. Quintessence Publishing (IL), 012001. 15).
114. What goes into cavernous sinus from upper lip? Infection
Subcutaneous tissue
Cavernous sinus thrombosis may also occur as the result of superior spread of odontogenic
infection via a hematogenous route. Bacteria may travel from the maxilla posteriorly via
the pterygoid plexus and emissary veins or anteriorly via the angular vein and inferior or
superior ophthalmic veins to the cavernous sinus. The veins of the face and orbit lack
valves, which permits blood to flow in either direction. Thus bacteria can travel via the
venous drainage system and contaminate the cavernous sinus, which results in thrombosis.
Cavernous sinus thrombosis is an unusual occurrence that is rarely the result of an infected
tooth.
Health Science, 122002. 21.1.2).
115. URI-no NO2 Upper Respiratory Infect (Empzema or COPD no Nitrous)
116. In posterior composite why do you have to redo-occlusal-wear
117. Periosteum- atthced vis sharpeys fibers (stick to bone and cementum) ,
cementum, alveolar bone, or all 3
118. Symphisis-intraocciptal, sphenoocciptal, which bone forms last( Notes
others are intersphenoid-first, sphenoethmoid-second, and sphenoocipital-last mosb
pg 146)
Endochondral bone formation occurs at the extremities of all long bones, vertebrae, and
ribs and at the articular extremity of the mandible and base of the skull. Early in embryonic
development a condensation of mesenchymal cells occurs. Cartilage cells differentiate from
these mesenchymal cells, and a perichondrium forms around the periphery, giving rise to a
cartilage model that eventually is replaced by bone. Intramembranous bone formation was
first recognized when early anatomists observed that the fontanelles of fetal and newborn
35
skulls were filled with a connective tissue membrane that was replaced gradually by bone
during development and growth of the skull. In intramembranous bone formation, bone
develops directly within the soft connective tissue. The mesenchymal cells proliferate and
condense. This sequence of events occurs at multiple sites within each bone of the cranial
vault, maxilla, body of the mandible, and midshaft of long bones.
(Nanci, Antonio. Oral Histology: Development, Structure, and Function, 7th Edition. Mosby,
092007. 6.3.3).
119. Vertical root fracture- taking bite registration? Doesn’t interfere with bite
class3 (Note: J-shaped lesion on xray. It can be the sequelae of cementation of post or
excessive condensation. Poor Prognosis. Pain upon biting.)
120. Pt with denture and need to increase VDO what do you do?remount
121. Calcification sequence (Primary teeth it is A(14 weeks), D(15 weeks), B(16
weeks), C (17 weeks) E (18 weeks) all are in utero. Permanent teeth 1st Molars (Birth),
All anterior teeth except max LI (6 months), Max LI (12months), 1st PM (18 months) 2nd
PM (24 months) 2M(30 months) Mosby pg 176
122. Nonworking-bull working-lubl LBCUp Ma
123. Transillumination-vertical fracture will not see crays lines ( Cracked tooth
syndrome is visible upon transillumination and VRF is often confirmed via
visualization) Mosby pg 9, 10,19 Dental Secrets pg. 122. Diagnosis 1.)transillumination
with fiberoptic light. 2.) Peristent periodontal defects in otherwise healthly teeth 3.)
wedging and staining of defect. 4. Radiographs rarely show VRF but do show a RL
defect laterlly from sulcus to apex.
124. Minor connector connects to
The primary function of a minor connector is to join the remaining components of a

removable partial denture to the major connector. Minor connectors also are responsible
for distribution of applied forces to the supporting teeth and oral tissues. Therefore,
rigidity is an essential characteristic of all minor connectors. The broad distribution of forces
prevents any one tooth or any one portion of an edentulous ridge from bearing a destructive
amount of stress. In contrast, bending or deformation of a minor connector may result in
stress concentration and damage to the supporting teeth and soft tissues.
Types of minor connectors

There are four categories of minor connectors. They may be described as follows:
1. Minor connectors that join clasp assemblies to major connectors
2. Minor connectors that join indirect retainers or auxiliary rests to major connectors
3. Minor connectors that join denture bases to major connectors
4. Minor connectors that serve as approach arms for vertical projection or bar-type
clasps
36
(Phoenix, Rodney D.. Stewart's Clinical Removable Partial Prosthodontics, 3rd Edition.
Quintessence Publishing (IL), 012003. 2.2).
125. Last number on instrument Width,Acut angle, Length, A- blade angle
Operative cutting instrument formulas. (e.g., 10-8.5-8-14). The first number

indicates the width of the blade or primary cutting edge in tenths of a millimeter
(0.1 mm). The second number of a four-number code indicates the primary cutting
edge angle, measured from a line parallel to the long axis of the instrument handle in
clockwise centigrades. The angle is expressed as a percent of 360 degrees. The
instrument is positioned so that this number always exceeds 50. If the edge is locally
perpendicular to the blade, then this number is normally omitted, resulting in a three-
number code. The third number (second number of a three-number code) indicates the
blade length in millimeters. The fourth number (third number of a three-number
code) indicates the blade angle, relative to the long axis of the handle in clockwise
centigrade. For these measurements, the instrument is positioned so that this number is
always 50 or less.
126. Seizure-gv diazepam (doesn’t not treat vomiting emetis) Tx. anexity ,
muscle relax spasm , insomnia
If convulsions occur, patients should be protected from hurting themselves. Basic life-
support measures are instituted as needed and venous access gained, if possible, for
administration of anticonvulsants. Medical assistance should be obtained. If venous
access is available, diazepam should be slowly titrated until the seizure activity stops
(5 to 25 mg is the usual effective range). Vital signs should be checked frequently.In
emergency cases for status epileptics lorazapam or diazepam can be given but preferably
diazepam since lorazapam has to be refridgerated.
Health Science, 122002. 7.3.4.5).
127. To far superior and anterior dentures-what sounds
The labiodental sounds f and v are made between the upper incisors and the labiolingual
center to the posterior third of the lower lip. If the upper anterior teeth are too short (set
too high up), the v sound will be more like an f. If they are too long (set too far down),
the f will sound more like v . Mosby pg 323. Linguoalveolar sounds are s, z, sh, ch.
They help determine the vertical overlap and length. Linguodental is this that those,
b,m, p sounds are strictly lip. If whistling sound occurs, it is indicative that the
posterior dental arch form is too narrow.
Implant-Supported Prostheses, 12th Edition. Mosby, 092003. 19).
37
128. If you did a DO what axioline angle is not there Mesial facial Line angle
(included distal facial,
129. If you fall and break incisor which class is it due to? Class 2 div 1
130. Indirect vs direct onlay while child is waiting
131. Only reason to remove cusp-decay
132. Large structure in mouth appears on xray-radiolucent
133. Support area for max and mand denture
Maxilla: residual ridge primary, rugea secondary
Mandible: buccal shelf primary secondary alveolar ridge
134. Cleidocranial dysplasia-supernumary teeth, membranous clavicle, flat
bones
135. Nitrates vs nitrites what do they do
Mosby p 298, decreace cardiac rate and force, prephreial vascular resistance , dialate
coronary bld vessile
the nitro vasodilators relax most smooth muscle, including that in arteries and veins.
Low concentrations of nitroglycerin produce dilation of the veins that predominates
over that of arterioles. Venodilation results in decreased left and right ventricular
chamber size and end-diastolic pressures but little change in systemic vascular
resistance. Systemic arterial pressure may fall slightly, and heart rate is unchanged or
slightly increased reflexly. Pulmonary vascular resistance and cardiac output both are
slightly reduced. Nitrites is for urine and Nitrates is for cardio
Edition. McGraw-Hill Professional Publishing, 082001. 34.1.3.1.1).
136. Nausea and vomiting from opoid receptor poisoning? Chemoreceptor
trigger zone – medulla oblongata , br stm
137. Xerostomia can cause what? Prilocaprine Tx and Sjo Cevelatimine
Tissues may be dry, pale, or red and atrophic. The tongue may be devoid of papillae and
may be atrophic, fissured, and inflamed. Multiple carious lesions may be present,
especially at the gingival margin and on exposed root surfaces.
Mosby, 072007. 31.3.8.2).
<vbk:978-0-323-04535-3#outline(31.3.8.2)>
138. PCN(cidal ) and tetracycline (static ) cancels each other out S
139. Obliterate pulps-dental dysplasia and dentinogenesis imperfect pp 123
mosbys
Dentin Dysplasia
Dentin dysplasia represents another group of inherited dentin disorders resulting in
characteristic features involving the circumpulpal dentin and root morphology. The roots
tend to be short and sharply constricted. Primary teeth have obliterated pulps. Both
38
primary and permanent dentitions demonstrate multiple periapical radiolucencies and

absent pulp chambers. Cascading tubule patterns result from blockage of normal dentin
tubules by calcified masses.
Dentinal dysplasia type 1. Note rootless primary teeth.
(Pinkham, Jimmy R.. Pediatric Dentistry: Infancy Through

Adolescence, 4th Edition. Mosby, 042005. 3.4.2.2).
140. Child heart failure-resp dysplasia
Bronchopulmonary dysplasia is a chronic lung disease usually resulting from the

occurrence during infancy of respiratory distress syndrome that requires prolonged
ventilation with a high concentration of inspired oxygen. About 20% of infants with
bronchopulmonary dysplasia die within the first year of life. The major causes of death
are cor pulmonale, respiratory infections, and sudden death.
(McDonald, Ralph. Dentistry for the Child and Adolescent, 8th Edition. Mosby, 022004.
23.14.2).
141. Which does not contribute to oral cancer-HIV, tobacco, alcohol, HBV
142. Hyperocclusion
143. Reason for not doing a inlay r r
144. Indirect vs direct adv of dir dentinal bonding, adv indir strength of
restoration.
145. Sodium hyperchlorite is not chelating agent- dissolve organic matter
146. EDTA is chelating agent- dissolve inorganic matter, remove smear layer.
147. Combination syndrome- decrease VDO, increase interocclusal distance
flabby max ridge, resorption of rid
148. Extraction sequence for molar-3,2,1-1,2,3-1,3,2-2,1,3
Max ext
149. Increasing spatulation does what to setting expansion: increase

Summary of Effect of Manipulative Variables on Properties of Gypsum
Products
39
(Powers, John M. Powers. Craig's Restorative Dental Materials, 12th Edition. C.V. Mosby,
022006.).
150. Increase water to powder ratio does what: increase setting time,
decrease setting expansion, decrease compressive strength
151. Die plaster Beta vs die stone Alpha (Note die plaster can either be Type 1
Gypsum product for Impression Plaster which is not used or Type 2 which is plaster
used for ortho molds. Type III gypsum is yellow stone used for diagnostic casts and
Type IV gypsum is die stone used to give more accuracy for RPD and crowns and
implants. It is harder.)
152. Why do teeth shift after braces removed? Supercrestal fibers
153. Tx mentally challenged patient with consistency or flattery
154. PIC-white spng nevus (bilateral , cleido cranial dysp, ging hyperplasia, COT
155. Hypertolerism
Hypertelorism. Space out eyes
Minor anomalies that affect the eyes and ocular region include widely spaced eyes
(hypertelorism) –seen in Apert’s syndrome
Cleidocranial dysplasia in a patient able to approximate his

shoulders because of hypoplastic clavicles.
40
The head is large and brachycephalic. Patients have pronounced frontal, parietal, and
occipital bossing. The facial bones and paranasal sinuses are hypoplastic, giving the face
a small and short appearance. The nose is broad based, with a depressed nasal bridge.
Ocular hypertelorism is often present. The entire skeleton may be affected, with defects
of the pelvis, long bones, and fingers. Hemivertebrae and posterior wedging of the
thoracic vertebrae may contribute to the development of kyphoscoliosis and pulmonary
complications.
Maxillary hypoplasia gives the mandible a relatively prognathic appearance, although

some patients may show variable mandibular prognathism because of an increased length
of the mandible in conjunction with a short cranial base. The palate is narrow and highly
arched, and there is an increased incidence of submucosal clefts and complete or partial
clefts of the palate involving the hard and soft tissues. Nonunion of the symphysis of the
mandible is seen.
Cleidocranial dysplasia
showing unerupted and supernumerary teeth.
41
042005. 16.4.1).
156. Why is 3 degree burn vs 1 degree burn less painful

First-degree (superficial) burns
First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful,
dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and
usually consists of an increase or decrease in the skin color.
Second-degree (partial thickness) burns

Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site
appears red, blistered, and may be swollen and painful.
Third-degree (full thickness) burns

Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage
the underlying bones, muscles, and tendons. The burn site appears white or charred. There is
no sensation in the area since the nerve endings are destroyed.
157. Arcon vs non arcon articulator (pg. 319 mosby)

(MMC) Arcon- where the condyles are attached to the lower member of the articulator
and the fossae are attached to the upper member. More accurate for fabricating fixed
restorations, especially when an interocclusal record is used to mount mandibular cast.
Nonarcon has upper and lower members rigidly attached. Provide easier control in
setting teeth for complete and partial dentures. Both are semiadjustable and use a
facebow.
1. Guy has problem with a tooth and has a hole drilled thru the O of MOD composite and the
pain is relieved. What caused it? polymerization shrinkage
42
2. Primary mandibular 2nd molar has how many canals? : 4

3. Patient removes denture and it’s red, also taking ampicillin what’s the reason? Candidiasis,
4. Radiolucency below 1 molar of a 18 yr old? Salivary gland occlusion, OKC
5. Which division is likely to break incisors? Class 2 div 1
6. Neuropraxia question-nothing severed, perioneum intact, can get it from stretching.
7. What happens if you over titrate amalgam? Increase creep
8. Sialolith commonly found? Submandibular gland-wharton’s duct
Most pathologies found in parotid gld
It is believed that the higher rate of sialolith formation in the submandibular gland is due
to (1) the torturous course of Wharton's duct, (2) higher calcium and phosphate levels,
and (3) the dependent position of the submandibular glands, which leave them prone to
stasis.
(Greenberg, Martin S.. Burket's Oral Medicine: Diagnosis and Treatment, 10th Edition. B.C.
Decker, 012003. 9.3.5).
9. Reason for mucocele on lip? Obstruction, minor salivary gland by mucus plug, trauma
The mucocele constitutes the most common nodular swelling of the lower lip. These
swellings are asymptomatic, soft, fluctuant, bluish-gray, and usually less than 1 cm in
diameter. Enlargement coincident with meals may be an occasional finding. The most
common location is the lower lip midway between the midline and commissure, but other
locations include the buccal mucosa, palate, floor of the mouth, and ventral tongue.
Children and young adults are most frequently affected. Trauma is the etiologic agent.
Wilkins, 012003. 8.5.1).
10. What is the best way to view Maxillary sinus? Water’s/ 2ndary PAN
11. What is best way to view TMJ? MRI
12. When you move to right what nonworking cusp lingual interfere with non working
movement
Non working interference- inner aspect of facial cusp of lower teeth. Lingual incline of buccal
cusp
Working interference- inner aspect of lingual cusp of upper teeth buccal in of the maxillary .
13. What do you Tx ANUG with? Antibiotics, chlorhexidine rinse
Treatment of ANUG includes evaluation of the medical history, application of topical

anesthetic followed by gently swabbing the necrotic lesions to remove the
pseudomembrane, and removal of local factors such as calculus (often with ultrasonics
unless contraindicated by the medical history). Systemic antibiotics should be
prescribed only if there is evidence of lymphadenopathy and/or fever. The patient
should be instructed to avoid alcohol and tobacco, rinse with chlorhexidine, get
adequate rest, gently remove bacterial plaque, and to take an analgesic as needed for
pain. They should return in 1 to 2 days for re-evaluation and further debridement.
Approximately 5 days later they should be seen for re-evaluation, further counseling
43
regarding diet, rest, and tobacco use, reinforcement of oral hygiene instruction
(including chlorhexidine rinses), and periodontal evaluation.
Sialendentitis, saugage(mucous extravasion/ retention phenomenum) like cells in

Wharthins Duct/ parotid gland. (Mosby. Mosby's Review for the NBDE, Part II.
Mosby, 042007. 7.7)
14. Common periodontal disease in school age disease? Gingivitis IgG
15. Tetracycline vs penicillin ( Tetracyclines are used in adjunct therapy to treat ppl with Perio
issues. They enter the gingival crevicular fluid. They are broad spectrum and they inhibit the 30
S Ribodome. They cause intrinsic staining in teeth and pregnant women should not take this
drug. Penicillin is a broad spectrum antibiotic. It inhibits cell wall synthesis. Often times ppl
become allegic. )
16. Methotextrate metronidazole (Methotextrate I an antineoplastic drug that targets
dihydrofolate reductase. Metronidazole is an antifungal drug. It is used in tx of people who
have perio. It is usually combined with amoxicillin. Don’t take alcohol while taking this drug. It
is indicated for ppl who have clostridium difficule, fusobacterium and bacteriodes. It is
contraindicated in pregnancy, alcohol or disulfram use. Mosby pg 307-309
17. Metronidazole is a drug of choice for ANUG and cause disulfarim affect(nausea, vomiting,
flushing of the skin, tachycardia, and shortness of breath). Rarely causes stevens- Johnson
syndrome (true or false) Steven Johnson, Erythemia M is due to drug; TEN, EM, self limiting
mucosal oral lesion.
18. Patient got 25% bleaching and has increased sensitivity. True or false (1st part is false
because home bleaching is 10%)
19. Home care patient responsibility is to brush teeth and remove bacteria and remove
subplaque. True then false.
20. Highest % of caries population-hispanic children
21. What do you see first the donors epithelium or recipients epithelium?
22. Glucose in kids what is most important? Quantity, time, composition , consistency
23. What do you see in freeze-dried bone? Osseous conductive material
Cadavor , Value is BMP bone morphogenic protein,
24. What is freeze dried bone? Allograft
25. What is malignant? Pagets b/c it is at risk of developing osteosarcoma but is benign.
Fibrous dysplasia Mosby pg 120. It is more common in maxilla. Affects children. Radiographic
appearance is diffuse opacity(ground glass). 2 syndromes: 1.) McCune-albright- polystotic, café
au lait spots, endocriopathies. 2.) Jaffe-lichenstein- polystotic and café au a lait spots. , paget’s
(Mosby pg. 121- Osteitis deformasns. Pt. complaint “Hat/denture doesn’t fit anymore.” Older
group. A progressive metabolic disturbance of many bones, usually spine femour, cranium,
pelvis and sternium. Symmetrical enlargement, dentures become too tight, and diastemas and
hypercementosis appears. Bone fragility. Paget’s disease has the increase tendency to develop
malignant bone neoplasms (per book pg 105 Oral Path) and Per Dr. Gibson Paget’s has the
tendency to develop into osteosarcoma. central giant cell granuloma (Mosby pg 120) a tumor
that exhibits undpredictable clinical behavior, some are aggressive and have recurrence. RL
44
sometimes loculated and in teenages in the mandibular anterior is favored. Composed of

fibroblast and and MNGC. Tx is excision Calcitonin is a medical management that can be used
for large lesions???
26. Pic of gingival hyperplasia, caused by what? Phenytoin( Dilantin)- anti-convulsant,
Dilatizam- Calcium Channel Blocker, Nifedipine(Procardia)- calcium channel blocker,
Verampil- calcium channel blocker and cyclosporine- used in immune graft host reponse
27. Grand mal(tonic-clonic) seizure drug of choice? Dilantin( phenytoin)
Status epilepticus-diazepam absence seizure (petit Mal)- Ethosuximide or valproic acid ( also
used to treat manic depressive illness and has more adverse effects than ethosuximide. Mosby
pg 285
The medical management of epilepsy usually is based on long-term drug therapy. Phenytoin
(Dilantin), carbamazepine (Tegretol), and valproic acid are considered first-line treatments.
Mosby, 072007. 27.1.4).
28. If you need to increase VDO on mounted cast how do you do it? Remount
29. What is contraindicated when treating a sickle cell Patient? Salicyclates, barbiturates,
vasoconstrictors
Dental Management of the Patient With Sickle Cell Anemia
1. Confirm with patient's physician that the condition is stable.
2. Arrange short appointments.
3. Avoid long and complicated procedures.
4. Maintain good dental repair.
5. Institute aggressive preventive dental care.
a. Oral hygiene instruction
b. Diet control
c. Toothbrushing and flossing
d. Fluoride gel application
6. Avoid oral infection; treat aggressively when present.
7. Use pulse oximeter, maintain O 2 saturation above 95%.

45
8. Use local anesthetic without epinephrine for routine dental care. For surgical
procedures, use 1:100,000 epinephrine in local anesthetic.
9. Avoid barbiturates and strong narcotics; sedation may be attained with

diazepam (Valium).
10. Use prophylactic antibiotics for major surgical procedures.
11. Avoid liberal use of salicylates; control pain with acetaminophen and
codeine.
12. Use nitrous oxide–oxygen with greater than 50% oxygen, high flow rate, and
good ventilation.
30. Fenestration-
Isolated areas in which the root is denuded of bone and the root surface is covered only by
periosteum and overlying gingiva are termed fenestrations. In these areas the marginal
bone is intact. When the denuded areas extend through the marginal bone, the defect is
called a dehiscence
Dehiscence on the canine and fenestration of the first premolar.
Company, 072006. 5.3.7).
31. 6 questions about furcations.
32. What do you do with probe if furcation is wide and narrow, narrow, wide? Probe or cant
probe? Grade 1 probe goes less than 1/3, G2 probe goes more than 1mm(do GTR n graft), G3
probe goes straight thru, G4
Grade I is incipient bone loss, grade II is partial bone loss (cul-de-sac), and grade III is
total bone loss with through-and-through opening of the furcation. Grade IV is similar to
grade III, but with gingival recession exposing the furcation to view.
Ci Tx SRP.Cii Tx GTR,
Company, 072006. 28.5.8).
33. What do you do for a furcation that you can see through? T or F. Tunneling, GTR
membrane?
46
Class I: Early Defects

Incipient or early furcation defects (class I) are amenable to conservative
periodontal therapy. Because the pocket is suprabony and has not entered the
furcation, oral hygiene, scaling, and root planing are effective.15 Any thick
overhanging margins of restorations, facial grooves, or CEPs should be eliminated by
odontoplasty, recontouring, or replacement. The resolution of inflammation and
subsequent repair of the periodontal ligament and bone are usually sufficient to restore
periodontal health.
Class II
Once a horizontal component to the furcation has developed (class II), therapy becomes
more complicated. Shallow horizontal involvement without significant vertical bone
loss usually responds favorably to localized flap procedures with odontoplasty and
osteoplasty. Isolated deep class II furcations may respond to flap procedures with
osteoplasty and odontoplasty. This reduces the dome of the furcation and alters gingival
contours to facilitate the patient’s plaque removal.
Classes II to IV: Advanced Defects

The development of a significant horizontal component to one or more furcations of a
multirooted tooth (late class II, class III or IV13) or the development of a deep vertical
component to the furca poses additional problems. Nonsurgical treatment is usually
ineffective because the ability to instrument the tooth surfaces adequately is
compromised.30,36 Periodontal surgery, endodontic therapy, and restoration of the
tooth may be required to retain the tooth.
34. 8 year old Central incisor canal is constricted but has apical RL what do you do? Refer
35. What is worst if doing a RCT? Insufficient obturation, insufficient cleaning and shaping,
36. In RCT was is plastic (fiber) post good to use? Same strength as dentin, better strength then
steel, same strength as steel, when cemented you can view on xray, Bonds to dentin, esthetics,
easy to remove.
37. RCT done and years have RL below what caused this? actinomyces
38. Xray of woman who had molar extracted, now has infection, what caused this?
Osteomyletis, residual cyst
A residual cyst is a cyst that remains after incomplete removal of the original cyst. The
term residual is used most often for a radicular cyst that may be left behind, most
commonly after extraction of a tooth.
21.3.7).
39. C factor(configuration factor)- composite ratio for bonded to unbounded
47
The C-factor is related to the cavity preparation geometry and is represented by the ratio
of bonded to nonbonded surface areas. Residual polymerization stress increases directly
with this ratio. Worst cfactor is cl 1, rating grade 5
Company, 072003. 18.4.10).
40. Bilateral split osteotomy what nerve do you worry about severing? Inferior alveolar
41. Cleft palate/lip- class 3
42. Main reason for redoing anterior composite-discolored or esthestics
43. Fluoride- how much do we use in community water 0.7-1.2 ppm
Temporate hotter (drinking more H2O more fluoride ingesting 1.2)
44. 5yr old has .28 fluoride how much do you supplement: 0.5
Fluoride Supplementation Schedule Fluoride Ion Level (ppm)

(Mosby. Mosby's Review for the NBDE, Part II. Mosby, 042007.).
45. What is true and not true about fluoride?
46. What is helpful in senior citizens????? Medicare
47. When you transilluminate tooth what does the light go thru? Thru fracture but not crays
line. Dx vertical fracture. Transillumination is the clinical practice of shining light
through hard or soft tissue as a diagnostic aid, to disclose or emphasize internal
defects.  
48. Flabby tissue for a denture what do you do first? Epuilis fisratura and excise.
Flabby ridges provide poor support for the denture, and it could be argued that the tissue
should be removed surgically to improve the stability of the denture and to minimize
alveolar ridge resorption. However, in a situation with extreme atrophy of the maxillary
alveolar ridge, flabby ridges should not be totally removed because the vestibular area
would be eliminated. Indeed the resilient ridge may provide some retention for the denture.
Implant-Supported Prostheses, 12th Edition. Mosby, 092003. 4.2.2).
48
49. Most likely to cause candidiases? Inadequate Vertical dimension of occlusion (loss of
intermaxillary space), excessive interocclusal distance
50. Glass ionomer benefits besides fluoride? Used as cement, covalent bond, resist to fracture
polyaryclic acid form ionic bond to enamel and dentin
51. Pic of white spongy nevus
52. Benefit of methadone vs morphine? Withdrawal less severe, used 2 detox morphine
addicts Methadone is used to relieve moderate to severe pain that has not been relieved by non-narcotic
pain relievers. It also is used to prevent withdrawal symptoms in patients who were addicted to opiate
drugs and are enrolled in treatment programs in order to stop taking or continue not taking the drugs.
Methadone is in a class of medications called opiate (narcotic) analgesics. Methadone works to treat pain
by changing the way the brain and nervous system respond to pain. It also works as a substitute for
opiate drugs of abuse by producing similar effects and preventing withdrawal symptoms in people who
have stopped using these drugs
53. Purpose of plaque index? Show the patient their cleaning ability
An interproximal plaque index is used to measure interproximal toothbrush

cleaning efficiency.
(Harris, Norman O.. Primary Preventive Dentistry, 6th Edition. Prentice Hall, 082003. 5.4.1).
54. Synchondrosis what is last to fuse? Sphenooccipital (starts in teens ends @ 20),
intraoccipital (frontal ethmoid/sphenoethmoid might be 1st) spheno-ethmoid second
At approximately 16 years of age the sphenooccipital synchondrosis fuses, thus

joining the basiocciput and the body of the sphenoid.
(Liebgott, Bernard. The Anatomical Basis of Dentistry, 2nd Edition. Mosby, 012001. 6.3.1.3.4).
55. Cauliflower like lesion on lip
Condyloma acuminata: on labial mucosa.
Condyloma acuminata are usually small and pink to dirty gray. The surface may be flat
but is more often pebbly and resembles a cauliflower. HPV 6 & 11
Wilkins, 012003. 10.3.4).
Wilkins, 012003. 10.3.5).
49
56. Naloxlone/ narcan antidote for opiods overdose
antidote for benzo over dose is flumazenil (I think fentanyl is used with benzo for preop
sedation
Fentanyl is an opioid reversed by naloxone and flumazenil reverses benzodiazepine

57. Start vomiting after because it triggers chemoreceptor zone
The central component of the vomiting response is due to stimulation of the emetic
chemoreceptor trigger zone in the area postrema of the medulla oblongata
Nausea and vomiting in the postoperative period continue to be a significant problem

following general anesthesia and are caused by an action of anesthetics on the
chemoreceptor trigger zone and the brainstem vomiting center, which are modulated by
serotonin, histamine, ACh muscarinic, and dopamine receptors. The 5-HT 3 serotonin
receptor antagonist ondansetron ( see Chapter 38) is very effective in suppressing nausea
and vomiting. Common treatment also includes droperidol, metaclopromide,
dexamethasone, and avoidance of N 2 O. The use of propofol as an induction agent and the
nonsteroidal antiinflammatory drug ketorolac as a substitute for opioids may decrease the
incidence and severity of postoperative nausea and vomiting.
Edition. McGraw-Hill Professional Publishing, 082001. 10.4.2.1.2).
58. Chemo causes thrombocytopenia and sickle cell
Myelosuppression—as manifested by leukopenia, neutropenia, thrombocytopenia, and

anemia—is a common sequela of several forms of cancer chemotherapy. Within 2 weeks
of the beginning of chemotherapy administration, the white blood cell count falls to an
extremely low level. The effect of myelosuppression in the oral cavity is marginal
gingivitis. Mild infections may develop, and bleeding from the gingiva is common. If the
neutropenia is severe and prolonged, severe infections may develop. The microorganisms
involved in these infections may be overgrowths of the usual oral flora, especially fungi;
however, other microorganisms may be causative. Thrombocytopenia can be significant,
and spontaneous bleeding may occur. This is especially common in the oral cavity after
oral hygiene measures. Recovery from myelosuppression is usually complete 3 weeks after
cessation of chemotherapy
18.2.2).
59. Dental office matches benefits of other offices but patient can choose dentist-PPO, HMO,
closed or open panel
60. Patient has to go to specific dentist in this plan-hmo,ppo,closed or open panel
PPOs differ from HMOs in that they are fee-for-service plans, so in PPOs a beneficiary
can go to any participating provider for any covered service, because payment is made
only when care is provided
50
"Open panel" dental plans. Like a PPO
Some dental plans will permit any dentist who so chooses to participate as a provider of
dental services for the plan. In these cases the dental plan is said to employ an "open
panel" of provider dentists. This type of dental plan is nice in the sense that your current
dentist, or else the dentist you would like to utilize, can provide your dental treatment.
"Closed panel" dental plans. Like HMO
Some dental plans dictate that the dentist providing your dental treatment must be one
approved by the dental insurance company
. This type of situation is termed a "closed panel" of dentists.
The concept of a closed panel plan has to do with the fact that the dental insurance
company has negotiated a contract with its network of provider dentists. In return for
receiving patient referrals from the dental insurance company the participating dentist
has agreed to discount their fees. Utilizing a closed panel is one way a dental insurance
company can reduce their costs.
(Burt, Brian A.. Dentistry, Dental Practice, and the Community, 6th Edition. Saunders Book
Company, 032005. 7.8.3).
61. How does collimation work? A device capable of collimating radiation, as a long narrow tube in
which strongly absorbing or reflecting walls permit only radiation traveling parallel to the tube axis to
traverse the entire length. Reduce from circu
62. What muscle does the denture cover? Buccinator
63. EDTA chelating agent inorganic material , smear layer remove
64. Sodium in RCT what does it NOT do? Not a chelating agent organic material
65. Antipsychotic drugs act on which receptors? Multi receptors but mostly dopamine
Radioligand-binding and autoradiographic assays for dopamine receptor subtypes have

been used to define more precisely the mechanism of action of antipsychotic agents.
Estimated clinical potencies of most antipsychotic drugs correlate well with their relative
potencies in vitro to inhibit binding of radioligands to D 2 -dopamine receptors. (Mosby
pg 281.- Anti-psychotics block dopamine receptors in the mesiolimbic and mesocortical
pathways.
(Brunton, Laurence. Goodman & Gilman's the Pharmacological Basis of Therapeutics, 11th
51
66. Nitrate(NO3) vs nitrites(NO2) mechanism of action? Nitrates increase O2 supply by

vasodilating action on smooth muscle in coronary arteries.
These agents are prodrugs that are sources of nitric oxide (NO). NO activates the soluble
isoform of guanylyl cyclase, thereby increasing intracellular levels of cyclic GMP. In turn,
this promotes the dephosphorylation of the myosin light chain and the reduction of cystolic
(Ca2+) and leads to the relaxation of smooth muscle cells in a broad range of tissues. The
NO-dependent relaxation of vascular smooth muscle leads to vasodilation; NO-mediated
guanylyl cyclase activation inhibits platelet aggregation and relaxes smooth muscle in the
bronchi and gastrointestinal
Edition. McGraw-Hill Professional Publishing, 092005. 31.2).
67. How do you treat dry sockets? Surgical dressing, and analgesic
68. If patient has excess saliva-realign, no affect, helps with retention(I think reline) The more
saliva the better it adds with retention to create the seal. For example in clinics when you insert
patients maxillary denture. You tell them to close and swallow so that you can seal the
peripheral borders and suction. The less saliva the worse.
69. Why do you place a functional cusp bevel? Retention & resistance, structural integrity,
As part of the occlusal reduction, a wide bevel should be placed on the functional cusps of
posterior teeth to provide structural durability in this critical area. Failure to place a
functional cusp bevel can result in thin, weak areas in the restoration
(Shillingburg, Herbert T.. Fundamentals of Tooth Preparation: For Cast Metal and Porcelain
Restorations. Quintessence Publishing (IL), 011987. 1.3.2).
70. Which patient is more likely to have thrombocytopenia- chemotherapy, taking oral
contraceptive??? Thrombocytopenia -Thrombocytopenia is any disorder in which there is an
abnormally low amount of platelets. Platelets are parts of the blood that help blood to clot. This
condition is sometimes associated with abnormal bleeding. Disorders that involve low production in
the bone marrow include: Aplastic anemia Cancer in the bone marrow, Cirrhosis (chronic liver disease),
Folate deficiency, Infections in the bone marrow (very rare), Myelodysplasia, Vitamin B12 deficiency
Board Busters pg 214. – results in multiple bruises, petechiae, hemorrhage into the tissue. Maybe
caused by heparin(warfarin) therapy. Oral manifestations are severe/profuse gingival hemorrhage and
palatal petechiae.
71. Patient has small cavity @ what point do you interfere with decay? ½ way thru enamel,
seen on xray, seen in dentin or cavitated
72. What do you see in thyroid storm exspect? High temperature, sweating, rapid heartbeats,
or weight loss. Thyroid storm is a life-threatening condition that develops in cases of untreated
thyrotoxicosis (hyperthyroidism).Causes, incidence, and risk factors Thyroid storm results from
untreated hyperthyroidism. It is usually brought on by a stress such as trauma or infection.Symptoms
Symptoms are severe and may include:
• Agitation
• Change in alertness (consciousness)

52
• Confusion
• Diarrhea
• Fever
• Pounding heart (tachycardia)
• Restlessness
• Shaking
• Sweating
Signs and tests
• The top number in a blood pressure reading may be high
• Increased heart rate
Blood tests are done to evaluate thyroid function.
73. What is a minor connector? Connects things to major connector

74. What is the rest seat connected to if that is connected to major connector? Minor
connector
75. Least congenitally missing tooth? 3m-mand-2pm-lat incisor
Most: 3rd molarmand 2 bicuspidmax lateral (least)
76. Erution sequence/ calc seq Look at Mosby pg 176
77. When is 1st sign of calcification (4months in utero) which is about 14 weeks and the first
tooth would be the primary central incisor Mosby pg 176
The crown of all primary begins to calcify 4-6 months in utero
78. Fractured mandible how long is appropriate to keep in closed reduction? 4weeks, 6 weeks,
9 weeks, 12 weeks(4-6 weeks) (2 weeks deciduous)
Once the closed reduction had been achieved, maxillomandibular wires replace the
elastics and are maintained for 6 weeks.
24.3.1).
79. Irreversible hydrocolloid is not used in fixed ( Note irreversible hydrocolloid is alginate and
is used for preliminary impressions. Must be poured immediately and goes from gel to sol. )
80. How do you increase working time with irreversible hydrocolloid? Increase spatulation,
increase cold water, increase hot water
81. Which stone and how do you make it set up faster? Slurry water, hot water, cold water
82. If you cut a DO what axiolineangle is not there? No distal wall
83. Flap surgery wide gap in between how do you clean interproximal furaction?
Interproximal brush, water pick, floss
84. Guy on recall for perio has mesial on #4 distl on #20 with 6mm perio pockets what do you
do? Surgery, scaling(6-7mm for 3-4month recall), etc
85. 10 yr old with gap what do you do? Take away frenum, ortho, wait for Mx k9 eruption
53
86. What isn’t seen on xray gingival cyst or nasiolabial cyst

87. Supragingival plaque is more gram negative or positive
Supragingival plaque is more gram positive (Note:) Major organic components of plaque
biofilm are polysaccharides, proteins, glycoproteins, lipids. The major inorganic component
of plaque is calcium and phosphorous.) – Mosby pg 242
Supragingival plaque (More gram positive)
saliva is the main source of inorganic component .Supragingival is either tooth-

associated or outer layer. Tooth-associated is composed primarily of gram -positive
cocci and short rods. Mature outer surface of plaque is gram-negative rods and
filaments and spirochetes.
Subgingival
Subgingival plaque is mainly derived from gingival crevicular fluid. tooth associated
is gram negative rods and Tissue associated is gram negative rods and cocci,
filaments, flagellated rods and spirochetes.
88. Key features of cleidocranial dysplasia. Retain primary dentition longer. Autosomal
dominant condition manifested by many alterations, especially of teeth and bones. The most
distinctive features include: delayed tooth eruption, supernumerary teeth, hypoplastic aplastic
clavicles, cranial bossing, and hypertelorism. ( Mosby pg 123)
89. After 10 years % of people with successful implants? (5 year 95 Mn 90 Mx) so 80-90%
The implant and related prosthesis can attain a 10-year survival of more than 90%.
(Misch, Carl E.. Contemporary Implant Dentistry, 3rd Edition. Mosby, 122007. 1.7).
90. Alvused teeth best prognosis? Something to do with time and what its stored in(best in 15-
30minutes, hanks solution, or milk,saline,saliva) Note viaspan is also a good solution and as long
as the tooth is replaced in less than a hour
91. Test for prevelance of incidence investigating oral cancer in a nursing home pts what kind
of study is this?
92. T test vs chi square (The t-test assesses whether the means of two groups are statistically
different from each other. Chi square- test measures the association between two categorical
variables. MOSBY pg 214)
93. INR determines PT measure warfarin dose, liver damage, vit k status
94. Kid wheezes with inspiration(vocal cord obstruction) ?? laryngospasm. Tx is with
succinylcholine
95. Common dental office problem? Asthma hyperventilation, syncope (Note: tx for syncope
would be inhaled ammonia)
96. Patient needs to be medicated for 8 hrs what do you give them? Aspirin, ibuprofen(4-8),
acetaminophen, naproxene(12)
Diflunisal (dolobid 8-12 hrs) Effectiveness of diflunisal is similar to other NSAIDs, but the duration of
54
action is twelve hours or more Though diflunisal has an onset time of 1 hour, and maximum analgesia at
2 to 3 hours. Diflunisal is in a class of medications called NSAIDs. It works by stopping the body's
production of a substance that causes pain, fever, and inflammation.
97. H2 histamine receptor is for gastric acid reduction( Mosby pg 293-294- examples are
cimetidine, ranitidine, famotidine, nizatidine. Omeprazole (Prilosec) and lanzsoprazole
(prevacid)
98. Most likely to reoccur OKC
99. What do you use to cool bone when place a implant? Air, irrigated solution
Bone cell survival is very susceptible to heat. Eriksson has demonstrated that in rabbit,
bone temperature as low as 3° C above normal (40° C) can cause bone cell necrosis.49
Therefore a conscious effort is made to control temperature elevation every time a rotary
instrument is placed in contact with bone. At least 50 mL/min of cooled irrigation, such
as sterile physiologic saline, is used as a profuse irrigant and is a critical element to
reduce heat.35-37,50 Distilled water should not be used, as rapid cell death may occur in
this medium.51 Intravenous dextrose solution (D 5 W) also may be used, with the
clinical advantage of decreasing hand piece breakdown occurring from the effects of
the salt in a saline solution, although the surgical gloves often feel sticky near the
conclusion of the surgery. The irrigant also acts as a lubricant and removes bone
particles from the implant osteotomy site. Without irrigation, drill temperatures above
100° C are reached within seconds during the osteotomy,52 and consistent temperatures
above 47° C are measured several millimeters away from the implant osteotomy. The
temperatures of the irrigant can also affect the bone temperature.36,39 Copious irrigation is
suggested, especially in D1 bone.
100. Maximum amount of nitrous? 70%
101. 100th in hue, value, chroma? ???Brightness, hue is measured in 100th i.e 100th, 200th,
300th not 344, 546 etc
102. Gardner syndrome- osteomas, polyps that turn into adenocarcinomas, supernumary
teeth (Mosby pg 123- autosomal dominant disorder, consists of intestinal polyposis,
osteomas, skin lesions, impacted permanent and supernumerary teeth and odontomas.
Intestinal polyps have a very high rate of malignant conversion to colorectal carcinoma.
103. Tell show do is for who-child
104. 2yr ol acting up what do you do-get down to their level and talk to them
105. Same question-show them another child behaving which is an example of modeling
106. LED cure light why is it more beneficial than halogen and know the range. 430-490
shorter curing time
107. Permanent teeth vs primary teeth-higher pulp horns, pulp chamber is bigger in primary
teeth
108. Pt has Mn molar extracted 3 days later have pain- alveolar osteitis (dry socket)
Dry socket or alveolar osteitis is delayed healing but is not associated with an infection.
This postoperative complication causes moderate to severe pain but is without the usual
signs and symptoms of infection, such as fever, swelling, and erythema. The term dry
55
socket describes the appearance of the tooth extraction socket when the pain begins. In the
usual clinical course, pain develops on the third or fourth day after removal of the
tooth.
11.9.3).
109. Infection on lip can cause cavernous sinus thrombosis thru infection travelling. Cavernous
sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base
of the brain which drains deoxygenated blood from the brain back to the heart. The cause is usually from
a spreading infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are
often the associated bacteria. Cavernous sinus thrombosis symptoms include; decrease or loss of vision,
chemosis, exophthalmos (bulging eyes), headaches, and paralysis of the cranial nerves which course
through the cavernous sinus. This infection is life-threatening and requires immediate treatment, which
usually includes antibiotics and sometimes surgical drainage. Cranial nerves 3, 4, 5, 6, are affected.
110. Autistic child-likes affection, needy, repeat things over and over
111. Patient with heart attack-answer is heart attack?
112. Ameloblastoma form from dentigerous cysts
113. What do you have with seizures-hyper…(hyperventilation, hyperthyroidism,
hyperexcitable nerves) ( Note: tx of seizures: grand mal- phenytonin (Dilantin), absence
seizures (petit mal) (ethosuxmide and valproic acid) prophylaxis for partial seizures-
Carbamazepine which also treats trigeminal neuralgia
114. What does cusp reduction do? Retention, resistance(conserve tooth struct and
gives rigidity)
115. Unbundling and beneficence definitions-bene promotes wellbeing of others,
unbundling is charging separately ie.post and core
116. Waive copay-price fixing
117. Pic of compound odontoma
118. Alpha agonist acts on?(adrenergic, epinephrine, SNS)
119. What can you get back? Tooth mobility
120. % of people that get fluoridation? 67-70
In 1992, when the last Fluoridation Census was published, approximately 135 million
Americans were consuming fluoridated water while an additional 10 million were drinking
water with optimal levels of naturally occurring fluoride, equating to 57% of the entire
population or 62% of those who are served by centralized piped-water systems.7–8 (see Table
8-2). As of 2000, the percentage of the population receiving optimally fluoridated water
through public water systems has risen to 65.8% and 26 states achieved the Healthy
People 2000 goal of 75% of the population served by community water fluoridation8 (see
Figure 8-2). From 1992 to 2000, 28 cities adopted fluoridation, with an estimated 8,295,552
million people added to the Fluoridation Census.
(Harris, Norman O.. Primary Preventive Dentistry, 6th Edition. Prentice Hall, 082003. 8.2).
121. Treat external resorption with what? RCT, CAOH2
Root canal treatment is therefore recommended routinely for replanted teeth with
closed apexes to prevent the occurrence of inflammatory resorption.
56
(Torabinejad, Mahmoud. Endodontics: Principles and Practice, 4th Edition. Saunders Book
Company, 032008. 10).
122. Apexification-nonvital tooth
123. Indirect vs direct on child
124. Pt on antidepressant what is your greatest concern? Epinephrine or time in chair
These patients are usually taking MAOI which may potentiate the effect of the Epi by inhibiting
the re-uptake.
125. Pt is emergency remove decay that is medium to deep but not pulpal exposure so you
temp it what are the indication for that? Emergency
126. Order of treatment perio not endo related, order of Tx endo not perio related.
127. Pt has Mn molar cracked? Best description? Stabbing pain, pain upon releasing bite is
Cracked Tooth Syndrome. Use transillumination for diagnosis. Prognosis depends on how
severe. Crack is in a M-D dimension. Note: Pain upon biting is a sign of Vertical Root
Fracture. It is diagnosed by transillumination. It is in a F-L dimension. Poor prognosis. Tx is
Extraction.On radiograph if can see lesion it is a J-shaped lesion.
128. 40 yr old pt has 32 teeth with deep fissures what do you do? Sealant, amalgam, observe
129. 1st molar decay what do you do? MOD & DO, MO & DO (what the hell !!!)
130. Hex implant prevents rotation
131. What is the initiator of caries? S. mutans not option so L. bac
132. Don’t give a pregnant woman what? Diazepam, (Other drugs cannot be given: warfin,
NSAIDS, methotrexate, merpidine, nitrous oxide, barbituates, Phenergan, prophyphene
tetracycline, carbamezapine, choloral hydrate, morphine, diphenhydramine, hydrocholoride,
cortiocosteroids, chlorodiazepine. DRUGS THAT CAN BE GIVEN- Tylenol, Tylenol #3, codeine
133. 5 year old child extraction what do you give them? Acetaminophen
134. Braces move due to supracreseptal fibers
135. Ortho Tx does…..pulpal response, decrease blood to PDL, widened PDL Mosby pp156-
157. Root resorption during otho tooth movement is a potential side effect of orhto therapy.
As the PDL experiences hyalinzation in specific stress areas of compression the adjacent
cementum shows signs of resorption by clastic cells.. Heavy forces applied to a tooth can
cause pain as soon as the PDL is initially compressed.
136. Important with successful RCT what is the least likely to happen-regen of dentin, regen
of cementum, regen of alveolar bone
The purpose of the pulp is dentin formation, and if your RCT was performed well there should
no longer be any vital pulp tissue in the canal. So… no pulp tissue, no dentin regeneration.
137. Prescribed opioid analgesic physical signs-headache, irritability, hypo… (nausea,
vomiting, drowsiness, itching, constipation, respiratory depression)
138. IV antibiotic has tachycardia and other problems 1st thing you do is what? Epinephrine,
stop antibiotic (if serious cardioversion, admin adenosine, stable refer,ECG)
Agree, sounds like an anaphylactic response: you already have an IV line so just give 3 ml of
1:10,000 epinephrine
139. All effects the success of implant except-remaining teeth
140. Epitomizes dental fear-chair
141. Causes sudden mobility- secondary traumatic occlusion
142. Mandibular lateral incisor eruption where do you get space- primate space
57
primate space, is located mesial to the maxillary canine and distal to the mandibular
canine.
042005. 18.4.5.2).
143. Pregnant woman in dental chair- lay on left side to prevent from laying on vena
cava
144. Perio disease time of life theory episodic or random-random burst theory
The "random burst" theory has recently been proposed as an explanation of the pattern
of periodontal disease progression. The theory predicts that the progression of bone
loss at individual sites is not dependent upon previous bone loss and age.
145. Neurofibromatosis –freckling(Crowe’s sign), lisch nodules(iris freckling), café au lait,
Mosby pg 113. Multiple neurofibromas, malignant transformation of neurofibromas in 5% to
15% of patients.
146. Major complaint from a denture patient-can say certain words, lack of retention in
mandibular denture
147. Osteoradionecrosis most associated with mandible
True because the maxilla is more vascularized than the mandible. Osteoradionecrosis occurs as
a result of hypoxia of tissue.
148. Best time to get children to stop children from sucking thumb- primary dentition period
To minimize the risk of habitinduced malocclusion, such habits should be eliminated by

24 months of age. Thus given the physiologic and psychological need for sucking in the
first year of life, it is not prudent to recommend elimination of habits prior to 12
months of age.
042005. 13.6.5).
149. Device place to prevent thumb-sucking-positive, negative, adversive
150. Smiling, praising down syndrome pt-social, positive reinforcement
151. Modeling & shaping questions
152. What model to get child to follow directions
153. Teach child to turn negative thoughts to positive experience-reshaping, modeling
154. Drug A has higher efficacy than B? more potent, smaller dose
efficacy is that property intrinsic to a particular drug that determines how “good” an
agonist the drug is. Historically, efficacy has been treated as a proportionality constant
that quantifies the extent of functional change imparted to a receptor-mediated response
system on binding a drug. Thus, a drug with high efficacy may be a full agonist
eliciting, at some concentration, a full response, whereas a drug with a lower
efficacy at the same receptor may not elicit a full response at any dose.
155. When do you do maintenance phase in perio?After phase II therapy
Phase 1- Nonsurgical
58
Phase 2- Surgical
Phase 3- Restorative
Phase 4- Maintenance (phase IV therapy). Periodontal procedures include periodic
evaluation of oral hygiene status, presence or absence of local factors, and condition of the
periodontium (pocket depths, attachment levels, mobility, occlusion). This phase actually
should begin after the completion of phase II therapy.
156. Added to polymethyl methacrylate for? Strength, polymerization, …
157. What size do you do a excision? (<1 cm in diameter)
(Regezi, Joseph A.. Oral Pathology: Clinical Pathologic Correlations, 4th Edition. Saunders
Book Company, 012003. 6.1.6.5).
158. Salivary gland defect
159. Palmar plantar keratosis- Lefevre Papillone ( autosomal dominant, palmar and plantar
keratosis. Erythematous and associated with aggressive periodontitis, The severe destruction of
periodontium results in loss of most primary teeth by the age of 4 and most permanent teeth by age 14.
Hyperkeratosis of palms and soles of feet appear in first few years of life.
160. #8 lighter than the rest of teeth what do you do? Bleach other teeth, crown
161. What’s not on ADA website? Licensing
162. How much do you take off facial view of veneer? .5 mm (.5mm in the middle, .3 mm in
the cervical and .7mm and in incisal)
for a two-shade color shift in all teeth, a 0.3-mm tooth reduction in the cervical one third
and a 0.5-mm tooth reduction in the remainder of the facial surface are sufficient.
(Rufenacht, Claude R.. Fundamentals of Esthetics. Quintessence Publishing (IL), 011990.

