DECKS Flashcards
Which of the following is a clinical diagnosis based on subjective and objective findings indicating that the vital inflamed pulp is incapable of healing and has the following additional descriptors: lingering thermal pain, spontaneous pain, and referred pain?
a. Reversible pulpitis
b. Asymptomatic irreversible pulpitis
c. Symptomatic irreversible pulpits
d. None of the above
c. Symptomatic irreversible pulpits
Which of the following is an inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues?
a. Symptomatic apical periodontitis
b. Acute apical abscess
c. Chronic apical abscess
d. Asymptomatic apical periodontitis
b. Acute apical abscess
Which of the following are related to vital teeth and usually do not warrant endodontic therapy?
Select 2.
a. Apical scar
b. Cementoma
c. Traumatic bone cyst
d. Radicular cyst
b. Cementoma: tooth is vital
c. Traumatic bone cyst: tooth is vital
The most superior of all other retrofilling material, mineral trioxide aggregate (MTA) has all of the following advantages, EXCEPT two. Which TWO are not properties of MTA?
a. Radiopaque
d. Easy to manipulate
c. Hydrophilic
e. Biocompatible
f. Not toxic
g. Short setting time
h. Induction of hard tissue formation
d. Easy to manipulate❌
g. Short setting time❌
The earliest and most common symptom associated with an inflamed pulp is:
a. A dull throbbing pain on mastication
b. Sensitivity to hot and/or cold stimuli
c. A persistent feeling of discomfort
d. Mild bleeding
e. Pain on percussion
b. Sensitivity to hot and/or cold stimuli
NOTES:
Thermal sensitivity is the earliest and most common symptom of an inflamed pulp.
A phoenix abscess is also known as a:
a. Recrudescent abscess
b. Granuloma
c. Cyst
d. None of the above
a. Recrudescent abscess
The chonic apical abscess is an inflammatory reaction to pulpal infection and necrosis characterized by gradual onset, little or no discomfort, and the intermittent discharge of pus through an associated sinus tract.
The acute apical abscess is an inflammatory reaction to pulpal infection and necrosis characterized by rapid onset, spontaneous pain, tenderness of the tooth to pressure, pus formation and swelling of associated tissues.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement s false, the second is true
a. Both statements are true
A patient is diagnosed with symptomatic apical periodontitis and refuses treatment due to fear of needles. Your statement to the patient should include the fact that:
a. Eventually, the acute nature of the lesion will progress into a chronic and nonpainful lesion
b. This lesion can progress into the bone causing osteomyelitis, a more severe condition
c. The apical lesion has been there for years and the tooth needs treatment immediately
d. None of the above
b. This lesion can progress into the bone causing osteomyelitis, a more severe condition.
NOTES:
Osteomyelitis is not a particularly common disease. It is a serious sequela of periapical infection that often results in a diffuse spread of infection throughout the medullary spaces, with subsequent necrosis of a variable amount of bone.
An acute apical abscess will not respond to pulp vitality tests.
An acute apical abscess is only observed in association with a necrotic pulp.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true
a. Both statements are true
NOTES:
The first symptom of acute apical abscess may be a slight tenderness of the tooth to pressure.
Condensing Osteitis is a diffuse radiopaque lesion representing a localized bony reaction ot a low-grade inflammatory stimulus, usualy seen at apex of tooth.
Osteomyeltis is a moderate to high level inflammation of bone marrow and adjacent bone that may remain localized or spread to involve the cortex, cancellous tissue, and periosteum.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement si false, the second is true
a. Both statements are true
A 7-year-old boy arrives at the office with a complaint that tooth #8 is draining pus into his mouth. The tooth had been traumatized earlier. The vitality tests reveal no response. What is the treatment of choice? Select 2.
a. Extraction
b. Apexogenesis / pulpotomy
c. Pulpectomy
d. Periodontal surgery to remove sinus tract
e. It is only necessary to give the child analgesics and antibiotics for pain and infection
f. Apexification
c. Pulpectomy
f. Apexification
All of the following statements regarding adjuncts to endodontic treatment are true EXCEPT one. Which one is the EXCEPTION?
a. Transplanted teeth with partial root development have a better prognosis than do those with developed roots
b. Orthodontic extrusion is commonly indicated prior to implant placement
c. Intentional replantation is a viable alternative to endodontic surgery
d. A major disadvantage of endodontic implants is the lack of an apical seal
c. Intentional replantation is a viable alternative to endodontic surgery❌
Intentional replantation is NOT viable alternative to endodontic surgery
Which of the following is the most characteristic radiographic evidence of a vertical root fracture?
a. A persistent periodontal defect
b. A radiolucent halo surrounding the root of the fracture
c. A radiopaque lesion at the sight of the fracture
d. A visible fracture when transillumination is used
b. A radiolucent halo surrounding the root of the fracture
NOTES:
Vertical root fracture: teardrop- shaped, J-shaped, or halolike radiolucency.