12.5.1).
163. Regen of periosteum needs- sharpeys fibers, cementum, alveolar bone, periodontal
ligaments
164. Benefits of PCN except? Cheap, low toxicity, not broad spectrum
Bactericidal with narrow-spectru, safe:low-toxicity, cheap, p.26 d.secrest
59
165. What will happen if you issue broad spectrum antibiotics-creates infection
166. Denture pt with opposing teeth? Mx bone resorption, post tuberosity droops, Mx
anterior resorption (Combination syndrome)pt. will have a flabby ridge and anterior resorption
167. What cause angular chelitis-VDO loss ( increased interocclusal space and tx will be
nystatin or clomatriazole)
168. Pt has hypoparathyroid disorder can be prevented by giving what?iodine?(vit d therapy,
calcium, no way to prevent primary) Note: hypothyroidism- myxedema in adults and cretinism
in children. Hyperthyroidism is goiter’s syndrome. Treatment with hyperthyroidism is iodine.
169. Pt has low alkaline phosphatase what do they have? (magnesium deficiency Symptoms of
magnesium deficiency include: hyperexcitability, dizzyness, muscle weakness and fatigue.[1] Severe
magnesium deficiency can cause hypocalcemia, low serum potassium levels (hypokalemia), retention of
sodium, low circulating levels of parathyroid hormone (PTH), neurological and muscular symptoms
(tremor, muscle spasms, tetany), loss of appetite, nausea, vomiting, personality changes [2] and death
from heart failure., hemolytic anemia, wilson’s disease( too much copper in body). Elevated levels
alkaline phosphatase in Paget’s/osteosarcoma ↑
A decrease in serum alkaline phosphatase and an increase in the urinary excretion of

phosphoenolamine are pathognomonic for hypophosphatasia.
(Cameron, Angus C.. Handbook of Pediatric Dentistry, 2nd Edition. Mosby Ltd., 062003. 6.7.6).
170. Periodontal disease in children? Acute periodontitis, marginal gingivitis

171. Articaine (septocaine) is metabolized where? Plasma esterase and liver.
172. A drug is first passed means? Excreted in urine, metabolized in liver or intestine
Following nonparenteral administration of a drug, a significant portion of the dose may be

metabolically inactivated in either the intestinal epithelium or the liver before it
reaches the systemic circulation. This first-pass metabolism significantly limits the oral
availability of highly metabolized drugs.
Edition. McGraw-Hill Professional Publishing, 082001. 2.5.2).
173. Diagnosis for bullemia A dental exam may show cavities or gum infections (such as gingivitis). The
enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit.
A physical examination may also show:
• Broken blood vessels in the eyes (from the strain of vomiting)
• Dry mouth
• Pouch-like look to the corners of the mouth due to swollen salivary glands
• Rashes and pimples
• Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit
A chem-20 test may show an electrolyte imbalance (such as hypokalemia) or dehydration.
174. Bullemia is form of erosion

60
175. Wipe something down and it kills everything but spores-disinfected ( disinfectants
should be able to kill Mycobacterium Tuberculosis, which is the benchmark organism. It is
the process in which antimicrobial agent destroys germicide or avoids the growths
microbiostatic of pathogenic microrganisms. Mosby pg 218
176. Allergic to amoxicillin give the patient what: clindamycin 600 mg in adults and 20 mg in
children, clarithomycin,/azithromycin 500 mg in adults and 15 mg, cephalexin 2g in adults and
50 mg in children
177. Identify nasal septum-zygoma
178. Where do you use base metal-bridge
179. Where do you use noble metal-single crown
180. Premed with endocarditis main concern? If had previous
181. Pt had hip replacement 10 months ago do you premed? Yes (less than 1 yr pre-
medicate)
182. 30 year old pt has deep fissure least likely to do? Sealant, amalgam, observe
183. Most common root fracture- Mandibular 1st molar
184. Most successful place to put a implant? Mandibular anterior
185. Ectodermal dysplasia
Hereditary ectodermal dysplasia
1. An X-linked recessive condition that results in partial or complete anodontia.
2. Patients also have hypoplasia of other ectodermal structures, including hair,

sweat glands, and nails.
186. Doxycycline does what? Inhibits collagenase it is used in sulcular depth.Tetracycline is a
broad spectrum antibiotic inhibits 30 S ribosome. It is can go into gingival crevicular
fluid
187. What sound is hard to make if denture is placed to far facially? “F” and “V” sound
188. Bony resorption from implant considered successful If you have .1mm of resorption per
year? Yes Note: if have less than 0.02 mm of bone loss per year it is successful. If have
greater than .2 mm year it is failure.
189. How much radiation exposure is considered bad? 4 Gy (acute radiation)?????
190. What is considered safe amount of radiation? 50 mSv of whole body radiation in 1year
individuals occupationally exposed in operation of dental xray equipment receive an
annual average of 0.2mSV (0.04% of allowable limit)Mosby pg. 129
Dentists and their staff are occupationally exposed workers and are allowed to receive up to
50 mSv of whole-body radiation exposure per year
3.2.1).
61
191. If xray goes through something thick what will it look like on xray? Cancer, thickness, no
cancer, radioopaque, had to penetrate thick structure looks radioopaque
192. Cementing all porcelain or all ceramic crown what resin good to use and what benefits?
Resin cement -Fracture, fill in margin, color control
193. Contraindication with St Johns Wort? Asthma, warfarin, pregnancy
194. Replacement resorption- necrotic pulp resorption(?) associated with ankylosis Mosby pg
23 Cause: PDL (nonviable PDL), occurs in about 60% of replanted teeth. Radiographic evidence
continuous replacement of lost root with bone. NO RL (loss of cementurm, dentin, PDL and with
the ingrowth and fusion of bone to the root defect.) CCL evidence. Irreversible: dental
treatment cannot stop progression. Metallic sound on percussion.
195. In a injury this acid is produced and is responsible for what? Prostaglandin??
196. Tooth fused to bone-replacement resorption
197. Porcelain is strongest in what stage? Firing, cooling, stressed I think its cooling
198. Most damaging type of mercury? Methyl, ethyl (organic)
Least damaging -inorganic
I think the concepts were basically the same…I can say I saw a good number of my
questions somewhere, not in the exact same form but a variation of some sort where
you could easily get it wrong if u just looked at remembered questions and didn’t seek
understanding of the concepts. I also noticed that at least 75% of my case patients had
things that were related to topics covered in the JADA(implants more in depth than
mosby, bisphosphanates, drug abusers, sjogren’s, u name it) that were not covered in
enough detail in our study aids for the test. Good Luck and make sure u give as you are
receiving if you are reading this.
Know hyper and hypo thyroid really well…each symptom of each and what goes with
what.
Animal has caries and feed them cariogenic food via stomach tube what will happen to
the caries intraorally? Decrease, stopped, increase, increase dramatically
Caries in Rats Fed a Decay-producing Diet Via Normal and Stomach Tube
Routes
(From Kite et al. J Nutr. 1950:42.)28
(Harris, Norman O.. Primary Preventive Dentistry, 6th Edition. Prentice Hall, 082003.).
Extension of retromolar pad in dentures? 1/3,2/3. In front
Daily requirement of fat? 10,20,30,40(who cares)

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What is most common reason children get coronary artery disease? Obesity, diabetes
Oseteogenesis surgery vs ostectomies why is one prefer over the other? Less
parasthesia and some more
What are leukotrienes are now being linked to? Asthma the leukotriene is montelukast.
Mosby pg 301
Leukotrienes (LTs) are synthesized from arachidonic acid by a different pathway, and they
are part of the airway inflammatory response. LTC 4 , LTD 4 , and LTE 4 may play a role in
asthma. These LTs are 1000 times more potent than histamine as bronchoconstrictors,
they stimulate mucous production, and they increase vascular permeability, which can lead
to edema. LTB 4 induces leukocyte chemotaxis, increased vascular permeability, and
vasodilation. LTs are removed almost completely by the pulmonary circulation, so their
effects are local.
(Johnson, Leonard. Essential Medical Physiology, 3rd Edition. Academic Press - Non Elseiver S
& T, 092003. 21.5.3).
Know what to do if you fracture the aleveolar bone while extracting….they had place
flap to visualize the pieces(which is what you should do) but they also had refer to oral
surgeon which is what a general dentist SHOULD do so who knows
Know how to remove mandibular tori. Is was like with osteotome, bur, etc. I said section
w bur and use the osteotome
I had the inverted Y question. I put floor of nasal and wall of max sinus
Know how to treat hypo(called insulin shock) and hyperglycemia in pediatric and adult
patients…I chose juice, had glucose but u they said IM and u give it via IV and u def
don’t give more insulin
I had a lot of fear vs anxiety questions…know the diff thoroughly in terms of children.
BOX 7.1 ANXIETY
Anxiety refers to a hypothetical psychological construct which is:
• Anticipatory
• Associated to a specific event (but not always)
• Aversive
• Unpleasant to experience; and
• Takes time to dissipate.

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Three components are helpful in explaining anxiety.
1. Physiological and somatic sensations, for example:
• Breathlessness
• Perspiration
• Palpitations
• Feelings of unease.
2. Cognitive features (that is, how changes occur in thinking processes), for
example:
• Interference of concentration
• A focusing of attention sometimes known as hypervigilance
• Inability to remember certain events while anxious
• Imagining the worst that could happen.
3. Behavioural reactions, for example:
• Avoidance, i.e. the postponing of a dental appointment, or requesting to have all

dental treatment conducted in a single session.
• Escape from the situation which precipitates the anxiety.

BOX 7.2 FEAR
Fear overlaps with the anxiety construct but emphasises a more biological response.
Someone who experiences fear will not necessarily be anticipating a negative event, — their
response will occur at the moment the unpleasant event (e.g. pain) occurs. In a sense the fear
response is a valuable one, in that it produces a protective 'fight or flight' response. That is,
the individual who experiences fear (and the physiological reactions can be magnified
relative to anxiety), usually in response to a clear unpleasant stimulus, selects whether to
engage in defence ('fight') or makes a hasty retreat ('flight'). Either way the fear response can
be quickly resolved and dissipated. In this sense fear may be seen more positively as the
individual is very often clear what precipitated the fear reaction.
A panic reaction is a special type of fear, sometimes regarded as a 'fear of fear itself'. The
individual who suffers a panic reaction is acutely aware of the physiological sensations
within his body and certain symptoms he experiences act to trigger a full-blown fear reaction.
This experience may well be more common in dental patients than has hitherto been realised
and will be discussed later in the chapter.
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Random statistic questions…
How far does floss and toothbrush penetrate sulcus? I put 2-3mm for both and I looked
it up before the test and couldn’t find a definitive answer but I did see that toothbrush
goes up to 3
Know IRM, ZOE, and Glass ionomer…they seemed to like them and know the
composition of each one of those materials
What surface is caries most prevalent? Occlusal, interprox, facial, lingual
Cutting access prep on Max incis, angle bur distally to avoid what? (this is in dental
decks) mesial perforation
Want to gain straight line access…they had many reasons that seemed good access
preps but ultimately this is what we want to do
Osteoporosis and bisphosphates…know what happens when on bisphosphanates and

get messed up jaw similar to osteoradionecrosis but here its called regular
osteonecrosis bcuz ur assuming pt didn’t have radiation treatment
Smiling, praising a child? Token reinforcement, social reinforcement ( positivie

reinforcement)
Know that you will use glass ionomer if you are close to gingival margins
GI over composite due to….fluoride release
Glass ionomer has….polyacrylic acid
IRM is ZOE combined with…… methyl methacrylate
Autistic people have? Heightened perception to sounds, lights, or greater than average
intelligence NOTE:
Autistic disorder (also called autism; more recently described as "mindblindedness") is a
neurological and developmental disorder that usually appears during the first three years of
life. A child with autism appears to live in their own world, showing little interest in others
and a lack of social awareness. The focus of an autistic child is a consistent routine and
includes an interest in repeating odd and peculiar behaviors. Autistic children often have
problems in communication, avoid eye contact and show limited attachment to others.
More than 500,000 people in the US have been diagnosed with some form of autism. Autism
can prevent a child from forming relationships with others (in part, due to an inability to
interpret facial expressions or emotions). A child with autism may resist cuddling, play
alone, be resistant to change and have delayed speech development. Persons with autism
tend to exhibit repeated body movements (such as flapping hands or rocking) and have
unusual attachments to objects. However, many persons with autism excel consistently on
certain mental tasks (i.e., counting, measuring, art, music, memory).
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What are the symptoms of autism?  The following are the most common
symptoms of autism. However, each child may experience symptoms differently.
Symptoms may include:
• Does not socially interact well with others, including parents.

Shows a lack of interest in, or rejection of, physical contact. Parents
describe autistic infants as "unaffectionate." Autistic infants and
children are not comforted by physical contact.
Avoids making eye contact with others, including parents.
Fails to develop friends or interact with other children.
• Does not communicate well with others.
Is delayed or does not develop language.
Once language is developed, does not use language to communicate with
others.
Has echolalia (repeats words or phrases repeatedly, like an echo).
• Demonstrates repetitive behaviors.
Has repetitive motor movements (such as rocking and hand or finger
flapping).
• Is preoccupied, usually with lights, moving objects, or parts of objects.
• Does not like noise.
• Has rituals.
• Requires routines.
Have implant should the emergence profile be from the? 1mm below CEJ of adjacent,
1mm above, 2-4mm below the CEJ, 2-4mm above
Asked what part of framework resists corrosion? Chromium-cobalt wasn’t there together
but listed as separate parts. Cobalt, chromium, blah blah Note Cobalt is for rigidity and
silver turns porecelain green
Epipheseal plate is most similar to what? Syncodrosis ( intersphenoid first,

spehenoethmoid second, and sphenoociptal last)
What don’t u take with methotrexate? Beta-lactam antibiotics
If you have a patient with an overdenture, what is the treatment for the roots? Fluroide
treatment for them
Fluoride + cholrhexidine is more effective than fluoride alone
Know when to biopsy and when not to (vague I know but its prob related to length of
lesion and common locations where cancer could be, refer to oral path book)
I had a patient who had like a super furcation on #18 bone loss all around and am
impacted #17, they said that these teeth were being sent to be biopsied upon extraction.
The question asked why…it was either due to #18 or because of the locsalozed
aggression on #18, which is what I chose
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Know when to use chlorohexidne rinse vs fluoride treatment in medically compromised

patients(unclear I know but I cant remember what the illness was)
Know tensile strength is the ultimate strength before breaking….yield strength is one
before it deforms permanently. They asked me this in relation to why would I choose a
metal framework for a patient.
They had a patient and they asked what would give her the best retention for her
dentures? Ridge augmentation, implant supported denture….i like both
In a case I had a man with sickle sell…know what special precautions needed to be
taken with these patients
I also had a man who was a crackhead…it asked me that since this patient is on
cocaine should I not expect him to maintain his
oral health. True or false
Also asked me what drug would I give him for pain…I chose the regular ibuprofen vs
Percocet,etc(just didn’t seem to give a drug abuser something more to abuse)
I had some SOPS too, ph caries etc
Know about the incisal guidance on the articulator….
Horizontal axis of rotation:-- Variability of the position of the horizontal axis of rotation in relationship to the
maxillary dental cast.
Condylar inclination/fossa components: -- Variability of the angle of the eminentia, directional guidance of the
superior, posterior, and medial walls of the fossa, and ability to simulate laterotrusive movement.
Inter Condylar distance: -- Adjustability of the distance between the vertical axes of rotation.
Bennett angle/Bennett movement:--Adjustability of the angle and capability of simulating sideshift movement.
Incisal guidance:--Adjustability and ability to simulate the anterior guidance of the natural dentition.
Know arcon vs non acron articulates and how they differ in terms of the condyle
Mosby pg.319. Acron the condyles are in the lower membrane and the fossa are in the
upper membrane. Non-acron the upper and lower are rigidly attached.
Know in terms of the solder that if u want it stronger than make it wider
Oral Bisphospanates heavy

IV Bisphosphonates Oral Bisphosphonates
Zoledroic acid ( zomate) Fosamax (Aldrenonate)
Pamidronate (Aredia) Actonel (Risedronate)
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Boniva ( ibandronate)
Genial turbercles picture but make sure
Know about a precision attachment…asked what was it used for, key is that it is used
for esthetics on people who don’t want the clasp showing on their RPD
What is a Precision Attachment?
A precision attachment is a precision-machined male and female (key and lock) housing that connects a removable
partial denture to fixed bridgework
The female part of the attachment is soldered to fixed crowns or bridgework the male part is attached to the partial
denture. The male is machined by the manufacturer to fit the female with such precision that any male out of the box
will fit any female with an exact degree of accuracy. All of the precision attachments in a partial denture are
positioned so that they are exactly parallel to each other.
If taking a palatal graft, know what nerves can be damaged (guessing u should know
MC location) Nasopaltine, ant palatine, greater palatine
Get plenty of sleep night before, review remembered question and pics before bed. That’s it!
400 questions is a lot to deal with in one day. They make you think. Its not hard, we have been
exposed, we have to use what we know. The test is kinda like a final at school. Lots of material
lots of 50/50 questions. Lots of “awe man if I only looked at that stuff just a little longer or
made myself remember the little facts”. Its stuff we should know. Its fair straight forward.
Broad not too specific. Implants were kinda tricky but we were not taught at school. Sucks to
be us…well only for that part. My test was heavy on perio, implants, behavioral mgmt, stats,
CD, everything else was about even. Little pharm and OS.
• Bisphosphonate, there is a concern with xrays while on bisphosphonates.

• Frey syndrome-sweat on parotid when you eat
Frey's syndrome (also known as Baillarger’s syndrome, Dupuy’s syndrome, Auriculotemporal
syndrome or Frey-Baillarger syndrome) is a food related syndrome which can be congenital or
acquired specially after parotid surgery and can persist for life.
The symptoms of Frey's syndrome are redness and sweating on the cheek area adjacent to the
ear. They can appear when the affected person eats, sees, dreams, thinks about or talks about
certain kinds of food which produce strong salivation. Observing sweating in the region after
eating a lemon wedge may be diagnostic.
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• Xrays of nutrient canals, inverted Y around pm and k9 max (max sinus and
zygomatic process I think), periapical cyst around max lat, perfectly round cyst on pan
right above pm( in mosby),
• Tons of perio from tx planning, to implants (implants were hit heavy), GTP, BMP,
furcations, how to treat, if it’s a deep c2 furcation what are some acceptable tx (I put
resection as least desirable),
• Implant success, what factors will help implant osseointegrate and what factors
will not let it osseoimtegrate Note Mosby pg 260. Titanium implants have a layer of
titanium oxidide on their surface that is responsible for osseointegration.
• What is more stable an single implant of 4mm or 5mm or a double implant ligated
together for a total of 4mm and 5mm ( I put double implant ligated for a combo of
4mm because it sounded like it would not be as stable as a single implant being 4mm
thick. The other one would be 2 2mm implants ligated together.
• 30% fat allowed for daily value
• What is the most a toothbrush and dental floss can peretrate into sulcus. I put
1mm and 1mm. the other choices were 2-3mm. I thought that was too much
• ID a CT scan. Look at MRI example just to be sure. My picture was of a CT image
of the brain and skull.
• Nutrient canals! I had to id 3 of them on pics
• Diabetic patient
• What could precipitate a seizure- hypoglycemia, hypokalemia, hypocalcemia,
hyponuternia, one other hypo-
• ANUG, NUG,
• Know differences of endo dx hard. I had at least 15 questions
• What Kennedys class does not have mods =(IV)
• SS crown prep for pedo, know what you need to do and guides etc (Note: 1.)
occlusal reduction 2.) M and D interproximal reduction 3.) Round off sharp edges 4.)
select crown 5.) adjust crown by crimping and checking occlusion. 6.) cement with
polycarboxylate cement.7.) remove excess cement 8.) check the area again. 9.) Follow
up where you will check occlusion and margins as well as gingiva margin.
• What pedo molar are you concerned with likely pulp horn exposure. Distobuccal ,
mesiobuccal, 1m or 2m (4 choices)
• Pulp tests. What you see to differentiate b/w acute perio abcess and acute
periodontitis, how to differentiate b/w chronic and periodontal abscesses
• Know perio and endo abscesses and what pulp test you would do to dx them.
• Tx planning for perio and implants
• Value, hue, chroma-know what they are and what they depict. Ie “saturation”
would be mean value. Hue- color chroma is saturation of hue and value is lightness and
darkness
• How to change the color. I put bleach the other teeth to match the cown.
• Few operative questions.15max- just the basics, outline, gold, cad/cam, inlay only
(the remembered ? are good)
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• Oral path like what is this pic most assoc with, know basics like what does each
mean and assoc with. Not too in depth, but deffinatley know what it is
• Peutz-jeughers, ewing, langerhans, histiocytosis x(what would you see if a child
was take a long time of antibiotics, also pt taking long history of corticosteroids what
would they be predisposed too. Also pt is on chemo what are they predisposed to. I
put candidiasis cause of opportunistic organism.
• Dude, leavell and Rivera had a combined I would say 60 questions. They are easy,
but definitely review. Mosbys has good explanation
• Cohort ( prospective- general population is followed through time to see who
develops the disease and then various exposure factors that affected the group are
evaluated. Cohort Retrospective- used to evaluate the effect that a specific exposure
has had on a population., Cross-sectional- a study in which the health conditions of a
group ar assumed to be a sample of a particular populatin assessed at one time., chi-
square- measures the association btw two categorical variables.It is used when the
data is expressed as counts or proportions.Mosby pg 210-214
• Code of Ethics-5questions. Benefiance, Nonmalfience- which one does keeping up
with skills and knowing when to refer fall under
1. Autonomy- self governance; protect the patients confidentiality- safe guarding patients privacy
1.patient involvement (options on alternatives)
2. confidentiality of patient records
3. Informed consent
2. Non Malificience- do no harm
1. keeping knowledge and skills current

2. knowing when to refer
3. staying up to date with CEs
4. second opinions
5. auxillary personnel
6. personal impairment- use of controlled substances which impair the doctor to practice
7. post-exposure to blood born pathogens- must inform the patient of possible exposure and must provide access
to care
8. patient abandonment- must give patient adequate notice and opportunity for patient to go elsewhere
9. dentist should avoid interpersonal relationships with patient
3. Beneficence- DO GOOD
1. Timely delivery of dental care

2. Community service
3. Reporting abuse and neglect
4. Justice- fairness; dentist has duty to treat people fairly without prejudice
1. Must provide care to patients with blood-borne pathogens

2. Dentist must make arrangements for emergency care for patients of record
3. Justifiable criticism
4. Expert testimony
5. Veracity- truthfulness. Respecting the position of trust
1. Dental amalgam and other restorative materials- removing amalgam from non-allergic patients and replacing
with composites because amalgam is “bad” is improper and unethical.
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2. Advertising
3. Dentists leaving practice- have up to 1 year to leave previous practitioners name on the practice until complete
transition
4. Representation of fees- overbilling, copayment, treatment dates- altering dates for insurance purpose
• I had 3 calculation question, how much MAX carpules lido 3% can you give a 40kg
child.
• How many carpules 2% lido 1:100,000 epi can you give chil?
• Had to figure how many grams of anesthetic you could give child. (something
knowing that anesth would be 4.4 or something like that. Pedo section in mosby pg
182 states that the MAX RECC. Dose of anesthetic for 2%lidocaine 1:100,000w/ epi, 3%
mepivacaine, and 4% prilocaine with 1:200,000 epi is 4.4 mg/kg
• How to tx plan Alzheimer pt, do you do what he would have wanted before end
stage or do you just do palliative keeping out of pain and disease (I put that one)
• If an 84 yr old man comes in for new appt with his son. Son had a paper stating a
legal guardian (not son) who can make decision. This was weird cause I didn’t know if
the old man was senile or independent. I put legal guardian must be there, but I think
they should have said that the pt is dependent on legal guardian.
• Remembered stuff was good
• Know about denture processing and resins and evaporation and temperatures.
They wanted to know something about shirking and leftover resin.
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• F,v, T, C, all sounds. >---- This is the labiodental sounds.These sound help
determine the position of the incisal edges of the maxillary anterior teeth Look in
mosby pg 323a
• S, z, ch, sh, and j are the lingualveolar sounds. The sound help to determine the
vertical length and overlap of the anterior teeth.
• This, That, Those, are linguodental sounds. If the tip of the tongue is not visible the
teeth are most likely too far anterior except in CLASS II malocclusion. If the tongue
sticks out the teeth are too far lingually
• B,P, M, sounds are made by the contacts of the lips
• Lisp, whistle, and what sound would that be the patient has a narrow palatal vault
• Denture should IDEALLY cover entire or 1/3 or 2/3 retromolar pad. I put entire
even though its 2/3 (wasn’t a choice) thought 1/3 too little
• Porpanolol what it is and what is it used for? It is the prototype of nonselective B

blockers. The effct of B blockers is lower BP, reduce angina, reduce rish afer myocardial
infarction, reduce heart rate and force, antiarrhythmic effect, cause hypoglycemia in
diabetics, and lower intraocular pressure. Mosby pg 277- 278
• Pharm was basic, what do you give as antidote for overdose of sedative (not
naloxone)- I think it was diphenhydramine. Something dr Williams said a couple times
in class Note sedative drugs are benzodiazapiene- antidote is flumanazil, and
barbituates don’t quote un quote have one. Naloxone is the antidote to opiods.
• Preg pt hypotension- lay on left side, right hip in air. To protect crushing Inferior
Vena Cava.
• Pt with moderate emphysema, stops often to catch breath- position least tolerate-
I put horizontal recline
• Composites- basic stuff pros cons contra, indications
• What was added to zinc oxide eugenol to make IRM- Poly methy mecrylate
• Glass ionomer mixed with polyacrylic acid to form a cemen of glass particles
surrounded by a matrix of fluoride elements. Dental Secrets pg 158 #109
• Have your articulator and want to adjust the VDO and condylar incline, where is
the pin? On the table, raised off the table,
• Arcon vs nonarcon- which one will let you do something with mounting casts??
Look at mosbys for explanationpg 319. The Acron is used to mount mandibular cast.
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The condyles are in the lower membrane and the fossa are in the upper membrane.
Nonarcon provide easier control for seeting teeth for completed and partial dentures
• Open impression technique. Whats its used for and the adv for doing so. I put
something like better detail
• CD pt with “abused” tissues. You want to make new dentures, what do you do
first. I put surgically remove “abused” tissues.
• Space you are concerned with extraction on 3 molar max. I put infratemporal
fossa. Though max sinus was too anterior
Impacted maxillary third molars are occasionally displaced into the maxillary sinus (from
which they are removed via a Caldwell-Luc approach). But if displacement occurs, it is
more commonly into the infratemporal space. During elevation of the tooth, the elevator
may force the tooth posteriorly through the periosteum into the infratemporal fossa. The
tooth is usually lateral to the lateral pterygoid plate and inferior to the lateral pterygoid
muscle. I
11.3.2).
• Infection from PM goes into buccal space
• If trying to take max impression and access buccal space, what muscle would be in
the way. I put masseter, maybe obicularis oris. Other choices were med and lat
ptyerygoid
• Pedo mgmt- sedations, behavioral mgmt
• Implant osseointegration Note Length of time it takes implants to osseointegrate
within the arches- mandibular anterior -4 months, mandibular posterior- 5 months,
max anterior and posterior is 6 months
• Main cell type in Established lesion (mast, tcell etc)- PLASMA CELLS
Over time, the established lesion evolves, characterized by a predominance of plasma cells
and B lymphocytes and probably in conjunction with the creation of a small gingival pocket
lined with a pocket epithelium.47 The B cells found in the established lesion are
predominantly of the immunoglobulin G1 (IgG1) and G3 (IgG3) subclasses.
Company, 072006. 21.4).
• Where do you put a suture for a laceration on the lip to inside of mouth first? I
put line the lip up then proceed
If a patient has a laceration of the tongue or lip that involves muscle, resorbable sutures
should be placed to close the muscle layer or layers, after which the mucosa is sutured.
Minor salivary gland tissue protruding into a wound can be judiciously trimmed to allow
for a more favorable closure.
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In lacerations extending through the entire thickness of the lip, a triple-layered closure is
necessary (Fig. 23-4). If the laceration involves the vermilion border, the first suture
placed should be at the mucocutaneous junction. Perfect alignment of this junction
of skin and mucosa is imperative, or it can result in a noticeable deformity that can
be seen from a distance.
23.1.3.4).
• Pt comes in with pain, what do you do first? Remove pain, comp tx plan and exam,
adv carious lesions. Also was comp tx plan first then remove pain. But I put remove
pain first cause that’s what we were taught in school, soooooo I hope they are right..lol
• What can cause hypoglycemia and thyroid issues. Read up on thyroid storm and
what you will see
• • If a pt is hypothyroid they will feel cold to touch or hypotension. I put cold to touch.
Note: Hypothryoidism is assoicted with Hashmito’s disease. In children its cretinism and
in adults its myxedema. For dental care for the myxedema patient, it is important not to
prescribe opiates for palliative tx bc the patient may be unusually sensitive and die from
normal doses of opiates. (Dental Secrets pg 33)Symptoms include constipation, cold to
touch, depression, fatigue, heavier menstrual periods, joint or muscle pain, paleness or
dry skin, thin brittle hair or fingernails, weakness, or unintentional weight gain.
Hyperthyroidism is associated with Hyperthyroidism is associated with Grave’s disease.
The symptoms in the patient is difficulty concentrating, fatigue, frequent bowel
movements, Goiter(enlarged thyroid) heat, weight loss, restlessness.
• INR values and when it is ok to do oral surgery- 3 or less Being more sensitive to
cold
• Pt on warfarin, when can you do OS- 2 or 3 days
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The INR is used to gauge the anticoagulant action of warfarin. Most physicians will
allow the INR to drop to about 2.0 during the perioperative period, which usually allows
sufficient coagulation for safe surgery. Patients should stop taking warfarin 2 or 3
days before the planned surgery. On the morning of surgery, the INR value should be
checked; if it is between 2 and 3 INR, routine oral surgery can be performed. If the PT is
still greater than 3 INR, surgery should be delayed until the PT approaches 3 INR.
of surgery
• Fluoride does what to bacteria, what to tooth structure, and anything to collagen?
I don’t think it does anything to collagen as far as reinforcement
Fluoride works primarily by topical effects to prevent and reverse the caries process, whether
in enamel, cementum, or dentin. Low concentrations of topical fluoride inhibit
demineralization, enhance remineralization, and inhibit the enzyme activity in bacteria by
acidifying the cells.
Company, 072006. 50.9).
• Leave a small carious lesion in by accident and place a sealant over it. What will
happen? Arrest decay or continue lesion.
• Primary Endo infection (Mosby pg 16) strict anerobes predominant.

Gram (-) anaerobic- Porphyromonas species and Bacteriodes
melaninogeica are most common. Gram (+) anaerobic Actinomyces is gram on
root caries
• Where to place a gingival margin for ant max incisor pfm. At the crest of gingiva or
between gingival crest and alveolar crest. I put the latter because it was the only one
that hinted at subgingival finish line. Mosby pg 331 states margins should ideally be
placed supragingival or at the gingival crest whenever possible for maintenance care,
ease of preparation and impression. The fixed book states on pg 244 Subgingival
margins may be indicated for esthetic reasons, particularly when the patient has a high
lip line and when the use of a metal collar labial margin is contemplated.
• Pic of nicotine stomatits or denture stomatits

• Steven Johnson syndrome is a severe form of EM with extensive involvement of
the mucos membrane of the oral cavity, eyes,genitalia, and occaisionaly upper GI and
Respiratory tract. Typical Target Lesions may be seen on the skin (dental secrets pg 55)
EM- Mosby pg 108 it is a self-limiting hypesensitivity rxn that affects skin/mucosa. IT is
caused by 1.) herpes simplex virus 2.) mycoplasma pneumonia 3.) medications. Pt has
targetoid lesions and oral ulcerations. It has a minor form which is associated
secondary to herpes hypersensitivity and Major form is Steven Johnson syndrome
which is ofter triggerd by drugs and 3.Toxic epidermal necrolysis which is seen in older
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patients for tx in hospital burn unit., pemphigoid mosby pg 110 – autoimmune disease.
autoantibodies attack the jxn btw epithelium and connective tissue leading to the
formation of subepitheial bulla. Oral lesions usually present as desquamative gingivitis.
Tx is steroid. Histology has suprabasilar vesicle without acantholyis (Board Buster pg
246) Pemphigus (BB pg 246) autoimmune. Autoantibodies attack desmosomal plaque
of the epithelial cells leading to acantholysis and supraepithelial bulla. Positive
nokolsky sign. Tx with corticosteroids or other immunosuppressive drugs.
1. Xerostomia can lead to = lymphoma

2. Most congenitally impacted tooth: max canine
3. Most congenitally missing tooth: max third, mand 3m man Pm , max li , max 2pm,
Primary li , Most impacted mand 1st primary
4. Know how to treat ANUG
The use of antibiotics varies widely in the management of ANUG but dental prophylaxis is
almost always prescribed. A typical clinical treatment includes: (1) dental scaling and
prohylaxis with local anesthesia, (2) chlorhexidine rinses, (3) metronidazole or tetracyline,
(4) adequate sleep, and (5) reduced smoking. Typically pain symptoms subside within 48
hours of treatment.
7.2.1).
5. Signs of neurofibratosis
Syndrome of neurofibromatosis 1
(a) Multiple neurofibromas.
(b) Six or more café-au-lait macules (each > 1.5 cm diameter).
(c) Axillary freckling (Crowe's sign), and iris freckling (Lisch spots).
(d) Malignant transformation of neurofibromas in 5% to 15% of patients.
6. Found on floor of mouth, bluish swelling- ranula
7. When to use base metal=bridge vs. `high metal=single unit crown (Fixed book pages 599-
609- Concept : An alloy with a higher modulus of elasticity has greater stiffness or rigidity for
elastic deformation. For the fabrication of a long-span FDP, an alloy with a relatively high
modulus of elasticity to reduce the amont of bending deflection under loading is preferred,
because excessive flexure can cause fracture of brittle porcelain. One benefit of predominatly
based alloy is their value of modulus of elasticity are much higher than those of noble metal
alloys. Therefore it is used for long span FPD. The difference btw high noble and noble alloy is
the cost. Either or is used for single crown.
76
** Green discoloration of a crown is due to silver but some green discoloration has been seemed
to be eliminated by substituting potassium ions for sodium ions s. The larger potassium ions
impede the diffuson of silver into the porcelain.
** FYI High noble has 60% noble metal content and > 40% gold
Noble metal has 25% noble metal content and no gold
Predominantly base has <25% noble metal content and no gold
Fixed Book pg 606
8. Affects basement membrane = pemphigoid
Mucous membrane pemphigoid
1. An autoimmune disease of mucous membranes; antibodies directed against

basement membrane antigens (Laminin 5, BP180, others).
2. Clinical features
a. Affects older adults, typically over the age of 50 years.
b. Presents as multiple, painful ulcers preceded by bullae which form below the
epithelium at the basement membrane.
c. Oral lesions may be found in any region, especially and sometimes exclusively in
the attached gingival; ocular lesions can lead to blindness if untreated.
d. Positive Nikolsky sign may be present.
e. Persistent disease.
3. Patients are managed with corticosteroids
9. Primary 2nd molar lost and 2nd premolar 1/3 root formed how is it effected:
You need 2/3 of the root formed for eruption through bone and ¾ through gingival.
10. Main complication during RCT- ledge formation, perforation, instrument separation,
vertical root fracture
11. IgG does what: seen in pemphigoid/pemphigus
Neutrophils then migrate through the endothelium (diapedesis) and ingest the
bacteria. IgG and C3b are opsonins, which enhance ingestion of the bacteria. There
are receptors for the heavy chain of IgG and for C3b on the surface of the neutrophils
(Levinson, Warren. Medical Microbiology & Immunology, 8th Edition. McGraw-Hill Medical
Publishing, 062004. 8.3.1).
12. How do u treat external resorption

77
When the cause of external root resorption is known, the treatment is usually to remove
the etiologic factors. This may mean cessation of excessive mechanical forces, removal
of an adjacent impacted tooth, or eradication of a cyst, tumor, or source of
inflammation. If the area of resorption is broad and on an accessible surface of the root
(such as at the cervical location), curettage of the defect and the placement of a
restoration usually stops the process.
22.2.4.2.5).
13. Which of the following is a schedule II drug

Oxycodone + acetaminophen (Percocet, Tylox) schedule 2
Oxycodone + aspirin (Percodan) schedule 2
Hydrocodone –III
Codeine/ acetaminophen/propoxyphene-III
Schedule I Controlled Substances

Substances in this schedule have a high potential for abuse, have no currently accepted medical use
in treatment in the United States, and there is a lack of accepted safety for use of the drug or other
substance under medical supervision.
Some examples of substances listed in schedule I are: heroin, lysergic acid diethylamide (LSD),
marijuana (cannabis), peyote, methaqualone, and 3,4-methylenedioxymethamphetamine (“ecstasy”).
Schedule II Controlled Substances

Substances in this schedule have a high potential for abuse which may lead to severe psychological
or physical dependence.
Examples of single entity schedule II narcotics include morphine and opium. Other schedule II
narcotic substances and their common name brand products include: hydromorphone (Dilaudid®),
methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®), and fentanyl
(Sublimaze® or Duragesic®).
Examples of schedule II stimulants include: amphetamine (Dexedrine®, Adderall®),

methamphetamine (Desoxyn®), and methylphenidate (Ritalin®). Other schedule II substances
include: cocaine, amobarbital, glutethimide, and pentobarbital.
Schedule III Controlled Substances

Substances in this schedule have a potential for abuse less than substances in schedules I or II and
abuse may lead to moderate or low physical dependence or high psychological dependence.
Examples of schedule III narcotics include combination products containing less than 15 milligrams
of hydrocodone per dosage unit (Vicodin®) and products containing not more than 90 milligrams of
codeine per dosage unit (Tylenol with codeine®). Also included are buprenorphine products
(Suboxone® and Subutex®) used to treat opioid addiction.  E xam ples of schedule III non
-narcotics
include benzphetamine (Didrex®), phendimetrazine, ketamine, and anabolic steroids such as
oxandrolone (Oxandrin®).
Schedule IV Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances in schedule III.
78
An example of a schedule IV narcotic is propoxyphene (Darvon® and Darvocet-N 100®).
Other schedule IV substances include: alprazolam (Xanax®), clonazepam (Klonopin®), clorazepate

(Tranxene®), diazepam (Valium®), lorazepam (Ativan®), midazolam (Versed®), temazepam
(Restoril®), and triazolam (Halcion®).
Schedule V Controlled Substances