A patient complains of a slight tooth ache that has been “on and off” for a week. The tooth in question #18. Which of the following teeth would be optimum to use as a baseline?
a. #19 virgin, #31 occlusal sealant
b. #15 primary cavitation on occlusal and #19 virgin
c. #3 FGC and #31 virgin
d. #30 occlusal amalgam and #31 virgin
a. #19 virgin, #31 occlusal sealant
The main concept of the cone shift technique is that as the vertical or horizontal angulations of the x-ray tube head changes, the object buccal or closest to the tube head moves to the ___ side of the radiograph when compared to the lingual object.
a. same
b. opposite
b. opposite
NOTE:
SLOB RULE
Same Lingual, Opposite Buccal
Your practice is involved with a local minor hockey team, the Millwrights. A player gets hit with a stick, and his central incisors are intruded. Which of the following is the least useful examination procedure?
a. Soft tissue exam
b. Hard tissue exam
c. Radiograph
d. Vitality test
e. Percussion test
d. Vitality test
____ require endodontic treatment more often than any other tooth, while ____ have the highest endodontic failure rate.
a. Mandibular first molars, maxillary first molars
b. Mandibular first molars, maxillary second molars c. Maxillary second molars, mandibular first molars
d. Maxillary first molars, mandibular first molars
a. Mandibular first molars, maxillary first molars
All of the following are correct associations EXCEPT one. Which one is the EXCEPTION?
a. Maxillary incisors most often refer pain to the forehead region
b. Maxillary second premolars most often refer pain to the temporal region
c. Maxillary molars most often refer pain to the ear
d. Mandibular molars most often refer pain to posterior region of the neck
c. Maxillary molars most often refer pain to the ear❌
Maxillary molars most often refer pain to the zygomatic, parietal and occipital regions of the head.
NOTES:
Max CI, LI: Forehead region
Max C, PM1: Nasolabial area
Max PM2: Temporal region
Max M: Zygomatic, parietal, and occipital regions of head
Mand M: Ear, angle of jaw, or posterior regions of neck
Mandibular CI, LI, C, PM: Mental region of mandible
Max and Mand M: Opposing quadrant or to other teeth in the same quadrant
Which of the following teeth is most likely to have two canals, in fact, it has two canals most of the time?
a. Tooth #4
b. Tooth #12
c. Tooth #20
d. Tooth #28
b. Tooth #12 - maxillary first premolars almost always have two canals
One year after performing endodontic treatment on tooth #3, you take a new periapical radiograph and notice that there is still a lesion present. What is the most likely problem?
a. You failed to locate a second mesiobuccal canal
b. You failed to locate asecond distobuccal canal
c. You failed to locate a second palatal canal
d. Nothing, it takes more than 12 months for the bone to heal
a. You failed to locate a second mesiobuccal canal
The following teeth have pulp chambers that can be characterized as oval or ovoid EXCEPT.
a. Maxillary central incisor
b. Mandibular central incisor
c. Maxillary lateral incisor
d. Mandibular lateral incisor
b. Mandibular central incisor
NOTES:
MAX➖MAND
CI: Δ ➖ ⬭
LI: Δ /⬭➖ ⬭
C: ⬭➖ ⬭
PM: ⬭➖ ⬭
M: Δ / Rhomboid➖Trapezoid
The pulp chamber shape will dictate the shape of the access preparation.
Approximately what percentage of mandibular first premolars may have two canals with two apical foramina?
a. 5%
b. 20%
c. 45%
d. 65%
b. 20%
A mandibular canine typically requires a triangular access preparation.
The access should be directed slightly toward the lingual surface due to slight labial axial inclination of the crown.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true.
d. The first statement is false, the second is true.
A mandibular canine typically requires a triangular access preparation.❌
A mandibular canine typically requires a LARGE OVAL access preparation.
Which of the following teeth is most likely to have a curved root?
a. Maxillary central incisor
b. Maxillary lateral incisor
c. Maxillary canine
d. Mandibular central incisor
b. Maxillary lateral incisor
While doing a vital pulpotomy on a young, immature permanent tooth, the hemorrhage after pulp amputation could not be controlled with cotton pellets, even after several minutes. What is the next step in completing this treatment?
a. Control the hemorrhage with hemostatic agents
b. Apply formocresol with cotton pellets at the amputation site
c. Irrigate the canal with sodium hypochlorite then apply calcium hydroxide
d. Perform the amputation at a more apical level
e. Stop the procedure and close the tooth with an interim restoration
f. All of the above
d. Perform the amputation at a more apical level
Which of the folowing situations offer better success for pulp capping? Select 2
a. Accidental exposure of the pulp
b. Pulp of a middle-aged person
c. Carious exposure of the pulp
d. Pulp of a young child
a. Accidental exposure of the pulp
d. Pulp of a young child
In which of the following scenarios would you consider using solvent-softened custom cones?
a. Lack of an apical stop
b. An abnormally large apical portion of the canal
c. An irregular apical portion of the canal
d. After an apexification procedure
e. All of the above
e. All of the above
During the master cone fitting procedure in the endodontic treatment of a patient’s tooth, the patient says he has a “sharp shooting pain in the same tooth that ached earlier.” What should be your response and why?
a. Continue with obturation, the anesthetic is simply wearing off
b. Continue with obturation, this is a normal complaint during this part of hte procedure
c. Consider looking for an accessory canal and refilling, there is likely pulpal tissue that has not been properly debrided
d. Irrigate further, the sodium hypochlorite should take care of this problem
e. Temporize the tooth and obturate at a later date
c. Consider looking for an accessory canal and refilling, there is likely pulpal tissue that has not been properly debrided
All of the following are suggested as irrigants during root canal therapy EXCEPT one. Which one is the EXCEPTION?
a. Urea peroxide (Gly-Oxide)
b. Hydrogen peroxide
c. Sodium hypochlorite
d. Calcium hydroxide
d. Calcium hydroxide❌
NOTES:
Urea peroxide (Gly-Oxide)- better tolerated by periapical tissue than NaOCl, yet has greater solvent action and is more germicidal than hydrogen peroxide.
Hydrogen peroxide (3% soln) - effervescent effect (bubbles)
Sodium hypchlorite- most widely used irrigant germicidal solvent action, but is dilute enough to cause only mild irritation when contacting periapical tissue, good tissue solvent, has antimicrobial effect and acts as a lubricant for root canal instrumentation.
Calcium hydroxide: NOT an irrigant
You are retreating a previously root canal treated tooth. you might possibly use all of the following EXCEPT
a. Rotary files
b. Chloroform
c. Glass bead sterilizer
d. Ultrasonic
e. Heated instruments
c. Glass bead sterilizer❌
Which of the following statements regarding ethylene diamine tetra-acetic acid (EDTA) are true? Select 4.
a. It is a chelating agent with the capability to remove the mineralized portion of the smear layer
b. It decalcify up to a 50 mm thin layer of the root canal wall
c. It is also an excellent irrigation solution
d. Normally used in a concentration of 17%
e. RC-Prep and EDTAC are other preparations of EDTA
f. It can be used in place of NaOCI
a. It is a chelating agent with the capability to remove the mineralized portion of the smear layer
b. It decalcify up to a 50 mm thin layer of the root canal wall
c. It is also an excellent irrigation solution❌
d. Normally used in a concentration of 17%
e. RC-Prep and EDTAC are other preparations of EDTA
f. It can be used in place of NaOCI❌
NOTES:
EDTA is not suitable as an irrigant and cannot be used in place of NaOCl. The decalcifying process induced by EDTA is self-limiting and stops as soon as the chelator is used up.