Substances in this schedule have a low potential for abuse relative to substances listed in schedule
IV and consist primarily of preparations containing limited quantities of certain narcotics. These are
generally used for antitussive, antidiarrheal, and analgesic purposes.
Examples include cough preparations containing not more than 200 milligrams of codeine per
100 milliliters or per 100 grams (Robitussin AC® and Phenergan with Codeine®).
14. Transdermal patch: fentanyl ( opiod)
Transdermal fentanyl patches are approved for use with sustained pain. The opioid
permeates the skin, and a “depot” is established in the stratum corneum layer.
15. Widending of pdl space: osteosarcoma and scleroderma
16. Reason for dual cured resin
Systems used to cement restorations often use both photo- and chemical-initiation (dual
curing) because it is often difficult to expose regions of the material to sufficient light
to reach the maximum degree of conversion and thus maximum strength. With
these dual-curing materials, maximum degrees of conversion of 80% have been
reported.
022006. 7.2.1.1).
17. Facial, lingual , mesial defect, is it horizontal, angular, crater or hemiseptal and how do u
treat bone graft
18. lesion on tongue the same exact lesion on palate what is it? Candadiasis, syphilis, lichen
planus
19. elementary school fluorid program, how often and what do u give them
Numerous studies have demonstrated that dental caries can be reduced by

approximately 25% to 28% by rinsing daily or weekly in school with dilute solutions of
fluoride. Rinsing weekly with a 0.2% neutral sodium fluoride (NaF) solution
requires fewer supplies and less time than daily rinsing with a 0.05% NaF solution
20. Caucasian with cleft lip=1/700
21. why does composite fail in primary teeth
(1) Placement of composite resin is highly technique sensitive, and the final restoration is
very negatively affected by any moisture contamination. If a dry field cannot be
maintained, resin-based composite is probably the worst choice of restorative material.
79
However, a resin-modified ionomer can tolerate some moisture and might be used as an
aesthetic material in such a situation. (
Because primary enamel is approximately one half the thickness of permanent enamel,
retention gained solely from acid etching will be similarly reduced, and therefore it is still
prudent to include some minor mechanical retention in the preparations.
042005. 21.4.5.2).
042005. 21.4.5.2).
22. construction overdenture what is least concern
23. pt taking corticosteroid, u give epi what is ur concern= hypertentions
Diseases of the adrenal cortex may cause adrenal insufficiency. Symptoms of primary
adrenal insufficiency include weakness, weight loss, fatigue, and hyperpigmentation of
skin and mucous membranes. However, the most common cause of adrenal insufficiency
is chronic therapeutic corticosteroid administration (secondary adrenal insufficiency).
Often, patients who regularly take corticosteroids have moon facies, buffalo humps,
and thin, translucent skin. Their inability to increase endogenous corticosteroid levels
in response to physiologic stress may cause them to become hypotensive, syncopal,
nauseated, and feverish during complex, prolonged surgery.
1.3.5.2).
24. NUG= interdental papilla (Blounting
The necrotizing periodontal diseases. The clinical appearance of the necrotizing

diseases is unique among the periodontal diseases because of the characteristic ulceration
and necrosis of the marginal gingival. This may be covered by a yellowish white or
grayish slough or pseudomembrane and have blunting of the papillae, bleeding on
provocation or spontaneous bleeding, pain, and fetid breath. The disease may present
as necrotizing ulcerative gingivitis (NUG; no attachment loss) or necrotizing ulcerative
periodontitis (NUP; with attachment and bone loss). Predisposing factors may be
stress, smoking, and immunosuppression such as seen with human immunodeficiency
virus (HIV) infection.
Treatment for both NUG and NUP consists of débridement of necrotic soft and hard
tissue, antibiotic therapy with metronidazole or tetracycline (500 mg four times a day)
for a week, and a follow-up with scaling and débridement
Decker, 012003. 20.3.2.5.3.1).
25. Post palatal seal, know all considerations
80
26. Most common tooth for dry socket: mandibular third molars
The occurrence of a dry socket after a routine tooth extraction is rare (2% of extractions),
but it is frequent after the removal of impacted mandibular third molars (20% of extractions
in some series).
11.9.3).
27. How does LA work
The membrane expansion theory states that local anesthetic molecules diffuse to
hydrophobic regions of excitable membranes, producing a general disturbance of the bulk
membrane structure, expanding some critical region(s) in the membrane, and preventing an
increase in the permeability to sodium ions.
The specific receptor theory, the most favored today, proposes that local anesthetics act
by binding to specific receptors on the sodium channel.24 The action of the drug is
direct, not mediated by some change in the general properties of the cell membrane. Both
biochemical and electrophysiological studies have indicated that a specific receptor site for
local anesthetic agents exists in the sodium channel either on its external surface or on the
internal axoplasmic surface.25,26 Once the local anesthetic has gained access to the
receptors, permeability to sodium ions is decreased or eliminated and nerve
conduction is interrupted.
(Malamed, Stanley. Handbook of Local Anesthesia, 5th Edition. Mosby, 072004. 1.3.1).
28. What dosen’t require premedication –refer to 1997 prophylaxis guidelines
29. With institutionalized elderly patient what is not concern
Many institutionalized persons have poor oral health.71 It is often conjectured that this is
because residents of institutions are likely to have more severe disabilities than those who are
disabled but live in the community, or that the oral care of institutionalized populations is
of poorer quality than those not institutionalized. A recent study examined the oral-
hygiene habits, gingival bleeding, food diaries, and oral microorganisms of moderately or
severely mentally retarded adults before and up to 21 months after relocating into the
community from an institutional setting.72 Of the oral-health parameters measured, none
worsened and some improved, demonstrating that the institutional environment does place
the compromised patient at greater risk for poor oral health.
Even the totally disabled or comatose patient who is no longer taking food by mouth
but is being nourished via a gastric tube or intravenous line is subject to intra-oral
plaque and calculus accumulation and should have daily oral-hygiene procedures
performed. Ironically, it has been shown that, although plaque accumulates at about
the same rate in tube-fed and normally fed patients, calculus accumulates faster in
tube-fed patients.
81
30. Pic looked like mucocele and asked what can cause it caused by traumatic severance of
salivary excretory duct. It is common in lower lip and buccal mucosa. It is often bluish in color
31. Minimum Distance between implants = 3 mm
32. Minimum distance between implant and nerve = 1mm (implant to adjacent tooth) 2mm
from implant to all vital nerves except for mental nerve which is 5 mm and all bony
structures (1 mm- ie buccal plate, lingual plate, maxillary sinus) and AVOID MIDLINE
33. Best flap for esthetics: papilla preserving flap
Anterior: #1) papilla preserving flap #2) sulcular incision flap #3) modified widman
Posterior: #1) papilla preserving flap#2) sulcular incision flap #3) modified widman
Therapy for Moderate to Severe Periodontitis in Anterior Sector
The papilla preservation flap can be used for both purposes and also offers a better
postoperative result, with less recession and reduced soft tissue crater formation
interproximally. 14The papilla preservation flap is the first choice when a surgical
approach is needed.
When the teeth are too close interproximally, the papilla preservation technique may not
be feasible, and a technique that splits the papilla must be used. The sulcular incision
flap offers good esthetic results and is the next choice.
When esthetics are not the primary consideration, the modified Widman flap can be
chosen. This technique uses an internal bevel incision about 1 to 2 mm from the
gingival margin without thinning the flap and may result in some minor recession.
Infrequently, bone contouring may be needed despite the resultant root exposure. The
technique of choice is the apically displaced flap with bone contouring.
Therapy for Moderate to Severe Periodontitis in Posterior Area
Treatment for premolars and molars usually poses no esthetic problem but frequently
involves difficult accessibility. Bone defects occur more often in the posterior than the
anterior sector, and root morphologic features, particularly in relation to furcations, may
offer unsurmountable problems for instrumentation in a close field. Therefore, surgery is
frequently indicated in the posterior region.
The purpose of surgery in the posterior area is either enhanced accessibility or the
need for definitive pocket reduction requiring osseous surgery. Accessibility can be
obtained by either the undisplaced or the apically displaced flap.
Most patients with moderate to severe periodontitis have developed osseous defects that
require some degree of osseous remodeling or reconstructive procedures. When osseous
defects amenable to reconstruction are present, the papilla preservation flap is the
82
technique of choice because it better protects the interproximal areas where defects
are frequently present. Second and third choices are the sulcular flap and the modified
Widman flap, maintaining as much of the papilla as possible.
When osseous defects with no possibility of reconstruction are present, such as

interdental craters, the technique of choice is the flap with osseous contouring.
Company, 072006. 59.6.2.4).
34. Syphilis mistaken for = scc
35. Associated with k9=AOT
Adenomatoid odontogenic tumors are frequently asymptomatic and are discovered

during the course of a routine radiographic examination or when films are made to
determine why a tooth has not erupted. Larger lesions cause a painless expansion of the
bone. In about 75% of cases, the tumor appears as a circumscribed, unilocular
radiolucency that involves the crown of an unerupted tooth, most often a canine.
This follicular type of adenomatoid odontogenic tumor may be impossible to differentiate
radiographically from the more common dentigerous cyst. The radiolucency associated
with the follicular type of adenomatoid odontogenic tumor sometimes extends apically
along the root past the cementoenamel junction. This feature may help to distinguish an
adenomatoid odontogenic tumor from a dentigerous cyst
062008. 15.3.4.1).
36. How to treat class 3 furcation
Isolated deep class II furcations may respond to flap procedures with osteoplasty and
odontoplasty
37. Narcotics to u give pregnant lady: propoxyphene/talwin (both are group C), however,
Acetaminophen is the drug of choice for pregnant pts.
Ideally, no drug should be administered during pregnancy, especially during the first
trimester. However, adhering to this rule is sometimes impossible. Most of the commonly
used drugs in dental practice can be given during pregnancy with relative safety, although
a few exceptions are notable.
The analgesic of choice during pregnancy is acetaminophen (category B). Aspirin

and nonsteroidal anti-inflammatory drugs convey risks for constriction of the ductus
arteriosus, as well as for postpartum hemorrhage and delayed labor (see Table 18-
3).39,40 The risk of these adverse events increases when agents are administered during
the third trimester. Risk also is more closely associated with prolonged administration,
high dosage, and selectively potent anti-inflammatory drugs, such as indomethacin.
Prolonged or high doses of opioids are associated with congenital abnormalities

and respiratory depression.41,42 For this reason, opioid-containing drugs should
generally be avoided.
83
Mosby, 072007. 18.2.4.1).
38. How do u test for acute periradicular periodontitis: percussion
Application of pressure by fingertip or tapping with the butt end of a mirror handle
can cause marked to excruciating pain. “Thickening” of periodontal ligament (PDL)
space may be a radiographic feature of AAP
Company, 012002. 3.6.1.2).
39. Pulp test on tooth with incomplete apex
Thermal testing is widely used with open apices but may be complicated by a lack of
neural development or by an exaggerated response caused by apprehension in a young
patient. No response to repeated thermal testing, as compared to a positive response in the
contralateral control tooth, may indicate the presence of a necrotic pulp; this can be
confirmed by other tests. A problem (with an open or closed apex) after a luxation injury
is that nerves may be damaged while the blood supply remains intact, and, therefore, the
pulp is healthy but unresponsive.
Company, 012002. 22.3.2.3).
40. Comp on post tooth what surface wears 1st –occlusal
41. All treat angina except
Nitrates, beta-blockers, calcium channel blockers, platelet aggregation inhibitors
(aspirin/plavix) are used to treat angina
The problem with angina is insufficient o2 to meet demands to the myocardium
Nitroglycerin; ( admin. Sublingual) increase oxygen supply to the heart by direct vasodilation of
smooth muscle
Propanolol: reduce oxygen demand by inhibiting chronotropic demands
Calcium channel blocker: deacrease o2 demands byreducing afterload
42. Scar on lip looks like mucocele do u want to biopsy, smear, excision, incision
43. Indication of class ii inlay
The indications for an inlay are virtually the same as for an amalgam restoration. The inlay
simply replaces missing tooth structure without doing anything to reinforce that which remains.
3
If the tooth requires protection from occlusal forces, the protection must be gained by the use
of some other type of restoration that incorporates a veneer of casting alloy over the occlusal
surface. 4 Inlays tend to wedge cusps apart, 5 and a lone-standing unsupported cusp is at risk of
fracture.
(Shillingburg, H.. Fundamentals of Fixed Prosthodontics, 3rd Edition. Quintessence Publishing

(IL), 011997. 12).
44. Palatal grooves most commonly found on which teeth? Molar, max incisior, canine, pm
84
45. Implant heat temp = 37 degrees celcius
Bone cell survival is very susceptible to heat. Eriksson has demonstrated that in rabbit,
bone temperature as low as 3° C above normal (40° C) can cause bone cell necrosis.49
Therefore a conscious effort is made to control temperature elevation every time a rotary
instrument is placed in contact with bone. At least 50 mL/min of cooled irrigation, such
as sterile physiologic saline, is used as a profuse irrigant and is a critical element to
reduce heat.35-37,50 Distilled water should not be used, as rapid cell death may occur in
this medium.51 Intravenous dextrose solution (D 5 W) also may be used, with the
clinical advantage of decreasing hand piece breakdown occurring from the effects of the
salt in a saline solution, although the surgical gloves often feel sticky near the conclusion
of the surgery
46. Most likely cause for implant failure? Heat, fracture, bone (or mobility)
47. Which antibiotic is used to treat infection from hospital vancomycin (fyi asprigilloss ass
wit nosicommal infe)
48. Palmar and platar pitting = Nevoid basil cell Papillon–Lefèvre syndrome- ( periodontitis
is also associated)
49. #30 has swelling facial to it, pulp test r normal , what is emergency tx? Incise and Drain,
curretage, debride canals
50. chelating agent = edta and inorganic
51. xray 4yr old u don’t see 2nd pm do you refer to pedo, close space , maintain space
52. concern of child with trauma, condylar hyper, facial asymmetry
53. bulimia= erosion of teeth (max lingual)
54. calcifacation seq: A-B-D-C-E in primary teeth and they occur in utero in the following
weeks 14-15-16-17-18
55. most prev disease= cleft lip/palate congent ial disorder most prevalient
56. with acromegaly = overgrowth of mandibular Ciii
57. when rpd continues to break? Occlusal trauma, poor design
Failure of an occlusal rest rarely results from a structural defect in the metal and rarely if ever
is caused by accidental distortion. Therefore the blame for such failure must often be
assumed by the dentist for not having provided sufficient space for the rest during
mouth preparations.
(Carr, Alan B.. McCracken's Removable Partial Prosthodontics, 11th Edition. Mosby, 072004.
22.2).
58. least material used in fixed impressions: irreversible hydrcolloid

59. cause allergic rxn with penicillin = cefelexin (1st generation cephalosporin pg 307- Mosby)
60. how to u measure interarch distance
measuring arch perimeter from the mesial of one first molar to the other, over the
contact points of posterior teeth and incisal edge of anteriors.
85
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006. 6.5.1.2.1).
61. HMO(aka capitation) = usual customary fee
62. What is synchondriasis related to
Histologically, a synchondrosis looks like a two-sided epiphyseal plate
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006. 2.6.2).
63. Purpose of crown lengthening
There are circumstances in which it may be desirable to have a longer clinical crown on a
tooth than is present. The lengthened tooth that results from this surgery should afford
better retention for any crown placed on it, with margin placement in an area of the tooth
more accessible for cleaning. If the band of attached gingiva is too narrow, it must be made
wider with a graft or an alternative restoration must be made for the tooth.

(IL), 011997. 16.2.10).
64. Person with missing teeth associated with = ectodermal dysplasia,
65. Recapping of needle = one handed , scoop tech,
66. Y when pt has 3rd degree burn doesen’t hurt but 1st degree burn does
Probably because the nerve endings are completely destroy in a 3rd degree burn which involves
the epidermis and dermis. Second degree would be more painful because if oly the epidermis is
destroy it will allow the nerve endings to come in contact with “outside environment” resulting
in great pain…
67. Pregnant patient = left side up

68. Sufonylureas , how it works
Sulfonylureas cause hypoglycemia by stimulating insulin release from pancreatic β cells. Sulfonylureas are a
class of antidiabetic drugs that are used in the management of diabetes mellitus type 2. MOA: close
potassium channels in cell membranes. Stimulate release of insulin from pancresas and increase the
sensitivity of target organs to insulin.
Examples: tolbutamide, acetohexamide,tolazmide,chlorpropamide,glyburide,glipizide, and glimepiride.
Adverse effects: hypoglycemia, GI upset, vertigo and edema,sodium retention. Mosby pg 302
Onset &Duration of action in the various types of insulins is the difference .
Sulfoneria are indicated for type II
Basis of Therapeutics, 11th Edition.

(Brunton, Laurence. Goodman & Gilman's the Pharmacological
McGraw-Hill Professional Publishing, 092005. 60.2.1.1).
86
69. Which is contraindicated for RCT tx- nonrestorable tooth

70. Pain to ear= man molars
71. MOD rest, pain on eating = crack tooth syndrome
72. Porcelain turn green = silver Ag Arguntum
73. Allergy to metal = nickel which is seen in RPD. Females more prone to having allergy
74. Test tooth with crown on it- percussion
When other tests are inconclusive or cannot be used and a necrotic pulp is suspected,
dentin stimulation with a test cavity is helpful. For example, a tooth with a porcelain-
fused-to-metal crown often cannot be tested accurately by standard thermal or electrical
tests. After careful subjective examination and an explanation of the nature of the test to
the patient, preparation without anesthesia is done with a small, sharp bur. With a
vital pulp, the surface of the restoration or the enamel can be penetrated without
too much discomfort. If the pulp is vital, there will be a sudden sensation of pain
when dentin is reached. In contrast, if discomfort or pain is absent, the pulp is
probably necrotic; an access preparation has already been started and the
procedure may be continued.
Company, 032008. 5.3.4.5.1).
75. Purpose of dowel
A post usually made of metal that is fitted into a prepared root canal of a tooth. A
dowel is combined with an artificial crown or core to provide the retention and
resistance for a crown

(IL), 011997. 13.5.1).
76. Most common reason to redo compo resto: probably shade !! or anterior esthetics
77. Pfm, discoloration around margin- cement polymerization
78. Question about headlighting
any obtrusive bulge areas must be flattened to avoid "headlight" show-through of the
underlying tooth color or opaque-bonding resin.
79. What is used in crosslinking with benzomethyl-acrylate: methyl methacrylate(monomer) use

PMMA (KiM)
80. Some led light wont cure resin because it outside range of light? True or not true
Most recently developed are the LED curing units. These units have a number of
advantages compared to other curing units, including a wavelength spectrum emission
that is closely matched to camphorquinone. In addition, these units are more energy
efficient, allowing them to be battery operated. The diodes have a life span that is
approximately 1,000 times longer than the typical halogen bulb. While the earlier
versions of LED curing units provided inadequate irradiance, the newer generation has
87
overcome this deficiency. About the only disadvantage to these units is their narrow
wavelength spectrum, limiting their usefulness in curing any materials that do not use
camphorquinone as the photoinitiator.
The practical consequence is that curing depth is limited to 2 to 3 mm unless excessively

long exposure times are used, regardless of lamp intensity.
81. Patient taking albuterol must have: asthma (B2 receptor)

82. Disadvantage of polyether: hard (high modulus of elasticity = high rigidity)
The impression material exhibits accuracy on par with, or somewhat superior to, that of other
elastomers. It has excellent dimensional stability even when pouring is delayed for
prolonged periods of time. 48,50,74 It is accurate when poured 1 week after removal from
the mouth. 62 Polyether has an affinity for water, making it hydrophilic (advantage).
Impressions should not be stored in a humidor or moist environment. The material is stiff,
and undercuts must be blocked out. Its resistance to tearing upon removal is roughly equal
to that of silicone and less than that of polysulfide. 73 It is somewhat brittle.

(IL), 011997. 17.7).
83. What do u do to close diasterma
The best approach, however, is to do nothing until the permanent canines erupt
(unless crowding or the appearance of the teeth becomes a major issue). If the
diastema does not close spontaneously at that time, an appliance can be used to move the
teeth together, and a frenectomy should be considered then if there is excessive tissue
bunched up in the midline. Early frenectomy should be avoided.
A small but unesthetic diastema (2 mm or less) can be closed in the early mixed
dentition by tipping the central incisors together. A maxillary removable appliance
with clasps, fingersprings, and possibly an anterior bow will successfully complete
this type of treatment.
A diastema greater than 2 mm is unlikely to close spontaneously. In most instances,

closing a large unesthetic diastema requires bodily repositioning of the central incisors to
maintain proper inclinations of the teeth. Mesial root movement also provides more space
for the eruption of the lateral incisors and canines. When the situation demands bodily
mesiodistal movement, an anterior segmental archwire from central to central incisor
or the classic 2 × 4 appliance can be quite satisfactory. Initial alignment of the incisors
with a flexible wire is required. Then a stiffer archwire can be employed as the teeth slide
together (18 mil round or 16 × 22 mil steel are good choices during the space closure).
The force to move the incisors together can be provided by an elastomeric chain tying
these teeth together, or by a coil spring compressed over the archwire between the first
molar and lateral incisors. The diastema closure is more predictable if only mesiodistal
movement is required. If protruding incisors are to be retracted as the space closes,
careful attention to the posterior anchorage is required.
88
There are two possible orthodontic techniques: a partial fixed appliance, typically with
bonded brackets on the maxillary incisors and a bonded tube on the first molars for
additional anchorage control; or a sequence of clear aligners. With a fixed appliance,
initial alignment is carried out using a light wire such as 16 mil A-NiTi or 17.5 mil
braided steel. This wire is replaced, after the teeth are aligned, with a 16 or 18 mil round
steel wire along which the teeth are repositioned using elastomeric modules or coil
springs. There is always a tendency for the space to reopen after any degree of diastema
closure. Bonding a flexible wire on the lingual of the incisors as a semi-permanent
retainer is recommended.
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006. 12.6.1.2).
84. Trisomy 21 associated with midface deformity

85. Which is associated with dentigenesis imperfecta = obliteration of pulp, bulbous crown,
cervical constriction, osteogenesis imperfecta, blue sclera
86. Said they have disease but they really don’t = false positive
Munchausen syndrome by proxy is a condition in which a person, usually a parent,

presents factitious symptoms and illnesses in a child, which may result in extensive testing
and/or hospitalizations.
Examples of emotional abuse include denial of affection, isolation, extreme threats, and
corruption. A parent who knowingly and willingly does not seek care for a child who has pain,
infection, or inadequate function is guilty of neglect.
87. Class V on k9 how do u bevel incisal and cervical margin
88. Osteogenesis linked to DI- true

89. How soon after bleaching can u do a restoration: 2-3 weeks + is optimal
3 or more weeks d.secrets p.168 (One wK)
90. Which antibiotics treats anaerobic bacteria
Metronidazole or clindamycin are both effective for aneorobes
91. What do u use if patient is taking Coumadin (warfarin)
Must have a PT test done or an INR (more common now) 24 hrs before surgery and value is 2-3
92. Most common cause of cardiac failure in kids- respiratory disease
93. X ray used to diagnose horizontal x-ray if hortizontal bone loss BW
94. Antifungal used to treat HIV induced candidiasis
Systemic therapy includes the use of any one of these three: ketoconazole, itraconazole,
and fluconazole. Fluconazole and amphotericin B may be used intravenously for the
treatment of the resistant lesions of CMC and systemic candidiasis. Fluconazole therapy
for oral candidiasis associated with HIV infection often results in the development of
resistance to fluconazole. Itraconazole can be substituted for fluconazole in resistant
patients, but fluconazole is still the mainstay of therapy for HIV-associated
candidiasis.
89
Decker, 012003. 5.3.2.8).
95. Widening of pdl- Related to disease

Osteosarcoma and scleroderma, ortho all have widening of PDL
96. How to evaluate primary tooth for endo
Make sure the apex is closed ! usually occurs 3 years after the eruption..
97. Disease ask with hand deformation
Rheumatoid arthritis, usually presents as pain in the joint at the end of the day and have + anti-
rheumatoid factor.
98. What is 3 wall defect called: intrabony defect
The three-wall vertical defect was originally called an infrabony defect.* This defect
appears most frequently on the mesial aspects of second and third maxillary and
mandibular molars. The one-wall vertical defect is also called a hemiseptum. The 2-wall
defect is a crater and the four wall defect is a trophe/molt
Company, 072006. 28.5.3).
99. Stridor = COPD / laryngospasm it is wheezing in inspiratory air and treated with
succynlcholine
Audible stridor, a high-pitched wheeze, is an ominous sign of airway obstruction in the

larynx or trachea.
(Bickley, Lynn S.. Bates' Guide to Physical Examination and History Taking, 9th Edition.
Lippincott Williams & Wilkins, 122005. 7.4.2).
100. Kvp causes: kvp controls the quality of the film and increases the penetration, density
↑mA, KvP, exposure time-↑density and a decrease in filtration and object to source
distance causes increase in density
101. Mode of action of NSAIDS inhibit COX
Aspirin and NSAIDs inhibit the COX enzymes and prostaglandin production; Aspirin
covalently modifies COX-1 and COX-2, irreversibly inhibiting cyclooxygenase activity.
This is an important distinction from all the NSAIDs because the duration of aspirin’s
effects is related to the turnover rate of cyclooxygenases in different target tissues. The
duration of effect of nonaspirin NSAIDs, which competitively inhibit the active sites of the
COX enzymes, relates more directly to the time course of drug disposition. The importance
of enzyme turnover in relief from aspirin action is most notable in platelets, which, being
anucleate, have a markedly limited capacity for protein synthesis. Thus, the consequences
of inhibition of platelet COX-1 (COX-2 is expressed only in megakaryocytes) last for the
lifetime of the platelet. Inhibition of platelet COX-1–dependent TXA2 formation therefore
is cumulative with repeated doses of aspirin (at least as low as 30 mg/day) and takes
roughly 8 to 12 days—the platelet turnover time—to recover once therapy has been
stopped.
90
102. Bleeding time is involved with: von willebrand’s diease

103. Tx benzo overdose- Flumazenile
104. # one disorder in America -Cardiovascular disease (adult)or obesity(children) !!!
105. what KvP causes quality
106. mode of action of NSAIDS
NSAIDs) inhibit both cyclooxygenase-1 (COX-1; constitutive) and cyclooxygenase-2 (COX-2;

induced in settings of inflammation) activities, and thereby synthesis of prostaglandins and
thromboxane. The inhibition of COX-2 is thought to mediate, at least in part, the antipyretic,
analgesic, and antiinflammatory action of NSAIDs, but the simultaneous inhibition of COX-1
results in unwanted side effects, particularly those leading to gastric ulcers, that result from
decreased prostaglandin formation.
Edition. McGraw-Hill Professional Publishing, 082001. 29).
107. Which bur gives u smoothest surface = diamond, straight fissure, cross-cut (roughest)
Restorations. Quintessence Publishing (IL), 011987. 9).
108. advantage of an indirect restoration over amalgam-Less polymerization shrinkage,

better proximal contact, less marginal leakage, increased flexure and tensile
strength
109. kid with open and flared ant teeth, what class- Class 2 division 1
110. last sensation to disappear with LA- 1)Pain 2) temp 3) touch 4) proprioception 5)motor
111. opioids act on which receptor: mu receptor (analgesia)
Three opioid receptor types, μ, δ, and κ,.
112. pt given anesthesia has inflammation, y is anesthesia not as effective
Not enough free base due to low (too much H+) ph in the inflamed tissue Not
enough free base
113. pt develops burn in corner of mouth and b/c of it pt develops angular chelitis
114. syneresis- sweating (humidity hot you sweat)
imbibitions –swelling (when you inbide drink)
1. Palatogingival grooves contributing to periodontal disease most commonly associated/found on

which maxillary teeth? Incisors, Canines, PMs, Ms
2. School-wide fluoridation? Weekly rinsing w/ NaF 0.2% /0.05% NaF daily
The major difference is that the recommended concentration for school water fluoridation
is 4.5 times the concentration of fluoride recommended for community water supplies in
the respective geographic area. The CDC no longer promotes school water fluoridation.
Radike et al observed schoolchildren who rinsed their mouths once each school day for 2
91
school years with a stannous fluoride mouthrinse containing 250 ppm fluoride (about 0.1%
stannous fluoride).107 There was a significant reduction in dental caries at the end of the
first and second school years. Two independent examiners found caries reductions of 33%
and 43% in DMFS scores. The anticaries benefit from the stannous fluoride mouthrinse
was especially encouraging because the children already were receiving the optimum
benefit of water fluoridation.
(McDonald, Ralph. Dentistry for the Child and Adolescent, 8th Edition. Mosby, 022004. 10.9.4).
1. You have a patient who is manic-depressive, in the manic state, refuses medication. During
treatment you will experience what with the patient?
a. Rigid OH rituals
b. Obsessed with facial esthetics
c. Mood swings/changes during treatment
d. Can’t remember last choice
2. Localized aggressive periodontitis? 1st molars and incisors
Localized aggressive periodontitis: At least one first molar and at least one incisor or
second molar and two or fewer canines or premolars had greater than 3 mm of attachment
loss.
Company, 072006. 8.6).
3. Pic of hands on older white female that looked like arthritis, pain in morning esp, positive for
antinuclear antibodies (ANA).What does she have? Rheumatoid arthritis, SLE, can’t remember
other choices
The main clinical finding is inflammation of the small joints of the hands and feet.
Other organs, such as the pleura, pericardium, and skin, can also be involved. Most of
the clinical findings are caused by immune complexes that activate complement and, as
a consequence, damage tissue. The diagnosis of rheumatoid arthritis is supported by
detecting rheumatoid factors in the serum.
Treatment of rheumatoid arthritis typically involves aspirin, nonsteroidal anti-

inflammatory drugs, immunosuppressive drugs, or corticosteroids.
(Levinson, Warren. Medical Microbiology & Immunology, 8th Edition. McGraw-Hill Medical
Publishing, 062004. 66.3.5.2).
4. Premature loss of what primary tooth will lead to most rapid loss of space if not maintained?
Primary second molar
Space regaining is most likely to be needed when primary maxillary or mandibular

second molars have been lost prematurely because of decay or, less frequently,
because of ectopic eruption of the permanent first molar. The permanent first molar
usually migrates mesially quite rapidly when the primary second molar has been
lost, and in the extreme case may totally close the primary second molar extraction
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site. If the primary second molar has been lost prematurely in a single quadrant, up to 3
mm of space may be regained by tipping the molar back distally. If space loss is bilateral,
the limit of space regaining is 5-6 mm for the total arch.
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006.
7.3.1.2).
5. Gave description of hemiseptum (defects related to how many walls present)
The three-wall vertical defect was originally called an intrabony defect.* This defect
appears most frequently on the mesial aspects of second and third maxillary and
mandibular molars. The one-wall vertical defect is also called a hemiseptum.
Company, 072006. 28.5.3).
6. Know Drug Schedules…mine asked me to pick the Schedule II drug from a list? Can’t remember
choices
Aproved by Kim; Schedule II are pure codeine or hydrocodone alone !!
Oxycodone + acetaminophen (Percocet and tylox) schedule 2
Oxycodone + aspirin (percodan) schedule 2
Codeine + acetaminophen (Tylenol 1,2,3) schedule 3
Hydrocodone + acetaminophen (lorcet,loratab, vicodin) schedule 3
Propoxyphene + acetaminophen (Darvocet) schedule 4
7. Codeine Allergy
In most cases, patients truly allergic to one opioid can tolerate an opioid from a structurally
different class. For example, patients truly allergic to codeine can usually take fentanyl
(Sublimaze), methadone, propoxyphene (Darvon), or meperidine, if appropriate. On the other
hand, patients truly allergic to codeine should not be prescribed morphine, hydrocodone,
oxycodone (Oxycontin, OxyFast, OxyIR, Roxicodone), or hydromorphone (Dilaudid, Palladone).
8. Question about null hypothesis and mouthwash
A clinical trial to test a preventive agent or treatment regimen begins with a null
hypothesis (i.e., the proposition that there is no difference in disease experience
between the test and control groups). Reject null hypothesis- no difference, chi
square is low Accept null hypothesis is if the value is high and results are called not
statistically significant – Mosby pg 213-214
9. What metal causes a restoration to look green in an RPD framework? Silver, chromium,
palladium…? Silver
10. What does maintenance phase of periodontal surgery seek to accomplish?
Immediately after completion of Phase I therapy, the patient should be placed on the
maintenance phase (Phase IV) to preserve the results obtained and prevent any
further deterioration and recurrence of disease. While on the maintenance phase, with
its periodic checkups and controls, the patient enters into the surgical phase (Phase II)
and restorative (reparative) phase (Phase III) of treatment.
93
Company, 072006. 41.1.2).
11. Digitalis and a diuretic? What is the effect: toxicity may occur with spironolactone or
hydrochlorothiazide
Salicylates may reduce the tubular secretion of canrenone and decrease the diuretic
efficacy of spironolactone, and spironolactone may alter the clearance of digitalis
glycosides. Spironolactone is a true antagonist of aldosterone.
Drug interactions may occur when loop diuretics are coadministered with: (1)
aminoglycosides (synergism of ototoxicity caused by both drugs); (2) anticoagulants
(increased anticoagulant activity); (3) digitalis glycosides (increased digitalis-induced
arrhythmias); (4) lithium (increased plasma levels of lithium); (5) propranolol (increased
plasma levels of propranolol); (6) sulfonylureas (hyperglycemia); (7) cisplatin (increased
risk of diureticinduced ototoxicity); (8) NSAIDs (blunted diuretic response; salicylate toxity
when given with high doses of salicylates); (9) probenecid (blunted diuretic response); (10)
thiazide diuretics (synergism of diuretic activity of both drugs leading to profound
diuresis); and (11) amphotericin B (increased potential for nephrotoxicity and toxicity and
intensification of electrolyte imbalance).
12. Dual-cure resin
13. Not on my test but need to know difference b/t Arcon and Non-Arcon articulator? Mosby pg 319.
Acron is where the condyles are in lower membrane and fossa in the upper and is used to mount
the mandibular cast and non-acron is for to provide easier control of setting teeth for complete and
partial dentures
14. Pic of Erosive Lichen Planus
Erosive lichen planus: of buccal mucosa.*
15. Know how to ID anatomical structures on radiograph…exs: lateral fossa, nasal fossa, zygomatic
process
94
Maxillary, or Mid-facial, Bony Anatomic Structures on the Panoramic Image.
The labeled (A) and unlabeled (B) images are duplicates of the same patient. 1, Articular tubercle,
temporal bone. 2, Zygoma. 3, Zygomatic process of maxilla. 4, Pterygomaxillary fissure. 5, Floor of orbit. 6,
Anterior aspect if inferior concha. 7, Nasal septum. 8, Anterior nasal spine. 9, Floor of maxillary sinus. 10,
Maxillary left third molar (developing). 11, Ear lobe. 12, Cervical vertebral body.
16. Pemphigus vs Pemphigoid? Where does the split occur with each? Spilt occus at suprabasilar cleft
but In pemphigus it is with acantholysis and pemphigoid its not.
95
Pemphigus Pemphigoid
IgG against desmosome ( above Basal cell) hemi desmosome against
17. Cross-over study? Can’t remember choices
Certain types of trial use a crossover design, in which subjects serve as their own
controls. Each subject receives an active treatment for a specific time and a placebo (or
no treatment) during a control period. Crossover designs are useful in short-term trials
(weeks or months, rather than years) for preventing reversible conditions like
gingivitis or calculus accumulation but are unsuitable for caries prevention trials
because the time needed for new lesions to develop is too long.
(Burt, Brian A.. Dentistry, Dental Practice, and the Community, 6th Edition. Saunders
Book Company, 032005. 13.3.3).
18. Pain to ear from? Mandibular molars
19. Occlusion…know it! Can’t remember specific questions
20. Acetaminophen and Aspirin? How are they similar? Both are antipyretic and analgesic
(They differ in that acetaminophen is not anti-inflammatory, no GI ulcers, no clotting
disturbance, and does not cause reye’s syndrome)
21. Cracked tooth with no pulpal involvement? What is the definitive treatment
Bad prognosis…
Directional percussion is also advocated. Percussion that separates the crack may cause
pain. Opposite-direction percussion usually is asymptomatic.
If the fracture appears to be incomplete (not terminating on a root surface), the

tooth is restored to bind the fractured segments (barrel-stave effect) and also to
protect the cusps. For a permanent restoration, a full crown is preferred, although
an onlay with bevels may suffice. Posts and internally wedging foundations are to be
avoided. Acid-etch dentin bonding resins or bonded amalgams may help to provide a
foundation for the crown to prevent crack propagation, although this approach is
unproven.31
The overall prognosis depends on the situation but is always questionable at best. The
patient is informed about the possible outcomes and the unpredictability of duration of
treatment. The fracture may continue to grow with eventually devastating consequences,
requiring tooth extraction or additional treatments (Figure 28-13). Furthermore, the patient
should be informed that cracks may be present in other teeth as well and could manifest in
the future.
Company, 012002. 28.6.7).
22. 76 y.o. man wants dentures replaced after 19 years…white lesion small on vestibular area…he
didn’t know it was there? What do you do? Biopsy, relieve denture and follow-up, can’t remember
other choices…
96
a lesion that is associated with the periphery of illfitting dentures,7 the so-called epulis
fissuratum, in which the growth is often split by the edge of the denture, one part of the
lesion lying under the denture and the other part lying between the lip or cheek and the
outer denture surface. This lesion may extend the full length of one side of the denture.
Many such hyperplastic growths will become less edematous and inflamed following the
removal of the associated chronic irritant, but they rarely resolve entirely. In the
preparation of the mouth to receive dentures, these lesions are excised to prevent
further irritation and to ensure a soft-tissue seal for the denture periphery.
(Greenberg, Martin S.. Burket's Oral Medicine: Diagnosis and Treatment, 10th Edition.
B.C. Decker, 012003. 7.2.1.1).
23. Pregnant woman…put on left side so right hip is up IVC

24. Pregnant woman with syncopal episode? What could be compressed if placed in wrong position?
Aortic valve, fetus, Inferior vena cava
25. HMO…aka capitation
26. Know how to determine rate of attachment loss (????)
27. Attachment loss is the measure from the CEJ to the base of the periodontal pocket.
With the free gingival margin 2 mm apical to the CEJ and the probing pocket depth
measurement 6 mm, there has been 8 mm loss of attachment.
28. External bevel incision made where
internal bevel incision is made at least 3 mm coronal to the mucogingival junction,

including the creation of new interdental papillae.
Student Doctor real quick??’s

When do you bevel occlusal rim?? VDO in length is correct
Government base dental on funds on ? need, demand, cost
Tarodontism , the pulp move s? Occlusal
Most common failure of the Ca RCT ? Cleaning and shaping
Most coming problem of teeth whn prepping? Heat
Found in crevecular fluid? Lymphocytes
To give dx of chronic periodontitis which surfaces need to be counted? 30 or more Answer is 40
Why is epinephrine contraindicated in Multiple scarosis Pt? B/c they are taking MAOI’s with endogenous
epinephrine.
Aspiration is not needed in ? Anerysmal bone cyst, simple bone cyst, traumatic bone cyst,
Site specific characteristic is associate with ? Recurrent Herpes b/c always in V3 and b/c all others can
show up anywhere , histoplasmosis
New root attachment is from what ? Pathonomoic or Iatrogenic ???? (may be talking about long jxnl
epithelium but what cause it to form? Did you create it when SRP.
Aspirin acts on the what pathway? Extrinsic pathway (heparIn – IV-Intrinsic)
Ideal age for treating malocclusion ? 5-10, 10-14, or at any again depending on the condition
97
29. Why are inorganic pyrophosphates put in toothpaste?: abrasive for tartar control
Colloidal binding agent. This agent acts as a carrier for the more active ingredients.
Sodium alginate or methylcellulose will thicken the vehicle and prevent separation of the
components in the tube during storage.
• Humectants. An example is glycerin, which is used to stabilize the composition
and reduce water loss by evaporation.
• Preservatives. Preservatives are used to inhibit bacterial growth within the
material.
• Flavoring agents. Peppermint, wintergreen, and cinnamon are added to enhance
consumer appeal and to combat oral malodors.
• Abrasives. Abrasives are incorporated into all pastes to aid in the removal of
heavy plaque, adhered stains, and calculus deposits. Calcium pyrophosphate,
dicalcium phosphate, calcium carbonate, hydrated silica, and sodium bicarbonate are
used in varying amounts to obtain this effect.
• Detergents. An example is sodium lauryl sulfate, which is used to reduce surface
tension and enhance the removal of debris from the tooth surface.
• Therapeutic agents. Therapeutic agents are added to most toothpastes marketed
in North America and Europe. The use of stannous fluorides has been demonstrated to
be effective in the uptake of the fluoride ion and improved resistance of fluorapatite
to acid demineralization in the initiation of carious lesions.
• Other chemicals. Minor miscellaneous ingredients are included to reduce tube
corrosion, stabilize viscosity, and provide pleasing coloration. Minor amounts of
peroxides are included in some pastes, with marketing claims that they will remove
innate discolorations and improve esthetics.
30. Most common reason for anterior composites to be replaced? Shade

31. Most common reason for posterior composites to be replaced? Microleakage
32. Patient had conservative MOD composite done and now has sensitivity..why? microleakage
33. Modified Widman flap
Perio book pg 937- facilitates instrumentation but does not attempt to reduce pocket depth. It
does not intend to remove the pocket wall but it does eliminate the pocket linining. Dental
secretsbook pg 110. It is known as an open or flap curettage. Sulcular or submarginal incisions are
made initially and full thickness flaps are elevated for debridement, scaling, and rooth planning and
flap is closed with sutures.
1) Pockets where the base are located coronal to the mucogingival junction
2) Where there is little or no thickness of marginal bone
3) Shallow to moderate pocket depth
4) When esthetics is important
34. Allograft question? FDB (osteoconductive) and DFDB(osseoinductive)

35. How far from vital nerves must implants be placed? 2 mm, 4 mm, 5 mm? except mental nerve
which is 5 mm (1mm is correct but if not answer )
98
36. Tetracyline and periodontal disease?

institutionalized older adults. Periostat is contraindicated for those patients with an allergy
to tetracycline.
Company, 072006. 45.6.1.1).
37. MC complaint about NSAIDS?

38. Aspirin? Irreversible action on platelets (Ibuprofen is reversible action)
39. Look at what for patient on coumadin? INR, PTT, PT, Ivy bleeding time
40. In regards to institutionalized elderly patients and dental care? Their care is worse than those non-
institutionalized
41. Chancre of syphilis most likely resemebles? Herpes, SCC?
• Patient with bifid ribs most like to have what else? OKCs (Nevoid Basal cell carcinoma or Gorlin
syndrome) Multiple basal cell carcinomas of the skin
• Odontogenic keratocyst: Seen in 75% of patients and is the most common finding. There are usually
multiple lesions found in the mandible. They occur at a young age (19 yrs average).
• Rib and vertebrae anomalies
• Intracranial calcification
• Skeletal abnormalities: bifid ribs, kyphoscoliosis, early calcification of falx cerebri (diagnosed with AP
radiograph)
• Distinct faces: frontal and temporopariental bossing, hypertelorism, and mandibular prognathism
42.
43. Patient with Trisomy 21? Midface deficiency- Down Syndrome
44. Incidence of cleft palate/lip in Causians? 1/700
Cleft lip and palate occur in about 1 in 800 white newborns, 1 in 2000 black newborns,
and 1 in 500 Japanese or Navaho Indian newborns
45. C1 esterase deficiency? Neuroangioedema
Hereditary angioneurotic edema results from inherited deficiency of C1 esterase

inhibitor, yielding uncontrolled activation of the early components of the complement
system (Chapter 2). The resulting urticaria affects the lips, throat, eyelids, genitals, and
distal extremities. When the larynx is affected it can be dangerous since airway patency
may be compromised.
(Kumar, Vinay. Robbins Basic Pathology, 8th Edition. Saunders Book Company,
46. Most common salivary gland tumor? Pleomorphic adenoma Mosby pg 115
The pleomorphic adenoma, or benign mixed tumor, is the most common salivary gland tumor.
The mean age of occurrence is 45 years, with a male-to-female ratio of 3:2. In the major glands
the parotid gland is involved in more than 80% of cases; in the minor glands the most
common intraoral site is the palate (Fig. 20-42). Pleomorphic adenomas are usually slow-
growing, painless masses. The histopathologic examination shows two cell types: (1) the ductal
epithelial cell and (2) the myoepithelial cell, which may differentiate along a variety of cell
lines (pleomorphic means many forms). A connective tissue capsule exists, which may be
99
incomplete. The treatment involves complete surgical excision with a margin of normal
uninvolved tissue. Parotid lesions are treated with removal of the involved lobe along with
the tumor. Recurrence is possible in rare occasions, as well as a small risk (5%) of malignant
transformation to a carcinoma ex pleomorphic adenoma.
(Hupp, James R.. Contemporary Oral and Maxillofacial Surgery, 5th Edition. Mosby,
032008. 20.9.1).
47. Motor branch of Trigeminal nerve exits the skull through? Foramen ovale, stylomastoid foramen,
superior orbital fissure
Motor Root
The motor root of the trigeminal nerve arises separately from the sensory root, originating
in the motor nucleus within the pons and medulla oblongata (Fig. 12-2). Its fibers,
forming a small nerve root, travel anteriorly along with, but entirely separate from, the
larger sensory root to the region of the semilunar (or gasserian) ganglion. At the
semilunar ganglion the motor root passes in a lateral and inferior direction under the
ganglion toward the foramen ovale, through which it leaves the middle cranial fossa
along with the third division of the sensory root, the mandibular nerve (Fig. 12-3 and Fig.
12-4). Just after leaving the skull, the motor root unites with the sensory root of the
mandibular division to form a single nerve trunk.
48. Motor fibers of the trigeminal nerve supply the following muscles:
49. 1. Masticatory
50. a. Masseter
51. b. Temporalis
52. c. Pterygoideus medialis
53. d. Pterygoideus lateralis
54. 2. Mylohyoid
55. 3. Anterior belly of the digastric
56. 4. Tensor tympani
57. 5. Tensor veli palatini
58. (Malamed, Stanley. Handbook of Local Anesthesia, 5th Edition. Mosby, 072004. 12.1.1).
59. Distraction osteogenesis vs. convention osteotomy? Why?
This surgical technique has been developed to increase vertical bone height in the deficient
jaw site and contrasts with the more conventional method of bone grafting with or without
membranes. Under the proper circumstances, most cells in bone can differentiate into
osteogenic or chondrogenic cells needed for repair. Ilizarov7,8 introduced the process of
generating new bone by “stretching,” referred to as distraction osteogenesis. Other
important advantages of distraction osteogenesis are that no second surgical site is
needed to harvest bone, and the newly created bone has native bone at the crest,
which are thought to withstand forces better than fully regenerated bone.
One of the most significant disadvantages of the distraction osteogenesis procedure

for intraoral application is the unidirectional limitation of current devices.
100
Company, 072006. 78.2.2).
60. Last sensation lost with local anesthesia? #1) pain #2) temp #3)touch #4) proprioception 5)motor
61. X-ray of compound odontoma? Toothlets
62. Something sounded like maybe snowflake calcifications (RO areas) in a 10 y.o. girl? AFO
Mosby pg 119 f
AOT- snowflake calcifications, adolescent females, impacted canines, anterior maxilla
AFO(ameloblastic fibroma-odontoma- young children, w/wo calcification, assoc w unerupted
teeth, posterior mandible
AF( ameloblastic fibroma)- similar to AFO
63. Description for Nasopalatine duct cyst…b/t centrals

Nasopalatine duct cyst. Well-circumscribed radiolucency between and apical to
the roots of the maxillary central incisors.
101
64. PCOD in female…periapical radiolucencies near mandibular incisors..teeth vital
I had 6 cases with a random number of questions per case.
NO FLUORIDE QUESTIONS
ERUPTION SEQUENCE SEEMED TO BE MORE IMPORTANT THAN AGE ON MY EXAM
THE ONLY L.A. QUESTION AS FAR AS CALCULATION GOES ASKED THE MAX. AMOUNT OF
MEPIVACAINE THAT COULD BE GIVEN TO AN ADULT: 5 CARPULES AND KNOW THAT A CHILDS DOSE
SHOULD NOT EXCEED AN ADULT SO THE MAX AMOUNT OF MG TO GIVE CHILD OF 2% LIDO WAS
EQUAL TO 290 (300 WAS NOT A CHOICE)
Pt. had RA along with other conditions and was taking Methotextrate
Which drug would increase the toxicity of Methotextrate? Aspirin, PNC
Examples of Drug-Drug Interactions Important in Dentistry

102
(Mosby. Mosby's Review for the NBDE, Part II. Mosby, 042007.).
Know antibiotic premedication in the incident that someone is allergic to Amoxicillin (Penicillin)
ASA Classification of a pt. who had a MI within the last year and has had a heart attack
American Society of Anesthesiologists (ASA) Classification of

Physical Status
ASA I: A normal, healthy patient
ASA II: A patient with mild systemic disease or significant health risk factor
ASA III: A patient with severe systemic disease that is not incapacitating
ASA IV: A patient with severe systemic disease that is a constant threat to life
ASA V: A moribund patient who is not expected to survive without the operation
ASA VI: A declared brain-dead patient whose organs are being removed for donor
purposes
1.2.3).
Child who was a “highly functioning autistic”…how would you treat them (Nitrous, General Anesthesia,
Hospital setting, Tell show do)
A pt. had a fear of “stroking out” in the dental chair while receiving care…how would you treat them?
Pt. has probing depths recorded and at a future visit the oral hygiene is good but the depths in one
quadrant has not improved…what do you do? (SC/RP, flap surgery…)
103
Penicllin and Cephalosporins cross reaction
Pt. allergic to aspirin, which drug would you prescribe for pain? (All choices had aspirin or an aspirin
combo, so choose the oddball)- tylenol
Child in one case had ectodermal dysplasia
Know the correct responses once a pt. tells you their chief complaint
Down Syndrome pts are not at risk for caries, more periodontal disease
Neurapraxia, axonapraxia, axonotmesis, neurotmesis
Pt. on Warfarin, concerned with :PT, PTT, CBC, INR
(warfarin  follows PT the ex patriot goes to WARfarin)
St. John Wort is used to treat: depression
Race with highest incidence of caries: native americans
NiTi vs. SS endo files
Mouthbreathers and how they present orally as far as the type of occlusion- ant open bite, pos xbite
Know SNA and SNB and if the value is + or – which Angles Classification is present
Know definitions of: yield strength, percent elongation, cross-sectional study, cohort study
The yield strength is defined as the stress at which a material exhibits a specified limiting
deviation from proportionality of stress to strain.
The deformation that results from the application of a tensile force is elongation
Modulus of elasticity
Children with coronary artery disease-obesity
Why do you splint teeth: pt comfort
Type of incision made to remove a palatal torus: y incision
Picture of a pt. with Lichen Planus
Difference btw a gingival margin trimmer and a hatchet
Gingival index: ordinal

104
Scores and Criteria for the Gingival Index.
0: Normal gingiva
1: Mild inflammation—slight change in color, slight edema; no bleeding on probing
2: Moderate inflammation—redness, edema, and glazing; bleeding on probing
3: Severe inflammation—marked redness and edema; ulceration; tendency to

spontaneous bleeding
(Burt, Brian A.. Dentistry, Dental Practice, and the Community, 6th Edition. Saunders Book
Company, 032005. 16.1.1).
Picture of a pts. Tongue that had unilateral lesion the entire length of the tongue: Herpes zoster
105
Child has an intruded tooth, what do you do? Monitor/ watch in hopes that they will re-erupt Mosby pg
195
Pt. with multiple neuromas??? MEN Type III Mosby pg 113. Mucosal neuromas of multiple endocrine
neoplasia syndrome MEN III 1.) inherited as autosomal dominant 2.) Syndrome components: a.) oral
mucosal neuromas (hamartomas) b.) medullary carcinoma of the thyroid c.) pheochromocytoma of
the adrenal gland. Pt has multiple neuromas and Marfarnoid appearance with thickened eyelids.
Mutation of RET protooncogene (ORAL PATH NOTES)
Sjogren associated with lymphoma. Mosby pg 114. It is a bilateral enlargement of the parotid.
Primary sjogren is associated with dry eyes (keratoconjunctivitis sicca) and xerostomia. Secondary
Sjogren is dry eyes, dry mouth rheumatoid arthritis and autoimmune disease. Diagnosis is LAB test for
autoantibodies (RF-rheumatoid arthritis), ANA- antinuclear antibodies. Patients at risk for developing
lymphomas and cervical caries associated with the dry mouth
Definition of chroma- saturation of hue, value- lightness and darkness and hue- color
Oral Cancer gene: p53
Metronidazole and disulfuram effect – alcohol should not be taken while taking metronidazole for at
least 48 hrs. Disulfuram is the antidote to alcohol abuse. It is given to treat chronic alcoholism.
Consuming ethanol (alcohol) while using metronidazole has long been thought to have a disulfiram-like
reaction with effects that can include nausea, vomiting, flushing of the skin, tachycardia (accelerated heart
rate), and shortness of breath,[17] however there are studies calling that notion into question.[18]
Consumption of alcohol should be avoided by patients during systemic metronidazole therapy and for at
least 48 hours after completion of treatment.[3] However, the mechanism of this reaction in the clinical
setting has recently been questioned by some authors,[19][20] and a possible central toxic serotonin
reaction for the alcohol intolerance suggested.[21]
Systemic antifungal agent: Ketoconazole
Ph that caries start 5.5
Prilocaine and methmoglobinemia
Oral Path: Lichen Planus- Mosby pg 109 .IT can also be caused by diuretic (hydroclorothiazide- dental
secrets) T- lymphocytes target the basal keratinocytes. Histo: saw tooth patten. 4 types: 1.) reticular-
wickam striae (lace like lines) 2.) erosive- ulceration . May have slight elevated risk to malignancy. 3.)
erythematous or atrophie- lesions predominately red 4.) plaque- plaque like lesions. Tx: corticosteroids,
Ectodermal Dysplasia, anodontia. Abonormal development of skin, sparse thin hair, no sweat Down
Syndrome – trisomy 21. Midface hypoplasia
Dental material with highest degree of thermal expansion (Resin)
Picture of child with #19 and 30 erupted with open apices…know that this is normal based on the childs
age (btw 6 and 8)
106
Internal vs. external bevel and which produces the least discomfort
The internal bevel flap promotes faster healing (stimulates primary healing), controls
postoperative bleeding, minimizes postoperative pain, and allows the optional use of a
periodontal pack. External bevel heal by secondary intention
LOTS OF PERIO…SO MUCH I DON’T REMEMBER. SORRY
THE CASES ARE VERY SUBJECTIVE, SOMETIMES THE RADIOGRAPHS ARE HORRIBLE AND YOU FIND
YOURSELF TRYING TO GUESS OR SEE STUFF THAT REALLY ISNT THERE. I DON’T HAVE A METHOD TO
GET THROUGH IT, JUST PRAY.
More to come as I remember…
Open impression tray technique: wtf
(Basically the open tray technique is used When it is preferable to have the impression coping retained in the
impression material to avoid uncertainty in re-seating).
An impression is necessary to transfer the position and design of the implant or abutment to
a master cast for prosthesis fabrication. A transfer coping is used in traditional prosthetics
to position a die in an impression. Most implant manufacturers use the terms transfer and
coping to describe the component used for the final impression. Therefore a transfer coping
is used to position an analog in an impression and is defined by the portion of the implant it
transfers to the master cast, either the implant body transfer coping or the abutment transfer
coping.
Two basic implant restorative techniques are used to make a master impression, and each
uses a different design transfer coping, based on the transfer technique performed. An
indirect transfer coping uses an impression material requiring elastic properties. 32 The
indirect transfer coping is screwed into the abutment or implant body and remains in
place when a traditional “closed tray” impression is set and removed from the mouth.
The indirect transfer coping is usually slightly tapered to allow ease in removal of the
impression and often has flat sides or smooth undercuts to facilitate reorientation in the
impression after it is removed.
A direct transfer coping usually consists of a hollow transfer component, often square,
and a long central screw to secure it to the abutment or implant body and may be used as a
pick-up impression coping. An “open tray” impression tray is used to permit direct
access to the long central screw securing the indirect transfer coping. After the
impression material is set, the direct transfer coping screw is unthreaded to allow
removal of the impression from the mouth. Direct transfer copings take advantage of
impression materials having rigid properties and eliminate the error of permanent
deformation because they remain within the impression until the master model is
poured and separated.
107
An indirect transfer (far left and center) is inserted into an implant body or abutment
for screw retention, and a closed tray impression is made. The impression is removed,
and the transfers are connected to an analog and reinserted into the impression. A
direct impression transfer (far right) uses an open tray to make the impression.
The direct transfer coping screw must be unthreaded before the impression is
removed from the mouth. (Courtesy BioHorizons, Birmingham, Ala.)
Type of radiograph used to view a midface fracture: CT scan
Trauma to the maxilla and midface may require CT or CBCT for a thorough evaluation.
15.1.10).
108
RADIOGRAPHS
TMJ MRI *gold standard
Maxillary, Frontal Sinuses Waters view/ Occipito-Mental
Condylar Neck Townes View
Zygomatic Arch 1. Submental Vertex/Bucket/Jug Handle

2. Waters View
Mid- Facial fractures 1. CT

2. Waters
Horizontal/Verital Bone loss Vertical Bitewing
Periapical lesions PA
Listerine and its MOA (Phenol)-
The active ingredients in Listerine are methyl salicylate and three essential oils
(eucalyptol, thymol, and menthol). Listerine has been shown to be effective in reducing
plaque and gingivitis compared with placebo rinses in young healthy adults. Listerine
may exacerbate xerostomia because of its high alcohol content, ranging from 21.6% to
26.9%. Listerine is generally contraindicated in patients under treatment for alcoholism
who take Antabuse (disulfiram). Listerine may benefit patients who do not tolerate the
taste or staining of chlorhexidine and who prefer OTC medicaments that are less
expensive and easier to obtain
Company, 072006. 45.6.1.1).
EDTA
Retentive and reciprocal clasps…which goes where, which is stronger
One finger of metal is termed a retentive clasp, while the other is termed a reciprocal
clasp. The retentive clasp is located in an undercut area of the clinical crown and resists
displacement of the prosthesis away from the underlying hard and soft tissues. The
reciprocal clasp is located in a non-undercut area and serves as a bracing or stabilizing
element for the prosthesis. The resultant assembly is termed an extracoronal retainer
because the retentive and reciprocal components lie on the external surfaces of an
abutment.
Quintessence Publishing (IL), 012003. 1.1.2).
109
Hyperbaric O2
hyperbaric oxygen treatment (60- to 90-minute dives 5 days per week, for a total of 20
to 30 dives before extraction, 10 dives after extraction).
Mosby, 072007. 26.2.5.2.6).
Space maintainers: Mosby pg 188 1.) Band and loop- indicatd withen you have unilateral or bilateral loss
of primary 1st molars 2.) Distal Shoe or acrylic partial- indicated when missing 2nd primary molars before
the eruption of the permanent 1st molar 3.) Lingual Holding arch (mandibular)- used in mixed dentition
when missing primary mandibular canines. It prevents lingual movement of incisors following premature
canine loss. It also prevents the posterior teeth from moving mesially 4.) Nance appliance (maxillary
arch)- features an acrylic button to aid in preventing mesial movement of maxillary posterior teeth.
Antidote for Opiods - naloxone
Radiograph of pt with candidiasis
97. Disease ask with hand deformation
Characteristic limb defects help to distinguish Apert syndrome from other

craniosynostosis syndromes. Syndactyly of the second, third, and fourth digits of the
hands (mitten hands) and feet always is observed
Dental significance
Common relevant features of Apert Syndrome are a high-arched palate, pseudomandibular prognathism
(appearing as mandibular prognathism), a narrow palate, and crowding of the teeth.
[edit]
(Neville, Brad W.. Oral & Maxillofacial Pathology, 2nd Edition. Saunders Book Company,
98. What is 3 wall defect called infrabony and treated via GTR
99. Stidor = copd or laryngospasm (inspiratory wheezing tx succyinlcholine)
Stridor: a harsh, high-pitched breath sound such as the one often heard on inhalation with an
acute laryngeal obstruction.
(Dorland, Newman W.. Dorland's Illustrated Medical Dictionary, 31st Edition. Saunders Book
Company, 052007.).
<vbk:978-1-4160-2364-7>
100. Kvp causes
Increasing mA, kVp, or exposure time increases the number of photons reaching
the film and thus increases the density of radiograph. And it’s a decrease in object-
source distance and filtration
Note Kvp= quality and mA= quantity

110
<vbk:978-0-323-02565-2#outline(4.2.4)>
101. Mode of actionof NSAIDS
There has been substantial progress in elucidating the mechanism of action of NSAIDs.
Inhibition of cyclooxygenase (COX), the enzyme responsible for the biosynthesis of the
prostaglandins and certain related autacoids, generally is thought to be a major facet of the
mechanism of NSAIDs
Edition. McGraw-Hill Professional Publishing, 082001. 29.1).
<vbk:0-07-135469-7#outline(29.1)>
102. Bleeding time is involved with
Platelet inadequacy usually causes easy bruising and is evaluated by a bleeding time and
platelet count. Von willibrand disease
1.3.6.1).
<vbk:9780323049030#outline(1.3.6.1)>
103. Tx benzo overdose
The primary indications for the use of flumazenil are the management of suspected
benzodiazepine overdose and the reversal of sedative effects produced by
benzodiazepines administered during either general anesthesia or diagnostic and/or
therapeutic procedures. Flumazenil is available only for intravenous administration
<vbk:0-07-135469-7#outline(18.2.4.3)>
104. # one disorder in America
105. what KvP causes (quality)
Increasing mA, kVp, or exposure time increases the number of photons reaching
the film and thus increases the density of radiograph.
<vbk:978-0-323-02565-2#outline(4.2.4)>
106. mode of action of NSAIDS
NSAIDs inhibit both cyclooxygenase-1 (COX-1; constitutive) and cyclooxygenase-2 (COX-2;

induced in settings of inflammation) activities, and thereby synthesis of prostaglandins and
thromboxane. The inhibition of COX-2 is thought to mediate, at least in part, the antipyretic,
analgesic, and antiinflammatory action of NSAIDs, but the simultaneous inhibition of COX-1
results in unwanted side effects, particularly those leading to gastric ulcers, that result from
decreased prostaglandin formation.
111
Edition. McGraw-Hill Professional Publishing, 082001. 29).
<vbk:0-07-135469-7#outline(29)>
107. which bur gives u smoothest surface = diamond, straight fissure, cross-cut
108. advantage of an indirect restoration over amalgam Dental secrets pg 153. They exhibit
reduced polymerization shrinkage, increased flexural tensile strength, resistance to abrasion and
fracture and improved color stability.
The indirect technique offers the advantage of allowing most of the procedure to be done
away from the chair. It affords an opportunity for visualization of the restoration and ready
access to waxing the margins. Because it allows a technician to fabricate the pattern, the
indirect technique has become the most popular means of fabricating cast restorations.

(IL), 011997. 19).
<vbk:0-86715-201-X#outline(19)>
109. kid with open and flared ant teeth, what class? Class II Div 1
110. last sensation to disappear with LA Mosby pg 288

Pain -- Temperature- Touch MOTOR
111. opioids act on which receptor ? mu receptor
opioids are the primary analgesics used during the perioperative period. Fentanyl (
SUBLIMAZE ), sufentanil ( SUFENTA ), alfentanil ( ALFENTA ), remifentanil ( ULTIVA ),
meperidine ( DEMEROL ), and morphine are the major parenteral opioids used in the
perioperative period. The primary analgesic activity of each of these drugs is produced
by agonist activity at μ-opioid receptors (Pasternak, 1993). Their order of potency
(relative to morphine) is: sufentanil (1000×) > remifentanil (300×) > fentanyl (100×) >
lfentanil (15×) > morphine (1×) > meperidine (0.1×)
<vbk:0-07-135469-7#outline(15.4.2)>
112. pt given anesthesia has inflammation, y is anesthesia not as effective
Inflammation, infection, or pain (either acute or chronic) usually decreases depth and
anticipated duration of anesthesia. Increased vascularity at the site of drug deposition results
in a more rapid absorption of the local anesthetic and a decreased duration of anesthesia.
(Malamed, Stanley. Handbook of Local Anesthesia, 5th Edition. Mosby, 072004. 4.2).
<vbk:0-323-02449-1#outline(4.2)>
113. pt develops burn in corner of mouth and b/c of it pt develops
114. syneresis---- process of giving off water to the aire causes shrinkage i.e humidity
imbibition----- process of taken in water, expanding i.e. swelling

112
022006. 2.2.4).
<vbk:0-323-03606-6#outline(2.2.4)>
• Bisphosphonate, there is a concern with xrays while on bisphosphonates. Xrays

can be taken. There Is a concern with the IV bisphosphonates Zomate (zolendroic acid)
and Aredia (Pamidronate). It can lead to osteoradionecrosis of the jaw. These patients
must be treated with hyperbaric oxygen therapy prior to dentoalveolar procedure.
Mosby pg 78. Bisphosphonate is the breakdown of hypocellular, hypovascular and
hypoxic tissuse (Dental secrets 58)
• Frey syndrome-sweat on parotid when you eat
Frey's syndrome is a relatively common complication of parotidectomy. This syndrome

presents as gustatory sweating. When regenerating postganglionic secretory
parasympathetic fibers from the parotid gland become mixed with the postganglionic
sympathetic fibers to the sweat glands, a condition in which a patient will flush or sweat
with salivary stimulation results. Minor's starch-iodine test can be used to
demonstrate the area of gustatory sweating. Frey's syndrome can occur in as many as
30 to 60% of patients who have undergone parotidectomy. The treatment of this
disorder consists of the topical application of antiperspirants or anticholinergics.
Botulinum toxin injections have been used to treat Frey's syndrome.
Decker, 012003. 9.6.3.1).
<vbk:1-55009-186-7#outline(9.6.3.1)>
• Xrays of nutrient canals, inverted Y around pm and k9 max (max sinus and
zygomatic process I think), periapical cyst around max lat, perfectly round cyst on pan
right above pm( in mosby),
• Tons of perio from tx planning, to implants (implants were hit heavy), GTP, BMP,
furcations, how to treat, if it’s a deep c2 furcation what are some acceptable tx (I put
resection as least desirable),
ultrasonic scalers were equal to hand scalers in reducing the bacteria in class I furcations
but more effective in class II and III furcations.
Company, 072006. 54.3.4).
<vbk:1-4160-2400-X#outline(54.3.4)>
• Implant success, what factors will help implant osseointegrate and what factors
will not let it osseoimtegrate
For the evaluation of implant success, immobility and radiographic evidence of bone
adjacent to the implant body are the two most accurate diagnostic aids in evaluating
success. Follow-up or recall radiographs should be taken after 1 year of functional loading
and yearly for the first 3 years.
113
<vbk:9780323043731#outline(3.15.6)>
• What is more stable an single implant of 4mm or 5mm or a double implant ligated
together for a total of 4mm and 5mm ( I put double implant ligated for a combo of
4mm because it sounded like it would not be as stable as a single implant being 4mm
thick. The other one would be 2 2mm implants ligated together.
• 30% fat allowed for daily value
• What is the most a toothbrush and dental floss can peretrate into sulcus. I put
1mm and 1mm. the other choices were 2-3mm. I thought that was too much
(I think the answer is 2-3 mm, until the floss or the tooth brush reaches the depth of the
biological width).
• ID a CT scan. Look at MRI example just to be sure. My picture was of a CT image
of the brain and skull.
Cat scans are a specialized type of x-ray. The patient lies down on a couch which slides into a
large circular opening. The x-ray tube rotates around the patient and a computer collects the
results. These results are translated into images that look like a "slice" of the person. MRI is a
completely different animal! Unlike CT it uses magnets and radio waves to create the images.
No x-rays are used in an MRI scanner.
CT Scan MRI
Radiation exposure: Moderate - high radiation None
Principal used for Uses magnets and radio waves

Uses X-rays for imaging
imaging: to create the images.
Time taken for complete Usually completed within 5 Scanning typically run for about
scan: minutes 30 minutes.
Less detailed compared to Much higher detail in the

Details of soft tissues:
MRI soft tissues
• Nutrient canals! I had to id 3 of them on pics

• Diabetic patient- HBA 1C levels- if 8% then good glycemic control if onver 10%
poor control. early morning appointments that are short( means high glucose, low
insulin) . Pt should have eaten and taken medicine. The most common diabeteic
emergency in dental office is hypoglycemia, when the blood glucose level drops below
60 mg/dL. If patient goes into insulin shock and conscious give 15mg of carbohydrate
(orange juice, candy, 3-4 teaspoon of sugar etc) If unconscious, give 50 mL of dextrose
114
in 50% concentration or 1 mg IV or IM of glucagon. These patients have the tendency

to have xerostomia and adverse affects in perio.
• What could precipitate a seizure- hypoglycemia, hypokalemia, hypocalcemia,
hyponuternia, one other hypo-
common causes include hypoglycemia, drug withdrawal, infection, and febrile illness
(e.g., meningitis, encephalitis). Specific triggers of seizures (e.g., odors, bright lights)
should be identified and avoided. Some medications used to control seizures may affect
dental treatment because of drug actions or adverse effects. For example, gingival
hyperplasia is a well-known adverse effect of diphenylhydantoin. TX of seizures ASAP
could be injection via IV of diazepam or phentobarbittal
Mosby, 072007. 1.1.4.2).
<vbk:978-0-323-04535-3#outline(1.1.4.2)>
Mosby, 072007. 27.1.2.2).
<vbk:978-0-323-04535-3#outline(27.1.2.2)>
• ANUG, NUG, - Mosby pg 240- necrotic ulceration of the marginal gingival tissues,
bleeding upon proing, pain, fetid breath. May sometimes be accompanied ith fever,
malaise, and lymphadenopathy
• Know differences of endo dx hard. I had at least 15 questions
• What Kennedys class does not have mods =(IV) Mosby pg 327
• SS crown prep for pedo, know what you need to do and guides etc
• What pedo molar are you concerned with likely pulp horn exposure. Distobuccal ,
mesiobuccal, 1m or 2m (4 choices)
• Pulp tests. What you see to differentiate b/w acute perio abcess and acute
periodontitis, how to differentiate b/w chronic and periodontal abscesses
periodontal abscess formation associated with pain, swelling, pus exudate, pocket
formation, and tooth mobility. A more chronic response may also occur without pain
and involves the sudden appearance of a pocket with bleeding on probing or exudation
of pus. Also, please note that a periodontal abscess will be EPT “positive” as
opposed to periapical abscess which will be EPT “negative”.
Company, 032008. 6.8.3.1.5).
<vbk:1-4160-3851-5#outline(6.8.3.1.5)>
• Know perio and endo abscesses and what pulp test you would do to dx them.
Probing helps in differentiating endodontic from periodontal disease. For example, a

periodontal abscess can simulate an acute apical abscess. However, with a localized
periodontal abscess, the pulp is usually vital. In contrast, an acute apical abscess is
115
related to an unresponsive (necrotic) pulp. These abscesses occasionally communicate with

the sulcus and have a deep probing defect.
Company, 012002. 17.7.4).
<vbk:0-7216-9160-9#outline(17.7.4)>
• Tx planning for perio and implants
• Value, hue, chroma-know what they are and what they depict.
The three characteristics of color are hue, chroma, and value. 24 To facilitate communication
with ceramists, the dentist should be thoroughly familiar with these terms and their
definitions. Hue is that quality which distinguishes one color from another. It is the name of
a color, such as red, blue, or yellow. Hue may be a primary color or a combination of colors.
Chroma is the saturation, intensity, or strength of a hue. For example, a red and a pink may
be of the same hue. The red has a high chroma, while the pink, which is actually a weak red,
has a low chroma. Value, or brightness, is the relative amount of lightness or darkness in a
hue. Value is the most important color characteristic in shade matching.

(IL), 011997. 23.2).
<vbk:0-86715-201-X#outline(23.2)>
• How to change the color. I put bleach the other teeth to match the cown.
• Few operative questions.15max- just the basics, outline, gold, cad/cam, inlay only
(the remembered ? are good)
• Oral path like what is this pic most assoc with, know basics like what does each
mean and assoc with. Not too in depth, but deffinatley know what it is
• Peutz-jeughers- freckle like lesions on the hands, perioral skin and oral mucosa
and intestinal polyps that may become malignant, Ewing- Mosby pg 122. I is a rare
round cell malignant RL in children. Aggressiv multimodality therapy fair prognosis.,
langerhans,histiocytosis x- mosby pg 121. Radiographic shows punched out lesions
and or lucencies around ooth rooths (floating teeth). Histo- eosinophils are mixed in
with the cells. Prognosis is very good if localized if not fatal. Tx is excision, low dose
radiationor chemotherapy. 3 different classifications 1.) eosinophilic granuloma-
chronic form with solitary or multiple bone lesions 2.) Hand-Schuler Christian disease –
chronic disseminated form with a triad (bone lesions, exophthalmos, and diabetes
insipidous and 3.) Letterer- siewe disease- acute disseminated form (bone, skin and
internal organs) (what would you see if a child was take a long time of antibiotics, also
pt taking long history of corticosteroids what would they be predisposed too. Also pt
is on chemo what are they predisposed to. I put candidiasis cause of opportunistic
organism.
• Dude, leavell and Rivera had a combined I would say 60 questions. They are easy,
but definitely review. Mosbys has good explanation
• Cohort, x-sectional, chi-square- mosbypg 210-214
• Code of Ethics-5questions. Benefiance, Nonmalfience- which one does keeping up
with skills and knowing when to refer fall under (benefiance)
116
• I had 3 calculation question, how much MAX carpules lido 3% can you give a 40kg
child. Mosby pg 182
40 kg x 4.4 mg/kg lido = 176 mg
3% x 10 x 1.8 = 54 mg/cartridge
176mg/54 mg/cartridge = 3.25 cartidges
• How many carpules 2% lido 1:100,000 epi can you give child
A 20 kg child (approximately 5 years old) can tolerate a maximum dose of 2% lidocaine

(lidocaine) with vasoconstrictor of:
7 mg/kg × 20 kg = 140 mg. Equivalent of 3 carpules (6.6 ml).
1.10.1.1).
<vbk:0-7234-3186-8#outline(1.10.1.1)>
• Had to figure how many grams of anesthetic you could give child. (something
knowing that anesth would be 4.4 or something like that. Pedo section in mosby
• How to tx plan Alzheimer pt, do you do what he would have wanted before end
stage or do you just do palliative keeping out of pain and disease (I put that one)
• If an 84 yr old man comes in for new appt with his son. Son had a paper stating a
legal guardian (not son) who can make decision. This was weird cause I didn’t know if
the old man was senile or independent. I put legal guardian must be there, but I think
they should have said that the pt is dependent on legal guardian.
• Remembered stuff was good
• Know about denture processing and resins and evaporation and temperatures.
They wanted to know something about shirking and leftover resin.
In general, heat-activated acrylic resins are polymerized by placing the flasks in a

constant temperature water bath at 74°C (165°F) for 8 hours or longer with or
without a 2- to 3-hour terminal boil at 100°C. A shorter cycle involves processing the
resin at 74°C for approximately 2 hours then boiling at 100°C for 1 hour or longer.
Rapid-cure type resins have been recently introduced in the market. The resins are
polymerized by rapidly heating the packed dough in boiling water for 20 minutes. The
materials are hybrid acrylics, in which activation of the polymerization reaction is carried
out through both chemical and heat activators, allowing rapid polymerization without
porosity.
It should be noted, however, that processing at temperatures that are too low or for
shorter times increases the residual monomer content in the processed denture base.
Excess residual monomer in the polymerized resin base could lead to tissue
irritation, sensitivity, or even allergic reactions in some patients. The plasticizing
effects of excess monomer could also adversely affect the properties and dimensional
stability of the denture. Fortunately, allergies to residual monomer are relatively rare, and
117
most patients are well able to tolerate the 0.2% to 0.5% of residual monomer that often
remains, even in a properly polymerized base.
After the polymerization procedure, the denture flasks are cooled slowly to room
temperature to allow adequate release of internal stresses and thus minimize warpage of
the bases. Deflasking then follows and should be done carefully to avoid fracture or
flexing of the dentures.
<vbk:0-323-02296-0#outline(12.1.4.1)>
• F,v, T, C, all sounds. Look in mosby and what they are for. Lisp, whistle, and what
sound would that be
• Denture should IDEALLY cover entire or 1/3 retromolar pad. I put entire even
though its 2/3 (wasn’t a choice) thought 1/3 too little
• Porpanolol what it is and what is it used for
Propanolol is a B-adrenergic blocker (Blocks B1 and B2) used to treat Hypertension
(decrease cardiac output and rennin secretion) Angina pectoris ( decrease heart rate
and contractility, which result in decrease O2 consumption) MI (decrease mortality )
• Pharm was basic, what do you give as antidote for overdose of sedative
The primary indications for the use of flumazenil are the management of suspected
benzodiazepine overdose and the reversal of sedative “effects” produced by
benzodiazepines. Naloxone is for Opioids overdose.
***No reversal agent exists for sedative and barbiturate overdose.***
Mosby, 072007. 31.1.3.2.7.3).
<vbk:978-0-323-04535-3#outline(31.1.3.2.7.3)>
• Preg pt hypotension- lay on left side
During late pregnancy, a phenomenon known as supine hypotensive syndrome may occur
that manifests as an abrupt fall in blood pressure, bradycardia, sweating, nausea, weakness,
and air hunger when the patient is in a supine position.1,3 Symptoms are caused by impaired
venous return to the heart that results from compression of the inferior vena cava by the
gravid uterus. This leads to decreased blood pressure, reduced cardiac output, and
impairment or loss of consciousness. The remedy for the problem is to roll the patient
over onto her left side, which lifts the uterus off the vena cava. Blood pressure should
rapidly return to normal.
Mosby, 072007. 18.1.1).
• Pt with moderate emphysema, stops often to catch breath- position least

tolerate- I put horizontal recline
118
Dental Management of the Patient With , Chronic obstructive pulmonary disease
Review history for evidence of concurrent heart disease; take appropriate precautions if
heart disease is present.
• Avoid treating if upper respiratory infection is present.
• Treat in upright chair position.
• Use local anesthetic as usual.
• Avoid use of rubber dam in severe disease.
• Use pulse oximetry to monitor oxygen saturation.
• Use low-flow (2 to 3 L/min) supplemental oxygen when oxygen saturation drops

below 95%; it may become necessary when oxygen saturation drops below 91%.
• Avoid nitrous oxide/oxygen inhalation sedation with severe COPD and

emphysema.
• Consider low-dose oral diazepam or other benzodiazepine; these may cause

oral dryness.
• Avoid use of barbiturates, narcotics, antihistamines, and anticholinergics.
• Supplemental steroids may be needed if patient is taking steroids and an invasive

procedure is planned.
• Avoid erythromycin, macrolide antibiotics, and ciprofloxacin for patients

taking theophylline.
• Do not use outpatient general anesthesia.
COPD, Chronic obstructive pulmonary disease.
Mosby, 072007. 7.1.5.1.1).
<vbk:978-0-323-04535-3#outline(7.1.5.1.1)>
• Composites- basic stuff pros cons contra, indications
• What was added to zinc oxide eugenol to make IRM- polymethyl methacrylate
Intermediate restorative material (IRM) is a zinc oxide and eugenol cement that has been
reinforced for increased strength. It is used as an intermediate base beneath a metallic restoration
and also as a temporary restoration.
119
Composition. (1) Powder. The powder is composed of 80 percent zinc oxide and 20 percent
polymethyl methacrylate (the powder used for acrylic resin). (2) Liquid. The liquid is 99
percent eugenol and 1 percent acetic acid.
• Glass ionomer mixed with polyacrylic something.

Glass ionomer is composed of:
Powder: Fluoro alumino-silicate glass
Liquid: polyacrylic acid
Source: Dental Decks Operative
• Have your articulator and want to adjust the VDO and condylar incline, where is
the pin? On the table, raised off the table,
Off the table.. can’t explain it…
1. How many miligrams of epinephrine do you give an adult in anaphylactic shock? 0.3 mg
Prevalence: indicates what proportion of a given population is affected by a condition at a given

point in time. It is expressed as percentage and ranges from 0% to 100%, (e.g., the prevalence of
periodontal disease among 100,000 adolescents was 5%).
Prevalence = Number of people with the disease/Total number of people at risk
Incidence: indicates the number of new cases that will occur within a population over a
period of time. (i.e. the incidence of ppl dying of oral cancer is 10% per year in men
aged 55 to 59 in our community)
Incidence: # of new cases of the disease/ total # of ppl at risk
1. Most repeated value: mode
2. In one liter you have 1 ppm fluoride, how many mg? 1
3. Metronidazole is an antibiotic and antiparasitic.
4. Metronizadole should not be given to alcoholics.
5. Temporal arteritis patient is not given steroids on time what would happen? Blindness
6. Which of the following is a characteristic of benzodiazapene? Increasing frequency of opening
of the associated chloride ion channel a
7. The hardest cement to wash away is: resin;
8. easiest cement to wash is zinc phosphate
Which metal causes allergic reaction? Nickel
Nickel allergy is a relatively common problem, occurring in 10% to 20% of females.
022006. 5.3.2).
9. Angle ANB used for relationship of maxilla to mandible

10. During asthma attack, if inhaler does not work what do you give? Epinephrine
120
Administer fast-acting bronchodilator (Note: Corticosteroids have delayed onset of

action), oxygen, and, if needed, subcutaneous 0.3 to 0.5 mL of epinephrine (1:1000)
(Little, James W.. Dental Management of the Medically Compromised Patient, 7th
Edition. Mosby, 072007. 7.2.5.1.1).
11. A five year old is prescribed tetracycline for infection, which tooth is affected? Canines
12. Intrusion of a primary tooth, what would you do? Let it re-erupt.
13. The edgewise appliance is best for achieving:
The principle of the edgewise appliance, control of tooth movement via rectangular
arch-wires in a rectangular slot, remains the basis of contemporary fixed appliance
therapy
14. What makes space for eruption of molars? Resporption in anterior and apposition of ramus in
posterior.
15. Overlap is the vertical relationship of maxillary to mandibular incisors
16. Underexposed radiograph, what went wrong? Not enough exposure time
Light films: Underexposed/image not dense enough) incorrect miliamperage (too low) or
exposure too short; incorrect focal film distance; cone too far from patient’s face, film placed
backwards. (Dental decks radiology technique)
17. Which xray would be better to determine bone level? Bitewings
18. A patient comes in, complains of denture not fitting; bone thick and dense in x ray; paget’s
disease
19. Photograph of palate with ulceration in hard palate, present for several days; salivary gland
tumor
The palate is the most common site for minor gland mixed tumors, accounting for
approximately 50% of intraoral examples. This is followed by the upper lip (27%) and
buccal mucosa (17%). Palatal tumors almost always are found on the posterior lateral
aspect of the palate, presenting as smooth-surfaced, dome-shaped masses. If the tumor is
traumatized, then secondary ulceration may occur. Because of the tightly bound
nature of the hard palate mucosa, tumors in this location are not movable, although those
in the lip or buccal mucosa frequently are mobile. The pleomorphic adenoma is typically
a well-circumscribed, encapsulated tumor However, the capsule may be incomplete or
show infiltration by tumor cells. This lack of complete encapsulation is more common for
minor gland tumors,
Pleomorphic adenoma.
Firm mass of the hard palate lateral to the midline.
121
062008. 11.13.2.1).
20. Picture of lateral border of tongue being blue? Hemangioma
(Kumar, Vinay. Robbins Basic Pathology, 8th Edition. Saunders Book Company,
052007. 10.11.1.1.2).
21. Vericuous carcinoma what does it look like? Wart looking, cauliflower appearance. Etiology:
tobacco and human papillomavirus (subtypes 16 & 18) Tx surgical excision and has good
prognosis Mosby pg 111
062008. 10.27.1).
22. All of these have antiplatelet properties except? Acetominophen
23. Ginseng is contraindicated in a person taking aspirin
24. Hemophilia A: which test would you perform? PTT
Best test for hemophilia (25-36 sec) OS dental decks
25. How long should aspirin be stopped before treatment? 1 week
The best screening test for aspirin effect is the PFA-100. Although aspirin affects platelets
and the coagulation process through its effects on platelet release, this does not usually lead
to a significant bleeding pro-blem unless the PFA-100 is greatly prolonged. If surgery must
be performed under emergency conditions, and the PFA-100 is greatly prolonged, DDAVP
can be used to shorten the PFA-100. This should be done in consultation with the patient's
physician or hematologist. On a less urgent basis, with approval from the physician,
122
aspirin may be discontinued for 3 days; this allows for arrival of a sufficient number of
new platelets into the circulation.
Mosby, 072007. 25.6.7.4).
26. Which of the following has the least effect on platelet aggregation? Naproxen
27. You give naloxone for which of the following? Fentanyl overdose
28. The duration of action of talbutal, a short acting benzodiazopene, is short because of
redistribution
29. Which of the following is a true cyst? Dermoid cyst (staphne, aneurismal, traumatic bone cyst
are not true cysts)
30. Traumatic bone cyst will have a scalloped appearance in between roots of teeth.
(White, Stuart C.. Oral Radiology: Principles and Interpretation, 6th Edition. Mosby,
092008. 21.5.5).
31. When you are taking an xray, which technique will show the maxillary sinus below the roots of
the maxillary teeth? Bisecting angle
32. Which radiographic technique will you use to see the relationship of the disc in the fossa? MRI?
MRI gold standard for visualization of TMJ (Dr. Ross’s notes… oh sorry Dr. EDMON’s notes !!)
Because of its excellent soft tissue contrast resolution, MRI is useful in evaluating soft
tissue conditions, for instance, the position and integrity of the disk in the TMJ
123
13.3.3).
13.2.10).
33. During Endo treatment of mandibular molar with three canals (mesiobuccal, mesilingual,
distobuccal) if file is put into the mesiolingual canal and you move the cone mesially, in which
order will you see the canals? Mesiolingual, mesiobuccal, and distobuccal
34. Common disorder among elderly? Depression
Depression is common among elderly people. Lack of motivation and lethargy are
features which will compromise oral health through lack of oral hygiene, though
strategies can be adopted to improve such situations. Dementia may influence treatment
planning at the mid to later stages of this degenerative disease, but detailed assessments
can be undertaken to determine the level of intervention when treatment is indicated.
(Humphris, Gerry. Behavioural Sciences for Dentistry. Churchill Livingstone, 022000. 7.2.4.4).
1. Dementia is long term memory or short term memory loss? Short term
2. Nightguards do which of the following? Stop grinding or distribute forces evenly
3. The cool slab for mixing zinc phosphate does which of the following? Allows you to incorporate
more powder
The manner in which the reaction between the zinc phosphate cement powder and liquid
is permitted to occur determines to a large extent the working characteristics and
properties of the cement mass. Incorporate the proper amount of powder into the
liquid slowly on a cool slab (about 21° C) to attain the desired consistency of cement.
A properly cooled, thick glass slab will dissipate the heat of the reaction. Should a rapid
reaction occur, ample working time would not be available for proper manipulation of the
cement before hardening or setting occurs. The mixing slab temperature should be low
124
enough to effectively cool the cement mass but must not be below the dew point. A
temperature of 18° to 24° C is indicated when room humidity permits.
The amount of powder that can be incorporated into a given quantity of liquid
greatly determines the properties of the mixed mass of cement. Because an increase
in the ratio of powder to liquid generally provides more desirable properties,
incorporate as much powder as possible to obtain a particular consistency.
(Powers, John M. Powers. Craig's Restorative Dental Materials, 12th Edition. C.V.
Mosby, 022006. 20.3.4.3).
4. Extrinsic staining on a crown could be accomplished by all of these except? Increasing the value.
5. Which of these would be least affected by radiation? Nerve
Least affected: mature bone, muscle, and nerve
Most affected: small lymphocytes, bone marrow, reproductive cells, immature bone cells
Dental decks, radiology
6. Where would you find the fluoride applied topically? On outer surface of enamel
7. Smooth surface carious lesion found apical to contact point
8. Pits and fissure cavity have apex of triangle pointing to outer surface of tooth
9. Dietary analysis done to determine amount and type of carbohydrate ingestion/sugar intake.
10. Which bacteria is responsible for the progression of decay? Lactobacillis
11. At what ph is tooth surface demineralized? 5.5
12. Nitrous-oxide would not be administered to someone with nasal congestion
13. When would you extract a third molar? When there is unrestorable decay
14. A 14 year old girl with erupted canine has radiolucenies has AOT (adenomatoid odontogenic
tumor)
At least 75% of adenomatoid odontogenic tumors occur in the maxilla. The incisor-
canine-premolar region, especially the cuspid region, is the usual area involved in both
jaws. It occurs more commonly in the maxilla. This tumor may have a follicular
relationship with an impacted tooth; however, often it does not attach at the
cementoenamel junction but surrounds a greater part of the tooth, most often a canine.
(Courtesy R. Howell, DDS, Morgantown, W.V.)
092008. 22.7.4.21.1).
15. Odontoma xray shows little teeth in lower mandible; its odontoma
125
Several examples of compound odontomas; note the

numerous internal components and the radiolucent capsule. A,
An example in the anterior maxilla that has interfered with the

eruption of the central incisor (C) and the lateral incisor (L). B,
Within the mandible. C, Within the anterior mandible
interfering with the eruption of the cuspid. D, Within the
mandible interfering with the eruption of the first premolar,
deciduous molar (d), and the first molar (m).
092008. 22.7.4.4.3).
16. Xray showing impacted third molar with cyst on occlusal: it’s a dentigerous cyst
Dentigerous cysts.A, A cyst surrounds the crown of a third
molar (arrows). B, The cyst has caused resorption of the distal
root of the second molar (arrow). C, A cyst that involves the
ramus of the mandible. D, A dentigerous cyst that is expanding
126
distally from the involved third molar.

092008. 21.3.15.1).
17. Periapical cemento osseuous dysplasia PCOD shown on xray; discussed black women
PCD is a common bone dysplasia that typically occurs in middle age; the mean age is 39
years. It occurs nine times more often in females than in males and almost three times
more often in blacks than in whites. It also frequently is seen in Asians. The involved
teeth are vital, and the patient usually has no history of pain or sensitivity. The lesions
usually come to light as an incidental finding during a periapical or panoramic
radiographic examination made for other purposes. The lesions can become quite large,
causing a notable expansion of the alveolar process, and may continue to enlarge slowly.
092008. 24.1.2.4.3).
18. By which method is plaque not removed? Water irrigation

19. How long will it take for plaque to mature? 24-36 hours
20. When a pediatric patient is shown another child in office who is behaving well, it is an example of
modeling
21. Prilocaine calculation, 600 mg max, 4%, 1.8 mL; how many carpules before overdose? 40 x 1.8=
72mg= 600/72 = 8 carpules
22. A patient needs premedication is allergic to penicillin give them clindamycin 600 mg 1 hour
before
Or: cephalexin 2g (adult), 50mg/kg (child)
Azithromycin or Clarithromycin 500mg (adult), 15 mg/kg (child)
23. Which of these conditions does not need premedication? Mitral valve prolapse without
regurgitation.
24. A patient comes in and you do a MOD composite. He comes in later complaining of pain, you
remove occusal composite replace and pain goes away. What was causing the pain?
Polymerization shrinkage
There is evidence that restorative materials may not bond to enamel or dentin with
sufficient strength to resist the forces of contraction during polymerization, wear, or
thermal cycling. If a bond does not form, or debonding occurs, bacteria, food debris, or
saliva may be drawn into the gap between the restoration and the tooth by capillary
127
action. This effect has been termed microleakage. The importance of microleakage in
pulpal irritation has been extensively studied.
(Powers, John M. Powers. Craig's Restorative Dental Materials, 12th Edition. C.V.
Mosby, 022006. 5.3.1.1).
25. Carpel Tunnel syndrome is result of repetitive movements.
Pain and numbness on the ventral surface of the first three digits of the hand (but not in
the palm), especially at night, suggest median nerve compression in the carpal tunnel,
which lies between the carpal bones dorsally and a ventral band of more superficial
fascia, the flexor retinaculum. Onset often related to repetitive motion with wrists
flexed (e.g., keyboard use, mail-sorting), pregnancy, rheumatoid arthritis, diabetes,
hypothyroidism
Thenar atrophy may also be present.
(Bickley, Lynn S.. Bates' Guide to Physical Examination and History Taking, 9th
Edition. Lippincott Williams & Wilkins, 122005. 15.4.43.1).
26. Complications of sagital osteotomy, what is complication? Paresthesia of lip.
27. Worst situation to place implant? Adolescent
28. Nitriglycerin and Epinephrine are physiologic antagonists
(epinephrine and histamine are physiologic antagonist, not sure about nitro and epi)
29. When you are waxing an rpd, you wax on the refractory cast
In removable partial denture fabrication, a cast made from refractory material serves
as the foundation for waxing and casting procedures.
Quintessence Publishing (IL), 012003. 10.6.6.3).
30. The purpose of the tissue stops in bilateral distal extension rpd? To prevent tilting while packing
resin into the rpd. It stabizes the rpd
The cast stop (arrow) projects from the tissue surface of the minor connector to contact
the dental cast.
The importance of cast stops As previously noted, relief is provided beneath minor
connectors of open construction and mesh construction. This relief provides space
between the minor connector and the underlying master cast (or residual ridge). This
space permits resin to encircle the minor connector and provides a mechanism for
attachment of the denture base to the framework. While this method works quite well for
tooth-supported removable partial dentures, it must be modified for distal extension
applications. In a distal extension prosthesis, the use of relief produces a minor
connector that is supported at only one end. As a result, the minor connector may bend
when a load is applied. Since considerable force is applied during the packing and
128
processing of acrylic resin, the probability of bending is increased during these

procedures. To prevent bending, a small area at the free end of the minor connector
should contact the master cast. This portion of the minor connector is termed a cast
stop.
31. In order to prevent vertical root fractures when doing post and core what do you do? Prevent
fracture via appropriate canal prep and balanced pressure of condensation forces
32. Transillumation helps you diagnose cracked tooth syndrome
33. A patient with a post and core and crown comes back in three days with pain on biting. What is
diagnosis? Vertical root fracture.
34. The tooth least likely to have two canals? Maxillary central
35. Sodium hypochlorite when used in endo does which of the following? Kills bacteria, removes
organic substances. It is a nonchelating agent.
Copious irrigation with sodium hypochlorite is performed throughout instrumentation to

reduce amounts of necrotic tissue and bacteria.
Torabinejad, Mahmoud. Endodontics: Principles and Practice, 4th Edition. Saunders
Book Company, 032008. 9.10.4.2).
36. Lidocaine toxicity treated with? Diazepam

Interesting question…actually if the lidocaine toxicity creates an epileptic procedure than yes
diazepam is the agent of choice for status epilepticus. However, they recently created
“Oraverse” which is “phentolamine mesylate” which can be used for reversal of soft tissue
anesthesia.
37. Patient needs a procedure. He goes to doctor for work up. Which of the following values will
indicate the need for more lab tests? Hematocrit of 25 normal is (Male: 40.7-50.3% Female:
36.1-44.3
38. X ray of mandible with dense bone showing vertical radioluncies. What are they? Nutrient
canals
129
092008. 10.2.6.11).
39. Glossoptosis, cleft palate, and micrognathia? Pierre-robin syndrome

40. Status epilepticus give them? Diazepam
Continuous or repeated seizures without periods of recovery between them are known as
status epilepticus. This problem warrants notification of outside emergency assistance
because it is the most common type of seizure disorder to cause mortality. Therapy
includes instituting measures already described for self-limiting seizures; in addition,
administration of a benzodiazepine is indicated. Injectable water-insoluble
benzodiazepines such as diazepam must be given IV to allow predictability of
results, which may be difficult in the patient having seizures if venous access is not
already available. Injectable water-soluble benzodiazepines such as midazolam provide
a better alternative, because IM injection will give a more rapid response. Intravenous
lorazepam (0.05-0.1 mg/kg) 4 to 8 mg, or 10 mg diazepam, is generally effective in
controlling it. Lorazepam is preferred by many experts because it is more efficacious and
lasts longer than diazepam.
032008. 2.3.4.3).
41. A child who is having frequent seizures is most likely taking a medication that causes gingival
hyperplasia in 50% of people. Phenytoin (dilantin)
42. Adrenal insuffiency has symptom of hypoglycemia (not hypertension)
Primary adrenal insufficiency (Addison's disease) produces signs and symptoms that
relate to a deficiency of aldosterone and cortisol. The most common complaints are
weakness, fatigue, and abnormal pigmentation of the skin and mucous membranes.
Hypotension, anorexia, and weight loss are additional common findings. If a patient with
Addison's disease is challenged by stress (e.g., illness, infection, surgery), an adrenal
crisis may be precipitated. This medical emergency manifests as severe exacerbation of
the patient's condition, including sunken eyes, profuse sweating, hypotension, weak
pulse, cyanosis, nausea, vomiting, weakness, headache, dehydration, fever, dyspnea,
myalgias, arthralgia, hyponatremia, and eosinophilia. If not treated rapidly, the patient
may develop hypothermia, severe hypotension, hypoglycemia, and circulatory collapse
that can result in death.2
43. Secondary hyperparathyroidisn is a result of renal failure, chronic renal disease

44. Which drug causes capillary dilation? Histamine
45. Which of the following restorative materials has the closest thermal coefficient of expansion with
real teeth? Direct gold, Amalgam, composite microfilled, dental acrylic plastics
Increasing values of coefficient of thermal expansion:
Porclainhuman teethdental amalgam unfilled acrylic plastics
46. Class II smooth caries lesion is most likely a result of plaque accumulation
47. A new restoration is done on a patient, he comes back complaining of sharp shooting pain when
the teeth are in contact. ( Unless more information is needed to say type of restorative material,
130
I would go with hyperocclusion. This is due to: galvanic response- a gold filling placed
immediately next to a silver, amalgam filling can cause a sharp pain (galvanic shock) to
occur. The interaction between the metals and saliva causes an electric current to occur -
it's a rare occurrence, hyperocclusion premature tooth contact during oral cavity closure. In
these cases, the bite appears normal immediately following the procedure, but over
the course of a few days following the procedure, the tooth begins to develop bite
tenderness and may contact first when the patient closes together.
48. All of the following except: the enamel hatchet can be used for gingival bevel
49. Which of the following is not a function of opaque porcelain? Opaque porcelain is used on the
incisal and provides translucency
Opaque porcelain conceals the metal underneath, initiates the development of the
shade, and plays an important role in the development of the bond between the
ceramic and the metal. Mosby pg 335 state it must mask the dark oxide color and
provide porcelain-metal bod. Bond strength depends on good wetting of the metal
surface. Masking must be accomplished with the minimum thickness of opaque
about 0.1 mm leaving maximum space to develop a natural appearance with body
and incisal porcelains.
Layers of a metal-ceramic restoration.
2. Dentin, or body, porcelain makes up the bulk of the restoration, providing most of
the color, or shade.
3. Enamel, or incisal, porcelain imparts translucency to the restoration.
(Shillingburg, H.. Fundamentals of Fixed Prosthodontics, 3rd Edition. Quintessence

Publishing (IL), 011997. 25).
50. Which tooth is most likely to be extracted if affected by periodontal involvement? Mandibular
pre-molar
51. Which antibiotic prevents collagen break down? Doxycycline

allergy to tetracycline. The semisynthetic compounds (e.g., doxycycline) were more
131
effective than tetracycline in reducing excessive collagenase activity in the gingival

crevicular fluid (GCF) of chronic periodontitis patients.
52. How is the junctional epithelium attached to the tooth? Hemidesmosome

53. Government spends more money in dental care through- Medicare, Medicaid, grants, HMOs
54. From the free gingival margin to the mucogingival junction measures keratinized gingiva.
55. If you get punched in right side, the left condyle will break- true
56. If you get punched on right side, you will break left condyle and right body of mandible-true
57. Pain in the auricular area is referred from ipsilateral mandibular tooth-true
58. HIV viral load of 100,000 T-cell count of 30 means you have a high viral load and are succeptible
to infections.
59. Rate of epithelial junction regeneration after periodontal surgery is 0.5-1.0 mm, 5-14 days
60. Emphysema is rupture of the terminus alveoli. Deficiency with alpha 1 antitrypsin. Majority is
caused by smoking
61. Wheezing is asthma is result of bronchial constriction and air squeezing through. Expiratory air
62. Most common side effect of antihypertensive drugs is orthostatic hypotension.
63. Pregnant women with hypotension should be treated with? left lateral tilt positioning
64. Intrapulpal injection… needs prophylaxis
65. Osteoporosis in xray appears with hypocalcification of osteocytes
66. Anesthetizing an infected area best done by block. In mandible IANB
67. Radiograph of calcification around molar: identify as cementoblastoma
Cementoblastoma
A, A portion of a panoramic radiograph showing a large,
bulbous, radiopaque mass attached to the roots of the
mandibular right first molar. A radiolucent band can be seen
surrounding the mass, and root resorption of the molar roots
has occurred. B, A periapical radiograph of a lesion associated
with a bicuspid. (Courtesy B. Pynn, Canada.)
092008. 22.7.5.14).
68. Huge radiolucency of skull, pain in back and in mandible? Multiple myeloma Mosby pg 116
69. Hypertensive patients should have K+levels checked regularly if treated with hydrochlorothiazides
132
70. New born with white spots on alveolar ridge: bohn’s nodule
71. White lesion on mid palate of infant: Epstein pearls
72. Intermaxillary suture pointed to on radiograph
The intermaxillary suture
73. Serial ceph used to track progress of growth

74. Arch analysis used to predict size of unerupted canine and premolar
75. Maxillary central incisor erupts ectopically; should correct as soon as possible.
76. Mandibular canine erupts facially to rest of teeth- likely to lead to… space insufficiency
In the lower arch, however, the canines often erupt before the first premolars, which causes
the canines to be displaced facially. To avoid this result, the lower primary first molar should
be extracted when there is ½ to ⅔ root formation of the first premolar. This usually will
speed up the premolar eruption and cause it to enter the arch before the canine. The result is
easy access for extraction of the first premolar before the canine erupts
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006.
12.6.5.5).
77. Unfavorable eruption sequence; mandibular second molar before mandibular second premolar
78. Intesifying screens in pan helps to reduce radiation to patient (exposure time)
Contemporary intensifying screens used in extraoral radiography use the rare earth
elements gadolinium and lanthanum. These rare earth phosphors emit green light on
interaction with x rays. Compared with the older calcium tungstate screens, rare earth
screens decrease patient exposure by as much as 55% in panoramic and cephalometric
radiography.
092008. 3.3.2.2).
79. Lots of jurisprudence questions/ vocab

80. Patient standing in corner of room with arms crossed what should you say? You look like you’re
stressed can you tell me what is wrong.
81. Look up cross sectional, cohort
Cross-sectional study: a study in which the health conditions in a group of people

who are, or are assumed to be, a sample of a particular population (a cross section) is
assessed at one time. Consider the hypothesis that drinking alcohol increases the risk of
133
developing oral cancer. If researchers chose to conduct a cross-sectional study to explore

this hypothesis, they might examine a group of men who drink alcohol and then compare
the occurrence of oral cancer among men who are not alcohol drinkers. The researchers
could then determine whether there is an association between the presence of oral cancer
and alcohol. Although this study is relatively quick and inexpensive, its potential to
contribute to a judgment of causation is limited because it cannot determine whether the
outcome (in this case, oral cancer) occurred before the men started drinking, or if it
developed as a result of some other cause (e.g., metastasis).
b. Case control study: people with a condition ("cases") are compared with people
without it ("controls") but who are similar in other characteristics. Hypothesized causal
exposures are then sought in the past medical records of the participants. If the
researchers had chosen to conduct a case control study to explore the same hypothesis,
subjects would have been split into two groups— those with oral cancer and those
without it, based on examinations. To search for an association with alcohol drinking, a
history before the occurrence of oral cancer would be sought (e.g., through past medical
records). Thus, the case control study could establish a temporal relationship between the
exposure and disease of interest, in this case a history of alcohol drinking before the
appearance of oral cancer.
Cohort study
(1) Prospective cohort study: a general population is followed through time to see
who develops the disease, and then the various exposure factors that affected the group
are evaluated. In this case the investigator chooses or defines a sample of subjects who do
not yet have the outcome of interest, such as oral cancer. She measures risk factors in
each subject (such as habits) that may predict the subsequent outcome. She follows these
subjects with periodic surveys or examinations to detect the outcome (s) of interest.
Following the group over a period of time, the investigator describes the prevalence of
outcomes (such as oral cancer) in the cohort. She then compares the prevalence of the
disease in men who drink alcohol with the prevalence of men who do not drink.
(2) Retrospective cohort study: used to evaluate the effect that a specific exposure
has had on a population (e.g., occupational hazards). The investigator chooses or defines
a sample of subjects who had the outcome of interest. He measures risk factors in each
subject that may have predicted the subsequent outcome.
82. Two different methods of learning, traditional, and self-instruction, evaluate results of tests and
want to know what is the independent variable. The method of instruction.
83. When would you do an elective root canal? Not enough tooth structure left for crown,
84. The disadvantage of ceramic veneer over resin veneer is ceramic is more expensive
85. The advantage of direct method in inlay onlay over indirect is that the direct has better bonding
to the tooth,
86. Which has better prognosis? Incomplete cleaning of root canal (bad prognosis)…. Answer
overextension of filling?
87. A vital tooth will respond to electric pulp test for 2-5 sec.
88. Thermal test used to distinguish between reversible and irreversible pulpitis.
134
89. Electric pulp test dintinguishes vital from nonvital teeth.