The most acceptable method to achieve adequate root canal debridement is:
a. To obtain clean shavings of the canal
b. To attain a clean irrigating solution
c. To achieve glassy smooth walls of the canal
d. All of the above criteria are reliable
e. None of the above criteria is acceptable
c. To achieve glassy smooth walls of the canal
While cleaning and shaping the canal, an instrument separates in the canal. As you attempt to retrieve it, the broken instrument passes partially through the apex, thus partly protruding into the periapical lesion. How do you manage this case?
a. Use a smaller H file ot bypass it and try retrieving it
b. Use Gates Glidden drills to widen the canal and then try retrieving it
c. Raise a flap and remove the instrument surgically followed by filling the canal with gutta-percha
d. Extract the tooth as irreparable damage has occurred to the apex
e. Just inform the patient, fil the canal with gutta-percha, and monitor
c. Raise a flap and remove the instrument surgically followed by filling the canal with gutta-percha
Which of the following are acceptable methods to clean and shape a canal using nickel titanium instruments?
a. Push and pull stroke
b. Reaming motion
c. Engine-driven rotary motion
d. All of the above
d. All of the above
The major advantage of zine oxide-eugenol based sealer types is:
a. Non-staining property
b. Fast setting time
c. Adhesion
d. Insolubility
e. Long history of successful usage
e. Long history of successful usage
Which tooth is IMPROPERLY matched with the reason for difficulty of its access preparation?
a. Maxillary first premolar - mesial concavity
b. Maxillary molar - proximity of canals to distobuccal line angle
c. Mandibular molar - mesio lingual tilt of tooth
d. Mandibular incisor - narrow mesial distal dimension
b. Maxillary molar - proximity of canals to distobuccal line angle
The action of using a file often dictates the shape of the canal.
A reaming action produces a canal that is relatively round in shape.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true
a. Both statements are true
Which of the following statements are true regarding files? Select 2.
a. Broaches can be used for canal enlargement
b. K-type files can be machined or twisted
c. Significant apical pressure is needed when using abroach
d. Stainless steel files are less flexible than Niti files
b. K-type files can be machined or twisted
d. Stainless steel files are less flexible than Niti files
All of the following cells characterize the cellular response at the onset of chronic pulpal inflammation EXCEPT one. Which one is the EXCEPTION?
a. Plasma cells
b. Macrophages
c. Lymphocytes
d. Polymorphonuclear (PMN) leukocytes
d. Polymorphonuclear (PMN) leukocytes❌
-for acute inflammation
A patient presents with all the characteristics of pulpal pathosis. Your assistant hands you an x-ray that shows no evidence of any restoration or caries. At first you don’t believe that the x-ray is from the right patient, but it is. This scenario is pathognomonic of:
a. Condensing osteitis
b. A vertical fracture of the tooth
c. Periodontal abscess
d. Secondary occlusal trauma
b. A vertical fracture of the tooth
Hydrogen peroxide is a key ingredient to internal and external bleaching.
The walking bleach technique requires the sodium perborate to be changed every day.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true
c. The first statement is true, the second is false
The walking bleach technique requires the sodium perborate to be changed every day. ❌
The walking bleach technique requires the sodium perborate to be changed every FOUR TO SEVEN DAYS.
Tooth #9 requires root-end surgery. Which flap design is generally NOT indicated?
a. A submarginal curved flap (semilunar)
b. A submarginal scalloped flap (Ochsenbein-Luebke)
c. A full mucoperiosteal flap (triangular, rectangular, trapezoidal, horizontal)
d. None of the above
a. A submarginal curved flap (semilunar)❌
In which of the following cases could a dentist choose not to perform root canal therapy even when it is advised?
a. On a nonrestorable tooth
b. On a periodontally insufficient tooth
c. On a tooth with a vertical root fracture
d. On an asymptomatic tooth with a calcified chamber
e. On a tooth that has massive external resorption
d. On an asymptomatic tooth with a calcified chamber
A periodontal probing defect that may not be managed by endodontic treatment alone is:
a. A conical shaped probing
b. A narow sinus tract type probing
c. A blow-out type probing
d. None of the above
a. A conical shaped probing (Perio problem)
Regarding the restoration of endodontically treated teeth, all of the following are generally believed to be true EXCEPT one. Which one is the EXCEPTION?
a. A major disadvantage of posts/dowels is that they do not reinforce the tooth structure, in fact, they weaken it
b. All post designs are predisposed to leakage
c. At least 4mm of gutta-percha must remain to preserve the apical seal
d. Threaded screw posts are preferred over parallel-sided and tapered posts
e. Pins add to stresses and microfractures in dentin and should not be used
f. Cusps adjacent to lost marginal ridges should be restored with an onlay
d. Threaded screw posts are preferred over parallel-sided and tapered posts ❌
PARALLEL-SIDED AND TAPERED POSTS are preferred over Threaded screw posts
Retreating a tooth with a post is the most common reason for an apicoectomy and retrograde filling.