90. Apex locator will not help you locate canal curvature.
91. Patient had root canal two years ago, come back and has radiolucency, asymptomatic what
would you do? Wait and evaluate
92. Way to distinguish between periodontal and periapical lesion? Palpation, probing
93. Acute periapical periodontitis can be determined by percussion.
94. In adult population in U.S. which group has highest rate of periodontitis? AA males
Native Americans- via website. http://www.raconline.org/pdf/HRSAposter083103.pdf, they have
the highest incidence of Periodontal Disease, tobacco use, and edentuolous rate.
95. In the U.S. the population that is most likely to have diabetes? Black
96. Worst prognosis for oral cancer in which population? Black
97. From 2000-2006 records, the surgeon general determined that the most preventable cause of
death in the united states is smoking.
98. Lately, we have seen a decrease in edentulism in elderly.
99. Miconazole inhibits ergosterol production in cell wall
100. Retraction cord epinephrine acts on alpha 1 receptor
101. Neurofibromatosis? pedunculated noducles in skin and mouth, freckling(Crowe’s sign), lisch
spots(iris freckling) café au lait pigmentation and multiple neurofibromas Mosby g 113
102. Mech of action of chlorhexidine? The mechanism of action is membrane disruption
Chlorhexidine is considered the most effective antiplaque and antigingivitis agent.1-4,35

Its antibacterial action can be explained by disruption of bacterial cell membrane by
the chlorhexidine molecules, increasing its permeability and resulting in cell lysis
and death.3
Company, 072006. 19.5.2.1).
103. How does chlorhexidine prevent gingivitis? Reducing bacterial counts in mouth
104. Complication of extracting molar? Perforate sinus, damage tuberosity
105. Ideal pontic? Passive contact on edentulous ridge. Mosby pg 3320 Mucosa pontics should be
concave and passively contact the ridge
106. A young child under nitrous starts snoring, what do you do? Remove rubber damn and check
position of pharynx.
107. Nitrous purpose? To calm anxious patients.
108. A patient is whimpering during procedure but not resisting. What do you do? Continue
treatment or sedate or tell patient to stop whinpering??
109. Different cultures, people have diffent perception of pain.
110. What would you not see in bell’s palsy? Hypersalivation
111. Parkinson’s disease all of the following except hyperactive gag reflex.
112. Mech of action of carbidopa, inhibits the enzymatic breakdown of Levodopa in systemic
circulation.
113. Down syndrome child recently adopted, before adoption lived in foster home; which one these
would not be a behavior of the child? Aggressive
114. Trisomy 21 has cleft palate, cardiac abnormality, class III, perio problems but not rampant
caries.
115. Tricyclic antidepressant not characterized by immediate effect. (they need time to become
effective).
116. Cerebral palsy- most are intellectually normal, enamel hypoplasia
117. Decreased oxygenation to brain will result in vaso-vagal syncope
135
118. Most common side effect of nitrous oxide therapy? Nausea

119. What happens if you remove oxygen before end of nitrous oxide? Diffusion hypoxia
120. patient with odontogenic infection, no allergies, first dose give 1 g of amoxicillin then 500 mg
every 6 hrs for 7-10 days. Note that Penicllin V is often preferred drug of choice Mosby pg 95
121. If you have to change the condylar inclination from 20 to 45 degrees, what adjustment will you
make to the teeth? Increase curve of spee
122. Widman flap, multiple questions
123. Perio operation in posterior area, what makes operation hard? External oblique ridge.
124. Which of the following is not a characteristic of ANUG? Characteristics are Necrosis / punched
out interdental papilla, psuedomembrane margin, bleeding, redness, fetid odor
125. Bleeding on probing indication of gingivitis.
1. Had to Identify Nasoplataine duct cyst(cyst between maxillary CI)
2. Pic of Erosive Lichen Planus( Person skin had been bleeding for 3 months, Pemphgoid and guis were
not choices) erosive kind has ulceration 109
3. HMO is ( Usuary, Customery, Capatiation, ... I choose Capatiation. Dentist paid a fix amount
4. Government base dental funds off ( need, demand, cost,..)
5. Which of the following can be delivered via. transdermal patch, fentanyl does have a transdermal
patch, use for cancer patients
6. I had the question on Empress and Zirconia Crowns (Zirconia is the strongest. Empress got crystalline
reinforced glass, imparts strength to the ceramic
7. Had a question on a reverse 3/4 crown; most frequently used on buccal mandibular molar
8. 55 y.o patient widening PDL space mandibular resportion on the inferior border ( I put Sclerosing
Sclerdoma) immunologically mediated condition, dense collagen deposition, female predilection,
raynaud phenomenon (fingertip turn blue), microstomia, diffuse widening of the PDL, acroosteolystis
(resorption of terminal phalanges, claw like)
9. Reason for dual cured resin( didn't know answer). To deal with problems of incomplete curing with
VLC due to the thickness of restorations and filler particles scattering light, manufacturers have
developed composite resins that are dual cured which combined self curing and visible light curing.
One way to overcome limits on curing depth and some of the other problems associated with light
curing is to combine chemical curing and visible-light curing components in the same resin. So-
called dual-cure resins are commercially available and consist of two light-curable pastes, one
containing benzoyl peroxide (BP) and the other containing an aromatic tertiary amine. When these
two pastes are mixed and then exposed to light, light curing is promoted by the amine/CQ
combination and chemical curing is promoted by the amine/BP interaction. Dual-cure materials are
136
intended for any situation that does not allow sufficient light penetration to produce adequate
monomer conversion, for example, cementation of bulky ceramic inlays. Like the chemically cured
resins, air inhibition and porosity are problems with dual-cure resins.
(Anusavice, Kenneth J.. Phillips' Science of Dental Materials, 11th Edition. Saunders Book Company,
072003. 18.4.7).
10. Advantage of using metal frame work all except..( high flexibility). Low density(weight), high
modulus of elasticity( stiffness), low material cost, and resitance to corrosion)
11. Pic of 14 y..o boy right mand expansion and RCT #30 and pain still present tooth was super erupted,
Question asked what could it be Osteosarcoma, Fibrous Dysplasia, etc.... I put FD because of age of
patient cant remember other choices
Fibrous dysplasia Mosby pg 120. - uncommon, entire half jaw usually in max. affect children,
stop growing after puberty, X-ray is diffuse opacity (ground glass). 2 types monostotic or polystotic. The
polystotic are associated with syndromes , 1.)McCune- Albright syndrome---- polystotic, café au lait
pigmentation, and endocrinopathies. 2.) Jaffe Lichenstein -----polystotic, café au lait
Osteosarcoma Mosby pg 122- , new bone is formed(osteoid). Cause unknown. CCL features,
pain, swelling, and paresthesia are typically present. PDL invasion results in widening. Mean age of 35
years old but range btw 10 to 85. Manidble more affected than maxilla. Tx. With resection and
neoadjuvant chemotherapy anor adjuvant chemotherapy. 5 year survival rate from 25 to 40 % and
Prognosis better for mandibular than maxilla ( im chosing this bc pt had RCT so possible widening of PDL
and the expansion could be from the sunburst appearance osteosarcoma gives expansile lesion)
12. Young patient mand trauma what happens during growth something like that (condylar hyperplasia,
normal growth)
13. Which mixture is a schedule 2 I put Perocet but they had Hydro + ace
Scheduled Drugs
Sched
Common Drugs Definition
ule
schedu HEROIN, LSD, mescaline, methylenedioxymethamphetamine no accepted medical use
le I (MDMA), methaqualone, racemoramide, tilidine, high risk for abuse
trimeperidine unsafe for use
schedu amobarbital, AMPHETAMINE, COCAINE, codeine, limited medical use
le II glutethimide, hydrocodone, hydromorphone, levorphanol, high risk for abuse
meperidine, METHADONE, methylphenidate, morphine, high risk for physical or
oxycodone, oxymorphone, pentobarbital psychological
dependence
schedu amobarbital, amphetamine, anabolic steroids, accepted medical use
le III BUPRENORPHINE, chlorphentermine, codeine compounds, moderate risk for abuse
GLUTETHIMIDE, hydrocodone compounds, phenmetrazine moderate risk for
physical or psychological
137
dependence
schedu BENZODIAZEPINES, CHLORAL HYDRATE, meprobamate, accepted medical use
le IV paraldehyde, pemoline, pentazocine, phenobarbital, low risk for abuse
propoxyphene compounds, zolpidem low risk for physical or
psychological
dependence
schedu codeine COUGH preparations, dihydrocodeine, diphenoxylate accepted medical use
le V negligible risk for abuse
negligible risk for
physical dependence,
low risk for psychological
dependence
14. Have patient who has perio abscess and chronic periodontitis after ER treatment what do you do
OHI, SRP
15.Which one will not tell pulpal status (thermal, EPT, Dental stimulus Percussion)
16. How do you treat 3-walled defect(A.k.a. infrabony)- guided tissue regeneration
17. Diagnostic test that always give good results something like that I put Reliability( Mosby pg 214- is
equal to the repeatability and reproducibility fo a test. A reliable test would produce very similar
results wehne used to measure a variable at different times.
18. Had Senstitivity question- true positives. Patient with the disease who are correctly classified as
having the disease
19. What metal is the target of x-ray made of (Lead, copper, Tungsten)
20. Move x-ray from 12in to 4in ( 3X, 6X, 9X, 12X)
21. What is the main difference in different insulin prep: Onset of Action, Mode of Action Mosby pg 303
22. Stridor/laryngospasm= inspiratory wheezing. Tx succinylcholine
23. Aids patient with Candadisis how do you treat- Flucanazole and amphotericin B
24. 3rd molar classification- mandibular(Distoangular, vertical, horizontal, mesioangular) in order from
hardest to easiet
25. Desenstitztion Mosby pg 228- exposing patient to items from a collaboratively constructed hierarchy
of slowly increasing anxiety provoking stimuli while using relaxation skills
26.. Pre-comptemplation Mosby pg 224. An individual is not considering a behavior change.

Contemplation- an individual begins to consider a behavior change preparing to take steps to change
often expresses a desire to change. Action- an individual is engaged in taking action toward behavior
138
changed(often requires support for his or her efforts). 4.) maintenance- and individual attempts to
maintain a changed behavior.
27. Pregnant women has syncope epioside in the supine position what do you do? Put her on left side
right hip up
What do leukotrienes to? Cause Asthma example of leukotriene receptor

antagonist is montelukast Mosby pg 301
Highest rate to get autoimmune disease?
Children with coronary artery disease…obesity
What does chemo cause? thrombocytopenia
What causes perio disease? plaque
What cause seizures? Mosby pg 284. They are caused by inappropriate and
excessive activity of motor neurons in the CNS.
Patient with pain after post/core? Root fracture
Contraindication for methotrexate?aspirin, pcn
Patient with Sjorgen Syndrome can develop? lymphoma
Pic. Of nicotine stomatitis
Highest prevalence for perio disease: AA males
Highest prevalence for caries in children: hispanics
A patient with retruded tongue, what does that cause? obstruction
Reason for splinting a tooth: comfort
If you do the outline form and there is still decay what to you do – use a large
round bur and remove from the periphery, use large round bur and go into the
deepest area, use small round bur and remove from periphery, or use small
round bur and go into the deep area.
139
Comparing girl and boy what do you use – Chi test- Measures the association
between 2 categorical values
Gemination – with one canal. Mosby pg 178 it is the division of a single tooth bud
resulting in a bifid crown.SINGLE PULP CHAMBER
Drug contraindicated for preg. Women PER DR. WILLIAMS NOT. CANNOT GIVE
WARFIN, NSAIDS, METHOTREXATE, PENTAZOCINE(TALWIN), PHENOBARBITAL,
MERPIDINE, NITROUS, BARBITUATES, PHENERGAN, PROPOXYPHENE,
TETRACYCLINE, CARBAMEZAPINE,CHLORAL HYDRATE, CHOLORDIAZEPINE,
CORTICOSTERIODS, DIAZAPAM, MORPHINE, DIPHENHYDRAINE AND
HYDROCHOLORIDE. ,,,, CAN GIVE TYLENOL, PROPOFOL, AND CODEINE
Inverted Y on xray across the molars and PM
Consequently, on periapical radiographs of the canine, the floors of the sinus and nasal cavity are
often superimposed and may be seen crossing one another, forming an inverted Y in the area.
The anterior border of the maxillary sinus (white arrows)

crosses the floor of the nasal fossa (black arrow).
Bright RO image on the chin of a pan…
Earlobe
Hey, here's some Q's I remembered. Hope it helps. Be blessed!
140
1. How long after bleaching can u do a restoration? 3 weeks or more (dental secrets p.168Q171)
Recent bleaching procedure : Wait 1 week after bleaching
(Powers, John M. Powers. Craig's Restorative Dental Materials, 12th Edition. C.V. Mosby, 022006.
10.4.3.1.1).
2. # 29 has an MOD onlay restoration, patient in pain and tooth responsive to NOTHING...whats the
pulpal and periapical dx? Necrotic pulp
3. C1 esterase deficiency-->angioedema of lips
4. What kind of epithelium will be @ a new graft site? (epi from graft site? epi from new site?,
connective tissue from graft site? or connective tissue from new site?)
The success of the graft depends on survival of the connective tissue. Sloughing of the
epithelium occurs in most cases, but the extent to which the connective tissue withstands the
transfer to the new location determines the fate of the graft
(Newman, Michael G.. Carranza's Clinical Periodontology, 10th Edition. Saunders Book Company,
072006. 69.5.1.1.3).
5. 6 y.o. bit lip one day, now it's a non-ulcerative lesion. What is it?
6. Why recapitulate?
Recapitulation is important regardless of the technique selected and is accomplished by taking a

small file to the corrected working length to loosen accumulated debris and then flushing it with 1
to 2 ml of irrigant. Recapitulation is performed between each successive enlarging instrument
regardless of the cleaning and shaping technique.
(Torabinejad, Mahmoud. Endodontics: Principles and Practice, 4th Edition. Saunders Book Company,
032008. 15.12.13).
7. Implants should be how many mm from nerves? 2 mm (minimum) from the nerve EXCEPT MENTAL
NERVE AND ITS 5MM
141
8. Opioids act on same receptor as?
Most of the clinically used opioids are relatively selective for μ receptors (analgesia), reflecting their
similarity to morphine
Drugs such as nalbuphine and butorphanol are competitive μ-receptor antagonists but exert their
analgesic actions by acting as agonists at K receptors
(Hardman, Joel G.. Goodman & Gilman's the Pharmacological Basis of Therapeutics, 10th Edition.
McGraw-Hill Professional Publishing, 082001. 24.8).
9. Penicillin cross allergy with... cephalosporin
10. Main reason to redo RCT's? (missed lateral canals?, extruded gutta percha?) reinfection
11. # 18 (opercule)in a young patient with pain. WWYD?
excision of the surrounding soft tissue, or operculectomy, has been advocated as a method for
preventing pericoronitis without removal of the impacted tooth, it is painful and is usually
ineffective. The soft tissue excess tends to recur because it drapes over the impacted tooth and
causes regrowth of the operculum. The gingival pocket on the distal also remains deep after
operculectomy. The overwhelming majority of cases of pericoronitis can be prevented only by
extraction of the tooth.
(Hupp, James R.. Contemporary Oral and Maxillofacial Surgery, 5th Edition. Mosby, 032008. 9.1.3).
12. Mouth wash A vs Mouth wash B--> null hypothesis (just know definition)
13. If a null hypothesis is rejected, how is it stated?
If the observed probability is less than or equal to .05 (5%), the null hypothesis is rejected (i.e.,
the observed outcome is judged to be incompatible with the notion of "no difference" or "no
effect") and the alternative hypothesis is adopted. In this case, the results are said to be
"statistically significant." If the observed probability is greater than 0.05 (5%), the decision is to
accept the null hypothesis, and the results are called "not statistically significant" or simply
NS—the notation often used in tables.
14. Teenager with proximal decay that will undermine all cusps. What restoration will u do on it?
15. Fluoride commonly used in elementary schools today? Fluoride mouth rinse: weekly with .02%
(neutral sodium fluoride) NaF p. 208 mosby
16. How to determine fluorosis in a patient? (two teeth? full mouth must have it? age?...)
Normal:
The enamel represents the usual translucent semivitriform type of structure. The surface is smooth,
glossy, and usually of a pale creamy white color.
142
Questionable:
The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a
few white flecks to occasional white spots. This classification is utilized in those instances in which
a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of
“normal” not justified.
Very mild:
Small, opaque, paper-white areas scattered irregularly over the tooth but not involving as much as
approximately 25% of the tooth surface. Frequently included in this classification are teeth showing
no more than about 1-2 mm of white opacity at the tip of the summit of the cusps of the bicuspids
or second molars.
Mild:
The white opaque areas in the enamel of the teeth are more extensive but do not involve as much as
50% of the tooth.
Moderate:
All enamel surfaces of the teeth are affected, and surfaces subject to attrition show marked wear.
Brown stain is frequently a disfiguring feature.
Severe:
Includes teeth formerly classified as “moderately severe” and “severe.” All enamel surfaces are
affected and hypoplasia is so marked that the general form of the tooth may be altered. The major
diagnostic sign of this classification is the discrete or confluent pitting. Brown stains are widespread
and teeth often present a corroded appearance.
(Burt, Brian A.. Dentistry, Dental Practice, and the Community, 6th Edition. Saunders Book Company,
032005. 17.2.1).
17. Plaque score? For us or the patient

18. Undercuts in anterior and big tuberosities, which do u eliminate? tuberosity
19. Which is the least important, hue, value or chroma? Hue I think…
The three characteristics of color are hue, chroma, and value. 24 To facilitate communication with
ceramists, the dentist should be thoroughly familiar with these terms and their definitions. Hue is that
quality which distinguishes one color from another. It is the name of a color, such as red, blue, or
yellow. Hue may be a primary color or a combination of colors. Chroma is the saturation, intensity,
143
or strength of a hue. For example, a red and a pink may be of the same hue. The red has a high
chroma, while the pink, which is actually a weak red, has a low chroma
Value, or brightness, is the relative amount of lightness or darkness in a hue. Value is the most
important color characteristic in shade matching. If it is not possible to achieve a close match with
a shade guide, a lighter shade should be selected since it can be stained more easily to a lower value.
It is impossible to stain a tooth to obtain a lighter shade (higher value) without producing opacity. If
major changes are attempted in the hue or chroma, there will be an accompanying decrease in value.
(Shillingburg, H.. Fundamentals of Fixed Prosthodontics, 3rd Edition. Quintessence Publishing (IL),
011997. 23.2).
20. X-ray's and something about humans versus things in nature...how are the levels determined??
21. Best way to tx external resorption?
Luxated teeth in which the pulps become necrotic are indicated for root canal therapy. Often in
luxated teeth, there has been damage to the root cementum. If the pulps become infected, external
resorption is stimulated by the presence of bacteria in the pulp space. To arrest any ongoing
resorption and to prevent additional resorption, it is important that the root canal
treatment includes all efforts to disinfect the root canal system. It has been recommended
that calcium hydroxide be placed in the canal for up to 2 weeks to aid in disinfection before
filling the root canals
(Torabinejad, Mahmoud. Endodontics: Principles and Practice, 4th Edition. Saunders Book Company,
032008. 10.3.6.3).
22. Which fracture produces paresthesia?
Probably body.. anything nwhich will affect inf.alv nerve

23. Difference b/w trough, dehesecience, hemiseptum
TROUGH IS 4 WALL DEFECT
When the denuded areas extend through the marginal bone, the defect is called a dehiscence
The one-wall vertical defect is also called a hemiseptum.
072006. 28.5.3).
24. Thickness of CaOH2 in a deep prep should be?

144
Removal of remaining infected dentin is accomplished in the same manner as described

previously for the conservative preparation. If a pulp exposure occurs, the operator must decide
whether to apply a direct pulp cap of calcium hydroxide to the exposure or to treat the tooth
endodontically. For pulpal protection in very deep carious excavations (where the
remaining dentin thickness is judged to be <0.5 mm and a pulpal exposure is suspected), a
thin layer (i.e., 0.5-0.75 mm) of a calcium hydroxide liner may be placed. The calcium
hydroxide liner may stimulate secondary dentin formation in an area where a micro-exposure is
suspected. If used, it is placed with the same instrument using the same technique as described
for the RMGI liner. The calcium hydroxide liner should be placed only over the deepest portion
of the excavation (nearest the pulp). A thin base of RMGI should be used to cover the calcium
hydroxide.31 The entire dentin surface should not be covered (Fig. 17-28). The RMGI liner is
recommended to cover the calcium hydroxide to resist the forces of condensation and to seal
the deeply excavated area.19 Usually no secondary resistance or retention form features are
necessary for extensive Class I amalgam preparations. Primary resistance form was obtained by
extending the outline of the tooth preparation to include only undermined and defective tooth
structure, while preparing strong enamel walls and allowing strong cuspal areas to remain. If
the excavation of caries has removed most (or all) of the flat pulpal floor that was initially
prepared, secondary resistance form may be indicated. If so, the dentist establishes flat seats in
dentin (0.2 mm inside the DEJ, at the pulpal wall level) that are equally spaced around the
periphery of the excavation. Primary retention was obtained by the occlusal convergence of the
enamel walls; secondary retention form may result from undercut areas that are occasionally
left in dentin (and that are not covered by a liner) after removal of infected dentin. The external
walls of the preparation are finished as described previously.
Placement of calcium hydroxide liner and RMGI base.
(Roberson, Theodore. Sturdevant's Art and Science of Operative Dentistry, 5th Edition. C.V. Mosby,
042006. 17.6.2.2.2).
25. Medicare...is it a federal program? yes

145
Since dental insurance is generally provided as an employee benefit, the elderly typically do not have
this benefit. According to the 1989 NHIS26, 50% of the 35 to 54 year, 37% of the 55 to 64 years and
15% of the 65+ population had private dental insurance. Dental benefits are not included in
Medicare, and very few states provide dental service to adults through the Medicaid program. In
1990, nearly 75% of edentulous persons 35+ years did not have private dental insurance compared to
about half of the dentate population.
Medicaid is a program established in 1965 to provide health insurance to low-income

populations. It is jointly funded by the federal and state governments, includes dental
services for children, and covers one in every four children in the United States. Medicaid's
Early and Periodic Screening Diagnostic, and Treatment program requires comprehensive
children's health and dental services to be provided by all states. Because Medicaid is an
entitlement program, enrollment must be offered to eligible children without regard to the fiscal
impact on the state. Many barriers exist that deter children from receiving dental services through
Medicaid, including low reimbursement rates to dentists, cumbersome claims processing, and real
or perceived poor health behaviors by recipients.
(McDonald, Ralph. Dentistry for the Child and Adolescent, 8th Edition. Mosby, 022004. 30.5.2.1).
26. I had the avulsed tooth transport medium question twice..Hank's solution
27. Last sensation to leave with local anesthesia
sympathetic functionpaintemptouch deep pressure(proprioceptio)motor function

28. IgG
Opsonization refers to the coating of particles, such as bacteria, with host proteins that facilitate
phagocytosis. For example, a bacterial cell may be coated with molecules derived from complement
components(e.g., iC3b) for which the neutrophil has receptors (CR3). Similarly, bacterial cells may
be coated with specific antibody that fixes complement and results in surface deposition of C3b that
is recognized by the CR3 neutrophil receptor when converted to iC3b. Specific antibody of the
immunoglobulin G (IgG) isotype also facilitates phagocytosis directly by binding with the
neutrophil Fc receptor and appears to be essential for phagocytosis of certain periodontal
pathogens.
Patients with periodontitis often exhibit very high serum titers of IgG to specific periodontal
pathogens. Although B cells are directly responsible for antibody production, T cells are required to
regulate the isotype switch from immunoglobulin M (IgM) to IgG. Antigen-presenting cells (APCs)
such as the peripheral dendritic cells (e.g., Langerhans cells, macrophages, B cells) are abundant
within the gingival tissues135 and can transport antigen to regional lymph nodes, thus promoting the
production of serum IgG antibody. Local immunoglobulin production also has been documented
within the gingiva, and the gingival tissues are impregnated with very high levels of
immunoglobulins.
146
072006. 13.2.2).
The main functions of antibodies are to neutralize bacterial toxins and viruses, opsonize
bacteria, activate complement to form a membrane-attack complex that can kill bacteria, and
interfere with attachment to mucosal surfaces. IgG is the main opsonizing antibody, IgG and
IgM activate complement, and IgA interferes with attachment to the mucosa.
(Levinson, Warren. Medical Microbiology & Immunology, 8th Edition. McGraw-Hill Medical Publishing,
062004. 8.3.1).
29. Issues with waiting period and insurance policy

30. Acryodinia definition
Acrodynia (pink disease)
Mercury toxicity causes alveolar destruction and sequestration. Extremely rare now, although in the
past it was not uncommon with the use of teething powders containing mercury.
____________________________________________________________________
On day two, most of my full mouth x-rays were shitty, clinical pics were okay, cephlograms and pans
were okay.
Remembered questions Dec 2009
I took first 400 hundred today. I will continue to add as I remember. I do remember more, But I need to
look over a few case studies for tomorrow. Good luck!! I had a lot of repeats.
1. what drug is contraindicated w/ nursing mother? Meperidine (ok), codeine(ok),

propoxyphene(ok)..tylenol(ok) TETRACYCLINE, CYCLOSPORINE, METHOTREXATE, ARE SOME I FOUND
THAT SHOULD NOT BE TAKEN.
2. description on fluctuant mass on midline floor of mouth? Ranula, dermoid cyst, lymphoepithelial
cyst…I chose dermoid cyst
147
3. At what age would a kid get ameologenisis imperfecta(hypoplatic type) on Max Central incisor? Ages
range from months to years (perm-6mos/ prim-3-4mos utero)
Amelogenesis imperfect occurs at birth !!!
4. fusion/germination.
Fusion
Joining of two teeth of the normal series or a normal tooth and a supernumerary tooth by pulp and
dentine. Two canals are usually present. The tooth has arisen from two tooth germs and so the
number of teeth in the dentition is normally reduced by one unit. If, however, the normal tooth
is fused to a supernumerary, the number of teeth in the arch will be normal. This fusion is
assumed to occur between normal and supernumerary teeth because of the close proximity of the
tooth buds.
Gemination
Budding of a second tooth from a single tooth germ. Usually one root canal is present.
(Cameron, Angus C.. Handbook of Pediatric Dentistry, 2nd Edition. Mosby Ltd., 062003. 7.6.4.2).
5. xray with inverted Y, ID the parts: inf border nasal cavity, ant border max sinus
The inverted Y is prominently seen in the canine film. The more-anterior arm of the Y with its
superior extension consists of the floor of the nasal cavity (fossa), whereas the more-posterior
curved arm is the anterolateral wall of the maxillary sinus. The soft tissue outline of the nasal
mucosa is delineated superiorly by a thin radiolucent line representing an airspace between the
nasal turbinate and nasal mucosa. In this example, the gingiva is seen at the crest of the alveolar
ridge in the edentulous area.
(Langlais, Robert P.. Color Atlas of Common Oral Diseases, 3rd Edition. Lippincott Williams & Wilkins,
012003. 1.4.3).
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6. xray of median palatal suture. See pg 336 in Principles of dental imaging
7. opiods contraindicated with hypothyroidism..
8. pt with existing crown, lighter than rest of other ant, what to do u do. I chose bleach
9. The advantages of NiTi files over SS files except. strength
10. advantage of placing direct composite resin vs indirect
11.which has less discomfort with healing. Internal or external bevel. internal
12. which 3 types of margins used for all ceramic crown. Butt joint, shoulder, bevel, chamfer, knife
edge….
13. if doing study on male/female with or without cancer what test do u use. T-test, Chi-square…
14. cholinergic and anticholinergic The parasympathetic nervous system, which uses
acetylcholine almost exclusively to send its messages, is said to be almost
entirely cholinergic. ( Causes increase in Saliva, lacrimation, urination, diarrhea)
Anticholinergics are a class of medications that inhibit parasympathetic nerve
impulses by selectively blocking the binding of the neurotransmitter acetylcholine
to its receptor in nerve cells.
15. reason for applying dressing after surgery it is a protective obtudent to the gingiva tissue
16. reason for splinting mobile teeth. To provide comfort to patient and function
17. what is best xray to view midface fractures: saggital, waters, pan, ct scan
18. st johns wart : tx depression and know drug contraindications with aspirin
19. purpose of keyway when prep for post and core. Antirotation
20. purpose in casting ring liner. Allow for expansion
21. what is sign of ectodermal dysplasia x-linked recessive. Partial or complete Anodontia. Sparse thin
hair, dry scaly skin, decreased sweating, abnormalities with ectoderm developments (nails, hair, skin)
22. listed symptoms of gardners syndrome and u had to choose what was missing. Gardner’s
syndrome,---- autosomal dominant, odontomas, osteomas, skin lesions, supernumerary teeth,
impacted permanent teeth, intestinal polyposis,( which have very high rate of malignant conversion to
colorectal carcinoma)
23. x ray of toothlets: compound odontom

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24. what if pain after post and core: root fracture
25.showed picture of CT scan. Had to know that is what it was
26. showed picture of nikolsy sign and said no mucosal or skin leasions present. Pemphigus – multiple
painful ulcers preceded by bullae which form within epitheilium. oral lesions precede skin lesion in
about half lesions. Heal with no scarring/Pemphigoid heal with scarring . Mucosal and cutaneous
involvement. presents as multiple painful ulcers preceded by bullae which form below epithelium oral
lesions that my be found in any region in attached gingival and ocular lesions can lead to blinidness
(Semblaspharon)Mosby pg 110
27. picture of mucocele ( description mosby pg 113- submucosaal nodule of saliva often bluish in color
due to escape due to escape from duct of salivary gland. Common in lower lip.
28. sjogren associated with lymphoma. Also sjogren is dry eyes, (keratoconjunctivitis sicca) dry mouth
(xerostomia) rheumatoid arthritis. Complication with cervical caries. Mosby pg 114
29. picture on nicotine stomatitis
30. described neurofibromatosis and you had to choose other features: cafe au lait, multiple
neurofibomas, axillary freckling and lisch nodules mosby pg 113
31.described pt with multiple neuromas. Only one made since to me was MEN (multiple endocrine
neoplasia syndrome) MEN III- mosby pg 113 multiple neuromas, syndrome components ( oral mucosa
neuromas (hamartomas), medullary carcinoma of the thyroid, and pheochromocytoma of the adrenal
gland)
32. if push on lesion it blanches: hemangioma
33. describe kid with ulcerative colitis- rectal bleeding
34. if have acromegaly what will be malocclusion class. III
35. how far to extend mand denture base… cover entire retromolar pad
36. if max tuberosity in the way, decrease it.
37. which kennedy class has no mods.. 4
38.. use glass ionomer to tx rampant class 5 decay
39. highest prevalence of perio. black males
40. highest for caries: I chose Hispanic
41. patient consent: I chose falls under autonomy
42. dentist knowledge and skills current/know own limitation: nonmaleficence

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43. if loose max primary 2nd molar too soon what will be dent maloccl classon that side : I chose class II
bcuz max 1st molar will drift mesially
44. 12 month old knee to knee: head on drs lap with parent and dr facing each other
45. retruded tongue. Bad speech, cant control lower denture, difficult swallowing
46. pt had SCRP but still have gen 5-6mm pocket with bop, perio surgery
47. insurance fraud: charging for something ur gonna do a next visit, cuz pt insurance is about to run
out or something like that
48. area most prone to develop caries on a class II composite: gingival
49. kid with incisor intruded: leave alone and let re-erupt
50. how to treat maxillar retrognathia: Lefort I osteomy
51. disulfaram:used for alcohol abuse
1. Know the glucose values HBa1C should be 7-9 fasting gluc. 70-130
2 how to treat a dry socket - place medicated obtudent- benzocaine ( irrigation by dentist or oral
surgeon, placement of medication and pain meds)
3 chiantix(Varenicline )- prescribe for somking cessation
4 Gensing and St Johns Wort avoid asp and St. John wort treats depressive
5 How to treat Prepubertal Periodontitis-- Antibiotics
6 Preg woman lying supine what vessel is smushed--IVC and Abdominal aorta were listed
7PCOD Complex odontoma Bells palsy Basal cell carcinoma AI
PCOD – non-odontogenic tumor in black females, uniquadrant, apex of lower incisors, RL/RO lesions.
Teeth are vital
Complex odontoma – most common odontogenic tumor, unerupted or missing teeth, younger age,
asymptomatic, purely RO, posterior, poorly developed dental hard tissue
Bells palsy – facial paralysis involving CN VII, Merkelson-rosenthal syndrome, Sarcoidosis (heerforts
syndrome)
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Basal cell carcinoma – mosby pg 112. most common skin cancer usually in sun damaged skin, rare in
oral cavity, usually presents as nonhealing indurated chronic ulcer does not metastasize
Amelogenesis imperfecta – developmental alterations in the structure of enamel in the absence of

systemic disorder.
8What increases in crevicular fliud of a diabetic pt. – glucose levels
9 Diazepam- don't give it to pregnant patients
10 Which part of the blade contacts the line angle of the tooth when scaling an root planing upper 1/3
middle 1/3 proximal 1/3
11 Receptors for phenothiazine antipsychotic dopamine D2 receptors or inhibit 5-HT receptors
12 Transillumination can show cracks in what instance- Cracked tooth syndrome vertical root fractures
13 Shaping - The process in which the dentist can reshape the tooth by filing or removing some of the
enamel. This process is usually not painful and can produce immediate results.
14 conditioned stimulus - In classical conditioning, the conditioned stimulus is previously neutral

stimulus that, after becoming associated with the unconditioned stimulus, eventually comes to trigger
a conditioned response.
For example, suppose that the smell of food is an unconditioned stimulus and a feeling of hunger is
the unconditioned response. Now, imagine that when you smelled your favorite food, you also heard
the sound of a whistle. While the whistle is unrelated to the smell of the food, if the sound of the
whistle was paired multiple times with the smell, the sound would eventually trigger the conditioned
response. In this case, the sound of the whistle is the conditioned stimulus.
15 hurler and hunter syndrome- pt has excess amts of Mucopolysaccharide mucopolysaccharidosis.
16 prevalence number of ppl with the disease/total number of ppl at risk incidence amount of new
cases / total of ppl at risk specificity ppl who do not have the disease and actually don’t have it and
sensitivity ppl with diseae actually correctly classify as having it
17 what is collimation used for - a collimator is a device that filters a stream of rays so that only those
traveling parallel to a specified direction are allowed through
18 when to premedicate joint replacements-- when pt is immunocomp and when the replacement
occured less than 2yrs ago
19 purpose of hex - he abutment hex interdigitates with the implant’s hex and forms a friction-fit
when the abutment is fully seated (pretty much the screw driver)
20 enamel dysplasia – aka amelogenesis imperfecta (An autosomal dominant or x-linked disorder in
which there is faulty development of the dental enamel owing to agenesis, hypoplasia, or
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hypocalcification of the enamel. It is marked by enamel that is very thin and friable and frequently
stained in various shades of brown.)
21 what treats grand mal sz choices were Dilantin(phenytoin) and ethosuximide DOC valproic acid, then
phenytoin and carbamezapine
22 know calcification sequence in primary and secondary teeth Mosby pg 176
primary: Mx: CI>1M>LI>K9>2M Mn: CI>1M>LI>K9>2M
secondary: Mx: 1M>CI>K9>LI>1PM>2PM>2M>3M
Mn: 1M>CI>LI>K9>1PM>2PM>2M>3M
23neurofibromatosis = lisch nodules in eye, von recklinghausens, café au lait, axillary freckling
1. You see a patient that has amalgams and you tell the patient to get them removed and put
composite because it is better for the patient. What ethical rule are you breaking? Veracity
2. When you over triturate the amalgam how does it affect the amalgam the reaction of silver
alloy with mercury. Undertriturated = low strength Overtriturated = extra low strength,
inc. corrosion, dec. setting expansion time, inc. creep Overtrituration results in
shorter setting time and increased shrinkage. Undertrituration results in
increased expansion, lengthened setting time, and weakened amalgam.
3. Had 2 questions on the SLOB rule. Know that if you move inferiorly and the image follows
you then it is on the lingual.
4. Know radiographic appearances for submandabular canal or mandibular canal, know lateral
wall of the maxillary sinus, osteoblastoma (non-odontogenic tumor, painful, doesn’t respond
to aspirin, RO or mixed, 2-4cm to 10), odontomas (compound and complex) Most common
odontogenic tumor, unerupted or missing teeth, purely RO, [compound-anterior,
toothlets],[complex-posterior, poorly developed dental hard tissue]. Know clinical pictures
of nicotinic stomatitis (pipe smokers, red dots on palate), candidasis, lichen planus (wickhams
striae n stuff).
5. Know the distance between 2 implants - 3mm, implant to tooth (1.5mm)
6. Know what makes an implant biocompatible – titanium oxide layer that allows for
osseointegration
7. Pain in the ear radiates from  Mandibular molars
Forehead region – Mx incisors,
Nasolabial area – Mx canines, PM,

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Temporal region – Mx 2PM,
Ear – Mn Molars,
Mental region of Mn – Mn incisors, canines, PM
8. The temperature of an implant drill while working doesn’t need to exceed  40 degrees, to
prevent necrosis (check dental secrets pg 226 number 145) 47 degrees Celsius is necrosis
9. Know how to differentiate between 1st , 2nd and 3rd degree burns (I know random as hell)
• First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at
the site of injury. These burns involve only the epidermis. Most sunburns can be included as
first-degree burns.
• Second-degree burns manifest as erythema with superficial blistering of the skin, and can
involve more or less pain depending on the level of nerve involvement. Second-degree burns
involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis
layer.
• Third-degree burns occur when the epidermis is lost with damage to the subcutaneous tissue.
Burn victims will exhibit charring and extreme damage of the epidermis, and sometimes hard
eschar will be present. Third-degree burns result in scarring and victims will also exhibit the
loss of hair shafts and keratin. These burns may require grafting.
• Fourth-degree burns damage muscle, tendon, and ligament tissue, thus result in charring and
catastrophic damage of the hypodermis. In some instances the hypodermis tissue may be
partially or completely burned away as well as this may result in a condition called
compartment syndrome, which threatens both the life and the limb of the patient. Grafting is
required if the burn does not prove to be fatal.
10. What causes a pfm to turn green  silver
11. How do you determine arch length  pm to pm. And nope canine to canine wasn’t an option
(mesial of the 1st molar to mesial of the 1st)
12. Treating a root canal on a maxillary molar and you go through the furcation, what do you
do? Repair immediately the ultimate goal is to clean, shape, and obturate as much of the canal as
accessible. Avoid using high concentrations of NaOCl bc it may inflame the periodontal tissue.
Mosby pg 19 ( this what they said showed on test I don’t know)Place calcium hydroxide and
wait, extract, some other choices. )The material of choice for the repair of a root perforation is
Mineral Trioxide Aggregate (MTA).
13. Most common salivary gland tumor – Benign(Pleomorphic Adenoma),

Malignant(Mucoepidermoid carcinoma)
14. Horizontal root fracture in the apical third and what do you do.  Mosby page 21 it has best
prognosis
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Mid 1/3 -splint and observe To facilitate pulpal and periodontal ligament healing, the
coronal and apical segments were repositioned in as close proximity as possible, and a rigid
splint of composite was placed
15. What nsaid is contraindicated in asthma patients, - Aspirin
16. Yes I had those question regarding the pregnant patient and what hip do you place her on,
and what is being obstructed. Look at old 09 remembered - With increase in uterine size with
growing fetus, the uterus can partially obstruct the inferior vena cava and aorta when the
patient is in a supine position. This will reduce blood pressure and placental perfusion.
This may result in fetal distress in the absence of maternal symptoms. Prevention of this is
accomplished by elevating the right hip 10- 12 cm. Patient may also feel sweaty, nauseated,
weakness, lack of air. Treatment: Place the patient in left lateral decubitus position (Roll
patient onto left side).
17. know about sulfonurea and how its used for diabetes. Know where it works and what it does.
Sulfonylureas bind to an ATP-dependent K+ (K ATP ) channel on the cell membrane of
pancreatic beta cells. This inhibits a tonic, hyperpolarizing efflux of potassium, thus
causing the electric potential over the membrane to become more positive. This
depolarization opens voltage-gated Ca2+ channels. The rise in intracellular calcium leads to
increased fusion of insulin granulae with the cell membrane, and therefore increased
secretion of (pro)insulin. Sulfonylureas are used almost exclusively in diabetes mellitus type
2
18. How is the face divided vertically  horizontally 1/3, vertically 1/5
19. Know what makes a schedule 2 drug –
 Schedule I is reserved for drugs or other substances that have no currently accepted medical use and
a high potential for abuse. Some Schedule I substances are heroin, LSD, marijuana and methaqualone.
 Schedule II is reserved for drugs or other substances that have a currently accepted medical use and
a high potential for abuse. Schedule II substances include Actiq®, morphine, methadone and
methylphenidate (Ritalin®).Percocet, Percodan
 Schedule III is reserved for drugs or other substances that have a currently accepted medical use and
a potential for abuse less than drugs or other substances in Schedules I and II. Their use may lead to
moderate or low physical dependence or high psychological dependence. Anabolic steroids, codeine and
hydrocodone with aspirin or Tylenol®, and some barbiturates are Schedule III substances. Lortab, vicodin
 Schedule IV is reserved for drugs or other substances that have a currently accepted medical use and
a potential for abuse less than drugs or other substances in Schedules II and III. Their use may lead to
limited physical dependence or psychological dependence relative to drugs or other substances in Schedule
III. Included in Schedule IV are Ambien®, PROVIGIL®, Darvon®, Sonata®, Valium® and Xanax®.
 Schedule V is the classification used for the least dangerous drugs. These drugs or
substances have a currently accepted medical use. Their use may lead to limited physical
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dependence or psychological dependence relative to drugs or other substances in Schedule IV.

Over-the-counter cough medicines with codeine are classified in Schedule V.
20.. Dentists can diagnose bulimia –EROSION ON TEETH. In many patients with bulimia,
such a large amount of the enamel coating dissolves that the underlying layers of the teeth
are uncovered. This has unfortunate effects. The teeth become much more sensitive
because nerve endings in the underlying layers become exposed. Dental cavities become
more numerous because the underlying layers are more sensitive to decay and cavities
without the protection of the enamel. Cosmetically, the underlying tooth structure revealed
by the loss of the enamel is more yellowish or grayish than healthy white enamel.
21. Know how to treat anug –Mosby pg 265. Application of LA and gently swab off necrotic
lesions to remove pseudomembrane and local factors. Antibiotics only prescribed if
lymphadenopathy and fever associated with it. Rinse with cholorhexidine and analgesic for pain.
1-2 day re-evaluation and debridement, 5 day re-evaulation reinforcement of OH. In patients
with ANUG, treatment involves antibiotics, NSAIDs, and topical Xylocaine for pain relief.
Saline rinses can help to speed resolution, and oral rinses with a hydrogen peroxide 3% solution
also may be of benefit. Metronidazole and Penicillin VK DOC
22. Most common allergy in dentistry to metal  nickel
23. After perio surgery what attaches first> long junctional epithelium
24. Odonotoblastic neurons moved by dentinal tubules from mechanical irritation
25. How do you test a perm tooth with an immature apex  hot test
26. How do you test a tooth with a crown on it - the cavity test is initiated on a suspicious
tooth, without anesthetic, and involves drilling a small window through either enamel or a
restoration to dentin. The cavity test will stimulate a vital pulp and provoke a painful
response when dentin is invaded. In the event of a vital response, a simple restoration is
placed. On the contrary, the cavity test will not stimulate a partially necrotic pulp to the
same extent as a vital pulp. In this situation, the dentist initiates the access cavity, invades
progressively deeper into dentin and often reaches the pulp chamber uneventfully.
27. What do you place over a tooth that has calcium hydroxide base varnish Cavity
varnish is a liner used to seal the dentinal tubules to help prevent microleakage and is
placed in a cavity to receive amalgam alloy after any bases have been placed.
28. What causes porcelain to have brown margins  cement polymerization
29. Common reason for composite failure  review this topic - The main cause of failure, for
most dental resin composites, is the breakdown of the resin matrix and/or the interface
between the filler and the resin matrix.
30. Class 2 decay located >> gingival to the contact (proximal caries on post. Teeth)
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31. Purpose of dowel - Use of a metal casting, usually with a post in the pulp or root canal,
designed to support and retain an artificial crown.
32. Most congenitally missing tooth Mn 3rd molars> Mx 3rd M> > mand 2PM>Mx Lat I
33. Most impacted tooth Mx canine
34. Between pemphigoid and pemphigus(desmosomes) which one affects the basement
membrane
35. Know what headlighting of the porcelain is caused by ??????
36. Know when to do GTR - • Class II furcations • 2 or 3 wall vertical defects • Recession •
Alveolar ridge preservation, • Augment bone in sinus • Augment bone for implant • Sinus
perforation after extraction • Augment bone after infection
37. I HAD TONS OF DR LEAVELL’S STUFF. I’M TALKING ABOUT 10-15 QUESTIONS
ON EMPATHY AND APATHY, MODELING, CONDITITIONING etc
Behavior Modification - a form of psychological management that comes about through the education
process and is directly influenced by communication.
Classical Conditioning - a form of learning in which the subject establishes a new association between
an outside stimulus and a response that is a natural reflex action.
Operant Conditioning – a behavior followed by a particular consequence (reinforcement or
punishment) and as a result the frequency of the behavior increases or decreaes
Modeling technique (shown in the photo) involves the modification of behavior by having a patient
observe another child who is displaying appropriate behavior.
Systematic desensitization technique involves the gradual presentation of the feared stimulus or
procedure, while at the same time working to replace the anxiety with more calm and relaxed
behavior.
Empathy - in a medical setting involves the health care provider’s appreciation of the patient’s
emotions and the expression of that awareness to the patient.
Apathy – lack of interest or concern or emotion.
38. I HAD 6 OR 7 QUESTIONS ABOUT DR. RIVERAS STUFF ON SPECIFICITY,

SENSITIVITY, VALIDITY etc
Sensitivity – Proportion of truly diseased persons who are identified by a screening test as being
diseased.
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Specificity – Proportion of truly nondiseased persons who are so identified by a screening test
Validity – Logical truth
39. Legal questions were there. So I have attached a little hand out to go over key facts.
40. Increase kvp what happens  increase intensity (more energy to reach film, shades of
grey are related)
41. Candida in hiv patient what do you give nystatin, topical clotrimazole, topical nystatin,
fluconazole, and topical ketoconazole.
42. Patient has deep pockets, a lot of calculus and needs ortho. What type of appliance do you
give him. Do you give him a removable appliance, fixed and do frequent fluoride tx
43. How do you treat periocoronitis (mild infection-rinse with warm salt
water>antibiotics>pain meds) severe infection- extract opposing third molar mosby pg 263
44. Incidence of cleft lip/palate Whites 1/700-1000, Asians 1.5x higher then white,
Blacks 0.4/1000, N. Americans 3.6/1000- highest incidence
45. I didn’t have to calculate anything. No local anesthesia, no fluoride supplementation, or

eruption sequence questions at all
46. Thiazide diuretics supplement with what  K (potassium)
47. Highest incidence of untreated caries in kids  Hispanics
48. Xerostomia can lead to infection of salivary gland, mucocele, tumor in salivary gland
49. Niti over stainless steel file  all except resistance to fracture
50. Angular chelitis caused by  decreased vdo(increased interocclusal distance)
51. Mouth breathers all except These ppl have what is called LONG FACE SYNDROME
anterior crossbite, low mandibular angle (JUST READ UP ON MOUTH BREATHING) (We
assessed the association between the severity of the obstruction by adenoids/tonsils
hyperplasia or the presence of allergic rhinitis and the prevalence of class II malocclusion,
anterior open bite and posterior crossbite.)
52. How do you treat alveolar osteitis(dry socket) – clean and rinse socket, place dressing, and
take NSAIDs
53. Patient asked about eyes, gloves masks, what don’t you say  don’t worry we have it under
control
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54. U do a post and core but the insurance company only pays for 1  downcoding
(down-coding, which is substituting less expensive and less desirable treatment, in an effort
to reduce benefit), bundling (having all diff types of insurance with the same company to
save money)
ADD ON'S
1. pt that has sjorgen syndrome most likely will develop: Non-hodgkins lymphoma
2. what is Multiple Myeloma associated with: amyloid tongue, punched out RL Systemic amyloidosis is
associated with MM
3. in which racial group is periodontitis most prevelant: black female, black male, hispanic f, hispanic m
4. in what group of kids is caries most prevelant: hispanic, black, native american, asian
5. radiology id pictures (about 10 questions): arrow on nasal floor, max sinus, earlobe (look at decks)
There was NO Histology!!!!!!
1. All of the following can be used to extract a max. 1st pm except- 23(cowhorn for Mn molars), 286,
150(Mx)
Mx incisors, canines, bicuspids – 1, 65, 120, 286,150
Mx molars – 53, 88, 210, 286,150
Mn I, C, PM – 151, 203
Mn M – 210, 151, 23
2. Know how to determine based on a cephalograph if the pt has a convex, concave, bimaxillary
protrusion profile.
Convex – Class II,
Convcave – Class III
Bimaxillary protrusion – looks like class II but the Mx are really slanted facially
3. If ANB=6 the patient has a class II malocclusion.
4. If patient has a class 4 for composite that is discolored, the margins are sealed. What do you do- use
composite tinting, replace the composite, bleach the tooth,or take off the top layer of composite and
place new composite on top. Take off the top layer of composite and place new composite on top. `
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5. Difference bt Sensitivity, Specificity, Valicity- several questions
Sensitivity – Proportion of truly diseased persons who are identified by a screening test as being
diseased.
Specificity – Proportion of truly nondiseased persons who are so identified by a screening test
Validity – Logical truth
6. If ANB = -3, then the patient has a class III malocclusion
SNA > 84° Mx prognathism, SNB < 78° Mn retrognathism, usually if ANB negative it is class III and if
ANB is above 4 it is class II.
Be sure to pay attention to the questions that come with the cases, some ask for angle's classification
and some ask for the classification based on the pt's profile
7. Patient is a soccer player with a class II malocclusion, the patient has several cavities and needs a
mouthguard, what is the proper sequence to finish their treatment plan and do you have to complete all
restorations prior to making the mouthguard. Yes, do all restoration prior to making the mouthguard.
8. Know the signs of Post Traumatic Stress Disorder- I know its random
• Recurring nightmares or thoughts about a traumatic event

• Trouble sleeping and eating
• Anxiety and fear when exposed to situations that resemble the trauma itself
• On edge all the time
• Easily startled, overly alert at all times
• Depression and sadness
• Low energy level
• Memory loss, especially of the traumatic event that caused the condition
• Inability to focus on work and other daily activities
• Difficulty making decisions
• Emotionally numb
• Withdrawn and disconnected from life and others
• Extremely protective and fearful where it comes to the safety of loved ones
• Avoidance of people, places, and activities that remind the person of the event
9. Had a question about FASCIA, yeah I missed that one NO IDEA
10. Know the purpose of the re-evaluation phase of periodontal treatment
this period is necessary for the tissues to heal. The patient usually is examined to evaluate
the treatment results; the examination is similar to the initial periodontal examination.
Clinical findings from the reevaluation examination are compared with those of the initial
periodontal examination. Depending on the findings at the reevaluation appointment,
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treatment may proceed in several directions: to additional nonsurgical treatment (phase I),
to surgical treatment (phase II) or to supportive periodontal care (phase III).
The reevaluation visit of nonsurgical therapy marks the end of phase I (inflammation
control, nonsurgical or initial therapy) of periodontal therapy. This stage is perhaps the
most important aspect of therapy because it involves determining whether nonsurgical
treatment was effective. Is the patient compliant? Is additional reinforcement necessary? Is
additional periodontal therapy indicated such as surgeries? How will the prognosis affect
the overall restorative plan? Depending on the case, there will be many questions to
answer; therefore, communication between the periodontist and the referring general
dentist is critical.
11. Know what all is included in the initial phase of periodontal treatment
lab test, med/dent consults>eliminate pain/infection, address chief complaint>prepare tissues for
surgery>remove etiological factors by mech means>increase OH> caries control,endo,extractions,
ortho, occl adj> antimicrobial therapy>antibiotics>peridex>eval of OH>eval of response to factors
listed above
12. 3rd degree burn, consists of a loss of nerve function - Third-degree burns occur when the epidermis
is lost with damage to the subcutaneous tissue. Burn victims will exhibit charring and extreme
damage of the epidermis, and sometimes hard eschar will be present. Third-degree burns result in
scarring and victims will also exhibit the loss of hair shafts and keratin. These burns may require
grafting.
By degree
A sunburn is a typical first degree burn.

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• First-degree burns are usually limited to redness (erythema), a white plaque and minor pain at
the site of injury. These burns involve only the epidermis. Most sunburns can be included as
first-degree burns.
Second-degree burn caused by contact with boiling water
• Second-degree burns manifest as erythema with superficial blistering of the skin, and can
involve more or less pain depending on the level of nerve involvement. Second-degree burns
involve the superficial (papillary) dermis and may also involve the deep (reticular) dermis layer.
Three day old burn caused by kart exhaust.

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Eight day old third-degree burn caused by motorcycle muffler.
• Third-degree burns occur when the epidermis is lost with damage to the subcutaneous tissue.
Burn victims will exhibit charring and extreme damage of the epidermis, and sometimes hard
eschar will be present. Third-degree burns result in scarring and victims will also exhibit the loss
of hair shafts and keratin. These burns may require grafting.
• Fourth-degree burns damage muscle, tendon, and ligament tissue, thus result in charring and
catastrophic damage of the hypodermis. In some instances the hypodermis tissue may be
partially or completely burned away as well as this may result in a condition called compartment
syndrome, which threatens both the life and the limb of the patient. Grafting is required if the
burn does not prove to be fatal.
13.What part of the body is the most likely to get a autogenous graft for a bone graft.- the hip, can't
remember the choices pelvis or iliac crest
14. What is NOT covered in the ADA Code of Ethics- Licensing
15. Know about composite tinting
tints are light cured, low viscosity, highly shaded composties used to add esthetic characteristics to
restorations.
More important for the entire color stability of a certain material are the internal color changes
caused by UV-irradiation or thermal energy. They mainly depend on the system of photo-initiators
used in the composite as well as on the applied form and time-span of polymerization [2] and [12].
They are caused by chemical changes in the material's matrices and therefore concern all layers of the
material. The fact that they cannot be eliminated by polishing [7] and [13] or post-processing
underlines their importance Creative Color Tints are used to impart character to a
restoration, such as craze and check lines, occlusal pit and fissure staining, incisal
translucency and cervical darkening. The Tints paint on easily and are very translucent
and polishable..
16.Pt. presents to the office and complains of a miscolored crown on t#8. You notice that the patient
needs perio treatment. The patient only wants the crown replace. WWUD
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17. Patient presents for the first appointment. The patient refuses a complete series of xrays. What
would you do 1st- Explain to the patient the importance of the xrays in creating a treatment plan, have
the patient sign a waiver, etc.
6. 12 yo boy has granulomatous gingivitis, apthous ulcers, bleeding from rectum: Ulcerative colitis
Crohn's Disease?
7. radiograph with radiolucency at bottom, didn't say patient had an extraction or anything: benign
neoplasm cyst, odontogenic cyst, salivary gland duct cyst...?? NO IDEA
8. what opiod should u not give a woman who is breast feeding: codeine or hydrocodone
9. which antibiotic has host modulating properties? Tetracycline’s
the tetracycline antibiotics have been found to inhibit host-derived collagenases and other matrix
metalloproteinases by a mechanism independent of the antimicrobial activity of these drugs; this
effect may suppress connective tissue breakdown during periodontal disease and during a variety of
medical disorders including (but not limited to) noninfected corneal ulcers, serious (sometimes life-
threatening) skin-blistering diseases, rheumatoid arthritis and osteoarthritis, systemically--as well as
locally--induced bone loss, and perhaps even tumor-induced angiogenesis
10. what blanches when u press on it: hemangioma (kaposi's sarcoma DOES NOT BLANCH)
11. Eosinophillic granuloma associated with langerhans cell histiocytosis:
12. Whic is most at risk for periodontitis?: smoker, diabetes pt...( probably the diabetes pt) Diabetes 1
and 2, Smoking is the single major preventable risk factor for periodontal disease.
13. know definitions about ultimate strength, proportional limit deformation, etc
-Ultimate strength is a material property determined during load/deformation testing of a material or

component. It is calculated by using the maximum load along the load/deformation plot and dividing
this by the nominal cross-sectional area of the specimen measured in a plane perpendicular to the
load. It can be determined for various types of loads (compressive, tensile, torsion, or shear). It is
useful for determining the maximum load a product can sustain during a single load cycle.
-proportional limit was defined as the stress at which permanent or plastic deformation occurs
-Stress causes deformation, namely, change in shape of a body. Deformation can range from
recoverable elastic deformation, to permanent plastic deformation, and to fracture.
14. differences b/w inlays and onlays, what are the indications for each
15. prep type for inlays or onlays
Inlay – 2mm occlusal reduction, convex walls with 10-15 degree taper, rounded corners and 90 degree
at gingival margin
164
Onlay – 1-2 mm occlusal (cuspal) reduction, 90 degree shoulder (not on occlusal contact), rounded
corners and convex walls
16. why only have a plaster index of maxillary teeth?: something about preserving facebow transfer
(internet)
This procedure orients Mx cast in same relations with opening axis of articular as in original facebow
transfer
17. lots of VDO and VDR questions
VDO – the vertical dimension of the face when the teeth are in CO
VDR - ‘ ‘‘ ‘ ‘ ‘ ‘ ‘ ‘ ‘ the mandible is in rest position.
18. scaling and root planing questions
- it leaves a smooth, clean, hard polished root surface
- primary treatment for perio inflammation
- it reduces shallow pockets, bacteria.
19.. denture fabrication procedure and steps (you should know this thru your own clinical experience)
20. know definitions of cohort study, etc
Mosby pg 210. Cohort Study Prospective: a general population is followed through time to see who
develops the disease and then various exposure factors that affect the group are evaluated.Following
the group over a period of time the investigator describe the prevalence of outcomes.
Retrospective Cohort: evaluate the effect that a specific exposure has had on a population(occupational
hazards) the investigator chooses or defines a sample of subjects who had the outcome of interest.
A cohort is a group of people who share a common characteristic or experience within a

defined period (e.g., are born, leave school, lose their job, are exposed to a drug or a
vaccine, etc.). Thus a group of people who were born on a day or in a particular period, say
1948, form a birth cohort.
21. cracked tooth symdrome mostly found in which tooth? 1st Mandibular Molar, First aid 179
22. most common odontogenic tumor? Odontoma
Most common odotogenic cyst-radicular
Most common non-odotogenic cyst- nasoplatine cyst
23.. postinsertion problems for complete dentures and partials

165
•Denture base
•Occlusion -
–Interferences - esp. protrusive
•Retention
•Vertical dimension
•Allergies and infections
•Tooth position
24.. major syndromes: triad of symptoms...Review Oral Path NOTES
Congenital Syphillis Hucthinson’s triad (incisors & mulberry molars, ocular interstitial keratitis CN VIII
deafness)
Langherhans cell histiocytosis – Chronic form Triad (exopthalmus, diabetes insipidus, lytic bone
defects)
Reiters syndrome Triad (nongonococcal urethritis, arthritis, conjunctivitis)
Pierre-robin triad (Mn micrognathia, cleft palate, glosoptosis)
Pernicous anemia triad (weakness, painful tongue, numbness or tingling of extremeties)
Vit B1 def – Wernicke’s encephalopathy (vomiting, nystagmus, mental deterioration)
Crouzon Syndrome (Craniofacial Dysostosis) – premature cranial suture closing Brachycephaly-short,

scaphocephaly-boat shaped, trigoncephaly- triangle shaped, Beaten Metal, underdeveloped maxilla.
Common features are a narrow/high-arched palate, posterior bilateral crossbite,
hypodontia (missing some teeth), and crowding of teeth. Due to maxillary
hypoplasia, Crouzon patients generally have a considerable permanent underbite
and subsequently cannot chew using their incisors. For this reason, Crouzon
patients sometimes eat in an unusual way--eating fried chicken with a fork, for
example, or breaking off pieces of a sandwich rather than taking a bite in it.
Treacher Collions Syndrome (Mandibulofacial dysostosis) autosomal dominant, hypoplastic zygomas,
narrow face with depressed cheeks, downward slanting palpebral fissures, mandible underdeveloped
Apert’s Syndrome- autosomal dominant, acrobrachycephaly (tower skull) ocular proptosis,

hypertelorism and downward slanting lateral palpebral fissures . known to have some form of
syndactyly- fusion of hands etcCommon relevant features of acrocephalosyndactyly are
166
a high-arched palate, pseudomandibular prognathism (appearing as mandibular

prognathism), a narrow palate, and crowding of the teeth.
25. opioid differential questions (dental decks and tufts review)
Opiod drugs are used for analgesics, antitussives, antidiarrheals, preanesthetic meds
They raise pain threshold and increase pain tolerance
Morphine- very effective for cancer pain (produces resp depression, euphoria, sedation, dysphoria,
analgesia, constipation) used for pulmonary edema
Meperidine – more potent than codeine less potent than morphine can cause seizures, tremors, and
muscle spasms contraindicated with MAO inhibitors
Methadone – treat heroin withdrawal used in treating opiod addiciton
Pentazocine Mixed agonist antagonist (also nalbuphine)
26. dental materials
27. cholinergic antagonist, agonists...which ones increase(agonist)/decrease(antagonist)

salivation....etc Antagonist Salivary: Decrease salivation significantly (dry mouth)
http://www.scribd.com/doc/19341469/13-Cholinergic-Antagonists
28. drug scheduling is based on what properties: efficacy, potencey, dependency... dental deck
1). Prevalence
Prevalence: indicates what proportion of a given population is affected by a

condition at a given point in time. It is expressed as percentage and ranges from 0% to
100%, (e.g., the prevalence of periodontal disease among 100,000 adolescents was 5%).
2) Incidence
167
Incidence = Number of new cases of the disease/Total number of people at risk
2). Pt. Takes Estrogen pills: it can decease osteoporosis, increase chance of cardiovascular disease,
increase chance of clots
Osteopenia and osteoporosis have been associated with the menopausal patient. Osteopenia
is a reduction in bone mass caused by an imbalance between bone resorption and
formation, favoring resorption and resulting in demineralization and osteoporosis.
Osteoporosis is a disease characterized by low bone mass and fragility and a consequent
increase in fracture risk.95 In most women, peak bone mass occurs between 20 and 30 years
of age, then declines. Menopause accelerates declining bone mass.93 An estimated 25
million Americans have osteoporosis, 80% of whom are female. Ongoing studies are
examining the association of postmenopausal primary osteoporosis with mandibular and
maxillary bone mineral density, tooth loss, alveolar ridge atrophy, and clinical periodontal
attachment loss. The effects of hormone replacement therapy (HRT) or estrogen
replacement therapy (ERT) on the oral bone and tooth loss also are under
investigation. Evidence indicates a probable association between osteoporosis and
tooth loss as well as alveolar bone loss.37,71,80,81
Company, 072006. 43.5.1).
3). Know all kinds of radiographs to see TMJ (CT, MRI and so on…)
4). Melanoma- malignant lesions of melanocytes found n the skin especially
extremities and head and neck region. Oral Melanomas are raire. .Distinguish from
nevus using A= asymmetry B=border irregularity C=color D=diameter >6mm and
E=evolving.Oral melanomas are located on the hard palate or maxillary gingiva.
Brown/black macule w/ irregular boarders. Diffuse spreading results in nodular
appearance.
Melanocytic nevus- mole various types intradermal/intramucosal, junctional, compound,
blue, spitz
Stafne bone cyst= RL below mandibular canal
gland salivary tumor= Pleomorphic Adenoma is most common benign and
Mucoepidermoid Carcinoma is most common malignant.
5). Which test is best to determine reversible/irreversible pulpitis? Thermal test
Reversible pulpitis can be clinically distinguished from a symptomatic

irreversible pulpitis in two ways:
(1) Reversible pulpitis causes a momentary, painful response to thermal

change that subsides as soon as the stimulus (usually cold) is removed.
168
However, symptomatic irreversible pulpitis causes a painful response to

thermal change that lingers after the stimulus is removed.
(2) Reversible pulpitis does not involve a complaint of spontaneous

(unprovoked) pain.
(Mosby. Mosby's Review for the NBDE, Part II. Mosby, 042007. 1.1.1.1).
6). Small fracture (to dentin) of corner of tooth #8 or 9. What needs to be done:
enameloplasty or composite restoration?
7). Order of TxPl: Perio, OS, Oper, Ortho,
Preliminary or emergency. Hopeless teeth may be extracted in this phase.
2. Nonsurgical (phase I therapy). The objective of this phase is to alter or eliminate

the microbial etiology and contributing factors to periodontal diseases, leading to
reduction in inflammation. This is achieved by caries control in patients with rampant
caries, removal of calculus, correction of defective restorations, treatment of carious
lesions, and institution of oral hygiene practices. It also may include local or systemic
antimicrobial therapy, minor orthodontic tooth movement, occlusal therapy, and
provisional splinting and prostheses. The evaluation phase is designed to determine the
effectiveness of treatment provided during phase I therapy. It should occur about 4 weeks
after the completion of phase I therapy. This permits time for epithelial and connective
tissue healing by the formation of a long junctional epithelium.
3. Surgical (phase II therapy). This phase includes all surgical therapy, including
placement of implants and endodontic therapy.
4. Restorative (phase III therapy). This phase includes placement of final

restorations and fixed and removable prosthetic appliances, evaluation of the
response to these restorations, and periodontal examination.
5. Maintenance (phase IV therapy). Periodontal procedures include periodic

evaluation of oral hygiene status, presence or absence of local factors, and condition
of the periodontium (pocket depths, attachment levels, mobility, occlusion). This phase
actually should begin after the completion of phase II therapy.
B. Risk factors, determinants, indicators, and markers for periodontal disease

8). Pedo radiolucency in furcation, what to do? Extraction
In primary teeth, any radiolucency associated with a nonvital tooth is usually located
in the furcation area, not at the apices. This is because of the presence of accessory
canals on the pulpal floor area. Thus, a bitewing film is frequently a useful diagnostic aid,
particularly in maxillary molars where the developing premolar obscures the furca in a
periapical radiograph.
042005. 22.2.3).
169
9). Adult – furcation, what to do? 1). Hemisection 2). RCT

Hemisection is most likely to be performed on mandibular molars with buccal and lingual class
II or III furcation involvements. As with root resection, molars with advanced bone loss in the
interproximal and interradicular zones are not good candidates for hemisection
Company, 072006. 68.6.2).
10). Pulp cap, how much we need to put Ca(OH)2 0.5mm
Calcium hydroxide liners may provide some thermal insulation to the pulp if used in
sufficiently thick layers. A thickness greater than 0.5 mm is not suggested. Practically,
thermal protection should be provided by the overlying high-strength base or composite
restoration.
022006. 20.7.3.1).
11). Know Apexogenesis/- vital immature tooth used MDTA. The process fof
maintaining pulp vitality during pulp treatment to allow continued development of the
entire root.
Apexification- non vital immature tooth. Use CaOH2 . ita s method to stimulate the
formation of calcified tissue at the open apex of pulples teeth /
Pulpotomy- removal of coronal portion of vital pulp to preserve the vitality of remaining
radicular pulp. Performed in pedo patients. Or traumatic exposures after 72 hrs/
Pulpectomy- non vital tooth. Removal of coronal and radicular pulp tissue. Temporay
pain relief on teeth with irreversible pulpitis unti nonsurgical endo can be preformed
MOSBY PG 26
12). Dry socket. What is a reason? Not enough blood, blood-clot fall down…
The cause of alveolar osteitis is not absolutely clear, but it appears to result from high
levels of fibrinolytic activity in and around the tooth extraction socket. This fibrinolytic
activity results in lysis of the blood clot and subsequent exposure of the bone.
In the usual clinical course, pain develops on the third or fourth day after removal of
the tooth. Almost all dry sockets occur after the removal of lower molars. On
examination the tooth socket appears to be empty, with a partially or completely lost
blood clot, and some bony surfaces of the socket are exposed. The exposed bone is
sensitive and is the source of the pain.
11.9.3).
13). Petit seizure – Ethosuximide (Zarontin), valproate, lamotrigine, or clonazepam.
170
Idiopathic seizure disorders are exhibited in many ways, ranging from grand mal
seizures, with their frightening display of clonic contortions of the trunk and extremities,
to petit mal seizures that may occur with only episodic absences (e.g., blank stare).
Drugs of choice for absence (petit mal) seizures: Ethosuximide (Zarontin), valproate,
lamotrigine, or clonazepam.
Drugs of choice for status epilepticus: Lorazepam 4 to 8 mg, or diazepam 10 mg,

intravenously.
Mosby, 072007. 27.1.4).
14). Be able to separate: Chronic periodontitis/ Supparative chronic periodontitis mosby

pg 4
Chronic periradicular periodontitis
a. Chronic periradicular periodontitis is a long-standing, asymptomatic, or mildly

symptomatic lesion.
b. It is usually accompanied by radiographically visible apical bone

resorption.
c. Bacteria and their endotoxins cascading out into the periradicular region from a
necrotic pulp cause extensive demineralization of cancellous and cortical bone.
d. Occasionally, there may be slight tenderness to percussion and/or

palpation testing.
e. The diagnosis of chronic apical periodontitis is confirmed by:
(1) The general absence of symptoms.
(2) The radiographic presence of a periradicular radiolucency.
(3) The confirmation of pulpal necrosis.
f. A totally necrotic pulp provides a safe harbor for the primarily anaerobic
microorganisms—if there is no vascularity, there are no defense cells.
g. Chronic periradicular periodontitis traditionally has been classified

histologically as periradicular granuloma or periradicular cyst. The only accurate
way to distinguish them is by histopathological examination.
171
4. Suppurative periradicular periodontitis (chronic periradicular abscess)
a. It is associated with either a continuously or intermittently draining sinus

tract without discomfort.
b. The exudate can also drain through the gingival sulcus, mimicking a
periodontal lesion with a "pocket."
c. Pulp tests are negative because of the presence of necrotic pulp.
d. Radiographic examination of these lesions shows the presence of bone

loss at the periradicular area.
e. Treatment: these sinus tracts resolve spontaneously with nonsurgical endodontic

treatment.
(Mosby. Mosby's Review for the NBDE, Part II. Mosby, 042007. 1.1.1.2).
15). Blow out fracture:
Blunt trauma to the eye can result in compression of the globe and subsequent blow-out
facture of the orbital floor. The zygomatic arch may also be affected, alone or in
combination with other injuries
Blunt-force trauma from a baseball, causing an orbital floor blow-out fracture, with
bony fragments and orbital contents sagging into the maxillary sinus below.
Periorbital ecchymosis, especially with subconjunctival hemorrhage, is often indicative of
orbital rim or zygomatic complex fractures
032008. 24.1.2).
24.3).
16). Calculate half-life of drugs
Equations:
a. k e × t 1/2 = 0.693,
172
where k = the first-order rate constant and t 1/2 = the half-time.
b. D = Cp 0 × Vd,
where D is the drug dose (single dose), Cp 0 is the plasma concentration at zero time,
and Vd is the apparent volume of distribution.
c. Cl = k e × Vd,
where k e is the first-order rate constant of elimination, Cl is the clearance, and Vd is

the apparent volume of distribution.
d. t 1/2 = 0.693 × Vd/Cl,
17). Best result is when “short from apex”(0.5-1mm from apex and fill same length) or
“at apex”
Working length is established, slightly short of the radiographic apex. Instrumentation

beyond the apex is not advocated as it may damage the tissue that will ultimately form the
barrier.
The objective is to establish the length (distance from the apex) at which canal preparation
and subsequent obturation are to be completed. Optimal length is 1 to 2 mm short of the
apex, although this may vary slightly with different diagnoses.26 Procedures may be
terminated 0 to 2 mm from the apex if the pulp is necrotic and 0 to 3 mm if the pulp is
vital.
Company, 012002. 12.3).
18). If crown-prep is too short, how to prevent rotation – need grove for retention. Where
to place it?
A three-quarter crown was used to restore this maxillary first molar after completion of
endodontic treatment and placement of an amalgam core (left). Because the tooth had a
short clinical crown, multiple grooves were used to enhance retention and resistance. These
can be seen in greater detail on the stone cast of the prepared tooth (right).
Restorations. Quintessence Publishing (IL), 011987. 5.2).
173
20). If we need to do a bridge and opposing is one tooth is super-erupted. What to do?
Place a crown if >=2mm of supereruption present
If supraeruption is relatively minor, the occlusal plane may be corrected by carefully

recontouring the surfaces of the teeth. If moderate supraeruption has occurred, correction of
the occlusal plane may require the placement of cast restorations such as onlays or crowns. If
supraeruption is extreme, extraction of the offending teeth may be the only logical solution.
Quintessence Publishing (IL), 012003. 9).
21). Occlusual caries and Proximal differ?
Occlusal First has it’s apex is to the surface, it’s base is on DEJ. Second base is on DEJ
apex is to the pulp
Proximal First triangle – base is o the surface of tooth, apex is toward DEJ, Second is
same- base is on DEJ and apex is toward pulp.
22). Some drug was left for a week, what left was a water /H2O. What drug originaly was left?
Hydrogen Peroxide /H2O2
23). Be able to differentiate on radiograph OKC and dentigerous cyst. Mosby pg 117
Dentigerous cyst is associaled with a RL around crown of impacted tooth. Called eruption cyst if
lesion occurs over tooth that has erupted into submucosa. Epithelial lining from reduced enamel
epithelium has potential to transform into ameloblastoma. O
OKC- lesions may be CCL aggressive and associated ith Nevoid basal cell carcinoma
syndrome/Gorlin Glotz Syndrome (multiple OKC, numerous basal cell carcinoma, skeletal abnormalities
frontal bossing, bifid ribs, shortened metacarpals, calcified falx) Lining epithelium is thin and
parkeratinized.Epithelium source is rests of dental lamina and tooth vitality Orthokeratinized OKC has
lower recurrence rate and is not syndrome associated
24). Be able to identify Verucous carcinoma: smokeless tobacco Mosby pg 111 it is associated with HPV
types 16 & 18. Cauliflower appearance.
25). If patient has a cleft lip + palate, what he may have:
Class II malocclusion or Mandibular Retrognatia or class III?
26). All kinds of Antibiotics questions
27). Drug against Xerostomia – Pilocarpine and Cevimeline stimulate salivary flow moby pg 279
Pilocarpine HCl and cevimeline HCl are the only systemic sialagogues that are
available in the United States.
174
Decker, 012003. 9.4.3.2).
28). Redistribution – short duration of action after a short administration

29). When does a maxillary torus needs a surgery? If it prevocates hyperplasia,
potential for malignancy problems, if it interfere with denture?
30). Forcep for maxillary #151, for extraction – is it good? No, 150max/151mand
31). On xray radiographs you see bone loss, reason is overhang restoration harbors plaque
32). To choose which reason is most affecting future prognosis Alcohol or Smoking?
33). On xray radiographs you can see patient lost enamel. He has gout disease. What
question is appropriate? Do you eat a lot of sugar? Did you drink a lot of beer? Are you
working on acid producing factory?
• Drinking 7 or more ounces of spirits a week -- roughly five drinks -- doubled the gout
risk in men and tripled it in women. Heavy beer drinking was associated with a doubling
of risk among men and a sevenfold increase in risk among women.
Beer contains high levels of the chemical purine, which breaks down into uric acid in the body.
But it is not clear why beer drinking would pose a higher gout risk for women than for men.
35). Pedo patient needs extrution of #8 Does he needs a Nance band-loop, t-loop, fixed
appliance?
A, Although a straight orthodontic wire activated apically will produce an extrusive

force on a tooth, it will also cause the teeth on either side to tip toward each other,
reducing the space available for the extruding tooth. B, A modified T-loop in a
175
rectangular wire (17 × 25 steel in 18 slot brackets, 19 × 25 beta-Ti in 22 slot) will

extrude a tooth while controlling mesio-distal tipping. C, Extrusion also can be done
without conventional orthodontic attachments, by bonding a 19 × 25 steel stabilizing wire
directly to the facial surface of adjacent teeth. An elastomeric module is stretched
between the stabilizing wire and a pin placed directly into the crown of the tooth to be
extruded. If a temporary crown is used for better esthetics while the extrusion is being
done, it must be progressively cut away to make the tooth movement possible. (C,
courtesy Dr. L. Osterle.)
(Proffit, William R.. Contemporary Orthodontics, 4th Edition. C.V. Mosby, 122006. 18.5.3.2).
36). To know Eruption of Permanent dentition table
37). Diabetes patient has a shock during procedure. Should you give him a drink of
carbonate water (sugar)
38). You are given a PAN with wide black stripe (almost a third of PAN) on your Right and
on you right side you can see a spine of patient. Middle of PAN is normal. How can you
describe defect / error of PAN? Is it an open mouth? Was film too long in developer or
fixer? Was the door open during development? Was mashine stucked during PAN rotation
(upon pt’s shoulder)?
39). Patient is on Warfarin. You need to do extraction. What should you do: tell pt to
stop taking drug a week before extraction? A 3 days before extraction ? A month
before extraction?
Patients requiring warfarin for anticoagulation but who also need elective oral surgery
benefit from close cooperation between the patient’s physician and dentist. Warfarin has
a 2- to 3-day delay in the onset of action; therefore, alterations of warfarin
anticoagulant effects appear several days after the dose is changed. The INR is used to
gauge the anticoagulant action of warfarin. Most physicians will allow the INR to drop
to about 2.0 during the perioperative period, which usually allows sufficient coagulation
for safe surgery. Patients should stop taking warfarin 2 or 3 days before the planned
surgery. On the morning of surgery, the INR value should be checked; if it is
between 2 and 3 INR, routine oral surgery can be performed. If the PT is still
greater than 3 INR, surgery should be delayed until the PT approaches 3 INR.
of surgery.
1.3.6.2).
40). What test needed to be checked for Warfarin/Caumadin? INR or bleeding time?
176
The INR is used to gauge the anticoagulant action of warfarin.
42). What nerve is inervating a soft palate? Lesser palatine nerve (V2)
(Malamed, Stanley. Handbook of Local Anesthesia, 5th Edition. Mosby, 072004.

12.1.2.2.2.2).
The lesser palatine nerve (posterior palatine nerve) descends through the pterygopalatine
canal, and emerges by the lesser palatine foramen. It also has nasal branches that innervate the
nasal cavity. It supplies the soft palate, tonsil, and uvula
43). Patient is in your office with infection/inflammation on nose, cheek, eye. You must t identify
infection – is it Odontogenic or not?
44). Need to be able to count some coefficient from Ortho Upper 4 Incisors = 34mm,
lower 4 Incisors = 28mm … count… (with numbers I’m not sure )))
Moyers Analysis: measure the mand. incisors to predict the max & mand canines and premolars
(1) Measure mesial-distal diameter of the mandibular incisors and sum.
(2) Measure the space available for mandibular incisors.
(3) Subtract (1) from (2); a negative number indicates crowding in the incisor
region.
177
(4) In the example, there is 3.2 mm of crowding in the anterior region.
45). About Nitrous everything – it’s not explosive, metabolized where in body? Is it in lung? It is
not metabolized. Per Dr. Williams notes: Nitrous is an inorganic gas, colorless,nonirritating to respiratory
mucosa, faintly sweet odor, not metabolized in body and is excreted unchanged through the lungs.
Elimination of nitrous oxie is through the alveoli. Primary satuation of blood and brain is 3-5 minutes.
46). To know Cross-Sectional- study in which the health conditions in a goup of people
who are or are assumed to be a sample of particular population is assessed at one
time.
Case Control- study people with a condition (cases) are compared with people without
but are similar in characterisitic s Mosby pg 210…
47). Uncooperative pedo patient what to do/to use: Modeling/Voice control/Refer to
pediatric dentist; in case of emergency can do physical restraint if the pt is physical and
cry accessively
48). Patient doesn’t like a bridge 7,8,9,10 (it looks very good for me) What’s wrong
with it: Value/Chroma/Hue/Translucensy?
49). What can tricyclic depression drugs NOT DO: immediate relieve from
depression…
50). From Asthma - epinephrine( epi can be use but it is better to use a Beta 2 blocker
like albuterol because it has less cardiovascular effect) or can use theophylline
51). Is N2O is absolute contraindication for Asthma or for Angina: No it’s indicated for
both Per Dr. Williams notes. Indications: anxiety, cardiovascular disease,
respiratory disease (asthma) hepatic disease (not metabolized), epilepsy and
seizure disorders allergy diabetes, and gagging (it helps with gag reflex to some
extent.
CONRAINDICATIONS: pregnancy. Compulsive personality, claustrophic patients,
child with severe behavioral problems-bc cant get them to cooperate, severe
personality disorders, upper respiratory tract infections (COPD)
Inhalation sedation (N2O2) is the most recommeneded sedative technique for both
adult and pediatric asthmatic patients. Its sedative properties and additional oxygen
administration is enough to prevent an asthmatic attack. (P.561 sedation book)
Angina patients have a discrepancy between myocardial oxygen demands and oxygen
delivery in the coronaries artery. Therefore, nitrous oxide is especially indicated in
these patients because you want to minimize stress and increase oxygenation (p.552
sedation book)
If patient has Angina have Nitroglycerine and Oxygen ready/available

178
52). Carpules calculation for LA for patient, by weight (kid 55lb/25kg) of 2% lidocaine,
3% meto…, 4%...for Lidocaine: 2mg/lb or 4.4mg/kg max is 300mg
53). Ethics…
54). Kid has a diastema. We can’t predict if it’ll close of if he will have crowding before Canine eruption –
if it is 2mm btw 8 and 9 it will most likely close if more maybe not
55). How epinephrine work by which receptors: Alpha1/2 /Beta1/2 /

Muscarinic?epinphrine is a nonselective agonist of all adrenergic receptors, including α₁, α₂ ,
β₁, β₂, and β₃ receptors.
56). For implant to know absolute Minimal space 4mm or between 0.5mm?between
implant 3mm; implant and tooth 1mm;
57). Candidas, what test do we need, what drug…do cytology smear and use
nystatin,mycelex or sys:fluconazole
58). Kid is very skinny, thin, pale, long nails what is disease ?
59). Radiographs was too light/dark what should be change to fix it? Mosby pg 132 Increase/decrease
kVp Note light radiographs is due to insufficient mA, kVp, time, film packet revered in mouth, or too
great of distance of film-source. Dark Radiographs is excessive mA, kVp, time, and too short film to
source distance.
60). You can see PAN with impacted 3rd molars. What should be done: who must to do extraction you
or Oral Surgery specialist? If it’s you how to do it - left side first visit, right side next or 2 Upper first then
2 lowers next? With General or Local Anesthesia?
61). Picture of tongue with blue bump on it… I put Varicosity or it was other name…hemangioma
62). Patient has Amoxicillin for some other old infection… He has some cardiac problem (don’t
remember) and needs extractions. What to prescribe for antibiotic prophilaxis – Amoxicillin +
179
Clindamicen? Or more/add to old dose of Amoxicillin? I put don’t change anything, I thought he doesn’t
need prophilaxis for that kind cardiac problems.
If a patient is already receiving long-term antibiotic therapy with an antibiotic that is also
recommended for IE prophylaxis for a dental procedure, it is prudent to select an antibiotic from
a different class rather than to increase the dosage of the current antibiotic (according to
American heart association new guidelines)
63). Coefficient LD50 know definitions LD50 - to 50% of the people that take the medication it is lethal.
TD = LD50/ED50 higher TD is better
64). In order to do etching we need to use acids in patient’s mouth. Which acid is harmless for patient:
Phosphoric acid or some other names… don’t remember. I choose Phosphoric acid 30-40% because we
using it every day (it’s just my guess)
65). Know treatment order in TxPl: Cleaning, Extractions, Operative, fixed,removable…
1. Preliminary or emergency. Hopeless teeth may be extracted in this phase.
2. Nonsurgical (phase I therapy). The objective of this phase is to alter or eliminate

the microbial etiology and contributing factors to periodontal diseases, leading to
reduction in inflammation. This is achieved by caries control in patients with rampant
caries, removal of calculus, correction of defective restorations, treatment of carious
3. Surgical (phase II therapy). This phase includes all surgical therapy, including
placement of implants and endodontic therapy.
4. Restorative (phase III therapy). This phase includes placement of final

restorations and fixed and removable prosthetic appliances, evaluation of the response to
these restorations, and periodontal examination.
5. Maintenance (phase IV therapy). Periodontal procedures include periodic

evaluation of oral hygiene status, presence or absence of local factors, and condition of
the periodontium (pocket depths, attachment levels, mobility, occlusion). This phase
actually should begin after the completion of phase II therapy.
180
66). Everything is INITIAL Perio treatment Except: OHI / Calculus Scaling / Root Surface Planing /
Antibiotic
Nonsurgical (phase I therapy). The objective of this phase is to alter or eliminate the
microbial etiology and contributing factors to periodontal diseases, leading to reduction
in inflammation. This is achieved by caries control in patients with rampant caries,
removal of calculus, correction of defective restorations, treatment of carious
67). The tooth must to be used as an abutment. What restoration will you choose: amalgam,3/4
crown, full-crown? I put full-crown…
68). Out of all selections water- irrigation is always the weakest/less efficient
69). Patient is very old, treatment cost a lot for him… we still can’t make a decision for him
70). What do we call combination perio-endo case: when patient needs RCT and perio scaling
(combination of both infections) do RCT first
71). LA esters/amines remember each group, their property
1). Longituginal study
A longitudinal study involves the follow-up of the initial baseline respondents at a later
date. The longer the follow-up from baseline the more likely that respondents will be lost to
the study (through mobility away from the study area) and interpretation becomes more
difficult. An important check is to determine who is lost to the study on follow-up, and an
analysis is then conducted that shows whether the people lost to the study are different
from those who are successfully followed-up. The importance of attempting longitudinal
studies should not be underestimated as they do make possible firmer interpretations of
causality not possible with cross-sectional designs. To illustrate with an example: if
children are exposed to a traumatic first dental visit and these children are subsequently
found to exhibit higher levels of disruptive behaviour in the dental surgery, then this
finding would be more meaningful to understanding how experiences might cause
behavioural difficulties than if the study was cross-sectional with the variable, traumatic
experience and behavioural problems associated strongly at the same point in time. The
cross-sectional interpretation of the results could be that the disruptive child causes the
dentist to resort to management strategies that become coercive and result in a traumatic
experience for the child. The cross-sectional approach therefore may produce equivocal
results that encourage researchers to embark on the more ambitious longitudinal studies.
181
2). Case control
Case control study: people with a condition ("cases") are compared with people
without it ("controls") but who are similar in other characteristics. Hypothesized causal
exposures are then sought in the past medical records of the participants. If the
researchers had chosen to conduct a case control study to explore the same hypothesis,
subjects would have been split into two groups— those with oral cancer and those
without it, based on examinations. To search for an association with alcohol drinking, a
history before the occurrence of oral cancer would be sought (e.g., through past medical
records). Thus, the case control study could establish a temporal relationship between
the exposure and disease of interest, in this case a history of alcohol drinking before the
appearance of oral cancer.
3). T-test
t-test: the t-test is used to analyze the statistical difference between two means. It
provides the researcher with the statistical difference between treatment and control
groups or groups receiving treatment A versus treatment B.
4). Chi 2 test
Chi-square (χ2) test: the chi-square test measures the association between two
categorical variables. It is used for the comparison of groups when the data are
expressed as counts or proportions. For example, an investigator might wish to compare
the proportion of caries-free children living in a district whose water supply is
fluoridated to the proportion of caries-free children living in a nonfluoridated district. In
each district, the investigator would count the number of caries-free and noncaries-free
children. The research question involves two categorical variables: caries status of the
child (caries-free or not) and fluoridation status of the district (yes or no)
5). Retrostudy Cohort test
Retrospective cohort study: used to evaluate the effect that a specific exposure has
had on a population (e.g., occupational hazards). The investigator chooses or defines
a sample of subjects who had the outcome of interest. He measures risk factors in
each subject that may have predicted the subsequent outcome.
Prospective Cohort Test:
A a general population is followed through time to see who develops the diseae and then
the various exposure factors that affect the goupr are evaluated
182
7). CAL (clinical attachment lost) = probing depth + recession
Width of keratinized gingiva = free gingival marghin to the mucogingival junction
Probind Depth= free gingiva margin to base of the pocket
8). Recession = space between CEJ and free gingival margin
9). Polyether – hardest, stiffer, more rigid

10). Fractures, most common location… (condyle)
condyle>angle>symphisis>body>ramus>coronoid
11). Osteotomy, La Fort 1, move head mandible
Maxillary surgery. Maxillary surgeries are referred to as LeFort I osteotomies.