Whenever a reverse filling procedure is to be used, apicoectomy is mandatory to provide a table into which the preparation and filling will be placed.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true
a. Both statements are true
Endodontic procedures involve taking multiple radiographs. How should you protect yourself or your staff while taking radiographs if there is no barrier available to stand behind?
a. Stand at least 4 feet away anywhere around the patient
b. Stand at least 5f eet away exactly opposite the x-ray beam source
c. Stand at least 6 feet away and in the area that lies between 90 to 135 degrees to x-ray beam
d. Stand at least 7 feet away and ni the area that lies between 60 to 90 degrees to x-ray beam
e. Never take an x-ray without a barrier
c. Stand at least 6 feet away and in the area that lies between 90 to 135 degrees to x-ray beam
Most bacteria in endodontic infections are strict aerobes.
The diversity of polymicrobial endodontic infections has been well established isolating anywhere from 3 ot 12 species of microbes in the majority of endodontic infections.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true
d. The first statement is false, the second is true
Most bacteria in endodontic infections are strict aerobes.❌
Most bacteria in endodontic infections are strict ANAEROBES.
During a routine radiographic evaluation, you notice bone loss extending from the cementoenamel junction to the apex of tooth #21. Further evaluation reveals that probing depths are above normal limits all around the tooth. However, at one point, the probe drops precipitously ot an even greater depth. Vitality test is negative. This patient may require:
a. Extensive periodontal treatment followed by vitality reassessment
b. Endodontic treatment only
c. Endodontic treatment followed by periodontic treatment
d. Root-end surgery
e. Periodontic treatment followed by endodontic treatment
c. Endodontic treatment followed by periodontic treatment
Which of the following are NOT found in the pulp?
a. Reticulin fibers
b. Collagen fibers
c. Unmyelinated nerve fibers
d. Myelinated nerve fibers
e. Proprioceptor nerve fibers
e. Proprioceptor nerve fibers
NOTES:
PULP NERVE FIBERS:
A- Delta: ACUTE, MYELINATED
C fibers: CHRONIC, UNMYELINATED
The absence of which layer of dentin predisposes it to internal resorption by cells present in the pulp?
a. Mantle dentin
b. Circumpulpal dentin
c. Predentin
d. Secondary dentin
e. Tertiary dentin
c. Predentin
The ____ in the apical portion of the pulp helps to form the pulp into a semisolid mass, facilitating a ____.
a. collagen, pulpectomy
b. network of capillaries and nerves, pulpectomy
c. collagen, pulpotomy
d. network of capillaries and nerves, pulpotomy
a. collagen, pulpectomy
An emergency patient walks into your office with a chief complaint of an avulsed maxillary central incisor following a game of basketball less than thirty minutes ago. Which of the following actions would be contraindicated? Select 2.
a. Immediate re-implantation of the avulsed tooth followed by placement of a flexible splint for 7-10 days
b. Soaking the tooth in neutral pH distilled water solution prior to re-implantation
c. Thorough curettage of socket prior to re-implantation to remove any debris
d. Beginning a root canal therapy ten days after re-implantation
a. Soaking the tooth in neutral pH distilled water solution prior to re-implantation
c. Thorough curettage of socket prior to re-implantation to remove any debris
Which of the following situations may be indications for intentional replantation?
a. When routine endodontic therapy is impractical
b. When a canal is obstructed
c. When perforating internal or external resorption is present
d. When previous treatment has failed
e. All of the above
e. All of the above
The main benefit of primary incisor replantation is:
a. Maintenance of a normal anterior dentition
b. To relieve parental guilt
c. To maintain child’s self-esteem
d. To maintain child’s social acceptance
a. Maintenance of a normal anterior dentition
Internal resorption of a tooth is generally believed to be caused by inflammation due to an infected coronal pulp.
This condition is frequently precipitated by traumatic injury to the tooth.
a. Both statements are true
b. Both statements are false
c. The first statement is true, the second is false
d. The first statement is false, the second is true
a. Both statements are true
“The external resorption in which an infected pulp may further complicate the resorptive process,” is termed as:
a. Surface resorption
b. Inflammatory resorption
c. Replacement resorption
b. Inflammatory resorption
Which of the following is NOT a key feature of replacement resorption?
a. Lack of mobility
b. Lack of PDL on x-ray
c. Pink appearance
d. Infraocclusion
c. Pink appearance
NOTES:
“pink” tooth is considered to be pathognomonic of INTERNAL resorption