The maxilla can be moved forward and down more easily than it can be moved up
or back. It can also be segmented into two or three pieces to better position the
occlusion.
2. Mandibular surgery. Mandibular surgery is most often done using one of two
osteotomies: bilateral
Figure 3-3.
183
LeFort midfacial fractures. A, LeFort I fracture separating inferior portion of

maxilla in horizontal fashion, extending from piriform aperture of nose to pterygoid
maxillary suture area. B, LeFort II fracture involving separation of maxilla and
nasal complex from cranial base, zygomatic orbital rim area, and pterygoid
maxillary suture area. C, LeFort III fracture (i.e., craniofacial separation) is
complete separation of midface at level of naso-orbital-ethmoid complex and
zygomaticofrontal suture area. Fracture also extends through orbits bilaterally.
(From Peterson LJ, Ellis E, Hupp JR, Tucker MR: Contemporary Oral and
Maxillofacial Surgery, ed 4, Mosby, St Louis, 2003.)
sagittal split osteotomy (Fig. 3-6), or vertical ramus osteotomy (Fig. 3-7). The
mandible can be moved anteriorly to correct a retrognathia, or posteriorly to
correct a prognathism. In addition, the chin can be moved using a genial
osteotomy (genioplasty) to correct macrogenia or microgenia.
Sagittal split osteotomy Vertical split osteotomy
3. Distraction osteogenesis (DO). Distraction osteogenesis has provided oral and

maxillofacial surgeons much greater flexibility in treating difficult deformities of the
facial skeleton. Patients with deformities such as cleft lip and palate and hemifacial
184
microsomia have previously required difficult surgeries. DO involves cutting an

osteotomy to separate segments of bone and the application of an appliance that
will facilitate the gradual and incremental separation of bone segments.
12). Anesthesia
13). LA ester(plasma-blood)/amide(liver). What is cross-allergic to ester?
Pt. couldn’t take ester
Hypersensitivity to the ester-type local anesthetics is much more frequent: procaine,

propoxycaine, benzocaine, tetracaine, and related compounds such as procaine
penicillin G and procainamide.
Amide-type local anesthetics are essentially free of this risk. However, reports from the
literature and from medical history questionnaires indicate that alleged allergy to amide
drugs appears to be increasing, despite the fact that subsequent evaluation of these reports
usually finds them describing cases of overdose, idiosyncrasy, or psychogenic
reactions.59,60 Allergy to one amide local anesthetic does not preclude the use of other
amides because cross-allergenicity does not occur.61 With ester-type local anesthetic
allergy, however, cross-allergenicity does occur; thus all ester-type local anesthetics
are contraindicated with a documented history of ester allergy.61
Allergic reactions have been documented for the various contents of the dental cartridge..
Of special interest with regard to allergy is the bacteriostatic agent methylparaben.
The parabens (methyl, ethyl, and propyl) are included, as bacteriostatic agents, in all
multiuse drugs, cosmetics, and some foods.
(Malamed, Stanley. Handbook of Local Anesthesia, 5th Edition. Mosby, 072004. 18.3.1).
14). Angle Fracture Favorable: masseter/digastrics/hyoid…

185
Fractures of the mandible are referred to as favorable or unfavorable, depending on the

angulation of the fracture and the force of the muscle pull proximal and distal to the
fracture. In a favorable fracture, the fracture line and the muscle pull resist
displacement of the fracture (Fig. 24-13). In an unfavorable fracture, the muscle pull
results in displacement of the fractured segments.
FIGURE 24-13
Favorable and unfavorable fractures of mandible. A, Unfavorable fractures resulting

in displacement at fracture site caused by pull of masseter muscle. B, Favorable
fracture in which direction of fracture and angulation of muscle pull resists
displacement.
24.2.2).
15). Horizontal apical fracture, no symptoms – splint and observe (no extraction)
16). Pulpotomy/pulpectomy
Pulpotomy procedures Mosby pg 187
Indications
• When the pulp is reversibly and minimally inflamed.
• Where the marginal ridge is already destroyed in first primary molars
• Where radiographic evidence of caries extends more than two-thirds in depth

through the dentine.
186
• If there is any doubt as to whether or not the pulp has been exposed (mechanical
or carious) .
In all other situations, where there is irreversible pulpitis or there is pulpal necrosis, a
pulpectomy or extraction should be performed.
Medicaments used (formocresol- 5 minute application or cotton pellet, ferric sulfate or

mineral trioxide aggregate (MTA)
Success rate
• Formocresol 90–98%.
• Calcium hydroxide 60%.
Pulpectomy procedures
Where there is irreversible pulpitis, or there is pulpal necrosis, a pulpectomy or extraction
should be performed. Pulpectomy carries a success rate of 67–80%.
Indications
• Evidence of pulpal necrosis.
• Hyperaemic pulp. The most common presentation of a hyperaemic pulp is

persistent bleeding during a pulpotomy procedure. In this case, the radicular pulp should
be removed and a pulpectomy performed instead.
• Evidence of furcation or periapical involvement on radiographs.
• Spontaneous pain (unstimulated pain). It must be remembered, however, that not

all the pulpal tissue may be necrotic and that such a tooth can still be painful when
attempting to remove the remaining pulp.
• Buccal or extra-oral swelling and increased mobility.
(Cameron, Angus C.. Handbook of Pediatric Dentistry, 2nd Edition. Mosby Ltd., 062003. 4.7).
Filling methods: 1.) pressure syringe using a paper point or file and coat the walls of the canals
with creamy mix of zince oxide eugenol and build up.
Decision making tree for pulp therapy on primary molars: Mosby pg 187-188
1.) Furcation - NO-- Pulpotomy

187
a. Yes- 1st Primary Molar---EXTRACTION due to the difficulty of adequately

removing diseased pulp tissue
b. Not a 1st Molar-- is it restorable-- can a SSC appropriately sit on tooth?
c. Not a 1st Molar---- non-restorable-- EXTRACTION
d. Not a 1st MolarRestorable-- Root Resorption-EXTRACTION and

EXCEPTION TO THIS RULE IS IF THE TOOTH IS LOCATED
STRATEGICALLY like if it there to mantian space unil 1st perm molar comes
in pulp treatment, once the perm molar comes In then extraction and do space
maintainer
e. Not a 1st Molar- Restorable- NO ROOT RESORPTION-Pulpectomy
Treatment options for primary teeth
17). Apexogenesis – Vital, immature, root open use MDTA
18). Apexofication – Non-Vital, same root open, create a barrier HTA/Ca(OH)2
Apexification
1. Apexification is not vital pulp therapy because the tooth is pulpless.
2. Definition
188
a. A method to stimulate the formation of calcified tissue at the open apex of

pulpless teeth.
b. Creation of the proper environment for formation of the calcified barrier involves
cleaning and removal of debris and bacteria, as well as placement of a material to
induce apical closure.
3. Indication
a. For teeth with open apices in which standard instrumentation techniques cannot
create an apical stop to facilitate effective obturation of the canal.
19). Franfort horizontal – line orbitale portion to ear on PAN
A, The Frankfort plane as originally described for orientation of dried skulls.

This plane extends from the upper border of the external auditory canal
(A) (porion) anteriorly to the upper border of the lower orbital rim
(orbitale) .
20). for ORTHO know SNA 82 +/- 2, SNB 78 +/- 2, ANB
In the Steiner analysis, the first measurement is the angle SNA, which is designed to
evaluate the anteroposterior position of the maxilla relative to the anterior cranial
base (Figure 6–50). The “norm” for SNA is 82 ± 2 degrees. Thus if a patient's SNA
were greater than 84 degrees, this would be interpreted as maxillary protrusion, while
SNA values of less than 80 degrees would be interpreted as maxillary retrusion.
Similarly, the angle SNB is used to evaluate the anteroposterior position of the
189
mandible, for which the norm is 78 ± 2 degrees. This interpretation is valid only if
the SN plane is normally inclined to the true horizontal (or if the value is corrected as
described above) and the position of N is normal.
FIGURE 6–49 If the cephalometric film is taken with the patient in natural
head position (NHP), a line perpendicular to the true vertical (shown by the
image of the freely-suspended chain that is seen on the edge of the film) is the
true (physiologic) horizontal line. NHP is preferred in modern cephalometrics to
anatomic head positioning.
FIGURE 6–50 In the Steiner analysis, the angles SNA and SNB are used to
establish the relationship of the maxilla and mandible to the cranial base, while
the SN-MP (mandibular plane) angle is used to establish the vertical position of
the mandible
The difference between SNA and SNB—the ANB angle—indicates the magnitude of
the skeletal jaw discrepancy, and this to Steiner was the measurement of real interest.
One can argue, as he did, that which jaw is at fault is of mostly theoretical interest:
what really matters is the magnitude of the discrepancy between the jaws that must be
overcome in treatment, and this is what the ANB angle measures.
190
21). If ANB = 2 Normal Class1, If ANB>2 Class2, If ANB<0 Class3 (check DESK)
ANB: A-P difference between maxilla and mandible: more positive indicates
skeletal Class II; more negative indicates skeletal Class III.
22). Operative 10-52-50-60 last is angle of blade, must to know each one-WALA
23). Behavior, angry patient…
24). All LA – they are vasodilators, except COCAINE – vasoconstriction
25). Radiology: KVP – speed energy, quality, mA – quantity, # number of electrons
26). TMJ, a lot…
27). Radiology, know anatomy, PAN what is what… ?

28). Pedo, Fluoride dose table
042005. 14.4.3.2).
29). Pedo, tables of permanent, primary teeth eruption and calcification
30). Ortho know 1).Nance holding arch- used in maxillary arch has an acrylic button
that can cause irritation. Used to prevent mesial tipping of molars 2).distal shoe- used
when have early exfoliation of 2nd primary molar before eruption of permanent 1st molar
once the permanent first molar has erupted the distal shoe can be replaced by band
and loop 3).band and loops –used when have early exfoliation of 1st primary molar
4).lingual holding arch- used in mandibular when more than one mandibular tooth is
mixing
The band and loop appliance is used to maintain the space after the premature loss of a
single tooth. The band and loop appliance is indicated when there is unilateral loss
of a primary first molar before or after the eruption of the permanent first molar.
The loop is constructed of 36-mil round wire and is soldered to the band.
191
The lingual arch is often suggested when teeth are lost in both quadrants of the same arch.
Because the permanent incisor tooth buds develop and erupt somewhat lingual to
their primary precursors in the lower arch, a conventional mandibular lingual arch is
not recommended in the primary dentition; the wire resting adjacent to the primary
incisors might interfere with the eruption of the permanent dentition. Instead, two
band-and-loop appliances are recommended when there is bilateral tooth loss in the
mandibular arch.
The distal shoe appliance is used to maintain the space of a primary second molar
that has been lost prematurely before the eruption of the permanent first molar. A
stainless steel extension is soldered to the distal end of the band and 36-mil loop; this
extension is positioned 1 mm below the mesial marginal ridge of the unerupted
permanent first molar. The extension serves to guide the eruption of the permanent first
molar.
042005. 25.2.3).
31). Know benzodiazepines and barbiturates Mosby pg 283-284

32). Perio know all kind flaps, gingivitis, periodontitis, NUG / how to treat, drugs
33). Pt has 5mm pockets after S&RP: > or = 5mm, need Perio Surgery
< 5mm, no surgery, just maintenance
After 4 weeks the gingival tissues are evaluated to determine oral hygiene adequacy, soft
tissue response, and pocket depth . This permits sufficient time for healing, reduction in
inflammation and pocket depths, and gain in clinical attachment levels. In deeper pockets
(>5 mm), however, plaque and calculus removal is often incomplete,42,46 with risk of future
breakdown7 . As a result, periodontal surgery to access the root surfaces for
instrumentation and to reduce periodontal pocket depths must be considered before
restorative care may proceed.
Company, 072006. 71.3.6).
34). Implants, where fail most often – screw between abutment and implant
35). Implants, osseointegration, min space between…

Osseointegration in mandibular anterior 3 months mandibular posterior 4 months and
maxillary anterior and posterior is 6 months.
36). Know bone graft: Allograft, from cadaver/Autograft-same person,from
you/Xenograft-from animal; alloplast-man made; isograft-from same species(twins,
cousin etc/… definition
192
37). Tissue graft, purpose: 1). Lateral, small defect, prevent reception, increase keratinized tissue
2). Apical, gummy smile 3). Free Gingival
38). On Mylohyoid ridge removal - be careful of Lingual Nerve; BSSO-be careful of IAN
39). Know that BOP (bleeding on probing) measures inflammation
Scores and Criteria for Gingival Index (GI)

0 = Normal gingiva.
1 = Mild inflammation: slight change in color and slight edema; no bleeding on

probing.
2 = Moderate inflammation: redness, edema, and glazing; bleeding on probing.
3 = Severe inflammation: marked redness and edema; ulceration; tendency to

spontaneous bleeding.
Company, 072006. 8.4.1.1.1).
40). Endo know eruption of primary and permanent teeth, calcification
Calcification of primary – Second semester, calcification of First Molar at birth
41). Know Apexification, Necrotic tooth + open apex
Apexogenesis, Vital tooth + open apex
42). When to do Pulpotomy-kids or Pulpectomy-can be done as in emergency to relieve pain
43). When mostly tooth fracture occur during endo? Condensation of gutta percha
Susceptibility of any root to fracture is markedly increased by excessive dentin

removal during canal instrumentation or post preparation.47,48 An additional factor
occurring during condensation is the placement of excessive numbers of accessory cones
requiring multiple spreader insertions.38,49 Also, the insertion of tapered, inflexible
condensing instruments into curved canals creates root distortion and the potential for
fracture.50
Company, 012002. 28.8.4).
44). In Primary teeth Radiolucency, Necrotic shows in Furcation, tx-Extraction,unless very young
193
In Permanent teeth Radiolucency shows at Apex, tx – RCT; Most common

response of teeth to trauma is necrosis
45).Mandible in molar area resorbs distally (the anterior boarder resorbs and apposition on the
posterior boarder of the ramus) as we grow up and Exposing space for 2nd molars, 3rd molars
46). Antibiotic Prophilaxis – endocarditis in Pedo and Adult, yes/no allergy…
Pharmo
47). Benzodiazepine is safer, work on GABA neurotransmitters, cause thrombophelibitis in vein due due
to propylene glycol
Barbituates are NOT for PAIN, for Sedation only. They can cause Respiratory depression, due to
lower sensitivity to CO2. Shouldn’t use if patient has porphoria?
opiate toxidrome include the classic triad of coma, pinpoint pupils, and respiratory depression
48). know LA = esters(blood)-plsama/amides (liver)… prilocaine metabolism-toulelene,

methhemogobinemia(tx by metheline blue); articaine-metabolize by liver and plasma and it is the only
with the ester ring…
49). Vasoconstrictor’s purpose in LA:
Vasoconstrictors are important additions to a local anesthetic solution for the following
reasons:
1. By constricting blood vessels, vasoconstrictors decrease blood flow (perfusion) to the

site of administration.
2. Absorption of the local anesthetic into the cardiovascular system is slowed, resulting
in lower anesthetic blood levels.
3. Local anesthetic blood levels are lowered, thereby minimizing the risk of local anesthetic
toxicity.
4. Increased amounts of the local anesthetic remain in and around the nerve for longer
periods, thereby increasing (in some cases significantly,3 in others minimally)4 the duration
of action of most local anesthetics.
5. Vasoconstrictors decrease bleeding at the site of administration; therefore they are useful
when increased bleeding is anticipated (e.g., during a surgical procedure).5,6
(Malamed, Stanley. Handbook of Local Anesthesia, 5th Edition. Mosby, 072004. 3).
50). Nitrious Oxide, tingling fingers-max you can give to adult patient 70%. Recommended max 50%;
children mx 50%
194
51). If you see Ptosis (druping of the eyes) during General Anesthesia – it is adequate amount, just good
enough, don’t give any more…
52). Midazolam (versed)– creates Amnesia (memory lost) Side effects of midazolam include tolerance,
withdrawal symptoms, confusion, amnesia including anterograde amnesia, ataxia, drowsiness, cognitive
impairment, sedation and an increased risk of falls in the elderly.[13] People experiencing amnesia as a
side effect of midazolam are generally unaware that their memory is impaired. Flumanezil is antagonist.
Continuous or repeated seizures without periods of recovery between them are known as
status epilepticus. This problem warrants notification of outside emergency assistance
because it is the most common type of seizure disorder to cause mortality. Therapy
includes instituting measures already described for self-limiting seizures; in addition,
administration of a benzodiazepine is indicated. Injectable water-insoluble
benzodiazepines such as diazepam must be given IV to allow predictability of
results, which may be difficult in the patient having seizures if venous access is not
already available. Injectable water-soluble benzodiazepines such as midazolam
provide a better alternative, because IM injection will give a more rapid response.
However, the doctor administering benzodiazepines for a seizure must be prepared to
provide BLS because patients may experience a period of apnea after receiving a large,
rapid dose of benzodiazepines.
2.3.4.3).
53). Know Histamine2, Hydrogen2 – Antihistamine is for Gastric Acid secretion (good for heart burn)
histamine 1 is for reaction allergic reaction
54). Pharmo 1). Ab-prophylaxis
2). Benzodiazepam/barbitures
3). LA
4). NO2
5). midazolam
6). H2 antihistamine
7). Alpha, beta blockers
Methadone- Methadone is useful in the treatment of opioid dependence. It has cross-tolerance

with other opioids including heroin and morphine and a long duration of effect: oral doses of
methadone can stabilise patients by mitigating opioid withdrawal syndrome. Higher doses of
methadone can block the euphoric effects of heroin, morphine, and similar drugs. As a result,
properly dosed methadone patients can reduce or stop altogether their use of these substances.
55). Behavior science, from back test… Now management of Insurance (2 questions)
195
If dentist done 2 surface composite & insurance pays 1 surface – is it Upcoding or

Downcoding?
Oral Patho
56) Traumatic Bone Cyst – scalloped radiolucency, vital teeth, young pt, posterior mandible, empty
cavity present upon entrance into area
A panoramic film demonstrating an SBC (A), an occlusal film (B), and a

periapical film (C). The occlusal film shows that no expansion has occurred in the
buccal or lingual cortical plates. Except for the superior border, the borders are
ill defined and the lesion has scalloped around the teeth and thinned the
inferior border of the mandible, but the lamina dura is still present.
21.5.4.2).
57). Lateral Periodontal Cyst Mosby pg 117 – vital, asymptomatic, mand k9/pre-molar area,
vital teeth epithelial source is dental lamina of seres
Lateral periodontal cyst
1. Unilocular or multilocular lucency in the lateral periodontal membrane of adults.
2. Most are found in the mandibular premolar region.
3. Associated tooth is vital.
4. Gingival cyst of the adult is soft-tissue counterpart of this lesion.

Lateral periodontal cyst: Botryoid lateral periodontal cyst: often multilocular.
196
58). Ranula:
Ranula: rare large lesion; impairs eating.
The most common lesion of the sublingual gland is the ranula, which may be
considered a mucocele of the sublingual salivary gland. Ranulas result from mucous
retention in the sublingual gland ductal system or mucous extravasation as a result of ductal
disruption. The two types of ranulas are the simple ranula and the plunging ranula. The
simple ranula is confined to the area occupied by the sublingual gland in the sublingual
space, superior to the mylohyoid muscle. The progression to a plunging ranula occurs when
the lesion extends beyond the level of the mylohyoid muscle into the submandibular space .
The usual treatment of the ranula is marsupialization, in which a portion of the oral
mucosa of the floor of the mouth is excised, along with the superior wall of the ranula.
20.4.2).
59). Which is the most common skin cancer? Mosby pg 112 – basal cell carcinoma
Basal cell carcinoma, the most common skin cancer (and the most common of all
cancers), is a locally invasive, slowly spreading, primary epithelial malignancy that arises
from the basal cell layer of the skin and its appendages. About 80% are found on the skin of
the head and neck. More than 800,000 new cases of basal cell carcinoma are diagnosed
annually in the United States, representing 80% of all skin cancers.
According to the dental decks basal cell carcinoma metastasis is rare !
(Neville,Brad. Oral and Maxillofacial Pathology, 3rd Edition. Saunders Book Company,
062008. 10.34).
60). Where do you see SCC frequently? 1) Lateral Border of Tongue 2) Floor of mouth
Increased risk of oral cancer in Patients with Plummer Vinson Syndrome(mucosal atrophy, dysphagia,
and iron deficiency syndrome) Mosby pg 111
The most common site for intraoral carcinoma is the tongue, usually the posterior
lateral and ventral surfaces. The oral floor is affected almost as frequently in men but is
involved much less commonly in women.
197
Carcinoma of the tongue accounts for more than 50% of intraoral cancers in
population studies in the United States. Two thirds of lingual carcinomas appear as
painless, indurated masses or ulcers of the posterior lateral border; 20% occur on
anterior lateral or ventral surfaces, and only 4% occur on the dorsum. The tongue
especially is the site of involvement in young patients and, in fact, is the site of the only
congenital oral squamous cell carcinoma reported.
Carcinoma of the oral floor represents 35% of all intraoral cancers in epidemiologic
surveys and appears to be increasing in frequency among females. It occurs a decade
earlier in women than in men but is still usually a disease of older adults. Of all intraoral
carcinomas, floor of mouth lesions are the most likely to arise from a preexisting
leukoplakia or erythroplakia. It is also the oral cancer site most often associated
with the development of a second primary malignancy of another aerodigestive tract
location or of a distant organ. The most common site of involvement is the midline
near the frenum.
The metastatic spread of oral squamous cell carcinoma is largely through the
lymphatics to the ipsilateral cervical lymph nodes. A cervical lymph node that contains
a metastatic deposit of carcinoma is usually firm to stony hard, nontender, and enlarged. If
the malignant cells have perforated the capsule of the node and invaded into
surrounding tissues, then the node will feel “fixed,” or not easily movable.
Extracapsular spread (extension of metastatic deposits outside of the lymph node capsule)
is a microscopic feature associated with poor prognosis, including increased risk of
locoregional recurrence, distant metastasis, and lower survival rates.
Occasionally, contralateral or bilateral metastatic deposits are seen, and at least 2% of

patients have distant (“below the clavicles”) metastasis at diagnosis; in some studies this
figure is as high as 22%. The most common sites of distant metastasis are the lungs, liver,
and bones, but any part of the body may be affected.
Carcinoma of the lower lip and oral floor tends to travel to the submental nodes;
tumors from the posterior portions of the mouth travel to the superior jugular and
digastric nodes. Lymphatic drainage from the oropharynx leads to the jugulodigastric
chain of lymph nodes or to the retropharyngeal nodes, and metastatic deposits from
oropharyngeal carcinoma are usually found there.
Squamous cell carcinoma, metastatic spread. Diagram demonstrating

potential sites for metastatic spread of oral carcinoma to regional lymph nodes.
198
062008. 10.26.3).
062008. 10.26.2.2).
61). Herpes, on attached or keratinized gingival,
Aphthous ulcers, on NOT-keratinized mucosa soft tissue
62). Angular Chelulitis (candidas), loss of VDO
63). Clefts – basic, palate
A cleft is a congenital abnormal space or gap in the upper lip, alveolus, or palate. The
colloquial term for this condition is harelip. The use of this term should be discouraged
because it carries demeaning connotations of inferiority. The more appropriate terms are cleft
lip, cleft palate, or cleft lip and palate.
Clefts of the lip and palate are the most common serious congenital anomalies to affect
the orofacial region. The initial appearance of clefts may be grotesque. Because clefts are
deformities that can be seen, felt, and heard, they constitute a serious affliction to those who
have them. Because of their location, clefts are deformities that involve the dental specialties
throughout their protracted course of treatment. The general dentist will become involved in
managing these patients’ special dental needs because these patients may have partial
anodontia and supernumerary teeth. Malocclusion is usually present, and orthodontic therapy
with or without corrective jaw surgery is frequently indicated.
199
The occurrence of a cleft deformity is a source of considerable shock to the parents of an

afflicted baby, and the most appropriate approach to the parents is one of informed explanation
and reassurance. Parents should be told that the defects are correctable and need not adversely
affect the child’s future. However, parents should be prepared for a protracted course of
therapy to correct the cleft deformities and to allow the individual to function with them.
The problems encountered in rehabilitation of patients with cleft deformities are unique.
Treatment must address patient appearance, speech, hearing, mastication, and deglutition. A
team manages most children currently affected with orofacial clefts.
Cleft teams are found in most cities of at least moderate size. These teams commonly comprise
a general or pediatric dentist, an orthodontist, a prosthodontist, an oral and maxillofacial
surgeon and a plastic surgeon, an audiologist, an otorhinolaryngologist, a pediatrician, a
speech pathologist, a psychologist or psychiatrist, and a social worker. The number of
specialists required reflects the number and complexity of the problems faced by individuals
with orofacial clefts.
The occurrence of oral clefts in the United States has been estimated as 1 in 700 births.1
Clefts exhibit interesting racial predilections, occurring less frequently in blacks but more so in
Asians. Boys are affected by orofacial clefts more often than girls, by a ratio of 3:2. Cleft
lip and palate (together) occurs about twice as often in boys as in girls, whereas isolated
clefts of the palate (without cleft lip) occur slightly more often in girls.
Oral clefts commonly affect the lip, alveolar ridge, and hard and soft palates. Three fourths of
clefts are unilateral deformities; one fourth are bilateral. The left side is involved more
frequently than the right when the defect is unilateral. The cleft may be incomplete; that is,
it may not extend the entire distance from lip to soft palate. Cleft lip may occur without
clefting of the palate, and isolated cleft palate may occur without clefting of the lip. A useful
classification divides the anatomy into primary and secondary palates. The primary palate
involves those structures anterior to the incisive foramen: the lip and alveolus; the secondary
palate consists of those structures posterior to the incisive foramen: the hard and soft palates.2
Thus an individual may have clefting of the primary palate, the secondary palate, or both.
Clefts of the lip may range from a minute notch on the edge of the vermilion border to a wide
cleft that extends into the nasal cavity and thus divides the nasal floor. Clefts of the soft palate
may also show wide variations from a bifid uvula (Fig. 27-2, D) to a wide inoperable cleft. The
bifid uvula is the most minor form of cleft palate, in which only the uvula is cleft.
Submucosal clefts of the soft palate are occasionally seen. These clefts are also called occult
clefts because they are not readily seen on cursory examination. The defect in such a cleft is a
lack of continuity in the musculature of the soft palate. However, the nasal and oral mucosa is
continuous and covers the muscular defect. To diagnose such a defect, the dentist inspects
the soft palate while the patient says “ah.” This action lifts the soft palate, and in
individuals with submucosal palatal clefts, a furrow in the midline is seen where the
muscular discontinuity is present. The dentist can also palpate the posterior aspect of the
hard palate to detect the absence of the posterior nasal spine, which is characteristically
absent in submucosal clefts. If a patient shows hypernasal speech without an obvious soft
palatal cleft, the dentist should suspect a submucosal cleft of the soft palate.
200
27).
64). Cyst and Granuloma - both: 1 Contain Epithelium 2 Can tell only by Microscope ( cyst is an
epithelium lined cavity
65). Dentigerous cyst, can be changed to Ameloblastoma
The distinction between an area of proliferating odontogenic epithelium in the wall of a

dentigerous cyst and early ameloblastoma may be difficult to make, and studies of lectins
and other cell markers on the proliferating epithelial cells have so far failed to identify
those lesions that are most likely to develop into an ameloblastoma.154 There is no clear
origin for the ameloblastoma; the dentigerous cyst is only one possibility, but
remnants of the dental lamina and the basal layer of the oral mucosal epithelium also are
strong contenders.
Decker, 012003. 7.4.2.2).
66). AOT young, female, maxilla by canine
The adenomatoid odontogenic tumor represents 3% to 7% of all odontogenic tumors, and

more than 750 examples have been reported in the literature. Although this lesion was
formerly considered to be a variant of the ameloblastoma and was designated as
“adenoameloblastoma,” its clinical features and biologic behavior indicate that it is a
separate entity. Although there is evidence that the tumor cells are derived from enamel
organ epithelium, investigators have also suggested that the lesion arises from remnants of
dental lamina.
Adenomatoid odontogenic tumors are largely limited to younger patients, and two
thirds of all cases are diagnosed when patients are 10 to 19 years of age. This tumor
is definitely uncommon in a patient older than age 30. It has a striking tendency to
occur in the anterior portions of the jaws and is found twice as often in the maxilla
as in the mandible. Females are affected about twice as often as males.
Most adenomatoid odontogenic tumors are relatively small. They seldom exceed 3 cm in
greatest diameter, although a few large lesions have been reported. Peripheral
(extraosseous) forms of the tumor are also encountered but are rare. These usually appear
as small, sessile masses on the facial gingiva of the maxilla. Clinically, these lesions
cannot be differentiated from the common gingival fibrous lesions.
Adenomatoid odontogenic tumors are frequently asymptomatic and are discovered

during the course of a routine radiographic examination or when films are made to
determine why a tooth has not erupted. Larger lesions cause a painless expansion of
the bone.
In about 75% of cases, the tumor appears as a circumscribed, unilocular

radiolucency that involves the crown of an unerupted tooth, most often a canine.
201
Adenomatoid odontogenic tumor. A small radiolucency is present between the

roots of the lateral incisor and canine. (Courtesy of Dr. Ramesh Narang.)
062008. 15.3.4).
67). Osteoradionecrosis , in mandible more common, before/after extraction,
tx hyperbaric oxygenation ( need prophylaxis - ?)
One of the most severe and complicating sequelae of radiotherapy for patients with head
and neck cancer is osteoradionecrosis. Basically, osteoradionecrosis is devitalization of
the bone by cancericidal doses of radiation. The bone within the radiation beam
becomes virtually nonvital from an endarteritis that results in elimination of the fine
vasculature within the bone. The turnover rate of any remaining viable bone is slowed to
the point of being ineffective in self-repair. The continual process of remodeling normally
found in bone does not occur, and sharp areas on the alveolar ridge will not smooth
themselves, even with considerable time. The bone of the mandible is denser and has a
poorer blood supply than that of the maxilla. Thus the mandible is the jaw most commonly
affected with nonhealing ulcerations and osteoradionecrosis.
After radiation treatment the dentist should see the patient every 3 to 4 months. A
prophylaxis is performed during these postirradiation visits, and topical fluoride
applications are made. The patient should be fitted with custom trays to deliver topical
fluoride applications. The patient should be instructed in the use of the trays and in daily
self-administration of topical fluoride applications. The use of a 1% fluoride rinse for 5
minutes each day has been found to decrease the incidence of radiation caries.
Pre-extraction (more chance of favorable outcome)
Traditionally, 7 to 14 days between tooth extraction and radiotherapy have been

suggested.17,22,23 Most authors base their recommendations on the clinical impression that
reepithelialization has occurred in this period. However, radiotherapy should be delayed
for 3 weeks after extraction, if possible. This helps to ensure that sufficient soft tissue
healing has occurred. The radiotherapy should be delayed further, if possible, if a local
wound dehiscence has occurred. In this instance, daily local wound care with irrigations
202
and postoperatively administered antibiotics are mandatory until the soft tissues have
healed.
Post extraction( more risky)
Postirradiation extractions are also the most undesirable extractions the dentist will
ever perform because the outcome is always uncertain.
The answer to the question of whether extractions can be done after radiotherapy is
certainly yes. The more important question is, How? If the tooth is to be extracted, the
dentist can perform a routine extraction without primary soft tissue closure or a
surgical extraction with alveoloplasty and primary closure. Either of these techniques
yields similar results, with a certain concomitant incidence of osteoradionecrosis. The use
of systemic antibiotics is recommended.
Another technique that has been shown to be effective and that is gaining in
popularity is the use of hyperbaric oxygen (HBO) before and after tooth extraction.
HBO therapy is the administration of oxygen under pressure to the patient. HBO has been
shown to increase the local tissue oxygenation and vascular ingrowth into the hypoxic
tissues.24,25 The usual protocol for such treatments is to have between 20 and 30 HBO
dives before extraction and 10 more dives immediately after extractions. HBO
chambers are not available in all communities and, when present, are usually in select
hospitals. A physician that is experienced in hyperbaric medicine manages patients referred
to these facilities. The patient usually undergoes one HBO session each day. Therefore,
it takes 4 to 6 weeks to get the 20 to 30 treatments before surgery, and 2 weeks of
treatment after surgery.
18.1.12).
68). Extraction: #150 = maxillary universal forcep, 151 = mandible universal forcep
69). To make front teeth to look younger – round off edges
cosmetic contouring to achieve youthful, feminine characteristics often includes

rounding incisal angles, reducing facial line angles, and opening incisal embrasures.
The opposite characteristics typically are considered more masculine features.
Cosmetic reshaping to smooth rough incisal edges and improve symmetry is equally
beneficial to women and men.
Loss of incisal embrasures from attrition.
203
Before (A) and after (B) recontouring teeth to produce a more youthful appearance
and improve resistance to fracture.
(Roberson, Theodore. Sturdevant's Art and Science of Operative Dentistry, 5th Edition. C.V.
Mosby, 042006. 15.2.1.2).
70). To look SMALLER – bring line angels closer (M-D smaller); polished shiny crown looks larger
than it really is
71). Add orange to crown to change HUE
72). Ortho: ANB – to check class norm2, SNA- measure maxillary norm82, +/- 2 SNB- measure
mandible norm 78 +/- 2
73). Missing Primary molar – unilateral Loop band,

Missing both, bylateral molars 1). Mandible – Lingual bar
2). Maxillar – Nancy retainer
If extracted Second primary molar, still no First Permanent molar – crown on First Primary molar and
Distal shoe
74). If severe crowding, class 1 malocclusion – serial extraction
Many children with arch-length inadequacy have spectacular growth when least expected
and may be treated successfully without sacrificing permanent teeth. The primary canine
is removed first, the first primary molar second, and the first premolar last in the
serial extraction procedure. The interval between extractions varies from 6 to 15
months. After removal of the primary canines, there is a degree of self-correction in the
position and alignment of the permanent incisors. Dewel advocates an alternative
extraction sequence in the borderline malocclusion when extraction of the first premolar
can be avoided; in this case, growth may yet be sufficient to accommodate all the teeth.
The first primary molar is extracted 6 to 12 months before the extraction of the primary
canine to encourage first premolar eruption and to retard canine eruption. If growth exceeds
expectations, as it occasionally does, there will be no need to extract the first premolar.
204
75). Most commonly missing Permanent teeth: 1). Third molars 2). Mand. Second premolars 3). Max
Later Incisors
76). Composite shrinks toward center of mass
77). Purpose of Post is to retain Core
5. Post preparation
a. The primary purpose of the post is to retain a core in a tooth when there is an
extensive loss of coronal structure.
b. The need for a post is dictated by the amount of remaining coronal tooth structure.
c. Posts do not reinforce the tooth, but further weaken it by additional removal of
dentin and by creating stress that predisposes to root fracture.
d. At least 4 to 5 mm of remaining gutta-percha is recommended.
78). Latex gloves – delay PVS setting
Some brands of latex gloves and some hemostatic agents contain chemicals that can
inhibit the setting of polyvinyl siloxane impression materials. Judicious cleaning of
the teeth and the retraction cord to remove any chemicals that could prevent the setting of
the impression material may be necessary.
Mosby, 042006. 20.8.3.1).
79). Patient back after finished restoration, with sensitivity on bite- check occlusion
80). Class 2 most conservative prep – slot prep
If approximal caries extends well into the dentin, undermining the marginal ridge areas to
the extent that a tunnel preparation with glass-ion-omer cement and composite resin
becomes non-viable, then the slot preparation may be an alternative. This preparation
incorporates the marginal ridge and proximal surface but not the complete occlusal surface;
thus it is an esthetic, conservative alternative to full-coverage or compound cast-metal
restorations.
205
Occasionally, the use of a slot in the dentin is helpful to provide the necessary retention
form. An example is the mandibular second molar that has no molar posterior to it and
requires a mesio-occlusal onlay restoration capping all of the. The distal, facial, and
lingual surfaces are free of caries or other injury, and these surfaces also are judged not
to be prone to caries. After cusp reduction, the vertical walls of the occlusal step portion
of the preparation have been reduced so as to provide very little retention form. The
necessary retention can be achieved by cutting a distal slot. Such a slot is preferred
over preparing a box in the distal surface because (1) the former is more
conserving of tooth structure and of strength of the tooth crown, and (2) the linear
extent of marginal outline is less.
Mosby, 042006. 20.7.2.3.6).
(Garber, David A.. Porcelain & Composite Inlays & Onlays: Esthetic Posterior Restorations.
Quintessence Publishing (IL), 011994. 4.3.4).
81). For Class 4 what is the best material – mod resin GI cement ???? I think nanofil composite..
(Microfill composite)
82). Radiology = density, potencial, intensity, Cathode to Anode, what cause error to film,
to PAN…
To change density-change focal and film
Dark,put in developer/white, put in fixer film, short roots, Negative Angulation
206
83). Radiopacity MB cusp of 14 – cusp of carribelli

(not sure but this carabelli business more likely the 2nd canal MB2…could be calcified !!!)
84). Skull radiopacity in middle (vertical white line in forehead) – BCC, basal cell carcinoma,
nasal BCC syndrome
Nevoid basal cell carcinoma syndrome. Anteroposterior skull film

showing calcification of the falx cerebri. (Courtesy of Dr. Ramesh Narang.)
The odontogenic keratocyst occurs as an isolated cyst and as a component of nevoid
basal cell carcinoma syndrome. Nevoid basal cell carcinoma syndrome is inherited as
an autosomal dominant trait that exhibits high penetrance and variable expressivity. In
addition to odontogenic keratocysts (usually multiple), components of the syndrome
include (among many others) basal cell carcinomas developing at an early age in
non–sun exposed skin, mild hypertelorism, enlarged calvarium, calcification of the
falx cerebri, and rib abnormalities.136,137 Pitting of the soles and palms (local areas
of undermaturation of the epithelial basal cells) is an additional finding in about half of
the individuals affected by the syndrome. Despite the syndrome’s name, multiple basal
cell carcinomas occur in only 50% of cases. Appropriate treatment is simple curettage
or marsupialization of the cysts.138
(Greenberg, Martin S.. Burket's Oral Medicine, 11th Edition. B.C. Decker, 112007. 6.3.6.1.3).
85). Tube Collimation-use lead, know definition, to reduce radiation, longer-better,
increase distance of tube and rectangular reduces radiation more than circular
86). Water View radiograph for Maxillary sinus and infraorbital and zygomatic fracture
Removable
207
The occipitomental (Waters) view provides a good image of the zygomatic bone and
midface that will show the displaced fracture fragment (Fig. 29-19). An underexposed
submentovertex projection (the so-called jug-handle view) provides a good view of the
zygomatic arch and can often show the V-shaped deformity of the zygomatic process of
the temporal bone. CT is, however, the imaging modality of choice for these fractures
(Fig. 29-20).
The Waters projection is optimal for visualization of the maxillary sinuses, especially to
compare internal radiopacities, and the frontal sinuses and ethmoid air cells. If the Waters
view is made with the mouth open, parts of the sphenoid sinuses may also be visualized.
27.2.3).
87). Mandible Complete denture, Disto-Buccal sore spot – masseter muscle dislodge
88). Posterior Palatal seal, purpose to compensate for shrinkage of acrylic, to create posterior
palatal seal
89). Plastic teeth are better than porcelain: 1). Adhere better to the acrylic2). Don’t wear opposing
natural teeth
90). Anterior teeth, first goal is ESTHETIC
Chroma is easier to change, by increased by external colorants, most frequently in the

gingival or interproximal areas. impossible to increase value; hue-slight change is
possible (ie orange to orange brown)ds188
91). Posterior Cheek Bite created by lack of posterior Overjet
92). Sore spot on mandible ridge – check occlusion bite

208
93). Franfort Horisontal, know definition (orbatale-porion)
94). Clasp, passive sit
Passivity is the quality of a clasp assembly that prevents the transmission of adverse
forces to the associated abutment when the prosthesis is completely seated. When fully
seated, a clasp assembly should be passive. The retentive arm should be activated only
when dislodging forces are applied to the removable partial denture. One of the major
causes of discomfort in removable partial denture therapy is incomplete seating of a clasp
assembly on the associated abutment. If the clasp assembly is not fully seated, the
retentive terminus will not be positioned in its intended location.
Quintessence Publishing (IL), 012003. 3.1.2.2).
95). I Bar & WW = infrabulge. Akers = suprabulge…
100). What is the best way to do Centric relation with rpd – with framework and wax rim
101). If supereruption of tooth and you need to do bridge or partial on opposite side, you cut
supererupted tooth and put a crown on it (for sensitivity)
102). Anterior PFM, facial reduction is 1.5mm; 2mm?
For a metal ceramic crown, 1.5 to 1.8 mm of reduction should be provided at the
junction of the incisal third and the middle third of the clinical crown according to the
desired shade.
Thickness Requirements According to Shade
Dark Shade:
• Facial reduction, 1.4 mm
• Tooth thickness, 2.9 mm
Light Shade:
• Facial reduction, 1.7 mm
• Tooth thickness, 3.2 mm
(Chiche, Gerard J.. Esthetics of Anterior Fixed Prosthodontics:. Quintessence Publishing (IL),
011994. 4.1.2).
103). Gold crown or onlay – Supporting cusp reduction 1.5mm, Non-supporting cusp 1mm
Cast Crown: To achieve a desired occlusal reduction of 1.0 to 1.5 mm,21 the depth-
orientation grooves should be 1.5 mm deep on the functional cusps (maxillary lingual
and mandibular facial cusps) and 1.0 mm deep on the nonfunctional cusps (maxillary
facial and mandibular lingual cusps).
209
Metal-ceramic crowns will require 1.5 to 2.0 mm on functional cusps that will be
veneered with porcelain and 1.0 to 1.5 mm on nonfunctional cusps to receive ceramic
coverage. There should be 2.0 mm of clearance on preparations for all-ceramic crowns

(IL), 011997. 9.3.1).
104). Jaw movement: working, non-working, Know Inner/outer inclination,
interference.
Protusive: DUML Retrusive: MUDL
Nonworking: NIFL:non-working interference, inner aspect of facial cusp of lower
Working: WILU: working interference, inner aspect of lingual cusp of upper
Statistics or behavior… ?
105). Nominal, Interval – temperature, Ratio – b.p., pulse, ordinal…
210
106). Fucation class 1,2,3 What to do?

211
Class I: Early Defects

Incipient or early furcation defects (class I) are amenable to conservative
periodontal therapy. Because the pocket is suprabony and has not entered the
furcation, oral hygiene, scaling, and root planing are effective.15 Any thick
overhanging margins of restorations, facial grooves, or CEPs should be eliminated by
odontoplasty, recontouring, or replacement. The resolution of inflammation and
subsequent repair of the periodontal ligament and bone are usually sufficient to restore
periodontal health.
Class II
Once a horizontal component to the furcation has developed (class II), therapy becomes
more complicated. Shallow horizontal involvement without significant vertical bone
loss usually responds favorably to localized flap procedures with odontoplasty and
osteoplasty. Isolated deep class II furcations may respond to flap procedures with
osteoplasty and odontoplasty (Figure 68-6). This reduces the dome of the furcation and
alters gingival contours to facilitate the patient’s plaque removal.
Classes II to IV: Advanced Defects

The development of a significant horizontal component to one or more furcations of a
multirooted tooth (late class II, class III or IV13) or the development of a deep vertical
component to the furca poses additional problems. Nonsurgical treatment is usually
ineffective because the ability to instrument the tooth surfaces adequately is
compromised.30,36 Periodontal surgery, endodontic therapy, and restoration of the
tooth may be required to retain the tooth.
Company, 072006. 68.5.1).
107). Fluoride chart/table
108) prevalenc/incidence
212
Prevalence: indicates what proportion of a given population is affected by a

condition at a given point in time. It is expressed as percentage and ranges from 0% to
100%, (e.g., the prevalence of periodontal disease among 100,000 adolescents was 5%).
b. Incidence: indicates the number of new cases that will occur within a population
109). Penumbra –
The penumbra is the unsharpness or blurring that surrounds the edge of a radiographic
image, whereas the umbra is the sharp area. It is desirable to keep the penumbra as small as
possible. This is done by using a small focal spot, angulation of the target, an increased FFD,
and a small OFD
(Frommer, Herbert H.. Radiology for the Dental Professional, 8th Edition. C.V. Mosby, 062005.
3.3).
110). Biological width = 2mm
A crown margin should not be placed any closer than 2.0 mm away from the alveolar crest,
or bone resorption will occur. The combined width of the epithelial and connective tissue
attachments is normally about 2.0 mm. If the margin intrudes into this "biological width,"
inflammation will result, and the bone will recede until it is once again at least 2.0 mm from
the crown margin. This can result in an interproximal cul de sac or an infrabony pocket that
would be impossible to maintain in a healthy state. The distance from the epithelial
attachment to the crest of the alveolar bone has been described as the "biologic width."
It is normally about 2.0 mm wide, including the epithelial attachment and the
connective tissue attachment.
111). Xerostomia-opiods does not cause dry mouth; sjogren syndrome does cause
arthiris
112). Gingival hyperplasia (cause it dilatin…)

113). Stain of dentin– tetracycline
Tetracycline is deposited in the dentin and to a lesser extent in the enamel of teeth that
are calcifying during the time the drug is administered. The location of the pigment in the
213
tooth can be correlated with the stage of development of the tooth and the time and
duration of drug administration.
114). Flaps modified, Widman flap, not apically repositioned flap…
115). Ectodermal dysplasia, andodontia either partial or complete, thin sparse hair,
sweat, dry skin, any abnormalities of things developing from ectoderm layer
116). Dr.Whitaker class - db cusp occlude where in opposite side?
117). Know all nerves – how to num pt? To extract #11 what anesthesia should I
do? ASA-incisors and canine, MSA premolars and mesial buccal of 1st molar, PSA molars
118). LaFort 1,2,3 fractures nerves

119). Fusion/Gemination
Fusion represents the union of two independently developing primary or permanent

teeth. The condition is almost always limited to the anterior teeth and, like gemination may
show a familial tendency. So it’s a single enlarged tooth with separate roots therefore the
tooth count reveals missing tooth
Fusion of a permanent central and lateral incisor.
GEMINATION (single enlarged tooth with single root canal and

normal tooth count)
A geminated tooth represents an attempted division of a single tooth germ by

invagination occurring during the proliferation stage of the growth cycle of the
tooth. The geminated tooth appears clinically as a bifid crown on a single root .
214
<
120). Ugly-duckling
In some children, the maxillary incisors flare laterally and are widely spaced when they
first erupt, a condition often called the "ugly duckling" stage. The spaced incisors tend
to improve when the permanent canines erupt, but this condition increases the
possibility that the canines will become impacted.
(Proffit, William R.. Contemporary Orthodontics, 3rd Edition. C.V. Mosby, 012000. 3.3.3).
1). is it best to have 4 or 1 C-Factor? C-factor of 1
C-factor
215
The configuration factor or ratio between the bonded surface area of a resin-based
composite restoration to the unbonded or free surface area. The higher the C-factor, more
will the detrimental effects of polymerization shrinkage.
Company, 072003. 18.1).
2). What is national % of cleft in USA? 1:700
The occurrence of oral clefts in the United States has been estimated as 1 in 700 births.1 Clefts
exhibit interesting racial predilections, occurring less frequently in blacks but more so in
Asians. Boys are affected by orofacial clefts more often than girls, by a ratio of 3:2. Cleft lip
and palate (together) occurs about twice as often in boys as in girls, whereas isolated clefts of
the palate (without cleft lip) occur slightly more often in girls.
27).
3). What’s Maximal temp for Implants placement to avoid bone necrosis? 40 degrees C 47 degrees C
is necrosis
The heat generated during an implant osteotomy is related to the presence and
temperature of irrigation,35-37 amount of bone being prepared,38,39 drill sharpness and
design,40-43 time of preparation,44 depth of the osteotomy,37,30,41,45 pressure on the drill,40
drill speed,39,46,47 and variation in cortical thickness.35,48
Bone cell survival is very susceptible to heat. Eriksson has demonstrated that in
rabbit, bone temperature as low as 3° C above normal (40° C) can cause bone cell
216
necrosis.49 Therefore a conscious effort is made to control temperature elevation every

time a rotary instrument is placed in contact with bone. At least 50 mL/min of cooled
irrigation, such as sterile physiologic saline, is used as a profuse irrigant and is a critical
element to reduce heat.35-37,50 Distilled water should not be used, as rapid cell death may
occur in this medium.51 Intravenous dextrose solution (D 5 W) also may be used, with the
clinical advantage of decreasing hand piece breakdown occurring from the effects of the
salt in a saline solution, although the surgical gloves often feel sticky near the conclusion
of the surgery.
Gutta percha-
The primary ingredient of a gutta-percha cone is zinc oxide (±75 percent). Gutta-
percha accounts for approximately 20 percent and gives the cone its unique properties
such as plasticity. The remaining ingredients are binders, opaquers, and coloring agents.
Company, 012002. 14.5.1.2).
4). Space between 2 implants – 3mm, between implant and tooth 1mm
Most successful implant is mand ant, most failure is mx post.
As a general rule, the top of the implant should be placed 2- 3 mm below the planned
position of the cementoenamel junction of the final restoration.
14.10.2).
For the evaluation of implant success, immobility and radiographic evidence of bone
adjacent to the implant body are the two most accurate diagnostic aids in evaluating
success. Follow-up or recall radiographs should be taken after 1 year of functional loading
and yearly for the first 3 years.105 Multiple studies have shown that, in the first year,
marginal bone loss and a higher rate of failure are seen.
5). Template for Implants can control all but? a). Number # of implants b). implant
size c). implant inclination, avoid hitting adjacent structures, saves time
The surgical guide template is a critical factor for implants placed in an esthetic area
because even slight variations of angulation can have large effects on the appearance of the
final restoration. The construction of the surgical guide template is nearly
indispensable for those patients for whom it is necessary to optimize implant
217
placement to ensure correct emergence profiles in the anterior esthetic zone. The four
objectives of using a surgical template for the partially edentulous patient are as
follows: (1) delineate embrasure, (2) locate implant within tooth contour, (3) align
implants with long axis of completed restoration, and (4) identify level of
cementoenamel junction or tooth emergence from the soft tissue. The template most
useful in the anterior esthetic zone is a clear resin template, which allows a surgeon ease of
access to the bone and uninterrupted visual confirmation of frontal and sagittal angulations
.
14.4.4).
The diagnostic template enables the dentist to incorporate the three-dimensional treatment
plan of the final prosthetic result into the imaging examination; evaluate the patient's
anatomy relative to the proposed implant sites, esthetics, and occlusion; and record and
transfer these findings to the patient at the time of surgery.
(Misch, Carl E.. Contemporary Implant Dentistry, 3rd Edition. Mosby, 122007. 3.10).
6). In TMJ which part responsible for rotation, which for translation? (TURL)
The TMJ is often referred to as a ginglymoarthrodial joint, meaning hinge and glide. The
TMJ is also somewhat capable of free movement or diarthrosis. As the mandible articulates
with both left and right TMJs, mandibular movement results in actions of both joints
simultaneously. Hinge (rotation) occurs in the lower joint space. Glide (translation)
occurs in the upper joint space. Each TMJ is able to rotate in three separate planes or axes.
(Mosby. Mosby's Review for the NBDE, Part I. C.V. Mosby, 072006. 4.9).
7). What test needed for WARFARIN? a). INR, b).bleeding time, c). prothrombine time
8). What test is NORMAL for Hemophilia? Clotting Factors ie. PT, PTT
For hemophilia the PT, platelet, and bleeding time is normal, only the PTT is increase thus why it is the
best test.
9). If pain in upper/maxillary what would be a prof that pain in NOT odontogenic? Pain is not
removed by anesthesia
Nonodontogenic toothache can often be differentiated from odontogenic toothache by local

provocation. Pulpal and periodontal pains are increased by local provocation of the
teeth such as percussion, hot, cold, or biting forces. When toothache pain is not
increased by provocation, one should be suspicious of nondental toothache. Local
anesthetic can be very helpful in differentiating true dental pain from pain referred to
the teeth.104-106 Local anesthetic applied in the region of a true dental toothache will
218
reduce or eliminate the pain. Local anesthetic at the site of the nonodontogenic toothache
often will not reduce the pain since the site of pain is not the true source of pain. When the
clinician finds it difficult to identify a source of toothache, diagnostic local anesthetic
blocking should be utilized.
7.1.4).
10). Picture of Sponge/nevus (in buccal fold)
White sponge nevus: of buccal mucosa.*

Wilkins, 012003.).
11). Radiograph of SINUS – know xray all names!!!!
12). Post-herpes Neuralgia could be after which HERPES? Zoster or Regular (type1)
Post-Herpetic Neuralgia.
Up to 10% of patients who have suffered recurrent varicella zoster infection of the
trigeminal nerve (shingles, herpes zoster) subsequently develop a persistent
neuralgia. Damage to neural tissue or persistence of virus within the trigeminal nerve
has been implicated in this condition.
The character of the pain can range from episodic severe shooting pain to a constant
burning sensation. The affected area may show signs of postinflammatory pigmentation
or scarring from the preceding herpes zoster infection. Diagnosis is made on the nature
of the symptoms and previous history of shingles.
Post-herpetic neuralgia is difficult to manage. Medications such as TCAs and

gabapentin may be effective in controlling pain. Some reports have suggested treatment
with topically applied capsaicin cream or lidocaine patch, opioids, and intrathecal
methylprednisolone, but these therapies need to be validated. Surgical approaches
produce no benefit. Transcutaneous electric nerve stimulation (TENS) has been found
helpful in certain patients.
219
(Regezi, Joseph A.. Oral Pathology: Clinical Pathologic Correlations, 5th Edition. Saunders
Book Company, 102007. 5.1.4.5.3).
13). On pan both Sinuses have some opacity like fog, dxn? Sinusitis
14). On xray radiograph big amalgam restoration on #30 just slightly touching on
distal #31. What cause that too light contact? Don’t use WEDGE
(don’t use wedge ??)
15). Which has highest % of Hyperactive kids ADDH – BOY or GIRLS? BOYS
Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder

affecting about 3–5% of the population, boys much more commonly than girls. It is
characterized by developmentally inappropriate degrees of impulsivity, inattention and
often hyperactivity. The symptoms are noted from early childhood, usually well before
school entry, and are present in all settings.
The term ADHD is currently used to describe a range of children with varying functional
difficulties, but who share the feature of poorly sustained attention. Some are extremely
impulsive, some aggressive, others quiet and restless. Many have low self-esteem.
Comorbidities include developmental language disorders, anxiety, oppositional-defiant
behaviours, fine motor and coordination difficulties and specific learning disabilities.
Virtually all children with ADHD have deficits in short-term auditory memory.
8.15.1).
16). Know definition FENESTRATION and DEHISENCE
Isolated areas in which the root is denuded of bone and the root surface is covered
only by periosteum and overlying gingiva are termed fenestrations. In these areas the
marginal bone is intact. When the denuded areas extend through the marginal bone,
the defect is called a dehiscence. Such defects occur on approximately 20% of the teeth;
they occur more often on the facial bone than on the lingual bone, are more common on
anterior teeth than on posterior teeth, and are frequently bilateral. Microscopic evidence of
lacunar resorption may be present at the margins. The cause of these defects is not clear.
Prominent root contours, malposition, and labial protrusion of the root combined with a
thin bony plate are predisposing factors.44 Fenestration and dehiscence are important
because they may complicate the outcome of periodontal surgery.
220
Dehiscence on the canine and fenestration of the first premolar.
Company, 072006. 5.3.7).
17). Question for metabolism drug detoxication in liver. When drug became completely useless, after?
a). Redation b). Oxidation c). Conjugation
Phase 1 (reduction, oxidation, hydrolysis ) yields slightly polar, water soluble metabolite (often still
active) : cytochrome p-450. Geriatric loose phase 1 first
Phase 2(acetylation, glucorinadation, sulfation) yields very polar inactive metabolite) renally excreted.
Phase 2 conjugation.
18). Flumazenil a). is competitive antagonist of diazapam b). antihistamine…
19). What is most important in determining for each PERIO surgery? Amount of keratinized tissue
20). Which one is PRIMARY support for complete mandibular denture? a). buccal shelf b). residual
alveolar ridge
the horizontal portion of the hard palate lateral to the midline provides the primary
support area for the denture. In the area of the rugae, the palate is set at an angle to
the residual ridge and is rather thinly covered by soft tissue. This area contributes to
the stress-bearing role, though in a secondary capacity. The submucosa covering the
incisive papilla and the nasopalatine canal contains the nasopalatine vessels and nerves.
The crest of the edentulous ridge is an important area of support. However, the bone is
subject to resorption, which limits its potential for support, unlike the palate, which is
resistant to resorption. Because of this, the ridge crest should be looked on as a
secondary supporting area, rather than a primary supporting area. The inclined facial
surface of the maxillary ridge provides little support, although the peripheral tissues should
be contacted to provide a border seal.
the bone of the buccal shelf is covered by a layer of cortical bone. This, plus the fact that
the shelf lies at right angles to the vertical occlusal forces, makes it the most suitable
primary stressbearing area for a lower denture
Implant-Supported Prostheses, 12th Edition. Mosby, 092003. 14.2.2).
21). You need to do anesthesia on inflamed tooth. Which one you can anesthetized more predictable?
a). mandible b). maxillary – because you can avoid inflamed spot by Inferior-alveolar block
When I&D procedures are performed extraorally, a more complex set of criteria must be
met when selecting a site for the incision. Once the area of incision has been selected, a
221
method of pain control must be used. Regional nerve block anesthesia is preferred when it
can be achieved by injecting in an area away from the site of the incision. Alternatively,
infiltration of local anesthetic solution into and around the area to be drained can be
performed. Once the local anesthetic needle has been used in an infected site, however, it
should not be reused in an uninfected area.
15.3.4).
22). Which salivary cancer has NEUROLOGICAL origin (around nerve)? Mucocarcinoma… or other names.
Don’t know, check in book
Adenoid cystic carcinoma and polymorphous low grade adenocarcinoma both have perineral invasion
The adenoid cystic carcinoma is one of the more common and best-recognized salivary
malignancies. Because of its distinctive histopathologic features, it was originally called a
cylindroma, and this term still is used sometimes as a synonym for this neoplasm.
However, use of the term cylindroma should be avoided because it does not convey the
malignant nature of the tumor, and also because this same term is used for a skin adnexal
tumor that has a markedly different clinical presentation and prognosis.
CLINICAL AND RADIOGRAPHIC FEATURES

The adenoid cystic carcinoma can occur in any salivary gland site, but approximately
50% to 60% develop within the minor salivary glands. The palate is the most common
site for minor gland tumors. The remaining tumors are found mostly in the parotid
and submandibular glands, with a fairly even distribution between these two sites.
On an individual basis, however, a striking difference can be seen among the various
glands. In the parotid gland, the adenoid cystic carcinoma is relatively rare, constituting
only 2% to 3% of all tumors. In the submandibular gland, this tumor accounts for 12% to
17% of all tumors and is the most common malignancy. It is also relatively common
among palatal salivary neoplasms; it represents 8% to 15% of all such tumors. The lesion
is most common in middle-aged adults and is rare in people younger than age 20.
There is a fairly equal sex distribution, although some studies have shown a slight female
predilection.
The adenoid cystic carcinoma usually appears as a slowly growing mass. Pain is a
common and important finding, occasionally occurring early in the course of the
disease before there is a noticeable swelling. Patients often complain of a constant,
low-grade, dull ache, which gradually increases in intensity. Facial nerve paralysis may
develop with parotid tumors. Palatal tumors can be smooth surfaced or ulcerated. Tumors
arising in the palate or maxillary sinus often show radiographic evidence of bone
destruction.
HISTOPATHOLOGIC FEATURES
222
The adenoid cystic carcinoma is composed of a mixture of myoepithelial cells and

ductal cells that can have a varied arrangement (Fig. 11-73). Three major patterns
Fig. 11-73 Adenoid cystic carcinoma. Islands of hyperchromatic cells forming
cribriform and tubular structures. Inset shows a high-power view of a small
cribriform island.
.
The cribriform pattern is the most classic and best-recognized appearance,
characterized by islands of basaloid epithelial cells that contain multiple cylindrical,
cystlike spaces resembling Swiss cheese. These spaces often contain a mildly basophilic
mucoid material, a hyalinized eosinophilic product, or a combined mucoid-hyalinized
appearance.
Fig. 11-75 Adenoid cystic carcinoma. Perineural
invasion.
223
adenocarcinoma, also may exhibit areas with a cribriform pattern.
In the tubular pattern, the tumor cells are similar but occur as multiple small ducts or
tubules within a hyalinized stroma. The tubular lumina can be lined by one to several
layers of cells, and sometimes both a layer of ductal cells and myoepithelial cells can be
discerned.
The solid variant consists of larger islands or sheets of tumor cells that demonstrate little
tendency toward duct or cyst formation. Unlike the cribriform and tubular patterns,
cellular pleomorphism and mitotic activity, as well as focal necrosis in the center of the
tumor islands, may be observed.
A highly characteristic feature of adenoid cystic carcinoma is its tendency to show

perineural invasion, which probably corresponds to the common clinical finding of pain
in these patients. Sometimes the cells appear to have a swirling arrangement around nerve
bundles. However, perineural invasion is not pathognomonic for adenoid cystic
carcinoma; it also may be seen in other salivary malignancies, especially polymorphous
low-grade adenocarcinomas.
062008. 11.13.14).
23). In Class2 which side of restoration more often has recurrent caries? Gingivo-
cervical in proximal box
24). In removable partial denture what is a name of part that connect “occlusal rest” with “major
connector”? Minor connector
224
25). You are doing LA Local Anesthesia to man, suddenly his b.p = 200/100. What is
a reason? a). stress b). epinephrine c). Lidocaine
26). In one city a scientist want to check all cases of oral cancer that ever happened
before. What kind of study does he perform? Longitudinal study
A longitudinal study involves the follow-up of the initial baseline respondents at a later
date. The longer the follow-up from baseline the more likely that respondents will be lost to
the study (through mobility away from the study area) and interpretation becomes more
difficult. An important check is to determine who is lost to the study on follow-up, and an
analysis is then conducted that shows whether the people lost to the study are different
from those who are successfully followed-up. The importance of attempting longitudinal
studies should not be underestimated as they do make possible firmer interpretations of
causality not possible with cross-sectional designs.
27). In that city 200 patients were sick out of 2000 in 2008 and 300 pt. are sick out of
2000 in 2009. What would be INDIDENCE? a). 100/2000 b). 200/2000 c). 300/2000
29). I have a patient that told you that she had a lot of BAD experience with all dentists in
the city before you – nobody satisfied her needs. And you are the best dentist in the
world, she will refer to you all of her friend and relatives… What is possible diagnosis for
that patient? a). pshycis…b) pshysiod d). borderline - borderline personality disorder is a condition
in which a person makes impulsive actions, and has an unstable mood and chaotic relationships. They
tend to see things in terms of extremes, either all good or all bad. They also typically view themselves as
victims of circumstance and take little responsibility for themselves or their problems.
30). Know on radiograph. MENTAL

PROTUBELANCE (genial tubricales) under lower
anteriors
225
The genial tubercles (arrow) appear as a radiopaque mass, in this case

without evidence of the lingual foramen.
(White, Stuart C.. Oral Radiology: Principles and Interpretation, 6th Edition. Mosby, 092008.).
31). How morphine work to do nausea? a). affect receptors in GI tract b). affect ememics centers c).
affect medulla centers
Morphine and related opioids also depress the cough reflex, at least in part by a direct
effect on a cough center in the medulla.
32). What BEVEL do for restoration? How does it work? a) . decrease Composite leakage b). strength –
Don’t remember exactly question, I now that amalgam doesn’t have bevel, composite – DOES NEED
bevel!
Beveling enamel margins in composite preparations is indicated primarily for larger

restorations that have increased retention needs. The use of a beveled marginal form
with a composite tooth preparation may be advocated because the potential for
retention is increased by increasing the surface area of enamel available for etch and
having a more effective area of etch obtained by etching the cut ends of the enamel
rods. Other advantages of beveling composites are as follows: (1) Adjacent, minor
defects can be included with a bevel, (2) esthetic quality may be enhanced by a
bevel creating an area of gradual increase in composite thickness from the margin
to the bulk of the restoration, and (3) the marginal seal may be enhanced.
Mosby, 042006. 6.7.2.4.3).
33). In what situation you shouldn’t place INLAY on 26 yrs old pt. ? a). when active caries/ frequent
b). when opposing teeth are enamel c). when opposing is bridge
34). Before denture construction you find that mandibular ridge contact maxillary tuberosity. You
need to do denture for that pt. What next treatment should be done? Surgical removal of maxillary
tuberosity to give space for dentures.
35). What muscle can be cut under mandibular complete denture because of it’s
close location? Buccinator
If mylohyoid is an answer choice I would go for it. The mylohyoid can be displaced during a
vestibloplasty to allow for a better seating of the lower denture. !!
36). What muscle affect lingual flange of impressions? Mylohyoid

226
37). Where is NOT recommended to do gingival graft – which site? a). pre-molar b). molar c). CANINE
area
Pain aggravated by cold and relieved by heat – reversible pulpitis, just information
Reversible pulpitis is usually asymptomatic. However, when present, symptoms usually

follow a particular pattern. Application of stimuli, such as cold or hot liquids, as well as
air, may produce sharp, transient pain. Removal of these stimuli, which do not normally
produce pain or discomfort, results in immediate relief. Cold and hot stimuli produce
different pain responses in normal pulp.44 When heat is applied to teeth with uninflamed
pulp, the initial response is delayed; the intensity of pain increases as the temperature
rises. In contrast, pain in response to cold in normal pulp is immediate; the intensity tends
to decrease if the cold stimulus is maintained. Based on these observations, pulpal
responses in both health and disease apparently result largely from changes in intrapulpal
pressures.
Company, 032008. 4.5.2.1).
38). Pain aggrevated by heat and releaved by cold ( irreversible pulpitis). What would be the
treatment for patient? a). RCT b). sedative filling c). temporal IRM d). composite
39). What is mechanism of Fluoride work? a). making fluoroappetite b). affect morphology
of eamel c). make surface softer
40). Which cells are more often could be seen in gingival fluids? Plasma, neutrophil
macrophage, mast cell… I don’t know
41). Know cells for Inflamation Acute-see lots of nuetruphil and Chronic-see lots of
plasma cells and names of bacteries for caries occlusial and smooth surface-strep
mutan, or on ROOT surface caries by actinomyces viscosus
42). How radiation affect human body, mostly by? a) Lysis of H2O b) direct affect on DNA c). on
mitosis…
Because water is the predominant molecule in biologic systems (about 70% by weight), it
frequently participates in the interactions between x-ray photons and biologic molecules. A
complex series of chemical changes occurs in water after exposure to ionizing radiation.
Collectively these reactions result in the radiolysis of water.
2.1.2).
43). Testing new fluoride rinses. Strange results Gingival Index is high in survey (good), but we see no
effect on regular patient’s health. How to characterize those data? a) bias b) bad
selectional/organizational experiment c) case controlled study
227
44). Which drug is least used in dentistry because of its longitudinal action? a)
diazepam b). lorazepam c). Nitrious Oxide
45). Most often cause of failure of amalgam restoration? a) condensation not strong enough b)
moisture contamination c) too long trituration
Normally, early failure of amalgams is uncommon, but when it does occur, it is related to
bulk fracture, improper preparation design factors, or postoperative sensitivity. C
Mosby, 042006. 4.3.1.6).
46). Cleidocranial dysplasia could be seen radiographically? Supernumerary teeth
47). Treatment for Alveolar Osteities (remember “dry socket”)? a). currett
socket b). dressing for calming medication c). dressing and antibiotic
48). What kind of resorption is Ankilosis? a). Replacement b). External c). internal
49). When you finishing RCT on #12 and part of file separated in canal. What to do
next? a). extract b). send to ER c). refer patient to Endodontist or if in apical
third, leave file, obturate, and follow up – this might be the other answer
choice
50). If dentist tell patient that he has to replace all of his Silver filling (amalgams) to
white composite, because it can poison him – what ethical principal would be
broken? a) Autonomy b) Veracity c) Non-maleficiency
51). Old patients has recession on teeth, leading to ROOT cervical caries. Best
treatment would be Resin modified Glass Ionomer (RMGI) because of ability of GI to
make bonds with Enamel and Dentin, Fluoride release and not big strength needed
Information: Composite make bond with Enamel only, but using adhesive help it
bond even to dentin (bond adhesive/dentine and adhesive/composite) Amalgam
DON’T make any bonds. Holds by strong compression and by retention form of
prep.
Reversible Pulpitis:
• exaggerated response to a stimulus (cold or hot)
• does not linger after the stimulus is removed.
• PDL space - WNL; EPT – positive; percussion – not unusual sensitivity.

Irreversible Pulpitis: (symptomatic or asymptomatic)
• symptomatic irreversible pulpitis

o spontaneous pain and/or an exaggerated lingering response to hot or
cold.
228
o difficult time localizing the origin of pain

o PDL space - may/may not be widened; EPT – positive; percussion –
may/may not be painful.
• irreversible pulpitis
o cold may alleviates the pain
o may be asymptomatic
o examples: internal resportion and hyperplastic pulpitis (pulp polyp)
Pulpal Necrosis
• partial necrosis may exhibit some of the signs and symptoms of irreversible
pulpitis.
• total pulpal necrosis are asymptomatic

Acute Periradicular Periodontitis
• extremely tender to occlusion or percussion
• periradicular area may be tender to palpation.

Acute Periradicular Abscess
• swelling and mild to severe pain.
• may exhibit fever, lymphadenopathy
• NO PARL may/may not see widened PDL space.
• Percussion positive & the palpation positive.

Chronic Periradicular Periodontitis
• Asymptomatic
• PARL
• Non vital tooth, percussion and palpation negative

Chronic Suppurative Periodontitis
• Asymptomatic
• PARL
• Sinus tract
229
• Non vital tooth, percussion and palpation negative

Phoenix Abscess
• acute exacerbation of a chronic periradicular periodontitis
• same signs and symptoms of an acute abscess except there is a PARL

Day2
Case 1
Long face, female, does not want to have those spaces between teeth – needs to close
them (she does not have Lateral Incisors) Good oral hygiene.
1). What treatment for flare out of Central Incisors? a). With removable dentures b).
Braces c). Face-gares
Case 2
AA man 46 yrs afraid of dentist, #3 and #6 crown decayed completely – lost.

1). Low blood pressure, low pulse - Syncope when have anesthesia
2). Fix #8,#9 esthetic edge/yellow stain. What treatment to #8, #9? (little bit cheeped off
enamel of #8) a). polished to smooth b). composite c). bleach
3). What treatment for #3, #6 space? a). bridge #2-6
4). Caries small/occlusal (brown spots on pits) on #31 can be seen on a). picture
clinically b). xray c). from chart
5). #12 has big caries lesion on mesial up to the bone level. What treatment needed?
a). crown lengthening b). post&core – next step because crown only can be on “sound
tooth structure” (ferrule rule = 1mm circular in prep increase strength in …10? Times -
check this)
Case 3
63 yrs old man… Picture teeth radiograph

1). #14 bone lost mesialy, overhang amalgam. Why? a). forget to put wedge
2). From #20 big amalgam restoration – you can see on xray pin goes out of tooth
distally. Patient complained that floss shred all the time between #20 and #19. What
should you do? a). explain patient current situation b). tell pt. that previous dentist
performance as bellow standard of dentistry c). extract tooth #20 d). try to cut pin with
hand piece
230
3). Can see well defined circular radiolucency under root tips of # 30, #31, #32.
Diagnosis? a). PA cyst b). OKC c). ameloblastoma
Case 4
53 yrs old Porcelain-fused-to-metal PFM bridge #8-10. On PAN can see 3rd molars are
impacted.
1). Why discoloration of bridge white color/translucency. Every explanation is possible
EXECPT? a). metal to thick b). not enough reduction in cervical third of #10 c). opack
layer is too much thick
2). On clinical picture you can see wear off mandibular incisors. What is a reason for
that? a). occlusional habite (bruxism) b). thin dentin/enamel 3). Opposing bridge
(reason for that in the next question, if it’s just opposite bridge why all canines are flat?)
3). Why is that shape of canine – no cusp, flat occlusialy? a). bruxism
4). Should we do 3rd molar extraction for the reason that #1 is close to sinus or #32 is
close to mandibular canal? NO (53yrs, 3rd molars are not bothering him)
5). 3rd molars are #1 disto-bucal and #32 is horizontal angulation of impaction. Plus
partial bone coverage. (check in book impaction angulations) TRUE
6). What would be the reason to extract #1? a). to place implant, if #2 in future
would be lost and pt. need a bridge.
7). If you do pulpal thermal test on his posterior teeth you may have Negative/False
result. Why? a). Age b). pulpal obliteration/ calcification see xray
Case 5
On clinical picture you can see adult complete dentition (no missing teeth) in position
central incisors touching edge-to-edge. On back, posterior teeth disarticulated.
1). Why discolored pre-molar? Amalgam stain
2). What movement of condyle in TMJ must be for that position? a). rotation b).
translation c). both - for protrusive you do both
3). What clinical picture is demonstrating? a). free way space [the space between the
max and mand occl surfaces when at physiological rest] b). maximum intercuspation c).
central occlusion d).incisor guidance (I don’t know the answer – I put “a” but may be “b”
or “d” also, check it)
231
4). On xray radiograph you may see circular radiolucency on middle root (close to apex)
on #9. Asymptomatic, no pain. Diagnosis? a). lateral periodonal cyst b). radicular cyst
c). medial palatine cyst
5). What is the main test needed to be done for diagnosis? a). Thermal vitality test b).
EPT c). percussion
Case 6
68 yrs female came for your appointment with old dentures (both max/mand), that didn’t
fit her anymore. She had history of using Fosamax medication (biphosphonate drug to
protect bones). She is after cancer surgery, radiation, chemo therapy… On xray all
teeth are missing except#6,7,8,9,10 and 25,26,27
1). What is possible diagnosis for her psychotic condition? Depression
2). If she is after breast cancer chem./radiation + biphosfonate drug Fosamax, what
treatment for her you CAN do if needed? a). extraction b). root canal c). alveolar
plasty/surgery d). implants (you can’t touch bone – risk of osteonecrosis)
3). After Fosamax was stoped for 1 week can you do extraction? NO, Fasle
4). What treatment is good for her? Root planning + cleaning, prophy
Case 7
Kid 5 yrs. 9 month fall 3 month ago. Tooth #F fall down. You can see on clinical picture
new erupting tooth is appeared. She has a FISTULAR, bump above #E.
1). Tooth #E has luxation. What treatment? Extraction
2). Does age of patient is identical for dental age? Yes, pt.’s age = dental age
3). What would be a treatment? Sealant on all permanent 1st molars
Prophylaxis, fluoride
4). What would be a treatment for posterior crossbite? Bilateral expansion
5). On biteweens you can see small insipient proximal caries on mesial of #19 (between
#K and #19) What is a treatment? a). composite b). don’t do anything c). disk between
teeth
Case 8
232
Mexican female. Has deafness because of accident. Parents help her in transportation
and financially. She complain in TMJ pain
1). What would be the easiest to improve? a). OHI oral hygiene b). financial limitation
c). deafness because of accident d). pain from TMJ
2). On Xray radiograph you can see #21 is good, normal angulation, no carries, #19
distaly tipped, a big carries lesion, # 14 is supererrupting. What treatment would you
recommend? a). build up #19 carries b). build up #21
3). What is next treatment after that? Build up with post and core in only ONE root
canal True or False (I don’t know, check)
3). What is LEAST possible when you are upringting #19? a). roots of #19 move
facialy b). encorrage of anterior teeth or #21
4). When you are upringting #19 what if possible to happend? Occlusial interfearance
5). What is LEAST possible treatment for supererrupting #14? a). Intrusion b). crown
c). RCT d). caries txn
6). If you do EXTRUSION of tooth #13? crown-to-root ratio increase and prognosis
decrease
Case 9
A little girl with CLEFT on clinical picture of Maxillary you can see all teeth lined up
normally in ONE line, except #6 & #7, also #10 & #11 are parallel to each other (one
behind other).
1). What is reason for strange position of laterals #7 and #10? CLEFT
2). On Cephalometric picture what is LEAST possible diagnosis? a) maxillary
prognatism b). class1 c).class2 div 2 d). class3
3). What arrow point on xray? HYOID
Case 10
Man 46 yrs also with CLEFT palate, fixed when he was a kid, by surgery. On clinical
picture he has Angular Chelulitis on corner of his mouth. He’s complaining that his
dentures are moving and discomfort him and lesion in corner bother him.
1). What is treatment for Angular Chelulitis? Clotrimasol cream 2%
2). On PAN two opacity left/right under his mandible? HYOID
233
3). He is missing #7 and #10 and bone here (because of cleft) look like resorbed up
to10 mm. What would you recommend treatment? a). extract #8, #9 and do bridge #6-
11 b). saving #8, #9 (not extraction) to preserve a bone/alveolar ridge (not sure – I
choose ”b”)
4). Implants for #7 and
What makes titanium crown biocompatible? sintering b4 milling, sintering b4 casting. titanium
makes some kind of oxide layer...these are 3 of the choices from that
For dental implants, biocompatibility depends on mechanical and corrosion/degradation

properties of the material, tissue, and host factors. Ti is very resistant to tarnish and corrosion.
The corrosion protection is derived from a thin (10 nm) passivating oxide film that
forms spontaneously. However, because the oxidation rate of titanium increases markedly
above 900° C, it is desirable to use ultralow-fusing porcelains (sintering temperature less
than 850° C) for titanium-ceramic prostheses. A porcelain sintering temperature below
800° C is desirable to minimize oxidation and to avoid the conversion of alpha phase to the
higher-temperature beta phase discussed in the following.
Titanium has the highest melting temperature of all metals used for metal-ceramic
prostheses and is highly resistant to sag deformation of metal frameworks at porcelain
sintering temperatures. This high melting point is accompanied by a relatively low thermal
expansion coefficient, and special low-expansion dental porcelains are necessary for
bonding to titanium.
Company, 072003. 22.5.8).
Teeth clicking when talking caused by what two phenomena: too much VDO and teeth set
unfavorably over ridge
Most bacteriostatic antibiotics MOA is: protein inhibition
which is the indirect acting sympathomimmetic? Tyramine, ephedrine, amphetamine (mixed)
By using a compatible color when tinting porcelain you accomplish what? Decrease value
What comprises a combination clasp? The combination clasp uses a wrought wire retentive
arm. A wrought wire is preferred for retention when the undercut occurs in the mesial third of the
buccal surface of an abutment tooth. The terminal third of the clasp arm lies gingival to the
height of contour while the proximal two-third lies on the height of contour.
Which crown is the weakest? (pg 190 #49 of dental secrets) Empress is aluminius porcelain
and strongest, Euphlite, and Zirconia
Dowel question…why would u use in an endodontically treated tooth?

234
A dowel is placed to provide the retention for a crown that ordinarily would have been
gained from coronal tooth structure. 61,62 The use of a dowel requires that the canal be
obturated with guttapercha.

(IL), 011997. 13.5.1).
Tooth whitening…just whitened tooth, how long should u wait before u do a bonded restoration?
24hr?3day?1 week? (should wait three or more weeks according to Dental secrets however this
wasn’t a choice)
Perio pocket and abssess around the tooth? Endo first then perio
What is the advantage of metal framework over plastic? Except type question
Bleeding time is measure of? Platelet function
Platelet inadequacy usually causes easy bruising and is evaluated by a bleeding time and
platelet count
1.3.6.1).
Clopidogrel bisulfate (Plavix)?Sum with aspirin and helping with blood clotting and prevent
thrombosis
an inhibitor of platelet aggregation used as an antithrombotic for the prevention of

myocardial infarction, stroke, and vascular death in patients with atherosclerosis;
administered orally.
(Dorland, Newman W.. Dorland's Illustrated Medical Dictionary, 31st Edition. Saunders Book
Company, 052007.).
Two questions about dual cure composite?
Patient has low occlusal plane what problem will they have? Pain over ridge…
Patient has untreated chemical burn at corner of mouth that has healed, What are
ramifications? Linugal dentition, labial displacement….
Fixed partial bridge has failed numerous times? Poor design of metal backing
Pan of radiolucency at inf border of man below inf canal that didn’t break cortical plate? Stafne
bone wasn’t there…maybe a submandibular gland space
Pt taking drug for depression, anxiety, OCD, and something? All choices were benzos (maybe
Alprazolam (xanax), Lorazepam (ativan)) the key to answering this is to find the drug that treats OCD(its
somewhere in the notes I took)
235
Of these medications, clonazepam (Rivotril ) may specifically affect serotonin balance and is a good choice for people
with OCD. Other alternatives that are commonly prescribed include lorazepam (Ativan), alprazolam (Xanax), diazepam
(Valium), oxazepam (Serax) and temazepam (Restoril).
Pt taking alkalyting agent for cancer(starts with M)? what are side effects of this type of drug?
Think myelosuppresion (mucositis (inflammation of the lining of the digestive tract) and alopecia
(hair loss))? methotextrate
What to drugs are used to treat angina? Nitroglycerine, beta blockers
Glass ionomer? aluminosilicate glass with polyacrylic acid. Releases fluoride
Direct pulp cap and place CaOH(look up double base)…cover with ZOE
Schedule 2 drugs? Things with oxycodone
What presents with congenitally missing teeth? Ectodermal dysplasia but garders there too
Diabtetic patient for routine dental visit getting IV sedation? Don’t
Why does 3rd degree hurt less than second? Nerves are destroyed in 3rd degree burns therefore
no pain sensation
Pt has bad hygiene need ortho do u treat with a fixed or removable appliance?
Chi square and when to do? Mosby pg 214
What patient isn’t on bisphonphanates? Patient with prostate cancer
Purpose of the maintenace phase?
Sequnce of perio? Revaluation after phase one
Pt who had condesing osteitis…perfect description? PM radiopacity next to a tooth that has little
or no wear
Fentanyl delivered by transdermal patch
B/t two dental implants how much space? 3mm
Pt presents with odontogenic infection? When do u refer? Have temp of 100 OR couldn’t open
more 10mm
Increae Kvp does what? Long scale contrast differences between structures is small and
contrast goes down.
When using a high speed which bur gives the smoothest finish? Straight fissue, diamond,
crosscut bur…
Pts presents with a nodule on the lip and explains that they bit their lip? Traumatic fibroma,
236
Vertical defect with facial, lingual, mesial wall gone? 3 wall defect so infrabony
Ulcer on the lip, what should you do? Biopsy, cytology smear, antibiotics
What neoplasm has early presentation of widened pdl space? Ewings…??? Osetosarcoma
Mosby pg 122
Pt with RL(radioluecency) around impacted K9, most likely? AOT
Compund odontoma picture
Periapical cemento osseous dysplasis? Individual RL around the apices of vital lower incisors
What turns porcelain green? Silver
Majority of dentisty is paid how? Outta pocket
14 y.o girl presents with bleeding on probing? Gingivitis
Pt exhibiting stridor, what is causing this? Caused by laryngospasm inspiratory wheezing, tx

succynlcholine
Referred pain to ear? Mandibular molars
Occurance of cleft palate? 1/700 births
Facial profile of a pt with Down Syndrome? Class 3
Causes down syndrome? Multifactorial
Perio disease not helped by adjunctive antibiotics? Chronic Periodontitis
Niti vs stainless steel(this is an except ?) know characteristics
14 y/o with a class 2 on 2nd molar how do u treat? SSC, crown and amalgam buildup
When placing an implant you shouldn’t heat the bone above what temp? 40 degrees was not a
choice 36 degrees was the closest
When performing an osteotomy on the ramus of the mandible parathesia of the lip results?
What kind of osteotomy was performed: saggital split osteotomy
Distance b/t implant and nutrient vessels? 2mm
Which space is most important to maintain? 1st molar, 2nd molar, K9, and
Im sorry you had a bad experience, your dentures really created? 1st Sympathetic and 2nd
empathic
Best test to use on a pt taking warfarin, when trying to determine bleeding tendency? INR
237
Most congenitally missing tooth? Man 2nd PM
Most impacted? Max K9
At what point can u tell the shape of tooth? Morphodiffertiation maybe
Osteogenis imperfecta is seen with? Dentogenisis imperfecta type I
Dens in dente picture
Patient having a myocardial infarction what do you do? Start BLS
Palatal gingival groove create perio? Max lateral Incisior
Pt with symptomatic cracked tooth and no pulpal involvement, how should ou treat? Bonded
restoration, extracoronal, take cusp out of occlusion… Mosby pg 9
Sinusitis of non odontogenic origin what antibiotic should you prescribe? Amox w clav,
erythromycin, tetracyclin, metronitazole
Operculum on tooth #18, how should you treat? Tissue out of occlusion, ext, adjust #15, scale
under operculum
MC
A tooth with a class 3 furcation involvement within 5mm of the apex, how do u treat?
Hemisection, bicuspidization, ext
6 y/o with unilateral macroglossia with pinkish gray fluctant nodule? Lympangioma,
nuerofibromatis, sterge weber
Pt wth advanced periodontitis and suspected Papillon-Lef’evre, will also present with? Palmar
plantar keratanosis
Pemphigoid question? Seperation from basement membrane
When do you use a base metal over a noble metal? Long span fpd is base, crown, is noble
A non carious tooth with short clinical crown is to be used as an abutment, what typae of
coverage is best? ¾ crown, full coverage crown, inlay/onlay…
This lesion more often than not is a severe dysplasia or carcinoma in situ? Erythoplakia, white
sponge nevus, lichen planus, leukoplakia
Lesion on lateral border of tongue white with red? Maybe geographic tongue
Altered eruption with gingival margin coronal to CEJ and normal bone, how do you improve
esthetics? Apically repositied, mod wid, replaced, think apically positioned
238
Increasing the lingual attached gingiva around man premolars and molars is inhibited by?
Myohyloid ridge, sum, anatomical
Pt with bifid ribs and basal cell carcinomas will also present with? multiple OKCs
Swelling of midline of ant palate and radilucency? Nasopalaline(incisive canal)
Most common cause of cardiac failure in infants? Respiratory
What determines placement posterior palatal seal? Vibrating line
Why don’t you set teeth on retromolar pad? Cause denture to dislodge
Primary reason for occlusal adjustment? Center forces down long axis of tooth, to achieve
bilateral balanced occlusion
Polymethly methacrylate, what is the initiator? Benzoyl peroxide
Making “F” sound teeth should contact? Lower lip
Teeth on set directly over maxillary ridge with marked ridge resorption? Teeth too far lingually
resorp up and backwards
Pt smile and denture fall out? Overextended flanges
No calculation
No L.A.
Just placed class 4 composite 3 days ago and good besides color is off? Compostie tint,
remove outer layer of composite and veneer…
45 y/o pt with a sound crown but its lighter than surrounding teeth WWYD? bleach, 2 stain
choices
Fluoride that’s not in toothpaste? APF and SnF are not found in toothpaste
School based fl program, how is fluoride given to them? (Know grams, concentration, and
frequent) .05% daily swallowed ,02% weekly expectorate…
LED curing light vs another aren’t able to cure all resins because they can only cure within
spectrum? 1st second true false joint
What is IgG? Recruit IgE(mast cells)
Pregnant patient, lay with right side up
Pregnant suppressing IVC
Don’t take gingko with aspirin because they hav same effect
239
St. Johns wart…all herbal supps cause excess bleeding dnt give with aspirin
Slurred speech in dental chair? stroke
Autonomy, respecting patients autonomy is respecting their decision to make informed decision
Inverse square law? Moved from 12 to 4 feet is 9X
What type of caries is represented by broad area and comes to point at DEJ? Smooth surface
Most common salivary gland tumor? Pleomorphic adenoma
Couple slob rule question, move xray beem to lingual what, moves where?
Inferior Alveolar Canal is buccal to the root of the mandibular molar, move xray cone inferiorly.
What moves with you? The canal…same buccal opposite lingual The object closest to the film
will move the least with the object closes to the radiation source will move the furtherst
Seated the crown and two to three days comes back with inflammation where it was cemented?
Allergic to cement, left cement around margin
Whats the most logical way to make a crown fit? Die spacer
Facial of tooth is divided vertically into? 5ths
Aids pt with candiasis what do you give? Nystantin
Aids pt w oralpharngeal candidiasis what do you give? Fluconozale
19yrs denture but presents with white lesion at denture border? Take margin down and call in
2weeks
Even under 100% humidity Irreversible hydrocollid undergoes? Synersis
Pt bisphosphanates and need extraction due to irrestorble teeth and EXT what do u do? Take
them off bisphos for 3 months…
Cortocsteriods used for what length of time cause immunosuppresion? 200mg/2weeks, 2

years, 20mg 2 weeks, 2 years…
Lack of C1esterase…what does it indicate?angioedema
Insurance bill insurance for post core and crown? Bundled
What is waiting period as pertains to dental insurance? Time btw when pt signs up and when
benefits kick in
Pt has distocclusion with upright max centrals with Low mandibular angle? Class 2 div 2 maybe
upright central
240
Making immediate denture, pt has anterior and tuborosity undercuts, what would do?
reduce tuberoity undercuts only
Main reason for rct failure? Coronal leakage
Opiods act on what receptors? Mu receptors
What does chemo cause? Thrombocytopenia
Inverted Y on the xray
HMO is a capitation plan
Govt based dental funds are distributed based on what? Need, cost, demand,
Arch perimeter is measured from what to what?
The arch length, also known as arch perimeter, is determined by measuring from the
mesial surface of one molar to the mesial surface of the contralateral molar along the
arch form presented by the teeth
(Riolo, Michael. Essentials for Orthodontic Practice, 2nd Edition. Essential Press 6.4.1).
You perforate a maxillary molar while looking for canal and what is best way to treat? Repair
immediately, CaOH
Gingival collar around natural tooth and soft tissue of implant have in common what?
The stimulation of Ondotoblastic neurons are moved by mechnical irritation
How do sulfaureas work? Increase insulin release from pancreas
Xerostomia can cause? Infection of salivary gland
Pt with sjogrens is likely to develop? lymphoma
Pt with 3mm pockets, you would do all except? NO SRP
Attrition on tooth is most likely caused by? Opposing tooth
When doing a gingivectomy the internal bevel should be placed?3mm coronal to MGJ 1-2 mm
from gingival margins
An implant is placed but when you attempt to loaded it, it’s loose what does this mean? FAIL
ANUG questions…signs and symptoms
Picture 14 y/o right man expansion and RCT on #30, key is what causes bone expansion and
tooth extruded? Osteosarcoma, fibrous dysplasia
Pt on tertracycline…what is not the outcome? Related to having decreased bacteria in sulcus

241
Pt has perio abscess and chronic perio? SRP
How does mouth breather present? steep mandibular angle
Pt w midface insufficiency? Down syndrome
Which is least acceptable for final impressions for crown? Irreversible hydrocolloid
Pyrophosphate in toothpaste is used for? Anti calculus or plaque
Peiodontitis of pregnancy and puberty is caused by? Plaque(prevotella gingival use hormones)
Freeze dried bone from bovine
What angulation do you hold currette for SRP? 45-90
Scenario where had to do full thickness vs partial thickness flap?
Implant fails, most likely due to what? Smoking
Pt smokes see all of the following except? Bleeding on probing
Sialadentitis of wharthins duct presents with constrictions that resemble a sausage, what
disease is this…uhhh
Health Science, 122002. 25.2.2.2).
Sialodochitis is a dilation of the salivary duct secondary to epithelial atrophy as a result

of repeated inflammatory or infectious processes, with irregular narrowing caused by
reparative fibrosis (i.e., "sausage link" pattern). Sialadenitis represents inflammation
mainly involving the acinoparenchyma of the gland. Patients with sialadenitis experience
sacculardilation of the acini of the gland secondary to acinar atrophy and infection, which
results in "pruning" of the normal arborization of the small ductal system of the gland.
Centrally located lesions or tumors that occupy a part of the gland or impinge on its
surface displace the normal ductal anatomy.
242
Health Science, 122002. 25.2.2.2).
What does OSHA require testing for every year? TB
What is least important when selecting teeth to be used for overdenture? Pg 199 DS…imp is
amount supportive bone,number exist roots,type and amount occlusal force,type
attachment,spint or nonspint roots
What is seen in sympysis synchondrosis of the mandible?
Which is the least appropriate way to store avulsed tooth? Water, hanks, milk, saliva
What is the storage media for avulsed tooth? Hanks but not called hanks (Viaspan)
A pt taking digitalis for CHF the question has something to do with fluid elimination? Digi
increase pumping, diuretics get flow out
Acromegaly class of occlusion? Class 3
Head lighting is opaque layer showing through crown caused by? Improper tooth prep
headlight" show-through of the underlying tooth color or opaque-bonding resin.
(Rufenacht, Claude R.. Fundamentals of Esthetics. Quintessence Publishing (IL), 011990.

12.7.4).
The auriculotemporal nerve is located near the ear and the top of the jaw on both sides. Common
headaches with problems to this nerve are temple headaches. This nerve is commonly damaged in TMJ
surgery. it is usually pounding because it is near the temporal artery.

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1

4. Child has pain? Osteomyletis, chronic osteitis

9. Hemisection: cut molar into 2, premolar

The primary objective of soft tissue maxillary tuberosity reduction is to provide

The practical consequence is that curing depth is limited to 2 to 3 mm unless excessively

(Summitt, James B.. Fundamentals of Operative Dentistry: A Contemporary Approach, 3rd

14. Test for boy/girl-chi square

Non-odontogenic tumo. r toothache can often be differentiated from odontogenic

???Odontogenic tumor relieved by _______________=osteoma

17. What turns porcelain green? Copper or silver

18. Referred pain

Recommended minimum distances (in millimeters) between implants and

21. Remove rampant caries from anterior

27. Which do you gain back? Tooth mobility, bone, etc,

Neurapraxia, the least severe form of peripheral nerve injury, is a contusion of a

Three types of peripheral nerve injury. A, Neurapraxia. Injury to nerve causes

31. Band and loop for 1st primary molar

Aspirin compounds and non-steroidal antiinflammatory agents are contraindicated because

Periapical cemento-osseous dysplasia

1. A reactive process of unknown cause that requires no treatment.

a. Commonly seen at the apices of one or more mandibular anterior teeth.

b. No symptoms; teeth vital.

c. Most frequently seen in middle-aged women.

d. Starts as circumscribed lucency, which gradually becomes opaque.

Hepatitis B virus (HBV)

(3) Diagnosis: HBV is diagnosed based on a physical examination, medical history,

(4) Prevention: a vaccine to immunize recipients against HBV is available. Three

35. Freeze dried bone: allograft

FDBA= osteo-conductive- potential of graft material to serve as a scaffold that favors

DFDBA= osteoinductive-the ability of the graft to contain molecules that convert

36. OKC-most likely to reoccur

The odontogenic keratocyst (OKC) is an important entity to differentiate from other

Nevoid basal cell carcinoma syndrome (Gorlin syndrome) is an autosomal dominant

38. #8 Reduce @ gingival-need crown lengthening

Surgical crown-lengthening procedures are performed to provide retention form to allow

and to adjust gingival levels for esthetics.32,43 It is important that crown-lengthening

40. H2 histamine-gastric reflux

The squamous papilloma is a soft, painless, usually pedunculated, exophytic nodule

When a diagnosis of irreversible pulpitis, pulp necrosis, or acute or chronic apical

Apexification is traditionally performed using a calcium hydroxide dressing that disinfects

Root-end resection (periradicular surgery or apicoectomy)

44. Apicoectomy-when do you do it-ant get to apex

a. Persistent or enlarging periradicular pathosis following nonsurgical endodontic

b. Nonsurgical endodontics is unfeasible when:

(1) A marked overextension of obturating materials is interfering with

(2) Biopsy is necessary.

(3) Access for root-end preparation and root-end filling is necessary.

45. Calcified canal what do you do-refer

48. Principle of tell show do:

58. Periostat and doxycycline. What does it do:

Subantimicrobial tetracycline (Periostat) is useful in treating moderate to severe chronic

59. Bevel for occlusal on a crown? structural integrity

61. Increase mucus from obstruction

a. Transmission: caused by a genetic mutation (nucleotide deletion) on chromosome

b. The most common hereditary disease in Caucasians.

c. Genetic transmission: autosomal recessive.

f. Diagnostic test: sweat test—sweat contains increased amounts of chloride.

saliva lubricates the oral tissues and increases denture comfort.

63. Emergency phase, perio, reeval, fixed, maintenance